Basic Pharmacology for Nurses 16th Edition Bruce D. Clayton -Test Bank
Chapter 1: Drug Definitions, Standards, and Information Sources
- What is the name under which a drug is listed by the U.S. Food and Drug Administration (FDA)?
- Which source contains information specific to nutritional supplements?
|a.||USP Dictionary of USAN & International Drug Names|
|b.||Natural Medicines Comprehensive Database|
|c.||United States Pharmacopoeia/National Formulary (USP NF)|
|d.||Drug Interaction Facts|
- What is the most comprehensive reference available to research a drug interaction?
|a.||Drug Facts and Comparisons|
|b.||Drug Interaction Facts|
|c.||Handbook on Injectable Drugs|
|d.||Martindale—The Complete Drug Reference|
- The physician has written an order for a drug with which the nurse is unfamiliar. Which section of the Physicians’ Desk Reference (PDR) is most helpful to get information about this drug?
|b.||Brand and Generic Name section|
|c.||Product Category section|
|d.||Product Information section|
- Which online drug reference makes available to health care providers and the public a standard, comprehensive, up to date look up and downloadable resource about medicines?
|a.||American Drug Index|
|b.||American Hospital Formulary|
|d.||Physicians’ Desk Reference (PDR)|
- Which legislation authorizes the FDA to determine the safety of a drug before its marketing?
|a.||Federal Food, Drug, and Cosmetic Act (1938)|
|b.||Durham Humphrey Amendment (1952)|
|c.||Controlled Substances Act (1970)|
|d.||Kefauver Harris Drug Amendment (1962)|
- Meperidine (Demerol) is a narcotic with a high potential for physical and psychological dependency. Under which classification does this drug fall?
- What would the FDA do to expedite drug development and approval for an outbreak of smallpox, for which there is no known treatment?
|a.||List smallpox as a health orphan disease.|
|b.||Omit the preclinical research phase.|
|c.||Extend the clinical research phase.|
|d.||Fast track the investigational drug.|
- Which statement is true about over the counter (OTC) drugs?
|a.||They are not listed in the USP NF.|
|b.||A prescription from a health care provider is needed.|
|c.||They are sold without a prescription.|
|d.||They are known only by their brand names.|
- Which is the most authoritative reference for medications that are injected?
|a.||Physician’s Desk Reference|
|b.||Handbook on Injectable Drugs|
|d.||Handbook of Nonprescription Drugs|
- The nurse is administering Lomotil, a Schedule V drug. Which statement is true about this drug’s classification?
|a.||Abuse potential for this drug is low.|
|b.||Psychological dependency is likely.|
|c.||There is a high potential for abuse.|
|d.||This drug is not a controlled substance.|
- The nurse is transcribing new orders written for a patient with a substance abuse history. Choose the medication ordered that has the greatest risk for abuse.
- The nurse is caring for a patient newly diagnosed with type 1 diabetes mellitus. Which approach(es) to therapeutic methods would be considered in this patient’s treatment? (Select all that apply.)
|b.||Concentrated carbohydrate diet|
|c.||Family centered care|
|d.||Regular daily exercise and activity|
- An older adult experiencing shortness of breath is brought to the hospital by her daughter. While obtaining the medication history from the patient and her daughter, the nurse discovers that neither has a list of the patient’s current medications or prescriptions. All the patient has is a weekly pill dispenser that contains four different pills. The prescriptions are filled through the local pharmacy. Which resource(s) would be appropriate to use in determining the medication names and doses? (Select all that apply.)
|a.||Martindale—The Complete Drug Reference|
|b.||Physicians’ Desk Reference, Section 4|
|c.||Senior citizens’ center|
|d.||Patient’s home pharmacy|
- The nurse planning patient teaching regarding drug names would include which statement(s)? (Select all that apply.)
|a.||Most drug companies place their products on the market under generic names.|
|b.||The official name is the name under which the drug is listed by the U.S. Food and Drug Administration (FDA).|
|c.||Brand names are easier to pronounce, spell, and remember.|
|d.||The first letter of the generic name is not capitalized.|
|e.||The chemical name is most meaningful to the patient.|
- When categorizing, the nurse is aware that which drug(s) would be considered Schedule II? (Select all that apply.)
Chapter 2: Basic Principles of Drug Action and Drug Interactions
- The nurse assesses hives in a patient started on a new medication. What is the nurse’s priority action?
|a.||Notify physician of allergic reaction.|
|b.||Notify physician of idiosyncratic reaction.|
|c.||Notify physician of potential teratogenicity.|
|d.||Notify physician of potential tolerance.|
- The nurse administers an initial dose of a steroid to a patient with asthma. Thirty minutes after administration, the nurse finds the patient agitated and stating that “everyone is out to get me.” What is the term for this unusual reaction?
- Which is the best description of when drug interactions occur?
|a.||On administration of toxic dosages of a drug|
|b.||On an increase in the pharmacodynamics of bound drugs|
|c.||On the alteration of the effect of one drug by another drug|
|d.||On increase of drug excretion|
- What occurs when two drugs compete for the same receptor site, resulting in increased activity of the first drug?
- What do drug blood levels indicate?
|a.||They confirm if the patient is taking a generic form of a drug.|
|b.||They determine if the patient has sufficient body fat to metabolize the drug.|
|c.||They verify if the patient is taking someone else’s medications.|
|d.||They determine if the amount of drug in the body is in a therapeutic range.|
- What is the process by which a drug is transported by circulating body fluids to receptor sites?
- The nurse assesses which blood level to determine the amount of circulating medication in a patient?
- The nurse administers 50 mg of a drug at 6:00 AM that has a half life of 8 hours. What time will it be when 25 mg of the drug has been eliminated from the body?
- What will the nurse need to determine first in order to mix two drugs in the same syringe?
|a.||Absorption rate of the drugs|
|b.||Compatibility of the drugs|
|c.||Drug blood level of each drug|
|d.||Medication adverse effects|
- A patient developed hives and itching after receiving a drug for the first time. Which instruction by the nurse is accurate?
|a.||Stop the medication and encourage the patient to wear a medical alert bracelet that explains the allergy.|
|b.||Explain to the patient that these are signs and symptoms of an anaphylactic reaction.|
|c.||Emphasize to the patient the importance to inform medical personnel that in the future a lower dosage of this drug is necessary.|
|d.||Instruct the patient that it would be safe to take the drug again because this instance was a mild reaction.|
- When obtaining a patient’s health history, which assessment data would the nurse identify as having the most effect on drug metabolism?
|a.||History of liver disease|
|b.||Intake of a vegetarian diet|
|d.||Teacher as an occupation|
- A physician’s order indicates to administer a medication to the patient via the percutaneous route. The nurse can anticipate that the patient will receive this medication:
- A nurse is preparing to administer tetracycline to a patient diagnosed with an infection. Which medication should not be administered with tetracycline?
- Which statement(s) about liberation of drugs is/are true? (Select all that apply.)
|a.||A drug must be dissolved in body fluids before it can be absorbed into body
|b.||A solid drug taken orally must disintegrate and dissolve in GI fluids to allow for absorption into the bloodstream for transport to the site of action.|
|c.||The process of converting the drug into a soluble form can be controlled to a certain degree by the dosage form.|
|d.||Converting the drug to a soluble form can be influenced by administering the drug with or without food in the patient’s stomach.|
|e.||Elixirs take longer to be liberated from the dosage form.|
- Which are routes of drug excretion? (Select all that apply.)
|a.||GI tract; feces|
|b.||Genitourinary (GU) tract; urine|
|d.||Circulatory system; blood/plasma|
|e.||Respiratory system; exhalation|
- Which route(s) enable(s) drug absorption more rapidly than the subcut route? (Select all that apply.)
- The nurse recognizes that which factor(s) would contribute to digoxin toxicity in a 92-year-old patient? (Select all that apply.)
|a.||Taking the medication with meals|
|b.||Prolonged half life of the drug digoxin|
|c.||Impaired renal function|
|d.||Diminished mental capacity|
- Which statement(s) about variables that influence drug action is/are true? (Select all that apply.)
|a.||An older adult will require increased dosage of a drug to achieve the same therapeutic effect as that seen in a younger person.|
|b.||Body weight can affect the therapeutic response of a medication.|
|c.||Chronic smokers may metabolize drugs more rapidly than nonsmokers.|
|d.||A patient’s attitude and expectations affect the response to medication.|
|e.||Reduced circulation causes drugs to absorb more rapidly.|
- Which factor(s) affect(s) drug actions? (Select all that apply.)
- A patient receives 200 mg of a medication that has a half life of 12 hours. How many mg of the drug would remain in the patient’s after 24 hours?
Chapter 3: Drug Action Across the Life Span
- What time will the trough blood level need to be drawn if the nurse administers the intravenous medication dose at 9:00 AM?
- What will the nurse expect the health care provider’s order to be when starting an older adult patient on thyroid hormone replacement therapy?
|a.||Administering a loading dose of the drug|
|b.||Directions on how to taper the drug|
|c.||A dosage that is one third to one half of the regular dosage|
|d.||A dosage that is double the regular dosage|
- Which drugs cause birth defects?
- Which life threatening illness may occur as a result of aspirin (salicylate) administration during viral illness to patients younger than 20 years of age?
- Which classification of medications commonly causes allergic reactions in children?
- After giving instructions to an expectant mother about taking medications during pregnancy, which patient statement indicates the need for further teaching?
|a.||“I will not take herbal medicines during pregnancy.”|
|b.||“For morning sickness, I will try crackers instead of taking a drug.”|
|c.||“If I get a cold, I will avoid taking nonprescription medications until I check with my physician.”|
|d.||“I will limit my alcohol intake to only one glass of wine weekly.”|
- When is the ideal time for a nursing mother to take her own medications?
|a.||Before the infant latches on to begin to breastfeed|
|b.||As soon as the mother wakes up in the morning|
|c.||Right before the mother goes to sleep at night|
|d.||As soon as the infant finishes breastfeeding|
- Which age-related change would affect transdermal drug absorption in geriatric patients the most?
|b.||Diminished kidney function|
|c.||Changes in pigmentation|
|d.||Altered circulatory status|
- Which intervention would be considered to reduce accumulation of a drug in a patient who has decreased liver function?
|a.||Decreasing the time interval between dosages|
|b.||Reducing the dosage|
|c.||Administering the medication intravenously|
|d.||Changing the drug to one that has a longer half life|
- The nurse is teaching an elderly patient with difficulty swallowing about his medications. Which explanation by the nurse is most helpful?
|a.||“Enteric coated tablets can be crushed and taken with applesauce.”|
|b.||“Tablets that are scored can be broken in half.”|
|c.||“Medications labeled ‘SR’ can be crushed.”|
|d.||“Avoid taking medications in liquid form.”|
- The nurse is administering an antibiotic intravenously. Which blood level determines the lowest amount of medication present in the patient?
- Which patient would the nurse identify as having the lowest rate of absorption of enteral medications?
|a.||A 5-year-old boy|
|b.||An 18-year-old woman|
|c.||A 55-year-old man|
|d.||An 85-year-old woman|
- What is the definition of cumulative effect of a drug?
|a.||Drug toxicity related to overmedication|
|b.||Drug buildup related to decreased metabolism|
|c.||The inability to control the ingestion of drugs|
|d.||The need for higher dosage to produce the same effect as previous lower dosages|
- Which patient, when compared with the general population, would require a larger dose or more frequent administration of a drug to attain a therapeutic response?
|a.||A 29 year old who has been diagnosed with kidney failure|
|b.||A 35 year old obese male who is being evaluated for an exercise program|
|c.||A 52 year old diagnosed with hypothyroidism and decreased metabolic rate|
|d.||A 72 year old with decreased circulatory status|
- A resident in a long term care facility reports difficulty swallowing enteric coated aspirin and asks the nurse to crush it prior to administration. The most appropriate action for the nurse to take is to:
|a.||crush the tablet and mix with applesauce.|
|b.||encourage the resident to swallow the tablet with a full glass of water.|
|c.||hold the medication and notify the physician.|
|d.||substitute a regular aspirin for the enteric coated tablet.|
- One of the prescribed medications for a 36 week gestational age baby girl is a topical water soluble medication to be applied to the perineum daily to treat an inflammatory rash. What considerations is the nurse aware of before medication administration? (Select all that apply.)
|a.||Age of the client|
|b.||Location of topical application|
|c.||Increased intestinal transit rate|
|d.||Condition of the skin|
|e.||Gastric pH of 8|
- The nurse is caring for a 4 month old child who is on a water soluble medication for seizures. The child’s mother voices concern that the dosage seems “too much” for the child’s age and would like the dosage verified. What actions will the nurse take? (Select all that apply.)
|a.||Verify dosage requirements in the Physicians’ Desk Reference( PDR) in mg/kg.|
|b.||Compare the water composition requirements of adults and children.|
|c.||Evaluate lean body mass and total fat content in adults and infants.|
|d.||Chart “refused per mother” on the MAR and do not administer.|
|e.||Compare transportation in the circulation of plasma bound proteins between adults and children.|
- For which reason(s) is/are elderly patients at increased risk for drug interactions and toxicity? (Select all that apply.)
|a.||They have a higher incidence of malnourishment.|
|b.||Their renal function is enhanced.|
|c.||They have increased use of multiple medications.|
|d.||Hepatic function is reduced.|
|e.||There are often issues with swallowing.|
- Which patient(s) require(s) special considerations for medication administration? (Select all that apply.)
|a.||A 29-year-old pregnant woman|
|b.||A 2-month-old baby|
|c.||An 18-year-old college student|
|d.||A 45-year-old farmer|
|e.||An 82-year-old retired nurse|
- Which factor(s) in a patient would influence GI absorption of medications? (Select all that apply.)
|b.||Level of consciousness|
|d.||Blood flow to gastric mucosa|
|f.||Body surface area|
- When receiving a report on a new admission from the emergency room, the nurse learns that the patient is newly diagnosed with renal failure. Which medication(s) in the patient’s medication history will require dosage adjustment by the physician? (Select all that apply.)
- Prenatal education is being provided by the nurse at a maternal family child clinic. What information should be relayed? (Select all that apply.)
|a.||Herbal medicines are considered safe.|
|b.||Limit tobacco consumption to less than two cigarettes per day.|
|c.||Encourage a folic acid supplement.|
|d.||One alcoholic beverage per day is acceptable in the last trimester.|
|e.||Encourage nonpharmacologic treatments for symptoms such as nausea.|
Chapter 4: The Nursing Process and Pharmacology
- What is the primary purpose of the nursing assessment?
|a.||Identifying underlying pathologic conditions|
|b.||Assisting the physician in identifying medical conditions|
|c.||Determining the patient’s mental status|
|d.||Exploring patient responses to health problems|
- What is the basis of the NANDA I taxonomy?
|a.||Functional health patterns|
|b.||Human response patterns|
|c.||Basic human needs|
- Which task is included in the assessment step of the nursing process?
|a.||Establishing patient goals/outcomes|
|b.||Implementing the nursing care plan (NCP)|
|c.||Measuring goal/outcome achievement|
|d.||Collecting and communicating data|
- Which statement regarding nursing diagnoses is accurate?
|a.||Nursing diagnoses remain the same for as long as the disease is present.|
|b.||Nursing diagnoses are written to identify disease states.|
|c.||Nursing diagnoses describe patient problems that nurses treat.|
|d.||Nursing diagnoses identify causes related to illness.|
- What do the classification systems NIC and NOC provide?
|a.||Individualized data banks of treatments related to disease processes|
|b.||Standardized language for reporting and analyzing nursing care delivery|
|c.||A measure for cost containment within medical institutions|
|d.||Specialized interventions for rare diseases|
- Which type of nursing diagnosis will be written when the patient exhibits factors that makes him or her susceptible to the development of a problem?
- Which outcome statement identified by the nurse is written correctly?
|a.||After surgery, patient will express acceptance of loss of breast.|
|b.||Patient will die with dignity.|
|c.||At the end of the shift, the nurse will determine whether the patient is more comfortable.|
|d.||Within the next 8 hours, urine output will be greater than 30 mL/hr.|
- Which is an example of an interdependent nursing action?
|a.||Assess lung sounds every 4 hours.|
|b.||Educate the patient about the prescribed medication.|
|c.||Administer Demerol 50 mg intramuscularly (IM) every 4 hours PRN.|
|d.||Encourage the patient to express feelings.|
- What is the nurse’s primary source of information when obtaining a patient history?
|b.||The patient record|
- An obese patient did not meet the goal of “by the end of the second week, is able to follow a 1500 calorie diet.” What will the nurse and the patient reassess?
|b.||Patient’s understanding of the 1500 calorie diet|
|c.||Nurse’s feelings about obese patients|
|d.||Health care agency’s ability to provide the prescribed diet|
- What is the priority nursing diagnosis for an older adult with diabetes who is hospitalized for pneumonia?
|a.||Deficient knowledge related to lack of information about diabetic medication|
|b.||Risk for falls related to weakness|
|c.||Impaired gas exchange related to decreased pulmonary ventilation|
|d.||Imbalanced nutrition: more than body requirements related to obesity|
- What is a critical care pathway?
|a.||A nursing care plan for a patient in a critical care unit|
|b.||A standardized care plan derived from best practice patterns|
|c.||A care plan that has been critiqued by a quality improvement officer|
|d.||A care plan based on measurable goals and outcomes|
- When a nursing diagnosis statement is written, who or what directs the nurse to identify appropriate nursing interventions?
|a.||Other nurses on staff who have experience with the diagnoses|
|b.||The patient and family who have an interest in the outcome|
|c.||The etiologies of the problems identified in the nursing diagnoses|
|d.||The medical staff who have more expertise than the nurses|
- A patient is experiencing adverse effects of a medication. Which information obtained by the nurse is subjective?
- The nurse has determined that the pain medication given to a patient an hour ago has been effective. The nurse is using which step of the nursing process?
- Prior to the administration of a nephrotoxic drug, the nurse determines that the kidney lab data are within normal range. Which step of the nursing process is being used?
