Nurselabs
The client is about to start the treatment for juvenile rheumatoid arthritis. Before the administration of etanercept (Enbrel), it is important for the nurse to: A. Ask for an allergy to latex. B. Ask the client to postpone a vacation trip abroad. C. Tell the client to not miss due vaccination while on treatment. D. To avoid people with a recent injection of etanercept.
A
A client with osteoporosis is asking the nurse regarding the use of Salmon calcitonin (Miacalcin) nasal spray. The nurse tells the client to do the following, except? A. Delivery system contains enough medication for at least 30 doses. Discard any unused solution after 30 doses. B. If you do not feel the spray while using it, repeat the dose on the other nostrils. C. Miacalcin is usually given as one spray per day into only one of your nostrils. D. Take extra vitamin D while you are using Miacalcin.
B
A contraindication for topical corticosteroid usage in a male patient with atopic dermatitis (eczema) is: A. Parasite infection. B. Viral infection. C. Bacterial infection. D. Spirochete infection.
B
A male patient is undergoing chemotherapy may also be given the drug allopurinol (Zyloprim, Aloprim). Allopurinol inhibits the synthesis of uric acid. Concomitant administration of allopurinol prevents: A. Myelosuppression. B. Gout and hyperuricemia. C. Pancytopenia. D. Cancer cell growth and replication.
B
A male patient needs a percutaneously inserted central catheter (PICC) for prolonged IV therapy. He knows it can be inserted without going to the operating room. He mentions that, "at least the doctor won't be wearing surgical garb, will he?" How will the nurse answer the patient? A. "You are correct. It is a minor procedure performed on the unit and does not necessitate surgical attire." B. "To decrease the risk of infection, the doctor inserting the PICC will wear a cap, mask, and sterile gown and gloves." C. "It depends on the doctor's preference." D. "Most doctors only wear sterile gloves, not a cap, mask, or sterile gown."
B
A month after receiving a blood transfusion an immunocompromised male patient develops a fever, liver abnormalities, a rash, and diarrhea. The nurse would suspect this patient has: A. An allergic response to a recent medication. B. Graft-versus-host disease (GVHD). C. Myelosuppression. D. Nothing related to the blood transfusion.
B
A nurse is caring for a client who is receiving cyclobenzaprine hydrochloride (Flexeril) for the treatment of muscle spasm. Which of the following medical conditions is contraindicated with the use of the medication? A. Diabetes Mellitus B. Angle-closure glaucoma C. Emphysema D. Urinary tract infection
B
Allopurinol (Zyloprim) is prescribed for a client for the treatment of gout. And the nurse is providing medication instructions. The nurse tells the client to? A. Take the medication on an empty stomach B. To limit the use of vitamin C C. A rash is a normal side effect of the medication D. The effect of the medication will happen immediately
B
Central venous access devices are beneficial in pediatric therapy because: A. They don't frighten children. B. Use of the arms is not restricted. C. They cannot be dislodged. D. They are difficult to see.
B
Colchicine is prescribed for a client with gout. The nurse reviews the client's record, knowing that this medication would be used in caution in which of the following medical conditions? A. Behcet disease B. Aplastic Anemia C. Amyloidosis D. Familial Mediterranean fever (FMF)
B
Gold salt toxicity can be reversed using which medication? A. Acetaminophen B. Dimercaprol C. Calcium salts D. Hydroxocobalamin
B
Methotrexate is a folate antagonist. It inhibits enzymes required for DNA base synthesis. To prevent harm to normal cells, a fully activated form of folic acid known as leucovorin (folinic acid; citrovorum factor) can be administered. Administration of leucovorin is known as: A. Induction therapy. B. Consolidation therapy. C. Pulse therapy. D. Rescue therapy.
B
Superficial bladder cancer can be treated by direct instillation of the antineoplastic antibiotic agent mitomycin (Mutamycin). This process is termed: A. Intraventricular administration. B. Intravesical administration. C. Intravascular administration. D. Intrathecal administration.
B
The most serious adverse effect of Alprostadil (Prostin VR pediatric injection) administration in neonates is: A. Bleeding tendencies. B. Apnea. C. Hypotension. D. Pyrexia.
B
The most serious adverse effect of tricyclic antidepressant (TCA) overdose is: A. Hyperpyrexia B. Cardiac arrhythmias C. Seizures D. Metabolic acidosis
B
The nurse is aware that the patients who are allergic to intravenous contrast media are usually also allergic to which of the following products? A. Eggs. B. Shellfish. C. Soy. D. Acidic fruits.
B
The nurse is reviewing the client's history who is about to take Methotrexate. Which of the following drugs can be safely administered together with methotrexate? A. Tetracycline B. Folic Acid C. Sulfamethoxazole D. Phenytoin
B
Walter, a teenage patient is admitted to the hospital because of acetaminophen (Tylenol) overdose. Overdoses of acetaminophen can precipitate life-threatening abnormalities in which of the following organs? A. Lungs B. Liver C. Kidney D. Adrenal Glands
B
What is the purpose of "Tunneling" (inserting the catheter 2-4 inches under the skin) when the surgeon inserts a Hickman central catheter device? A. Increases the patient's comfort level. B. Decreases the risk of infection. C. Prevents the patient's clothes from having contact with the catheter. D. Makes the catheter less visible to other people.
B
Which of the following adverse effects is specific to the biguanide diabetic drug metformin (Glucophage) therapy? A. Hypoglycemia B. Lactic acidosis C. GI distress D. Somnolence
B
A male patient is to receive a percutaneously inserted central catheter (PICC). He asks the nurse whether the insertion will hurt. How will the nurse reply? A. "You will have general anesthesia so you won't feel anything." B. "It will be inserted rapidly, and any discomfort is fleeting." C. "The insertion site will be anesthetized. Threading the catheter through the vein is not painful." D. "You will receive sedation prior to the procedure."
