Pharm 3: Midterm Review
The nurse is reviewing a patient's medication orders for prn (as necessary) medications that can be given to a patient who has bronchitis with a productive cough. Which drug will the nurse choose? a. An antitussive b. An expectorant c. An antihistamine d. A decongestant
B
The order reads: "Give promethazine (Phenergan) 12.5 mg IM q4hr prn nausea/vomiting." The medication is available in 25-mg/mL vials. How many milliliters will the nurse draw up for this dose?
0.5 mL
The order for patient reads: "Give guaifenesin, 300 mg per enteral feeding tube every 4 hours as needed for cough." The medication comes in a bottle that has 100 mg/5 mL. How many milliliters will the nurse give per dose?
15 mL
A patient is receiving a continuous tube feeding via a percutaneous endoscopic gastrostomy tube. Which drug would most likely be prescribed for this patient? A. metoclopramide (Reglan) B. meclizine (Antivert) C. aprepitant (Emend) D. phosphorated carbohydrate solution (Emetrol)
A. Metoclopramide is a prokinetic drug that promotes the movement of substances through the GI tract and increases GI motility. This action is helpful in preventing aspiration in those receiving tube feedings.
The medication order for a patient who receives nutrition via a feeding tube reads: "Give digoxin 0.125 mg per feeding tube once every morning." The medication is available in a liquid form 50 mcg/mL. How many milliliters will the nurse give for each dose?
2.5 mL
A patient is in the emergency department with new-onset rapid-rate atrial fibrillation. The nurse is about to add a continuous infusion of diltiazem (Cardizem) at 5 mg/hr but must first give a bolus of 0.25 mg/kg over 2 minutes. The patient weighs 220 pounds. The medication comes in a vial of 25 mg/5 mL. How many milligrams will the patient receive for the bolus dose and how many milliliters will the nurse draw up for this dose?
25 mg, 5 mL
The order reads, "Give metoprolol (Lopressor) 300 mg/day PO in 2 divided doses." The tablets are available in 50-mg strength. How many tablets will the patient receive per dose?
3 tablets per dose (150 mg per dose)
The order for an adult who needs passive hepatitis B pro-phylaxis reads: "Give hepatitis B immunoglobulin (BayHep B), 0.06 mL/kg IM now, and then again in 30 days." The patient weighs 176 pounds. How many milliliters will this patient receive per dose?
4.8 mL
The nurse notes in a patient's medication history that the patient is taking benzonatate (Tessalon Perles) as needed. Based on this finding, the nurse interprets that the patient has which problem? a. Cough b. Seasonal allergies c. Chronic rhinitis d. Motion sickness
A
When monitoring a patient who is receiving an intravenous infusion of nesiritide (Natrecor), the nurse will look for which adverse effect? a. Dysrhythmia b. Proteinuria c. Hyperglycemia d. Hypertension
A
Which statement by the patient reflects the need for additional patient education about the calcium channel blocker diltiazem (Cardizem)? a. "I can take this drug to stop an attack of angina." b. "I understand that food and antacids alter the absorption of this oral drug." c. "When the long-acting forms are taken, the drug cannot be crushed." d. "This drug may cause my blood pressure to drop, so I need to be careful when getting up."
A
A patient asks the nurse to tell her more about a new drug the patient has been prescribed called ranolazine (Ranexa). Which response by the nurse is accurate? A. "We do not know how Ranexa works." B. "This drug is the first medication your health care provider will use to treat your angina." C. "This drug must be given intravenously." D. "Ranexa is safe to use in patients with liver failure."
A Rationale: The mechanism of action of Ranexa is not known. Ranexa is used only after treatment with other antianginals have not been effective. Ranexa is administered by mouth and is contraindicated for use in patients with liver failure.
Before administering Gardasil, it is most important for the nurse to assess the patient for an allergy to: A. yeast B. milk C. eggs D. penicillin
A Rationale: The nurse should not administer the papillomavirus vaccine (Gardasil, Cervarix) to patients with allergies to yeast or patients who have a documented allergic reaction to the first injection of the vaccine.
A patient has an order for the varicella vaccine. It is most important for the nurse to assess the patient for: A. use of high dose systemic steroids in the past month B. allergy to aspirin C. allergy to eggs D. history of hypertension
A Rationale: Varicella vaccine is not to be given to immunodeficient patients or to patients who have received high doses of systemic steroids in the previous month. It is also recommended that salicylates be avoided for 6 weeks after administration of varicella vaccine because of the possibility of Reye's syndrome.