- Which statement best describes the planning phase of the nursing process?
|a.||Administer insulin subcutaneously (subcut) in the abdominal area.|
|b.||Patient is at high risk for falls related to hypotension.|
|c.||The patient will state the expected adverse effects of medication by the end of the teaching session.|
|d.||Itching has resolved; medication given is effective.|
- The nurse is prioritizing care of a pediatric patient diagnosed with cystic fibrosis. Which nursing diagnosis would the nurse consider the highest priority?
|a.||Risk for altered nutrition: less than body related to decreased appetite|
|b.||Altered breathing pattern related to thickened mucus secretions|
|c.||Knowledge deficit related to disease process|
|d.||Impaired skin integrity related to decreased mobility|
- Which statement(s) regarding critical pathways is/are true? (Select all that apply.)
|a.||Efficient for specific diseases or case types|
|b.||The same as medical plans|
|c.||Standardized and enhanced quality care|
|d.||Evaluated less frequently than care plans|
|e.||Enhanced communication for a variety of health care providers|
- In which way(s) is nursing diagnosis different from a medical diagnosis? (Select all that apply.)
|a.||Statement of the patient’s alterations in structure and functions|
|b.||Description of the patient’s ability to function in relation to impairment|
|c.||Tend to remain the same throughout the course of illness or recovery from injury|
|d.||Varies depending on patient’s state of recovery|
|e.||Based on research done by nurses|
|f.||Conditions can be accurately identified by nursing assessment methods|
- The nurse is participating in the planning phase of the nursing process for a new admission to a long term care facility. When formulating a plan to meet the patient’s needs, the nurse will take which action(s)? (Select all that apply.)
|a.||Formulate nursing interventions.|
|c.||Make a clinical judgment about the patient.|
|e.||Develop measurable goals.|
- The nurse is preparing a patient’s prescribed medications. In order to ensure patient safety, the nurse will perform which intervention(s)? (Select all that apply.)
|a.||Select the correct supplies.|
|b.||Administer the medication by the correct route.|
|c.||Use room number to identify correct patient.|
|d.||Educate patient regarding medications prescribed.|
|e.||Document in chart all aspects of medication administration.|
- Rank the patient needs according to Maslow’s hierarchy, beginning with the lowest level need to the highest level need. (Enter your answer with a comma and space between each lettered option as follows: A, B, C, D, E.)
- A patient would like to write a book.
- A patient becomes frightened when no one answers the call light during the night.
- A pediatric patient is worrying that school friends will forget him.
- A patient needs to be repositioned in bed.
- A chronically ill patient states that he feels worthless because he is unable to support his family.
Chapter 5: Patient Education to Promote Health
- The nurse is educating a 13-year-old boy newly diagnosed with diabetes and his parents about diet and glucose monitoring. Which domain of learning is represented when the patient expresses concern about feeling different from his peers?
- The nurse has taught a patient’s spouse to administer an injectable medication. After the spouse completed a return demonstration of the injection in the hospital, the nurse does not feel confident that this can be carried out independently at home and requests referral for a home health nurse. The nurse is using which phase of the nursing process?
- In preparing for health teaching with a patient who has an auditory learning style, which would be most appropriate?
|a.||Pamphlets from a pharmaceutical company|
|b.||Models of equipment used in a procedure|
|c.||Verbal description of the steps of a procedure|
|d.||A workbook with space to record actions and results|
- Which is the most intangible portion of the learning process?
- Which would positively affect readiness to learn?
|a.||Fear and denial|
|b.||Willingness to attain an optimal level of health|
|c.||Poor cognitive and motor development|
|d.||Lack of trust and confidence in the staff|
- Which represents the psychomotor domain of learning?
|a.||The patient draws up insulin in a syringe.|
|b.||The patient expresses a belief about medication use.|
|c.||The patient is able to verbalize foods that should be avoided.|
|d.||The patient relates past experience with smoking cessation.|
- Which is an example of ethnocentrism?
|a.||A 5-year-old Native American child colors in a book about diabetes.|
|b.||A 14-year-old African American attends a support group to learn about disease management.|
|c.||A 36-year-old Asian prefers to take herbs instead of an oral medication.|
|d.||A 72-year-old Hispanic asks questions about potential adverse effects to a newly prescribed medication.|
- What is the most important nursing consideration when teaching an older adult patient about a newly prescribed medication?
|a.||Provide detailed information.|
|b.||Lengthen the time of each teaching session.|
|c.||Present information slowly.|
|d.||Limit discussion on the necessity of learning the information.|
- The nurse caring for a Spanish speaking patient uses the assistance of an interpreter to help with preoperative teaching. While implementing the education, the nurse should:
|a.||look directly at the patient.|
|b.||never use pantomime gestures.|
|c.||ask lengthy questions to provide clarity.|
|d.||ask a family member to assist with interpretation.|
- A teaching plan has been developed by the nurse to educate the mother of a pre term infant on prescribed medications. Before initiating this teaching plan, the nurse should:
|a.||recognize the individual’s health beliefs.|
|b.||provide a formal learning setting.|
|c.||ensure that information is generalized.|
|d.||be sure that all care to the patient has been delivered.|
- Which item(s) would be considered characteristic of the cognitive domain level of learning? (Select all that apply.)
|a.||A patient’s opinion regarding wellness|
|b.||Basic mathematical formulas learned in grade school|
|c.||Incorporation of a person’s previous experiences and perceptions|
|d.||Skill demonstration using a step by step approach|
|e.||Relationship between prior experiences and new concepts|
- The nurse is preparing to instruct a patient and his wife on technique and importance of assessing pulse prior to taking heart medication. Which principle(s) of learning would be appropriate in this situation? (Select all that apply.)
|a.||The learning environment|
|b.||The patient’s and wife’s learning styles|
|c.||The objectives/goal statements listed on the patient’s care plan|
|d.||The patient’s financial ability to purchase the medication|
|e.||The patient’s understanding of the seriousness of his illness|
- The nurse is writing a teaching plan for a 30-year-old patient who has AIDS. Which objective(s) is/are written in the correct format? (Select all that apply.)
|a.||The patient will state adverse effects of the daily medications before discharge.|
|b.||The patient will correctly fill the daily medication pillbox with the correct medications in the appropriate time slots prior to discharge.|
|c.||The patient will adjust the medications accordingly.|
|d.||The patient will schedule an appointment with the infectious disease physician before discharge.|
|e.||The patient will have lab tests performed regularly.|
- Which action(s) by the nurse can foster patient responsibility for adhering to the therapeutic regimen? (Select all that apply.)
|a.||Assessing the patient’s readiness to learn|
|b.||Determining the patient’s level of understanding of content|
|c.||Determining the patient’s education level and learning style|
|d.||Maintaining an aloof attitude toward presented content|
|e.||Documenting expected outcomes independently|
- What should the nurse include during discharge in addition to verbal instructions? (Select all that apply.)
|a.||Written instructions for the patient’s reference|
|b.||A phone number of the provider or hospital unit for follow up questions|
|c.||Written instructions for monitoring of parameters used to evaluate therapy|
|d.||Documentation in the nurse’s discharge notes of the nursing and collaborative problems that require continued monitoring and intervention|
|e.||Identification of the patient’s unreasonable expectations of therapy|
- Which action(s) would let the nurse know that the patient has mastered a psychomotor skill? (Select all that apply.)
|a.||Describe the process verbally.|
|b.||Write a description of the process.|
|c.||Give a reciprocal demonstration of the process.|
|d.||Ask questions about the process.|
|e.||Demonstrate the process to another person while the nurse supervises.|
|f.||State whether the patient feels the process has been mastered.|
- The nurse and patient are participating in cooperative goal setting regarding drug therapy. The nurse is aware that it is imperative to encourage the patient to perform which task(s)? (Select all that apply.)
|a.||Contact the hospital for advice regarding discontinuation of medication.|
|b.||Keep records of essential data needed to evaluate prescribed therapy.|
|c.||See the health care provider regularly.|
|d.||Avoid community based agencies for assistance.|
|e.||Monitor parameters used to evaluate therapy.|
Chapter 6: A Review of Arithmetic
- Which medication consists of a liquid solvent that contains one or more dissolved substances?
|d.||Intravenous (IV) solution|
- What is the most accurate way for the nurse to document the administration of two milligrams of a medication?
- 1/7 + 3/7 = _____
- 2 1/2 + 1 1/3 = _____
- 7/30 + 9/30 + 1/30 = _____
- 1/18 + 1/9 + 1/12 + 1/4 = _____
- 5/18 – 2/9 = _____
- 10 7/9 – 6 1/6 = _____
- 1 1/2 – 7/11 = _____
- 11/15 – 1/4 = _____
- 1/2 ´ 1/3 = _____
- 5/12 ´ 3/4 = _____
- 75/20 ´ 5 = _____
- 300/125 ´ 5/1 = _____
- 3/32 ÷ 1/8 = _____
- 7/10 ÷ 3/5 = _____
- 1/200 ÷ 1/150 = _____
- 3/4 ÷ 3 = _____
- 0.5 + 0.05 = _____
- 1.5 + 0.75 = _____
- 0.125 + 0.25 = _____
- 4.302 + 1.88 + 0.009 = _____
- 19.83 – 4.51 = _____
- 3.75 – 1.5 = _____
- 4 – 0.8 = _____
- 3.7 – 1.9 = _____
- 0.125 ´ 10 = _____
- 10,000 ´ 0.75 = _____
- 1.5 ´ 8.04 = _____
- 0.25 ´ 1/2 = _____
- 0.6 ÷ 2 = _____
- 0.5 ÷ 4 = _____
- 5.5 ÷ 10 = _____
- 0.100 ÷ 1000 = _____
- 0.305 = _____
- 0.5 = _____
- 0.13 = _____
- 0.00007 = _____
- 2/5 = _____
- 1 3/4 = _____
- 0.125/0.25 = _____
- 1/0.5 = _____
- 32% = _____ (ratio), _____ (fraction), _____ (decimal)
- 1:45 = _____ (%), _____ (fraction), _____ (decimal [round to the nearest thousandth])
- 5/7 = _____ (%), _____ (ratio), _____ (decimal [round to the nearest thousandth])
- 0.62 = _____ (%), _____ (ratio), _____ (fraction)
- 1 mg = _____ mcg
- 1 kg = _____ pounds
- 1 qt = _____ cups
- 1 tsp = _____ mL
- 1 L = _____ mL
- 6.2 L = _____ mL
- 55 g = _____ kg
- 1 tbs = _____ tsp
- 75 lb = _____ kg
- 1 c = _____ oz
- 1 dL = _____ L
- 15 kg = _____ lb
- The physician has ordered 3500 units of heparin subcutaneously q12h
Available: Heparin 5000 units/mL
What volume of heparin will you administer? _____
- Health care provider’s order: Versapen 2.5 mg/kg qid (patient weighs 20.2 kg).
Available: Versapen 112.5 mg/5 mL
How many mL will you give? _____
- Health care provider’s order: 0.75 g amoxicillin PO
Available: Amoxicillin 250 mg tablets
How many tablets will you give? _____
- Infuse 150 mL gentamicin over 1 hour (set calibration is 10 gtt/mL).
Calculate the flow rate. _____ gtt/minute
- An IV of 750 mL was ordered to run over 6 hours with a set calibration of 10 gtt/mL.
After 2 hours you notice that 300 mL has infused. Recalculate the flow rate in gtt/min. _____
- Zephrin chloride solution 1:5000 is ordered for an irrigation. How much 1:2000 stock solution is needed to prepare 1000 mL? _____ mL
- 1000 mL of solution containing 50 g glucose in water: _____
- 500 mL of solution containing 350 mL alcohol in water: _____
- 200 mL of solution containing 2 g of boric acid in water: _____
- Convert 1 tablespoon to milliliters (mL): _____
- Convert 2 tsp to milliliters (mL): _____
- Convert 400 mcg to mg: _____
- Convert 25 g to mg: _____
- Convert 0.2 mg to mcg: _____
Chapter 7: Principles of Medication Administration and Medication Safety
- Where would the procedures and treatments directed by the health care provider be found?
|b.||Physician’s order form|
|c.||Physician’s progress notes|
|d.||History and physical examination form|
- Which action will the nurse take when it is determined that the narcotic count is incorrect while obtaining a medication from the narcotic area?
|a.||Determine the cause of the discrepancy at the end of the shift.|
|b.||Notify the health care provider stat.|
|c.||Call the nurse from the previous shift to determine if there was a discrepancy earlier.|
|d.||Report the discrepancy to the charge nurse immediately.|
- Which action will the nurse take if a dosage is unclear on a health care provider’s order?
|a.||Ask the patient what dosage was given in the past.|
|b.||Ask another physician to determine the correct dosage.|
|c.||Tell the patient that the medication will not be given.|
|d.||Contact the health care provider to verify the correct dosage.|
- What is the most reliable method to calculate a pediatric patient’s medication dosage?
|c.||Body surface area (BSA)|
|d.||Placement on a growth scale|
- Which medication route provides the most rapid onset of a medication, but also poses the greatest risk of adverse effects?
- Which is known as the “fifth vital sign”?
- Which is true regarding the unit dose drug distribution system?
|a.||The inventory is delivered to each nursing unit on a regular and recurring basis.|
|b.||The system delivers one dose of each medication to be administered until the subsequent delivery of inventory.|
|c.||The use of single dose packages of drugs dispensed to fill each dose requirement as it is ordered.|
|d.||The amount of inventory needed to dose all patients on the unit for a 24 hour interval.|
- The nursing assessment identifies that the client is nauseated and cannot take acetaminophen (Tylenol) orally. Which is true regarding the substitution of this medication to suppository form?
|a.||It is standard practice when the patient is unable to take the ordered medication.|
|b.||It is acceptable if the patient agrees to the altered route form.|
|c.||It is preferable to having the patient miss a dose of the medication.|
|d.||It is contraindicated without an order from the health care provider.|
- Which medication order requires nursing judgment and means “administer if needed”?
|a.||Morphine 4 mg IV stat|
|b.||Morphine 4 mg IV prior to procedure|
|c.||Morphine 4 mg IV four times a day|
|d.||Morphine 4 mg IV every 4 hours PRN|
- What is medication reconciliation?
|a.||Comparing the patient’s current medication orders to all of the medications actually being taken|
|b.||The administration of high alert medications that have been ordered on admission to an acute care facility|
|c.||The completion of an incident report following a variance that resulted in a serious complication|
|d.||A printout of computerized patient data that identifies the times that all of the ordered medications are to be administered|
- Which example best demonstrates safe drug administration by the nurse?
|a.||Administering an oral medication with the patient sitting upright|
|b.||Asking children to say their name before administering the medication|
|c.||Leaving the medications on the bedside stand after verifying patient identification|
|d.||Returning the unused portion of a medication to a stock supply bottle|
- The nurse determines that a prescribed medication has not been administered as ordered on the previous shift. What action will the nurse take?
|a.||Administer the medication immediately.|
|b.||Complete an incident report.|
|c.||Notify the nurse responsible for the error.|
|d.||Record the occurrence in the nurse’s notes.|
- A patient’s liquid cough medicine has been discontinued with one half of the bottle remaining. The home health nurse is aware that according to the U.S. Food and Drug Administration (FDA) guidelines on prescription medication disposal, the next step should be to:
|a.||save the remainder for another patient with the same prescription.|
|b.||flush the remainder down the toilet.|
|c.||read the drug label for specific disposal instructions.|
|d.||pour remaining medication into a hazardous waste container.|
- Who defines the standards of care for the practice of nursing? (Select all that apply.)
|a.||State boards of nursing|
|b.||Hospital policy and procedures|
|c.||Federal laws regulating health care facilities|
|d.||The Joint Commission|
|e.||Professional nursing associations|
- What must the nurse have before administering any medication? (Select all that apply.)
|a.||A current license to practice|
|b.||A medication order signed by a practitioner licensed with prescription privileges|
|c.||Knowledge of the medication|
|d.||Consultation with a pharmacist|
|e.||Knowledge of the client’s diagnosis|
- Which advantage(s) does the unit dose drug distribution system include? (Select all that apply.)
|a.||There is decreased participation by the pharmacy.|
|b.||The pharmacist is able to analyze prescribed medications for each client for drug interactions and contraindications.|
|c.||There is less waste of medications.|
|d.||The time spent by nursing personnel preparing these medications is increased.|
|e.||Credit is given to the patient for unused medications.|
- Which statement(s) is/are true regarding the types of medication orders? (Select all that apply.)
|a.||Stat orders are the same as single dose orders.|
|b.||Standing orders indicate the number of specified doses of a medication to be given.|
|c.||Renewal orders facilitate physician review before continuance of high risk medications.|
|d.||PRN medications will designate a mandatory number of times the medication is to be administered.|
|e.||Verbal orders should be used as much as possible.|
- Which statement(s) is/are true regarding computerized prescriber order entry (CPOE)? (Select all that apply.)
|a.||Integrates the ordering system with the pharmacy, laboratory, and nurses’ stations|
|b.||Provides instant access to online information to facilitate patient care needs|
|c.||Facilitates review of ordered medications for potential drug interactions|
|d.||Facilitates review of drugs for appropriateness of dosages|
|e.||Alleviates the need to perform mathematical computations|
- Which lab test(s) would be used to assess liver and/or renal function before administering medications? (Select all that apply.)
- The nurse is preparing to administer Lanoxin to a patient on the telemetry unit. In addition to understanding the patient’s diagnosis, the nurse must also know which characteristic(s) of the medication? (Select all that apply.)
|d.||Contraindications for use|
- The nurse transcribes an order to administer Valium 10 mg IV stat. This order is correctly interpreted by the nurse to mean it should be provided how? (Select all that apply.)
|c.||One time only|
|d.||In divided doses|
Chapter 8: Percutaneous Administration
- A patient has an infected wound with large amounts of drainage. Which type of dressing would the nurse use?