C
A nurse is analyzing the laboratory studies on a client receiving dantrolene sodium (Dantrium). Which of the following laboratory tests would identify an adverse effect associated with the use of the medication? A. Blood urea nitrogen B. Creatinine C. Liver function test D. Triglyceride
C
A nurse is providing instructions to a client receiving baclofen (Lioresal). Which of the following would be included in the teaching plan? A. Limit fluid intake. B. Hold the medication if diarrhea occurs. C. Restrict alcohol intake. D. Notify the physician if weakness occurs.
C
Alendronate (Fosamax) is given to a client with osteoporosis. The nurse advises the client to? A. Take the medication in the morning with meals. B. Take the medication before bedtime. C. Take the medication with a glass of water after rising in the morning. D. Take the medication during lunch.
C
An adult patient has been taking a drug (Drug A) that is highly metabolized by the cytochrome p-450 system. He has been on this medication for 6 months. At this time, he is started on a second medication (Drug B) that is an inducer of the cytochrome p-450 system. You should monitor this patient for: A. Increased therapeutic effects of Drug A. B. Increased adverse effects of Drug B. C. Decreased therapeutic effects of Drug A. D. Decreased therapeutic effects of Drug B.
C
An infection in a central venous access device is not eliminated by giving antibiotics through the catheter. How would bacterial glycocalyx contribute to this? A. It protects the bacteria from antibiotic and immunologic destruction. B. Glycocalyx neutralizes the antibiotic rendering it ineffective. C. It competes with the antibiotic for binding sites on the microbe. D. Glycocalyx provides nutrients for microbial growth.
C
Anticipatory nausea and vomiting associated with chemotherapy occurs: A. Within the first 24 hours after chemotherapy. B. 1-5 days after chemotherapy. C. Before chemotherapy administration. D. While chemotherapy is being administered.
C
Hormonal agents are used to treat some cancers. An example would be: A. Thyroxine to treat thyroid cancer. B. ACTH to treat adrenal carcinoma. C. Estrogen antagonists to treat breast cancer. D. Glucagon to treat pancreatic carcinoma.
C
How can central venous access devices (CVADs) be of value in a patient receiving chemotherapy who has stomatitis and severe diarrhea? A. The chemotherapy can be rapidly completed allowing the stomatitis and diarrhea to resolve. B. Crystalloid can be administered to prevent dehydration. C. Concentrated hyperalimentation fluid can be administered through the CVAD. D. The chemotherapy dose can be reduced.
C
In infants and children, the side effects of first-generation over-the-counter (OTC) antihistamines, such as diphenhydramine (Benadryl) and hydroxyzine (Atarax) include: A. Reye's syndrome B. Cholinergic effects C. Paradoxical CNS stimulation D. Nausea and diarrhea
C
Jonas comes into the local blood donation center. He says he is here to donate platelets only today. The nurse knows this process is called: A. Directed donation B. Autologous donation C. Apheresis D. Allogeneic donation
C
Medications bound to protein have the following effect: A. Enhancement of drug availability. B. Rapid distribution of the drug to receptor sites. C. The more drug bound to protein, the less available for the desired effect. D. Increased metabolism of the drug by the liver.
C
Some drugs are excreted into bile and delivered to the intestines. Prior to elimination from the body, the drug may be absorbed. This process is known as: A. Hepatic clearance. B. Total clearance. C. Enterohepatic cycling. D. First-pass effect.
C
A client with influenza is prescribed with an antiviral drug. The nurse determines that the client indicates an understanding of the treatment if he or she states the following? A. "I will take the medication exactly as prescribed". B. "I will not be able to infect others while I am on this treatment". C. "I will stop the medication once I feel okay". D. "I will resume my usual activities because these medications have minimal undesirable effects".
Correct Answer: A. "I will take the medication exactly as prescribed". Antiviral drugs are taken exactly as prescribed. When used as directed, these medicines may help decrease the duration of flu symptoms and lessen the severity of common flu symptoms. Option B: Antiviral drugs do not prevent the spread of influenza and patients are still contagious for up to two days after the start of the therapy. Option C: The durations for the medications are followed until the last day of the treatment. Option D: Side effects such as dizziness and drowsiness will alert the client to be careful resuming their daily activities.
Nurse Rita is giving instructions to her client who is taking antihistamine. Which of the following nurse teachings is appropriate for the client? A. Avoid ingesting alcohol B. Be aware that you may need to take a decongestant C. Be aware that you may have increased saliva D. Expect relief in 24 hours
Correct Answer: A. Avoid ingesting alcohol Because alcohol and antihistamines have sedating properties, concurrent administration of these drugs should be avoided. Antihistamines are a pharmaceutical class of drugs that act to treat histamine-mediated conditions. There are two main classes of histamine receptors: H-1 receptors and H-2 receptors. Antihistamine drugs that bind to H-1 receptors are generally used to treat allergies and allergic rhinitis. Drugs that bind to H-2 receptors treat upper gastrointestinal conditions that are caused by excessive stomach acid. Option B: Antihistamines and decongestants are often given together. Histamine (an endogenous chemical messenger) induces an increased level of vascular permeability, which leads to fluid moving from capillaries into the surrounding tissues. The overall outcome of this is increased swelling and dilation of vessels. Antihistamines stop this effect by acting as antagonists at the H-1 receptors. The clinical benefit is a reduction in allergy symptoms and any related symptoms. Option C: Dry mouth is a common side effect, not increased salivation. H-1 receptor antihistamines have anticholinergic properties, which are adverse effect-inducing; this principally occurs from the first generation category of antihistamines only. As a whole, they are sedating but may cause insomnia in some users. Due to their anticholinergic properties, dry mouth is a relatively common adverse effect. Option D: Not all antihistamines last 24 hours. The duration of the pharmacological action of first-generation antihistamines is about 4 to 6 hours. In contrast, second-generation antihistamines work for 12 to 24 hours. They are both metabolized by the liver using the P450 cytochrome system.
