Pharm Unit 4 questions
A client with influenza is prescribed with an antiviral drug. The nurse determines that the client indicates an understanding of the treatment if he or she states the following? A. "I will take the medication exactly as prescribed" B. "I will not be able to infect others while I am on this treatment" C. "I will stop the medication once I feel okay" D. "I will resume my usual activities because these medications have minimal undesirable effects"
A. "I will take the medication exactly as prescribed" Rationale: Antiviral drugs (such as rimantadine) are taken exactly as prescribed. When used as directed, these medicines may help decrease the duration of flu symptoms and lessen the severity of common flu symptoms. Option B: Antiviral drugs do not prevent the spread of influenza and patients are still contagious for up to two days after the start of the therapy. Option C: The durations for the medications are followed until the last day of the treatment. Option D: Side effects such as dizziness and drowsiness will alert the client to be careful resuming their daily activities.
A nurse is giving instructions to her client who is taking antihistamine (such as diphenhydramine and loratadine). Which of the following nurse teachings is appropriate for the client? A. Avoid ingesting alcohol B. Be aware that you may need to take a decongestant C. Be aware that you may have increased saliva D. Expect relief in 24 hours
A. Avoid ingesting alcohol Rationale: Because alcohol and antihistamines have sedating properties, concurrent administration of these drugs should be avoided. Option B: Antihistamines and decongestants are often given together. Histamine induces an increased level of vascular permeability, which leads to fluid moving from capillaries into the surrounding tissues. The overall outcome of this is increased swelling and dilation of vessels. Antihistamines stop this effect by acting as antagonists at the H-1 receptors. The clinical benefit is a reduction in allergy symptoms and any related symptoms. Option C: Dry mouth is a common side effect, not increased salivation. H-1 receptor antihistamines have anticholinergic properties, which are adverse effect-inducing; this principally occurs from the first generation category of antihistamines only. As a whole, they are sedating but may cause insomnia in some users. Due to their anticholinergic properties, dry mouth is a relatively common adverse effect. Option D: Not all antihistamines last 24 hours. The duration of the pharmacological action of first-generation antihistamines is about 4 to 6 hours. In contrast, second-generation antihistamines work for 12 to 24 hours.
A client with which of the following conditions may experience a dangerous or fatal side effect of theophylline? A. Cardiac disorder B. Diabetes C. Renal disease D. Hepatic disease
A. Cardiac disorder Rationale: A client with a heart condition may experience dangerous stimulation from this drug. Use cautiously in patients who have cardiac arrhythmias (excluding bradyarrhythmias), as it may exacerbate arrhythmias. Theophylline, a bronchodilator and anti-asthmatic, should be administered cautiously with all the other choices, but the consequences are most dangerous or possibly fatal for clients with a heart condition. Option B: Use cautiously in patients with hyperthyroidism, as increased theophylline clearance may occur. Theophylline has a very narrow therapeutic window, and its interaction with various other drugs has led to the limitation of its use. The serum theophylline concentrations require monitoring directly to avoid toxicity as the adverse effects of theophylline are related to its plasma concentration and have been observed when plasma concentrations exceed 20 mg/L. Some patients have also experienced adverse effects at low plasma concentrations. The dose gradually increases until achieving therapeutic plasma concentrations. This approach reduces side effects. Option C: Serum theophylline concentrations should be checked after the initiation of therapy, before increasing dose and if any signs or symptoms of toxicity appear. Worsening of the current illness, an occurrence of a new illness or any change in the patient's treatment protocol that may alter theophylline clearance should also prompt the physician to check serum concentrations of theophylline. Attention should also be necessary for the infusion site. Option D: Use cautiously in patients with a hepatic impairment such as cirrhosis, cholestasis, acute hepatitis because there is an increased risk of severe and potentially fatal complications. This risk exists because clearance decreases by 50% or more in these patients. Frequent monitoring and dose reduction of theophylline are necessary for these patients.