When teaching the patient about the signs and symptoms of cardiac glycoside toxicity, the nurse should alert the patient to watch for which of these? (Select all that apply.) a. Dizziness b. Visual changes such as halos around lights c. headaches d. increased urine output e. dark stools
A, B, C
The nurse is administering an intravenous infusion of a phosphodiesterase inhibitor to a patient who has heart failure. The nurse will evaluate the patient for which therapeutic effects? (Select all that apply.) a. Positive inotropic effects b. Vasodilation c. Decreased heart rate d. Increased blood pressure e. Positive chronotropic effects
A, B, E
When assessing a patient who is to receive a decongestant, the nurse will recognize that a potential contraindication to this drug would be which condition? Select all that apply. a. Glaucoma b. Fever c. Hypertension d. Peptic ulcer disease e. Allergic rhinitis
A, C
The nurse is reviewing drug interactions with a male patient who has a prescription for isosorbide dinitrate (Isordil) as treatment for angina symptoms. Which substances listed below could potentially result in a drug interaction? (Select all that apply.) a. A glass of wine b. Thyroid replacement hormone c. Tadalafil (Cialis), an erectile dysfunction drug d. Metformin (Glucophage), an antidiabetic drug e. Carvedilol (Coreg), a beta blocker
A, C, E
While assessing a patient with angina who is to start beta blocker therapy, the nurse is aware that the presence of which condition may be a problem if these drugs are used? (Select all that apply.) a. Diabetes mellitus b. Essential tremors c. Exertional angina d. Asthma e. Hypertension
A, D
The nurse is providing patient teaching to a 24-year old woman regarding human papillomavirus (HPV) vaccine. Which statement by the woman indicates that more teaching is needed? (Select all that apply) a. "The vaccine only takes one injection." b. "My 13 year old sister should take this vaccine too." c. "I need to have this vaccination before I turn 26." d. "This vaccination prevents the virus that commonly causes genital warts." e. "It is safe to take this vaccination when I am pregnant."
A, E
A middle-aged woman is experiencing severe vertigo associated with motion sickness. The nurse expects that this patient will receive which drug? A. meclizine (Antivert) B. prochlorperazine (Compazine) C. metoclopramide (Reglan) D. dronabinol (Marinol)
A.
When the nurse teaches a patient about taking bisacodyl tablets, which instruction is correct? A "Take this medication on an empty stomach." B. "Chew the tablet for quicker onset of action." C. "Take this medication with juice or milk." D. "If it upsets your stomach, take this medication with an antacid."
A.
Which antidiarrheal does the nurse associate with the development of adverse effects of urinary retention, headache, confusion, dry skin, rash, and blurred vision? A. Anticholinergics B. Adsorbents C. Probiotics D. Opiates
A. Anticholinergics work by decreasing GI peristalsis through their parasympathetic blocking effects. Adverse effects include urinary retention, headache, confusion, dry skin, rash, and blurred vision.
A patient is experiencing diarrhea while completing a course of antibiotic therapy. Which of the following agents does the nurse anticipate administering to the patient? A. L. acidophilus (Bacid) B. bismuth subsalicylate (Pepto-Bismol) C. diphenoxylate with atropine (Lomotil) D. loperamide (Imodium A-D)
A. L. acidophilus (Bacid) is a probiotic often used in the treatment of antibiotic-induced diarrhea. The other agents are usually not used in the treatment of antibiotic-induced diarrhea.
A patient is taking a beta blocker as part of the treatment plan for heart failure. The nurse knows that the purpose of the beta blocker for this patient is to a. increase urine output. b. prevent stimulation of the heart by catecholamines. c. increase the contractility of the heart muscle. d. cause peripheral vasodilation
B
A patient is 2 months' pregnant. She comes to the clinic complaining of severe morning sickness. She has tried numerous nonpharmacologic measures to relieve the morning sickness, but they have not worked. The nurse anticipates the use of which antinausea drug? A. phosphorated carbohydrate solution (Emetrol) B. aprepitant (Emend) C. palonosetron (Aloxi) D. dolasetron (Anzemet)
A. Phosphorated carbohydrate solution (Emetrol) is a mint-flavored, pleasant-tasting oral solution used to relieve nausea. It works by direct local action on the walls of the GI tract, where it reduces cramping caused by excessive smooth muscle contraction. It can be used to control mild cases of nausea and vomiting. It does not have a pregnancy category rating, but one of its listed unlabeled (not approved by the U.S. Food and Drug Administration) uses is for treatment of morning sickness during pregnancy. The other drugs are not indicated for use in pregnancy.
A patient has been instructed to use an over-the-counter (OTC) form of the bulk-forming laxative methylcellulose (Citrucel) to prevent constipation. The nurse will advise the patient of potential adverse effects, including which of these? (Select all that apply) A. Electrolyte imbalances B. Decreased absorption of vitamins C. Gas formation D. Darkened stools E. Discolored urine
A. and C.
The nurse is preparing to administer dronabinol (Marinol) to a patient. Which statements about dronabinol therapy are true? (Select all that apply.) A. It is approved for nausea and vomiting related to cancer chemotherapy. B. It is approved for use with hyperemesis gravidarum (nausea and vomiting associated with pregnancy). C. It is approved to help stimulate the appetite in patients with nutritional wasting due to cancer or AIDS. D. It may cause extrapyramidal symptoms. E. It may cause drowsiness or euphoria
A., C., and E.
