PHARM - Exam 4

An adult patient is admitted for an asthma attack. Which assessment obtained by the nurse would support that albuterol (Proventil) was effective? a. Decrease in wheezing present on auscultation b. Less dyspnea while positioned in a high Fowlers position c. Sputum production is clear and watery d. Respiratory rate decreased to 38 breaths/min

ANS: A A bronchodilator would open the airways and result in a reduction of wheezing. Less dyspnea while positioned in a high Fowlers position, clear and watery sputum, and a respiratory rate decreased to 38 breaths/min would not indicate that the medication was effective.

A young male patient taking an antipsychotic is experiencing an oculogyric crisis. The nurse prepares to administer a. diphenhydramine. b. haloperidol. c. aripiprazole. d. risperidone.

ANS: A Acute dystonic reactions may be controlled by intramuscular injections of diphenhydramine. Haloperidol, aripiprazole, and risperidone are not used for dystonic reactions.

Which type of adverse effects is present when a patient displays prolonged tonic contractions of the tongue, oculogyric crisis, and torticollis? a. Dystonic reactions b. Pseudoparkinsonism c. Akathisia d. Tardive dyskinesia

ANS: A Dystonic reactions are the first extrapyramidal symptoms to occur when a patient is taking antipsychotic agents. Dystonias are spasmodic movements of muscle groups such as tongue protrusion, rolling back of the eyes (oculogyric crisis), jaw spasms (trismus), or neck torsion (torticollis). Pseudoparkinsonism is characterized by tremor and rigidity. Akathisia is characterized by subjective feelings of anxiety and restlessness, accompanied by pacing and the inability to remain in one place for extended periods. Tardive dyskinesia is characterized by persistent involuntary hyperkinetic movements.

What information would be most important for the nurse to provide to a patient when teaching about the adverse effects of succinimide therapy? a. Nausea, vomiting, and indigestion are common during the initiation of therapy. b. Avoid taking the medication with food or milk to minimize adverse effects. c. Sedation, drowsiness, and dizziness tend to worsen with continued therapy. d. Reducing the dosage of medication will relieve symptoms of nausea.

ANS: A Nausea, vomiting, and indigestion are common during initiation of therapy. Taking the medicine with food or milk reduces the nausea and indigestion. Sedation, drowsiness, and dizziness tend to disappear with continued therapy. Gradual increases in dosage tend to decrease nausea and vomiting.

From where do the fluids of the respiratory tract originate? a. Specialized mucous glands called goblet cells b. Lymph fluid drawn across nasal membranes by osmosis c. Specialized beta cells in the islets of Langerhans d. Cells that produce aqueous humor

ANS: A The fluids of the respiratory tract originate from specialized mucous glands (goblet cells) and serous glands that line the respiratory tract. The goblet cells produce gelatinous mucus that forms a thin layer over the interior surfaces of the trachea, bronchi, and bronchioles. Lymph does not make up fluid in the respiratory tract. The beta cells in the islets of Langerhans are located in the pancreas. Cells that produce aqueous humor are located in the interior of the eye.

Which premedication assessment by the nurse is most important prior to the initiation of carbamazepine (Tegretol) therapy? a. Determine patients ancestry. b. Monitor blood pressure (BP) lying, sitting, and standing. c. Auscultate lung sounds. d. Obtain smoking history.

ANS: A The nurse needs to review the patients history to exclude Asian ancestry, including South Asian Indians. If the patient does have this ancestry, bring it to the prescribers attention so that genetic testing may be completed. BP monitoring is important and hypotension is an adverse effect, but it is not as significant to monitor prior to the initiation of therapy. Lung sound assessment and smoking history assessment are important assessments, but not prior to the initiation of carbamazepine therapy.

The nurse is teaching a patient who is taking clozapine (Clozaril) to have weekly blood tests for the first 6 months of treatment to monitor for which potential complication? a. Agranulocytosis b. Vitamin deficiencies c. Clotting abnormalities d. Polycythemia

ANS: A The use of clozapine requires a baseline and weekly white blood cell (WBC) counts because of the high incidence of agranulocytosis. Clozapine does not cause vitamin deficiencies. Clozapine does not interfere with clotting abilities. Clozapine does not affect red blood cell volume.

Dystonic reactions, pseudoparkinsonism, akathisia, and tardive dyskinesia are types of which effect? a. Extrapyramidal symptoms b. Allergic reactions c. Idiosyncratic reactions d. Therapeutic responses

ANS: A There are four categories of extrapyramidal symptoms: dystonic reactions, pseudoparkinsonism, akathisia, and tardive dyskinesia. These are not allergic reactions, idiosyncratic reactions, or therapeutic responses.

Which patient(s) would be able to take an alpha adrenergic decongestant safely? (Select all that apply.) a. 24-year-old woman with allergic rhinitis b. 18-year-old man with cold symptoms c. 64-year-old woman with a history of heart disease d. 70-year-old woman with glaucoma e. 56-year-old man with prostatic hypertrophy

ANS: A, B A 24-year-old woman with allergic rhinitis and an 18-year-old man with cold symptoms should be able to take an alpha adrenergic decongestant safely. Alpha adrenergic decongestants will stimulate alpha receptors throughout the body. Therefore, oral therapy should be prescribed with caution in patients with a history of cardiac disease, intraocular pressure, or prostatic hypertrophy.

When does allergic rhinitis occur? (Select all that apply.) a. Nasal mucosa become inflamed. b. Exposure as a result of an allergen produces inflammation. c. Histamine is released following allergen exposure. d. The weather is cold during the winter. e. A person has an initial exposure to an antigen.

ANS: A, B, C Allergic rhinitis is inflammation resulting from an allergic reaction. Following allergen exposure, and with subsequent inhalation of the allergen, an antigen antibody reaction occurs, causing inflammation and swelling of the nasal passages. Histamine is released during the allergic reaction. Allergic rhinitis can occur during any season, depending on when the allergen is most abundant in the air. Allergic rhinitis occurs in patients who have experienced previous exposure to one or more allergens and have developed antibodies.

