NUR 301 Exam 1 TestBank Questions

About which of the following patient assessment data sets would the nurse be most concerned prior to medication administration? 1. White blood cell count, ability to speak, and temperature 2. Age, allergies, and level of consciousness 3. Hair color, gender, and body mass index 4. Weight, height, and blood type

Correct Answer 2: Of the data sets listed, age, allergies, and level of consciousness includes the most concerning data, with allergies and level of consciousness being the most concerning. In every situation, the nurse should know whether the patient is allergic to a medication prior to administering. If a patient has an impaired level of consciousness, the route of drug administration needs to be addressed. Hair color is not concerning, while the other listed data are of concern only in certain situations with certain drugs.

An order for a medication to be given prn means 1. as needed. 2. every day. 3. at bedtime. 4. with food.

Correct Answer: 1

The nurse teaches a class about medication used during pregnancy to pregnant women. The nurse determines that additional instruction is required when a patient makes which response? 1. The baby can only be harmed by medications during the first trimester. 2. It is important to not take over-the-counter (OTC) drugs during my pregnancy. 3. Exposure to teratogens can result in my babys death or in malformations. 4. If I breastfeed my baby, drugs can come through my breast milk.

Correct Answer: 1 A baby can be harmed by medication used throughout the period of gestation. Over-the-counter (OTC) drugs should be avoided during pregnancy. Many drugs are transferred through breast milk. Teratogens can cause fetal demise and congenital malformations.

The physician orders a hypertonic crystalloid solution for the patient in critical care who has cerebral edema. The nurse hangs a bag of a hypotonic solution. What will the priority assessment by the nurse include? 1. Headache, irritability, and decreasing level of consciousness 2. Nausea, projectile vomiting, and pinpoint pupils 3. Confusion, hallucinations, and agitation 4. Hypertension, headache, and nausea

Correct Answer: 1 A hypotonic solution will cause a fluid shift out of the plasma into the tissues and cells in the intracellular compartment. This will increase cerebral edema. Headache, irritability, and decreasing level of consciousness are signs of cerebral edema. Confusion, hallucinations, and agitation are not classical signs of cerebral edema. Hypertension and nausea are not classical signs of cerebral edema. Projectile vomiting and pinpoint pupils are not classical signs of cerebral edema.

Which of the following is an example of a medication error? 1. The wrong dose of a medication is drawn up, but is caught and corrected prior to administration. 2. A medication is administered to a patient with no allergies, yet an anaphylactic response occurs. 3. A medication is administered in liquid form instead of tablet form due to the patients difficulty swallowing. 4. A patient experiences unexpected hypotension as a result of medication administration.

Correct Answer: 1 A medication error can occur even when it does not reach the patient. Unexpected reactions to medications are not preventable, and would be considered adverse effects, not medication errors. Altering the form from a tablet to a liquid does not constitute a medication error.

Which of the following best represents adherence to a standard of care? 1. Administering a medication within the time frame specified by hospital policy 2. Administering a medication intramuscularly when a patient refuses to take it orally 3. Using abbreviations while charting to save time 4. Discontinuing a medication at the request of a patient

Correct Answer: 1 Administering medications as specified by agency policy is meeting the standard of care. Discontinuing medications is outside the scope of nursing. Changing the route of medication administration requires an order, and would not be appropriate, since the patient is refusing it. Using abbreviations might save time, but is not generally considered meeting a standard of care.

The physician prescribes cyclobenzaprine (Flexeril) for the patient. When doing medication education, what will the best information of the nurse include? 1. Increase the intake of fiber while taking this medication. 2. Restrict the intake of sodium while taking this medication. 3. Increase the intake of protein while taking this medication. 4. Do not drink any caffeine while taking this medication.

Correct Answer: 1 Cyclobenzaprine (Flexeril) has anticholinergic properties and can cause constipation, so the patient should increase the intake of fiber while taking this medication

The elderly patient is receiving chlorothiazide (Diuril). What does the best teaching by the nurse include with this medication? 1. Take the medication early in the morning. 2. Avoid foods that are high in potassium. 3. It is alright to have a glass of wine with this medication. 4. Take the medication on an empty stomach.

Correct Answer: 1 Elderly patients should take diuretics early in the morning to avoid nocturia. Absorption of chlorothiazide (Diuril) is decreased when taken on an empty stomach. Chlorothiazide (Diuril) is a potassium excreting drug and foods high in potassium should be encouraged. Alcohol can potentiate the hypotensive effects of chlorothiazide (Diuril) and should be avoided, especially in the elderly.

Which statement is the most accurate regarding medication use in pregnant women? 1. Inhaled drugs are absorbed more quickly. 2. Drug excretion rates are lowered. 3. Oral drugs absorption rate is lowered. 4. Drug use should be avoided during pregnancy.

Correct Answer: 1 Increases in tidal volume and pulmonary vasodilation during pregnancy lead to quicker absorption rates. Gastric emptying is delayed, leading to prolonged oral drug absorption rates. Renal blood flow is increased, leading to higher excretion rates. Some circumstances call for drug administration during pregnancy.

The physician orders potassium chloride (KCL) for the patient who has a nasogastric (NG) tube. What will the nurse plan to do prior to the administration of this drug? 1. Dilute the drug prior to administration through the nasogastric (NG) tube. 2. Flush the nasogastric (NG) tube with Coca-Cola before and after administration. 3. Flush the nasogastric (NG) tube with normal saline before and after administration. 4. There is no particular preparation prior to administration.

Correct Answer: 1 Liquid forms of potassium chloride (KCL) must be diluted prior to administration through a nasogastric (NG) tube to decrease gastrointestinal (GI) distress. There is a preparation; the drug must be diluted to decrease gastrointestinal (GI) distress. Flushing the tube with Coca-Cola is an outdated practice, and should not be done. Flushing the tube before and after administration of the drug is important, but the drug must still be diluted to decrease gastrointestinal (GI) distress.

The patient receives a drug that is excreted in the bile. What will the best nursing assessment of the effect of this drug on the patient include? 1. The effect of the drug will be a prolonged action. 2. The effect of the drug will be increased side effects. 3. The effect of the drug will be decreased side effects. 4. The effect of the drug will be decreased.

Correct Answer: 1 Most bile is circulated back to the liver so drugs secreted into the bile will be recirculated numerous times with the bile, resulting in a prolonged action of the drug. Bile-excreted drugs do not have a decreased effect, nor are side effects decreased. Side effects may or may not be increased; this is dose dependent.

The physician orders potassium chloride (KCL) intravenous (IV) for the patient. The nurse administers this drug intravenous (IV) push. What will be the most likely outcome for this patient? 1. The patient will most likely experience cardiac arrest. 2. The patient will not experience adverse effects if the push was given slowly. 3. The patient will most likely experience tissue necrosis at the injection site. 4. The patient will most likely experience renal failure.

Correct Answer: 1 Potassium chloride (KCL) must never be administered intravenous (IV) push, as bolus injections can overload the heart and cause cardiac arrest. Potassium chloride must never be administered via intravenous (IV) push, even if slowly, as cardiac arrest may result. Cardiac failure, not renal failure, is the most likely outcome of administering potassium chloride intravenous (IV) push. Although tissue necrosis may occur, this is not the primary concern.

Which statement about skeletal muscle relaxants is correct? 1. They inhibit upper motor neuron activity within the central nervous system. 2. They work primarily by stimulating the peripheral nervous system. 3. They increase the amount of neurotransmitter within the muscles. 4. They stimulate motor activity within the brainstem.

Correct Answer: 1 The exact mechanism by which skeletal muscle relaxants work is not fully understood. It is believed that they inhibit upper motor neuron activity, causing CNS depression.

Acetaminophen reduces fever by 1. directly acting on the hypothalamus. 2. inhibiting prostaglandins. 3. blocking impulses to the brain. 4. affecting nerve fibers.

Correct Answer: 1 - Acetaminophen (Tylenol) directly acts on the fever center of the hypothalamus and dilates peripheral blood vessels. - Anti-inflammatory drugs such as ibuprofen (Advil) inhibit prostaglandins. - Blocking impulses to the brain is not a mechanism of action of drugs for inflammation and fever. - Acetaminophen dilates blood vessels, not nerve fibers.

A client is taking aspirin (ASA) for arthritis. The nurse will advise the client to take the medication 1. with a glass of milk. 2. with other medications. 3. with orange juice at bedtime. 4. on an empty stomach in the morning.

Correct Answer: 1 - Aspirin is an acid, which can cause GI distress, so it is best to take it with milk or food. - Several medications can interact with aspirin. - Orange juice is highly acidic, and so can increase the risk for GI distress. - Taking aspirin on an empty stomach can increase the risk of gastric acid production.

Loop diuretics 1. inhibit reabsorption of sodium and chloride in the loop of Henle. 2. block sodium in the distal and proximal loops. 3. block aldosterone. 4. promote excretion of water by adding sodium to the filtrate.

Correct Answer: 1 - Loop diuretics inhibit sodium in the loop of Henle and increase urine output. - Thiazide diuretics block sodium in the distal tubule and nephron. - Potassium-sparing diuretics block aldosterone. - Some miscellaneous diuretics have this mechanism.

The nurse teaches clients with rheumatoid arthritis about the side effects of nonsteroidal anti-inflammatory drugs (NSAIDs). The nurse evaluates that education has been effective when the clients make which statement? 1. We must have our blood tests monitored with this medication. 2. We must be careful about falling with this medication. 3. We must take the medicine just as the doctor said to take it. 4. We must be sure and keep all scheduled doctors appointments.

Correct Answer: 1 - Nonsteroidal anti-inflammatory drugs (NSAIDs) can cause bleeding, so blood tests must be monitored. - Nonsteroidal anti-inflammatory drugs (NSAIDs) do not cause sedation, so falling is not a concern. - Taking the medication as prescribed is important, but this does not address the side effects. - Keeping scheduled doctors appointments is important, but this does not address the side effects.

Which of the following is a sign or symptom of inflammation? 1. Redness 2. Cyanosis 3. Dizziness 4. Cold skin

Correct Answer: 1 - Redness occurs from antigen reaction. - Cyanosis is not a sign of inflammation. - Dizziness is not a symptom of inflammation. - Warm skin, not cold skin, is a sign of inflammation.

Placement of a tablet between the cheek and gum would be which route? 1. Buccal 2. Oral 3. Transdermal 4. Sublingual

Correct Answer: 1 -This is the term used to describe a medication placed between the cheek and gum. -An oral medication is swallowed. -A transdermal medication is applied to the skin. -A sublingual medication is placed under the tongue.

The adolescent is supposed to go to the school nurse at 12:00 to receive his medication for attention-deficit hyperactivity disorder (ADHD). He often does not go for the medication. What best describes the nurses understanding of this situation? 1. The adolescent is embarrassed in front of his peers. 2. The adolescent does not understand the need for the medication. 3. The adolescent forgets that he is supposed to take the medication. 4. The adolescent has made a conscious decision not to take the medication.

Correct Answer: 1 Adolescents relate strongly to peers and are easily embarrassed; the adolescent does not want to be made fun of. The adolescent is most likely not forgetting the medication. Most adolescents receiving attention-deficit hyperactivity disorder (ADHD) medication recognize that it helps them. Most adolescents know why they are receiving medication.

The nurse commits a medication error. The nurse documents the error in the patients record and completes the incident report. What does the nurse recognize as the primary reason for doing this? 1. To verify that the patients safety was protected 2. To protect the patient from further harm 3. To protect the health care facility from litigation 4. To protect the nurse from liability

Correct Answer: 1 Documentation in the patients medical record and completion of an incident report verify that the patients safety was protected. Documentation of an error does not necessarily protect the health care facility from litigation. The patient has already been harmed; the documentation will not protect the patient from future harm. Documentation of an error does not necessarily protect the nurse from liability.

Graded dose-response curves are most useful for determining 1. response intensity within an individual. 2. response intensity within a large group of people with different characteristics. 3. response intensity within a large group of people with similar characteristics. 4. response intensity within a small group of people with similar characteristics.

Correct Answer: 1 Graded dose-response curves are used to determine response intensity within an individual.

A patient has an increased reaction to a drug following a change in her dietary habits. Which of the following changes would most likely be the cause? 1. Increased intake of grapefruit juice 2. Reduced intake of alcohol 3. Increased fiber intake 4. Reduced intake of citrus fruit

Correct Answer: 1 Grapefruit juice lowers the acidity of enzymes in the GI system that break down medications. This in turn results in higher medication absorption into the bloodstream. A reduction in citrus fruit intake would likely cause a lowered drug reaction. A reduced intake of alcohol or fiber would not likely produce an increased reaction to a drug.

The pregnant patient tells the nurse that her prescribed medication is not as effective as it was before her pregnancy. What is the best response by the nurse? 1. This is because your blood volume has increased. 2. Tell me how you have been taking your medication. 3. This is because your baby is receiving part of the medication. 4. Maybe the medication has expired; check the label.

Correct Answer: 1 Increased blood volume results in hemodilution and increased excretion of the medication. The medication effectiveness is not reduced because of the baby. Asking the patient how she is taking the medication is a good idea, but in this case, increased blood volume is responsible for decreased drug effect. The medication has most likely not expired; most patients have it refilled monthly.

The nurse teaches a class to patients about how to help prevent medication errors when in the hospital. What is a priority question for the nurse to ask the patients? 1. Do you know the names of all the medications you take? 2. Do you trust your physician to order the correct medication? 3. Do you have a friend to verify that you are receiving the correct medication? 4. Do you know what your illness is, and if you will need surgery?

Correct Answer: 1 Knowing the names of all medications taken can reduce drug errors when a patient is admitted to the hospital. Knowing the illness and anticipating surgery do not necessarily help prevent medication errors. Asking the patients if they trust their physicians to order the correct medication is inappropriate. It is inappropriate for friends of patients to verify medications prior to administration.

The nurse is managing care for a group of patients on a renal failure unit. What does the nurse recognize as the most important patient safety precaution with regard to medication administration? 1. Know that patients will require less-than-average doses of medications. 2. Know which drugs will increase fluid retention. 3. Ensure that each patients intake and output is measured precisely. 4. Be aware of what drugs are nephrotoxic.

Correct Answer: 1 Rationale 1: Administering the average dose of medication to a patient in severe renal failure can have mortal consequences. The consequences of recognizing that renal patients will require less-than-average doses of medications cannot be overemphasized. Recognizing which drugs are nephrotoxic is important, but not as important as knowing that patients will need less-than-average doses. Ensuring that each patients intake and output is measured precisely is important, but not as important as knowing that patients will need less-than-average doses. Knowing which drugs will increase fluid retention is important, but not as important as knowing that patients will need less-than-average doses.

The median effective dose is best described as 1. the amount of a drug that produces an effect without the presence of adverse effects. 2. the amount of a drug that is metabolized within 24 hours. 3. the amount of a drug that causes an effect in half the population. 4. the amount of a drug that causes an effect in more than half of the population.

Correct Answer: 1 Rationale 1: The median effective dose is the amount of a drug that produces an effect without the presence of adverse effects.

Which patient would be at greatest risk for developing opioid dependence? 1. 24-year-old with sickle-cell anemia 2. 33-year-old with diabetes 3. 17-year-old with a broken arm 4. 75-year-old with congestive heart failure

Correct Answer: 1 Sickle-cell anemia is a chronic and painful disorder, and is often treated with opioids. Diabetes and congestive heart failure are chronic disorders, but are not typically managed with opioids. Broken bones are painful, and opioids may be used. However, broken bones and the associated pain are acute events.

Spasticity is most commonly caused by damage to what area of the body? 1. Cerebral cortex 2. Peripheral nerves 3. Brainstem 4. Spinal cord

Correct Answer: 1 Spasticity usually results from damage to the motor area of the cerebral cortex.

The patient is an American Indian admitted to the hospital for chemotherapy. At any given time, five family members are in the patients room, which is private. The nurse tells the patient that according to hospital policy; only two visitors at a time are allowed. What does the best analysis by the nurse manager reveal about the nurses action? 1. The nurse should have assessed the patients preferences about how many family members she wanted to be present. 2. The nurse should have called the physician and obtained an order for additional family members to be present. 3. This was the correct action; the nurse was following protocol by informing the patient about hospital policy. 4. The nurse should have allowed the patient to have as many family members as she wanted to be present.

Correct Answer: 1 The nurse should have assessed the patients preference about how many visitors she wanted in her room before so strictly interpreting the hospital rules. Many hospital rules, such as how many visitors are allowed, are flexible and do not have to be strictly interpreted; this patient is in a private room. The nurse must be realistic with regard to the number of family visitors the patient wants present; five family members is acceptable; twenty would be too many. This situation could be resolved by the nurse, there is no need for a physicians order at this point.

The patient is receiving a sustained-release capsule for his cardiac condition. The patient tells the nurse there is no way he can swallow such a large pill. What is the best response by the nurse? 1. Withhold the medication and contact the physician. 2. Place the capsule on the back of the patients tongue, and have him drink a full glass of water. 3. Open the capsule and sprinkle the contents over applesauce. 4. Encourage the patient to try and swallow the capsule because it is the best medication for his heart condition.

Correct Answer: 1 The only option is to contact the physician. Several sustained-release medications cannot be opened and sprinkled on food. Placing the capsule on the back of the patients tongue and having him drink a full glass of water may cause the patient to aspirate the capsule and/or the water. Encouraging the patient to try to swallow the capsule is coercive, and may result in the patient choking on the medication.

Aspirin is ionized as it enters the small intestine. Which statement is accurate regarding the absorption of aspirin in the small intestine? 1. Absorption is decreased. 2. Absorption is increased. 3. Ionization has nothing to do with the absorption rate. 4. Aspirin must travel past the small intestine for absorption to occur.

Correct Answer: 1 The small intestine is a more alkaline environment, which facilitates the absorption of basic drugs. Aspirin is an acidic drug that is ionized in the small intestine, and will have lower absorption rates. Higher rates of absorption occur in the stomach (an acidic environment).

Which statement is accurate regarding gender and pharmacology? 1. Women tend to seek medical care earlier than men do. 2. Currently, it is not considered sexual discrimination for health plans to exclude covering oral contraceptives. 3. Since the 1980s, the FDA has mandated that research studies include both male and female subjects. 4. Studies indicate that men and women suffer from Alzheimers disease in equal numbers.

Correct Answer: 1 Women are quicker to seek medical care than are men. Studies indicate that more women than men suffer from Alzheimers disease. In 1993, the FDA mandated that research studies include both male and female subjects. In 2001, a federal court ruling deemed exclusion of oral contraceptives sexual discrimination.

The nurse explains to a student nurse that the median lethal dose of drugs is often determined in laboratory preclinical trials because...Select all that apply. 1. it would be unethical to determine these values in human subjects. 2. the safety of the medication must be determined prior to clinical trials. 3. it is difficult to obtain sufficient participants for clinical trials. 4. clinical trials determine only the effective dose of a drug. 5. it is too costly to conduct the studies during clinical trials.

Correct Answer: 1,2 - Laboratory animals are used in clinical trials to determine the LD50, or the dose that kills 50% of the subjects. It would be unethical to kill human subjects. - Before a drug is released for trials in human subjects, its safety must be determined. - It can be challenging to obtain sufficient subjects at times, but this is not the reason for doing lethal studies during preclinical trials. - Clinical trials determine not only the effectiveness of a drug, but also its adverse and toxic effects. - The cost of the trials is the reason they are conducted with animal subjects.