A patient with a rapid, irregular heart rhythm is being treated in the emergency department with adenosine. During administration of this drug, the nurse will be prepared to monitor the patient for which effect? a. Nausea and vomiting b. A brief period of systole c. Muscle tetany d. Hypertension
B
During a routine checkup, a 72-year-old patient is advised to receive an influenza vaccine injection. He questions this, saying, "I had one last year. Why do I need another one?" What is the nurse's best response? A. "The effectiveness of the vaccine wears off after 6 months." B. "Each year a new vaccine is developed based on the flu strains that are likely to be in circulation" C. "When you reach 65 years of age, you need boosters on an annual basis." D. "Taking the flu vaccine each year allows you to build your immunity to a higher level each time."
B
A 68-year-old male patient has been taking the nitrate isosorbide dinitrate (Isordil) for 2 years for angina. He recently has been experiencing erectile dysfunction and wants a prescription for sildenafil (Viagra). Which response would the nurse most likely hear from the prescriber? a. "He will have to be switched to isosorbide mononitrate if he wants to take sildenafil." b. "Taking sildenafil with the nitrate may result in severe hypotension, so a contraindication exists." c. "I'll write a prescription, but if he uses it, he needs to stop taking the isosorbide for one dose." d. "These drugs are compatible with each other, and so I'll write a prescription."
B
A nurse is stuck by a used needle while starting an IV. Which preparation is used as prophylaxis against the disease after exposure to blood and body fluids? a. HIB vaccine b. Hepatitis B immune globulin c. Rh (D) immune globulin d. Hepatitis antitoxin
B
A patient is mowing his lawn on a hot Saturday afternoon. He begins to notice chest pain. What should his first action be? A. Take his nitroglycerin tablet B. Stop mowing and sit or lie down C. Go inside the house to cool off and get a drink of water D. Call 911
B Rationale: At the first sign of chest pain, the person should stop all activity and sit or lie down before taking the nitroglycerin tablet.
A patient is in the emergency department with an unspecified supraventricular dysrhythmia. The physician orders a dose of diltiazem (Cardizem) IV push. While the nurse administers the medication through the IV lock, the patient says she feels something wet spilling on her arm. Her heart rate was unchanged. What will the nurse do next? A. Assess the patient for diaphoresis. B. Check the IV lock to see if it is functioning properly. C. Repeat the dose of diltiazem (Cardizem). D. Restart the IV in another location.
B Rationale: Because the heart rate was unchanged and the patient felt fluid on her arm, the IV lock is probably not working properly. Before anything else is done, the IV lock should be checked for proper functioning. Another dose would be wasted if the IV lock is not working.
A patient is receiving oral quinidine. Which assessment finding is of most concern? A. Nausea B. Prolonged QT interval C. Diarrhea D. Occasional palpitations
B Rationale: Patients taking quinidine need to be monitored for prolonged QRS and QT intervals, which may be a precursor to more serious dysrhythmia problems.
The common cold is treated with empiric therapy, which means A. the medications cure the cold. B. the medications only treat the symptoms. C. herbal medications are useful to eliminate symptoms. D. it is prevented with careful use of medications.
B Rationale: There is no cure for the common cold, and the efficacy of herbal products is not proven. Treatment rendered can only treat the presenting clinical symptoms.
A patient with AIDS was cut by a rusty piece of metal while walking outside. He recalls that his last tetanus booster was more than 20 years ago. Which immunization therapy will he receive at this time? A. He cannot receive any type of immunization therapy B. Tetanus immunoglobulin C. Tetanus toxoid, adsorbed D. Tetanus and diphtheria toxoid (Td) booster
B Rationale: Vaccines and toxoids rely on a person's immune system to work. Patients who are immunocompromised (as in those receiving immunosuppressive therapy and those with AIDS) may not benefit from vaccines or toxoids because they are unable to mount an immune response. In these situations, passive immunizing drugs such as immunoglobulins are warranted.
The nurse is giving an antihistamine and will observe the patient for which side effects? (Select all that apply.) a. Hypertension b. Dizziness c. "Hangover" effect d. Drowsiness e. Tachycardia f. Dry mouth
B, C, D, F
When assessing a patient who will be receiving a measles vaccine, the nurse will assess for which contraindication(s)? (Select all that apply.) A. Anemia B. Pregnancy C. Ear infection D. Neomycin allergy E. Latex allergy
B, D
The nurse is assessing a patient who has been taking quinidine who asks about adverse effects. Which of these are potential adverse effects of quinidine? Select all that apply. a. Muscle pain b. Tinnitus c. Dyspnea d. Diarrhea e. Anorexia
B, D, E
When the nurse is teaching a patient about taking an anti-dysrhythmic drug, which statements by the nurse are correct? (Select all that apply.) a. "Take the medication with an antacid if stomach upset occurs." b. "Do not chew sustained-release capsules." c. "If a weight gain of 5 pounds occurs within 1 week, notify your physician at the next office visit." d. "If you experience severe adverse effects, stop the drug and notify your physician." e. "If stomach upset occurs, you may take the medication with food."