Which action(s) is/are true of antihistamines? (Select all that apply.) a. Reduce inflammation locally b. Antagonize H1 receptors c. May be administered orally d. Are systemically distributed e. Reduce nasal congestion

ANS: A, B, C, D Antihistamines reduce the symptoms of nasal itching, sneezing, rhinorrhea, lacrimation, and conjunctival itching through local and systemic actions. Antihistamines are H1 antagonists or blockers, may be administered orally, are distributed systemically, and do not reduce nasal congestion.

Which is/are extrapyramidal adverse effect(s) of antipsychotic agents? (Select all that apply.) a. Spasmodic movements of muscle groups b. Masklike expression c. Lip smacking d. Inability to sit in one place for an extended period e. Weight gain

ANS: A, B, C, D Dystonic reactions, pseudoparkinsonism, tardive dyskinesia, and akathisia are extrapyramidal symptoms of antipsychotic agents. Antipsychotic drug therapy often causes substantial weight gain, but this is not classified as an extrapyramidal adverse effect.

Which physical assessment(s) would be pertinent to the patient with asthma? (Select all that apply.) a. Lung sounds b. Patient color c. Respiratory rate and effort d. Peak expiratory flow e. Pulse oximetry reading f. Bowel sounds

ANS: A, B, C, D, E Lung sounds, pallor and color, respiratory rate and effort, peak expiratory flow, and pulse oximetry should be assessed in the patient with asthma. Assessment of bowel sounds is not pertinent.

What is true about arterial blood gases (ABGs)? (Select all that apply.) a. They are measured from an arterial sample. b. They measure partial pressures of carbon dioxide. c. They measure blood pH. d. They measure partial pressures of sodium e. They measure partial pressures of oxygen.

ANS: A, B, C, E ABGs are taken from samples from arterial blood, which must be drawn and analyzed immediately. ABGs measure partial pressures of carbon dioxide and bicarbonate, pH, and partial pressures of oxygen. ABGs do not measure partial pressures of sodium.

The nurse is preparing education for a patient who has developed rebound nasal congestion resulting from use of topical decongestants. What information will the nurse include? (Select all that apply.) a. For future topical decongestant use, follow the dosage directions daily. Do not overuse. b. Stop the topical decongestant at once. c. A decrease in congestion will occur immediately. d. Nasal steroid solutions can be used but may take several days to reduce inflammation and congestion. e. Use nasal saline spray to moisturize irritated mucosa.

ANS: A, B, D, E The best treatment for rebound nasal congestion caused by use of topical decongestants is prevention. Further use of the medication will exacerbate the nasal congestion. Nasal steroid solutions may help gradually reduce the congestion without exacerbating the symptoms. Nasal saline spray will bring comfort to the irritated nasal mucosa by moisturizing them. A decrease in the nasal congestion will occur gradually.

A patient on anticonvulsant therapy confides to the nurse at an outpatient clinic that she suspects she may be pregnant. The nurse should encourage the patient to take which action(s)? (Select all that apply.) a. Consult an obstetrician. b. Discontinue medications. c. Carry an identification card. d. Provide a list of seizure medications. e. Consider oral contraception.

ANS: A, C, D Pregnancy considerations include encouraging the patient to consult with an obstetrician, provide a list of seizure medications, and carry an identification card. Medications should not be discontinued unless told to do so by the health care provider. If pregnancy is suspected, oral contraceptives should not be encouraged.

Which topically active aerosol steroids are highly effective for reducing sneezing, nasal itching, stuffiness, and rhinorrhea? (Select all that apply.) a. Beclomethasone (Beconase AQ) b. Prednisone (Deltasone) c. Fluticasone (Flonase) d. Flunisolide (Nasarel) e. Budesonide (Rhinocort Aqua)

ANS: A, C, D, E Beclomethasone, fluticasone, flunisolide, and budesonide are drugs used to reduce sneezing, nasal itching, stuffiness, and rhinorrhea. Prednisone is not used to treat these symptoms.

Which principle(s) would be when teaching a patient to use a steroid inhaler? (Select all that apply.) a. Frequent oral hygiene is necessary. b. The inhaler should be used on a PRN basis only. c. Rinse and spit after inhalation of the medication. d. When taking a steroid drug as well as a bronchodilator, the bronchodilator should be administered first. e. Hold the breath for 10 seconds during inhalation of the medication.

ANS: A, C, D, E Steroid medications may predispose patients to secondary fungal infections in the mouth. To prevent this, patients should be instructed on good oral hygiene technique and told to gargle and rinse the mouth with a hydrogen peroxide mouthwash after each aerosol treatment. In addition to good oral hygiene, patients should rinse and spit after inhalation of the medication. When a bronchodilator and steroid are prescribed, the bronchodilator should be administered as the first puff of medication and, after waiting a few minutes, the steroid medication should be administered. This procedure facilitates bronchodilation so that the second medication will have a better chance of reaching lower parts of the lungs. Patients should hold their breath for 10 seconds during inhalation of the medication so that the medication is fully inhaled. Steroid inhalers should be used on a regular basis to prevent symptoms.

The health care provider orders diazepam (Valium) 10 mg IV stat for a patient who was admitted with status epilepticus. What important nursing interventions(s) associated with administration of this medication IV should the nurse perform? (Select all that apply.) a. Apply a cardiac monitor to the patient to assess for continuous heart rate, if not already done. b. Administer the prescribed dosage over 1 minute. c. Mix diazepam in a primary IV solution to avoid overdosing. d. Continuously assess the patients airway. e. Obtain the correct dose (10 mg) and administer over slow IV push.

ANS: A, D, E It is important to monitor the patient for bradycardia during administration of diazepam. During a seizure of any type, it is important to assess for airway patency continuously. Diazepam should be administered slowly by the IV route at a rate of no more than 5 mg/min. For status epilepticus, 5 to 10 mg is typical, preferably by slow IV. The dose may be repeated every 5 to 10 minutes, up to a total dosage of 30 mg. If necessary, repeat therapy in 2 to 4 hours; other drugs are preferable for long term control. Diazepam is incompatible with most other IV medications and should not be combined.