A client with which of the following conditions may experience a dangerous or fatal side effect of theophylline? A. Cardiac disorder B. Diabetes C. Renal disease D. Hepatic disease
Correct Answer: A. Cardiac disorder A client with a heart condition may experience dangerous stimulation from this drug. Use cautiously in patients who have cardiac arrhythmias (excluding bradyarrhythmias), as it may exacerbate arrhythmias. Theophylline should be administered cautiously with all the other choices, but the consequences are most dangerous or possibly fatal for clients with heart conditions. Option B: Use cautiously in patients with hyperthyroidism, as increased theophylline clearance may occur. Theophylline has a very narrow therapeutic window, and its interaction with various other drugs has led to the limitation of its use. The serum theophylline concentrations require monitoring directly to avoid toxicity as the adverse effects of theophylline are related to its plasma concentration and have been observed when plasma concentrations exceed 20 mg/L. Some patients have also experienced adverse effects at low plasma concentrations. The dose gradually increases until achieving therapeutic plasma concentrations. This approach reduces side effects. Option C: Serum theophylline concentrations should be checked after the initiation of therapy, before increasing dose and if any signs or symptoms of toxicity appear. Worsening of the current illness, an occurrence of a new illness or any change in the patient's treatment protocol that may alter theophylline clearance should also prompt the physician to check serum concentrations of theophylline. Attention should also be necessary for the infusion site. Option D: Use cautiously in patients with a hepatic impairment such as cirrhosis, cholestasis, acute hepatitis because there is an increased risk of severe and potentially fatal complications. This risk exists because clearance decreases by 50% or more in these patients. Frequent monitoring and dose reduction of theophylline are necessary for these patients.
Rifabutin (Mycobutin) is prescribed to a client with active Mycobacterium avium complex disease and tuberculosis. The nurse determines that the client is experiencing side effects in which of the following, except? A. Tingling and numbness of the fingers B. Blurred vision C. Arthralgia D. Flu-like symptoms
Correct Answer: A. Tingling and numbness of the fingers Tingling and numbness of the fingers (peripheral neuropathy) is associated with the use of isoniazid (INH) due to the ability of the medication to damage nerves. Options B, C, & D: These are the side effects of Rifabutin.
A nurse is giving teachings to a client receiving desloratadine (Clarinex). Which of the following statements made by the client will need further instructions? A. "I can eat gum after I drink the medicine". B. "I can take the medicine on an empty stomach". C. "I should avoid using alcohol". D. "I will avoid driving while using this medication".
Correct Answer: B. "I can take the medicine on an empty stomach". Desloratadine (Clarinex) is an antihistamine that is used to treat symptoms of allergies and urticaria. This medicine should be taken with food or milk to minimize gastrointestinal upset. Option A: Use gum or hard candy is allowed to minimize dry mouth. Options C & D: The medication causes drowsiness so avoid taking alcohol or engaging in activities that require mental alertness such as driving a car.
A nurse is about to administer albuterol (Ventolin HFA) 2 puffs and budesonide (Pulmicort Turbohaler) 2 puffs by a metered-dose inhaler. The nurse plans to administer by? A. Alternating with a single puff each, starting with albuterol B. Albuterol inhaler first then the budesonide C. Alternating with a single puff each, starting with budesonide D. Budesonide inhaler first then the albuterol
Correct Answer: B. Albuterol inhaler first then the budesonide If two different inhaled medications are prescribed and one of the medications contains a corticosteroid, administer the bronchodilator (Albuterol) first and the corticosteroid (Budesonide) second. This will allow for the widening of the air passages by the bronchodilator, making the corticosteroids more effective.
A client is taking streptomycin. The nurse explains the nervous system side effects of this medication. The nurse correctly states that this medication causes damage in which cranial nerve? A. Cranial nerve VII B. Cranial nerve VIII C. Cranial nerve IX D. Cranial nerve X
Correct Answer: B. Cranial nerve VIII Nervous system side effects of streptomycin include eighth cranial nerve toxicity, which typically affects the vestibular system (Clumsiness, dizziness, unsteadiness), but may also affect the auditory component (Ringing in the ear, loss of hearing). Option A: Cranial nerve VII is the facial nerve Option C: Cranial nerve IX is the glossopharyngeal nerve. Option D: Cranial nerve X is the vagus nerve.
The nurse should instruct a client who is taking an expectorant to: A. Restrict fluids B. Increase fluids C. Avoid vaporizers D. Take antihistamines
Correct Answer: B. Increase fluids Increasing fluids will help liquefy secretions and facilitate removal. Drink plenty of fluids while taking this medication. Fluids will help to break up mucus and clear congestion. An expectorant is a type of cough medicine that thins and loosens mucus. These medications are typically used for managing the effects of chest congestion, especially when symptoms are caused by persistent mucus. Option A: Expectorants are commonly used for management of the symptoms of acute (short-term) respiratory tract infections, like the common cold, pneumonia, or bronchitis. These infections can cause a build-up of phlegm in your throat or lungs. It is often difficult to cough up this thick mucus, and you can develop a nagging cough and chest discomfort due to mucus accumulation. Option C: When cold and flu season hits, dry air can make breathing issues worse. There are several types of humidifiers on the market, including cool-mist humidifiers and steam vaporizers. Both add moisture to the air, helping to ease cold and cough congestion. Option D: Antihistamines specifically block the tissue effects of histamine and thereby reduce or prevent all the symptoms except stuffiness. Decongestants are required to relieve the stuffiness, thus explaining the popularity of combination products containing both antihistamines and decongestants.