B, E
A 45-year-old woman has been diagnosed with irritable bowel syndrome (IBS) and will be taking linaclotide (Linzess). Which of these conditions that may be a contraindication to this drug will the nurse look for during the assessment? A. Constipation B. Bowel obstruction C. Renal calculi D. Anemia
B.
A patient has been given a new prescription for alosetron (Lotronex), and the nurse is providing education about this medication. Which statement by the patient indicates a need for further education? A. "I will not take a double dose in the afternoon if I forget my morning dose." B. "I should be seeing improvement within a few days." C. "I will call my doctor if I experience severe constipation or bloody diarrhea." D. "This drug will improve symptoms but won't cure my IBS.
B.
A patient has been receiving long-term antibiotic therapy as part of treatment for an infected leg wound. He tells the nurse that he has had "spells of diarrhea" for the last week. Which medication is most appropriate for him at this time? A. bismuth subsalicylate B. L. acidophilus C. diphenoxylate with atropine D. codeine
B.
A patient is in the outpatient cancer center for his first round of chemotherapy. Which schedule does the nurse consider most appropriate in terms of timing for the intravenous antiemetic drug? A. Four hours before the chemotherapy begins B. Thirty to sixty minutes before the chemotherapy begins C. At the same time as the chemotherapy drugs are given D. At the first sign of nausea
B.
The nurse is providing patient teaching regarding scopol-amine transdermal patches (Transderm-Scōp) to a patient who is planning an ocean cruise. Which instruction is most appropriate? A. "Apply the patch the day before traveling." B. "Apply the patch at least 4 hours before traveling." C. "Apply the patch to the shoulder area." D. "Apply the patch to the temple just above the ear."
B.
The antidiarrheal drug Lomotil contains both diphenoxylate, a synthetic opiate agonist, and atropine, an anticholinergic. The purpose of the atropine in this combination is to: A. enhance the effects of the diphenoxylate. B. discourage recreational use of the opiate diphenoxylate. C. counteract the adverse effects of the diphenoxylate. D. act as an adsorbent for bacteria in the bowel.
B. A small dose of atropine, combined with diphenoxylate, discourages recreational use of this drug because if taken in large doses, a person will experience unpleasant anticholinergic effects such as dry mouth, abdominal pain, blurred vision, and tachycardia.
The nurse is preparing to administer scopolamine to a patient. It is most important for the nurse to determine if the patient has a history of which condition? A. Cataracts B. Narrow-angle glaucoma C. Presbyopia D. Detached retina
B. The nurse should only administer the anticholinergic drug scopolamine after careful assessment of the patient's health history and medication history. One very important concern to reemphasize with scopolamine, which is commonly administered in patch form to prevent motion sickness, is the contraindication to its use in patients with narrow-angle glaucoma. If the patient has a history of this disorder, then another antiemetic or antinausea drug should be used.
A hospitalized patient is experiencing diarrhea. Which of the following does the nurse identify as adverse side effects of diphenoxylate with atropine therapy? (Select all that apply.) A. Increased salivation B. Abdominal pain C. Bradycardia D. Blurred vision
B. and D. When administering diphenoxylate with atropine, the nurse should assess the patient for adverse effects, including dry mouth, abdominal pain, tachycardia, and blurred vision.
The nurse is reviewing the current medications for a patient who has a new prescription for aprepitant (Emend). Which of these medications may have an interaction with aprepitant? (Select all that apply.) A. digoxin B. warfarin C. Oral contraceptives d. Nonsteroidal antiinflammatory drugs E. Corticosteroids
B., C., and E.
A 28-year-old patient is in the urgent care center after stepping on a rusty tent nail with her bare feet. The nurse evaluates the patient's immunity status and notes that the patient thinks she had her last tetanus booster about 10 years ago, just before starting college. Which immunization would be most appropriate at this time? A. Immunoglobulin intravenous (Gammar-P IV) B. DTaP (Daptacel) (diphtheria, pertussis) tetanus, and acellular C. Tdap (Adacel) (diphtheria, tetanus, and acellular pertussis) D. No immunizations are necessary at this time
C
A nurse with adequate knowledge about the administration of intravenous nitroglycerin will recognize that which statement is correct? a. The intravenous form is given by IV push injection. b. Because the intravenous forms are short-lived, the dosing must be every 2 hours. c. Intravenous nitroglycerin must be protected from exposure to light through use of special tubing. d. Intravenous nitroglycerin can be given via gravity drip infusions
C
A patient calls the family practice office to report that he has seen his pills in his stools when he has a bowel movement. How will the nurse respond? a. "The pills are not being digested properly. You need to take them on an empty stomach." b. "The pills are not being digested properly. You need to take them with food." c. "What you are seeing is the wax matrix that contained the medication, but the drug has been absorbed." d. "This indicates that you are not tolerating this medication and will need to switch to a different form."