The effects of theophylline may be increased by: (select all that apply) A. Ciprofloxacin B. Phenytoin C. Rifampin D. Cimetidine E. Levofloxacin
A. Ciprofloxacin and E. Levofloxacin Rationale: Both ciprofloxacin and levofloxacin are antibiotics in the class fluoroquinolones. When they are combined with theophylline, a bronchodilator and anti-asthmatic, it increases the levels of theophylline, so levels must be monitored.
Your pt has vertigo, which antihistamine is best for his condition? A. Meclizine B. Hydrocodone C. Guaifenesin
A. Meclizine Rationale: Meclizine is an anticholinergic/antihistamine that prevents and treats N & V, motion sickness, and vestibular problems. Option B: Hydrocodone is a semi-synthetic opioid medication used to treat pain. Option C: Guaifenesin is an expectorant. It helps loosen congestion in the chest and throat, making it easier to cough out through the mouth. Guaifenesin is used to treat dry, non-productive cough.
A nurse is about to administer albuterol 2 puff and budesonide 2 puff by a metered-dose inhaler. The nurse plans to administer by? A. Alternating with a single puff each, starting with albuterol B. Albuterol inhaler first then the budesonide C. Alternating with a single puff each, starting with budesonide D. Budesonide inhaler first then the albuterol
B. Albuterol inhaler first then the budesonide Rationale: If two different inhaled medications are prescribed and one of the medications contains a corticosteroid, administer the bronchodilator (Albuterol) first and the corticosteroid (Budesonide) second. This will allow for the widening of the air passages by the bronchodilator, making the corticosteroids more effective.
The nurse should instruct a client who is taking an expectorant to: A. Restrict fluids B. Increase fluids C. Avoid vaporizers D. Take antihistamines
B. Increase fluids Rationale: Expectorants, such as guaifenesin, is administered on empty stomach with a full glass of water. Increasing fluids will help liquefy secretions and facilitate removal as they help to break up mucus and clear congestion. An expectorant is a type of cough medicine that thins and loosens mucus. These medications are typically used for managing the effects of chest congestion, especially when symptoms are caused by persistent mucus. Option A: Expectorants are commonly used for management of the symptoms of acute (short-term) respiratory tract infections, like the common cold, pneumonia, or bronchitis. These infections can cause a build-up of phlegm in your throat or lungs. It is often difficult to cough up this thick mucus, and you can develop a nagging cough and chest discomfort due to mucus accumulation. Option C: When cold and flu season hits, dry air can make breathing issues worse. There are several types of humidifiers on the market, including cool-mist humidifiers and steam vaporizers. Both add moisture to the air, helping to ease cold and cough congestion. Option D: Antihistamines specifically block the tissue effects of histamine and thereby reduce or prevent all the symptoms except stuffiness. Decongestants are required to relieve the stuffiness, thus explaining the popularity of combination products containing both antihistamines and decongestants.
When administering theophylline, the nurse can expect: A. Decreased pulmonary function B. Increased pulmonary function C. Increased residual volume D. Decreased tidal volume
B. Increased pulmonary function Rationale: Theophylline, a bronchodilator/anti-asthmatic, will improve ventilation so there will be an overall improvement of pulmonary measurements. Theophylline relaxes smooth muscles, causes bronchial dilation, diuretic, cardiac and central nervous system (CNS) stimulant activities. Other choices are the opposite of what will actually occur with theophylline administration. Option A: Theophylline relaxes the smooth muscles located in the bronchial airways and pulmonary blood vessels, causing an increase in pulmonary function, not a decrease. Option C: Theophylline improves pulmonary function, decreasing residual volume as more air can be expelled. Option D: Tidal volume increases as theophylline is a bronchodilator, allowing more air to move in and out of the lungs.
A nurse is caring for a client who is starting a long-term therapy of isoniazid (INH). The nurse plans to instruct the client to which of the following? A. Discontinue vitamin supplements such as Pyridoxine Vit B6. B. Report an incidence of yellowish skin. C. Increase intake of tuna for additional nutrition. D. Drink alcohol in moderation.