When administering the methylxanthine theophylline, the nurse can expect: A. Decreased pulmonary function B. Increased pulmonary function C. Increased residual volume D. Decreased tidal volume
Correct Answer: B. Increased pulmonary function Theophylline will improve ventilation so there will be an overall improvement of pulmonary measurements. Theophylline is a drug derived from methylxanthine (a purine derivative) and has smooth muscle relaxant, bronchial dilation, diuretic, cardiac and central nervous system (CNS) stimulant activities. Other choices are the opposite of what will actually occur with theophylline administration. Option A: Theophylline relaxes the smooth muscles located in the bronchial airways and pulmonary blood vessels. It also reduces the airway responsiveness to histamine, adenosine, methacholine, and allergens. Option C: It acts as a competitive nonselective phosphodiesterase inhibitor (inhibiting type III and type IV phosphodiesterase), which increases the concentration of intracellular cAMP, activates protein kinase A, inhibits TNF-alpha and leukotriene synthesis, and also decreases inflammation and innate immunity. Option D: It is also a nonselective adenosine receptor antagonist. It acts on A1, A2, and A3 receptors with almost the same affinity, and this possibly explains the cardiac effects of theophylline. Adenosine-mediated channels also increase the contraction force of diaphragmatic muscles by enhancing their calcium uptake.
Daniel has vertigo, which antihistamine is best for his condition? A. Terfenadine B. Meclizine C. Hydrocodone D. Guaifenesin
Correct Answer: B. Meclizine Meclizine (Antivert) is given for vertigo and motion sickness. Meclizine, an FDA- approved drug, is a first-generation antihistamine used for the symptomatic management of motion sickness. These symptoms include dizziness, nausea, and vomiting. It also treats vertigo symptoms caused by vestibular diseases that commonly affect the inner ear, such as Meniere's disease. Meclizine is a first-generation antihistamine (non-selective H1 antagonist). It also has central anticholinergic actions. The blocking actions on these receptors give meclizine its antiemetic and antivertigo properties. This blocking effect occurs in the vomiting center and chemoreceptor trigger zone (CTZ) located in the medulla. Choices C and D are not antihistamines. Option A: Terfenadine is an antihistamine, but meclizine is the standard drug in the treatment of vertigo. Terfenadine was withdrawn from the U.S. market in 1998. Terfenadine is an antihistamine. Antihistamines prevent sneezing runny nose, itching and watering of the eyes, and other allergic symptoms. Terfenadine is used to treat allergies, hives (urticaria), and other allergic inflammatory conditions. Option C: Hydrocodone is a schedule II semi-synthetic opioid medication used to treat pain. Immediate-release (IR) hydrocodone is available as a combination product (combined with acetaminophen, ibuprofen, etc.) and is FDA approved for the management of pain severe enough to require an opioid analgesic and for which alternative (non-opioid) treatments are inadequate. Option D: Guaifenesin is an expectorant. It helps loosen congestion in the chest and throat, making it easier to cough out through the mouth. Guaifenesin is used to reduce chest congestion caused by the common cold, infections, or allergies.
A nurse is caring for a client who is starting a long-term therapy of isoniazid (INH). The nurse plans to instruct the client to which of the following? A. Discontinue vitamin supplements such as Vit B6. B. Report an incidence of yellowish skin. C. Increase intake of tuna for additional nutrition. D. Drink alcohol in moderation.
Correct Answer: B. Report an incidence of yellowish skin. Isoniazid (INH) is hepatotoxic hence the client is instructed to report signs of jaundice (Yellowish of the skin or the sclera). Option A: Vitamin B6 can help in preventing peripheral neuritis. Option B: Tuna which contains tyramine causes a reaction characterized by redness, flushing, sweating, itching of the skin while taking INH. Option D: Avoid alcohol because the medication is hepatotoxic.
All of which are examples of antiviral influenza medications except? A. baloxavir marboxil (Xofluza) B. ethionamide (Trecator) C. oseltamivir (Tamiflu) D. zanamivir (Relenza)
Correct Answer: B. ethionamide (Trecator) Ethionamide (Trecator) is an antibiotic used in the treatment of tuberculosis. Options A, C, & D: These are antiviral medications that are effective in the prevention and treatment of flu.
Raul, a 20-year-old student, used to buy OTC drugs whenever he felt sick. Which of the following statements best describes the danger of self-medication with over-the-counter drugs? A. Clients are not aware of the action of over-the-counter drugs. B. Clients are not aware of the side effects of over-the-counter drugs. C. Clients minimize the effects of over-the-counter drugs because they are available without a prescription. D. Clients do not realize the effects of over-the-counter drugs.
Correct Answer: C. Clients minimize the effects of over-the-counter drugs because they are available without a prescription. This choice is correct because it includes the other three risks noted in choices A, B, and D. The body processes every medicine differently. When medicines are used together, the ways they affect the body can change. This is called a drug-drug interaction. It happens whether they are prescription or OTC medicines. It can increase the chance that the client will have side effects from the medicines he or she is taking. Option A: Duplication is when the client takes 2 medicines that have similar active ingredients. It can give the client more medicine than he or she needs. An example is when the client takes OTC ibuprofen (Advil, Motrin) plus a prescription anti-inflammatory medicine. Too much of either an anti-inflammatory or pain reliever can hurt the kidneys or liver. Option B: Medicines with active ingredients that have opposite effects on the body can interact. This may reduce the effectiveness of 1 or both medicines. For example, OTC decongestants may raise blood pressure. This can work against (cause opposition to) medicines that lower blood pressure. Option D: Food may change how the body processes some OTC or prescription medicines. This is called a drug-food (or drug-nutrient) interaction. Sometimes what we eat and drink can affect the ingredients in medicine we are taking. This can prevent the medicine from working the way it should.