- Where would the nurse apply nitroglycerin ointment on a male patient?
|a.||The same site that was previously used|
|b.||A hairy area of the chest|
|c.||The upper arm|
|d.||The back of the knee|
- Where will the nurse administer a medication that was ordered to be given sublingually?
|a.||Between the molar teeth and cheek|
|b.||Below the skin surface|
|c.||Under the tongue|
|d.||Into the conjunctival sac|
- Why are sublingual and buccal medications rapidly absorbed?
|a.||Their action is localized to the mouth.|
|b.||They are metabolized in the liver.|
|c.||Blood flow is diminished in these sites.|
|d.||These drugs pass directly into systemic circulation.|
- Which medications must be sterile?
- Which action will the nurse perform when doing a wet to dry dressing every 4 hours on a patient with a deep wound?
|a.||Pack the wound tightly with gauze.|
|b.||Saturate the dressing with as much liquid as possible.|
|c.||Use Montgomery tapes or a binder to secure the dressing.|
|d.||Apply the new moist dressing over the existing one.|
- When applying nitroglycerin topically, which nursing intervention is correct?
|a.||Secure the paper on two sides with tape.|
|b.||Shave the area prior to application of the paper.|
|c.||Wear gloves while placing the new paper.|
|d.||Remind the patient to discontinue use of the medication if chest pain is relieved.|
- Where does the nurse correctly administer ophthalmic medication?
|a.||At the inner canthus of the eye|
|b.||In the lower conjunctival sac|
|c.||Directly onto the eyeball|
|d.||To the outer corner of the eyelid|
- Which effect would be important for the nurse to address when teaching a patient about the overuse of nose drops?
- Which nursing assessment accurately describes the results of an intradermal skin test?
|a.||Itching and weeping|
|b.||Erythema and induration|
|c.||Swelling and coolness|
|d.||Pallor and drainage|
- The nurse is teaching a patient about nitroglycerin ointment. Which is an advantage of this form of the medication?
|a.||It does not give the patient a bad taste in the mouth.|
|b.||The amount of ointment does not matter in obtaining a therapeutic response.|
|c.||It does not cause headaches as an adverse effect.|
|d.||It provides relief of anginal pain for several hours longer than sublingual medication.|
- A patient with metastatic cancer is being admitted for pain control. Which action will the nurse perform in administering a transdermal patch?
|a.||After removal, dispose of the old patch in a receptacle in the patient’s room.|
|b.||Change the fentanyl patch every day, either in the morning or at bedtime.|
|c.||Hold the short acting oral pain medication when a fentanyl patch is initiated.|
|d.||Label the patch with date, time, dosage, and initials after patch placement.|
- What is the rationale for the nurse applying gentle pressure to the inner corner of the eyelid after instilling eye drops?
|a.||Decreases the risk of infection|
|b.||Maintains intraocular pressure|
|c.||Prevents systemic effects|
|d.||Provides comfort to the patient|
- The nurse is instructing a patient to use a corticosteroid inhaler. Which statement by the patient indicates the need for further teaching?
|a.||“I will shake the inhaler before I use it.”|
|b.||“I need to rinse my mouth after I use the inhaler.”|
|c.||“I will use this when I’m lying in bed in the morning.”|
|d.||“After I inhale, I will hold my breath and then breathe out slowly.”|
- What is the appropriate nursing action when administering a vaginal suppository?
|a.||Ask the patient to urinate prior to insertion.|
|b.||Assist the patient to a side lying position.|
|c.||Keep suppository refrigerated prior to insertion.|
|d.||Insert the suppository 1 inch into the vagina.|
- Which is an accurate nursing action when treating a patient’s rash with a lotion?
|a.||Avoid shaking the container prior to application.|
|b.||Cleanse area with alcohol prior to treatment.|
|c.||Cover the area with gauze because of the oil base.|
|d.||Pat on the area with a gloved hand.|
- A 2-year-old child is hospitalized with the diagnosis of tonsillitis and bilateral otitis media. The nurse is preparing to administer ear drops. When instilling the ear drops, the nurse will pull the earlobe:
|a.||upward and back.|
|b.||sideways and down.|
|c.||downward and back.|
|d.||sideways and up.|
- The nurse is preparing an otic solution. When instructing the patient in regard to area of administration, the nurse will explain that the solution will be placed:
|a.||into the eye.|
|b.||under the tongue.|
|d.||into the ear.|
- Which order(s) would be examples of percutaneous medication administration? (Select all that apply.)
|a.||Timolol 0.5% 1 drop to each eye daily|
|b.||Albuterol nebulizer 2.5 mg qid|
|c.||Heparin 5000 units IV|
|d.||Lasix 20 mg PO every AM|
|e.||Silvadene 1% topically to affected area|
- Which action(s) will the nurse perform when preparing to administer a topical medication? (Select all that apply.)
|a.||Wash hands before and after administration.|
|b.||Maintain a dry environment to encourage wound healing.|
|c.||Wear gloves during the application process.|
|d.||Use sterile dressings for all wounds.|
- Which dressings would be appropriate to use for treating wounds with exudates?
- Place the following steps for administration of nose drops in the correct order. (Enter your answer with a comma and space between each lettered option as follows: A, B, C, D, E.)
- Draw medication into the dropper.
- Instruct patient to blow the nose gently.
- Review practice setting policy.
- Explain the steps to the patient.
- Position the patient into supine position with head backward over edge of bed.
- Instill medication.
Chapter 9: Enteral Administration
- In which position would the nurse place a patient before the administration of an enteral feeding?
- Which type of lubricant would the nurse use to administer a rectal suppository?
- Which is a characteristic of medication administration via the rectal route?
|a.||Irritation of the mouth|
|b.||Nausea and vomiting|
|c.||Bypassing of the digestive enzymes|
|d.||Use of the first pass metabolism|
- Which medications are provided in dried, powdered form compressed into small disks?
- Which action by the nurse is appropriate when administering enteric coated tablets?
|a.||Administer with an antacid.|
|b.||Crush the tablet and mix with applesauce.|
|c.||Encourage the patient to drink a full glass of water.|
|d.||Instruct the patient to place the medication between the cheek and teeth.|
- Which route of administration would be ordered by the health care provider if a patient is vomiting?
- After entering the patient’s room to administer oral medications, which action will the nurse take first?
|a.||Assist the patient to sit upright.|
|b.||Check the patient’s identification.|
|c.||Inform the patient about the medications.|
|d.||Offer the patient something to drink.|
- The nurse is preparing to administer a medication in tablet form to a patient. In administering this medication, the nurse will encourage the patient to:
|a.||drink a large amount of water prior to administration so that swallowing is easier.|
|b.||place the medication on the front of the tongue.|
|c.||keep the head forward while swallowing.|
|d.||minimize the amount of fluid taken following medication administration.|
- When assessing aspirated stomach contents, the nurse notes the color to be green with sediment. The nurse is aware that this most likely represents _____ fluid.
- Oral drug administration includes which principle(s)? (Select all that apply.)
|a.||Dependable rate of absorption|
|c.||Insulin able to be administered via this route|
|d.||Drugs delivered directly by the oral, rectal, or nasogastric (NG) methods|
|e.||Dosage forms are convenient and readily available|
- The nurse is administering an oral medication to a 90 year old patient who has difficulty swallowing pills. One of the medications to be administered is a spansule type capsule. What nursing consideration(s) should be applied in this case? (Select all that apply.)
|a.||Wash hands before preparing medications and before administration.|
|b.||Crush medications and administer with a soft food, such as applesauce.|
|c.||Check the patient’s ID band with the MAR to ensure patient rights are followed.|
|d.||Have an 8 ounce glass of water available.|
|e.||Check with the pharmacist to see if the spansule medication comes in a liquid form.|
- Which receptacle(s) is/are commonly used in the hospital with pediatric oral medications? (Select all that apply.)
|b.||Baby bottle full of formula|
|c.||Infant feeding nipple|
- Which data will the nurse document when administering a PRN oral pain medication to a patient? (Select all that apply.)
|a.||Date, time, drug name, dosage, and route of administration|
|b.||Essential patient education about the drug completed|
|c.||Administration receptacle used|
|d.||Signs and symptoms of adverse drug effects|
|e.||Evaluation of therapeutic effectiveness|
- NG medication administration includes which principle(s)? (Select all that apply.)
|a.||The tube must be assessed for correct placement.|
|b.||All medications can be combined into one syringe.|
|c.||Tablets and capsules should be dissolved in water.|
|d.||The suction source should be immediately reconnected.|
|e.||Flush the tube with 30 mL of water after drug administration.|
- Which nursing action(s) would be appropriate when administering a disposable enema? (Select all that apply.)
|a.||Position the patient on the left side.|
|b.||Allow the solution to flow in by gravity.|
|c.||Instruct the patient to hold the solution 30 minutes before defecating.|
|d.||Maintain the six rights of medication administration.|
|e.||Lubricate the rectal tube.|
- In preparing to administer medications to a patient with an NG tube, which would be appropriate to give through that route? (Select all that apply.)
|b.||Tablets crushed and diluted in 30 mL of water|
|c.||Enteric coated tablets crushed and diluted in 30 mL of water|
|d.||Capsules emptied into 30 mL of water|
|e.||Timed release capsules emptied into 30 mL of water|
- An adult patient is to receive 10 mL of cough syrup at 0800. The nurse can prepare to administer this medication in a(n): (Select all that apply.)
Chapter 10: Parenteral Administration: Safe Preparation of Parenteral Medications
- Which part of the syringe contains the calibrations for drug volume measurement?
- Which needle will the nurse use to administer an intramuscular (IM) immunization on an 18 month old child?
|a.||18-gauge, 1 inch needle|
|b.||20-gauge, 1/2 inch needle|
|c.||27-gauge, 1 1/2 inch needle|
|d.||25-gauge, 1/2 inch needle|
- Which syringe will the nurse use to administer insulin subcutaneously to a patient?
|a.||A syringe calibrated in minims|
|b.||A syringe calibrated in units|
|c.||A syringe calibrated in tenths of mL|
|d.||A syringe calibrated in mL|
- Which action by the nurse is most accurate when drawing up medication from an ampule?
|a.||Consider the rim of the ampule as sterile.|
|b.||Use a filter needle to withdraw the medication.|
|c.||Wrap a paper towel around the neck of the ampule before breaking it.|
|d.||Inject 0.5 mL of air into the ampule before withdrawing the medication.|
- Which action by the nurse is accurate when withdrawing medication into a syringe from a vial?
|a.||Inject an amount of air equal to the medication into the vial.|
|b.||Break the thin neck of the vial container.|
|c.||Remove the rubber stopper on the top of the vial.|
|d.||Discard the initial 0.5 mL of medication to ensure sterility.|
- An adult patient is to receive two medications IM. Which action by the nurse is most important in order to mix the medications in one syringe?
|a.||Assess for the presence of adequate muscle mass.|
|b.||Ensure that the combined medication amount is less than 2 mL.|
|c.||Determine the compatibility of the medications.|
|d.||Use a needle that is 25 gauge.|
- The nurse is preparing to administer insulin. What does U 100 indicate?
|a.||100 mL per unit|
|b.||10 units per mL|
|c.||100 units per mL|
|d.||10 units per 100 mL|
- After teaching a diabetic patient about proper disposal of used syringes and needles, which statement by the patient indicates a need for further teaching?
|a.||“Even needles with sleeves should be disposed of appropriately.”|
|b.||“It is unusual that anyone could get a needle injury or disease from used needles.”|
|c.||“It is important for me to use the designated container to dispose of my syringes and needles.”|
|d.||“I am going to purchase the ‘Sharps by Mail Disposal System’ once I am home.”|
- Which nursing action is accurate when administering parenteral medication?
|a.||Adjust the route of the medication, if needed.|
|b.||Document the response to PRN medications at the end of the shift.|
|c.||Request the pharmacist to provide education about the medication to the patient.|
|d.||Use clinical judgment when rescheduling missed doses of a medication.|
- What is an advantage of administering a drug parenterally?
|a.||The duration of action is longer.|
|b.||Medications given by this route are inexpensive.|
|c.||The onset of action is more rapid.|
|d.||The dose is usually larger than an oral dose.|
- Which information provided by the nurse is most important to include when teaching a patient about the use of an EpiPen?
|a.||“Hold the syringe at a 45-degree angle against the skin.”|
|b.||“Monitor the expiration date of this medication.”|
|c.||“After using the EpiPen, lie down for 1 hour.”|
|d.||“Place the syringe in a cartridge prior to using.”|
- Which type of parenteral medication container is made of glass, is scored, and needs to be broken open before withdrawing the medication?
- The operating room (OR) nurse is preparing medications for use in a sterile field during a surgical procedure. While preparing these medications, the nurse will:
|a.||save unused portions of medication for use in another procedure.|
|b.||differentiate between sterile and nonsterile medications to be used in the OR.|
|c.||ensure the scrub (sterile) nurse retrieves the medication from storage.|
|d.||read the label aloud for verification against the order from the surgeon.|
- The mother of a 6-year-old child informs the school nurse that the child is allergic to insect stings and requires an EpiPen. If the child is stung by an insect while in school, the nurse must:
|a.||hold the EpiPen perpendicularly against the thigh and activate.|
|b.||provide additional care in the nurse’s office prior to sending the child back to class.|
|c.||call the physician prior to administration.|
|d.||provide a second dose within 2 minutes following initial dose.|
- Which principle(s) is/are correct for mixing insulin? (Select all that apply.)
|a.||Insulin orders and calculations must be checked with another nurse.|
|b.||Air is injected into the vial of the shorter acting insulin first.|
|c.||The longer acting insulin is drawn up first.|
|d.||The nurse must verify the compatibility of the insulin types.|
|e.||Withdraw the shorter acting insulin first.|
- Which risk factor(s) should be considered when administering medications by injection? (Select all that apply.)
|a.||Trauma at the site of the needle puncture|
|b.||Possibility of infection|
|c.||Irretrievability of the medication once administered|
|e.||Delayed onset of action|
|f.||Chance of allergic reaction|
- When preparing parenteral medications, the nurse should perform which intervention(s)? (Select all that apply.)
|a.||Check the expiration date.|
|b.||Use sterile technique throughout the entire procedure.|
|c.||Check the drug dose form ordered against the source available.|
|d.||Prepare the drug in a clean well lighted area.|
Chapter 11: Parenteral Administration: Intradermal, Subcutaneous, and Intramuscular Routes
- The nurse is educating a patient about diabetes. Based on recommendations from the American Diabetes Association, which statement by the nurse is best regarding site rotation?
|a.||“Insulin injection sites should always be in the abdomen to ensure absorption into the stomach.”|
|b.||“It is important to rotate injection sites systematically within one area before progressing to a new site for injection.”|
|c.||“Following exercise, site rotation is not indicated because the circulation in the muscles will absorb the medication efficiently.”|
|d.||“If you aspirate, site rotation can be done every other day to avoid developing problems with absorption.”|
- Which technique by the nurse is accurate when administering heparin to a thin, older adult patient?
|a.||Aspirate before injecting the medication.|
|b.||Inject at a 45-degree angle.|
|c.||Inject at a 90-degree angle.|
|d.||Massage site following injection.|
- The nurse is preparing to administer kindergarten immunizations at the local health clinic. Which anatomic site would be best for the injection of the immunizations containing 0.5 mL?
- A 65-year-old man who weighs 180 lb (81.8 kg) is to receive 1.5 mL of a viscous antibiotic by intramuscular (IM) injection. Which needle and syringe will be used?
|a.||5/8 inch, 25-gauge needle with 5 mL syringe|
|b.||1 inch, 28-gauge needle with 4 mL syringe|
|c.||1 1/2 inch, 21-gauge needle with 3 mL syringe|
|d.||3 inch, 16-gauge needle with 1.5 mL syringe|
- Which is the preferred IM site for injecting a 6-month-old child?
- Which angle is appropriate when administering an IM medication in the dorsogluteal site to a 46 year old obese man?
- Which parenteral route has the longest absorption time?
- Which site is identified by the posterior superior iliac spine and greater trochanter?
- Which nursing action is accurate when administering an IM injection using the Z track method?
|a.||Use a 1-inch needle.|
|b.||Add 0.5 mL of air to the syringe.|
|c.||Vigorously massage the injection site.|
|d.||Pinch up the skin.|
- Which gauge needles are used for subcut injections?
|a.||14 to 16 gauge|
|b.||18 to 21 gauge|
|c.||22 to 24 gauge|
|d.||25 to 29 gauge|
- When is it acceptable to use the deltoid muscle as an injection site for infants?
|a.||Medication is irritating.|
|b.||Dose is a long acting medication.|
|c.||Child is combative.|
|d.||Volume is quite small.|
- Which action by the nurse is most accurate when administering an intradermal injection?
|a.||Insert the needle at a 45-degree angle.|
|b.||Inject 0.1 mL.|
|c.||Use a 22-gauge needle.|
|d.||Wipe the site with alcohol after injection.|
- Which assessment by the nurse is most important to obtain prior to performing allergy sensitivity testing?
|a.||Identify areas of loose connective tissue.|
|b.||Question the patient about frequency of exercise.|
|c.||Determine if the patient is using aspirin.|
|d.||Palpate and measure the size of induration.|
- The nurse administers a skin prick test (SPT) to a patient at 9 AM. The earliest time the nurse can expect to read the test is:
|a.||the next day at 9 AM.|
|b.||by 9 PM the same day.|
|c.||by 9:10 AM the same day.|
|d.||one week from the date and time of administration.|
- The nurse cleansing the skin surface of a patient prior to injection will start at the:
|a.||periphery and work inward in a back and forth motion.|
|b.||periphery and work inward in a cyclical motion.|
|c.||injection site and work outward in a straight line.|
|d.||injection site and work outward in a circular motion.|
- The nurse is preparing to administer allergy sensitivity testing to a patient. Which statement(s) pertain(s) to this type of administration? (Select all that apply.)
|a.||Allergy sensitivity testing requires the intradermal route.|
|b.||Injections are made into the loose connective tissue.|
|c.||Equipment needed includes gloves, antiseptic pledget, metric ruler, and physician’s order sheet.|
|d.||Record of previous injection sites is needed.|
|e.||The needle should be inserted at a 15-degree angle with the needle bevel up.|
- Which statement(s) about administering medications parenterally is/are true? (Select all that apply.)
|a.||Subcut absorption is slower than intradermal absorption.|
|b.||Two mL or less should be administered in a subcut site.|
|c.||The gluteal area is recommended for children.|
|d.||Needles 1 to 1 1/2 inches in length are common for IM injections.|
|e.||The scapular areas of the back may be used for intradermal injections.|
- The vastus lateralis muscle is appropriate for injections for which patient(s)? (Select all that apply.)
|a.||Children younger than 3 years of age|
- The nurse administers B12 IM to a patient in a long term care facility. After administering this medication, the nurse will: (Select all that apply.)
|a.||carefully recap the needle.|
|b.||identify the patient.|
|c.||massage site of injection.|
|d.||dispose of the used needle according to policy.|
|e.||apply a small bandage to the site.|
Chapter 12: Parenteral Administration: Intravenous Route
- A patient is diagnosed with cancer and requires 6 months of chemotherapy infusions. Which type of intravenous (IV) access device will likely be used?
|a.||Peripheral venous access device|
|c.||Winged needle venous access device|
|d.||Implantable venous infusion port|
- The nurse notes that a patient with cardiac disease has IV heparin infusing and that it is behind by 2 hours. What is the best nursing action?
|a.||Increase the IV rate and recheck in 1 hour.|
|b.||Change the infusion rate to TKO.|
|c.||Discontinue the solution using aseptic technique.|
|d.||Contact the health care provider for consultation.|
- What is the composition of hypotonic intravenous solutions such as 0.45% NaCl?
|a.||Fewer dissolved particles than blood|
|b.||Approximately the same number of dissolved particles as blood|
|c.||Higher concentrations of dissolved particles than blood|
|d.||Electrolytes and dextrose|
- Which condition would the nurse expect to be treated with an isotonic solution?