The nurse is preparing to administer zonisamide (Zonegran) to a newly admitted patient with the diagnosis of adult partial seizures. The nurse should hold this medication if the patient has which sign(s) or symptom(s)? (Select all that apply.) a. Skin rash b. Urinary frequency c. Drowsiness d. Allergy to Bactrim e. Pruritus

ANS: A, D, E Zonisamide should not be administered without specific approval if the patient has an allergy to Bactrim or a dermatologic reaction such as a skin rash and/or pruritus. Urinary frequency is not associated with zonisamide. Drowsiness is a common adverse effect of zonisamide.

The nurse is providing nutrition information to a patient diagnosed with a lower respiratory tract disease. What is the rationale for limiting caffeine? a. Caffeine increases the respiratory rate. b. Caffeine can result in thicker lung secretions. c. Caffeine will increase the anxiety response associated with dyspnea. d. Caffeine can cause bronchospasm.

ANS: B Avoid caffeine containing beverages because caffeine is a weak diuretic. Diuresis promotes thickening of lung secretions, making it more difficult to expectorate them.

The nurse is preparing discharge instructions for a patient with a history of diabetes who has just been diagnosed with seizure disorder. The patient has been prescribed hydantoin therapy. What will the patient most likely experience? a. Hunger b. Hyperglycemia c. Diarrhea d. Pupil dilation

ANS: B Hydantoins may elevate blood sugar levels. Hunger, diarrhea, and pupil dilation are adverse effects of hydantoin therapy. Constipation and nystagmus are potential adverse effects.

What is the action of zafirlukast (Accolate), a leukotriene receptor antagonist? a. Dilates the alveolar sacs b. Decreases leukotriene release c. Inhibits histamine release d. Increases viscosity of secretions

ANS: B Leukotrienes are a class of anti inflammatory agents that block leukotriene formation, and they are part of the inflammatory pathway that causes bronchoconstriction. Leukotrienes work to reduce bronchoconstriction, and they do not inhibit histamine release or affect viscosity of secretions.

Which condition would indicate to the nurse that a patient has phenytoin (Dilantin) toxicity? a. Oculogyric crisis b. Nystagmus c. Strabismus d. Amblyopia

ANS: B Nystagmus (involuntary rhythmic, uncontrollable movements of one or both eyes) may be a sign of phenytoin toxicity. Oculogyric crisis is an adverse effect of some antipsychotic medications. Strabismus is a visual disorder in which the eyes are misaligned and point in different directions. Amblyopia is a loss of visual acuity in the nondominant eye caused by lack of use of the eye in early childhood.

What dose is within the acceptable range for administering IV phenytoin (Dilantin) to a patient with a seizure disorder? a. 5 mg/min b. 30 mg/min c. 60 mg/min d. 100 mg/min

ANS: B Phenytoin is administered slowly at a rate of 25 to 50 mg/min. A rate of 5 mg/min is too slow. A rate of 60 mg/min or 100 mg/min is too fast.

What is the reason for administering potassium iodide to a patient with emphysema? a. To increase blood iodide levels b. To decrease mucus viscosity c. To reduce metabolic needs of the body d. To decrease bronchial irritation

ANS: B Potassium iodide acts as an expectorant by stimulating the bronchial glands to secrete. This will decrease the viscosity of mucous plugs, which makes it easier for patients to cough up the dry hardened plugs blocking the bronchial tubes. Potassium iodide is not given to increase serum potassium iodide levels. Potassium does not reduce metabolic needs of the body or bronchial irritation.

What initiates the sneeze reflex? a. Stimulation of the vagus nerve b. Irritation of the nasal mucosa by foreign particulate matter c. Stimulation of the tonsils d. Enervation of the olfactory cranial nerve

ANS: B Sneezing is a physiological reflex used by the body to clear the nasal passages of foreign matter. Stimulation of the vagus nerve, stimulation of the tonsils, and enervation of the olfactory cranial nerve are not what initiates the sneezing reflex.

Which is a serious adverse effect of decongestants? a. Hypotension b. Hypertension c. Orbital edema d. Facial flushing

ANS: B Sympathomimetic decongestants cause stimulation of the alpha adrenergic receptors that can increase blood pressure. Excessive use of decongestants when taking a beta adrenergic blocking agent or monoamine oxidase inhibitor can cause significant hypertension. Alpha receptor stimulation does not cause hypotension, orbital edema, or facial flushing.

The health care provider in an outpatient clinic has prescribed omalizumab (Xolair) to a patient. Which primary outcome will the nurse teach the patient to expect? a. Easier expectoration of phlegm b. Less frequent asthma exacerbations c. Increased moisture of the mucous membranes d. Liquefaction of thick secretions

ANS: B The primary therapeutic outcome associated with omalizumab therapy is reduced frequency of acute asthmatic exacerbations. Easier expectoration of phlegm, increased moisture of the mucous membranes, and liquefaction of thick secretions are not outcomes of omalizumab.

The nurse is providing instruction about ipratropium (Atrovent) to a patient with chronic obstructive pulmonary disease (COPD). Which is a common adverse effect that tends to resolve with therapy? a. Anxiety b. Dry mouth c. Tachycardia d. Urine retention

ANS: B Dry mouth is usually mild and tends to resolve with continued therapy. Anxiety, tachycardia, and urine retention are not common adverse effects.

Which statement(s) is/are true regarding the nursing assessment of a patient with a respiratory disorder? (Select all that apply.) a. Central cyanosis typically is observed on the fingers and earlobes. b. Clubbing of the fingernails is a sign of hypoxia. c. As oxygen levels diminish, mental alertness will progressively deteriorate. d. The normal respiratory rate in an adult is 10 breaths/min. e. Episodes of apnea are present in Cheyne-Stokes.

ANS: B, C, E Fingernail clubbing is a sign of hypoxia. Mental status will deteriorate as the oxygen level in the body diminishes. Apnea is present in Cheyne-Stokes respirations. Central cyanosis is not observed on the fingers and earlobes. The normal respiratory rate in an adult is more than 10 breaths/min.