The patient has been keeping a headache diary of her migraines. Upon review of this diary, the nurse notes that the headaches are described as mild and have happened four times in the last 3 months. The patient reports that she generally just lies down until they pass but that her new job will not allow that time. She is requesting information about pain medication. What medications would the nurse expect to be prescribed? Select all that apply. 1. Ibuprofen 2. Acetaminophen and caffeine 3. Sumatriptan (Imitrex) 4. Ergotamine (Ergostat) 5. Amitriptyline (Elavil)

Correct Answer: 1,2 - NSAIDs are often effective for the mild migraines this patient experiences. - Acetaminophen and caffeine together are used for treatment of mild migraines. - Sumatriptan is a serotonin receptor agonist and is usually used only for moderate to severe migraines. - Ergotamine is an ergot alkaloid that is a serotonin receptor agonist. This drug is used only with moderate to severe migraines. - Amitriptyline is used to prevent migraines, not to reduce pain once they occur.

The student nurse asks the nursing instructor why drug plateaus occur with medications. What is (are) the best response(s) by the nursing instructor? Select all that apply. 1. It could be that all of the receptors for the drug are occupied. 2. It may mean that the drug has brought 100% relief to the patient. 3. It means that the patient has developed resistance and needs another drug. 4. It probably means that the drug is losing efficacy. 5. It means that the patient needs a higher dose of the drug.

Correct Answer: 1,2 Drug plateaus occur with medications because all the receptors for the drug are occupied; the drug has brought 100% relief to the patient. A drug plateau is not related to efficacy of the drug. When a drug has reached its plateau, giving additional amounts will not result in an increased therapeutic effect.

The patient has been diagnosed with chronic renal failure and is receiving hydrochlorothiazide (HCTZ). The nurse has taught the patient about the importance of kidney function, and evaluates that learning has occurred when the patient makes which statements? Select all that apply. 1. Kidneys help my heart by balancing potassium. 2. Kidneys balance the fluid and electrolytes in my body. 3. Kidneys keep blood pressure from getting too low. 4. Kidneys help decrease infections by excreting bacteria. 5. Kidneys help regulate the oxygen levels in my blood.

Correct Answer: 1,2,3 The kidneys are the primary organs for regulating fluid and electrolyte balance. The kidneys are the primary organs for regulating potassium balance. They secrete rennin, which helps to regulate blood pressure. The kidneys do not affect serum oxygen levels. The kidneys do not have any impact on bacterial infections.

The nurse is working very hard to prevent medication errors. What plan(s) will assist the nurse in preventing most errors? Select all that apply. 1. Plan to always check the patients identification band prior to administration of medications. 2. Plan to open all of the medications immediately prior to administration. 3. Plan to tell physicians that verbal orders will not be accepted. 4. Plan to record the medication on the medication administration record (MAR) immediately prior to administration. 5. Plan to validate all orders with another nurse prior to administration of medications.

Correct Answer: 1,2,3 Ways to reduce medication errors include checking the patients identification band prior to administration of medications, telling physicians that verbal orders will not be accepted, and opening all of the medications immediately prior to administration. Medications should be documented on the medication administration record (MAR) after they have been administered. All orders do not need to be validated with another nurse, only the orders that the nurse is unsure about.

A patient asks the nurse why a medication prescribed by the provider didnt do anything at all. Which statement by the nurse accurately describes how genetics influence drug action? Select all that apply. 1. Genetic differences can result in significant differences in how each patients body handles the same medication. 2. Genetic differences can cause mutations in enzymes, changing the way they function. This can alter how the body metabolizes and excretes drugs. 3. Because of genetic differences, medication may accumulate to toxic levels in one patient while in another patient may be inactivated before it can have a therapeutic effect. 4. Genetic differences can be expressed as an alteration in the structure of an enzyme, which can cause a defective receptor and an allergic response to drugs. 5. Genetic differences in patients who are biracial result in an allergic response to medications.

Correct Answer: 1,2,3 - 99.8% of human DNA sequences are identical. The remaining 0.2% can account for significant differences in peoples ability to handle medications. - The structure of an enzyme is closely related to its function. A mutation can cause a change in the structure of the enzyme, resulting in a change in its function. - When enzymes are functionally changed by genetics, metabolism and excretion can be altered, resulting in the drug either accumulating or being inactivated. - Small changes in the structure of a protein may result in a defective receptor that will not accept the drug and the drug not having any therapeutic effect. - Genetic differences can result in mutations of enzymes or proteins, which may result in changes in function. Being of a certain race may predispose a patient to mutations and, therefore, uncommon responses to medication, but this does not mean the patient will have an allergic response to medications.

The nurse is reviewing the role of diffusion in the distribution of medications. Drugs that cannot be distributed by simple diffusion include those with which characteristics? Select all that apply. 1. Large molecules 2. Ionization 3. Water-soluble agents 4. Alcohol 5. Urea

Correct Answer: 1,2,3 - Large molecules have difficulty crossing plasma membranes by simple diffusion. - Ionized drugs have difficulty crossing plasma membranes by simple diffusion. These drugs may require carrier, or transport, proteins to cross membranes. - Water-soluble agents have difficulty crossing plasma membranes by simple diffusion. - Diffusion assumes that the chemical is able to freely cross the plasma membrane. Drugs may also enter through open channels in the plasma membrane; however, the molecule must be very small, such as alcohol. - Diffusion assumes that the chemical is able to freely cross the plasma membrane. Drugs may also enter through open channels in the plasma membrane; however, the molecule must be very small, such as urea.

A pregnant patient suspected of drug abuse is admitted to the emergency department. The nurse plans to teach the patient about which complications associated with drug use during pregnancy? Select all that apply. 1. Preterm birth 2. Low birth weight 3. Birth defects 4. Allergies to narcotics 5. Increased labor

Correct Answer: 1,2,3 - Many illicit drugs can cause preterm birth. - Many illicit drugs can cause low birth weight. - Many illicit drugs can cause birth defects. - No research suggests that drug use can cause allergies to narcotics. - No research suggests that drug use can cause increased labor.

The nurse is planning care for a pregnant patient prone to substance abuse. When the patient states, My baby isn't getting my drugs, I am, how does the nurse respond? Select all that apply. 1. Most illicit drugs will cross the placenta and hurt the baby. 2. Even drugs that do not cross the placenta can hurt your baby by preventing nutrients from getting across the placenta. 3. Research shows taking drugs can cause your baby to be born too early. 4. You are correct. You are far enough along in your pregnancy that drugs will not harm your baby. 5. If you continue to take drugs, it will make you have a very irritable infant.

Correct Answer: 1,2,3 - Most illicit drugs cross the placenta and can cause premature birth, low birth weight, birth defects, and withdrawal symptoms. - Certain drugs can cause constriction of placental blood vessels, resulting in decreased nutrient exchange. - Most illicit drugs cross the placenta and can cause premature birth, low birth weight, birth defects, and withdrawal symptoms. - The effect the drug has on the fetus will depend on the stage of fetal development. There is a greater potential for harm during the first trimester but nutrients to the fetus can be compromised by drug abuse during the latter stages of pregnancy. - While withdrawal can cause irritability in infants born to drug addicts, the risk for irritability is not the reason for abstaining from drug use during pregnancy.

The nurse is preparing an intramuscular (IM) injection for a patient with strep throat. What principles of absorption may have guided the health care providers decision to order the medication by IM route? Select all that apply. 1. IM drugs are rapidly absorbed. 2. IM drugs bypass the gastrointestinal tract, resulting in increased absorption. 3. IM drugs avoid drug?drug and food?drug interactions, which can decrease absorption. 4. IM drugs have the ability to accumulate in the muscle and may remain in the body for an extended amount of time. 5. IM drugs bypass the gastrointestinal tract and are delivered to the small intestine, where most medications are rapidly absorbed.

Correct Answer: 1,2,3 - Muscles have a high blood flow, which maximizes absorption. - The thick mucous layer of the stomach decreases absorption. IM drugs bypass this obstacle, resulting in increased absorption. - Oral medications and food can interfere with absorption of medications. Bypassing the gastrointestinal tract will remove this possibility. - Some tissues do have the ability to accumulate and store drugs. Muscle tissue is not one of these. The bone marrow, teeth, eyes, and adipose tissue have an affinity to store drugs. - IM drugs do bypass the gastrointestinal tract but are not exposed to the small intestine. IM drugs are absorbed from the muscle into the blood stream.

For which patient would the nurse expect the health care provider to continue prescribed medications during pregnancy? Select all that apply. 1. The patient recently diagnosed with gonorrhea 2. The patient with a history of frequent asthma attacks 3. The patient with hypertension 4. The patient with frequent insomnia 5. The patient with a family history of stroke

Correct Answer: 1,2,3 - Sexually transmitted infections are treated during pregnancy. - Asthma is treated during pregnancy. - Hypertension is treated during pregnancy. - Insomnia would not be treated during pregnancy. - This patient would not be treated unless she has a history of stroke.

The client experienced a sports-related injury to his leg. During the morning assessment, what signs of inflammation will the nurse most likely assess? Select all that apply. 1. Swelling 2. Pain 3. Warmth 4. Pallor 5. Pitting edema

Correct Answer: 1,2,3 - Swelling is a sign of inflammation. - Pain is a sign of inflammation. - Warmth is a sign of inflammation. - Pallor is not a sign of inflammation; redness is. - Pitting edema is not a sign of inflammation.

The nurse is assessing several patients. For which patient does assessment reveal a psychosocial history that may affect the patients outcome? Select all that apply. 1. Older adult who recently suffered a stroke, has an unsteady gait, and lives in a two-story home 2. Middle-aged patient with Down syndrome living in a group home 3. Recently divorced mother of three children with breast cancer 4. Sixteen-year-old requesting birth control without parental consent 5. Seven-year-old with asthma in a foster care home

Correct Answer: 1,2,3 - This patient may not be able to return to a home that requires climbing stairs. - A patient with Down syndrome needs additional care to ensure that treatment outcome is successful. - This patient may be the familys sole provider and may have financial concerns. - Many teens seek contraception without their parents consent. This should not have a negative impact on outcome. - Residing in foster care should not have a negative impact on outcome.

A patient asks the nurse why he experiences a metallic taste after taking certain medications. The nurse explains that a medication may cause glandular secretions that occur by which routes? Select all that apply. 1. Saliva 2. Sweat 3. Breast milk 4. Urine 5. Feces

Correct Answer: 1,2,3 - Water-soluble drugs may be secreted into the saliva, which can cause a funny taste after the administration of a medication. - Water-soluble drugs may be secreted into the sweat, which may cause an odor to be omitted by the person who has taken a medication. - Water-soluble drugs may be secreted into the breast milk. Breastfeeding mothers must use caution in regards to medications while lactating as the medications can be passed to their infants via the breast milk. - Urine is excreted by the kidneys and does not play a role in glandular activity. - Feces are excreted by the gastrointestinal system and do not play a role in glandular activity.

When teaching the patient about a new medication, the nurse should include which information? Select all that apply. 1. Adverse effects that can be expected 2. Which adverse effect to report to the health care provider 3. The drugs therapeutic action 4. Chemical composition of the drug 5. Name of the drug manufacturer

Correct Answer: 1,2,3 In order to help the patient identify and prevent adverse effects, the patient should be taught the therapeutic action, adverse effects, and when to notify the health care provider of adverse effects.

The nurse is participating in the clinical trial of a new medication for the treatment of hypertension. To assess the effectiveness of the medication, which interventions would the nurse perform to help determine whether the average dose is effective for the patient? Select all that apply. 1. Monitoring blood pressure 2. Monitoring heart rate 3. Interpreting laboratory values 4. Monitoring diet 5. Monitoring sleep habits

Correct Answer: 1,2,3 Rationale 1: By monitoring the patients vital signs, the nurse helps to determine whether the average dose is effective for the patient.

The nurse teaches the patient with a neuromuscular disorder about nonpharmacological treatment of muscle spasms. What will the best information include? Select all that apply. 1. Application of heat or cold 2. Ultrasound 3. Massage 4. Relaxation techniques 5. Guided imagery

Correct Answer: 1,2,3 Rationale 1: Nonpharmacological treatment of muscle spasms includes application of heat or cold, ultrasound, and massage. Guided imagery is not a nonpharmacological treatment for muscle spasms. Relaxation techniques are not a type of nonpharmacological treatment for muscle spasms.

A nurse is caring for a patient diagnosed with acute asthma who is taking several medications. The nurse would suspect a common adverse drug effect with which symptoms? Select all that apply. 1. Headache 2. Nausea 3. Vomiting 4. Changes in blood pressure

Correct Answer: 1,2,3,4 - Headache is a common adverse effect of some medications. - Nausea is a common adverse effect of some medications. - Vomiting is a common adverse effect of some medications. - Changes in blood pressure is a common adverse effect of some medications.

A nurse is preparing care for a newly admitted diabetic patient. Which information would be critical for the nurse to assess? Select all that apply. 1. Medical history 2. Current lab results 3. Medication allergies 4. Use of dietary supplements 5. Number of previous hospitalizations

Correct Answer: 1,2,3,4 - Medical history may reveal conditions that contraindicate the use of certain drugs. - Current lab results may reveal important information about the health of organs, such as the kidneys and liver, which would be important to metabolism and excretion of drugs. - Allergies to one drug may cross over to another drug and would need to be avoided. - Some dietary supplements can interact with drugs. - While this is good information, it is not critical to this admission.

A community health nurse is preparing a teaching plan regarding medications and safety for a new parent class. Which topics should be addressed? Select all that apply. 1. Parents should maintain a list of current medications for each child. 2. Parents should be aware of each childs medication allergies. 3. Parents should know what the childs prescribed medication is for, how it should be administered, and when to expect the child to feel better. 4. Parents should be aware that any leftover medication should be appropriately disposed of, not saved for future use. 5. Parents should read the drug label for any foods the child should avoid while taking the medication and for possible adverse effects to watch out for.

Correct Answer: 1,2,3,4 - Parents should make a complete list of all prescribed medications, over-the-counter drugs, and any vitamins the child takes. - It is very important that parents be aware of a childs allergies in order to prevent an unnecessary allergic response. - Parents should know what condition the childs medication is prescribed for, and how, when, and how much to administer. It is also important for parents to know when to expect the child to feel better so a follow-up visit can be made if the child is not feeling better. - Parents should be aware that it is not safe to self-diagnose and treat with leftover medication. - Parents should be aware the label often describes food and drinks to avoid. The label will not describe possible adverse effects; the nurse will need to describe these to the parents.

A patient returns to the clinic for follow up after taking a newly prescribed medication for a month. The nurse recognizes medication teaching was successful when the patient makes which statement? Select all that apply. 1. Ive been taking my medication on an empty stomach like the prescription label said to. 2. I always take my medication with a full glass of water. 3. Im not drinking any alcohol close to the time that I take my medication. 4. I switched all my medications to one pharmacy like you suggested. 5. I was glad I could take my medications and supplements together. I dont really like to take a lot of pills during the day.

Correct Answer: 1,2,3,4 - Some medications must be taken on an empty stomach. It is important to know if the medication should be taken with food or on an empty stomach. - Taking medications with water will decrease the chance of an interaction that can occur with other juices or fluids. - Alcohol can cause adverse interactions with medications. - Filling all prescriptions at the same pharmacy will assist the pharmacist in comparing current and new medications for interactions. - It is best not to take herbal supplements and vitamins with prescribed medications to avoid interactions.

A nurse is reinforcing discharge instructions concerning food?drug interactions. The nurse determines that the patient understands when the patient makes which statement? Select all that apply. 1. I should take my medications with water to avoid any problems with my medications being absorbed. 2. I cannot take one of my medications with grapefruit juice because it will decrease the absorption of the medication. 3. I need to be sure to read the prescription label because the pharmacist will indicate if I need to take my medication with food or without food. 4. I should take my daily vitamin 2 hours after my medication so they do not affect each other. 5. If I take my medication with hot tea, it will not affect absorption.

Correct Answer: 1,2,3,4 - The safest fluid to take with medications is water. - Grapefruit juice can increase absorption of certain drugs and should be avoided. - The pharmacist will indicate on the medication label if the medication should be taken with or without food. - Herbal supplements and vitamins can cause adverse effects when taken with medication. - Taking medication with caffeine or a hot drink can affect absorption and the effectiveness of medication.

A client presents with a rash and is prescribed an over-the-counter ointment for treatment. The client says, I thought I would need a shot or an expensive prescription. How should the nurse respond? Select all that apply. 1. Medications that go on your skin dont usually have as many side effects. 2. Mild rashes often respond well to topical ointments. 3. Many of the products used on the skin are available over-the-counter. 4. You should try to discover what caused your rash. 5. Prescription ointments are usually better at healing.

Correct Answer: 1,2,3,4 - Topical drugs should be used when applicable because they cause few adverse effects. - Inflammation of the skin is best treated with topical medication if possible. - Many products used on the skin are fairly inexpensive and are available over-the-counter. - Inflammation is not a disease, but is a symptom. The cause of the inflammation should be identified and treated. In this case, the client should avoid the offending substance. - Many over-the-counter anti-inflammatory medications exist and do a good job of helping the client heal.

A patient admitted to the hospital tells the nurse she is very nervous about getting all her medications while she is in the hospital because her health care provider has her on a very strict schedule. Which principles describe how medication dosing schedules are determined? Select all that apply. 1. The physical and biologic characteristics of a drug may determine dosing schedule. 2. Specific times may improve effectiveness and decrease risk of adverse effects. 3. Some drugs must be taken a certain time prior to an event or immediately after an event. 4. Dosing may be set for the convenience of patient and nurse. 5. Hospitals have routine dosing intervals so that all patients receive medications at the same time each day.

Correct Answer: 1,2,3,4 -The properties of a medication will determine how often it must be given to keep the drug at a therapeutic level in the body. -Some medications are administered at certain times of day to improve effectiveness or decrease adverse effects. -Some medications are taken to prevent or to cause an effect. For example, insulin should be given 30 minutes prior to eating to promote glucose usage. -If the drug does not have a characteristic that relies on a certain event to take place, then the drug can be given at the convenience of patient and/or nurse. -While most hospitals do have specific times of day (agency protocol) when medications are administered, this is not a principle that determines any specific dosing schedule.

A new nurse on the orthopedic floor makes a medication error. Which statements by the nurse manager foster a safe environment in which nurses will report medication errors? Select all that apply. 1. Many of us have made a medication error in our careers. The most important issue is to identify why the error occurred. 2. I know you could not feel any worse than you already do. We need to discuss how this error happened and how we can prevent it from happening again. 3. Its really good that your patient is OK and did not suffer any harmful effects of this error. We should discuss why this error occurred and how it can be prevented in the future. 4. Because you are a new nurse, we should sit down and discuss the procedure you followed to see what you could have done to prevent this error. 5. We need to sit down as soon as possible and write up an incident report describing everything you did incorrectly that caused this error.

Correct Answer: 1,2,3,4 All errors should be investigated with the goal of identifying why they occurred. This investigation should be done in a manner that is not punitive and will encourage staff to report errors without fear of punishment.

The nurse is preparing medications prior to administration. To promote patient safety, the nurse uses rights of drug administration. What do these rights include? Select all that apply. 1. The right medication 2. The right time of delivery 3. The right dose 4. The right route of administration 5. The right patient

Correct Answer: 1,2,3,4,5 The five rights of drug administration are the right patient, the right medication, the right dose, the right route of administration, and the right time of delivery.

The nurse makes a medication error, but the patient is not harmed. The patients family asks the nurse manager what is considered a medication error. Which of the following are potential responses by the nurse manager? Select all that apply. 1. Failure to follow health care providers orders 2. Failure to give the right medication 3. Failure to give a medication at the ordered time 4. Failure to call the pharmacy and report that the medication has been given 5. Failure to give the right dose of the medication

Correct Answer: 1,2,3,5 - In this medication error, the patient does not receive the drug as the health care provider intended it to be given. - In this medication error, the patient does not receive the drug the health care provider intended to be given. - In this medication error, the patient does not receive the drug at the time the health care provider intended it to be given. - The delivery of the medication is recorded on the medical administration record (MAR); the nurse does not report to the pharmacy each time a medication has been given. - In this medication error, the patient does not receive the dose of the drug the health care provider intended to be given.