- The nurse determines that an elderly patient’s IV of D50.2NS with 20 mEq KCl at 75 mL/hr is running 3 hours behind. After determining the IV site is patent, what action will the nurse take?
|a.||Call the health care provider to obtain an order to decrease the IV rate.|
|b.||Administer a bolus to make up the deficit.|
|c.||Recalculate the flow rate and slowly make up the fluids.|
|d.||Maintain the ordered rate.|
- Which technique by the nurse accurately maintains asepsis of a peripheral IV access device?
|a.||Wear gloves when hanging all IV solutions.|
|b.||Apply a topical antibiotic ointment to the insertion site.|
|c.||Change fluid administration sets according to institutional policy.|
|d.||Flush with heparin before use.|
- Which needle is used to access implanted infusion devices?
- The nurse assesses erythema, warmth, and burning pain along the patient’s IV site. Which complication is this patient most likely experiencing?
- An elderly patient receiving an infusion of an isotonic fluid at 100 mL/hr complains of dyspnea. The nurse notes shallow rapid respirations and a cough that produces frothy sputum. Which is the priority nursing action?
|a.||Assess the urine output.|
|b.||Elevate the head of the bed.|
|c.||Encourage the patient to cough.|
|d.||Maintain the IV rate.|
- A diabetic patient requires the administration of insulin continuously at home. Which system would most likely be used in this instance?
|a.||Central line catheter|
- A patient is admitted with hypovolemia resulting from lack of fluid intake and requires an infusion of isotonic fluids. Which IV solution will the nurse administer?
- Which potential complication will the nurse expect in patients with a venous access device?
- A patient has a peripherally inserted central catheter (PICC) line inserted to continue IV antibiotic therapy at home. With proper care, how long can this type of venous access device remain in place?
- In assessing a patient with a central venous access device, which sign or symptom indicates that the patient is experiencing an air embolism?
- Following the insertion of a central venous access device, the nurse notes a weak, thready pulse and decreased blood pressure. The patient complains of shortness of breath and palpitations. Which action will the nurse take first?
|a.||Place the patient on the left side.|
|b.||Reassess vital signs.|
|c.||Stop the infusion.|
|d.||Verify placement of the device.|
- The nurse is about to administer a prescribed medication IV push into a patient’s Hickman catheter. When providing this medication, the nurse will first:
|a.||administer the prescribed drug.|
|b.||flush with saline.|
|c.||flush with heparin.|
|d.||prepare a pump.|
- A 90 year old woman is admitted to an acute care facility with the diagnosis of pneumonia. She has a past medical history of diabetes mellitus, hypertension, and right sided mastectomy. When starting an IV for infusion of antibiotic therapy, the nurse will:
|a.||insert the IV catheter into the left hand.|
|b.||use a lower extremity vein for insertion.|
|c.||choose the left radial artery for insertion.|
|d.||attempt insertion into the left antecubital space vein.|
- What will the nurse explain when teaching a patient about a PICC line? (Select all that apply.)
|a.||The catheter may have a single or double lumen.|
|b.||There is greater risk of clotting and infiltration with this type of catheter.|
|c.||The patient will be receiving infusions continuously to ensure patency.|
|d.||The tip of the catheter may be open or valved.|
|e.||The catheter may be used for drawing blood.|
- Which patient assessment finding(s) suggest(s) extravasation of an IV solution? (Select all that apply.)
|d.||Pain at venipuncture site|
|e.||Redness at the site|
|f.||Shortness of breath|
- The nurse assesses a patient’s right hand IV site to be infiltrated. Appropriate nursing actions include: (Select all that apply.)
|a.||stopping the infusion.|
|b.||attempting to aspirate the medication.|
|c.||elevating the affected limb.|
|d.||checking capillary refill.|
|e.||removing the catheter as directed by policy.|
Chapter 13: Drugs That Affect the Central Nervous System
- Which condition would alert the nurse of the need to use beta adrenergic blockers cautiously?
- A patient with chronic obstructive pulmonary disease (COPD) reports having insomnia and a racing heart after starting terbutaline therapy. Which explanation by the nurse is most accurate?
|a.||“The symptoms are typical and indicate that the medication is at a therapeutic level.”|
|b.||“The symptoms will tend to resolve with continued therapy.”|
|c.||“The symptoms are unusual and need to be reported to the health care provider immediately.”|
|d.||“The symptoms are indicative of toxicity.”|
- What is the primary response to alpha 1 receptor stimulation?
- Which category of medications is used for peripheral vascular diseases characterized by excessive vasoconstriction, such as Raynaud’s disease?
|b.||Alpha adrenergic blocking agents|
|c.||Beta adrenergic blocking agents|
- Why are beta blockers used cautiously in patients with respiratory conditions?
|a.||They mask the signs and symptoms of acute hypoglycemia.|
|b.||They cause extensive vasodilation and cardiac overload.|
|c.||They may produce severe bronchoconstriction.|
|d.||They increase hypertensive episodes.|
- A patient with Parkinson’s disease asks the nurse why anticholinergics are used in the treatment. Which response by the nurse is most accurate?
|a.||“These drugs help you urinate.”|
|b.||“These drugs will decrease your eye pressure.”|
|c.||“These drugs inhibit the action of acetylcholine.”|
|d.||“These drugs will assist in lowering your heart rate.”|
- Before the initiation of anticholinergic medications, it is important for the nurse to screen patients for which condition?
|d.||Closed angle glaucoma|
- Which nerve endings liberate norepinephrine?
- The autonomic nervous system can be subdivided into which types of adrenergic receptors?
|a.||Nicotinic and muscarinic|
|b.||Afferent and efferent|
|c.||Alpha and beta|
|d.||Agonists and antagonists|
- Prior to the administration of metoprolol, a beta adrenergic blocking agent, which is most important for the nurse to assess?
- A patient with a history of type 1 diabetes after myocardial infarction has been placed on a beta adrenergic blocking agent. Which statement by the patient indicates a need for further teaching?
|a.||“This medication should not be discontinued suddenly.”|
|b.||“This medication lowers my blood pressure by helping me get rid of fluid.”|
|c.||“I may not have my usual symptoms of a hypoglycemic reaction while on this drug.”|
|d.||“This medication may take a few weeks to work.”|
- An older adult patient is to receive atenolol, a beta adrenergic blocking agent. Prior to administration of the drug, the nurse assesses an apical pulse rate of 58 and notes ankle edema. Which action will the nurse take first?
|a.||Determine the therapeutic blood level.|
|b.||Encourage the patient to decrease water intake.|
|c.||Elevate the patient’s legs.|
|d.||Withhold the medication.|
- A patient hospitalized in an acute care setting reports to the nurse that since starting on an adrenergic medication, he has been feeling “dizzy and weak.” The most appropriate action for the nurse is to:
|a.||immediately notify the physician.|
|b.||teach the patient to move slowly from standing to sitting.|
|c.||discontinue the adrenergic blocker.|
|d.||monitor the blood pressure in both the supine and standing positions.|
- A long term care resident is taking an anticholinergic agent. The nurse observes the resident to be disoriented and hallucinating. The priority nursing action is to:
|a.||report development of alterations to the charge nurse.|
|b.||assess blood glucose.|
|c.||provide for resident’s safety.|
|d.||medicate with antianxiety medication.|
- The nurse is caring for a patient taking a cholinergic agent. When auscultating lung sounds, the nurse notes inspiratory and expiratory wheezing bilaterally. The best action for the nurse to take would be to:
|a.||provide the next dose of the cholinergic agent immediately.|
|b.||assess heart rate and blood pressure.|
|c.||reposition the patient.|
|d.||withhold the next dose and notify the physician.|
- Which adverse effect(s) is/are common when a patient is receiving a cholinergic agent? (Select all that apply.)
- Which statement(s) is/are true about efferent nerves? (Select all that apply.)
|a.||They transmit signals to the spinal cord and brain.|
|b.||They leave the CNS to carry impulses to other body parts.|
|c.||They are part of the peripheral nervous system.|
|d.||They transmit signals that control contractions of smooth and skeletal muscle.|
|e.||They transmit signals that control contractions of some glandular secretions.|
- Which instruction(s) given by the nurse will assist a patient to cope with the common adverse effects of anticholinergic medications? (Select all that apply.)
|a.||“Take the medication with meals.”|
|b.||“Increase fluids daily.”|
|c.||“Decrease fiber in the diet.”|
|d.||“Suck on candy or ice chips.”|
|e.||“Monitor blood glucose.”|
- Which body function(s) is/are controlled by the autonomic nervous system? (Select all that apply.)
|b.||Skeletal muscle contraction|
- A patient is being discharged on an adrenergic bronchodilator. Which common adverse effect(s) will the nurse include in discharge teaching? (Select all that apply.)
- Neurotransmitter(s) include: (Select all that apply.)
|a.||gamma aminobutyric acid.|
- Which disorder(s) would indicate the use of anticholinergic agents? (Select all that apply.)
|b.||Benign prostatic hypertrophy|
|e.||Preparation for surgery|
|f.||Stimulation of the vagus nerve|
Chapter 14: Drugs Used for Sleep
- The nurse finds that a patient is extremely agitated, yells frequently, and is attempting to get out of bed without assistance. What is the nurse’s initial action?
|a.||Administer zolpidem after taking the patient’s vital signs.|
|b.||Close the patient’s door for privacy after administering Tylenol.|
|c.||Administer benzodiazepine before calling the health care provider.|
|d.||Spend uninterrupted time listening to the patient.|
- An older adult patient received a hypnotic agent at 9:00 PM. At 2:00 AM, the nurse discovers that the patient has removed her gown and is attempting to get out of bed without assistance. What type of medication effect is the patient exhibiting?
- For what conditions are benzodiazepines prescribed?
- A patient receiving diazepam (Valium) is complaining of nausea and vomiting and is becoming jaundiced. Which type of blood work will be performed?
|a.||Renal function tests|
|b.||Liver function tests|
- In addition to facilitating sleep, what is another benefit of sedatives?
|a.||Increased pain control postoperatively|
|b.||Reduced bronchial secretions|
|c.||Decreased patient anxiety|
|d.||Increased patient alertness|
- Which two phases make up normal sleep?
|a.||Hypnagogic and hypnopompic|
|b.||Rapid eye movement (REM) and non REM|
|c.||Alpha and beta|
|d.||Delta and theta|
- Which sleep pattern stage diminishes as an effect of aging?
- A patient has been prescribed lorazepam (Ativan), a benzodiazepine used to treat insomnia. Which action will the nurse take?
|a.||Advise the patient to take the medication with food.|
|b.||Assess the patient’s blood pressure in sitting and lying positions.|
|c.||Inform the patient to discontinue the medication once sleep improves.|
|d.||Instruct the patient to lie down before taking the medication.|
- Which disease is associated with insufficient sleep?
- The nurse is caring for an older patient recently admitted to an assisted living center who is experiencing insomnia associated with the recent relocation. At bedtime, which nursing action will assist the patient to sleep?
|a.||Offering the patient hot tea|
|b.||Encouraging the patient to ambulate in the hallway|
|c.||Performing back massage|
|d.||Administering an analgesic|
- The nurse is explaining the use of medications to a patient with insomnia. Which statement about sedatives is true?
|a.||A sedative will produce sleep.|
|b.||Sedatives increase the total time in REM sleep.|
|c.||Increased relaxation occurs with sedatives.|
|d.||Sedatives are more potent than hypnotics.|
- The nurse is assessing a patient who is being evaluated in an outpatient clinic for complaints of back pain. The patient reports taking diphenhydramine for insomnia related to job stress. Which statement by the nurse is accurate regarding this medication?
|a.||“This medication should only be taken for 1 week.”|
|b.||“This medication can cause nausea.”|
|c.||“The medication should not be taken after eating a high fat meal.”|
|d.||“This is an herbal medication that has been used for hundreds of years.”|
- When reviewing a patient’s history and physical information, the nurse notes that the patient has physician’s orders for chloral hydrate and warfarin. During assessment of this patient, the nurse observes areas of petechiae and ecchymosis on the upper and lower extremities. The most appropriate lab work for the nurse to assess next is:
|a.||liver function studies.|
- The nurse is administering Somnote to a patient. When providing medication education to the patient, the nurse will include that Somnote should be:
|b.||taken with a full glass of water.|
|c.||taken on an empty stomach.|
|d.||taken only before bedtime.|
- Why are benzodiazepines often preferred over barbiturates? (Select all that apply.)
|a.||They have selective action at specific receptor sites.|
|b.||There is a wide range of safety between therapeutic and lethal levels.|
|c.||REM sleep is decreased to a lesser extent.|
|d.||Accidental overdoses are well tolerated.|
|e.||There are no hypotensive episodes when rising to a sitting position.|
- Barbiturates have which common adverse effect(s)? (Select all that apply.)
|a.||Residual daytime sedation|
- What can occur as a result of rapid withdrawal from long term use of barbiturate therapy? (Select all that apply.)
|d.||Grand mal seizures|
- The nurse is assessing a patient prior to discharge from same day surgery following an incisional breast biopsy. When assessing the patient’s central nervous system (CNS) function following sedative hypnotic therapy, what will the nurse include? (Select all that apply.)
|a.||Level of alertness|
|c.||Ability to perform motor functions|
|e.||Usual pattern of sleep|
Chapter 15: Drugs Used for Parkinson’s Disease
- Which adverse effects associated with levodopa therapy would support the nursing diagnosis Risk for injury?
|a.||Nausea and vomiting|
|c.||Anorexia and depression|
|d.||Tachycardia and palpitations|
- Which vitamin will reduce the therapeutic effects of levodopa?
- Which cholinergic symptoms of Parkinson’s disease are reduced with anticholinergic drugs?
|c.||Tremors and drooling|
- What is the pharmacologic action of entacapone, a potent catechol O methyl transferase (COMT) inhibitor?
|a.||Slows the deterioration of dopaminergic nerve cells|
|b.||Inhibits the relative excess of dopaminergic activity|
|c.||Reduces the destruction of dopamine in peripheral tissues|
|d.||Enhances the cholinergic symptoms of Parkinson’s disease|
- The nurse is teaching a patient with Parkinson’s disease about levodopa. Which statement by the nurse is accurate regarding drug administration?
|a.||“Take this medication in between meals.”|
|b.||“Take this medication at bedtime to prevent dizziness.”|
|c.||“Take this medication when your tremors get worse.”|
|d.||“Take this medication with food or antacids to reduce GI upset.”|
- Dopamine agonists have been linked with which adverse effects in patients with Parkinson’s disease?
|c.||Sudden sleep events|
- What is the rationale for administering levodopa instead of dopamine for treatment of Parkinson’s disease?
|a.||Dopamine does not cross the blood–brain barrier when administered orally.|
|b.||Levodopa is much less expensive.|
|c.||The half life of dopamine is too short.|
|d.||Dopamine has too many reactions with other medications.|
- The nurse is providing education to a patient recently placed on selegiline disintegrating tablets. Which statement by the patient indicates a need for further teaching?
|a.||“This medication will help slow the development of symptoms.”|
|b.||“I will place the tablet on my tongue before breakfast.”|
|c.||“I may need to use a stool softener for constipation.”|
|d.||“I should not push the tablet through the foil.”|
- The nurse is providing information to a patient recently prescribed entacapone. Which statement is correct?
|a.||This medication is not to be taken with carbidopa levodopa.|
|b.||Dosage is adjusted according to the patient’s response.|
|c.||There will be fewer incidences of dopaminergic effects, such as confusion.|
|d.||This medication increases the production of dopamine in the brain.|
- The nurse is assessing an older patient with Parkinson’s disease who was started on entacapone 1 week ago. The patient has a history of coronary artery disease and takes an antihypertensive and aspirin. Which information would support the need for a reduction in medication dosage by the health care provider?
|b.||Brownish orange urine|
- When a patient taking a monoamine oxidase B inhibitor receives his dietary tray, the nurse knows to remove the:
- A patient taking rasagiline is assessed by the nurse to have a lasting significant increase in blood pressure. When reviewing the patient’s current list of medications, the nurse decides to hold the next dose of:
- Parkinson’s disease has which characteristic symptom(s)? (Select all that apply.)
|e.||Slow body movement|
- What point(s) should be included when teaching a patient about the use of apomorphine for treatment of Parkinson’s disease? (Select all that apply.)
|a.||The restoration of function resulting from stimulation of dopamine receptors is permanent.|
|b.||Apomorphine may be administered intravenously for rapid relief.|
|c.||Apomorphine does not have any opioid activity.|
|d.||A multidose injector pen is commonly used to administer apomorphine.|
|e.||You may experience nausea and vomiting, which can be treated with trimethobenzamide (Tigan).|
|f.||You may experience sleep attacks or episodes of daytime sleepiness.|
- The nurse is preparing to begin administration of apomorphine to a patient. Before administering, the nurse will perform a baseline assessment of the patient’s: (Select all that apply.)