A client with a chronic obstructive pulmonary disease is prescribed with ipratropium (Combivent). Upon a review of the medical history of the client, the nurse questions the prescription if which of the following is noted? A. History of smoking B. History of allergy to egg C. History of allergy to peanut D. History of a previous infection
Correct Answer: C. History of allergy to peanut The client with a peanut allergy should not take ipratropium because the product contains soy lecithin, which is in the same plant family as peanuts.
A nurse is giving instructions to a client receiving Pyrazinamide. Which of the following is not true regarding this medication? A. Take the medication with food. B. Photosensitivity is one of the side effects. C. It enhances the effect of allopurinol. D. Use with caution in patients with diabetes mellitus.
Correct Answer: C. It enhances the effect of allopurinol. Patients taking pyrazinamide decrease the effects of allopurinol, colchicine, probenecid, and sulfinpyrazone. Option A: Taken with food to reduce gastric upset. Option B: To instruct the client to avoid sunlight. Option D: This medication causes hyperglycemia.
A client has been taking isoniazid (INH). The client went to the health care facility with complaints of numbness and tingling sensation in the extremities. The nurse determines that the client is most likely suffering from? A. Impaired peripheral circulation B. Hypercalcemia C. Peripheral neuritis D. Guillain Barre syndrome
Correct Answer: C. Peripheral neuritis Isoniazid (INH) causes peripheral neuritis characterized by numbness, tingling, and paresthesias in the extremities. Options A & B: These are not related to the use of the medication. Option D: Guillain-Barre syndrome is a rare condition in which your immune system attacks your nerves, leading to muscle weakness and even paralysis.
A nurse is about to administer naloxone hydrochloride (Narcan) to a client with a known opioid overdose. Which of the following equipment should be readily available at the bedside? A. Suction machine B. Nasogastric tube C. Resuscitative equipment D. Dressing tray
Correct Answer: C. Resuscitative equipment Naloxone is an opioid antagonist medication that is used to rapidly reverse an opioid overdose. While administering, resuscitation equipment, oxygen, mechanical ventilator should be readily available in case of the occurrence of an overdose which is life-threatening and requires immediate emergency attention. Options A, B, & D: These are not used during the medication therapy.
A pediatric client with asthma has just received omalizumab (Xolair). The nurse determines that the client might be suffering a life-threatening effect in which of the following? A. Headache and dizziness B. Nausea and vomiting C. Swelling of the tongue D. Joint pain
Correct Answer: C. Swelling of the lips Omalizumab (Xolair) Xolair is an anti-inflammatory that is used to treat moderate to severe asthma that is caused by allergies. An anaphylactic reaction may happen such as flushing, rash, wheezing, or swelling of the face, lips, or tongue. Options A, B, & D: These are some of the side effects but will not alert the nurse for an anaphylactic reaction.
A client with tuberculosis is receiving ethambutol (Myambutol). All of which are laboratories to be examined, except? A. Complete blood count B. Liver function test C. Triglyceride level D. Uric acid level
Correct Answer: C. Triglyceride level Triglyceride level is not monitored during the treatment. Option A: This is to monitor for thrombocytopenia. Option B: This is to check for hepatotoxicity. Option D: This is to monitor for hyperuricemia.
A cromolyn sodium (Intal) inhaler is prescribed to a client with asthma. A nurse provides instructions regarding the side effects of this medication. The nurse tells the client to immediately report which of the following side effects? A. Sore throat B. Drowsiness C. Wheezing D. Hypotension
Correct Answer: C. Wheezing Cromolyn Sodium (Intal) is used to prevent asthma attacks in people with bronchial asthma. Serious side effects associated with the use of this inhaler are wheezing, chest tightness, skin rash, hives, itching, swelling of the face, lips, throat, or tongue, and joint pain. Options A & B: These are expected side effects of Intal. Option D: Hypotension is not directly related to the medication.
Montelukast (Singulair) is prescribed to a client with asthma. During the medication therapy, which of the following laboratories should be monitored? A. Complete blood count (CBC) B. Sodium and Potassium C. Calcium and Platelet count D. Alanine transaminase (ALT) and aspartate transaminase (AST)
Correct Answer: D. Alanine transaminase (ALT) and aspartate transaminase (AST) Montelukast (Singulair) is a leukotriene receptor and is used with caution in clients with impaired renal function. Alanine aminotransferase (ALT) and Aspartate aminotransferase (AST) should be monitored while taking this medication. Options A, B, & C: These are not related to the use of this medication.
The effects of theophylline may be increased by: A. Phenobarbital B. Phenytoin C. Rifampin D. Cimetidine
Correct Answer: D. Cimetidine Cimetidine will increase the effects of theophylline. Other medications can affect the removal of theophylline from the body, which may affect how theophylline works. Examples include cimetidine, disulfiram, fluvoxamine, interferon, mexiletine, propranolol, rifampin, drugs used to treat seizures (such as carbamazepine, phenytoin). Option A: Theophylline, ephedrine, and phenobarbital combination is used to treat the symptoms of bronchial asthma, asthmatic bronchitis, and other lung diseases. theophylline, ephedrine, and phenobarbital relieves cough, wheezing, shortness of breath, and troubled breathing. Option B: The effect of phenytoin, 100 mg thrice daily for 3 weeks, on theophylline disposition was studied in eight healthy volunteers. 2. The anticonvulsant significantly reduced the half-life of theophylline and this was associated with an increase in the rate of theophylline clearance. Option C: The effect of rifampicin pre-treatment (600 mg daily for 6 days) on theophylline disposition at steady state was investigated in six healthy males. Following rifampicin treatment total plasma clearance of theophylline increased by 82%.
The nurse is giving medication teachings to a client receiving theophylline. The nurse instructed the client to limit the intake of which of the following? A. Apple and banana B. Yogurt and cheese C. Tuna and oysters D. Cola and chocolate
Correct Answer: D. Cola and chocolate Theophylline is a methylxanthine bronchodilator. The nurse instructs the client to limit the intake of xanthine-containing foods such as chocolate, cola, and coffee. Options A, B, & C: These food items can be eaten by a client taking theophylline.