The nurse is preparing a teaching plan for an older patient who is taking multiple medications. Which principles should the nurse keep in mind during the planning phase? Select all that apply. 1. The patient should use only one pharmacy to fill prescriptions. 2. The patient should keep a list of all medications for easy accessibility. 3. Polypharmacy is a common cause of medication errors in older patients. 4. Polypharmacy is unique to older patients and is the most common cause of medication errors. 5. The patient should be aware of each prescribed medication, the dose, and possible side effects.

Correct Answer: 1,2,3,5 - It is common for older patients to have medical conditions requiring the use of multiple medications that could have possible interactions. Using one pharmacy will ensure the pharmacist will discover any problematic interactions between multiple drugs. - Keeping a list available is important for unexpected trips to a health care facility. - The use of multiple drugs for multiple chronic conditions is a common cause for medications errors in older patients. - Polypharmacy is not unique to older patients, although it is most often seen in this group. - Knowing the names, dose, and possible side effects of medications will reduce the risk for medication errors.

The client has gout and receives allopurinol (Zyloprim). The nurse has completed medication education and evaluates that learning has occurred when the client makes which statements? Select all that apply. 1. It may take a few days or weeks for me to get the full effect of this medication. 2. I should not drink alcohol while taking this drug. 3. If I develop a skin rash I should contact the prescriber. 4. I should not crush this medication. 5. I should take this medication with food.

Correct Answer: 1,2,3,5 - It may take 1-3 weeks for blood levels of uric acid to return to normal range. - Alcohol may inhibit the renal excretion of uric acid. - Skin rash is a possible adverse reaction of allopurinol and can be serious. - Allopurinol tablets may be crushed for administration. - Allopurinol should be taken with or after meals.

A nurse on the medical-surgical unit is caring for several very ill patients. One patient says, I was supposed to get my medications an hour ago. The nurse recognizes that medication errors can have what repercussions? Select all that apply. 1. Medication errors can potentially extend the patients length of hospital stay. 2. Medication errors can result in expensive legal costs to the facility. 3. Medication errors can damage the facilitys reputation. 4. Medication errors can be physically devastating to nurse and patient. 5. Medication errors cause preventable deaths during hospitalizations.

Correct Answer: 1,2,3,5 - Medication errors can cause harm, which can extend the patients length of stay. - If a medication error causes a patient harm, it can result in expensive legal fees for hospital defense. - If the incidence of medication errors is publicized, it can cause the facility to be seen as unsafe or to be delivering substandard care. - Medication errors can be physically devastating to patients but would be emotionally devastating to the nurse. - Medication errors are the most common cause of morbidity and preventable death within hospitals.

The nurse is caring for a patient who is experiencing acute renal failure. The nurse knows that this patient may experience problems regulating...Select all that apply. 1. fluid balance. 2. electrolyte composition. 3. the pH of body fluids. 4. heart rate. 5. blood pressure.

Correct Answer: 1,2,3,5 - The kidneys are the primary organs for regulating fluid balance through filtration and urine output. - The kidneys are the primary organs for regulating electrolyte composition through filtration and urine output. - The kidneys are the primary organ for regulating the pH of body fluids through filtration and urine output. - The kidneys do not play a role in regulating heart rate. - The kidneys play a role in regulating blood pressure through the secretion of renin.

The nurse has finished teaching a patients husband how to administer drugs and enteral feeding through a gastrostomy tube. The nurse knows the husband understands the use of the tube when he makes which statement? Select all that apply. 1. My wife has a gastrostomy tube instead of a nasogastric tube because she will have the tube for a long time. 2. I will need to use liquid medications. If any of the medications are in pill form, I will use the pill crusher to crush them and mix them with water before putting them in the tube. 3. This medication says it is enteric coated. Im not supposed to crush this kind of medication. I will need to ask the doctor to substitute another medication that is liquid or can be crushed. 4. Theres a big difference in how the drugs work in the body when theyre taken orally and when theyre administered through the tube. Thats why my wife has to have this tube. 5. I have to be very careful to flush the tube after I put medication in it. If I dont, the tube could get clogged.

Correct Answer: 1,2,3,5 -Nasogastric tubes are used for short-term care while gastrostomy tubes are placed in patients who will need long-term care. -Most health care providers order drugs in liquid form for NG and G tube patients. If a medication does not come in liquid form, the solid form will need to be crushed and mixed with water prior to administration unless there is a contraindication for crushing the medication. -Enteric-coated medications should not be crushed. To do so would expose the drug to the acid in the stomach when it is intended to bypass the stomach acid and be dissolved in the alkaline environment of the small intestine. -Drugs administered via gastrostomy tube are affected by the same physiological processes as those given orally. -While solid drugs may be crushed and dissolved in water prior to being administered, they tend to clog the tubes if the tubes are not routinely flushed.

A nurse administering medications to a variety of patients on a medical-surgical floor recognizes that which patients may need additional education about medication adherence? Select all that apply. 1. Fifty-year-old recently remarried male taking antihypertensive medication 2. Thirty-four-year-old female with family history of blood clots taking an estrogen oral contraceptive 3. Sixty-eight-year-old male recently started on antidepressants known to cause gynecomastia 4. Twenty-eight-year-old female started on acne medication known to cause male-patterned hair growth 5. Seventy-eight-year-old male taking estrogen as therapy for prostate cancer

Correct Answer: 1,2,4 - Antihypertensive medications can cause impotence. This patient will need additional education about this possible side effect. - Estrogen can cause an increased risk for thrombolytic events, especially in patients who have a positive family history. - Men at this age usually already have some degree of enlargement of breast tissue due to decreasing testosterone and would not necessarily need additional education to prevent medication nonadherence. - Some acne medications cause increased hair growth in a male pattern, such as on the face. While controlling acne is a goal, the patient may not want the extra hair growth. - Although estrogen therapy can result in breast enlargement, men at this age usually already have some degree of breast enlargement due to decreased testosterone levels

The nursing instructor teaches the student nurses about how medication errors can occur. What information will the nursing instructor include in the presentation? Select all that apply. 1. The nurse miscalculates the medication dose. 2. The nurse does not check the patients identification band. 3. The nurse does not validate an order with the physician. 4. The nurse misinterprets a physicians order. 5. The nurse administers the incorrect drug.

Correct Answer: 1,2,4,5 Medication errors may be related to misinterpretations, miscalculations, and misadministration. The nurse should always check the patients identification band. As long as the nurse understands the physicians order, there is no need to validate the order with the physician.

The home hospice nurse is completing the initial assessment of a patient who is has terminal congestive heart failure. The patient frequently has pain with breathing. What questions should the nurse ask? Select all that apply. 1. How much pain are you willing to tolerate? 2. What do you like to do throughout the day? 3. Have you ever been addicted to a pain medication? 4. Are there any pain medications you would like to avoid? 5. What things besides drugs help with your pain?

Correct Answer: 1,2,4,5 - It is sometimes impossible to eliminate all pain and all adverse medication effects. The nurse needs to know how much pain and how many of the effects the patient is willing to tolerate. - Knowing what the patient likes to do and when it is important for the patient to be most awake and alert helps the nurse create a pain management plan. - Addiction is not a concern at the end of life. Many patients are already concerned about becoming addicted and the nurse should not reinforce this myth. - Some patients cannot tolerate the side effects of some medications. It is important for the nurse to assess for these preferences. - Nonpharmacologic pain relief strategies should also be investigated.

The patient has been started on morphine sulfate (MS Contin) for chronic back pain resulting from inoperable disk degeneration. What nursing actions are indicated? Select all that apply. 1. Use the prn order of docusate (Dulcolax) routinely every night. 2. Ask the dietary department to add bran cereal to the patients breakfast trays. 3. Ask the health care provider to write an order for an indwelling urinary catheter. 4. Review the trending of the patients hemoglobin and hematocrit levels. 5. Check the medical record for a prn order for an antiemetic.

Correct Answer: 1,2,4,5 - therapy is constipation. The nurse should be proactive by giving the docusate every night. - Intake of additional fiber, as long as sufficient fluid is taken, is useful in preventing the constipation that is common with the use of morphine. - While morphine may promote urinary retention, other methods of controlling this adverse effect should be used initially. - Morphine should not be administered to those who are hypovolemic due to the risk of hypotension. - Nausea and vomiting are adverse effects of the use of morphine. Until the patient becomes tolerant of this effect, an antiemetic may be necessary.

The nursing instructor is teaching pharmacology to student nurses. What will the nursing instructor include as the four major components of pharmacokinetics? Select all that apply. 1. How drugs move from the site of administration to circulating fluids 2. How drugs are converted to a form that is easily removed from the body 3. How drugs change body illnesses and pathogens 4. How drugs are transported throughout the body 5. How drugs are removed from the body

Correct Answer: 1,2,4,5 Absorption describes how drugs move from the site of administration to circulating fluids. Distribution describes how drugs are transported throughout the body. Metabolism describes how drugs are converted to a form that is easily removed from the body. Excretion describes how drugs are removed from the body. Pharmacodynamics describes how drugs change body illnesses and pathogens.

A patient who has cerebral palsy is beginning to experience spasticity of the muscles in the upper arm. Which medications would the nurse question if prescribed for this patient? Select all that apply. 1. Metaxalone (Skelaxin) dosed three times a day 2. Chlorzoxazone (Parafon Forte) dosed four times a day 3. Carisoprodol (Soma) dosed three times a day 4. Intrathecal baclofen (Lioresal) 5. Tizanidine (Zanaflex) dosed twice a day

Correct Answer: 1,2,5 - Metaxalone (Skelaxin) is ineffective in the treatment of spasticity-related neurologic disorders. - Chlorzoxazone (Parafon Forte) is ineffective in the treatment of spasticity related to neurodegenerative disorders. - Carisoprodol (Soma) is effective in relieving the pain, muscle spasms, and spasticity associated with cerebral palsy and is dosed three times a day. - Baclofen (Lioresal) is effective in reducing muscle spasticity and can be delivered intrathecally. - Tizanidine (Zanaflex) is used for muscle spasticity but has a short half-life and must be dosed every 6-8 hours.

The nurse assesses the patient with diabetes mellitus prior to administering medications. Which questions are important to ask the patient? Select all that apply. 1. Are you allergic to any medications? 2. Are you taking any herbal or over-the-counter medications? 3. How difficult is it for you to maintain your ideal body weight? 4. Will you please tell me about the kind of diet you follow? 5. What other medications are you currently taking?

Correct Answer: 1,2,5 These questions refer specifically to medications. Diet and ideal body weight are important questions, but do not refer specifically to medication administration.

The nurse teaches patients about nonpharmacological techniques for pain management. The nurse determines learning has occurred when the patients make which statement(s)? Select all that apply. 1. Nonpharmacological techniques are a good adjunct to pharmacotherapy. 2. Nonpharmacological techniques have not reached mainstream yet. 3. Nonpharmacological techniques may be used in place of drugs. 4. Nonpharmacological techniques include an aerobic exercise. 5. Nonpharmacological techniques are not usually valued by nurses.

Correct Answer: 1,3 Nonpharmacological techniques may be used in place of drugs, or as an adjunct to pharmacotherapy. An aerobic exercise is not considered a nonpharmacological technique for relief of pain. Nonpharmacological techniques have reached mainstream and are commonly used. Nonpharmacological techniques are valued and used by most nurses.

A client is prescribed methotrexate (Rheumatrex) for treatment of osteogenic sarcoma. The client says, My friend took methotrexate, but she has never had cancer. How should the nurse respond to this statement? Select all that apply. 1. Does your friend have rheumatoid arthritis? 2. She must have had cancer and not told you. 3. Methotrexate is used to treat some autoimmune disorders as well. 4. You must have misinterpreted what your friend said. 5. Methotrexate is used to treat some forms of liver disease.

Correct Answer: 1,3 - Methotrexate has powerful immunosuppressant properties and is used to treat rheumatoid arthritis, ulcerative colitis, lupus, and psoriasis. - There are other reasons to take methotrexate. - Methotrexate is a powerful immunosuppressant. - It is very possible that the friend did not have cancer and was being treated with methotrexate. - Methotrexate is hepatotoxic and would not be used to treat liver diseases.

The patient has had hypertension for many years. The physician orders an antihypertensive drug that has just come on the market. The nurse teaches the patient that this drug works more effectively than his prior drug, and has fewer side effects. The patient asks how this can be. What is the best response by the nurse? Select all that apply. 1. Newer drugs are altered to affect your cells receptors in a different way. 2. Receptors tend to burn-out, so newer drugs are required. 3. Research into receptors helps fine-tune drugs to be more effective. 4. Changing the response of the drug to protein receptor-complexes produces fewer side effects. 5. It is a process of trial and error with receptors until the new drug proves effective.

Correct Answer: 1,3 Receptor research results in the development of new medications that activate very specific receptors to produce a greater therapeutic response as well as fewer side effects. Research into receptors has resulted in the fine-tuning of medications that are more effective with fewer side effects. Research is not a process of trial and error with receptors. Receptors do not burn-out. There is no such thing as a protein receptor-complex.

The patient tells the nurse that he is on many medications, and questions how they all get to the right places. What is the best response by the nurse? Select all that apply. 1. It depends on how much protein you have in your body. 2. It depends on the health of your kidneys. 3. It depends on whether they are fat based or water based. 4. It depends on the amount of blood flow to your body tissues. 5. It depends on the health of your liver.

Correct Answer: 1,3,4 Distribution of drugs depends on the amount of blood flow to body tissues, the lipid solubility of the drug, and protein binding. The health of the liver refers to metabolism, not distribution. The health of the kidneys refers to excretion, not distribution.

The nurse is preparing to discharge a patient who has been placed on a loop diuretic for the treatment of congestive heart failure. Which foods should the nurse encourage the patient to consume to prevent serious adverse effects associated with the medication? Select all that apply. 1. Bananas 2. Red meat 3. Oranges 4. Dried dates 5. Green, leafy vegetables

Correct Answer: 1,3,4 - Bananas are a potassium-rich food. Patients on loop diuretics should eat foods rich in potassium. - Red meats are high in iron and would not be a good source of potassium for this patient. - Citrus fruits are a good source of potassium. Patients on loop diuretics should eat foods rich in potassium. - Dried dates are a good source of potassium. Patients on loop diuretics should eat foods rich in potassium. - Green, leafy vegetables are a good source of iron but not of potassium. Patients on loop diuretics should eat foods rich in potassium.

The nurse is caring for a patient who has been involved in a motor vehicle crash. The health care provider has written orders for a transdermal patch for pain to be applied for steady pain control. The nurse knows that... Select all that apply. 1. the transdermal patch should not be applied to areas of abrasion. 2. transdermal medications undergo the first-pass effect in the liver. 3. transdermal medications completely bypass digestive enzymes. 4. the actual dose received by the patient from this pain patch may vary. 5. transdermal patches are not considered an effective means of delivering medications because the rate of delivery and actual dose can vary.

Correct Answer: 1,3,4 -Applying transdermal patches to skin that has abrasions may unintentionally increase the dose of the medication. -Transdermal medications avoid the first-pass effect. -Transdermal medications never come into contact with digestive enzymes but go straight into the bloodstream. -While transdermal patches do contain a specific amount of medication, the rate of delivery may vary for each patient. -It is true that the rate of delivery and actual dose received can vary, but this route is an effective means of delivering many medications such as birth control medications and nitroglycerin for angina.

The nurse is doing a holistic assessment on a patient prior to the initiation of antihypertensive medication. What will the best assessment include? Select all that apply. 1. Blood pressure 2. The cause of the hypertension 3. Mood 4. Level of education 5. Belief in a higher power

Correct Answer: 1,3,4,5 Holistic health care incorporates the whole patient to include the biological (blood pressure), psychological (mood), sociocultural (level of education), and spiritual (belief in a higher power) dimensions. The cause of the hypertension focuses on a specific disease, its cause and treatment; this is a medical model, not a holistic model.

The nurse recognizes that medications can be excreted by which routes? Select all that apply. 1. Fecal 2. Gastric 3. Glandular 4. Pulmonary 5. Renal

Correct Answer: 1,3,4,5 - Drugs can be excreted via feces. - Drugs are not excreted through the gastric system. - Drugs can be secreted glandularly. - Drugs can be secreted via the lungs. - Drugs can be excreted by the renal route.

When possible, drug therapy is postponed until after pregnancy and lactation. However, certain acute and chronic conditions must be managed during pregnancy, including...Select all that apply. 1. epilepsy. 2. serious cystic acne. 3. sexually transmitted infections. 4. gestational diabetes. 5. hypertension.

Correct Answer: 1,3,4,5 - Epilepsy is a preexisting disease. It would not be wise to discontinue therapy during pregnancy and lactation. - Cystic acne may be treated with isotretinoin (Accutane). Isotretinoin is a Class X drug and can cause fetal brain damage. Other antibiotics such as tetracycline are Class D and should not be used in pregnancy. - Sexually transmitted infections can harm the fetus. - Gestational diabetes is a complication related to pregnancy that must be treated for the safety of both the mother and growing fetus. - If hypertension is present prior to pregnancy, it would be unwise to discontinue therapy during pregnancy and lactation.

The nurse is conducting a holistic assessment of a patient with alcoholism. What are the important questions to ask? Select all that apply. 1. How is drinking alcohol viewed by your culture? 2. Have you ever attended Alcoholic Anonymous meetings? 3. Did you see your parents drinking alcohol when you were growing up? 4. Have you been in alcohol rehabilitation before now? 5. What blood relatives of yours are addicted to alcohol?

Correct Answer: 1,3,5 Biological, environmental, and cultural questions are valid questions to ask during a holistic assessment. Participation in a rehabilitation program refers to treatment, and does not have relevance to a holistic assessment. Participation in Alcoholics Anonymous refers to treatment, and does not have relevance to a holistic assessment.

Which client statement would the nurse evaluate as indicating the goal of treatment with an anti-inflammatory drug has been met? Select all that apply. 1. My fever went away yesterday. 2. Ive not been coughing up so much phlegm. 3. The skin over my knee is red and hot to the touch. 4. The pain in my shoulder is much relieved. 5. My rash is spreading.

Correct Answer: 1,4 - Fever reduction is a goal of treatment with anti-inflammatory drugs. - Reduction of secretions is not a goal of treatment with anti-inflammatory drugs. - Redness and heat are symptoms of inflammation. The therapy may not be working in this client. - Pain is a sign of inflammation. Reduction of pain indicates that the anti-inflammatory medication is working. - The goal of anti-inflammatory medications would be that the rash resolved. Since it is spreading, the goal has not been met.

A patient is admitted to the burn unit with 75% body surface area burns. Which orders would be appropriate for this patient to control pain? Select all that apply. 1. Morphine 10 mg IV every 2 to 4 hours as needed for pain 2. Morphine 10 mg IM every 2 to 4 hours as needed for pain. 3. Morphine 10 mg transdermal patch every 2 to 4 hours as needed for pain. 4. Morphine 10 mg sublingual every 2 to 4 hours as needed for pain. 5. Morphine 10 mg subcutaneous every 2 to 4 hours as need for pain.

Correct Answer: 1,4 - Pain medication given by the intravenous (IV) route will be rapidly and completely absorbed. - The patient has 75% surface area burns; there may not be an area available for intramuscular injections of morphine. - The patient has 75% surface area burns; there may not be an area available to place a transdermal patch. - Sublingual morphine can be used as a rescue drug. - The patient has 75% surface area burns; there may not be an area available for subcutaneous injections.