C
A patient has a new prescription for transdermal nitroglycerin patches. The nurse teaches the patient that these patches are most appropriately used for which reason? a. To relieve exertional angina b. To prevent palpitations c. To prevent the occurrence of angina d. To stop an episode of angina
C
A patient is in the clinic for a follow-up visit. He has been taking amiodarone (Cordarone) for almost 1 year, and today he tells the nurse, "I am noticing some blue color around my face, neck, and upper arms. Is that normal?" Which is the nurse's correct response? a. "This is an expected side effect and should go away soon." b. "This is a harmless effect. As long as the medication is working, we'll just monitor your skin." c. "This can happen with amiodarone. I will let your doctor know about it right away." d. "How much sun exposure have you had recently?"
C
During assessment of a patient who is receiving digoxin, the nurse monitors for findings that would indicate an increased possibility of toxicity, such as a. apical pulse rate of 62 beats/min. b. digoxin level of 1.5 ng/mL c. serum potassium level of 2.0 mEq/L d. serum calcium level of 9.9 mEq/L
C
In assessing a patient who has been taking amiodarone for 6 months, the nurse monitors for which potential adverse effect? a. Hyperglycemia b. Dysphagia c. Photophobia d. Urticaria
C
The nurse is preparing to give a second dose of DTaP vaccine to a 6-month old infant. The infant's mother tells the nurse that the last time he received this vaccination, the injection site on his leg became warm and slightly reddened. Which is the nurse's best action? a. Skip the dose and notify physician b. Wait 6 months and then administer the dose c. Explain that these effects can be expected and give the medication d. Give half the prescribed dose this week and the other half next week if tolerated well
C
The nurse knows that an antitussive cough medication would be the best choice for which patient? a. A patient with a productive cough b. A patient with chronic paranasal sinusitis c. A patient who has had recent abdominal surgery d. A patient who has influenza
C
When giving a vaccination to an infant, the nurse will tell the mother to expect which adverse effect? A. Fever over 101°F (38.3°C) B. Rash C. Soreness at the injection site D. Chills
C
When giving decongestants, the nurse must remember that these drugs have alpha-adrenergic-stimulating effects that may result in which effect? a. Fever b. Bradycardia c. Hypertension d. CNS depression
C
When reviewing various immunizing drugs, the nurse recalls that some products provide long-lasting immunity against a particular pathogen. Which is an example of this type of product? a. Tetanus immune globulin b. Black widow spider antivenom c. Poliovirus vaccine d. Rh (D) immune globulin
C
Before administering an adrenergic decongestant, it is most important for the nurse to asses the patient for a history of A. cataracts. B. gastric ulcer. C. diabetes mellitus. D. hypothyroidism.
C Rationale: Adrenergic drugs are contraindicated in patients with narrow-angle glaucoma, uncontrolled cardiovascular disease, hypertension, diabetes, and hyperthyroidism. They are also contraindicated when the patient is unable to close his or her eyes (e.g., after a cerebrovascular accident), as well as in patients with a history of cerebrovascular accident or transient ischemic attacks, long-standing asthma, BPH, or diabetes.
A patient with a history of HF presents to the emergency department with difficulty breathing, cough, and edema of the lower extremities. The nurse anticipates administration of which type of medication? A. Positive chronotrope B. Negative chronotrope C. Positive inotrope D. Negative inotrope
C Rationale: Positive inotropes are used to increase the force of myocardial contraction in the treatment of patients with HF. Negative inotropes would cause the heart to have a decreased force of myocardial contraction and would not be effective. Positive chronotropes increase the rate at which the heart beats, and negative chronotropes decrease the rate at which the heart beats.
A patient who has had an MI is taking a beta blocker. What is the main benefit of beta blocker therapy for this patient? A. Vasodilation of the coronary arteries B. Increased force of cardiac contraction C. Slowing of the heart rate D. Maintaining adequate BP
C Rationale: Slowing the heart rate in patients with ischemic heart disease reduces myocardial oxygen demand and allows the coronary arteries time to fill with oxygen- and nutrient-rich blood. Beta blockers also block the irritating effects of circulating catecholamines on the heart.
The patient is prescribed an ACE inhibitor. The nurse understands the primary mechanism by which the ACE inhibitors exert their therapeutic effect in a patient in HF is A. to inhibit catecholamine release. B. to inhibit acetylcholine release. C. to inhibit aldosterone secretion. D. to prevent vagal stimulation.