A nurse is monitoring a client receiving ethambutol (Myambutol) for adverse effects. The nurse determines that the client is experiencing a side effect of the medication, in which of the following? A. Red-orange colored bodily secretions B. Damaged hearing C. Loss of smell D. Difficulty distinguishing the color red from green
Correct Answer: D. Difficulty distinguishing the color yellow from orange Ethambutol (Myambutol) causes optic neuritis characterized by decreased visual acuity and the ability to distinguish between the color red from green. Option A: Red-orange discoloration of secretions is a side effect of Rifampin. Option B: Ototoxicity is a side effect of Streptomycin. Option C: This is not a related symptom of this anti-TB medication.
A client is prescribed with guaifenesin (Mucinex). The nurse determines that the client understands the proper administration of this medication if the client states that he or she will: A. Limit oral fluid intake B. Take the medication with meals only C. Take an additional dose once fever and cough persist D. Drink extra fluids while taking this medication
Correct Answer: D. Drink extra fluids while taking this medication Guaifenesin is an expectorant. Drink extra fluids to help loosen the congestion and lubricate the throat while taking this medication. Option A: Fluids are needed to loosen the secretions. Option B: The medication does not have to be taken with meals. Option C: Additional doses should not be taken without the prescription of the doctor.
Tamisha will be having her exam in pharmacology tomorrow. She should be aware that antitussive is indicated to: A. Encourage removal of secretions through coughing B. Relieve rhinitis C. Control a productive cough D. Relieve a dry cough
Correct Answer: D. Relieve a dry cough An antitussive is a cough suppressant. Antitussives constitute a heterogeneous class of compounds that inhibit cough through either a central or a peripheral mechanism, or a mixture of the two. Antitussives are cough suppressants. There are two ways to inhibit coughing: centrally and peripherally. Choices A and C describe the action of an expectorant. Option A: Expectorant is a medication that helps bring up mucus and other material from the lungs, bronchi, and trachea. An example of an expectorant is guaifenesin, which promotes drainage of mucus from the lungs by thinning the mucus, and also lubricates the irritated respiratory tract. Option B: Decongestants are a type of medicine that can provide short-term relief for a blocked or stuffy nose (nasal congestion). They can help ease the symptoms of conditions such as colds and flu, hay fever and other allergic reactions, catarrh and sinusitis. They work by reducing the swelling of the blood vessels in the nose, which helps to open the airways. Option C: An expectorant is a type of cough medicine that thins and loosens mucus. These medications are typically used for managing the effects of chest congestion, especially when symptoms are caused by persistent mucus. Expectorants are designed to thin the respiratory secretions in the airways so that one can cough up excessive mucus more effectively. These medications do this by lubricating the airway passages.
A 25 year old man with chronic bronchitis is receiving theophylline intravenously. After several dosages, the client started to become restless and complains of palpitations. The nurse determines that the client is experiencing theophylline toxicity in which of the following? A. Theophylline level of 8 mcg/ml B. Theophylline level of 10 mcg/ml C. Theophylline level of 15 mcg/ml D. Theophylline level of 25 mcg/ml
Correct Answer: D. Theophylline level of 25 mcg/ml Theophylline toxicity is most likely to occur when the serum level is higher than 20 mcg/ml. Early signs of toxicity include restlessness, nervousness, tachycardia, tremors, and palpitations. Options A, B, and C: These theophylline values are within the safe range.
To evaluate the effectiveness of theophylline therapy, which of the following laboratory values must be drawn? A. Glucose B. Hematocrit C. Potassium D. Theophylline levels
Correct Answer: D. Theophylline levels Theophylline levels must be drawn to determine if the drug is present in therapeutic amounts in the client's serum. Theophylline has a very narrow therapeutic window, and its interaction with various other drugs has led to the limitation of its use. The serum theophylline concentrations require monitoring directly to avoid toxicity as the adverse effects of theophylline are related to its plasma concentration and have been observed when plasma concentrations exceed 20 mg/L. Some patients have also experienced adverse effects at low plasma concentrations. The dose gradually increases until achieving therapeutic plasma concentrations. This approach reduces side effects. Option A: The most common side effects are nausea and vomiting, headache, increased stomach acid secretion, and gastroesophageal reflux, which could be due to PDE inhibition. CNS symptoms (irritability, lightheadedness, and dizziness) can also occur in patients. In severe cases, seizures have also occurred. At high serum concentrations, adenosine A1-receptor antagonism could lead to convulsions and cardiac arrhythmias. Option B: For patients taking oral treatment, monitor serum concentrations at 6-month intervals for rapidly developing children and at annual intervals for all other patients (if their symptoms are well controlled). Option C: The serum concentration of theophylline should be checked 30 minutes after the completion of an intravenous loading dose in patients with no theophylline use in the last 24 hours to determine if additional loading may be required (if the serum concentration is less than 10 mcg/mL) or to delay initiating the constant IV infusion (if the serum concentration is greater than 20 mcg/mL).
A client is to begin taking rifampin (Rifadin). The nurse correctly teaches the client this medication: A. Is to be discontinued after three months. B. Is to be taken with food and antacids. C. Take an additional dose once with skip dose. D. Will cause orange discoloration of sweat, urine, and feces.
Correct Answer: D. Will cause orange discoloration of sweat, urine, and feces. Rifampin causes red-orange discolorations of bodily secretions such as sweat, urine, tears, and feces. Option A: The client should not stop the therapy unless with a doctor's advice. Option B: The medication is taken on an empty stomach. Option C: Doses are not to be doubled or skipped.