The patient rings the nurse call button and requests pain medication. Upon assessment, the nurse finds the patient sitting up in a chair, watching television with a friend. Vital signs are normal and the patients skin is warm and dry. Which nursing actions are appropriate? Select all that apply. 1. Ask the patient to rate his pain on the pain scale. 2. Tell the patient that he does not look as if he is in pain. 3. Have the patient go back to bed and ask the visitor to leave. 4. Check to see when the patient last received pain medication. 5. Have another nurse assess the patient.

Correct Answer: 1,4 - When the patient complains of pain, the nurse should always ask for a pain rating. - Patients respond to pain differently. For example, this patient may be trying to hide the intensity of his pain from his friend. - Having the patient go back to bed and asking the visitor to leave is punitive and could be interpreted as the nurse not believing the patient. Being active and having diversions can help with pain management. - The nurse should check to see when the patient last had pain medication, what drug was given, what dose was given, and by what route it was administered. - There is no reason to have another nurse assess the patient. This action may imply that the nurse does not trust the patient.

A client has just been prescribed ibuprofen for a mild ankle sprain. Which health history information should alert the nurse to question this prescription? Select all that apply. 1. The client has asthma. 2. The client had a similar ankle strain a year ago. 3. The client reports getting a rash when eating strawberries. 4. The client is allergic to aspirin. 5. The client reports having a peptic ulcer 6 months ago.

Correct Answer: 1,4,5 - Clients with asthma are more likely to have hypersensitivity to ibuprofen. - There is no reason a previous injury would change the decision to prescribe ibuprofen. - There is no cross-sensitivity between ibuprofen and strawberries. - Clients who have an allergy to aspirin are more likely to be hypersensitive to ibuprofen. - Ibuprofen increases the risk of serious gastrointestinal bleeding, especially in someone with a recent history of this problem.

A client is receiving therapy for gout. Which information should the nurse provide? Select all that apply. 1. You should not drink alcohol. 2. You should increase intake of fatty fish like salmon and sardines. 3. Take a vitamin C supplement while on your medication for gout. 4. Increase your fluid intake to 2 to 4 liters each day. 5. If your joint pain does not improve, let us know.

Correct Answer: 1,4,5 - Limiting or eliminating alcohol consumption is standard treatment for gout. - Salmon and sardines should be eliminated from the diet. - Vitamin C may acidify the urine and lead to formation of uric acid stones. - Increasing fluid intake increases uric acid excretion. - The client should be taught to report worsening or continued inflammation or pain.

Which patients should the nurse be concerned about regarding non-adherence to prescribed medication regimens? Select all that apply. 1. A 70-year-old hypertensive male patient who has a prescription for a diuretic and is complaining that his medication is keeping him up all night 2. A 30-year-old college student who has a prescription for birth control pills and tells the nurse she has had breakthrough bleeding this past cycle 3. A 45-year-old diabetic who has a prescription for insulin and whose blood sugar is within the normal range 4. A 57-year-old day laborer who has a prescription for Lipitor for high cholesterol and a prescription card for a free health clinic 5. An 18-year-old male with a prescription for an acne medication that must be taken 4 times a day

Correct Answer: 1,5 -This patient has been taking his diuretic in the evening instead of in the morning and is most likely experiencing increased urination at night that is disrupting his sleep. Adverse side effects are common causes for nonadherence. -Birth control pills often cause midcycle bleeding. This does not raise any red flags for nonadherence. -The fact that this diabetic patients blood sugar is within the normal range may be evidence that the patient is taking insulin as directed. -The means to pay for medication (free clinic prescription card) decreases the patients risk for nonadherence. -One of the most common reasons for nonadherence is forgetting a dose, particularly with drugs that must be taken more than twice a day.

A drug for which research has shown an adverse effects in animals but not in pregnant women would be categorized as Category 1. A. 2. B. 3. D. 4. C.

Correct Answer: 2 A drug that has adverse effects in animals but not in pregnant women is a Category B drug.

Identify the correct statement regarding the neural mechanism of pain 1. Once the pain impulse reaches the spinal cord, neurotransmitters inhibit the signal. 2. Alpha fibers are wrapped in myelin; C fibers are not. 3. When tissues are damaged, pain impulses go directly to the brain via alpha and beta fibers. 4. Myelin is a substance that slows nerve transmission.

Correct Answer: 2 A pain impulse travels to the spinal cord via alpha and C fibers. The alpha fibers are wrapped in myelin (a lipid substance that speeds nerve transmission); the C fibers are not. Once the impulse reaches the spinal cord, neurotransmitters pass the message along to the next neuron.

Which nursing intervention would take priority following administration of a new medication? 1. Monitoring lab values 2. Monitoring the patients respiratory status 3. Prescribing additional medications if side effects occur 4. Measuring patient weight

Correct Answer: 2 Any time a new medication is provided to the patient, it is important to monitor for an allergic reaction. Anaphylaxis, a life-threatening allergic reaction, can impair breathing. Monitoring lab values and measuring weight might be appropriate nursing interventions with some medications, but would not be the priority. Nurses do not prescribe medications.

Which of the following kinds of drugs would be most likely to enter breast milk? 1. Ionized 2. Lipid-soluble 3. Water-soluble 4. Bound to plasma protein

Correct Answer: 2 As with the placenta, drugs that are ionized, water-soluble, and bound to plasma protein are less likely to enter breast milk.

A patient with hypertension is receiving medication to lower his blood pressure. Which of the following demonstrates the evaluation process related to medication administration? 1. Asking the patient whether he is compliant in taking his medications 2. Determining that goals were not met 3 days following medication administration 3. Administration of IV antihypertensive agents 4. Determination of the patients baseline blood pressure

Correct Answer: 2 Evaluation is the final step in the nursing process where goal attainment is determined. Administering medications is the intervention step. Determining the patients baseline blood pressure and asking him about compliance would be the assessment step.

The nurse administers an evening medication to the patient in the morning. The medication did go to the correct patient. What is the nurses best course of action at this time? 1. Change the medication administration time to the morning. 2. Notify the physician about the error and complete an incident report. 3. Tell the evening nurse to hold the evening dose just for tonight. 4. Notify the physician and ask if any further action needs to be taken.

Correct Answer: 2 Even though the medication went to the correct patient, this is still considered a medication error. The time of the medication cannot be changed without an order from the physician. Telling the evening nurse to hold the evening dose is unethical; an error has been committed. There is no need to ask the physician if any further action needs to be taken; an incident report needs to be completed.

The patient is receiving chlorothiazide (Diuril). The nurse suspects the patient is exhibiting side effects to the medication. What will the best assessment of the nurse include? 1. Ataxia and frequent diarrhea 2. Serum potassium level of 3.0 and low blood pressure 3. Serum sodium level of 160 and headaches 4. Mental confusion and dependent edema

Correct Answer: 2 Hypokalemia and hypotension are serious side effects of diuretic therapy. Hypernatremia and headaches are not side effects of diuretic therapy. Ataxia and frequent diarrhea are not side effects of diuretic therapy. Mental confusion and dependent edema are not side effects of diuretic therapy.

The patient has been running in a long-distance marathon on a very warm day. The patient complains of dizziness and nausea, and is taken to the hospital where she becomes lethargic. The serum sodium level is 125 mEq/L. What will be the best plan of the nurse? 1. Prepare to encourage the patient to drink fluids. 2. Prepare to administer normal saline intravenous (IV). 3. Prepare to administer 0.45% NaCl. 4. Prepare to provide a diet high in NaCl.

Correct Answer: 2 Hyponatremia is a serum sodium level less the 135 mEq/L. Hyponatremia caused by sodium loss may be treated with intravenous (IV) fluids containing salt, such as normal saline. 0.45% NaCl is a hypotonic solution and will further lower the serum sodium. The patient requires intravenous (IV)

The pregnant patient plans to breastfeed her baby. She asks the nurse about the use of herbal products during breastfeeding. What is the best response by the nurse? 1. Be sure to check the label to see if the herbal product could be used during breastfeeding. 2. Most drugs can be transferred to the infant during breastfeeding, so this is not recommended. 3. Herbal products are considered natural, so it should be fine to use them during breastfeeding . 4. This should be fine, as long as there is at least 12 hours between the time you use the product and when you breastfeed.

Correct Answer: 2 It is best to avoid as many drugs as possible during breastfeeding. The bottle may not be labeled for breastfeeding, so the patient should check with the nurse. There is no safety time limit established between the use of the product and breastfeeding. Herbal products are drugs.

Which statement is accurate regarding medications that end up being secreted in bile? 1. All medications secreted in bile are excreted in the feces. 2. Some medications are excreted in the feces while others can be recirculated to the liver many times. 3. Most medications secreted in bile are metabolized in the gallbladder. 4. Generally, medications are not secreted in the bile.

Correct Answer: 2 Most bile is circulated back to the liver by enterohepatic circulation, where medications are metabolized in the liver. Some bile (and medications within) is excreted in the feces.

The nurse is teaching a caregivers support group for caretakers of elderly patients. The focus is medication compliance. The nurse determines that learning has occurred when the caregivers make which response? 1. We should crush their medicine and put it in applesauce so they will swallow it. 2. We should use a medication management box so they wont forget to take it. 3. We should ask the doctor if all the medication is really necessary. 4. We should give them more education about the medicine so they will take it.

Correct Answer: 2 Most elderly patients will be medication compliant if they have a way to remember to take the medication; a medication management box is an excellent idea. Many elderly can swallow pills just fine, and many medications cannot be crushed. The problem is not the education; it is that the elderly often forget what medication to take at what time. Asking the physician about medications is fine, but this will not help the elderly patient to remember when to take it.

The patient is receiving chlorothiazide (Diuril). The nurse assesses the patient for hypokalemia. What does the best assessment include? 1. Confusion and decreased urine output 2. Muscle weakness or cramps 3. General irritability and increased urine output 4. Diarrhea and projectile vomiting

Correct Answer: 2 Muscle weakness or cramps are indications of hypokalemia. Diarrhea and projectile vomiting are not signs of hypokalemia. Confusion and decreased urine output are not signs of hypokalemia. General irritability and increased urine output are not signs of hypokalemia.

The nurse is assessing a newly admitted patients current medications. What does the best objective data include? 1. The patients wife tells the nurse what medications the patient has been receiving. 2. The nurse checks the prescription bottles the patient has brought to the hospital. 3. The nurse asks the physician what medications the patient was currently taking. 4. The patient lists the medications that have been prescribed.

Correct Answer: 2 Objective data includes information gathered through assessment, and not necessarily what the patient says or perceives. The most reliable and objective assessment by the nurse is to check the patients prescription medication bottles. A list of medications provided by the patient and the patients wife is subjective, not objective data. Asking the physician what medication the patient was receiving is subjective data, and the physician may not remember all the medication the patient was receiving.

The patient is receiving spironolactone (Aldactone). The nurse has completed dietary education and evaluates that the patient needs additional education when the patient makes which statement? 1. I am really happy that I can have my cranberry juice. 2. Thank goodness I can still have my orange juice and bananas for breakfast. 3. I need an apple a day to stay regular; Im glad I can still have this. 4. I am German, so I could not give up my cabbage and mushrooms.

Correct Answer: 2 Orange juice and bananas are high in potassium, and are contraindicated with a potassium-sparing diuretic. Cranberries are low in potassium and are not contraindicated with a potassium-sparing diuretic. Cabbage and mushrooms are low in potassium and are not contraindicated with a potassium-sparing diuretic. Apples are low in potassium and are not contraindicated with a potassium-sparing diuretic.

The nurse is preparing for medication administration to a group of patients. What is the best overall outcome for the patients? 1. Patients will take the medications after receiving medication instruction. 2. Patients will receive the best therapeutic outcome from the medications. 3. Patients will state the reason they are receiving the medications. 4. Patients will experience minimal side effects after taking the medications.

Correct Answer: 2 Outcomes should focus first on the therapeutic outcome of the medications. The fact that the patient takes the medication is not the best overall outcome for the patients. The treatment of side effects is not the best overall outcome for the patients. Having the patients state the reason they are receiving the medications is the best overall outcome for the patients.

The patient is receiving chlorothiazide (Diuril). What is the best medication education by the nurse? 1. Avoid foods high in potassium, such as bananas. 2. Weigh yourself, and report a gain of more than 2 pounds in 24 hours. 3. Weigh yourself and report a gain of more than 0.5 pounds in 24 hours. 4. Report signs of hypokalemia, such as vomiting and diarrhea.

Correct Answer: 2 Patients receiving thiazide diuretics should check weight daily and report a weight gain of 2 or more pounds in 24 hours. Patients receiving thiazide diuretics should consume foods high in potassium. Vomiting and diarrhea are not signs of hypokalemia. A weight gain of more than 2, not 0.5, pounds in 24 hours is considered the gold standard for fluid overload.

Patients who are discharged from the hospital on new medications should 1. be advised that their local pharmacy will provide them with the drug information and instructions they need. 2. be provided with oral and written drug information and instructions. 3. be provided oral drug information and instructions as opposed to written. 4. be provided with written drug information and instructions only.

Correct Answer: 2 Patients should be provided with oral and written drug information and instructions prior to discharge. Patients may receive these oral and written materials from their pharmacy, but should be supplied initially by the hospital.

The nurse is administering medications to an elderly patient. Which laboratory tests are important for the nurse to assess prior to the administration of medication? 1. Complete blood count (CBC) and electrolytes 2. Kidney and liver function tests 3. Arterial blood gases (ABGs) and basic metabolic panel 4. Lipid panel and thyroid function tests

Correct Answer: 2 Renal and hepatic function tests are essential for many patients, particularly older patients and those who are critically ill, as these will be used to determine the proper drug dosage. Complete blood count (CBC) and electrolytes will not help to determine the proper drug dosage. Lipid panel and thyroid function tests will not help to determine the proper drug dosage. Arterial blood gases (ABGs) and a basic metabolic panel will not help to determine the proper drug dosage.

Which method is the most appropriate for administering medications to school-age children? 1. Allowing the child to make decisions regarding the time the medications are taken 2. Providing a brief explanation 3. Administering drugs while holding the child down 4. Providing a lengthy explanation followed by quick drug administration

Correct Answer: 2 School-age children should be provided a brief explanation followed by quick drug administration. Children should not be held down. Lengthy explanations and allowing for choices are more appropriate for adolescents.

The patient is admitted to the hospital following an abortion, and she is septic. The physician orders antibiotics that the patient refuses stating, I dont deserve them. The nurse providing care has anti-abortion beliefs. What is the best response by the nurse? 1. I think you need to do what is best for you. 2. You have a serious infection and really need the drug. 3. Do you think you should be punished because you had an abortion? 4. Ill call your physician and let him know about your decision.

Correct Answer: 2 Telling the patient she needs the drug is providing the best care possible; this must be done even though the nurses beliefs are different from the patients beliefs. Telling the patient she needs to do what is best is inappropriate; the nurse knows she needs the drug. Calling the physician is inappropriate; the nurse knows the patient needs the drug. Asking the patient if she thinks she should be punished is inappropriate; she is septic and needs the medication.

A patient looks up the drug he is taking in a drug guide. The patient asks the nurse why the physician prescribed a medication that has a lethal dose measure. What is the best response by the nurse? 1. It just refers to what is done in research; it is not used by doctors prescribing drugs. 2. It is a value determined during research, which helps to determine the safe dose to give. 3. All that means is that the drug could be lethal, but I will watch you for side effects. 4. Dont worry about that, Ill have your doctor explain it to you.

Correct Answer: 2 The difference between a median effective dose and a median lethal dose is a measure of a drugs safety margin, which helps determine the safest dose to give. The lethal dose measure is used by doctors prescribing drugs. Telling a patient not to worry is non-therapeutic; this is a condescending response. Telling a patient that the drug could be lethal, but he will be observed for side effects, will frighten him and most likely result in refusal of the medication.

A trauma patient in the emergency department has a low hemoglobin and hematocrit, and has an order to receive normal saline IV solution. Which nursing diagnosis would be most appropriate regarding the need for administering the IV solution? 1. Activity intolerance 2. Fluid volume deficit 3. Decreased cardiac output 4. Risk for Infection

Correct Answer: 2 The drop in hemoglobin and hematocrit signify blood loss following trauma. Fluid volume deficit would be the best nursing diagnosis. The patients activity might be altered, and he might be at risk for infection following the trauma, but these do not relate to administering the IV normal saline. It is more likely that the patient has a drop in hemoglobin and hematocrit as a result of the trauma than a cardiac problem.

The symptoms of gout are due to 1. an increase in the excretion of uric acid. 2. buildup of uric acid in the blood. 3. cartilage loss in the joints. 4. a decrease in uric acid in the blood.

Correct Answer: 2 - An increase in excretion would not cause gout. - Gout is due to buildup of uric acid in blood or joints. - Cartilage loss is characterized by osteoarthritis. - A decrease in uric acid would not cause gout.

The client receives a nonsteroidal anti-inflammatory drug (NSAID) for treatment of arthritis. What is a priority for the nurse to include when doing medication education? 1. Constipation is common; include roughage in your diet. 2. Drink at least eight glasses of water a day. 3. Take your medication with food. 4. Take your medication on an empty stomach.

Correct Answer: 2 - Constipation is not an issue with nonsteroidal anti-inflammatory drugs (NSAIDS). - Nonsteroidal anti-inflammatory drugs (NSAIDS) are nephrotoxic; keeping the client well hydrated will help prevent kidney damage. - Taking the medication with food will decrease gastrointestinal (GI) irritation, but kidney damage is more of a priority. - Taking the medication on an empty stomach will increase gastrointestinal (GI) irritation.

Pharmacotherapy with diuretics can cause which of the following general adverse effects? 1. Constipation 2. Orthostatic hypotension 3. Weight gain 4. Hypertension

Correct Answer: 2 - Diarrhea, not constipation, might be a problem. - Orthostatic hypotension is a common adverse effect of all the prototype drugs. - Weight loss, not weight gain, will occur. - Hypertension usually does not occur.

The nurse assesses the client might be experiencing toxicity from colchicine. Which statement by the client would most likely confirm the nurses suspicion? 1. My joints hurt more. 2. I have nausea, vomiting, and abdominal pain every day. 3. I dont see as well as I used to, and my taste has changed. 4. I wake up at night with muscle cramps.

Correct Answer: 2 - Joint pain is not a sign of colchicine toxicity. - Nausea, vomiting, and abdominal pain are signs of colchicine toxicity. - Vision and taste changes are not signs of colchicine toxicity. - Muscle cramps are not a sign of colchicine toxicity.

The most appropriate food for the patient taking loop diuretics is 1. meat. 2. bananas. 3. cheese. 4. Yogurt.

Correct Answer: 2 - Meat provides protein, but not much potassium. - Bananas are great source of potassium. Other foods high in potassium are green leafy vegetables. - Cheese is a good source of calcium. - yogurt is a good source of calcium.

A patient with chronic kidney failure is taking a loop diuretic. The nurse will advise the patient to take the drug 1. with food. 2. in the morning. 3. at bedtime. 4. in the late afternoon.

Correct Answer: 2 - The medication does not need to be given with food. - It is best to take loop diuretics in the morning, since they increase urine flow, which could lead to injury. - Taking a loop diuretic at bedtime will cause nighttime urination and interfere with sleep. - Late afternoon is too late, since the drug will increase urine flow.

The physician orders acetaminophen (Tylenol) for a client with a fever. The nurse would plan to validate which other order with the physician? 1. Heparin 5,000 units subcutaneously every 8 hours 2. Warfarin (Coumadin) 2 mg orally every day 3. Penicillin G benzathine (Bicillin LA) 2.4 million units IM one time 4. Paroxetine (Paxil) 37.5 mg orally every day

Correct Answer: 2 - There is no contraindication to the use of heparin and acetaminophen (Tylenol). - Acetaminophen (Tylenol) inhibits warfarin (Coumadin) metabolism. Concomitant use of these two medications could result in a toxic accumulation of warfarin (Coumadin). - There is no contraindication to the use of penicillin G benzathine (Bicillin LA) and acetaminophen (Tylenol). - There is no contraindication to the use of paroxetine (Paxil) and acetaminophen (Tylenol).