Chapter 16: Drugs Used for Anxiety Disorders
- What is the recommended time over which antianxiety medications must be gradually tapered before discontinuation?
- Which is a benzodiazepine of choice when treating anxiety associated with alcohol withdrawal?
- Which is the drug of choice to treat a patient with obsessive compulsive disorder (OCD)?
- The outcome statement for a patient suffering from anxiety disorder reads, “After 1 week on alprazolam (Xanax) therapy, patient will exhibit a manageable level of anxiety.” Which assessment finding validates that this outcome is met?
|a.||Patient is unable to participate in group therapy conversations.|
|b.||Patient reports persistent fear about dying of a rare illness.|
|c.||Patient verifies that family reunions trigger anxiety and excessive drinking.|
|d.||Patient reports sleeping better and increased interest in activities.|
- Which is true regarding psychological drug dependence?
|a.||It is easier to treat than physiological dependence.|
|b.||It is not considered a true addiction.|
|c.||It is easily controlled by influencing the patient’s perceptions.|
|d.||It requires medical intervention to treat.|
- The nurse is preparing to educate a patient and significant other about antianxiety medications before the patient’s discharge. What is pertinent information to be included in the teaching plan?
|a.||Discuss, review, and validate the behavior monitoring system and intervention flow sheet the patient and significant other will continue to use following discharge.|
|b.||Discuss the possible dependence associated with the medication at length to make sure the patient does not overuse the drug.|
|c.||Instruct the patient to educate family members about the medication therapy, based on recollection of discussions with the nurse.|
|d.||Provide all instructions verbally, with repetition as needed when requested by the patient.|
- What will the nurse caution a patient about when providing information about the prescribed azaspirone antidepressant?
|a.||Risk for addiction|
|b.||Adverse effect of nausea|
|c.||Risk of injury when using machinery|
|d.||Additive effects of central nervous system (CNS) depression with alcohol|
- Which patient is most likely to respond quickly to antianxiety therapy with benzodiazepines?
|a.||Patient with a history of long-term anxiety|
|b.||Patient with recent anxiety reactions|
|c.||Patient with severe depression in addition to being anxious|
|d.||Patient with incidents of auditory hallucinations|
- What instruction is most important for the nurse to teach the patient who has recently been prescribed alprazolam (Xanax)?
|a.||“The medication needs to be taken on an empty stomach.”|
|b.||“You may feel dizzy or unsteady when rising to a standing position.”|
|c.||“Smoking will require a reduction in dosage of the medication.”|
|d.||“Over the counter medications are safe to take while on this medication.”|
- The nurse is developing a teaching plan for patients prescribed buspirone (BuSpar). Which information about this medication should be included?
|a.||There is minimal potential for abuse.|
|b.||Signs of improvement can be seen within 3 days.|
|c.||Sedation is increased compared with other antianxiety medications.|
|d.||It stimulates the action of gamma-aminobutyric acid (GABA).|
- A newly admitted psychiatric patient repetitively states, “I wish I were dead. I just want to kill myself.” The priority nursing at this time is to:
|a.||establish a trusting relationship.|
|b.||encourage a nonstimulating environment.|
|c.||provide for patient safety.|
|d.||identify signs of increased anxiety.|
- The nurse transcribes an order for lorazepam for a patient experiencing nausea and vomiting as a result of alcohol withdrawal. The most appropriate route of administration for lorazepam with this patient would be:
- A female patient is admitted to the adult psychiatric floor with a diagnosis of generalized anxiety disorder. Anxiolytic medications and group therapy have been prescribed. Evaluation of therapeutic outcomes related to her acute stay can be measured by which assessment(s)? (Select all that apply.)
|a.||She is able to sleep 5 hours during the night.|
|b.||The tremor and pacing she exhibited on admission are reduced.|
|c.||She is able to attend and actively participate in group sessions.|
|d.||She is eating only 10% of her meals.|
|e.||She complains of chest pain before group therapy.|
- Which substance(s) may increase the toxic effects of benzodiazepines? (Select all that apply.)
- In addition to the relief of mild to moderate anxiety, hydroxyzine (Vistaril) has which additional therapeutic outcome(s)? (Select all that apply.)
|a.||Reduced need for sedation and analgesia before and after surgery|
|b.||Elimination of psychotic thinking|
|c.||Control of itching in allergic reactions|
|d.||Control of vomiting|
|e.||Control of obsessive compulsive thoughts|
|f.||Prevention of extrapyramidal adverse effects and tardive dyskinesia|
- Which assessment(s) would be included in the evaluation of a patient with anxiety? (Select all that apply.)
|c.||History of precipitation stressors|
|e.||Substance abuse history|
|f.||Blood glucose level|
- The prenatal nurse is educating a woman regarding preconception care. The patient informs the nurse that she is currently taking a benzodiazepine drug for management of anxiety. Appropriate teaching for this patient will include that benzodiazepines: (Select all that apply.)
|a.||readily cross into breast milk.|
|b.||are safe to take throughout pregnancy.|
|c.||enter fetal circulation.|
|d.||are not associated with ill effects on the infant following birth.|
|e.||may increase newborn muscle tone.|
Chapter 17: Drugs Used for Mood Disorders
- What occurs with mania associated with bipolar disorder?
|a.||Varying degrees of sadness|
|b.||Distinct episodes of elation|
- Which postoperative narcotic analgesic will most likely be prescribed to a patient whose current medications include a monoamine oxidase inhibitor (MAOI), a thyroid hormone, and a multivitamin?
- What is the major advantage of selective serotonin reuptake inhibitors (SSRIs) over other types of antidepressant therapy?
|a.||They are less expensive than the other classes of antidepressants.|
|b.||They cure major depressive illnesses.|
|c.||They do not cause the anticholinergic and cardiovascular adverse effects.|
|d.||Therapeutic relief is immediate.|
- Lithium (Eskalith) is the drug of choice for which of the following disorders?
|b.||Obsessive compulsive disorders (OCDs)|
- Which psychological manifestation of depression will improve in response to antidepressant therapy?
|a.||Loss of energy|
- On what is the choice of tricyclic antidepressants based?
|a.||The need to decrease the action of norepinephrine, dopamine, or serotonin|
|b.||Patient age and gender|
|c.||An absence of adverse effects, such as orthostatic hypotension|
|d.||The need for stimulation and increased mental alertness|
- The nurse is teaching a patient about medication treatment for depression. The patient asks how long it will take before sleep and appetite will begin to improve. Which response by the nurse is most accurate?
- What is the action of MAOIs on neurotransmitters?
|a.||Blocking their reuptake|
|b.||Increasing their production|
|c.||Blocking their destruction|
|d.||Increasing their reuptake|
- A patient who is taking an MAOI to treat depression admits to eating pickled herring and cheese and drinking red wine. Which assessment finding alerts the nurse to a potential complication?
- Which assessment would the nurse expect to observe in a patient who has been prescribed trazodone for treatment anxiety?
- The nurse is caring for a patient who is taking a newly prescribed drug, nefazodone, for treatment of depression. Which physical assessment finding is most important for the nurse to report to the health care provider immediately?
- The nurse is providing education to a patient who has been prescribed bupropion (Wellbutrin) for smoking cessation. Which statement by the patient would indicate the need for further teaching?
|a.||“My dose will increase after 3 days.”|
|b.||“I should swallow this medication whole.”|
|c.||“If I have the urge to smoke, I will take more medication.”|
|d.||“I do not need to taper my dose when the drug is discontinued.”|
- Which nursing action is most important when providing care to a patient diagnosed with a mood disorder?
|a.||Assess the patient for thoughts of suicide.|
|b.||Provide supplemental feedings as needed.|
|c.||Assist with activities of daily living.|
|d.||Offer opportunities for interaction with other patients.|
- A patient is admitted to a long term psychiatric setting. The MAOI medication previously prescribed is discontinued by the physician. New orders are obtained to initiate imipramine therapy. The nurse will provide the first dose of imipramine to the patient _____ the MAOI drug.
|a.||immediately following the last dose of|
|b.||in 1 week following the last dose of|
|c.||in 14 days following the last dose of|
- A patient taking vilazodone has been vomiting persistently for 12 hours. The priority nursing diagnosis for this patient is:
|b.||imbalanced nutrition (less than body requirements).|
|c.||fluid volume deficit.|
|d.||altered peripheral tissue perfusion.|
- Which area(s) should be addressed by the nurse when obtaining a history of a patient admitted with depression? (Select all that apply.)
|a.||Current medications and medical history|
|b.||Recent stressors and support system|
|c.||Family history of mood disorder|
- Which instruction(s) is/are most pertinent to include in the discharge teaching of a patient on lithium (Eskalith) who is being discharged? (Select all that apply.)
|a.||“Persistent vomiting and profuse diarrhea are signs of toxicity and must be reported to the health care provider immediately.”|
|b.||“It is important to comply with schedules for blood tests to assess therapeutic levels.”|
|c.||“You should avoid foods such as Chianti wine and aged cheeses.”|
|d.||“The common adverse effects to expect, which are excessive nausea, anorexia, and abdominal cramps, tend to resolve.”|
|e.||“You will be gradually weaned off this medication.”|
|f.||“Take the medication with food or milk.”|
- What will the nurse include in a teaching plan for a patient with depression being treated with amitriptyline (Elavil)? (Select all that apply.)
|a.||Dryness of the mouth is normal; sucking on sugar free hard candy and ice chips or chewing gum may help alleviate this problem.|
|b.||Rise slowly from a supine or sitting position to avoid dizziness and orthostatic hypotension.|
|c.||Avoid alcohol and barbiturates.|
|d.||If adverse effects occur, discontinue the medication.|
|e.||An immediate elevation in mood will be noted.|
- Which food(s) containing significant amounts of tyramine will be contraindicated when a patient is on MAOI therapy? (Select all that apply.)
- Which nursing assessment(s) is/are important before the initiation of antidepressant therapy? (Select all that apply.)
|a.||Compliance with medication therapy within the last 2 months|
|b.||Nonverbal interactions among patient and significant others present|
|c.||Evaluation of the coherency, relevancy, and organization of thoughts in responses|
|d.||Appearance and posture|
- Which statement(s) is/are true regarding the pharmacologic actions of certain antidepressant drugs? (Select all that apply.)
|a.||MAOIs block the effects of dopamine in the CNS.|
|b.||SSRIs inhibit the destruction and reuptake of serotonin at the synaptic cleft.|
|c.||Tricyclic antidepressants block the action of norepinephrine and epinephrine in the SNS.|
|d.||Monocyclic antidepressants such as bupropion (Wellbutrin) have an unknown mechanism of action.|
|e.||SNRIs prolong the action of neurotransmitters by decreasing the destruction of serotonin and norepinephrine.|
- Which drug(s) interact(s) with SSRI agents? (Select all that apply.)
- The nurse must be sure to instruct the patient about which potential adverse effect(s) of tricyclic antidepressants? (Select all that apply.)
|b.||Dryness of mouth, nose, and throat|
- The nurse is preparing 0800 medications for a patient with the medical diagnosis of end stage renal disease. When reviewing the medication administration record (MAR), the nurse notices the patient is scheduled to receive an MAOI drug. Which intervention(s) will the nurse perform before administering the drug? (Select all that apply.)
|b.||Provide an alternative drug.|
|c.||Hold the MAOI drug.|
|d.||Consult with the prescribing health care provider.|
|e.||Assess urine output prior to administration.|
Chapter 18: Drugs Used for Psychoses
- The nurse is assessing a patient who is complaining of hearing voices. What is this patient experiencing?
|b.||Flight of ideas|
- 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|
- What is the most common cause of nonadherence to antipsychotic pharmacologic treatment?
|b.||Increased symptoms of chemical dependency|
|d.||Inability of the patient to understand the need to take medications|
- Which type of adverse effects is present when a patient displays prolonged tonic contractions of the tongue, oculogyric crisis, and torticollis?
- 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 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.|
- 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.|
- 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|
- Dystonic reactions, pseudoparkinsonism, akathisia, and tardive dyskinesia are types of which effect?
- 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.|
- A young male patient taking an antipsychotic is experiencing an oculogyric crisis. The nurse prepares to administer:
- 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|
- 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.|
- Which is/are extrapyramidal adverse effect(s) of antipsychotic agents? (Select all that apply.)
|a.||Spasmodic movements of muscle groups|
|d.||Inability to sit in one place for an extended period|
- Which sign(s) and symptom(s) may occur in neuroleptic malignant syndrome? (Select all that apply.)
|c.||Severe extrapyramidal symptoms|
|d.||Alterations in consciousness|
- Which adverse effect(s) may occur as a result of antipsychotic drug therapy? (Select all that apply.)
|d.||Neuroleptic malignant syndrome|
- 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.|
- 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.|
Chapter 19: Drugs Used for Seizure Disorders
- Which condition is associated with hydantoin therapy?
|c.||Seizure threshold reduction|
- 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?
- What is a guideline for the nurse when administering phenytoin (Dilantin) intravenously?
|b.||Monitor for signs of tachycardia.|
|c.||Assess for hypertensive crisis.|
|d.||Administer without mixing with other medications.|
- For which condition may carbamazepine (Tegretol) be used?
|c.||Trigeminal neuralgia pain|
- What is the drug of choice when treating a generalized tonic clonic seizure?
|c.||Valproic acid (Depakene)|
- 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.|
- Which medication is used to control seizures or prevent migraine headaches?
|c.||Valproic acid (Depakene)|
- Which condition would indicate to the nurse that a patient has phenytoin (Dilantin) toxicity?
- 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.|
- What dose is within the acceptable range for administering IV phenytoin (Dilantin) to a patient with a seizure disorder?
- 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.”|
- Which premedication assessment by the nurse is most important prior to the initiation of carbamazepine (Tegretol) therapy?
|a.||Determine patient’s ancestry.|
|b.||Monitor blood pressure (BP) lying, sitting, and standing.|
|c.||Auscultate lung sounds.|
|d.||Obtain smoking history.|
- 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.”|
- 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:
- What is included in the nursing management of the patient with generalized tonic clonic seizure activity? (Select all that apply.)
|a.||Restraining the patient’s arms to avoid further injury|
|b.||Placing padding around or under the patient’s head|
|c.||Attempting to insert a tongue depressor into the patient’s 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|
- 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 patient’s airway.|
|e.||Obtain the correct dose (10 mg) and administer over slow IV push.|
- Patients taking phenytoin (Dilantin) for control of seizures must be aware of the risk for which adverse effect(s)? (Select all that apply.)
- 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.)
|d.||Allergy to Bactrim|
- 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.|
|c.||Carry an identification card.|
|d.||Provide a list of seizure medications.|
|e.||Consider oral contraception.|
Chapter 20: Drugs Used for Pain Management
- The nurse is completing an assessment on a nonverbal adult patient. Which type of pain scale assessment tool is the most accurate to use?
- Which action will the nurse take when a patient receiving morphine sulfate via percutaneous coronary angioplasty (PCA) has a shallow, irregular respiratory rate of 6 breaths/min?
|a.||Elevate the patient’s head of bed to facilitate lung expansion.|
|b.||Increase the patient’s primary intravenous (IV) flow rate.|
|c.||Complete the FLACC scale.|
|d.||Notify the health care provider and prepare to administer naloxone (Narcan).|
- Which patient assessment would indicate to the nurse that salicylate toxicity is occurring?
|a.||Gastrointestinal (GI) bleeding|
|b.||Increased bleeding times|
- What is the advantage of taking a nonsteroidal anti inflammatory drug (NSAID) that is a COX 2 inhibitor?
|a.||The medication is cheaper than aspirin.|
|b.||There are fewer GI adverse effects.|
|c.||They are more effective than COX 1 inhibitors.|
|d.||They have no known adverse effects.|
- An 86 year old patient who was admitted with GI bleeding as a result of salicylate therapy is being discharged. As the nurse reviews the discharge medication list, the patient states that she doesn’t understand why Tylenol doesn’t work as well as the aspirin she had been taking. What would be the nurse’s best response?
|a.||“Tylenol and aspirin are chemically the same drug.”|
|b.||“Tylenol is appropriate for only minor pain.”|
|c.||“Tylenol does not help with inflammatory discomfort.”|
|d.||“A therapeutic blood level must be established with Tylenol.”|
- What term is used to define an awareness of pain?
- Which statement is true about neuropathic pain?
|a.||This pain is the result of a stimulus to pain receptors.|
|b.||Patients describe it as dull and aching.|
|c.||It commonly originates in the abdominal region.|
|d.||The pain is a result of nerve injury.|
- How long after the administration of a parenteral pain medication will the nurse complete the next pain assessment to evaluate the effectiveness of the medication?
- Which sign or symptom displayed by a patient would be indicative of opiate withdrawal?
- Which medication is contraindicated when a patient is taking warfarin (Coumadin)?
- What is the best way for the nurse to evaluate the effectiveness of the patient’s opiate agonist?
|a.||Ability of the patient to tolerate more activity|
|b.||Increased sleep time throughout the night|
|c.||Reduction of respiratory rate from 24 to 18 breaths/min|
|d.||Verbal report of 2 on a 1 to 10 scale|
- Which medication would the nurse administer to a patient who is rating the pain at 8 on a 0 to 10 scale?
|d.||Oxycodone and aspirin (Percodan)|
- In which case would the nurse be correct in withholding an opiate agonist?
|a.||Evidence of postural hypotension|
|b.||Presence of constipation|
|c.||Pain rating of 7 on a 0 to 10 scale|
|d.||Respiratory rate of 10 breaths/min|
- What information is most accurate regarding the nurse’s understanding of pain management?
|a.||Older patients have difficulty describing their pain level.|
|b.||Encourage patients to report pain before the pain becomes too severe.|
|c.||Use the smallest dose of medication possible to control pain.|
|d.||Pain medication administration ordered PRN will maintain a constant blood level.|
- The nurse is assessing a patient’s pain. When the patient describes his pain as cramping and burning, which component of the pain history is being addressed?