B. Report an incidence of yellowish skin. Rationale: Isoniazid (INH) is an antimycobacterial that treats TB. Hepatic function needs to be monitored before and monthly during the long-term therapy. Due to the risk of hepatotoxicity, the client is instructed to report signs of jaundice (yellowish of the skin or the sclera). Option A: Vitamin B6 can help in preventing peripheral neuritis and is also administered as an antidote to an overdose of isoniazid (INH). Option B: Tuna which contains tyramine causes a reaction characterized by redness, flushing, sweating, itching of the skin while taking INH. Tyramine foods (including alcohol, Swiss cheese, fish) need to be avoided. Option D: Avoid alcohol because the medication is hepatotoxic.
What should the nurse include when teaching a patient regarding the use of omeprazole? a. Take after meals to increase drug effectiveness b. Take before meals to increase drug effectiveness c. Take with meals to increase drug effectiveness d. May take without regard to meals or other medications
B. Take before meals to increase drug effectiveness
Which of the following is treated with pseudoephedrine? a. COPD b. Hypotension c. Congestion d. Incontinence
B. congestion Rationale: Pseudoephedrine, an oral decongestant, treats nasal congestion and pain and congestion of otitis media. Other decongestants include oxymetazoline and fluticasone. Anticholinergic (ipratropium) and inhaled steroid (budesonide) work to prevent and treat the bronchospasms in asthma and COPD.
A client with a chronic obstructive pulmonary disease is prescribed with ipratropium. Upon a review of the medical history of the client, the nurse questions the prescription if which of the following is noted? A. History of smoking B. History of allergy to egg C. History of allergy to peanut D. History of a previous infection
C. History of allergy to peanut Rationale: The client with a peanut allergy should not take ipratropium because the product contains soy lecithin, which is in the same plant family as peanuts. NOTE: newer formulations do not contain soy/lecithin and are safe for those with soy or peanut allergy
A client has been taking isoniazid (INH). The client went to the health care facility with complaints of numbness and tingling sensation in the extremities. The nurse determines that the client is most likely suffering from? A. Impaired peripheral circulation B. Hypercalcemia C. Peripheral neuritis D. Guillain Barre syndrome
C. Peripheral neuritis Rationale: Isoniazid (INH) causes peripheral neuritis characterized by numbness, tingling, and paresthesias in the extremities. To prevent neuropathy, pyridoxine vitamin B6 is administered.
The nurse will be administering an antitussive medication containing codeine to a patient. What is the priority assessment? a. Pulse oximeter reading b. Lung sounds c. Respiratory rate d. Sputum consistency
C. Respiratory rate Rationale: Antitussives can contain codeine, causing CNS depression. An example of an antitussive is dextromethorphan.
A pt is prescribed with guaifenesin (Mucinex). The nurse determines that the client understands the proper administration of this medication if the client states that they will: A. Limit oral fluid intake B. Take the medication with meals only C. Take an additional dose once fever and cough persist D. Drink extra fluids while taking this medication
D. Drink extra fluids while taking this medication Rationale: Guaifenesin, an expectorant is taken with a full glass of water to decrease the viscosity of secretions. These extra fluids help loosen the congestion and lubricate the throat while taking this medication. Option A: Fluids are needed to loosen the secretions. Option B: The medication does not have to be taken with meals. Option C: Additional doses should not be taken without the prescription of the doctor.
An antitussive such as dextromethorphan is indicated to: A. Encourage removal of secretions through coughing B. Relieve rhinitis C. Control a productive cough D. Relieve a dry cough
D. Relieve a dry cough Rationale: An antitussive is a cough suppressant that inhibit cough through either a central or a peripheral mechanism. There are two ways to inhibit coughing: centrally and peripherally. Choices A and C describe the action of an expectorant. An expectorant is a medication that helps bring up mucus and other material from the lungs, bronchi, and trachea. An example of an expectorant is guaifenesin, which promotes drainage of mucus from the lungs by thinning the mucus, and also lubricates the irritated respiratory tract. Option B: Decongestants are a type of medicine that can provide short-term relief for a blocked or stuffy nose (nasal congestion). They can help ease the symptoms of conditions such as colds and flu, hay fever and other allergic reactions, catarrh and sinusitis. They work by reducing the swelling of the blood vessels in the nose, which helps to open the airways. Decongestants include oxymetazoline, pseudoephedrine, and fluticasone.