The nurse plans to teach a class on acetaminophen (Tylenol) to mothers with young children. What will the best plan by the nurse include? 1. It is best to give your child acetaminophen (Tylenol) with a high-carbohydrate meal. 2. Read the labels of all over-the-counter (OTC) medications for the amount of acetaminophen (Tylenol) in them. 3. Acetaminophen (Tylenol) will only need to be given once a day because it is long-lasting. 4. It is okay to substitute a baby aspirin for acetaminophen (Tylenol) if you run out of acetaminophen (Tylenol).

Correct Answer: 2 - There is no indication that Tylenol should be given with high-carbohydrate foods. - It is very easy for parents of young children to overdose them with acetaminophen (Tylenol). All medication labels should be read. -The duration of action of acetaminophen (Tylenol) is only 34 hours. - Aspirin is not recommended for children due to the possibility of Reyes Syndrome.

The nurse administers narcotics to surgical patients. Which statement represents the nurses best understanding as it relates to the potency of different narcotics? 1. Codeine is less potent than morphine; it will not produce an allergic reaction. 2. Morphine is more potent than codeine; a lesser dose will be required. 3. Morphine is more potent than codeine; it will produce more adverse effects. 4. Codeine is less potent than morphine; it will not relieve pain as well.

Correct Answer: 2 A drug that is more potent will produce a therapeutic effect at a lower dose. Potency does not mean the drug will produce more adverse effects. Less potent narcotics can be very effective with pain relief. The potency of a drug is not related to its ability to cause an allergic reaction.

The nurse uses the nursing process prior to administering any medications. Which step will assure the best patient safety? 1. Assess the patients developmental level. 2. Assess the patients medical history. 3. Assess the patients disease process. 4. Assess the patients learning needs.

Correct Answer: 2 An assessment of the patients medical history, which includes allergies, is the most important assessment prior to administering medications. Assessing the patients learning needs is important for medication education, but not for safely administering medications. Assessing the patients developmental level is important for medication education, but not for safely administering medications. Assessing the patients disease process is important in evaluating the effects of the medications, but not for safely administering medications.

Which statement is accurate concerning the use of aspirin (ASA) to treat pain? 1. High doses are necessary (1 gram) to achieve anticoagulant effects. 2. Enteric-coated capsules are available to reduce GI side effects. 3. Increase consumption of herbs such as garlic and ginger to potentiate the anti-inflammatory effects. 4. In low doses (325 mg), it significantly reduces inflammation.

Correct Answer: 2 Aspirin can cause bleeding in low doses. Enteric-coated capsules can help prevent bleeding, and avoiding certain herbs such as ginger and garlic should be advised. The anti-inflammatory effects of aspirin occur in high doses.

The patient is malnourished and has a low serum albumin. The physician has ordered aspirin, a highly protein-bound drug, for the patient. Which evaluation by the nurse best describes the effect this will have on the patient? 1. The patient will be at risk to experience a decreased effectiveness of the drug. 2. The patient will be at risk to experience toxic effects of the drug. 3. The patients kidneys will excrete the drug at a faster rate. 4. The patients serum globulin is more important than serum albumin.

Correct Answer: 2 Aspirin is a protein-bound drug. With a low albumin, there is less protein for aspirin to bind with, making more free drug available. There may be toxic, not decreased, effects from the drug because there is less protein for aspirin to bind with and more free drug available. The kidney will not be able to balance the amount of the drug and excrete it at a faster rate. Serum albumin plays a major role, more than serum globulin.

The patient receives aspirin. The nurse assesses an adverse effect to this drug when the patient makes which response? 1. My stools have been gray in color. 2. There is a constant ringing in my ears. 3. Bright lights give me a headache. 4. I have to get up a lot at night to urinate.

Correct Answer: 2 Aspirin is ototoxic, and may cause ringing in the ears. Aspirin does not cause photophobia. A decrease in bilirubin (gray stools) is not caused by aspirin. There isnt any relationship between aspirin and nocturnal renal output.

The patient has meningitis. The physician initially prescribed a water-soluble drug. Another physician changed the order to a lipid-soluble drug. The patient is confused about this. Which plan best resolves the patients concern? 1. Teach the patient that lipid-soluble drugs are better because of protein binding. 2. Teach the patient that lipid-soluble drugs are more effective in treating his illness. 3. Teach the patient that lipid-soluble drugs are better because they have fewer side effects. 4. Teach the patient that lipid-soluble drugs are more effective because they are excreted at a slower rate.

Correct Answer: 2 Drug molecules that are lipid soluble will usually pass through plasma membranes by simple diffusion and more easily reach their target cells. Lipid-soluble drugs do not necessarily have fewer side effects. Not all lipid-soluble drugs are protein bound. Lipid solubility does not affect drug excretion.

The nurse is conducting medication education about the difference between potency and efficacy to a group of patients. The nurse correctly determines that learning has occurred when the patients makes which response? 1. The best drug for us is the one with the highest potency. 2. The best drug for us is the one with the greatest efficacy. 3. Drugs with the greatest efficacy will produce the least side effects. 4. Low potency drugs have efficacy and do not produce side effects.

Correct Answer: 2 Efficacy means the magnitude of maximal response that can be produced from a particular drug. Potency refers to the dose of the drug; high-potency drugs do not necessarily provide the best response in the patient. Efficacious drugs and low-potency drugs do produce side effects.

The nurse provides care for elders in an assisted living facility. What does the nurse assess as a primary contributing factor for medication complications in the elderly? 1. The elderly often abuse alcohol. 2. The elderly are frequently dehydrated. 3. The elderly are frequently constipated. 4. The elderly have decreased stomach acid.

Correct Answer: 2 Fluid deficit is a critical factor in the older adult that can contribute to medication complications. Decreased stomach acid is not a critical factor with medication complications in the elderly. Frequent constipation is not a critical factor with medication complications in the elderly. Alcohol abuse could be a factor in medication complications with the elderly, but is not as critical as fluid volume deficit.

The patient and his wife receive the same medication for hypertension. The patients wife asks the nurse why she is receiving a higher amount of the medication. What is the best response by the nurse? 1. Females have a higher metabolism, so you need more medication. 2. Everyone is unique and responds differently to medications. 3. Your hormones are different from your husbands, so you need more medication. 4. You have a greater percentage of body fat, so more medication is needed.

Correct Answer: 2 Many variables will influence how patients will respond to medications; each patient must be individually evaluated for response to medications. The percentage of body fat, hormones, and the patients rate of metabolism are only a few of the variables involved in the patients response to medications. Females do not necessarily have higher metabolic rates than men.

The nurse in the emergency department administers an adult dose of an antibiotic to a 3-month-old baby. As a result, the baby suffers permanent brain damage. What best describes the effect of this error on the health care facility? 1. The professional license of the nurse will be lost. 2. The morale of the staff involved will be depleted. 3. The reputation of the health care facility will suffer. 4. The health care facility will pay a very large settlement.

Correct Answer: 2 Medication errors that result in permanent damage increase self-doubt and destroy the morale of all staff involved; some may choose to leave the nursing profession. Payment of a large settlement is not the primary concern; staff morale is the concern. The professional license of the nurse may or may not be lost depending on the circumstances of the case. The reputation of the facility will probably suffer, but this is not as important as the staff morale.

The patient, addicted to heroin, is being treated for opioid dependence. He has been prescribed methadone (Dolophine). The patient asks how this will help because methadone (Dolophine) is another opioid. What is the best response by the nurse? 1. Methadone (Dolophine) will make you really sick if you use heroin. 2. Methadone (Dolophine) does not cause euphoria like heroin does. 3. Methadone (Dolophine) cures your addiction to heroin. 4. Methadone (Dolophine) causes you to have an allergy to heroin.

Correct Answer: 2 Methadone (Dolophine) does not cause the euphoria of heroin, or cure the dependence. It is a substitute drug that allows the patient to be productive. Methadone (Dolophine) does not cure heroin addiction. Methadone (Dolophine) does not cause an allergy to heroin. Methadone (Dolophine) will not cause a person to become sick if they use heroin.

The nurse was very busy and unfamiliar with a new medication, but administered it anyway. Later the nurse looked up the medication. How does the nurse manager evaluate this behavior? 1. This was acceptable as long as the nurse looked up the action and side effects of the drug later. 2. An error could have occurred because the nurse was unfamiliar with the medication. 3. The nurse manager was partially at fault because the nursing unit was understaffed and the nurse was too busy. 4. An error did occur because the nurse could have administered the medication via the incorrect route.

Correct Answer: 2 Nurses should never administer a medication unless they are familiar with its uses and side effects; an error could have occurred because the nurse was unfamiliar with the medication. It is not acceptable for a nurse to administer an unfamiliar medication and then look up the action and side effects later; an error could occur. An error did not occur, but could have because the nurse was unfamiliar with the medication. There is no information in the stem of the question that the nursing unit was understaffed, so the nurse manager is not partially at fault.

The nurse administers medications by various routes of delivery. The nurse recognizes which route of administration as requiring higher dosages of drugs to achieve a therapeutic effect? 1. Intravenous route 2. Oral route 3. Rectal route 4. Sublingual route

Correct Answer: 2 Oral medications pass into the hepatoportal circulation and may be completely metabolized before reaching the general circulation. This so-called first pass effect may necessitate the use of higher dosages of oral medications to achieve a therapeutic effect. None of the other routes, sublingual, rectal, or intravenous, are affected by the first-pass effect.

A patient presents with hypotension and bradycardia. The patient indicates that one of her physicians recently prescribed three new medications to her current list of 10 medications per day. Based on this information, which statement would be the most accurate? 1. The patient is having an allergic reaction to one of the new medications. 2. The patient is experiencing adverse reactions as a result of polypharmacy. 3. The patient is not in compliance with her prescribed medications. 4. The patient is experiencing an adverse effect that will go away in time.

Correct Answer: 2 Polypharmacy increases the risk of drug interactions and side effects. It is not appropriate to assume the side effects will go away. The information provided does not reveal anything about patient compliance. Bradycardia and hypotension do not necessarily indicate an allergic reaction.

The patient has a routine urinalysis done, and the results show protein in the urine. What does the nurse correctly conclude about this result? 1. The patient is in acute renal failure, and needs to be hospitalized. 2. The patient probably has kidney damage; protein should not be present in the urine. 3. There could be a mistake with the results; the patient should have another test done. 4. The results probably mean nothing if the amount of protein is very small.

Correct Answer: 2 Rationale 1: When filtrate passes through Bowmans capsule, its composition is similar to plasma. Plasma proteins are too large to pass through the filter, and if they appear in the filtrate or urine, this indicates kidney pathology. There is no evidence to support a mistake with the results of the urinalysis. Any amount of protein in the kidney is considered abnormal. There is no evidence that this patient is in acute renal failure.

The patient is admitted to the hospital in chronic renal failure, and is on several medications. What best describes the nurses assessment of this patient? 1. The patients liver may compensate for renal failure; the drugs may be effective. 2. The patient may have drug toxicity from all the drugs. 3. The patient may have drug toxicity only if the drugs are excreted by the kidneys. 4. The patient may have decreased effectiveness of the drugs.

Correct Answer: 2 Since the kidneys are the primary route of excretion for many drugs, chronic renal failure puts the patient at risk for drug toxicity. The patient in chronic renal failure will more likely have drug toxicity than decreased effectiveness of the drugs. The liver cannot compensate for renal failure; the patient is at risk for drug toxicity. Since the majority of drugs are excreted by the kidneys, the patient will most likely have drug toxicity.

Which of the following treatments has the highest potential to provide total pain relief? 1. Chiropractic manipulation 2. Neuronal injection of alcohol 3. Acupuncture 4. Transcutaneous electrical nerve stimulation (TENS)

Correct Answer: 2 TENS, chiropractic manipulation, and acupuncture are less likely to provide total pain relief. Nerve blocks irreversibly stop impulse transmission along the treated nerves.

The physician prescribes an oral medication for the patient. What is the primary nursing assessment of the patient prior to receiving this medication? 1. The patients understanding of the medication 2. The patients ability to swallow 3. The patients allergies 4. The patients eyesight

Correct Answer: 2 The ability of the patient to swallow is a safety issue to prevent aspiration of the medication. The patients understanding is important, but not a priority. The patients eyesight is not significant. The patients allergies are important, but if the patient cannot swallow the medication, then the allergies are not significant.

Which of the following would most accurately indicate that a therapeutic range for a medication had been reached? 1. No serious adverse effects are experienced following administration. 2. The indication for administration was achieved without serious side effects. 3. A pre-specified amount (in milligrams) was administered. 4. The medication was effective, but the patient experienced a lethal dysrhythmia.

Correct Answer: 2 The therapeutic range of a drug is between the minimum effective concentration and the toxic concentration.

Which of the following is accurate regarding medication administration via the intradermal route? 1. Injections should be limited to 12 milliliters. 2. Hairy sites should be avoided. 3. Usual administration sites include the upper and lower abdomen. 4. Medications should be injected into the epidermis skin layer.

Correct Answer: 2 Usual sites of intradermal administration include nonhairy surfaces, including the forearm, upper chest, and scapulae. Intradermal injection involves administering small amounts (0.10.2 milliliters) of medication into the dermis layer of skin.

The nurse teaches a class about muscle movement to a group of patients who have neuromuscular disorders. What will the best plan of the nurse include? Select all that apply. 1. Body movement depends on an intact spinal cord. 2. Body movement depends on proper functioning of muscles. 3. Body movement depends on intact nerves. 4. Body movement depends on proper endocrine functioning. 5. Body movement depends on the level of consciousness.

Correct Answer: 2,3 - Body movement depends on intact nerves and on proper functioning of muscles. Body movement does not depend on the level of consciousness. Body movement does not depend on an intact spinal cord. Body movement does not depend on proper endocrine functioning.

The nurse is discharging a 72-year-old man who was hospitalized after a muscle strain injury to his back. One of the discharge prescriptions for this patient is cyclobenzaprine (Flexeril) 10 mg three times per day with food. The prescription is written for 90 tablets and there are three refills available. Which information from this situation would alert the nurse for the need to collaborate with the patients health care provider? Select all that apply. 1. The dosage amount is too low for the type of injury this patient sustained. 2. Cyclobenzaprine should be used with great caution in those over 65. 3. If taken as directed, the patient would be able to take the medication for 120 days. 4. Cyclobenzaprine is not effective for back pain. 5. Cyclobenzaprine should not be taken with food.

Correct Answer: 2,3 - The dosage of 10 mg three times daily is standard. - The adverse reactions from cyclobenzaprine include confusion, hallucinations, and cardiac events, which are more common in patients over 65. - The manufacturer recommends that treatment not extend beyond 3 weeks or 21 days. - Cyclobenzaprine is not effective for muscle spasm due to spinal cord injury, but is useful in the treatment of back pain from muscle strain. - The drug may be taken with food or milk if gastric upset occurs.

A nurse is caring for a patient who is exhibiting signs of an adverse reaction to warfarin (Coumadin). Which statements made by the patient would lead the nurse to suspect that this is the case? Select all that apply. 1. Im from the South, and we have buttermilk almost every meal. 2. I was suffering so much from hot flashes until my friend told me to try an herb called St. Johns wort. I dont seem to have as many symptoms as before. 3. My husband makes me put garlic in everything! He heard it helps keep our blood pressure normal. 4. I heard ginkgo was really good for improving memory so I started taking it a couple of months ago. 5. I was having difficulty sleeping a couple months ago, and my neighbor recommended I try kava. It seems to calm my nerves.

Correct Answer: 2,3,4 - Calcium products do not affect the action of warfarin. - St. Johns wort may increase the risk for bleeding when taken with warfarin. - Garlic may increase the risk for bleeding when taken with warfarin. - Ginkgo may increase the risk for bleeding when taken with warfarin. - Kava can increase drowsiness and sedation when taken with CNS depressants. It does not interact with warfarin.

The nurse has just taken a job in a hospital that cares for an ethnically diverse population and is concerned about being culturally sensitive. How should the nurse plan to manage caring for patients in pain? Select all that apply. 1. Treat all patients alike. 2. Listen carefully as the patients comments about pain are translated. 3. Show respect for the patients preferences even if they are very different from the nurses. 4. Ask questions about the patients beliefs and customs regarding pain management. 5. Watch how other nurses provide care to their patients.

Correct Answer: 2,3,4 - Not all patients respond identically to interventions. - Even if the nurse has to use the services of a translator, careful listening is an important step in providing culturally sensitive care. - Showing respect is important in providing culturally sensitive care in all areas, including pain management. - The nurse cannot practice what the nurse does not know. Asking questions is the method used to gain information to facilitate sensitive care. - Other nurses may not be providing the care needed for this nurses patients.

The nurse is managing care for clients who will receive ibuprofen (Advil) for long term therapy. What are the primary laboratory tests the nurse will assess prior to initiation of therapy? Select all that apply. 1. Electrolytes 2. Hemoglobin and hematocrit 3. Bleeding times 4. Liver function tests 5. Serum amylase

Correct Answer: 2,3,4 1- There is no specific reason to monitor the clients electrolytes. 2- Ibuprofen may result in a decrease in hemoglobin and hematocrit. Baseline levels should be documented. 3- Ibuprofen may increase bleeding times. Baseline values should be documented. 4- AST and ALT may be increased so it is important to document baseline levels. 5- It is not necessary to draw baseline serum amylase levels.

The physician has ordered several medications for the patient. What does the nurse recognize as responsibilities regarding administration of medications? Select all that apply. 1. Knowing whether or not the medication is on the hospital formulary 2. Knowing the reason the medication was prescribed for this patient 3. Knowing how the medication is to be administered. 4. Knowing how the medication is supplied by the pharmacy 5. Knowing the name of the medication

Correct Answer: 2,3,4,5 How the medication is supplied by the pharmacy, how the medication is to be administered, the name of the medication, and the reason the medication was prescribed for the patient are the responsibilities of the nurse regarding medication administration. Whether or not a drug is on a hospital formulary list is not a primary responsibility of the nurse.

The nurse is teaching a patient the importance of taking the medication as prescribed. Patient teaching is guided by the nurses knowledge of which principles of pharmacokinetics? Select all that apply. 1. A medication taken by injection must cross the membranes of the gastrointestinal tract to get to the blood stream before it can be distributed throughout the body. 2. A drug may be exposed to several physiological processes while en route to target cells. 3. Liver enzymes may chemically change the drug. 4. Excretion organs such as kidneys and intestines must be healthy enough to eliminate the drug. 5. Many processes to which drugs are exposed are destructive, thereby helping facilitate the drugs movement throughout the body.

Correct Answer: 2,3,4,5 -Medications taken by mouth must cross the membranes of the GI tracts to get to the blood stream in order to be distributed throughout the body. This is not the case for medications administered by injection. - Drugs taken orally are often exposed to physiological processes such as stomach acid and digestive enzymes. -Enzymes in the liver may chemically change some drugs. -Drugs will continue to act on the body until they are either metabolized to an inactive form or are excreted. Pathologic states such as kidney disease can increase the drugs action on the body. -Many destructive processes, such as when stomach acid breaks down food, can break down the drug molecule before it can reach the target cells. This will facilitate the drugs movement throughout the body.