- A patient experiencing chronic pain as a result of metastatic cancer has a new order for fentanyl (Duragesic) transdermal patch. The initial patch is applied at 8 AM on Monday. At 8 PM on Monday, the patient reports a pain level of 8. The nurse’s best response is to:
|a.||immediately contact the physician.|
|b.||reassess pain level in 30 to 45 minutes.|
|c.||remove current patch and reapply a new patch.|
|d.||provide a PRN analgesic medication as ordered.|
- A patient is taking meperidine (Demerol) as needed for moderate to severe pain following an open appendectomy. The nurse assesses the following: current pain level 2, temperature 99° F, BP 130/76, respirations 10, lung sounds clear, abdomen soft and tender, bowel sounds present. Based on this assessment information, the priority nursing diagnosis is:
|a.||altered breathing pattern.|
|b.||risk for altered body temperature.|
|c.||risk for constipation.|
- Which additional nursing intervention(s) would be effective with pain management in the pediatric population? (Select all that apply.)
|a.||Provide diversional activities such as coloring, puzzles, and games.|
|b.||Allow uninterrupted sleep and rest.|
|c.||Perform hygiene measures.|
|d.||Encourage parental participation with caregiving to diminish the child’s anxiety.|
|e.||With the health care provider’s approval, encourage the child to drink eight to ten 8 ounce glasses of fluid daily.|
- Which common adverse effect(s) is/are associated with opiate agonists? (Select all that apply.)
- Which condition(s) may be managed by salicylates? (Select all that apply.)
- When teaching a patient who is starting therapy with NSAIDs, the nurse must be sure to mention drug interactions with which drug(s)? (Select all that apply.)
- When performing a baseline neurologic assessment prior to the administration of an NSAID medication, the nurse will assess which patient characteristic(s)? (Select all that apply.)
|b.||Orientation to date, time, and place|
|e.||Concurrent use of anticoagulant agents|
Chapter 21: Introduction to Cardiovascular Disease and Metabolic Syndrome
- A patient with a body mass index (BMI) of 25 would be considered to be in which weight category?
- What is the most critical approach to the treatment of metabolic syndrome?
- Healthy diets should include no more than which percentage of saturated fat based on total calories?
- Which ethnic group or gender is at greatest risk for developing metabolic syndrome?
|c.||African American men|
- What is the incidence of metabolic syndrome in the United States?
|a.||1 in 4000|
|b.||1 in 400|
|c.||1 in 40|
|d.||1 in 4|
- Which is the mechanism of action demonstrated by exercise in managing blood glucose levels?
|a.||Exercise causes release of glucose and promotes a reduced blood glucose level.|
|b.||Exercise on a regular basis causes a reduction in lean body mass, which helps regulate blood glucose levels.|
|c.||Increased muscle mass and less fat tends to normalize blood glucose levels because glucose is used by muscle cells when exercising.|
|d.||Exercise stimulates the liver, the primary storage and utilization site of glucose, to release glucose.|
- Which instruction by the nurse is accurate to include in a patient’s care to manage metabolic syndrome?
|a.||Encourage the client to exercise 20 minutes every day.|
|b.||Eliminate alcohol intake.|
|c.||Increase simple carbohydrates in the diet.|
- What lifestyle choice(s) may aggravate metabolic syndrome? (Select all that apply.)
|a.||Excessive tobacco smoking|
|d.||Inadequate caloric intake|
|e.||Excessive consumption of alcohol|
- In addition to type 2 diabetes and heart disease, which condition(s) is/are associated with metabolic syndrome? (Select all that apply.)
|d.||Obstructive sleep apnea|
|f.||Polycystic ovary syndrome|
- Drug therapy for initial treatment of metabolic syndrome is targeted at controlling which condition(s)? (Select all that apply.)
|a.||Obstructive sleep apnea|
- Which cardiovascular condition(s) is/are related to coronary artery diseases (CADs)? (Select all that apply.)
|c.||Acute myocardial infarction|
|e.||Venous stasis ulcers|
- Metabolic syndrome includes which key characteristic(s)? (Select all that apply.)
|c.||Low high density lipoproteins|
- The mother of a school aged child asks the nurse how to help prevent her child from acquiring metabolic syndrome. The nurse informs the child’s mother that education for children in primary grades should focus on which action(s)? (Select all that apply.)
|a.||Treatment of dyslipidemia|
|b.||Prevention of smoking|
|c.||Importance of moderate activity|
|d.||Discouraging use of alcohol|
|e.||Increase in saturated fat|
- Weight: 140 pounds. Height: 5 feet 4 inches. What is the BMI?
- Weight: 70 kilograms. Height: 164 cm (1.65 m). What is the BMI?
Chapter 22: Drugs Used to Treat Dyslipidemias
- Which lipoprotein contributes to the development of atherosclerosis?
|b.||Very-low-density lipoprotein (VLDL)|
|c.||Low-density lipoprotein chylomicron (LDL C)|
|d.||High-density lipoprotein chylomicron (HDL C)|
- The nurse is preparing medications for a patient. When is the best time for the nurse to administer lovastatin (Mevacor)?
|a.||2 hours after breakfast|
|b.||During the patient’s dinner|
|c.||1 hour before breakfast|
|d.||30 minutes before lunch|
- The nurse has completed an admitting patient history and notes the patient’s current medications to be simvastatin (Zocor) and warfarin (Coumadin). What is the result of the interaction of these drugs?
|c.||Low serum level of simvastatin|
- Which deficiency may develop in patients taking cholestyramine?
|c.||Vitamin K deficiency|
|d.||Hydrochloric acid deficiency|
- A patient is prescribed a bile acid resin. The nurse instructs the patient to report which adverse reaction related to vitamin K deficiency?
|b.||Coffee ground emesis|
|d.||Changes in skin pigmentation|
- Which vitamin has antilipemic actions?
- Why are statins, or HMG CoA reductase inhibitors, administered at bedtime?
|a.||The stomach is empty.|
|b.||Metabolic needs of the body are decreased.|
|c.||Cholesterol production is at its peak.|
|d.||The body temperature is increased.|
- What is the desired effect of any antilipemic therapy?
|a.||Reduced LDLs and total cholesterol levels|
|b.||Reduced HDLs and total cholesterol levels|
|c.||Reduced LDLs and HDLs|
|d.||Reduced HDLs and dietary cholesterol levels|
- In addition to controlling hyperlipidemia, what are bile acid–binding resins prescribed to treat?
|a.||Constipation secondary to excess fecal bile acids|
|b.||Constipation related to pseudomembranous colitis|
|c.||Pruritus secondary to biliary stasis|
|d.||Jaundice related to cholelithiasis|
- Which antilipemic agent is most potent?
|b.||HMG CoA reductase inhibitor|
|c.||Bile acid–binding resin|
- The nurse is teaching a patient about statin therapy. Which statement by the patient indicates a need for further teaching?
|a.||“I will take this medication at night.”|
|b.||“This medication will reduce blood clot formation.”|
|c.||“I will avoid drinking grapefruit juice.”|
|d.||“If I get a headache, I will notify my health care provider.”|
- The nurse is providing education to a patient who has recently been prescribed niacin. Which information given by the nurse is accurate?
|a.||“Weigh yourself weekly because of the risk of fluid retention.”|
|b.||“Nausea can be decreased if you take this medication with food.”|
|c.||“Because your blood pressure may increase while taking this drug, have it checked monthly.”|
|d.||“You should not take aspirin while on this medication.”|
- The nurse is assessing a patient who is being evaluated for hyperlipidemia. Which assessment will most increase the risk of coronary artery disease (CAD)?
|a.||Blood pressure, 168/90 mm Hg|
|b.||Hemoglobin A1c, 6%|
|c.||Walks 3 miles briskly, usually 4 days a week|
|d.||Eats five servings of fruits and vegetables daily|
- A patient is taking a HMG CoA reductase inhibitor and reports muscle aches, soreness, and weakness. The nurse suspects these symptoms to indicate early signs of myopathy. When notifying the physician of these symptoms, the nurse will also be sure to report the results of the patient’s:
|a.||serum creatine phosphokinase levels.|
|b.||red blood cell count.|
- The nurse is educating a patient about niacin prescribed to treat his hyperlipidemia. Which important teaching point(s) should be included in the educational plan? (Select all that apply.)
|a.||Effectiveness of niacin in lowering total cholesterol|
|b.||Information on high cholesterol foods and food preparation using unsaturated fats|
|c.||Importance of smoking cessation and daily exercise|
|d.||Alternative funding resource information because of the high cost of niacin|
|e.||Adverse effects to report (e.g., fatigue, anorexia, nausea, malaise, jaundice, muscle aches)|
- Which nutritional concept(s) is/are necessary to provide to patients receiving colestipol? (Select all that apply.)
|a.||Take on an empty stomach to enhance absorption.|
|b.||Whole grains, raw fruits, and vegetables will minimize constipation.|
|c.||Drink eight to ten 8 ounce glasses of water daily to eliminate dehydration that results from frequent loose stools.|
|d.||Report signs of vitamin K deficiency, including bleeding gums, dark tarry stools, and coffee ground emesis.|
|e.||Supplemental fat soluble vitamins may be necessary.|
- A teaching plan for a patient with hyperlipidemia would instruct the patient to avoid which food(s)? (Select all that apply.)
|c.||Unsaturated vegetable oils|
- What will the nurse review when teaching a patient about therapy with statins? (Select all that apply.)
|a.||Statins are the most potent antilipemic agents available.|
|b.||Statins should be taken with food.|
|c.||Statins replace dietary therapy for the control of hyperlipidemia.|
|d.||Statins cause mild increases in HDL levels.|
|e.||Statins are administered in the morning when cholesterol production is high.|
|f.||Statins reduce inflammation, platelet aggregation, and plasma viscosity.|
- The nurse transcribes a new order for Lovaza on a patient in a long term care facility. When providing education to the patient about this medication, the nurse will include which statement(s)? (Select all that apply.)
|a.||Liver function tests should be completed before initiating therapy.|
|b.||Lovaza is available in tablet form.|
|c.||Triglyceride levels should increase with use.|
|d.||Lovaza should be used with caution if the patient has an allergy to fish.|
|e.||Lovaza does not cause myositis.|
- The nurse is preparing to administer niacin for the first time to a patient being treated for dyslipidemia. Before administering this medication, the nurse will assess: (Select all that apply.)
|a.||blood glucose levels.|
Chapter 23: Drugs Used to Treat Hypertension
- A patient who has just begun taking an angiotensin converting enzyme (ACE) inhibitor calls the nurse and reports feeling very dizzy when standing up, and asks if the medication should be discontinued. What is the nurse’s best response?
|a.||“Stop taking the medication immediately.”|
|b.||“Rise to a sitting or standing position slowly; your symptoms will resolve.”|
|c.||“I will schedule you to visit the health care provider today.”|
|d.||“Cut the pill in half and take a reduced dosage.”|
- Which nursing assessment confirms that the angiotensin II receptor blocker (ARB) that a patient is taking is effective?
|a.||Weight loss of more than 2 pounds/week|
|b.||LDL cholesterol levels have decreased.|
|c.||Urinary output is increased.|
|d.||Blood pressure has decreased.|
- How does propranolol (Inderal) control hypertension?
|a.||Blocks alpha receptors throughout the body|
|b.||Increases the diuretic response in the renal tubules|
|c.||Reduces the sympathetic stimulation in cardiac muscle|
|d.||Inhibits the conversion of angiotensin I to angiotensin II|
- Which class of antihypertensive agents should be avoided by patients with asthma?
|c.||Aldosterone receptor antagonists|
|d.||Beta adrenergic blocking agents|
- Which is true about postural hypotension during therapy with direct vasodilators?
|a.||It indicates a therapeutic effect.|
|b.||It gradually resolves with continued medication use.|
|c.||It is a dose limiting complication of drug therapy.|
|d.||It is a precursor to hypertensive crisis.|
- The nurse instructs the patient to avoid the sudden discontinuation of beta adrenergic blockers so as to avoid which symptom?
- What is mean arterial pressure (MAP)?
|a.||The difference between the systolic and diastolic pressures|
|b.||An indicator of the tone of the arterial blood vessel walls|
|c.||The average pressure throughout each cycle of the heartbeat|
|d.||The product of the cardiac output and the peripheral vascular resistance|
- Which agents are preferred for the initial treatment of hypertension?
|a.||ACE inhibitors and angiotensin receptor antagonists|
|b.||Calcium ion agonists and central acting alpha agonists|
|c.||Thiazide diuretics and beta adrenergic blockers|
|d.||Direct vasodilators and peripherally acting adrenergic antagonists|
- Prior to the administration of a beta adrenergic blocker, the nurse notes the patient to have a heart rate of 52 beats/min, peripheral edema, crackles in the bases of the lungs, and mottled skin. Which is the priority nursing action?
|a.||Administer the medication as ordered.|
|b.||Re evaluate the patient in 20 minutes.|
|c.||Obtain a serum blood level.|
|d.||Withhold the medication and notify the health care provider.|
- When displayed by the patient, which symptom would be most indicative to the nurse to withhold a recently prescribed beta adrenergic blocker?
- The nurse has provided information to a patient with diabetes who has been prescribed a beta adrenergic blocker. Which statement by the patient indicates a need for further teaching?
|a.||“If I get dizzy, I will stop taking the medication.”|
|b.||“I may not have my usual symptoms of low blood sugars.”|
|c.||“My dosage may need adjustment if I start taking any NSAIDs.”|
|d.||“I will need to be evaluated in a few weeks to see if my dosage is effective.”|
- The nurse is providing instruction to a patient who was recently prescribed an ACE inhibitor for hypertension. Which is an adverse effect of this medication?
- The nurse is explaining to a patient how ACE inhibitors affect blood pressure. Which statement accurately describes the action of these medications?
|a.||They increase aldosterone secretion.|
|b.||They inhibit vasoconstriction.|
|c.||They lower heart rate.|
|d.||They promote sodium retention.|
- Which common adverse effect of an angiotensin II receptor antagonist will the nurse expect to assess in a patient?
- Which medication lowers blood pressure by directly inhibiting renin?
- A patient asks the nurse how amlodipine (Norvasc) works to reduce the blood pressure. Which response will the nurse provide?
|a.||“It causes blood vessel dilation.”|
|b.||“It helps you get rid of fluid.”|
|c.||“It helps your heart beat stronger.”|
|d.||“It slows your heart rate.”|
- A patient recently prescribed felodipine (Plendil) for treatment of hypertension is experiencing dizziness when rising to a standing position. Which action will the nurse take?
|a.||Encourage the patient to sit down if feeling faint.|
|b.||Advise the patient to increase dietary sodium.|
|c.||Inform the patient to discontinue the medication.|
|d.||Instruct the patient to monitor weight daily.|
- Which physiologic response will the nurse expect to assess in patients taking hydralazine (Apresoline)?
|c.||Increased urinary output|
- Which medication is often administered with hydralazine to reduce reflex physiological responses to the drug?
|d.||Angiotensin II receptor blocker|
- Hydralazine, a direct vasodilator, is used to treat hypertension associated with which condition?
- A patient’s blood pressure is 134/78 mm Hg. The nurse records the pulse pressure as:
- Which complication(s) is/are associated with uncontrolled hypertension? (Select all that apply.)
- The nurse is finished conducting nutritional education with a patient about the DASH (dietary approaches to stop hypertension) diet. The patient would like to complete the breakfast menu for tomorrow. Which foods offered for breakfast would be most appropriate for the patient to choose? (Select all that apply.)
- Which statement(s) concerning the use of antihypertensive therapy for the treatment of hypertension would be considered true? (Select all that apply.)
|a.||Diuretics are the most commonly prescribed antihypertensive agent.|
|b.||Diuretics are not used for older adult patients.|
|c.||Diuretics are the most expensive of the antihypertensive agents.|
|d.||Diuretics are often prescribed in combination therapy with other antihypertensive agents.|
|e.||Loop diuretics are considered potassium sparing.|
- Which statement(s) about diuretics is/are true? (Select all that apply.)
|a.||A mechanism of action for the antihypertensive effects of diuretics includes volume depletion.|
|b.||They have been shown to reduce cardiovascular morbidity associated with hypertension.|
|c.||Thiazide diuretics are effective only if renal creatinine clearance is less than 30 mL/min.|
|d.||Diuretics are sodium sparing.|
|e.||Electrolytes must be evaluated periodically for patients on loop diuretics.|
- The nurse is preparing to assess blood pressure on a patient who has had two prior readings of 160/100. Physician’s notes from a prior visit indicate that the patient is suspected to have hypertension. When reassessing this patient for hypertension, the nurse will do what? (Select all that apply.)
|a.||Instruct patient to sit on the exam table.|
|b.||Choose a cuff encircling at least 80% of the arm.|
|c.||Support patients arm at heart level.|
|d.||Encourage patient to sit quietly for 5 minutes before assessing blood pressure.|
|e.||Instruct the patient that one more increased reading is required before hypertension is diagnosed.|
- If blood pressure is 120/70, what is the MAP?
Chapter 24: Drugs Used to Treat Dysrhythmias
- What is the action of amiodarone (Cordarone), a class III agent used to treat cardiac dysrhythmias?
|a.||It acts as a myocardial depressant by inhibiting sodium ion movement.|
|b.||It prolongs the duration of the electrical stimulation on cells and the refractory time between electrical impulses.|
|c.||It acts as a beta adrenergic agent.|
|d.||It slows the rate of electrical conduction and prolongs the time between contractions.|
- How many milligrams of lidocaine will the nurse administer via intravenous (IV) bolus to a 30 year old patient with ventricular tachycardia who weighs 75 kg after a myocardial infarction?