A 13-month-old child recently arrived in the United States from a foreign country with his parents and needs childhood immunizations. His mother reports that he is allergic to eggs. Upon further questioning, you determine that the allergy to eggs is anaphylaxis. Which of the following vaccines should he not receive? A. Hepatitis B. B. inactivated polio. C. diphtheria, acellular pertussis, tetanus (DTaP). D. mumps, measles, rubella (MMR).
D
A child is admitted with a serious infection. After two days of antibiotics, he is severely neutropenic. The physician orders granulocyte transfusions for the next four days. The mother asks the nurse why? The nurse responds: A. "This is the only treatment left to offer the child." B. "This therapy is fast and reliable in treating infections in children." C. "The physician will have to explain his rationale to you." D. "Granulocyte transfusions replenish the low white blood cells until the body can produce its own."
D
A client who is taking Methotrexate (Trexall) asks the nurse on what is the appropriate activity while taking the medication. The nurse advised the client to play which activity? A. Basketball B. Ice hockey C. Football D. Tennis
D
Chemotherapeutic agents often produce a certain degree of myelosuppression including leukopenia. Leukopenia does not present immediately but is delayed several days to weeks because: A. The patient's hemoglobin and hematocrit are normal. B. Red blood cells are affected first. C. Folic acid levels are normal. D. The current white cell count is not affected by chemotherapy.
D
Chris asks the nurse whether all donor blood products are cross-matched with the recipient to prevent a transfusion reaction. Which of the following always require cross-matching? A. Granulocytes B. Platelets C. Plasma D. Packed red blood cells
D
Gold sodium thiomalate is prescribed to a client with rheumatoid arthritis. Which of the following side effects indicates an overdose of the medication? A. Flushing B. Dizziness C. Joint pain D. Metallic taste
D
Mandy, a patient, calls the clinic today because he is taking atorvastatin (Lipitor) to treat his high cholesterol and is having pain in both of his legs. You instruct him to: A. Stop taking the drug and make an appointment to be seen next week. B. Continue taking the drug and make an appointment to be seen next week. C. Walk for at least 30 minutes and call if symptoms continue. D. Stop taking the drug and come to the clinic to be seen today.
D
Myeloablation using chemotherapeutic agents is useful in cancer treatment because: A. It destroys the myelocytes (muscle cells). B. It reduces the size of the cancer tumor. C. After surgery, it reduces the amount of chemotherapy needed. D. It destroys the bone marrow prior to transplant.
D
Nurse Blessy is doing some patient education related to a patient's central venous access device. Which of the following statements will the nurse make to the patient? A. "These types of devices are essentially risk-free." B. "These devices seldom work for more than a week or two necessitating replacement." C. "The dressing should only be changed by your doctor." D. "Heparin is instilled into the lumen of the catheter to decrease the risk of clotting."
D
Nurse Bryan knows that the age group that uses the most units of blood and blood products is: A. Premature infants. B. Children ages 1-20 years. C. Adults ages 21-64 years. D. The elderly above age 65 years.
D
Serious adverse effects of oral contraceptives include: A. Increase in skin oil followed by acne. B. Headache and dizziness. C. Early or mid-cycle bleeding. D. Thromboembolic complications.
D
Some central venous access devices (CVAD) have more than one lumen. These multi-lumen catheters: A. Have an increased risk of infiltration. B. Only work a short time because the small-bore clots off. C. Are beneficial to patient care but are prohibitively expensive. D. Allow different medications or solutions to be administered simultaneously.
D
The primary complication of a central venous access device (CVAD) is: A. Thrombus formation in the vein. B. Pain and discomfort. C. Infection. D. Occlusion of the catheter as the result of an intra-lumen clot.
C
Which of the following adverse effects is associated with levothyroxine (Synthroid) therapy? A. Hypotension B. Bradycardia C. Tachycardia D. Constipation
C
A nurse is giving medicinal instructions to a female client receiving leflunomide (Arava). Which of the following is an appropriate instruction with the use of the medication? A. To use an effective form of birth control while on the treatment. B. Breastfeeding does not have to be stopped during the treatment. C. To use cholestyramine to lessen the side effects. D. It may take 3-5 days to notice any improvement while taking leflunomide.
A
Adalimumab (Humira) is given to a client for the treatment of rheumatoid arthritis. Which of the following side effect is associated with the medication? A. Numbness B. Constipation C. Urinary retention D. Weight gain
A
Chemotherapy induces vomiting by: A. Stimulating neuroreceptors in the medulla. B. Inhibiting the release of catecholamines. C. Autonomic instability. D. Irritating the gastric mucosa.
A
A client taking probenecid is complaining of gout pain. Which of the following medication should the nurse expect to be administered? A. acetaminophen (Tylenol) B. aspirin (Ecotrin) C. orphenadrine (Norflex) D. tizanidine (Zanaflex)
A
Currently, there is no way to prevent myelosuppression. However, there are medications available to elicit a more rapid bone marrow recovery. An example is: A. epoetin alfa (Epogen, Procrit). B. glucagon (Glucagen). C. fenofibrate (Tricor). D. lamotrigine (Lamictal).
A
Drugs can cause adverse events in a patient. Bone marrow toxicity is one of the most frequent types of drug-induced toxicity. The most serious form of bone marrow toxicity is: A. Aplastic anemia. B. Thrombocytosis. C. Leukocytosis. D. Granulocytosis.
A
Epinephrine is administered to a female patient. The nurse should expect this agent to rapidly affect: A. Adrenergic receptors. B. Muscarinic receptors. C. Cholinergic receptors. D. Nicotinic receptors.
A
Estrogen antagonists are used to treat estrogen hormone-dependent cancer, such as breast carcinoma. Androgen antagonists block testosterone stimulation of androgen-dependent cancers. An example of an androgen-dependent cancer would be: A. Prostate cancer. B. Thyroid cancer. C. Renal carcinoma. D. Neuroblastoma.