A patient has been referred to an allergist for allergy testing. Which parenteral routes would the nurse not expect to be used for the tests? Select all that apply. 1. The intradermal (ID) route 2. The subcutaneous route 3. The intramuscular (IM) route 4. The intravenous (IV) route 5. The buccal route

Correct Answer: 2,3,4,5 -The ID route is used to administer very small volumes of a drug into the intradermal layer of skin. This route is most commonly used for allergy and TB skin testing. - The subcutaneous route is used to deliver medication into the deepest layer of skin. Drugs that are delivered by this route include insulin, heparin, and some vaccines. -The IM route is used to deliver medication deep into a muscle. Antibiotics, vitamins, and some vaccines are delivered by this route. -The IV route delivers medication directly into the bloodstream. Fluid replacement, antibiotics, blood products, and many other drugs can be delivered via this route. -Medications administered by the buccal route are intended to be absorbed. This is not a route used for allergy testing.

The nurse plans to teach a safety class to parents of toddlers about household exposure to medications. What will the best plan of the nurse include? Select all that apply. 1. Keep the toddler awake and observe for side effects of the medication. 2. Keep all medications locked up and stored out of reach of the toddler. 3. Use syrup of ipecac immediately if the toddler has ingested medication. 4. Call the Poison Control Center for guidance with any medication ingested. 5. Teach the toddler that medications are for adult use only.

Correct Answer: 2,4 Locking up medications is the safest way to childproof the home. The Poison Control Center should be contacted for any type of medication the toddler has ingested. Syrup of ipecac should only be used if recommended by the Poison Control Center. The Poison Control Center should be contacted, and they will advise if the child is to be kept awake. It is unrealistic to expect a toddler to understand that medications are for adult use only.

A patient with hypertension is taking a potent antihypertensive without results. The patient is concerned when the health care provider orders a new drug. The nurse explains... Select all that apply. 1. The drug you took is very potent, and a higher dose is needed. 2. The new drug has greater efficacy, so it will help reduce your blood pressure. 3. The prescriber must have made an error in the orders. 4. Efficacy in treating your hypertension is more important than potency. 5. You are correct. I think the prescriber meant to order both drugs.

Correct Answer: 2,4 - A higher dose of a potent drug may cause more serious adverse effects without greater efficacy. - Efficacy is more important than potency in providing blood pressure control. - This is not an appropriate response by the nurse. - Efficacy is more important than potency in pharmacologic treatment. - This is not an appropriate response, and the nurse cannot assume the order was supposed to be for two drugs.

The patient has advanced cancer and is experiencing malignant pain. How should the nurse plan to manage this pain? Select all that apply. 1. Use the intravenous route for pain medication administration. 2. Set up a dosing schedule that provides for around-the-clock doses. 3. Encourage the patient to wait 10 minutes after pain medication is required to ask for a dose. 4. Augment the patients regimen with other pharmaceutical and nonpharmaceutical pain relief measures for breakthrough pain. 5. Counsel the patient that it is not possible to eliminate all the pain of cancer and that some must be tolerated.

Correct Answer: 2,4 - Approximately 90% of cancer pain can be controlled by use of oral medications if they are dosed appropriately. - Often the problem in controlling pain of any type is that the patient gets behind the pain rather than medicating for it before it gets severe. Around-the-clock dosing helps to prevent playing catch-up to the pain. - This plan would allow the pain to worsen before medication is given and would result in the patient getting behind the pain. - Breakthrough pain is expected and may require additional pharmaceutical or nonpharmaceutical measures. - While it is true that some cancer patients develop intractable pain, many are able to control pain to a level that is very tolerable.

A patient at a community health center has been prescribed oral medications and tells the nurse that medications were administered intravenously when the patient was in the hospital. The nurse discusses the benefits and disadvantages of oral medications, including which facts? Select all that apply. 1. The oral route is considered the second safest route, after the intradermal route. 2. Tablets that are scored may be crushed for easier swallowing. 3. Enteric-coated drugs are designed to dissolve in the stomach, not the small intestine. 4. A major disadvantage of oral medications is that the patient must be conscious and able to swallow. 5. Enteric-coated drugs should be crushed to help facilitate dissolving by the stomach acid.

Correct Answer: 2,4 -The oral route is considered the safest because the skin barrier is not compromised; if an overdose occurs, drugs remaining in the stomach can be evacuated with stomach contents. -The purpose of scoring a tablet is the greater ease of cutting the tablet in half or quarters. These same tablets may be crushed, if needed. -Some drugs irritate the stomach lining and are coated to prevent being dissolved in the stomach. These drugs go on to the small intestine and are dissolved in the alkaline environment. -This is a major disadvantage of oral medications. -Enteric-coated drugs are designed specifically to bypass the stomachs acidic environment and continue to the alkaline environment of the small intestine.

The nurse is assessing a patient prior to the administration of a diuretic. The nurse knows it is essential to assess which vital signs at this time? Select all that apply. 1. Temperature 2. Pulse 3. Respirations 4. Blood pressure 5. Pain

Correct Answer: 2,4 The nurse must assess the patients pulse and blood pressure prior to administering a diuretic.

The nursing instructor teaches student nurses about the Food and Drug Administration (FDA) Pregnancy Categories. What is the best information to include? Select all that apply. 1. Food and Drug Administration (FDA) Pregnancy Category C is safe to use during pregnancy. 2. Food and Drug Administration (FDA) Pregnancy categories provide a framework for safe use of drugs in pregnant women. 3. Food and Drug Administration (FDA) Pregnancy categories for individual drugs seldom change once they are established. 4. Food and Drug Administration (FDA) Pregnancy categories are based on studies using clinical human research trials. 5. Food and Drug Administration (FDA) Pregnancy Category X has been associated with teratogenic effects.

Correct Answer: 2,5 Food and Drug Administration (FDA) Pregnancy Categories provide a framework for safe use of drugs in pregnant women. Food and Drug Administration (FDA) Pregnancy Category X has been associated with teratogenic effects. Food and Drug Administration (FDA) Pregnancy Categories are based on animal studies. Pregnancy Category C is not necessarily safe, it just means that animal studies have shown an adverse effect, but well-controlled studies in pregnant women have not been done. Food and Drug Administration (FDA) Pregnancy categories for individual drugs do change based on reported effects on fetuses.

The patient is dehydrated, but has a normal blood pressure. The new medical intern orders normal serum albumin intravenously (IV) for this patient. What is the best evaluation by the nurse regarding this order? 1. It is a correct and valid order. 2. The intern should have ordered 5% dextrose in normal saline. 3. The intern should have ordered 0.45% NaCl. 4. The intern should have ordered 0.9% NaCl.

Correct Answer: 3 0.45% NaCl is a hypotonic solution. This will cause fluid to shift from plasma to the tissues and cells in the intravascular compartment. Hypotonic solutions are indicated for patients who are dehydrated with normal blood pressure. Normal serum albumin is a hypertonic solution; the patient requires a hypotonic solution 5% dextrose in normal saline is a hypertonic solution; the patient requires a hypotonic solution. 0.9% NaCl is an isotonic solution, the patient requires a hypotonic solution.

A patient on a morphine patient-controlled analgesic (PCA) IV pump has a respiratory rate of 8, and is difficult to arouse. Which of the following would be the priority intervention? 1. Administering activated charcoal 2. Lowering the dose of morphine 3. Administering a medication that blocks mu and kappa receptors 4. Intubation and mechanical ventilation

Correct Answer: 3 Administering the opioid antagonist naloxone (Narcan) is indicated in the given situation. Lowering the dose is not aggressive enough, and intubation is too aggressive. Activated charcoal is not indicated for an overdose that has occurred via the IV route.

Which of the following is an adverse effect associated with morphine, and would be the priority if present? 1. Restlessness 2. Constipation 3. Respiratory depression 4. Psychological dependence

Correct Answer: 3 All are adverse effects, but respiratory depression is the top priority.

If a clinician wanted to prevent the effects elicited from a previously administered medication, which type would be of the most use? 1. An agonist 2. A partial agonist 3. An antagonist 4. A partial antagonist

Correct Answer: 3 An antagonist occupies receptor sites, preventing them from being activated by the medication.

The hospitalized patient is receiving spironolactone (Aldactone). A consulting physician sees the patient and orders lisinopril (Prinivil). What will be the primary assessment by the nurse? 1. Decreased effect of spironolactone (Aldactone) 2. Hypokalemia 3. Hyperkalemia 4. Decreased effect of lisinopril (Prinivil)

Correct Answer: 3 Concurrent use of spironolactone (Aldactone) and ACE inhibitors such as lisinopril (Prinivil), may predispose the patient to hyperkalemia. The patient will be at risk for hyperkalemia, not hypokalemia. Lisinopril (Prinivil) does not decrease the effect of spironolactone (Aldactone). Spironolactone (Aldactone) does not decrease the effect of spironolactone (Aldactone).

Following ingestion, a drug crosses a membrane from an area of higher concentration to an area of lower concentration. This is an example of 1. active transport. 2. osmosis. 3. diffusion. 4. metabolism.

Correct Answer: 3 Diffusion is the movement of a chemical from an area of higher concentration to an area of lower concentration. Active transport is the movement of a chemical against concentration or gradient. Osmosis involves the movement of water, and metabolism involves chemical conversion.

The Joint Commission (TJC) documented that patient education was deficient on several medical-surgical units of a local hospital. A nursing committee was formed to address this problem and focused on what likely nursing intervention? 1. Providing educational pamphlets about medications to the patients. 2. Asking the physicians to provide medication education to the patients. 3. Discussing medications each time they are administered to patients. 4. Requesting more frequent pharmacy consults for the patients.

Correct Answer: 3 Discussing medications each time they are administered is an effective way to increase the amount of education provided. Medication education is considered to be a responsibility of the nurse, not the physician or pharmacist. Educational pamphlets can be effective, but are not as effective as the nurse providing education to the patient.

The nurse has several educational pamphlets for the patient about medications the patient is receiving. Prior to giving the patient these pamphlets, what is a primary assessment for the nurse? 1. Assess the patients readiness to learn new information. 2. Assess the patients religious attitudes toward medicine. 3. Assess the patients reading level. 4. Assess the patients cultural bias toward taking medicine.

Correct Answer: 3 Educational pamphlets are ineffective if the reading level is above what the patient can understand. Assessing the patients readiness to learn, cultural bias, and religious attitudes are important, but not as important as the patients reading level.

The patient is having chest pain. The physician orders sublingual nitroglycerine STAT. The nurse obtains the medication from the pharmacy and administers it to the patient 30 minutes later. Which statement best describes the nurses action? 1. The medication should have been administered immediately. 2. The physician should have specified the time frame for the medication. 3. The medication should have been administered within a 5-minute time frame. 4. The nursing action was correct because the medication was not on the unit.

Correct Answer: 3 For a STAT order, the time frame between writing the order and administering the drug should be 5 minutes or less. Not having a drug on the unit is not an excuse, as commonly ordered STAT medications should be kept in stock. Although the drug does not need to be administered immediately, it should be done within 5 minutes. It is not the physicians responsibility to specify the time frame.

The patient receives morphine for pain. Which comment by the patient does the nurse assess to be a side effect of morphine? 1. My ears are constantly ringing. 2. My heart feels like it is skipping beats. 3. I feel like I am going to throw up. 4. I feel cold shivers all over.

Correct Answer: 3 Nausea is a common side effect of morphine. Feeling cold shivers is not associated with morphine. Ringing ears are not associated with morphine. Heart palpitations are not associated with morphine.

The nurse administers an oral preparation of liquid Tylenol 650 mg as ordered. Afterward, the patient indicates he had been receiving Tylenol 650 mg in pill form. Which of the following is accurate in regards to the five rights? 1. The nurse failed to deliver the correct dose. 2. The nurse failed to administer the right medication. 3. The nurse did not violate the five rights. 4. The nurse failed to give the medication via the correct route.

Correct Answer: 3 Nothing in the question depicts a violation of the five rights.

Identify the correct statement regarding opioid receptors. 1. The sigma and kappa receptors are of greatest concern from a pharmacologic standpoint. 2. Drugs that block opioid receptors inhibit the pain impulse. 3. Opioid agonists will activate mu and kappa receptors, producing analgesia. 4. Opioids exert their actions by interacting with a total of four receptors.

Correct Answer: 3 Opioid agonists stimulate mu and kappa receptors, resulting in a variety of effects, including analgesia. There are at least six types of receptors. The mu and kappa receptors are of greatest concern from a pharmacologic standpoint. Drugs that block opioid receptors are called opioid antagonists, and do not inhibit the pain impulse.

The patient is 3 days postop, and the physician orders an oral pain medication. The patient asks the nurse if it wouldn't be better to get the medication in the intravenous (IV) line. What is the best response by the nurse? 1. No, because you could not medicate yourself intravenously (IV) at home. 2. No, because pills are more effective than intravenous (IV) medications. 3. No, because pills are safer than intravenous (IV) medications. 4. No, because we are going to take your intravenous (IV) line out.

Correct Answer: 3 Oral medications are safer than intravenous (IV) medications. Telling the patient that she cannot have the medication intravenously because the intravenous line is to be removed does not answer the patients question. There is no evidence that the patient will be going home with an intravenous line, so this answer is incorrect. Oral medications are not more effective than IV medications.

Enzymatic activity that changes a medication into a less active form is an example of 1. pharmacodynamics. 2. active transport. 3. pharmacokinetics. 4. diffusion.

Correct Answer: 3 Pharmacokinetics describes how drugs are handled within the body. Pharmacodynamics involves how drugs change the body. Diffusion is the movement of a chemical from an area of higher concentration to an area of lower concentration. Active transport is the movement of a chemical against concentration or gradient

Which of the following are the four categories of pharmacokinetics? 1. Diffusion, active transport, interspersing, and storage 2. Ingestion, metabolism, interspersing, and excretion 3. Absorption, distribution, metabolism, and excretion 4. Ingestion, settling, movement, and storage

Correct Answer: 3 The four categories of pharmacokinetics are absorption, distribution, metabolism, and excretion.

The physician ordered an intravenous medication for a patient with nausea. The patient asks the nurse how it will help his nausea. What is the best response by the nurse? 1. We have more intravenous drugs for nausea than we do oral drugs. 2. If you take an oral medication, you will just vomit it up. 3. This will work much faster for your nausea. 4. You cant have anything by mouth, so will receive the medication intravenously.

Correct Answer: 3 The intravenous route provides the quickest route of medication absorption. Telling the patient that he will vomit the medication is non-therapeutic. Telling the patient that the nurse has more intravenous drugs than oral drugs does not answer the patients question. There is no evidence that the patient cannot have anything by mouth.

The physician has prescribed a chemotherapeutic drug for the patient with cancer. This drug commonly causes loss of hair. The patient asks the nurse, Will all of my hair fall out? What is the most therapeutic response by the nurse? 1. We are not really sure; applying an ice bag to your head may help. 2. Dont worry, we can recommend an excellent wig company if need be. 3. Yes, that is one of the expected side effects of this medication. 4. It might. Have you discussed this with your physician?

Correct Answer: 3 The nurse must always be forthright in explaining drug actions and potential side effects; minimizing potential adverse effects can result in a distrust of the nurse. Ice bags can minimize hair loss with some patients, but the nurse is not honestly answering the patients question. Telling a patient not to worry is one of the most non-therapeutic responses a nurse can make. In this case, the nurse, not the physician, is responsible for answering the patients questions.

The nurse is caring for an adolescent with depression and suicidal thoughts. The nursing diagnosis is Risk for Suicide related to depression. What is the best outcome for this adolescent? 1. The patient will discuss his feelings in group therapy today. 2. The patient will list five reasons why he should not harm himself today. 3. The patient will not commit any acts of self-harm today. 4. The patient will take the antidepressant medication as prescribed today.

Correct Answer: 3 The patient not committing any acts of self-harm relates to the problem statement in the nursing diagnosis and is measurable. Listing five reasons why the patient should not harm himself will not prevent him from committing an act of self-harm. Taking antidepressant medication will not prevent the patient from committing an act of self-harm. Discussion of feelings will not prevent the patient from committing an act of self-harm.

The physician ordered an oral medication. The nurse incorrectly administered the medication intravenously. What does the best analysis of the nurses action reveal? 1. An antidote cannot be given. 2. The nurse will be terminated from her job. 3. The medication cannot be retrieved. 4. A lawsuit by the patient will be impending.

Correct Answer: 3 When a medication is given intravenously, its effects cannot be reversed because it is already in the bloodstream. A lawsuit may occur, but this is not the primary concern; patient safety is the primary concern. The nurse may be terminated, but patient safety is the main concern, and the effect of the medication cannot be reversed. Antidotes may be given, but this must be done very quickly.

The client has experienced a sports-related injury. He asks the nurse how long it will take for him to heal and feel better. What is the best response by the nurse? 1. With proper care, it will take about a month for symptoms to resolve. 2. It will depend on your response to the medications. 3. It will take about a week and a half for symptoms to resolve. 4. The inflammatory process is too complex to predict a time frame for healing.

Correct Answer: 3 - A month is longer than it takes for acute symptoms to resolve. - Medications will relieve some symptoms, but the time frame for repair to begin is the same. - During acute inflammation, 8 to 10 days are normally needed for the symptoms to resolve and repair to begin - The inflammatory process is complex, but the time frame is still 8 to 10 days.

The nurse in the emergency department frequently sees clients who have overdosed on acetaminophen (Tylenol). Which client is at highest risk for developing hemolysis? 1. A Native American client 2. A Jewish client 3. An African American client 4. A Caucasian client

Correct Answer: 3 - African Americans have higher rates of G6PD enzyme deficiency. Clients with this deficiency are at risk for developing hemolysis after ingestion of certain drugs, including acetaminophen (Tylenol).

A client is placed on aspirin. A toxic reaction to this medication that the nurse will teach the client to report is 1. blurred vision. 2. muscle cramps. 3. tinnitus. 4. joint pain.

Correct Answer: 3 - Blurred vision is not a sign of toxicity. - Muscle cramps are not a sign of toxicity. - Tinnitus, or ringing in the ears, is a common early sign of aspirin toxicity. - Joint pain is not a sign of toxicity.

Which of the following is a common adverse effect of anti-inflammatory drugs, such as ibuprofen? 1. Diarrhea 2. Palpitations 3. Heartburn 4. Hypotension

Correct Answer: 3 - Diarrhea is not a common adverse effect. - Palpitations are not an adverse effect. - Heartburn and other GI upset are common adverse effects of these drugs. - Hypotension is not an adverse effect.

Which of the following is a sign of hypokalemia? 1. Constipation 2. Hypertension 3. Muscle weakness 4. Weight gain

Correct Answer: 3 - Diarrhea, not constipation, will occur. - Hypertension is usually not a sign of hypokalemia. - Muscle weakness can occur, since muscle fibers are very sensitive to changes in potassium - Weight gain is usually not a sign of hypokalemia.

The nurse plans care for the elderly client receiving nonsteroidal anti-inflammatory drug (NSAID) therapy. What is the best outcome for this client as it relates to side effects of nonsteroidal anti-inflammatory drugs (NSAIDs)? 1. The client will refrain from taking other medications with the nonsteroidal anti-inflammatory drug (NSAID). 2. The client will avoid the use of caffeine while taking the nonsteroidal anti-inflammatory drug (NSAID). 3. The client will report any bleeding or bruising while taking the nonsteroidal anti-inflammatory drug (NSAID). 4. The client will report any mood changes while taking the nonsteroidal anti-inflammatory drug (NSAID).

Correct Answer: 3 - Elderly clients are often on several medications, and refraining from taking them with nonsteroidal anti-inflammatory drugs (NSAIDs) is an unrealistic outcome. - There is no reason for avoiding use of caffeine while using a nonsteroidal anti-inflammatory drug (NSAID). - Elderly clients are at risk for increased bleeding with nonsteroidal anti-inflammatory drug (NSAID) therapy. - Mood changes are not a side effect of nonsteroidal anti-inflammatory drug (NSAID) therapy.