The nurse is preparing to administer two inhalations of ipratropium bromide (Atrovent). When providing this medication, the nurse will instruct the patient to: (Select all that apply.) a. hold the canister horizontally. b. keep the eyes closed. c. exhale through the mouthpiece. d. wait 15 seconds before the second inhalation. e. shake the canister thoroughly prior to use.

ANS: B, D, E The eyes should be kept closed because temporary blurred vision may result if the aerosol is sprayed into the eyes. The patient should wait approximately 15 seconds, and repeat the second inhalation. The canister should be shaken thoroughly prior to use. The base of the canister should be held vertically. The patient should inhale through the mouthpiece.

The nurse is providing counseling to a patient on cromolyn sodium (Nasalcrom) nasal spray. Information relayed to the patient will include that: (Select all that apply.) a. cromolyn must be taken immediately following exposure to the stimulus. b. the patient should blow the nose before nasal instillation. c. therapeutic effects are immediate. d. inhalation will cause coughing. e. the maximum is six sprays in each nostril daily.

ANS: B, E Patients should blow their noses before nasal instillation. The maximum is six sprays in each nostril daily. Cromolyn must be taken before exposure to the stimulus that initiates an attack or allergic rhinitis. Therapeutic effects require regular use and are usually evident within 2 to 4 weeks. Coughing is not an expected adverse effect. The health care provider should be notified if inhalation causes coughing.

The nurse is teaching a patient about the administration of antihistamines. The nurse will instruct the patient to take the medication at what time of day? a. PRN throughout the day b. After contact with an allergen c. 45 minutes before exposure to an allergen d. Once nasal congestion begins

ANS: C Allergies may be seasonal or perennial. People are commonly allergic to more than one antigen simultaneously, so seasons may overlap or occur more than once per year. Antihistamines do not prevent histamine release, but reduce the symptoms of an allergic reaction by competing with the histamines for receptor sites. Antihistamines are most effective when taken 45 to 60 minutes before anticipated exposure to the allergen or when symptoms first appear. PRN use of antihistamines, waiting until after contact with an allergen, or waiting until nasal congestion begins is not the most effective administration of antihistamines.

What is the drug of choice when treating a generalized tonic clonic seizure? a. Diazepam (Valium) b. Haloperidol (Haldol) c. Valproic acid (Depakene) d. Risperidone (Risperdal)

ANS: C Anticonvulsant therapy should start with the use of a single agent selected from a group of first line agents based on the type of seizure. Valproic acid is indicated for generalized tonic clonic seizures. Diazepam is not the drug of choice for treatment of tonic clonic seizures. Haloperidol is an antipsychotic medication. Risperidone is an antipsychotic agent.

A male patient becomes verbally aggressive and insists the nurse is poisoning him as she attempts to administer haloperidol (Haldol). Which action will the nurse take? a. Support the patient's decision to refuse the medication. b. Discreetly ask an assistant to put the medication in the patient's food. c. Firmly redirect the patient to take the medication. d. Speak privately with the patient and reinforce medication action.

ANS: C During episodes of acute psychosis, the patient is out of touch with reality and often does not understand the need for medication in stabilizing his or her condition. Target symptoms such as agitation, suspicion, and paranoia are common. Health care providers must be supportive yet firm in their expectations. An open and direct manner in handling patients who are highly suspicious is critical. Delusions should not be supported. The patient is not competent to determine his need for medication. It is dishonest to hide medication in a patient's food and destroys a trusting relationship. Reasoning with the patient is unlikely to change his mind; he needs external structure for making decisions when he is aggressive and paranoid.

The clinic nurse is assessing a patient being seen for a severe allergic reaction to environmental allergens. Which symptom should the nurse prioritize as the most important? a. Hypotension b. Urticaria c. Dyspnea d. Rhinorrhea

ANS: C Dyspnea (difficulty breathing) caused by constriction and spasm of the bronchial tubes is the priority. Hypotension (low blood pressure), urticaria (severe itching), and rhinorrhea (running nose) can occur during a severe allergic reaction, but are not the priority.

What can result if a patient overuses topical decongestants? a. Hypertensive crisis b. Allergic reaction c. Secondary congestion d. Permanent olfactory damage

ANS: C Overuse of topical decongestants may lead to a rebound or increase in nasal secretions, causing a secondary congestion (known as rhinitis medicamentosa). This secondary congestion is thought to be caused by excessive vasoconstriction of blood vessels and direct irritation of the mucous membranes by the medication. As vasoconstriction wears off, the irritation triggers excessive blood flow to the passages, which in turn causes swelling and engorgement to reappear in greater intensity. Although decongestants can cause elevated blood pressure, they are not likely to cause hypertensive crisis. Allergic reaction is unlikely with decongestants. Damage to nasal tissues resulting from the use of decongestants is unlikely to be permanent.

What occurs in the nasal structures when cholinergic fibers are stimulated? a. Dryness of mucous membranes in the nostrils b. Bleeding in the mucous membranes in the nostrils c. Production of serous and mucous secretions in the nostrils d. Enhanced olfactory perception in the mucous membranes of the nostrils

ANS: C The cholinergic fibers innervate the secretory glands; when stimulated, they produce serous and mucous secretions within the nostrils. Nasal dryness is the result of treatment with anticholinergic medications. Bleeding may be a result of overtreatment with anticholinergic medications, as a result of dryness of the nasal mucous membranes. Medications tend to dull olfactory function rather than enhance it.

The pediatric nurse is caring for a patient diagnosed with refractory seizures. The physician orders a ketogenic diet. When the child receives his food tray, the nurse should remove any food containing high levels of: a. fat. b. salt. c. carbohydrates. d. vitamin K.

ANS: C The ketogenic diet is used in children and includes restriction of carbohydrate and protein intake. Fat is the primary fuel that produces acidosis and ketosis in the ketogenic diet. Salt and vitamin K are not restricted in the ketogenic diet.