A
Kent, a new staff nurse asks her preceptor nurse how to obtain a blood sample from a patient with a portacath device. The preceptor nurse teaches the new staff nurse: A. The sample will be withdrawn into a syringe attached to the Portacath needle and then placed into a vacutainer. B. Portacath devices are not used to obtain blood samples because of the risk of clot formation. C. The vacutainer will be attached to the Portacath needle to obtain a direct sample. D. Any needle and syringe may be utilized to obtain the sample.
A
Serotonin release stimulates vomiting following chemotherapy. Therefore, serotonin antagonists are effective in preventing and treating nausea and vomiting related to chemotherapy. An example of an effective serotonin antagonist antiemetic is: A. ondansetron (Zofran). B. fluoxetine (Prozac). C. paroxetine (Paxil). D. sertraline (Zoloft).
A
Some institutions will not infuse a fat emulsion, such as Intralipid, into central venous access devices (CVAD) because: A. Lipid residue may accumulate in the CVAD and occlude the catheter. B. If the catheter clogs, there is no treatment other than removal and replacement. C. Lipids are necessary only in the most extreme cases to prevent essential fatty acid (EFA) deficiency D. Fat emulsions are very caustic.
A
The cell and Coombs classification system categorizes allergic reactions and is useful in describing and classifying patient reactions to drugs. Type I reactions are immediate hypersensitivity reactions and are mediated by: A. immunoglobulin E (IgE). B. immunoglobulin G (IgG). C. immunoglobulin A (IgA). D. immunoglobulin M (IgM).
A
The chemotherapeutic DNA alkylating agents such as nitrogen mustards are effective because they: A. Cross-link DNA strands with covalent bonds between alkyl groups on the drug and guanine bases on DNA. B. Have few, if any, side effects. C. Are used to treat multiple types of cancer. D. Are cell cycle-specific agents.
A
The nurse is aware that the following solutions are routinely used to flush an IV device before and after the administration of blood to a patient is: A. 0.9 percent sodium chloride. B. 5 percent dextrose in water solution. C. Sterile water. D. Heparin sodium.
A
Methotrexate, the most widely used antimetabolite in cancer chemotherapy does not penetrate the central nervous system (CNS). To treat CNS disease this drug must be administered: A. Intravenously. B. Subcutaneously. C. Intrathecally. D. By inhalation.
C
A client is prescribed Colchicine. After taking three doses, the client complains of nausea, vomiting, and loose bowel stools. Which of the following should the client do? A. Skip the next dose, and take the another dose. B. Withhold the medication and the physician is notified. C. Continue taking the medication as these symptoms will go away. D. Cut in half the next dosage.
B
Reye's syndrome, a potentially fatal illness associated with liver failure and encephalopathy is associated with the administration of which over-the-counter (OTC) medication? A. acetaminophen (Tylenol) B. ibuprofen (Motrin) C. aspirin D. brompheniramine/pseudoephedrine (Dimetapp)
C
A client with rheumatoid arthritis has been receiving hydroxychloroquine (Plaquenil) in recent months. The nurse tells the client to visit which of the following while on the treatment? A. Dentist B. Ophthalmologist C. Pulmonologist D. Endocrinologist
B
The most common dose-limiting toxicity of chemotherapy is: A. Nausea and vomiting. B. Bloody stools. C. Myelosuppression. D. Inability to ingest food orally due to stomatitis and mucositis.
C
A client has just been prescribed with methotrexate (Trexall) for the treatment of rheumatoid arthritis who did not respond to any other treatment. An important reminder for the client is to? A. Clay-colored stool is a normal response to the treatment. B. Pregnancy is not contraindicated with the use of the medication. C. Strict hand washing. D. Get a daily source of sunlight during the day.
C
A client is receiving methocarbamol (Robaxin) as an adjunct to physical therapy for the relief of painful muscle discomfort. Which of the following is not true regarding the use of the medication? A. The parenteral form causes hypotension and bradycardia when given rapidly. B. The medicine can cause the urine to turn brown, black, or green. C. The use of a cold or allergy medicine will lessen the side effects of the medication. D. The parenteral form is contraindicated in clients with liver damage.
C
A client receiving azathioprine (Imuran) complains of hair loss. The nurse tells the client that? A. Hair loss is irreversible B. Hair loss is uncommon C. Hair loss is temporary D. Hair loss is a sign of toxicity
C
What volume of air can safely be infused into a patient with a central venous access device (CVAD)? A. It is dependent on the patient's weight and height. B. Air entering the patient through a CVAD will follow circulation to the lungs where it will be absorbed and cause no problems. C. It is dependent on comorbidities such as asthma or chronic obstructive lung disease. D. None.
D
Phenylephrine hydrochloride (Neo-Synephrine) is prescribed for a client with nasal congestion. The nurse who is providing teachings about the medication should include which of the following? Select all that apply. A. Avoid consuming high amounts of caffeine B. Use caution with clients with hypertension C. Report for breathing problems such as shortness of breath, and audible wheezing D. May take naratriptan once with headache E. May extend the use of nasal solution If symptoms do not improve after 3 days
Correct Answer: A, B, & C Option A: Taking large amounts of caffeine can increase restlessness, palpitations, nervousness, or other side effects of phenylephrine. Option B: The medication stimulates alpha1 receptors, causing an increase in blood pressure. Option C: The medication can trigger asthma so it is important to notify the health care provider if a client has a history of asthma. Option D: Some medications used for migraine headaches such as naratriptan may worsen the serious side effects of phenylephrine and therefore should be avoided. Option E: Extended use of nasal spray may result in tolerance and rebound nasal congestion which is caused by irritation of the nasal mucosa. Therefore, the client should be instructed to notify the doctor if the symptoms do not improve after 3 days of treatment.