Intravenous therapy would be indicated if 1. hypertension were present. 2. fluid intake were greater than 2500 mL/day. 3. intake and output were deregulated. 4. constipation were present.

Correct Answer: 3 - Hypertension would not require IV therapy. - Fluid intake of 2500 mL/day is the average intake for adults. - Intake and output imbalance would require IV therapy to treat dehydration or shock and correct fluid imbalance. - Constipation might indicate lack of fluid, but would not require IV.

Which of the following is a common adverse effect of furosemide (Lasix)? 1. Weight gain 2. Bradycardia 3. Hypotension 4. Vomiting

Correct Answer: 3 - Loop diuretics can produce dehydration and electrolyte imbalances. Signs of dehydration include thirst, dry mouth, weight loss, and headache. Hypotension, dizziness, and fainting can result from the rapid fluid loss. - Tachycardia when dehydrated is the cardiac systems response to fluid loss. - Hypotension results from large amounts of fluid being excreted. - Vomiting is not a common adverse effect.

The primary functional unit of the kidney is the 1. loop of Henle. 2. Bowmans capsule. 3. nephron. 4. distal tubule.

Correct Answer: 3 - The loop of Henle filtrates. - The Bowmans capsule filters the blood. - The nephron is the functional unit which receives blood. - The distal tubule passes filtrate.

The nurse teaches a group of clients with arthritis about the use of ibuprofen (Motrin), emphasizing the maximum daily amount. The nurse evaluates that education has been most effective when the clients make which statement? 1. We cannot take over 4,000 mg/day. 2. We cannot take over 3,600 mg/day. 3. We cannot take over 3,200 mg/day. 4. We cannot take over 3,000 mg/day.

Correct Answer: 3 - The maximum amount of ibuprofen (Motrin) to be taken in 24 hours is 3,200 mg.

What is an important instruction for the nurse to give to the patient who is taking acetaminophen (Tylenol)? 1. Check your gums for bleeding when taking acetaminophen (Tylenol). 2. Do not take any narcotics with acetaminophen (Tylenol). 3. Do not drink alcohol with acetaminophen (Tylenol). 4. Do not take acetaminophen (Tylenol) on an empty stomach.

Correct Answer: 3 Acetaminophen (Tylenol) is toxic to the liver, and should not be taken by patients who will be consuming alcohol. Acetaminophen (Tylenol) can be taken with or without food. There is no contraindication between acetaminophen (Tylenol) and narcotics; they are often combined for more effective pain relief. Bleeding in the gums is an effect of aspirin, not acetaminophen (Tylenol).

Which of the following is a common adverse effect of cyclobenzaprine (Flexeril)? 1. Alopecia 2. Tongue swelling 3. Drowsiness 4. Hypotension

Correct Answer: 3 All centrally acting agents have the potential to cause sedation. Tongue swelling is serious, but rare. Tachycardia is possible, but would likely lead to hypertension, not hypotension. Alopecia is not an associated adverse effect.

The patient is scheduled to receive a medication that is an enzyme inducer of the P450 system. What best describes the effect of this medication on the patient? 1. In time, the patient will experience no effect from other medications. 2. In time, the patient will experience increased effects from other medications. 3. In time, the patient will experience a reduced effect from this medication. 4. In time, the patient will experience an increased effect from this medication.

Correct Answer: 3 An enzyme inducer will increase the rate of its own metabolism, thereby reducing its effectiveness. An enzyme inhibitor will result in an increased effect of this medication. An enzyme inhibitor will result in an increased effect from other medications. The patient will experience a reduced effect from other medications, not an absence of effect.

Which of the following statements correctly identifies factors that contribute to medication errors? 1. A nurse who observes the five rights will prevent all medication errors from occurring. 2. Nurses are always liable when a medication error occurs. 3. Handwritten orders are more frequently associated with medication errors than are typed orders. 4. An incorrect dose (based on weight) is ordered, dispensed, and administered to a patient. The administering nurse and ordering clinician would be the only parties held accountable.

Correct Answer: 3 Handwritten orders can be illegible, leading to higher medication error rates. Although the nurse is a major player in medication safety, there are instances when medication errors occur that do not involve the nurse, such as when patients take medications at home. Observing the five rights is essential to avoiding medication errors, but will not prevent all medication errors from occurring. The clinician ordering the medication, the nurse administering the medication, and the pharmacist dispensing the medication would be held accountable

Which statement regarding human DNA sequences is accurate? 1. Only 2% of human DNA is different among the different ethnicities. 2. Due to enzyme polymorphism, Hispanics are less likely to metabolize codeine to morphine. 3. Even though human genetic differences are small, significant differences can be seen with drug metabolism. 4. Asian Americans are the ethnic group known to be slow acetylators.

Correct Answer: 3 Human DNA differences of only 0.2% can produce significant differences in the way drugs are handled within the body. Asian Americans are less likely to metabolize codeine to morphine, and Caucasians are known to be slow acetylators.

Which of the following substances would have the lowest rate of crossing renal tubular membranes, and would therefore be excreted in the urine? 1. Lipid-soluble drugs 2. Water 3. Ionized drugs 4. Non-ionized drugs

Correct Answer: 3 Ionized and water-soluble drugs are less likely to cross renal tubular walls, and will therefore be excreted.

Which statement regarding medication distribution within the body is accurate? 1. The bloodbrain barrier inhibits rapid crossing of all medications. 2. Body organs with high levels of blood flow are more difficult organs to which to deliver drugs. 3. Medications that are lipid-soluble are more completely distributed. 4. Drugprotein complexes must form prior to crossing capillary membranes.

Correct Answer: 3 Lipid-soluble medications are absorbed and distributed quicker and more quickly than those that are not. Body organs with low levels of blood flow are more difficult organs to which to deliver drugs. When medications bind to proteins, their size increases, preventing them from passing through capillary membranes. Some medications (sedatives) are able to rapidly cross the bloodbrain barrier.

The physician ordered a loading dose of medication for the patient; it is to be followed by a lower dose. When the patient receives the lower dose, she says to the nurse, I think my doctor made a mistake; my medication dose is too low. What is the best response by the nurse? 1. The initial dose shortened the half-life, so the medication would work more quickly. 2. We always give medications this way; the doctor did not make a mistake. 3. You had a larger dose initially so that the medication would work more quickly. 4. Giving a larger dose initially will reduce the chance of side effects.

Correct Answer: 3 Loading doses of medications are used to quickly induce a therapeutic response. Loading doses do not shorten the half-life of a drug. Not all medications are initiated with a loading dose. Loading doses do not reduce the occurrence of side effects.

The nursing mother asks the nurse if it is all right to take St. Johns wort for mild depression. What is the best response by the nurse? 1. No, it will probably cause your baby to have more allergies. 2. No, because it might decrease the amount of milk you produce. 3. No, it could be excreted in your milk and affect the baby. 4. No, it will affect the taste of your milk, and your baby might reject nursing.

Correct Answer: 3 Many drugs are excreted in breast milk and can affect the nursing infant. Taking St. Johns wort is not likely to cause the baby to have more allergies. Taking St. Johns wort is not likely to decrease the amount of milk the mother produces. Taking St. Johns wort may affect the taste of the mothers milk, but this is not the most important response.

Which of the following lists of treatment options would be considered optimal for treating a muscle spasm with an unknown cause? 1. Anti-inflammatory agents, casting, and ultrasound 2. Analgesics, antibiotics, and heat application 3. Analgesics, muscle relaxants, and massage 4. Anti-inflammatory agents, immobilization, and fluid and electrolyte replacement

Correct Answer: 3 Muscle spasms can be treated with a variety of pharmacologic and non-pharmacologic methods. When the cause is unknown, a more general approach is indicated, such as analgesics, muscle relaxants, and massage. Antibiotics and casting are not indicated for muscle spasms. Fluid and electrolyte replacement can be indicated, if determined to be the cause.

The nurse will administer medication to a school-age child. What is the preferred action by the nurse? 1. Teach the child the action and expected side effects of the medication. 2. Tell the child he will not be allowed to go to recess if the medication is not taken. 3. Offer the child a choice of beverage with which to take the medication. 4. Offer to play with the child prior to medication administration.

Correct Answer: 3 Offering the child a choice fosters cooperation and compliance. Playing with the child is a preschool child activity. Teaching the child the action and expected side effects of the medication is too advanced for the school-age child. Threatening a school-age child will antagonize him; he will most likely not take the medication.

The public health nurse notices that several patients in the hypertension clinic have poorly controlled hypertension, even though they have been prescribed appropriate antihypertensive drugs. Which question will best enable the nurse to assess these patients? 1. Does your religion allow the use of high blood pressure medication? 2. Do you think your high blood pressure is a problem? 3. Can you afford the high blood pressure medication? 4. Does your culture use herbs to treat high blood pressure?

Correct Answer: 3 Once treatment is rendered, the cost of prescription drugs may be far too high for patients on limited incomes. The use of herbs may be important in the patients culture, but the cost of the medication is more likely the problem. To ask a patient if they think hypertension is a problem should not be necessary; the nurse could eliminate this by appropriate medication education when the medication is prescribed for the patient. Religious beliefs could result in the patient not taking the medication, but the cost of the medication is more likely the problem.

Which statement about the nursing process is accurate? 1. Generally, goals are more measurable than outcomes. 2. Goals involve very specific criteria that evaluate interventions. 3. Obtaining the outcomes is essential for goal attainment. 4. After selecting the nursing diagnosis, interventions are completed.

Correct Answer: 3 Outcomes are specific, measurable criteria that are used to measure goal attainment. The planning phase (including outcomes and goals) follows nursing diagnosis. Goals are more general than specific.

The nurse recognizes that agency system checks are in place to decrease medication errors. Who commonly collaborates with the nurse on checking the accuracy of the medication prior to administration? 1. The nursing supervisor 2. The nursing unit manager 3. The pharmacist 4. The physician

Correct Answer: 3 Pharmacists and nurses must collaborate on checking the accuracy and appropriateness of drug orders prior to patient administration. The physician does not commonly collaborate with the nurse on checking the accuracy of the medication prior to administration. The nursing unit manager does not commonly collaborate with the nurse on checking the accuracy of the medication prior to administration. The nursing supervisor does not commonly collaborate with the nurse on checking the accuracy of the medication prior to administration.

The patient is receiving hydrochlorothiazide (HCTZ). The patient asks the nurse what the best fluid to drink to avoid dehydration is. What is the best response by the nurse? 1. Iced teas, especially the green teas. 2. Any kind of fluid is okay, but avoid alcohol. 3. Plain water is really the best. 4. Electrolyte-replacement drinks like Gatorade

Correct Answer: 3 Plain water is the best fluid for the patient to consume while receiving diuretic therapy. Electrolyte-replacement drinks like Gatorade are not as good as plain water in avoiding dehydration. Iced teas, especially the green teas, are not as good as plain water in avoiding dehydration. Plain water is the best fluid for the patient to drink to avoid dehydration.

Drug X has a median lethal dose of 30 mg and a median effective dose of 10. Drug Y has a therapeutic index of 4, while drug Z has a therapeutic index of 3. Which statement is accurate based on this information? 1. Drugs X and Y are safer than drug Z. 2. The therapeutic index of drug X is 20. 3. Drug Y is the safest of the three. 4. Drug Z is the safest of the three.

Correct Answer: 3 Rationale 1: Drug Y is the safest.

The patient receives morphine for pain. He asks the nurse how it works to relieve pain. What is the best response by the nurse? 1. It inhibits the primary pain neurotransmitters in your brain. 2. It stimulates the receptors that secrete endorphins in your brain. 3. It stimulates a receptor in your brain that induces pleasure. 4. It promotes the primary pleasure neurotransmitters in your brain.

Correct Answer: 3 Rationale 1: Opioids exert their actions by interacting with the mu and kappa receptors in the brain. Drugs that stimulate these receptors are opioid agonists. Opioids do not promote release of the pleasurable neurotransmitters. Opioids do not promote secretion of endorphins. Opioids do not inhibit neurotransmitters responsible for pain.

Which organ is the most responsible for the first-pass effect? 1. Bladder 2. Kidneys 3. Liver 4. Stomach

Correct Answer: 3 The first pass effect occurs in the liver.

The physician orders enteric-coated aspirin, 300 mg every day, for the patient with a nasogastric tube. What is the priority action by the nurse? 1. Crush the tablet, dissolve it in 30 mL of water, and administer through the tube. 2. Put the tablet in the tube, milk it down the tube, and then flush the tube with 60 mL of water. 3. Withhold the medication and contact the physician. 4. Substitute plain aspirin, dissolve it in 30 mL of water, and administer through the tube.

Correct Answer: 3 The only option is to withhold the medication and contact the physician. Crushing the tablet destroys the enteric coating. Putting the tablet in the tube will result in clogging of the tube. The nurse cannot substitute plain aspirin; this requires a physicians order.

Which of the following correctly identifies and orders the primary steps of the nursing process? 1. Establish nursing diagnosis, assessment, intervene, collaborate, evaluation 2. Establish goals, assessment, intervention, planning, communication 3. Assessment, establish nursing diagnosis, planning, interventions, evaluation 4. Assessment, planning, establish objectives, communication, evaluation

Correct Answer: 3 The primary steps (in order) include assessment, establish nursing diagnosis, planning, interventions, evaluation. Although some steps might not be in this precise order, assessment is done first. The establishment of goals and objectives is generally considered part of planning. Communication is important, but is not a primary step of the nursing process.

The nurse is on a committee to reduce medication errors in a large health care facility. What is a recommendation the nurse proposes that will most likely help to reduce medication errors? 1. Train medication technicians to administer medications. 2. Use robots to prepare all medications for administration by the nurse. 3. Use automated, computerized cabinets on all nursing units. 4. Designate nurses whose only function is to administer medication.

Correct Answer: 3 To help reduce medication errors, many health care agencies are using automated, computerized, locked cabinets for medication storage on patient-care units. Health care agencies are not planning to designate nurses who just do medication administration. Health care agencies are not planning to have medication technicians administer medications. Health care agencies are not planning to have robots prepare all medications for administration by the nurse.

A patient is diagnosed with cancer. The physician has recommended chemotherapy, which would likely save the patients life. The patient tells the nurse, This is punishment from God for sins I have committed; some women at my church say so. What will the best plan of the nurse include? 1. With the patients permission, plan to involve a hospital minister to discuss the patients perspective about cancer. 2. With the patients permission, plan to bring the case before the hospitals board of ethics. 3. With the patients permission, plan to contact the patients minister to discuss the patients perspective about cancer. 4. With the patients permission, plan to meet with family members to discuss the patients perspective about cancer.

Correct Answer: 3 When patients have strong religious beliefs, these can affect the outcome of the illness. The nurse should involve the patients religious leader when possible. Meeting with family might help; however, they may have the same perspective as the patient. Bringing the case before the hospitals board of ethics is premature at this point. Involving a hospital minister may be an option, but it is best to work through the patients minister initially.

Several patients have been seen in the acute-care clinic. The nurse will plan to administer diuretic therapy to which patients? Select all that apply. 1. The patient experiencing visual and auditory hallucinations 2. The patient with confusion and ataxia 3. The patient with a blood pressure of 200/98 mmHg 4. The patient with generalized edema and decreased urine output 5. The patient with pinpoint pupils and extreme paranoia

Correct Answer: 3,4 Diuretics are indicated for the treatment of renal failure, hypertension, and for the removal of edema fluid. Confusion and ataxia could be the result of non-renal pathology; there is no evidence of fluid overload or hypertension here. Visual and auditory hallucinations could be the result of non-renal pathology; there is no evidence of fluid overload or hypertension here. Pinpoint pupils and extreme paranoia could be the result of non-renal pathology; there is no evidence of fluid overload or hypertension here.

The nurse cares for a patient in the critical care setting who was severely burned. The wife of the patient asks the nurse, Why does he need those intravenous infusions (IVs)? What is (are) the best response(s) by the nurse that indicates the primary reason for intravenous infusions (IVs) with a burned patient? Select all that apply. 1. So we have an open line for resuscitation in case his heart stops. 2. So he can receive his antibiotics. 3. So we can keep his blood pressure stable. 4. So we can be sure he keeps enough blood volume. 5. So we can rapidly administer his pain medications.

Correct Answer: 3,4 Net loss of fluids from the body can result in dehydration and shock. Intravenous (IV) fluid therapy is used to maintain blood volume and support blood pressure. Antibiotic therapy is not a primary reason for intravenous (IV) fluid replacement. Cardiac resuscitation is not a primary reason for intravenous (IV) fluid replacement. Administration of analgesics is not a primary reason for intravenous (IV) fluid replacement.

The clinic nurse will immediately alert the health care provider when which category X drugs are identified on a recently diagnosed pregnant patient? Select all that apply. 1. Tetracycline 2. ACE inhibitor antihypertensive medication 3. Methotrexate 4. Isotretinoin (Accutane) 5. Oral contraceptives

Correct Answer: 3,4,5 - Tetracycline is in category D, not category X. It should be avoided during pregnancy, and the nurse should alert the health care provider. - ACE inhibitor antihypertensive drugs are in category C and are considered safe during pregnancy. - Methotrexate is in category X and should be avoided during pregnancy. - Isotretinoin is in category X and should be avoided during pregnancy. - Oral contraceptives are in category X and should be avoided during pregnancy.

The patient is complaining of a severe headache. The physician orders aspirin. Which action by the nurse will result in the fastest relief of the patients headache? 1. Administer the aspirin with an alkaline food, like cottage cheese. 2. Administer the aspirin in an enteric-coated formulation. 3. Administer the aspirin with a high-fat food, like peanut butter. 4. Administer the aspirin on an empty stomach.

Correct Answer: 4 Acids such as aspirin are best absorbed in the acidic environment of the stomach, so the aspirin should be administered on an empty stomach. Administering the aspirin in an enteric-coated formulation will lessen gastrointestinal irritation, but will increase the time for the drugs effect. Peanut butter and cottage cheese will slow absorption and increase the time for the drugs effect.

The nurse is providing group education about warfarin (Coumadin) to minority patients who have experienced strokes (brain attacks). The nurse determines that learning has occurred when the patients make which statement? 1. We may need to have more frequent blood tests. 2. We may need to have less frequent blood tests. 3. We may need more medication than other ethnic groups. 4. We may need less medication than other ethnic groups.

Correct Answer: 4 Asian and African American patients are poor metabolizers of warfarin (Coumadin), so they will often require lower dosages. There is no need for Asian and African American patients to have more frequent blood tests than Caucasian patients.

The nurse plans to teach a group of patients about how their medications work in their bodies. If education has been successful, what will be the best understanding of the patients? 1. Medications change the function of the cells in the body. 2. Medications help the body produce new enzymes. 3. Medications change how body tissues function. 4. Medications work by enhancing or blocking normal body functioning.

Correct Answer: 4 Medications work by enhancing or blocking normal body functioning. Medications cannot help the body produce new enzymes, or change the function of the cells or tissues of the body.

Which statement is accurate concerning the management of migraine headaches? 1. Acute treatment and prevention are achieved via the same medications. 2. There are no pharmacologic agents available to prevent migraine headaches. 3. Chronic headache pain is managed via daily NSAID use. 4. Vasoconstriction of cranial arteries helps reduce acute headache pain.

Correct Answer: 4 Migraine headaches are thought to occur from an initial vasoconstrictive episode that is followed by vasodilation and acute pain. Acute episodes are treated with cranial artery vasoconstrictors and prevention via vasodilators.

A patient who recently returned from surgery is experiencing nausea. Which statement best explains why this patient would benefit from IV medication administration? 1. The IV is already in place following the surgery. 2. IV medication administration should be avoided in patients with nausea. 3. Medications are more effective when given IV. 4. IV medications bypass the need for GI absorption.