A patient at sports camp is complaining of itchy and watery eyes, coughing, and sneezing when outdoors. The patients chart states that he has an allergy to grasses. Which medication will the nurse administer? a. Antitussive b. Expectorant c. Antihistamine d. Decongestant

ANS: C Antihistamines are used for inflammation and swelling resulting from the release of histamine during an antigen antibody reaction. A grass allergy means that the patient experiences a release of histamine (antibody reaction) when exposed to the antigen, grass. Antitussive medications are for relief of cough. Expectorants are for the loosening of mucus so the patient can expel it by coughing. Decongestants would not help these symptoms as much as antihistamines.

Which medication may be given to patients with allergic seasonal rhinitis who do not respond to antihistamines and sympathomimetics? a. Leukotrienes b. Mineralocorticoids c. Corticosteroids d. Cortisol

ANS: C Corticosteroids, whether applied topically or administered systemically, have been shown to be highly effective for the treatment of allergic rhinitis. Leukotrienes, made in the body, are mediators of the inflammatory response. Mineralocorticoids do not affect allergic responses. Cortisol is not the steroid of choice for the treatment of an allergic response.

Premedication assessments before the use of anticholinergic bronchodilating agents should verify that the patient has no history of which condition? a. Diabetes b. Hypertension c. Liver disease d. Glaucoma

ANS: D Anticholinergic bronchodilating agents cause mydriasis (dilation of the pupils) and cycloplegia (loss of power in the ciliary muscle); therefore, they should not be used in patients with a history of closed angle glaucoma. Diabetes, hypertension, and liver disease are not affected by the use of anticholinergic bronchodilating agents.

Which condition is associated with hydantoin therapy? a. Postictal state b. Atonia c. Seizure threshold reduction d. Gingival hyperplasia

ANS: D Encouraging good oral hygiene practices is indicated when a patient is on hydantoin therapy because its use contributes to gingival hyperplasia. Postictal state is a characteristic of generalized tonic clonic seizures. Atonia is not associated with hydantoin therapy. Hydantoin raises the seizure threshold.

The nurse is assessing a patient who is complaining of hearing voices. What is this patient experiencing? a. Delusions b. Flight of ideas c. Disorganized thinking d. Hallucinations

ANS: D Hallucinations are false sensory perceptions that are experienced without an external stimulus but seem real to the patient. Auditory hallucinations are prominent in a schizophrenic patient. Additional sensory hallucinations include those of touch, sight, smell, and body sensation. Delusions are false beliefs that persist despite evidence to the contrary. Flight of ideas is characterized by rapid changes in thought from one topic to another. Disorganized thinking is commonly associated with psychoses and consists of a flight of ideas during which the individual jumps from one idea or topic to another one.

What process in the antigen antibody reaction causes the symptoms of allergies? a. Release of antihistamines b. Production of antibodies c. Suppression of histamine d. Release of histamine

ANS: D One of the major causes of symptoms associated with an allergy is the release of histamine during the antigen antibody reaction. Antihistamines suppress the symptoms of allergic reactions. Antibodies are not responsible for the allergic symptoms. Suppressing histamine diminishes the symptoms of allergies.

What is a guideline for the nurse when administering phenytoin (Dilantin) intravenously? a. Deliver rapidly. b. Monitor for signs of tachycardia. c. Assess for hypertensive crisis. d. Administer without mixing with other medications.

ANS: D Phenytoin should not be mixed in the same syringe with other medications or added to other intravenous (IV) solutions because a precipitate will form. Phenytoin should be administered slowly at a rate of 25 to 50 mg/min. Patients should be monitored with an ECG closely for bradycardia. Patients should be monitored for hypotension.

Within minutes of the initiation of a nebulizer treatment with a sympathomimetic bronchodilator, the patient turns on his call light and states that he feels panicky and his heart is racing. Which action will the nurse take? a. Reassure the patient this is expected. b. Add more diluents to the nebulizer. c. Administer a sedative. d. Stop treatment and notify the health care provider.

ANS: D Sympathomimetic drugs increase sympathetic nervous stimulation. Symptoms such as nervousness, palpitations, tremors, tachycardia, and anxiety typically are dose related. These symptoms should be reported to the health care provider immediately because the patient may require a decreased dosage. These symptoms could lead to further complications if allowed to persist and are not common adverse effects. Although this may be a common result, it is not an expected outcome. Diluting the medication would not decrease the dose. Although a sedative might be appropriate for the patient, this is not the intervention of choice.

What is albuterol (Proventil) used to treat? a. Acute bronchospasm b. Acute allergies c. Nasal congestion d. Dyspnea on exertion

ANS: A The short-acting beta agonists have a rapid onset (few minutes) and are used to treat acute bronchospasm. Beta agonists are not used to treat allergies. Decongestants are used for nasal congestion. Long-acting beta agonists are used for exertional dyspnea.

Which medication is used to control seizures or prevent migraine headaches? a. Topiramate (Topamax) b. Zonisamide (Zonegran) c. Valproic acid (Depakene) d. Tiagabine (Gabitril)

ANS: A Topiramate has been approved for adults in the prevention (but not treatment) of migraine headaches. Zonisamide, valproic acid, and tiagabine do not affect migraine headaches.

Which sign(s) and symptom(s) may occur in neuroleptic malignant syndrome? (Select all that apply.) a. Fever b. Hypertension c. Severe extrapyramidal symptoms d. Alterations in consciousness e. Bradycardia

ANS: A, B, C, D Fever, severe extrapyramidal symptoms, hypertension, and alterations in consciousness (such as stupor, mutism, and coma) are characteristic of neuroleptic malignant syndrome. Bradycardia is not a sign of neuroleptic malignant syndrome.

What is included in the nursing management of the patient with generalized tonic clonic seizure activity? (Select all that apply.) a. Restraining the patients arms to avoid further injury b. Placing padding around or under the patients head c. Attempting to insert a tongue depressor into the patients mouth d. Positioning the patient on the side once the relaxation stage is entered to allow oral secretions to drain e. Requesting additional assistance and/or necessary equipment in case the patient does not begin breathing spontaneously when the seizure is over

ANS: B, D, E Managing a patient during a seizure includes protecting the patient from further injury, (placing padding around or under the head to help prevent head injury), positioning the patient in the recovery position to facilitate respiratory effort, clearing the airway, and initiating ventilations should the patient lack spontaneous respirations after seizure. Restraining a patient who is having a seizure can cause, rather than prevent, injury. Inserting anything into the mouth of someone who is having a seizure can cause injury.