- A patient is taking amiodarone (Cordarone) for hypertrophic cardiomyopathy and begins to complain of dizziness. What will the nurse instruct the patient to do?
|a.||Discontinue the medication immediately.|
|b.||Decrease the medication dosage for 1 week, and then resume the original order.|
|c.||Change positions slowly.|
|d.||Increase the dosage per health care provider directions.|
- A patient who is started on phenytoin (Dilantin), who is also taking amiodarone (Cordarone), should be assessed for what possible effect?
|a.||Central nervous system depression and sedation|
|b.||Decrease in effectiveness of phenytoin|
|d.||Increase in serum phenytoin levels|
- Which lidocaine preparation is appropriate for the treatment of cardiac dysrhythmias?
|a.||0.1% lidocaine with preservative|
|b.||2% lidocaine for topical use|
|d.||Injectable lidocaine without preservative|
- Patients who are on neuromuscular blocking agents and lidocaine must be closely observed for which complication?
- Which statement is true regarding the antidysrhythmic agent adenosine (Adenocard)?
|a.||It is synthesized from petroleum products.|
|b.||It is created through recombinant DNA.|
|c.||It is extracted from plants.|
|d.||It is a naturally occurring chemical in the body.|
- Amiodarone is contraindicated for patients with which condition?
|b.||Severe sinus node dysfunction causing bradycardia|
|d.||Premature ventricular contractions (PVCs)|
- The patient recently prescribed quinidine is at highest risk for which common adverse effect?
- Which symptom will the nurse encourage the patient taking flecainide to report to the health care provider?
- A patient is admitted to the acute care telemetry unit with a diagnosis of atrial fibrillation. The physician orders dofetilide (Tikosyn). Before initiating this medication, the nurse will:
|a.||hold anticoagulant medications.|
|b.||remove ECG leads.|
|c.||assess potassium level.|
|d.||ensure QTc interval is more than 440 to 500 msec.|
- A patient is admitted to the telemetry unit with a diagnosis of cardiovascular disease. When performing the initial assessment, the nurse records blood pressure in the left arm of 142/84, blood pressure in the right arm of 138/80, temperature of 98.8° F, and radial pulse of 80 and that is weak and irregular. The nurse should notify the physician regarding:
|a.||both blood pressure and pulse.|
|b.||blood pressure only.|
|d.||both blood pressure and temperature.|
- The nurse is assessing a patient who was recently admitted to the emergency department with dysrhythmias and shortness of breath. Which baseline nursing assessment(s) should be the priority(ies)? (Select all that apply.)
|d.||Presence of chest pain, dyspnea, and fatigue|
- The nurse is preparing to administer adenosine to a patient with supraventricular tachycardia. Which consideration(s) should the nurse take into account before administration? (Select all that apply.)
|a.||Constant ECG monitoring is necessary.|
|b.||Initial recommended dosage is 12 mg IV bolus.|
|c.||Rapid IV bolus administration is recommended.|
|d.||Saline flush following bolus is necessary.|
|e.||Long half life of adenosine may prolong adverse medication effects.|
- The nurse is preparing to mix a lidocaine infusion for a patient. Which consideration(s) should the nurse take into account before administration? (Select all that apply.)
|a.||Lidocaine with preservatives should be used.|
|b.||Dextrose 5% is the solution to mix with lidocaine.|
|c.||Therapeutic blood levels should be 1 to 5 mg/L.|
|d.||The rate of administration is 1 to 4 mg/min.|
|e.||Monitor for changes in neurologic status.|
- The nurse is preparing to administer procainamide hydrochloride for the first time to a patient newly diagnosed with atrial fibrillation. Before administering this medication, the nurse will assess: (Select all that apply.)
|d.||blood glucose levels.|
|e.||liver function tests.|
Chapter 25: Drugs Used to Treat Angina Pectoris
- Which medication combinations may be beneficial in treating angina pectoris?
|a.||Antidysrhythmics and platelet active agents|
|b.||ACE inhibitors and statins|
|c.||Vasoconstrictors and diuretics|
|d.||Analgesics and thrombolytics|
- A patient has been diagnosed with angina pectoris and an elevated LDL cholesterol level. The health care provider has prescribed HMG CoA reductase inhibitor. What is the primary indication in using this medication?
|a.||Reduce coronary vessel spasm.|
|b.||Simplify oxygen requirements of the cardiac cells.|
|c.||Lower cholesterol levels.|
|d.||Dilate the coronary arteries.|
- What will the nurse advise the patient to do to avoid the development of tolerance to nitroglycerin?
|a.||Use the sublingual form only.|
|b.||Administer subsequent doses parenterally.|
|c.||Allow for a daily 8 to 12 hour nitrate free period.|
|d.||Store the drug in a dark container, free from light and moisture.|
- Which instruction will the nurse include for a patient prescribed sublingual nitrate PRN for angina?
|a.||Take a dose routinely at bedtime.|
|b.||Place the tablet under the tongue and swallow immediately.|
|c.||Take one tablet and then seek medical attention if the pain is not relieved within 5 minutes.|
|d.||Take one tablet every 2 to 3 minutes until relief is obtained.|
- How frequently are nitroglycerin tablets discarded and prescriptions refilled?
|b.||Every 3 months|
|c.||Every 6 months|
- When are sustained release nitroglycerin tablets administered?
|a.||Once a day|
|c.||When symptoms of acute angina appear|
|d.||Every 8 to 12 hours|
- Which instruction will the nurse include when teaching a patient about the administration of translingual nitroglycerin spray?
|a.||Shake the container to disperse the medication evenly.|
|b.||Inhale the medication slowly over 1 to 2 minutes.|
|c.||Administer the medication under the tongue.|
|d.||Close the mouth and “swallow” the spray.|
- Which statement is true regarding the pain associated with angina?
|a.||It does not subside until treatment is initiated.|
|b.||It is highly variable in intensity and location.|
|c.||It typically subsides after 1 to 3 minutes.|
|d.||It is directly related to the degree of myocardial damage.|
- How do beta adrenergic blocking agents reduce myocardial oxygen demand?
|a.||By inhibiting the stimulation of norepinephrine and epinephrine|
|b.||By increasing the production of dopamine and acetylcholine|
|c.||By delaying the destruction of acetylcholinesterase and cholinesterase|
|d.||By enhancing the sensitivity of alpha receptors and beta receptors|
- The nurse is teaching a patient about nitroglycerin prior to discharge to home. Which instruction will the nurse provide the patient?
|a.||“Report any headaches following self administration to your health care provider.”|
|b.||“Carry the medication in a pocket directly next to the body.”|
|c.||“Carry the medication with you at all times.”|
|d.||“Store nitroglycerin in a clear glass container with a tight lid.”|
- What risk is minimized when the smallest dose of nitroglycerin is used to provide satisfactory results?
- The nurse is performing pain assessment on a patient admitted for evaluation of angina. Which type of angina is precipitated by physical exertion and is relieved by rest?
- What is the rationale behind administering calcium channel blockers to patients with angina?
|a.||They decrease heart rate.|
|b.||They dilate blood vessels.|
|c.||They increase cardiac contractility.|
|d.||They promote fluid excretion.|
- Which action by the nurse is most accurate when administering nitroglycerin ointment to a patient?
|a.||Spread the ointment on the patient’s legs in a thin, uniform layer.|
|b.||Cover the patch with a clear plastic wrap.|
|c.||Rub the ointment into the skin in a circular motion.|
|d.||Shave the skin prior to application.|
- Which response will the nurse provide when a patient complains of a headache when using sublingual nitroglycerin?
|a.||“This is a common adverse effect that can be managed with acetaminophen.”|
|b.||“Discontinue taking this medication.”|
|c.||“Try taking this medication at night to minimize the possibility of headaches.”|
|d.||“Lie down after using nitroglycerin to avoid a headache.”|
- Which statement about ranolazine (Ranexa), a fatty oxidase enzyme inhibitor, is true?
|a.||It causes coronary artery vasodilation.|
|b.||It causes no gastrointestinal (GI) side effects.|
|c.||It causes QT interval prolongation.|
|d.||It elevates LDL levels.|
- The nurse is assisting with a patient admission to the telemetry unit. The patient is diagnosed with angina pectoris. When obtaining information for angina therapy in regard to the central nervous system (CNS), the nurse will document:
|a.||history of smoking.|
- Which therapy(ies) is/are used in the treatment of angina pectoris? (Select all that apply.)
|b.||Coronary artery bypass|
|d.||Avoidance of caffeine and emotional stress|
|e.||Use of nitrates|
- Which lifestyle modification(s) will the nurse include when educating the patient with angina pectoris? (Select all that apply.)
|a.||Weight reduction therapy|
|b.||Low potassium diet|
- What will the nurse include in discharge teaching for patients on nitrate therapy? (Select all that apply.)
|a.||Increase caffeine in diet|
|c.||Proper storage of medications|
|e.||Isometric exercise program|
- What will the nurse include in the teaching plan for a patient with angina who is prescribed a beta adrenergic blocking agent? (Select all that apply.)
|a.||Goals include reduced frequency of attacks, reduced nitrate use, and improved exercise tolerance.|
|b.||Only some beta blockers are effective in treating angina pectoris.|
|c.||Comorbidities, such as diabetes or COPD, influence the product selection of beta blockers to treat angina.|
|d.||Cardioselective agents minimize pulmonary and peripheral vascular adverse effects.|
|e.||Stress exercise is an effective way to determine the most appropriate dosage.|
|f.||Acebutolol, atenolol, and metoprolol must be taken in divided doses to be effective in treating angina.|
- The nurse transcribes a new order for ranolazine (Ranexa) for a patient with chronic stable angina. Before initiating this medication, the nurse will ensure that which laboratory study result(s) is/are available? (Select all that apply.)
- The nurse is performing a head to toe assessment on a resident in a long term care facility with a history of angina pectoris. When assessing peripheral perfusion, the nurse will perform which intervention(s)? (Select all that apply.)
|a.||Count heart rate and describe rhythm.|
|b.||Note any loss of hair on lower legs.|
|c.||Auscultate blood pressure.|
|d.||Check pedal pulses.|
|e.||Assess pupil reaction.|
Chapter 26: Drugs Used to Treat Peripheral Vascular Disease
- The nurse is assessing the patient’s leg for peripheral vascular disease (PVD) and is unable to palpate the pedal pulse in either foot. Which action will the nurse take first?
|a.||Contact the health care provider for further orders.|
|b.||Request x-ray studies of the lower extremities.|
|c.||Request that the patient lie flat.|
|d.||Obtain a Doppler ultrasound device for auscultation.|
- What is the action of pentoxifylline (Trental), a hemorheologic agent used to treat chronic occlusive arteriole disease?
|a.||Vasodilates the peripheral arteries|
|b.||Potentiates the blood clotting mechanism|
|c.||Increases erythrocyte flexibility|
|d.||Increases blood viscosity|
- Which assessment verifies increased blood perfusion to the lower extremities?
|a.||Toes cool to the touch|
|b.||Decreased sensation below the knees|
|c.||Increased amplitude of pedal pulses|
|d.||Paleness of the foot|
- Which patient statement indicates to the nurse that the patient has a good understanding of PVD?
|a.||“Symptoms are warning signs of the increased potential to develop diseases.”|
|b.||“Pharmacologic treatments can reverse the disease process.”|
|c.||“Surgical interventions will cure the disease.”|
|d.||“Controlling contributing factors may affect the progression of the disease.”|
- The nurse is assessing a patient on papaverine therapy and notes tachycardia, which is a compensatory effect of which condition?
|c.||Excessive sympathetic stimulation|
- When assessing a client recently prescribed pentoxifylline (Trental), which medication will alert the nurse to monitor closely for adverse effects?
- The nurse advises a patient taking papaverine to consult the health care provider or pharmacist before taking which over the counter (OTC) medication?
|b.||Cough and cold remedies|
- A patient has recently been prescribed cilostazol (Pletal). Which statement by the patient indicates that this medication is effective?
|a.||“I have less leg cramping when I walk.”|
|b.||“My pulse rate is more regular.”|
|c.||“I have had fewer episodes of angina.”|
|d.||“My blood pressure has decreased.”|
- The nurse has completed teaching to a patient recently prescribed cilostazol (Pletal). Which statement by the patient indicates a need for further teaching?
|a.||“I will sit down if I feel lightheaded or faint.”|
|b.||“Because this medication helps my circulation, I will try to quit smoking.”|
|c.||“Grapefruit juice will increase the effects of this medication.”|
|d.||“Diarrhea may occur but likely will stop with continued therapy.”|
- The nurse observes a patient taking papaverine hydrochloride to be flushed and diaphoretic following the initial dose. The nurse’s best response is to:
|a.||hold the next dose.|
|b.||assess blood glucose.|
|c.||provide comfort measures.|
|d.||immediately notify the physician.|
- The nurse is preparing to provide personal care to a patient with peripheral vascular disease. When providing foot care, the nurse will:
|a.||assist the patient to a supine position.|
|b.||keep feet moistened with lotion.|
|c.||trim toenails daily.|
|d.||change socks daily.|
- Which are included in the baseline assessment of PVD? (Select all that apply.)
|a.||History of heart disease|
|b.||Smoking and dietary habits|
- The nurse is preparing a teaching plan for a patient with Raynaud’s disease who is soon to be discharged. What information will be included to improve circulation and prevent complications of this disease? (Select all that apply.)
|a.||Begin a daily exercise program.|
|b.||Keep hands and feet warm.|
|c.||Surgery is often the most effective treatment.|
|d.||Elevate the lower extremities when reclining.|
|e.||Smoking cessation will improve outcomes.|
- What will the nurse include in the discharge teaching plan for a patient with PVD? (Select all that apply.)
|a.||Intermittent cold applications to the extremities|
|c.||Stress reduction techniques|
|d.||An exercise program|
|e.||Bed positioning techniques|
- Which are necessary steps in the assessment of the patient preparing for treatment PVD with pentoxifylline (Trental)? (Select all that apply.)
|a.||Check for intolerance to caffeine.|
|b.||Obtain baseline data on pain that may be present.|
|c.||Obtain test results for PT and aPTT.|
|d.||Perform baseline gastrointestinal assessment to determine if the patient has nausea, vomiting, or dyspepsia.|
|e.||Ask specifically if the patient has any cardiac symptoms or dizziness.|
|f.||Schedule the patient for an exercise stress test.|
- The nurse has admitted a resident with the diagnosis of PVD to a long term care facility. When providing care to this patient, the nurse will: (Select all that apply.)
|a.||initiate elevation of lower extremities.|
|b.||implement pain management as ordered.|
|c.||assess skin temperature.|
|d.||vigorously dry feet after washing.|
|e.||palpate pedal pulses.|
Chapter 27: Drugs Used to Treat Thromboembolic Disorders
- A trauma patient arrives in the emergency department via EMS. He is bleeding profusely. A medical alert bracelet indicates that he is on heparin therapy. The nurse will most likely administer which medication that counteracts the action of heparin?
|a.||Warfarin sodium (Coumadin)|
- A patient receiving IV heparin therapy for a deep vein thrombosis (DVT) in his right calf asks why his calf remains painful, edematous, and warm to touch after 2 days of anticoagulant therapy. Which response by the nurse is most accurate?
|a.||“It takes at least 3 days for the symptoms to resolve once the clot dissolves.”|
|b.||“Heparin does not dissolve blood clots, but neutralizes clotting factors, preventing extension of the clot and the possibility of it traveling elsewhere in your body.”|
|c.||“I will report this to your health care provider because there may be a need to look at alternative treatments.”|
|d.||“You appear anxious. The health care provider will eventually put you on ticlopidine, which allows for an earlier discharge.”|
- A patient is receiving IV heparin therapy. The aPTT is 90; the laboratory control is 30 seconds. Which nursing intervention is most accurate?
|a.||Document in the nursing notes that these results are within therapeutic range.|
|b.||Note the RBC count and wait for the health care provider to make the next round to discuss all laboratory values.|
|c.||Stop the heparin drip.|
|d.||Assess the patient for signs and symptoms of decreased sensorium.|
- Which is an accurate nursing action when administering subcutaneous enoxaparin, a low-molecular-weight heparin product?
|a.||Expel the air bubble from the prefilled syringe.|
|b.||Leave the needle in place for 10 seconds after injection.|
|c.||Administer the medication into the deltoid muscle.|
|d.||Massage the site after injection to increase absorption.|
- A patient is receiving 1400 units of heparin/hour on an IV pump. The aPTT time is 54. The laboratory control is 25. Which action by the nurse is accurate?
|a.||Bolus the patient with an additional 5000 units of heparin.|
|b.||Stop the heparin immediately and notify the health care provider that the patient’s blood level is toxic.|
|c.||Administer protamine sulfate stat.|
|d.||Continue with the prescribed rate.|
- What is the rationale for administering fibrinolytic agents, such as streptokinase, within hours of the onset of myocardial infarction?
|a.||Enhances myocardial oxygenation|
|b.||Lyses the blood clot|
|c.||Promotes platelet aggregation|
|d.||Inhibits clotting mechanisms|
- What is the mechanism of action of drugs used to treat thromboembolic disease?
|a.||Dissolving clots and preventing formation of new clots|
|b.||Making platelets more flexible and preventing formation of new clots|
|c.||Causing vasodilation and increased blood flow|
|d.||Preventing platelet aggregation and inhibiting clot formation|
- Dipyridamole (Persantine) has been used extensively in combination with warfarin to prevent the formation of thromboembolism after which type of event?
|b.||Transient ischemic attack|
|c.||Cardiac valve replacement|
- Which action will the nurse implement to decrease the risk of clot formation in an older patient on bed rest?
|a.||Assess peripheral pulses.|
|b.||Encourage passive leg exercises.|
|c.||Limit fluid intake.|
|d.||Position pillows behind the knees.|
- The nurse is teaching a patient about dietary implications while on warfarin (Coumadin) therapy. Which salad is highest in vitamin K?