C Rationale: The ACE inhibitors are beneficial in the treatment of HF because they prevent sodium and water resorption by inhibiting aldosterone secretion. This causes diuresis, which decreases blood volume and blood return to the heart. This in turn decreases preload, or the left ventricular end-diastolic volume, and the work required of the heart.
Before administering an antihistamine to a patient, it is most important for the nurse to assess the patient for a history of which condition? A. Chronic urticaria B. Motion sickness C. Urinary retention D. Insomnia
C Rationale: The anticholinergic effects of antihistamines may cause difficulty urinating. The other answers are potential indications for an antihistamine.
A patient is receiving digoxin 0.25 mg/day as part of treatment for HF. The nurse assesses the patient before medication administration. Which assessment finding would be of most concern? A. Apical heart rate of 58 beats/min B. Ankle edema +1 bilaterally C. Serum potassium level of 2.9 mEq/L D. Serum digoxin level of 0.8 ng/mL
C Rationale: The hypokalemia may precipitate digoxin toxicity; therefore, it is the biggest concern. The apical pulse is slightly under 60 beats/min, but bradycardia may occur with digoxin therapy, and the heart rate should be monitored. The ankle edema may be a manifestation of his HF and not a new concern. The digoxin level is within the normal range.
A patient asks how to apply transdermal nitroglycerin. What is the nurse's best response? A. "Always apply the transdermal patch over the area of your chest where your heart is." B. "Keep the previous patch on for 1 full day so you always have two patches on at a time." C. "Apply the patch to hairless areas of the body." D. "First apply Vaseline to your body; then apply the transdermal patch."
C Rationale: The transdermal patch should be applied to a hairless, residual-free area of the body with the sites being rotated each time. The old transdermal patch should be completely removed and a new one applied.
After immunizations at a well-baby check-up, a mother notes that her infant has redness and swelling at the injection site, is irritable, and has a fever of 99.9° F. She calls the clinic and is worried about her baby. Which action by the nurse is appropriate? A. Tell the mother there's nothing to worry about and that these symptoms are normal and will go away. B. Tell the mother that she should bring her baby in to the office for an examination. C. Tell the mother that acetaminophen and rest should help to alleviate these symptoms, which are not unusual after immunizations. D. Complete a VAERS form.
C Rationale: These minor reactions may be treated with acetaminophen and rest. Reactions that are more serious or unusual should be reported with a VAERS form.
What information will the nurse include when teaching the patients about taking beta2-blocking drugs for the treatment of angina? A. "Call your health care provider if you heart rate is 64 beats/min." B. "These drugs are safe to use in patients who have asthma." C. "Call your health care provider if you experience a weight gain of 2 lb or more in 24 hours or 5 lb or more in 1 week." D. "Avoid taking these medications with grapefruit juice."
C Rationale: Weight gain can indicate serious adverse effects of beta2-blocking drugs, so the health care provider should be called. A pulse of 64 beats/min is acceptable; these drugs should be avoided in patients with asthma, and there is no interaction with grapefruit juice. CCBs should not be administered with grapefruit juice.
A patient who was walking his dog developed chest pain and sat down. He continues to experience chest pain when sitting down. When should he call 911? A. Immediately B. If the pain becomes more severe C. If one sublingual tablet does not relieve the pain after 5 minutes D. If the pain is not relieved after three sublingual tablets, taken 5 minutes apart
C Rationale: With sublingual nitroglycerin, the medication should be taken at the first sign of chest pain and not be delayed until the pain is severe. The patient should sit or lie down and take one sublingual tablet. According to current guidelines, if the chest pain or discomfort is not relieved in 5 minutes after one dose, the patient (or family member) should call 911 immediately. The patient can take one more tablet while awaiting emergency care and a third tablet 5 minutes later but no more than three tablets total. These guidelines reflect the fact that angina pain that does not respond to nitroglycerin may indicate an MI.
A patient with heart failure will be starting the beta blocker metoprolol (Lopressor). The nurse will monitor for which expected cardiovascular effects? (Select all that apply.) a. Increased heart rate b. Increased myocardial contractility c. Delayed AV node conduction d. Reduced heart rate e. Decreased myocardial automaticity
C, D, E
The nurse is providing teaching after an adult receives a booster immunization. Which adverse reactions will the nurse immediately report to the health care provider? (Select all that apply.) A. Swelling and redness at the injection site B. Fever of 100°F (37.8°C) C. Joint pain D. Heat over the injection site E. Rash over the arms, back, and chest F. Shortness of breath
C, E, F
A patient is being prepared for a colonoscopy. The nurse expects which laxative to be used as preparation for this procedure? A. Methylcellulose B. Docusate sodium C. PEG-3350 D. Glycerin
C.
A patient is taking lactulose four times a day but does not have a history of constipation. In fact, he has had bowel movements every day. What is the probable reason for the lactulose? A. Cleansing the bowel before a procedure B. Removal of helminths C. Reduction of high ammonia levels associated with liver failure D. Daily maintenance to prevent constipation
C. Lactulose helps to reduce blood ammonia levels by converting ammonia to ammonium, which can then be eliminated by the body.