Which is an appropriate nursing intervention for a patient who has recently been prescribed clozapine (Clozaril)? a. Assess for signs and symptoms of hypoglycemia. b. Encourage a low-fiber diet. c. Measure the patient's waist circumference. d. Monitor for insomnia.

ANS: C Waist circumference baseline measurement is appropriate because of the weight gain and onset of diabetes with use of these medications. Hypoglycemia and insomnia do not occur with this medication. A low-fiber diet is not appropriate.

The nurse is obtaining a history of respiratory symptoms on a patient with the diagnosis of COPD. The patient reports smoking one pack of cigarettes per day for the past 20 years. The nurse calculates the pack years as: a. 5. b. 10. c. 20. d. 40.

ANS: C Pack years is defined as number of packs of cigarettes smoked per day times the number of years of smoking; 1 20 = 20.

A college student is being seen at an outpatient clinic with reports of allergic rhinitis and conjunctivitis. The health care provider orders fexofenadine. When providing information regarding this medication, the nurse will include statements indicating that: a. fexofenadine is one of the least sedating antihistamines. b. tolerance will not develop. c. antihistamines are more effective if taken after histamine is released. d. histamine release will be prevented by this medication.

ANS: A Fexofenadine is one of the least sedating antihistamines. Occasionally, a tolerance to antihistaminic effects will develop. Antihistamines are more effective if taken before histamine is released. Histamine release is not prevented by this medication. Symptoms are reduced.

The nurse is completing the admission of an older adult patient with a history of COPD whose diagnosis is pneumonia. Which assessments would be most important to include in obtaining the history? (Select all that apply.) a. Smoking history and exposure to second hand smoke b. Current medications c. Chief complaint and onset of symptoms d. Support system e. Home oxygen use f. Liver function

ANS: A, B, C, D, E It is important to assess present and past respiratory history (including smoking history and exposure to second hand smoke), obtain thorough medication history, ascertain the chief complaint and current pulmonary symptoms (including cough and sputum color), determine the patients support system, and ask about any home treatments when obtaining information from a patient with acute and chronic lung disease. Liver function testing is not necessary for the assessment of this patient.

Which statement(s) about acetylcysteine is/are true? (Select all that apply.) a. It reduces viscosity of secretions. b. It treats acetaminophen toxicity. c. It is stored at room temperature. d. It is given to improve airway flow. e. It is odorless. f. It is administered by inhalation.

ANS: A, B, D, F Acetylcysteine is given to reduce the viscosity of secretions, used to treat acetaminophen toxicity, used to improve airway flow, and is a mucolytic given by inhalation. Acetylcysteine should be refrigerated after opening and has an odor similar to that of rotten eggs.

Which adverse effect(s) may occur as a result of antipsychotic drug therapy? (Select all that apply.) a. Acute dystonia b. Akathisia c. Weight loss d. Neuroleptic malignant syndrome e. Hypoglycemia f. Tardive dyskinesia

ANS: A, B, D, F Antipsychotic drugs can cause neuroleptic malignant syndrome and motor dysfunctions such as dystonia, akathisia, and tardive dyskinesia. Antipsychotic drugs may cause weight gain and hyperglycemia.

Patients taking phenytoin (Dilantin) for control of seizures must be aware of the risk for which adverse effect(s)? (Select all that apply.) a. Blood dyscrasias b. Hyperglycemia c. Urinary retention d. Gingival hyperplasia e. Insomnia f. Sedation

ANS: A, B, D, F Phenytoin may cause blood dyscrasias, gingival hyperplasia, and sedation and may elevate blood glucose levels, especially if higher doses are used. Urinary retention and insomnia are not adverse effects of phenytoin.

Which statement(s) about ipratropium bromide (Atrovent) is/are true? (Select all that apply.) a. It is administered by aerosol inhalation. b. It relieves nasal congestion. c. It decreases mucus secretion. d. It has minimal effect on ciliary activity. e. It is used for short term treatment of bronchospasm. f. It may cause tachycardia or urinary retention.

ANS: A, D, F Ipratropium bromide is administered by aerosol inhalation, has minimal effect on ciliary activity, and may cause tachycardia, urinary retention, or exacerbation of pulmonary symptoms. Ipratropium bromide does not relieve nasal congestion; has minimal effect on mucous secretion, sputum volume, and viscosity; and is used as a bronchodilator for long term treatment of reversible bronchospasm associated with COPD.

Which statement is true regarding the adverse effects associated with antipsychotic medications? a. Tardive dyskinesia is a common, reversible condition. b. Painful dystonic reactions can occur in the first 72 hours of initiation of therapy. c. Neuroleptic malignant syndrome (NMS) is a common adverse effect. d. Pseudoparkinsonian symptoms can cause Parkinson's disease.

ANS: B Approximately 90% of all dystonic reactions occur in the first 72 hours of antipsychotic therapy. These symptoms are often frightening and painful. Tardive dyskinesia is present in 20% to 25% of patients and may become irreversible. NMS is not a common adverse effect. Pseudoparkinsonism is not related to Parkinson's disease.

The nurse is providing education to a patient recently prescribed pregabalin (Lyrica). Which statement by the patient indicates a need for further instruction? a. I may feel tired at first, but this should improve with continued use. b. Once my pain improves, I will stop taking this medication. c. Taking sleeping aids will increase the sedative effect of this medication. d. This drug may affect my mental alertness, so I need to be careful around machinery.

ANS: B When discontinuing therapy, taper over at least 1 week to minimize the potential for withdrawal symptoms. Drowsiness tends to disappear with continued use of the medication. Sleeping aids enhance the sedative effects of pregabalin. Pregabalin causes sedation, so people who work around machinery, drive a car, or perform other duties in which they must remain mentally alert should be particularly cautious.

A patient has questions regarding a recently prescribed antitussive agent. Which response by the nurse is the best? a. It will eliminate your cough at night. b. It will reduce the frequency of your cough. c. It should be used in the morning. d. It should be taken before sleep.