Correct Answer: 4 Nauseated patients might find medications that need to be absorbed through the GI system irritating, worsening their nausea. The presence of an existing IV line is not a reason to administer medications through it. Some medications are more effective when given IV, but bypassing the need for GI absorption is the better answer.

The patient has intractable pain, and the physician has proposed a nerve block. The nurse plans to teach the patient about nerve blocks. Which statement would be included in the best plan of the nurse? 1. A nerve block depresses the activity of the sympathetic nervous system. 2. A nerve block enhances the effect of most of the endogenous opioids. 3. A nerve block modifies sensory information being sent to the spinal cord. 4. A nerve block stops pain transmission along the nerve to stop the pain.

Correct Answer: 4 Nerve blocks are accomplished by injection of alcohol or another neurotoxic substance into neurons. This blocks nerve transmission and has the potential to provide total pain relief. A nerve block does not enhance the effect of endogenous opioids. A nerve block does not modify sensory information sent to the spinal cord. A nerve block does not depress the activity of the sympathetic nervous system.

The home health nurse notes that the elderly patient doubled up on his pain medication, even though the prescribed dose was at a therapeutic level. The patient says, If one pill is good, two pills are better. Which statement best describes the result of the patients action? 1. The patient develops tolerance and does not experience any difference. 2. The patient experiences more pain relief from the additional dose. 3. The patient develops tolerance and will need increased doses of the drug. 4. The patient exhibits side effects from the additional dose.

Correct Answer: 4 Once the plateau of a drug has been reached, increasing the dose may produce adverse effects. Once the plateau of a drug has been reached, increased doses will not provide added therapeutic benefit, such as more pain relief. Tolerance may occur, but is not the primary issue here.

The patient comes to the emergency department with a head injury, broken ribs, and internal bleeding. Opioid analgesics are contraindicated. What does the nurse recognize as the primary rationale for this? 1. The use of opioid analgesics will depress the patients blood pressure. 2. The patient may not be able to communicate his level of pain. 3. Opioids will not effectively relieve pain in the patients periphery. 4. Opioids can mask changes in the patients level of consciousness.

Correct Answer: 4 Opioids are central nervous system (CNS) depressants and can mask the patients level of consciousness; this is dangerous when the patient has a head injury. Depression of blood pressure could occur, but this is not as critical as level of consciousness. The patient may not be able to determine his level of pain, but this is not as critical as level of consciousness. Opioids do not effectively relieve pain in the patients periphery, but this is not as critical as level of consciousness.

What is the best plan as the nurse prepares to administer a topical medication? 1. Check the medication for interactions with other medications. 2. Take the patients vital signs. 3. Educate the patient to not disturb the patch. 4. Assess the patients skin where the medication will be applied.

Correct Answer: 4 Planning to assess the patients skin is imperative; if it is cracked, dry, or irritated, the medication may not be properly absorbed. Patient education is important, but is not the priority. Vital signs are not always indicated; it depends on the medication. Checking for drug interactions is important, but it is not the priority.

The nurse is instructing a patient on the importance of eating foods rich in potassium while taking a diuretic that causes hypokalemia. Which diuretics do not require potassium supplements? Select all that apply. 1. Furosemide (Lasix) 2. Chlorothiazide (Diuril) 3. Amiloride (Midamor) 4. Spironolactone (Aldactone)

Correct Answer: 4 Spironolactone (Aldactone) is a potassium-sparing diuretic. Patients on this medication are not required to eat foods high in potassium or take a potassium supplemen

Which stage of fetal development poses the greatest risk to the fetus related to medication administration? 1. Each stage is equal in risk. 2. Pre-implantation period 3. Third trimester 4. Embryonic

Correct Answer: 4 The embryonic phase poses the greatest risk to fetal development.

The nursing instructor prepares to teach student nurses about how mean effective doses of medications are related to clinical practice. As a result of the instruction, what is the best understanding of the student nurses? 1. About 50% of patients will experience severe side effects from the drug. 2. Some patients will respond differently depending on their ethnic background. 3. About 50% of patients will not experience any effect from the drug. 4. Some patients will require more or less than the average dose of the drug.

Correct Answer: 4 The mean effective dose predicts how 50% of the population will respond to the average dose of the drug. Some patients will require more or less of the drug. The mean effective dose is not related to ethnicity. The mean effective dose does not predict how many patients will experience severe side effects from the drug. The mean effective dose does not predict that 50% of patients will not experience any effect of the drug.

A mother calls the clinic and tells the nurse that her 4-month-old baby has a fever. The mother asks if she can use the liquid acetaminophen (Tylenol) that is used for her 10-year-old child. What is the best response by the nurse? 1. Infants should not have acetaminophen (Tylenol) because it damages the liver. 2. It is best if the pediatrician is called; he can be asked this question. 3. It is fine to use the same medicine for both children. 4. Infant drops should be used for the baby; they are different from liquid medicine.

Correct Answer: 4 - Acetaminophen (Tylenol) is the preferred antipyretic drug for infants and children. - The nurse can answer the mothers question; it is not necessary to refer to the pediatrician. - It is not fine to use the same medicine for both children because the concentration of medication is different. - Infant drops should be used for the baby; they have a different concentration of medication than the liquid preparations.

Which of the following signs are common with hypocalcemia? 1. Bruising 2. Hypertension 3. Muscle wasting 4. Muscle spasms

Correct Answer: 4 - Bruising is not a sign of hypocalcemia. - Hypertension is not a sign of hypocalcemia. - Muscle wasting is not a sign of hypocalcemia. - Signs and symptoms of hypocalcemia are nerve and muscle excitability. Muscle spasms, tremors, or cramping can be evident. Numbness and tingling of the extremities can occur, and convulsions are possible.

The diuretic drug that will most likely be used to reduce mortality in heart failure is 1. chlorothiazide (Diuril). 2. acetazolamide (Diamox). 3. furosemide (Lasix). 4. spironolactone (Aldactone).

Correct Answer: 4 - Chlorothiazide is a thiazide diuretic used primarily for hypertension. - Acetazolamide is a carbonic anhydrase inhibitor used primarily for patients with glaucoma. - Furosemide is used for hypertension and reduction of edema. - Spironolactone is used to reduce mortality in heart failure patients.

The client has osteomalacia and the physician has ordered a treatment to restore calcium balance. What will the nurse plan to administer to the client? 1. Calcium supplements and dark green, leafy vegetables 2. Calcium supplements and milk products 3. Calcium supplements and potassium 4. Calcium supplements and vitamin D

Correct Answer: 4 - Dark green, leafy vegetables are not the best of the sources of calcium listed. - Calcium supplements and milk products are good choices, but the client must also have vitamin D. - Potassium is not necessary with this illness. - Calcium supplements and vitamin D are considered the most effective treatments for osteomalacia.

The client receives methotrexate (Rheumatrex). The nurse assesses for side effects of this drug. Which side effects are a primary concern for the nurse? 1. Hyperglycemia and fatigue 2. Nausea and vomiting 3. Hypertension and seizures 4. Ulcerative stomatitis and diarrhea

Correct Answer: 4 - Hyperglycemia is not an adverse effect of methotrexate. - Nausea and vomiting are expected adverse effects and are not of primary concern. - Hypertension and seizures are not adverse effects of this drug. - Ulcerative stomatitis and diarrhea require suspension of therapy because they may lead to hemorrhagic enteritis and death from intestinal perforation.

Potential causes for respiratory alkalosis include 1. hypotension. 2. hypertension. 3. hypoventilation. 4. hyperventilation.

Correct Answer: 4 - Hypotension is unrelated. - Hypertension is unrelated. - Hypoventilation is associated with respiratory acidosis. - Hyperventilation occurs with respiratory alkalosis.

The nurse plans to administer medication to the preschool child. Which approach indicates the nurse has an understanding of growth and development? 1. The child is often more cooperative if the parent is not in the room. 2. The child does better with verbal instruction than with play instruction. 3. There should be no need to restrain a child of this age. 4. Use a brief rationale, followed by quick administration of the medication.

Correct Answer: 4 A brief rationale, followed by quick administration, decreases the childs anxiety and promotes cooperation with the medication process. It may be necessary to restrain a preschool child for medication administration. Having a parent in the room usually promotes more cooperation from the preschool child. Preschool children do better with play instruction.

The nurse provides care for several patients. For which patient would the nurse assess acetaminophen (Tylenol) to be contraindicated? 1. A 2-year-old with a high fever due to the flu 2. A 65-year-old with osteoarthritis 3. A 19-year-old with a bladder infection 4. A 55-year old who socially drinks alcohol

Correct Answer: 4 Acetaminophen (Tylenol) is hepatotoxic, and may cause problems in patients who consume alcohol. Acetaminophen (Tylenol) would be the drug of choice for a child with the flu. Acetaminophen (Tylenol) would not be contraindicated with osteoarthritis, but aspirin would be more effective. There isnt any association between the use of acetaminophen (Tylenol) and a bladder infection.

At a dose of 10 mg, drug X lowers total cholesterol by 50 mg/dL, while a maximum drop in cholesterol of 65mg/dL is achieved at 40 mg. At a dose of 5 mg, drug Y lowers cholesterol by 50 mg/dL, while a maximum drop in cholesterol of 55 mg/dL is achieved at 10 mg. What can be concluded about the efficacy and potency of these two drugs? 1. Drug X is more potent, and drug Y has a higher efficacy. 2. Drug X is more potent, and has higher efficacy. 3. Drug Y is more potent, and has higher efficacy. 4. Drug Y is more potent, and drug X has a higher efficacy.

Correct Answer: 4 Drug Y causes a greater drop in cholesterol at lower doses (higher potency), whereas drug X causes the highest drop in total cholesterol (efficacy).

Prior to administering medications, the student nurse reviews the therapeutic index. Which statement best describes the students understanding of therapeutic index? 1. The student is able to determine if the physician prescribed the best drug for the patient. 2. The student is able to determine if the patients are receiving safe doses of the medications. 3. The student is able to identify interactions among the drugs each patient is receiving. 4. The student is able to identify the patients who will need to have serum blood levels monitored.

Correct Answer: 4 Drugs with a narrow therapeutic index have a low safety margin and the concentration of the drug should be monitored by regular serum tests. The therapeutic index will give some information about safe doses, but this is not the most complete response. The therapeutic index will not help to determine if the physician prescribed the best drug for the patient. The therapeutic index will not help to identify interactions among the drugs the patients receive.

The nurse is conducting medication education for patients with hypertension. The focus of the education is on enhancing the absorption of their medications. The nurse determines that learning has occurred when the patients make which statement? 1. We can safely take the drug for at least 6 months beyond the expiration date. 2. We dont need to worry about storage of the drug, it wont lose potency. 3. We should not take our medications with milk or dairy products. 4. We need to be careful about taking the medication with certain foods.

Correct Answer: 4 Food can alter the absorption of many medications. Storage can affect the medications strength and may affect how it responds in the body. There are many more foods that will alter the absorption of medications other than milk and dairy products. Patients should be taught to avoid taking medications beyond the expiration date.

The patient has a patient-controlled analgesia (PCA) pump following surgery. The nurse keeps naloxone (Narcan) in the patients room as per protocol. What does the nurse recognize as the rationale for this protocol? 1. Naloxone (Narcan) enhances the effect of the opioid in the patient-controlled analgesia (PCA) pump and increases analgesia. 2. Naloxone (Narcan) is the antidote if an anaphylactic reaction to the opioid in the patient-controlled analgesia (PCA) pump occurs. 3. Naloxone (Narcan) is available to treat any systemic side effects, like constipation, of the opioid in the patient-controlled analgesia (PCA) pump. 4. Naloxone (Narcan) will reverse the effects of the narcotic in the patient-controlled analgesia (PCA) pump if an overdose occurs.

Correct Answer: 4 Naloxone (Narcan) is an opioid antagonist, and will reverse the effects of the narcotic in the pump if an overdose occurs. Naloxone (Narcan) does not enhance the effects of opioids. Naloxone (Narcan) is not used to treat anaphylactic reactions. Naloxone (Narcan) is not used to treat opioid-related constipation.

The patient is from an Arab culture and is in labor and delivery. Her husband insists he must stay with her, and will not allow her to receive any analgesia during the experience. What is the best action by the nurse? 1. Inform the husband that it is his wifes choice whether or not to receive analgesia. 2. Inform the husband that he must sign a release of responsibility to avoid future litigation against the hospital. 3. Allow the request, but inform the husband that the physician will make the final decision about analgesia. 4. Allow this request, and be available in the event the request changes.

Correct Answer: 4 Nurses must allow and support cultural differences. The husbands decisions must be respected as long as patient safety is not involved, and it is not involved in this situation. With some cultures, the husband makes the choices, not the wife or the physician. When cultural differences are allowed and supported, patients are not as likely to become involved in litigation.

A drug that is known to cause birth defects is known as 1. category A. 2. category C. 3. cautionary. 4. teratogenic.

Correct Answer: 4 Rationale 1: Drugs that are known to cause birth defects are called teratogenic, or classified as category D or category X.

The nursing instructor teaches the nursing students about neural mechanisms of pain. What does the nursing instructor teach about substance P? 1. Substance P modifies sensory information in the spinal cord. 2. Substance P is also known as an endogenous opioid. 3. Substance P stimulates pain receptors in the spinal cord. 4. Substance P controls which pain signals reach the brain.

Correct Answer: 4 Rationale 1: Spinal substance P is critical because it controls whether pain signals will continue to the brain. Endogenous opioids, not substance P, modify sensory information at the level of the spinal cord. Substance P does not stimulate pain receptors in the spinal cord. Substance P is not an endogenous opioid.

Which of the following demonstrates ethical reporting of a medication error? 1. The nurse does not report the error, because the error was caught and corrected prior to drug administration. 2. The nurse does not report or document the error, since the error did not result in any harm to the patient. 3. The nurse reports the error to the physician and the charge nurse but does not document the error due to possible legal action. 4. The nurse informs the patient, documents the error as per hospital policy, and notifies the physician.

Correct Answer: 4 Rationale 1: The nurse should report and document all medication errors whether the patient was harmed or not. It is essential to report and document medication errors to identify possible system failures, even when the error is caught prior to administration or has potential for legal action.

Which statement is accurate regarding pharmacotherapy in the older adult? 1. Increased body water can lead to a higher risk of drug toxicity. 2. Plasma levels are increased, leading to a heightened drug response. 3. Generally, drug doses should be increased due to prolonged drug metabolism. 4. Drug absorption is slower due to increased gastric pH.

Correct Answer: 4 The elderly have an increase in gastric pH, which slows absorption. Plasma levels are lower, causing a diminished drug response. Body water is reduced, leading to a higher risk of drug toxicity. Generally, drug doses are reduced because of prolonged drug metabolism.

The student nurse has been reading about the Human Genome Project and asks the nursing instructor how this will impact future pharmacological therapies. What is the best response by the instructor? 1. We will be able to alter genes so we will not need drugs. 2. We will be able to standardize drug doses to make prescribing easier. 3. It will help prevent disease through gene manipulation, but will not impact drugs. 4. It will help to individualize drug therapy for people in a more effective way.

Correct Answer: 4 The goal of pharmacogenetics is to help individualize drug therapy for people in a more effective way. Altering genes to prevent illness is a possibility, but we will always need medications. Individuals will still respond differently to medications; not all drugs will have standardized doses. Medications will be very much impacted by this research.

What is a priority assessment question to ask a postsurgical patient prior to administration of an opioid analgesic? 1. Have you ever been addicted to prescription pain medications? 2. Why do you want to receive this pain medication? 3. Would you like me to help you change your position for comfort? 4. Would you please rate your pain on a scale of 0-to-10?

Correct Answer: 4 The nurse should always assess the patients level of pain prior to the administration of an analgesic. Asking a postsurgical patient why a pain medication is requested does not make a lot of sense. Administration of pain medication postsurgery is a priority; this is not the time to assess if the patient has an addiction. Offering to help a postsurgical patient change positions is appropriate, but should be done after the patient receives the pain medication.

The postsurgical patient has an order for morphine 2 mg IV push every 2 hours and propoxyphene 100 (Darvon 100) every 3 hours. He received the morphine 2 hours ago, and is complaining of pain again. What will the best plan of the nurse include? 1. Plan to administer the morphine again. 2. Plan to administer the propoxyphene 100 (Darvon 100). 3. Plan to have the patient do some distraction techniques. 4. Plan to assess the patients level of pain.

Correct Answer: 4 The patients level of pain should be assessed prior to the administration of any analgesic. The patients level of pain should be assessed prior to administration of propoxyphene (Darvon) 100. The patients level of pain should be assessed prior to administration of additional morphine. Distraction techniques are appropriate, but should not take the place of a pain assessment and administration of an analgesic.

The patient is started on a medication to treat a neuromuscular disorder. What does the nurse teach as the primary therapeutic goal of the medication? 1. To stop the patients muscle spasms 2. To improve the patients appearance 3. To promote exercise in the patient 4. To allow the patient increased independence

Correct Answer: 4 The therapeutic goals of pharmacotherapy include minimizing pain and discomfort, increasing range of motion, and improving the patients ability to function independently. Stopping muscle spasms can be achieved, but this is not the primary goal. Promoting exercise is not a goal. Improving the patients appearance is not a goal.

A dull, aching pain is defined as 1. nerve pain. 2. somatic. 3. neuropathic. 4. visceral.

Correct Answer: 4 Visceral pain is defined as a dull, throbbing, or aching pain.

The physician has ordered hydrochlorothiazide (HCTZ) for the patient in chronic renal failure. The nurse suspects the patient is experiencing an ineffective response to the medication. Which assessment is a priority for this patient? 1. Reviewing the lab work for hypokalemia and hyponatremia 2. Assessing the vital signs for hypertension 3. Assessing the skin for moisture and turgor 4. Auscultating breath sounds for wheezes

Correct Answer: 4 Wheezes are commonly auscultated with pulmonary edema, which can occur with chronic renal failure and fluid retention. This is a priority because pulmonary edema affects the patients oxygenation. Skin assessment is important, but is not the priority here. Vital sign assessment is important, but is not the priority here. Reviewing lab work is important, but is not the priority here.

The nurse is preparing medications for a group of patients. Another nurse begins telling the nurse about her recent engagement. What is the best action by the first nurse? 1. Ask the second nurse to help with administering medications so they can have more time to talk. 2. Continue to prepare the medications for administration and pretend to listen to the first nurse. 3. Stop preparing medications until the first nurse has finished talking about her engagement. 4. Tell the second nurse that the conversation is distracting and must cease while medications are being prepared.

Correct Answer: 4 When preparing medications, the nurse must focus entirely on the task at hand and instruct others who are talking to stop. It is inappropriate to ask another nurse to assist with medications so there is more time for the nurses to talk. The nurse cannot stop preparing medications; the patients must receive them on time. Pretending to listen to the second nurses conversation will also be distracting

The patient receives antibiotics for a serious infection. The patient asks the nurse, Why dont you just give me more of that drug to cure this infection faster? What is the best response by the nurse? 1. I will check with the doctor to see if it is time to increase the medication. 2. You are at a maximum dose; taking more will cause interactions with other medications. 3. You must stay on this drug for 2 more weeks before it can be increased. 4. You are at a maximum dose; taking more will not help.

Correct Answer: 4 When the plateau of a drug has been reached, administering more of the drug will not produce additional benefit. Once the plateau of a drug has been reached, there is no time frame for an increase in dosage because an increase in dosage will not produce a greater effect. Telling the patient the nurse will check with the physician is inappropriate because the plateau of the drug has been reached; the physician will not change the dosage. An increase in dosage may cause interactions with other medications, but this is not the best answer.