A 25 year old man with chronic bronchitis is receiving theophylline intravenously. After several dosages, the client started to become restless and complains of palpitations. The nurse determines that the client is experiencing theophylline toxicity in which of the following? A. Theophylline level of 8 mcg/ml B. Theophylline level of 10 mcg/ml C. Theophylline level of 15 mcg/ml D. Theophylline level of 25 mcg/ml
D. Theophylline level of 25 mcg/ml Rationale: Theophyllinelevels should be 10-20 mcg/ml. When serum level is between 20-25, pt can experience N & V, diarrhea, insomnia, headache, and irritability. When serum level is between 30-35, pt can experience hyperglycemia, hypotension, cardiac arrhythmias, tachycardia, seizures, brain damage, and death.
To evaluate the effectiveness of theophylline therapy, which of the following laboratory values must be drawn? A. Glucose B. Hematocrit C. Potassium D. Theophylline levels
D. Theophylline levels Theophylline levels must be drawn to determine if the drug is present in therapeutic amounts in the client's serum. Theophylline has a very narrow therapeutic window (10-20 mcg/mL), and its interaction with various other drugs has led to the limitation of its use.
Which is matched correctly? A. When acting centrally, dextromethorphan decreases irritation that causes the cough B. When acting locally, dextromethorphan suppresses the medullary cough center C. When acting centrally, dextromethorphan is working as an anesthetic. D. When acting centrally, dextromethorphan suppresses the medullary cough center
D. When acting centrally, dextromethorphan suppresses the medullary cough center Rationale: Dextromethorphan works locally as an anesthetic to decrease irritation causing cough.
A client is to begin taking rifampin. The nurse correctly teaches the client this medication: A. Is to be discontinued after three months. B. Is to be taken with food and antacids. C. Take an additional dose once with skip dose. D. Will cause orange discoloration of sweat, urine, and feces.
D. Will cause orange discoloration of sweat, urine, and feces. Rationale: Rifampin is an antimycobacterial that treats TB. An adverse effect of rifampin is that body fluids may turn reddish orange. Option A: The client should not stop the therapy unless with a doctor's advice. Option B: The medication is taken on an empty stomach with a full glass of water Option C: Doses are not to be doubled or skipped.
Which is the most potent histamine 2 antagonist? A. cimetidine B. calcium carbonate C. omeprazole D. sucralfate E. famotidine F. esomeprazole
E. famotidine Of the ones listed, famotidine and cimetidine are the only histamine 2 antagonists, with famotidine being the most potent of the two
Your pt states they've been taking dextromethorphan for 2 weeks. What is your next step?
Tell them that since their nonproductive cough hasn't been resolved after taking dextromethorphan, there may be a serious underlying medical cause that must be investigated.
As you are preparing morning medications, the patient says, "I have had loose stools all night long." Your patient has scheduled docusate at 0900. What is the priority action? a. Hold the medication and inform the healthcare provider. b. Administer the medication as ordered. c. Increase IV flow rate d. Ask the healthcare provider to increase the dose of the medication.
a. Hold the medication and inform the healthcare provider.
Which of the following is not treated with Epinephrine? a. Renal disease b. Asthma c. Hypotension d. Glaucoma
a. Renal disease Rationale: Epinephrine is a sympathomimetic that is indicated for acute bronchospasms and anaphylactic reactions. Therefore, it treats asthma, hypotension, and glaucoma.
Your pt being treated for their nonproductive cough is starting to have dizziness, dry mouth, GI upset, and a headache. What drug are they experiencing adverse effects of?
dextromethorphan
Your pt comes in with a nonproductive cough. What drug are they likely to be prescribed?
dextromethorphan Rationale: dextromethorphan is a cough suppressant that treats a nonproductive cough
What is needed to take famotidine?
good kidney function
A pt is about to start a short term treatment for their duodenal ulcer. What class of drug is expected to be part of their treatment plan?
histamine 2 antagonists (famotidine and cimetidine)