ANS: B Antitussive agents act by suppressing the cough center in the brain. The expected therapeutic outcome is reduced frequency of nonproductive cough to promote rest. Antitussive agents should be taken as prescribed by the health care provider. Antitussives are not likely to eliminate a cough. Antitussives should be taken throughout the day.

A child has been diagnosed with asthma and the nurse is providing education to the family. Which statement by the mother indicates a need for further teaching? a. I will place the stuffed animals in the freezer overnight. b. We will confine our dog to the kitchen area. c. I should wash bedding in hot water. d. A damp cloth should be used when I dust.

ANS: B Pets should be removed from the home or kept outside if at all possible.

Why is a combination of antipsychotic agents with benzodiazepines useful in initial treatment of the agitated patient? (Select all that apply.) a. Antipsychotics are not effective for 2 days. b. Benzodiazepines allow for lower dosages of antipsychotic agents to be used, thereby decreasing serious adverse effects seen with high-dose therapy. c. It assists in calming the psychotic patient. d. It allows for rapid increase in dosing of the antipsychotic agents to expedite treatment of hallucinations. e. It effectively treats extrapyramidal adverse effects associated with antipsychotic agents.

ANS: B, C The use of benzodiazepines allows lower dosages of antipsychotic agents to be used. Benzodiazepines assist in calming the agitated psychotic patient. Antipsychotic medications can be effective in a matter of minutes when injected. Benzodiazepines do not facilitate the increase of antipsychotic medications or treat extrapyramidal adverse effects associated with antipsychotic agents.

Which principle(s) will the nurse include in a teaching plan for antihistamine therapy? (Select all that apply.) a. It is typical to experience an increase in energy. b. Dietary fiber and fluids should be increased. c. Do not take with prescription medications unless approved by a physician. d. Blurred vision is an expected adverse effect. e. Over the counter (OTC) medications are safe to use with any currently prescribed prescription medications.

ANS: B, C, D All histamines cause anticholinergic adverse effects such as dry mouth, constipation, and urinary retention. Therefore, fluids and fiber should be increased in the diet when taking antihistamines. It is important to seek approval from the health care provider if currently using other scheduled medications with antihistamines. Blurred vision is an adverse effect of antihistamine use; patients should be urged to use caution because their cognitive and sensory abilities are impaired. Because of the sedative effect of most antihistamines, patients feel a decrease in energy. OTC medications must be approved by the health care provider to prevent drug interactions.

A patient admitted to the hospital is exhibiting psychotic behavior. Which sign(s) and/or symptom(s) would support the diagnosis of psychosis? (Select all that apply.) a. Constant eye contact during the admission history b. Deterioration of social functioning c. Reporting that the FBI has solicited important secret information from his phone conversations d. Confirmation of hearing voices in his head e. Changing the topic of conversation inappropriately

ANS: B, C, D, E Social deterioration, disordered thinking (including delusions), disordered perception, (including hallucinations), and flight of ideas are symptoms of psychotic behavior. It is uncommon for a psychotic patient to maintain eye contact.

A patient admitted to a psychiatric facility is hallucinating, pacing, and acting highly suspicious. Based on this information, the nurse will take which action(s)? (Select all that apply.) a. Use the most restrictive restraints available to subdue the patient. b. Be open and direct when handling the patient. c. Encourage a variety of interactions with others. d. Provide high-protein, high-calorie foods. e. Reinforce hallucinations.

ANS: B, D Nursing interventions for patients with psychosis must be individualized and based on patient assessment data. The nurse should be open and direct when handling patients who are highly suspicious. High-protein, high-calorie foods are appropriate for the individual to eat while pacing or highly active. If physical restraints are necessary, they should be the least restrictive possible for the circumstances. Interactions should be minimized when perceptions are altered. Hallucinations should not be reinforced.

The psychiatric nurse is educating an elderly patient and family about antipsychotic drug therapy. When providing this education, the nurse will include which statement(s)? (Select all that apply.) a. Hallucinations may be reduced within 1 week of starting. b. Rapid increase in dosages will increase frequency of adverse effects. c. Older patients should be observed for hypertension. d. Tardive dyskinesia may be reversible in early stages. e. Full therapeutic response may require 6 to 8 weeks to be achieved.

ANS: B, D, E Rapid increases in dosages of antipsychotic medication will not reduce the antipsychotic response time but will increase the frequency of adverse effects. Tardive dyskinesia may be reversible in early stages, but it becomes irreversible with continued use of the antipsychotic medication. Reduction in hallucinations, delusions, and thought disorders often requires 6 to 8 weeks for a full therapeutic response to be achieved. Older patients should be observed for hypotension.

For which condition may carbamazepine (Tegretol) be used? a. Tardive dyskinesia b. Psychotic episodes c. Trigeminal neuralgia pain d. Sedation

ANS: C Carbamazepine has been used successfully to treat pain associated with trigeminal neuralgia and for bipolar disorders when lithium therapy has not been optimal. Carbamazepine does not have antidepressant, antipsychotic, or sedative effects.

A patient with schizophrenia has been nonadherent with his home medication regimen. He requires frequent admissions to the intensive psychiatric unit for treatment of acute psychotic episodes. Which medication regimen would be appropriate for this patient? a. Daily home nursing visits to administer the prescribed oral medication b. Continuous inpatient hospitalization for medication therapy c. Administration of depot antipsychotic medication d. Subcutaneous medication administration

ANS: C Depot antipsychotic medications are long-acting injections that may be used with noncompliant patients and may assist in avoiding repeated hospital admissions. Daily home nursing visits are not an efficient way to ensure medication compliance. Continuous inpatient hospitalization is not an efficient way to ensure medication compliance. Subcutaneous medication administration is not an option for this patient.