A patient tells the nurse that he takes ginger almost every day for nausea. It is most important for the nurse to determine if the patient is taking which medication? A. furosemide (Lasix) B. acetaminophen (Tylenol) C. warfarin (Coumadin) D. calcium supplements
C. Use of ginger can increase absorption of all oral medications and may theoretically increase bleeding risk with anticoagulants (e.g., warfarin [Coumadin]) or antiplatelet drugs (e.g., clopidogrel [Plavix]).
Before administering belladonna alkaloids, it is most important for the nurse to assess the patient for a history of which condition? A. Anemia B. Diabetes mellitus C. Myasthenia gravis D. Hypertension
C. Use of the belladonna alkaloid preparations is contraindicated in patients who have shown a hypersensitivity to anticholinergics and in patients with narrow-angle glaucoma, GI obstruction, myasthenia gravis, paralytic ileus, and toxic megacolon.
In reviewing the various types of antinausea medications, the nurse recognizes that prokinetic drugs are also used for which condition(s)? (Select all that apply.) A. Motion sickness B. Vertigo C. Gastroesophageal reflux D. Delayed gastric emptying e. GI obstruction
C. and D.
A patient is taking a decongestant to help reduce symptoms of a cold. The nurse will instruct the patient to observe for which possible symptom, which may indicate an adverse effect of this drug? a. Increased cough b. Dry mouth c. Slower heart rate d. Heart palpitations
D
A patient with angina has been given a prescription for a calcium channel blocker. The nurse knows that this class of drugs is used to treat which type of angina? a. Effort b. Unstable c. Crescendo d. Vasospastic
D
An animal control officer was bitten by a stray dog that showed signs of rabies. Which statement by the nurse is correct regarding the treatment for rabies prophylaxis? A. "You will receive treatment if you begin to show symptoms of rabies B. "You will receive one oral dose of medication today, and one more in 1 week." C. "You will need to receive 3 subcutaneous injections over the next week." D. "You will need to receive 5 intramuscular injections over the next 28 days"
D
The immunity that is passed from a mother to her nursing infant through antibodies in breast milk is known as what type of immunity? a. Genetic immunity b. Active immunity c. Artificially acquired passive immunity d. Naturally acquired passive immunity
D
The nurse is administering lidocaine and considers which condition, if present in the patient, is a caution for the use of this drug? a. Tachycardia b. Hypertension c. Ventricular dysrhythmias d. Renal dysfunction
D
The nurse is assessing a patient who is receiving a milrinone infusion and checks the patient's cardiac rhythm on the heart monitor. What adverse cardiac effect is most likely to occur in a patient who is receiving intravenous milrinone? a. Tachycardia b. Bradycardia c. Atrial fibrillation d. Ventricular dysrhythmia
D
The nurse is reviewing the Centers for Disease Control (CDC) recommendations for vaccines. The pneumococcal vaccine (Pneumovax 23) is recommended for which group? A. Newborn infants B. Patients who are immunosuppressed C. Patients who are transplant candidates D. Smokers between 19 and 64 years of ag
D
A patient is in the emergency department with new-onset atrial fibrillation. Which order for digoxin would most likely have the fastest therapeutic effect? A. Digoxin 0.25 mg PO daily B. Digoxin 1 mg PO now; then 0.25 mg PO daily C. Digoxin 0.5 mg IV push daily D. Digoxin 1 mg IV push now; then 0.25 mg IV daily
D Rationale: A digitalizing dose is often used to quickly bring serum levels of the drug up to a therapeutic level. IV doses would accomplish this more quickly.
Which patient is the best candidate to receive nesiritide therapy? A. A patient with atrial fibrillation who has not responded to other drugs B. A patient needing initial treatment for HF C. A patient with reduced cardiac output D. A patient with acutely decompensated HF who has dyspnea at rest
D Rationale: At this time, nesiritide is generally used in the intensive care setting as a final effort to treat severe, life-threatening HF, often in combination with several other cardiostimulatory medications. The manufacturer recommends that nesiritide not be used as a first-line drug for this purpose. In 2005, an expert panel reviewed nesiritide at the request of the U.S. Food and Drug Administration in response to reports of worsened renal function and mortality. The expert panel stated that the use of nesiritide should be strictly limited to treatment of patients with acutely decompensated HF who have dyspnea at rest. It should not be used to replace diuretics and should not be used repetitively or to improve renal function.
The patient is discharged home and returns to the emergency department 4 days later. The patient is admitted to the ICU with acute decompensated HF with dyspnea at rest. The nurse anticipates administration of which medication? A. atropine B. carvedilol (Coreg) C. lisinopril (Prinivil) D. nesiritide (Natrecor)
D Rationale: Nesiritide is used in the ICU setting as a final effort to treat severe, life-threatening HF, often in combination with several other cardiostimulatory medications. Lisinopril (Prinivil) is an ACE inhibitor that is used in the management of HF. Carvedilol (Coreg) has been shown to slow the progression of HF and to decrease the frequency of hospitalization in patients with mild to moderate (class II or III) HF. Atropine is used to increase heart rate.
A patient with extremely high blood pressure (BP) is in the emergency department. The physician will order therapy with nitroglycerin to manage the patient's BP. Which form of nitroglycerin is most appropriate? A. Sublingual spray B. Transdermal patch C. Oral capsule D. IV infusion
D Rationale: The IV infusion of nitroglycerin will have the fastest effect, and the dose will be titrated to the patient's response.
A patient has received an IV dose of adenosine, and almost immediately the heart monitor shows asystole. What should the nurse do next? A. Check the patient's pulse. B. Prepare to administer cardiopulmonary resuscitation. C. Set up for defibrillation. D. Continue to monitor the patient.
D Rationale: The half-life of adenosine is very fast—only 10 seconds—and the asystole only lasts for a few seconds. The nurse should continue to monitor the patient for therapeutic and adverse effects of the medication.
The zoster vaccine (Zostavax) is used in which situation? A. To prevent chickenpox in children B. To prevent chickenpox in children who have been exposed to herpes zoster C. To prevent postherpetic neuralgia in patients who have shingles D. To prevent reactivation of the zoster virus that causes shingles in patients age 60 years and older
D Rationale: Zoster vaccine (Zostavax) is a vaccine for the prevention of herpes zoster. The vaccine is recommended for patients 60 years and older to prevent reactivation of the zoster virus that causes shingles. The vaccine does not prevent postherpetic neuralgia. It can be given to patients who have already had shingles. The vaccine should not be used for the prevention of chickenpox and should not be given to children.
A parent calls to ask about giving a medication for diarrhea to his child, 15 years of age, who is recovering from the flu. The nurse expects the prescriber to recommend which medication? A. bismuth subsalicylate (Pepto-Bismol) B. Lactobacillus GG (Culturelle) C. belladonna alkaloid/phenobarbital combination (Donnatal Elixir) D. loperamide (Imodium A-D)
D.
A patient who has been receiving chemotherapy tells the nurse that he has been searching the Internet for antinausea remedies and that he found a reference to a product called Emetrol (phosphorated carbohydrate solution). He wants to know if this drug would help him. What is the nurse's best answer? A. "This may be a good remedy for you. Let's talk to your prescriber." B. "This drug is used only after other drugs have not worked." C. "This drug is used only to treat severe nausea and vomiting caused by chemotherapy." D. "This drug may not help the more severe nausea symptoms associated with chemotherapy."
D.
The nurse is administering oral methylcellulose (Citrucel), keeping in mind that a major potential concern with this drug is which of these? A. Dehydration B. Tarry stools C. Renal calculi D. Esophageal obstruction
D.
A patient with terminal cancer has not had chemotherapy for a few weeks and has had no nausea or vomiting since then. However, he is taking dronabinol twice a day. The reason for the dronabinol order is to: A. prevent recurrence of the chemotherapy-induced nausea and vomiting. B. prevent stress ulcers. C. improve his mood. D. stimulate his appetite.
D. Dronabinol is used as an appetite stimulant in patients who are experiencing nutritional wasting caused by cancer and cancer treatment.
A patient who takes Coumadin has been prescribed an adsorbent for diarrhea. It is important for the nurse to assess the patient for bruising because use of Coumadin with adsorbents interferes with the absorption of vitamin: A. A. B. D. C. E. D. K.
D. The oral anticoagulant warfarin is more likely to cause increased bleeding times or bruising when co-administered with adsorbents. This is thought to be because the adsorbents bind to vitamin K, which is needed to make certain clotting factors. Vitamin K is synthesized by the normal bacterial flora in the bowel.
Which group of drugs used to treat nausea does the nurse identify as most likely to cause a prolonged QTc interval? A. Prokinetics B. Antidopaminergics C. Tetrahydrocannabinoids D. Serotonin blockers
D. The serotonin blockers have the potential to cause prolonged QTc interval.
A 48-year-old patient has been admitted with abdominal pain, and states that she has not had a bowel movement for 4 days. Her abdomen is distended and slightly tender. Which laxative would be appropriate for this patient? A. Milk of Magnesia B. A bulk-forming laxative C. Mineral oil D. No laxative should be given at this time.
D. These laxatives are contraindicated in the presence of undiagnosed abdominal pain because taking a laxative in cases of intestinal obstruction could be very harmful to the patient. No laxatives should be given if the patient has undiagnosed abdominal pain.
The nurse is preparing to educate a group of patients on the management of angina. Which drug groups are most often used to treat patients with angina?
nitrates/nitrites beta blockers CCBs