What is the most common cause of nonadherence to antipsychotic pharmacologic treatment? a. Expense b. Increased symptoms of chemical dependency c. Extrapyramidal effects d. Inability of the patient to understand the need to take medications

ANS: C Extrapyramidal effects are the most common reason for nonadherence to antipsychotic therapy. The four categories of extrapyramidal effects are dystonic reactions, pseudoparkinsonism, akathisia, and tardive dyskinesia. Although expense may be a concern, it is not the most common reason for noncompliance. Chemical dependency is not a feature of therapy with antipsychotic drugs. Although knowledge deficit is a concern, it is not the most common reason for noncompliance.

To what does potency of an antipsychotic medication refer? a. Severity of adverse effects associated with the drug b. Length of time that it takes to reach a therapeutic blood level of the drug c. Milligram doses used for the medication d. Effectiveness of the drug in alleviating psychotic behavior

ANS: C Low and high potency refers only to the milligram doses used for the medications and does not suggest any difference in effectiveness. Potency is not related to severity of adverse effects or onset of action. Potency does not refer to effectiveness.

The nurse is providing discharge teaching to a patient prescribed phenytoin (Dilantin) for management of a seizure disorder. Which patient statement indicates a need for further teaching? a. I need to avoid or limit caffeine intake. b. I will check with the pharmacist before taking over the counter medication. c. If I develop enlarged gums, I will stop taking the medication. d. It is important for me to take my medicine at the same time daily.

ANS: C Medications are not discontinued unless approved by the health care provider. Gingival hyperplasia is a common adverse effect that can be reduced by oral hygiene. Limiting caffeine intake, checking with the pharmacist about any additional over the counter medications, and taking the medication at the same time every day are appropriate actions by the patient.

What structures in the respiratory tract assist in removing foreign bodies such as smoke and bacteria? a. Villi b. Golgi bodies c. Ciliary hairs d. Erector pili

ANS: C Normally, respiratory tract fluid forms a protective layer over the trachea, bronchi, and bronchioles. Foreign bodies, such as smoke particles and bacteria, are caught in the respiratory tract fluid and are swept upward by ciliary hairs that line the bronchi and trachea to the larynx, where they are removed by the cough reflex. The villi are hair like protrusions into the intestine emanating from the wall of the intestine. The purpose of the villi is to slow the passage of food and allow food particles to be captured among these finger like villi, so that the blood inside the villi can absorb the nutrients in the food. The primary function of the Golgi apparatus, an organelle found in most eukaryotic cells, is to process proteins targeted to the plasma membrane, lysosomes, or endosomes and those that will be formed from the cell and to sort them within vesicles. Thus, it functions as a central delivery system for the cell. Erector pili are small muscles that cause hairs on the skin to rise when contracted.

A resident in a long term care facility diagnosed with COPD has a new medication order for indacaterol. When the nurse is providing education to the resident regarding this medication, information will include that: a. it is a short-acting beta antagonist. b. the patient should wait approximately 5 minutes between inhalations. c. onset of action is within 5 minutes. d. duration of action is about 12 hours.

ANS: C Onset of action is within 5 minutes. Indacaterol is an ultra-long-acting beta 2 agonist. Patients using inhaled bronchodilators should wait approximately 10 minutes. Duration of action is about 24 hours.

A patient is seen in the emergency department. The patient had been maintained on theophylline (Theo Dur), and a blood sample reveals the serum theophylline level is subtherapeutic. Which may cause a subtherapeutic serum level? a. Cimetidine use b. Drug tolerance c. Smoking d. Overuse of the inhaler

ANS: C The patient is not tolerant to the drug if the serum theophylline levels are too low. Cimetidine would enhance the effects of theophylline, not decrease the effects. Smoking reduces the therapeutic effects of xanthine derivatives, including theophylline. Overuse of the inhaler would cause a high level of serum theophylline.

The nurse is teaching a patient with a history of COPD to self administer tiotropium (Spiriva) by dry powder inhalation. Which information provided by the nurse is accurate? a. The medication capsules can be used multiple times. b. Press on the canister while inhaling. c. Avoid breathing into the mouthpiece. d. Wash the device with cold water.

ANS: C The patient should not breathe into the mouthpiece at any time. Capsules are meant to be used as a single dose and should be disposed of after taking the daily dose. The HandiHaler uses capsules of medication that should be pierced before the patient inhales. The inhaler should be washed with hot water.

Which instruction will the nurse include when teaching a patient with seasonal rhinitis and blocked nasal passages about intranasal corticosteroid therapy? a. Clear your nasal passage after administration. b. Anticipate a therapeutic benefit within 24 hours. c. Use a decongestant prior to administration. d. Report nasal burning to your health care provider.

ANS: C Use of a decongestant just before intranasal corticosteroid administration ensures adequate penetration. The patient should clear the nasal passages before, not after, administration. The therapeutic benefit occurs after 24 hours. Nasal burning tends to resolve with continued therapy.

Which is a common expectorant in over-the-counter medications? a. Dextromethorphan b. Diphenhydramine c. Guaifenesin d. Codeine

ANS: C Guaifenesin is used for symptomatic relief of conditions characterized by a dry, nonproductive cough such as the common cold, bronchitis, laryngitis, pharyngitis, and sinusitis. Guaifenesin is also used to remove mucous plugs from the respiratory tract. Dextromethorphan is an antitussive. Diphenhydramine is an anticholinergic agent with antihistaminic and antitussive properties. Codeine is an antitussive.

Which response by the nurse is accurate when a patient who has been on lamotrigine (Lamictal) for seizure control reports a skin rash and urticaria? a. Reassure the patient that this is a common adverse effect of the medication and not to worry. b. Instruct the patient to discontinue use of the drug immediately. c. Instruct the patient to decrease the dosage of the medication until the rash disappears. d. Advise the patient that this adverse effect usually resolves but should be reported to the health care provider.

ANS: D The nurse is not authorized to recommend dosage changes to the patient. The nurse should not trivialize the patients concern about the adverse effect; it is common only in 10% of patients who take lamotrigine and can lead to more serious adverse effects. The nurse should not recommend discontinuing the medication without orders from the health care provider. This is not a common adverse effect and should be monitored. Approximately 10% of patients receiving lamotrigine develop a skin rash in the first 4 to 6 months of therapy. The health care provider should be notified promptly because the rash could be an indicator of a more serious condition.