- The nurse has provided instruction to a patient recently prescribed warfarin (Coumadin). Which statement by the patient indicates to the nurse the need for further teaching?
|a.||“I will always wear a medical alert bracelet.”|
|b.||“I will check with my health care provider before I take any OTC medications.”|
|c.||“I will be careful when I use a knife or other sharp objects.”|
|d.||“I will rinse my mouth with mouthwash instead of brushing my teeth.”|
- Which symptom is indicative of bleeding in a patient taking warfarin (Coumadin)?
|c.||Increased urinary output|
- The nurse is caring for a 27-year-old woman on the postpartum unit one day following a C section. To prevent clot formation, the nurse will:
|a.||position the patient with knees flexed.|
|b.||initiate use of fitted thromboembolic disease deterrent (TED) stockings.|
|c.||maintain complete bedrest.|
|d.||implement deep breathing and coughing exercises.|
- Rivaroxaban (Xarelto) is ordered on a patient following knee replacement surgery. When providing education on this medication to the patient, the nurse conveys that treatment will continue:
|a.||only while hospitalized.|
|b.||for 35 days postsurgically.|
|c.||for 12 days postsurgically.|
|d.||as long as creatinine clearance is less than 30.|
- Anticoagulant therapy may be used for which situation(s)? (Select all that apply.)
|a.||To prevent stroke in patients at high risk|
|b.||Following a myocardial infarction|
|c.||Following total hip or knee joint replacement surgery|
|e.||To prevent thrombosis in immobilized patients|
|f.||Peptic ulcer disease|
- The nurse is preparing discharge education for a patient who will be receiving warfarin (Coumadin) at home. Which important point(s) will the nurse include? (Select all that apply.)
|a.||“Do not make any major changes to your diet without discussing it with your health care provider.”|
|b.||“Keep outpatient laboratory appointments for monitoring of therapy.”|
|c.||“Take the medication after meals.”|
|d.||“Report signs of bleeding to your health care provider, including observing skin for bruising; petechiae; blood in emesis, urine, or stools; bleeding gums; cold, clammy skin; faintness; or altered sensorium.”|
|e.||“Avoid aspirin products.”|
- Which nursing intervention(s) would be accurate when administering heparin subcutaneously? (Select all that apply.)
|a.||Assessment of recent aPTT levels|
|b.||Massaging the site after injection of medication|
|c.||Aspirating after needle insertion|
|d.||Documenting ecchymotic areas|
|e.||Monitoring of vital signs|
- The pharmacologic agents used to treat DVT may act in which way(s)? (Select all that apply.)
|a.||Prevent platelet aggregation.|
|b.||Prevent the extension of existing clots.|
|c.||Inhibit steps in the fibrin clot formation cascade.|
|d.||Prolong bleeding time.|
|e.||Lower serum triglycerides.|
- The nurse is preparing to administer dalteparin (Fragmin) to a patient in order to prevent DVT following a hip replacement. When providing this medication to the patient, the nurse will: (Select all that apply.)
|c.||remove needle immediately after injection.|
|d.||rub injection site following administration.|
|e.||alternate injection sites every 24 hours.|
Chapter 28: Drugs Used to Treat Heart Failure
- Which drug will be administered to a patient being admitted with severe digoxin intoxication?
|c.||Digoxin immune Fab (Digibind)|
- The nurse is caring for a 3-year-old girl who has a congenital heart anomaly. The patient’s current medications include digoxin and furosemide (Lasix). The apical pulse rate is 100 beats/min. Which action will the nurse take?
|a.||Administer the medication.|
|b.||Contact the pediatric cardiologist for further orders.|
|c.||Hold the digoxin.|
|d.||Request that another unit nurse assess the child.|
- An older adult male patient with long term heart failure has presented for an office visit. The nurse obtains information that he has recently begun taking St. John’s wort. What results with the use of this herbal supplement?
|b.||Altered potassium electrolyte balance|
|c.||Reduced therapeutic benefits of digoxin|
|d.||Enhanced digoxin effectiveness without producing toxicity|
- The nurse is to administer digoxin to an 18 month old patient who weighs 16.5 lb. Guidelines for administration read as follows: 0.0075-0.010 mg/kg/day. Which is a safe medication dosage?
- The nurse monitors a patient receiving digoxin closely for toxicity when which other medication is prescribed?
|c.||Acetylsalicylic acid (aspirin)|
- Which is the initial manifestation of digoxin toxicity in children?
- Which agents stimulate the heart to increase the force of contractions, thereby increasing cardiac output?
- Which drug is used to obtain vasodilation in the treatment of chronic heart failure?
- Which action of ACE inhibitors results in effective treatment of heart failure?
|d.||Increased cardiac output|
- The nurse is providing teaching to a patient with heart failure who has been prescribed nifedipine, a calcium channel blocker. Which statement by the nurse is accurate?
|a.||“This medication dilates your coronary arteries.”|
|b.||“This medication will help your kidneys get rid of fluid.”|
|c.||“This medication reduces volume returning to your heart so it doesn’t overstretch.”|
|d.||“This medication reduces the resistance your heart has to pump against.”|
- Which instruction by the nurse will be included when teaching an adult patient about digoxin (Lanoxin) for management of heart failure?
|a.||“Report nausea and vomiting to your health care provider.”|
|b.||“Decrease the amount of high potassium foods you eat.”|
|c.||“Omit your dose of digoxin if your pulse is 60 beats/min.”|
|d.||“Visual disturbances are common adverse effects.”|
- Which nursing assessment is most important to determine fluid status for a patient with heart failure?
|a.||Auscultation of lungs|
|c.||Intake and output|
|d.||Measurement of abdominal girth|
- A patient with altered cardiac function is being assessed by the nurse. When auscultating lung sounds, the nurse will assist this patient into a _____ position.
- The nurse transcribes a new order for a daily diuretic on a patient diagnosed with congestive heart failure. The nurse will schedule this medication:
|a.||in the morning.|
- The nurse is assessing an emergency department patient who was recently discharged following a myocardial infarction (MI). Which symptom(s) would the nurse observe in this patient with left ventricular systolic failure? (Select all that apply.)
|a.||Reports of recent weight loss|
|b.||Complaits of peripheral edema|
|c.||Diminished exercise tolerance|
|d.||Shortness of breath with activity|
|e.||Blood pressure elevation|
- Before administering digoxin (Lanoxin), the nurse takes the adult patient’s apical pulse for 1 full minute. What additional nursing consideration(s) will be taken before administration of the medication? (Select all that apply.)
|a.||Review of the digoxin blood level|
|b.||Administration of the medication with pulse less than 60 beats/min|
|c.||Review of serum electrolytes, liver, and kidney function studies|
|d.||Administration of the medication with a pulse of 110 beats/min|
|e.||Obtaining baseline patient assessment data, including lung sounds, vital signs, and weight|
- Which action(s) will the nurse take when caring for a patient with heart failure? (Select all that apply.)
|a.||Administer diuretics at bedtime.|
|b.||Assess electrolyte levels.|
|c.||Report daily weight fluctuations.|
|d.||Encourage sodium intake.|
|e.||Maintain skin hygiene.|
- Which contributing factor(s) to heart failure is/are modifiable? (Select all that apply.)
|b.||Addiction to smoking|
- A patient with heart failure has been prescribed nesiritide (Natrecor). Which statement(s) is/are true regarding this medication? (Select all that apply.)
|a.||It increases preload.|
|b.||Cardiac ventricles secrete this hormone in response to fluid overload.|
|c.||It suppresses aldosterone.|
|d.||It promotes norepinephrine secretion.|
|e.||It causes vasodilation.|
- Which statements about vasodilators is/are true? (Select all that apply.)
|a.||They reduce systemic vascular resistance.|
|b.||They increase afterload.|
|c.||They reduce preload.|
|d.||They decrease pulmonary congestion.|
|e.||They increase tissue perfusion to muscles and organs.|
|f.||They increase the volume of blood returning to the heart.|
- The nurse is providing education to a patient with altered cardiac function. When instructing this patient the nurse will encourage: (Select all that apply.)
|a.||alcohol consumed in moderation.|
|b.||use of salt substitute.|
|c.||regular, mild exercise.|
|d.||good skin care.|
Chapter 29: Drugs Used for Diuresis
- What would the nurse anticipate if a patient with a history of type 2 diabetes is prescribed a thiazide diuretic?
|a.||No change in the antidiabetic regimen|
|b.||Decreased need for antidiabetic medication|
|c.||Increased blood sugar levels|
|d.||Less frequent monitoring of blood sugar level|
- When teaching a patient who is taking thiazide diuretics, the nurse will encourage the patient to increase the intake of which electrolyte?
- On admission, a patient with a history of cardiac insufficiency complains of shortness of breath. The nurse auscultates the lungs and notes bilateral crackles throughout both fields. In addition, there is bilateral +2 edema of the lower extremities. Which medication does the nurse anticipate that the health care provider will prescribe?
- Which medication is a potassium sparing diuretic?
- How soon will diuresis be expected to occur after the nurse has administered 20 mg of furosemide (Lasix) intravenously (IV) to a patient with heart failure?
|a.||As soon as injected|
|b.||Within 10 minutes|
|c.||After 2 hours|
|d.||After 4 hours|
- Which foods will the nurse recommend for a patient taking loop diuretics?
|a.||Protein-rich foods such as poultry, whole grains, and fish|
|b.||Fiber-rich foods such as yellow vegetables, nuts, and lentils|
|c.||Potassium-rich foods such as raisins, figs, and bananas|
|d.||Sodium-rich foods such as canned vegetables and processed foods|
- Which condition warrants the use of acetazolamide (Diamox) as a diuretic?
|a.||Increased intracranial pressure|
|b.||Increased extravascular fluid pressure|
|c.||Increased intraocular pressure|
- The nurse would expect to assess which serum potassium level in a patient who has severe vomiting and diarrhea?
|a.||Less than 3.5 mEq/L|
|b.||Between 3.5 and 4.5 mEq/L|
|c.||Between 4.6 and 5 mEq/L|
|d.||Higher than 5.5 mEq/L|
- Which medication, if administered with spironolactone (Aldactone), will alert the nurse to assess the patient for signs and symptoms of hyperkalemia?
- The nurse has provided patient teaching about potassium sparing diuretic therapy. Which statement by the patient indicates a need for further teaching?
|a.||“I will take my medication in the morning.”|
|b.||“I will report a weight gain of 2 pounds in 2 days.”|
|c.||“I will rise slowly when I get up from a sitting position.”|
|d.||“I will use a salt substitute because I limit my salt intake.”|
- Which patient assessment would alert the nurse to withhold a loop diuretic?
|a.||Crackles in the lung bases|
|b.||+2 pitting peripheral edema|
|c.||Serum potassium of 2.6 mEq/L|
|d.||Weight gain of 2 pounds in 2 days|
- A 37-year-old male presents at the emergency department reporting severe vomiting for the past 48 hours. When assessing skin turgor, the nurse will:
|a.||exert pressure against the shin.|
|b.||gently pinch the skin together over the sternum.|
|c.||assess for vein distention.|
|d.||inspect oral mucous membranes.|
- The nurse is reviewing lab work received on a patient admitted with the diagnosis of dehydration. The nurse will notify the physician of which lab value?
|a.||Serum sodium level: 115 mEq/L|
|b.||Serum potassium level: 5.0 mEq/L|
|c.||Serum sodium level: 140 mEq/L|
|d.||Serum potassium level: 3.5 mEq/L|
- A patient who has heart failure and difficulty breathing is being admitted. Which physical assessment(s) indicate(s) fluid volume excess? (Select all that apply.)
|a.||Rapid, bounding, irregular pulse rate|
|b.||Clear lung sounds|
|c.||3+ pitting ankle edema|
|d.||Neck vein engorgement|
|e.||Shortness of breath|
- Which premedication assessment(s) would the nurse obtain prior to the initiation of bumetanide (Bumex)? (Select all that apply.)
- Which are common signs and symptoms of dehydration? (Select all that apply.)
|b.||Decreased intake and output levels|
|c.||Bounding pulse rate|
|e.||Elastic skin turgor|
- Which nursing intervention(s) would be performed for a patient who is on diuretic therapy? (Select all that apply.)
|a.||Auscultation of lung sounds|
|b.||Assessment of skin turgor|
|c.||Initiation of electrolyte supplements|
|e.||Monitoring of intake and output|
- Which sign(s) and/or symptom(s) of dehydration may occur as a result of a diuretic? (Select all that apply.)
|a.||Decreased urine specific gravity|
|b.||Skin remains peaked on turgor assessment|
|c.||Bounding peripheral pulses|
|d.||Neck vein engorgement|
|e.||Soft, sunken eyeballs|
- Which medical condition(s) may contribute to fluid volume excess? (Select all that apply.)
|d.||Use of corticosteroids|
- Individuals with which disorder(s) are particularly susceptible to the development of electrolyte disturbances during diuretic therapy? (Select all that apply.)
|a.||History of cardiac disease|
|b.||History of renal disease|
|c.||History of hormonal disorders|
|d.||History of psychiatric illness|
- The nurse transcribes a new order for ethacrynic acid (Edecrin) on a patient with edema resulting from cirrhosis of the liver. Which currently prescribed medication(s) should the nurse report to the ordering health care provider? (Select all that apply.)
Chapter 30: Drugs Used to Treat Upper Respiratory Disease
- Which is a serious adverse effect of decongestants?
- 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|
- What can result if a patient overuses topical decongestants?
|d.||Permanent olfactory damage|
- A patient at sports camp is complaining of itchy and watery eyes, coughing, and sneezing when outdoors. The patient’s chart states that he has an allergy to grasses. Which medication will the nurse administer?
- Which medication may be given to patients with allergic seasonal rhinitis who do not respond to antihistamines and sympathomimetics?
- 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|
- 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|
- 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|
- 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.”|
- 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 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.|
- 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.|
- 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|
- 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.|
- 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|
- 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.|
- Which topically active aerosol steroids are highly effective for reducing sneezing, nasal itching, stuffiness, and rhinorrhea? (Select all that apply.)
|a.||Beclomethasone (Beconase AQ)|
|e.||Budesonide (Rhinocort Aqua)|
- 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.|
Chapter 31: Drugs Used to Treat Lower Respiratory Disease
- 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.”|
- Which is a common expectorant in over-the-counter medications?
- 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|
- 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.|
- Premedication assessments before the use of anticholinergic bronchodilating agents should verify that the patient has no history of which condition?
- 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?
|d.||Overuse of the inhaler|
- 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|
- What is albuterol (Proventil) used to treat?
|d.||Dyspnea on exertion|
- 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|
- What structures in the respiratory tract assist in removing foreign bodies such as smoke and bacteria?
- 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?
- 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 Fowler’s position|
|c.||Sputum production is clear and watery|
|d.||Respiratory rate decreased to 38 breaths/min|
- 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.”|
- 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.|
- 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.|
- 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|
- 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 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.|
- 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.|
- 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.|
- 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|
|c.||Chief complaint and onset of symptoms|
|e.||Home oxygen use|
- Which physical assessment(s) would be pertinent to the patient with asthma? (Select all that apply.)
|c.||Respiratory rate and effort|
|d.||Peak expiratory flow|
|e.||Pulse oximetry reading|
- 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.|
- 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.|
- 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.|
- 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.|
Chapter 32: Drugs Used to Treat Oral Disorders
- A patient with chronic obstructive pulmonary disease (COPD) uses a corticosteroid inhaler bid. Which adverse effect is associated with this medication?
- The nurse is assessing a patient’s mouth and notes white, milk curd–appearing plaques attached to the oral mucosa. Which condition is present?
- What is the primary pharmacologic therapy for Candida albicans?
|d.||Topical anti inflammatory agents|
- Which condition is treated by saliva substitutes?
- Which information will the nurse include when teaching a patient about cold sores?
|a.||Use of drying agents prevents the spread of secretions.|
|b.||Erupted lesions are not contagious.|
|c.||Eruptions are related to breaks in personal hygiene.|
|d.||Pus filled lesions indicate a secondary bacterial infection.|
- Which local anesthetic is used for inflammation of oral mucous membranes?
|b.||2% viscous lidocaine|
- Which medication helps prevent or reduce mucositis in patients undergoing chemotherapy or radiation treatment?
|a.||Amlexanox paste (Aphthasol)|
- Which infection is often called the “disease of the diseased” because it appears in debilitated patients?
- What is the most common cause of most tooth, gum, and periodontal disease?
- Which instruction by the nurse is most important when educating a patient about using viscous lidocaine (Xylocaine) for mucositis?
|a.||“Cleanse the oral cavity after using.”|
|b.||“This medication can be used as a gargle.”|
|c.||“After using, wait for 30 minutes before eating.”|
|d.||“Your sense of taste will be diminished.”|
- A patient is being treated with topical amlexanox paste 5% (Zilactin). Which statement by the patient indicates a knowledge deficit?
|a.||“This medicine will help control discomfort.”|
|b.||“I will apply the paste before meals.”|
|c.||“The paste will be applied to each lesion.”|
|d.||“Healing will be promoted.”|
- A patient using carbamide peroxide (Gly Oxide) to treat multiple canker sores develops tissue irritation and black hairy tongue. The patient asks the nurse what can be done to soothe the pain. The nurse will first encourage use of:
|a.||Milk of Magnesia.|
|b.||viscous lidocaine 2%.|
- The nurse is assisting with care of a patient on chemotherapy with severe mucositis. The patient reports mucous membrane pain level to be “8” on the pain scale. The priority nursing diagnosis for this patient is:
|a.||altered nutrition: less than body requirements.|
|b.||risk for aspiration.|
|c.||fluid volume deficit.|
- The nurse is completing education for a patient who will be undergoing chemotherapy next week. In anticipation of adverse effects associated with oral mucositis resulting from chemotherapy, which information will the nurse include in the teaching plan? (Select all that apply.)
|a.||Avoid acidic and spicy foods.|
|b.||Using docosanol (Abreva) will decrease the pain.|
|c.||Milk of Magnesia can be used to rinse the mouth and coat mucous membranes.|
|d.||Nystatin liquid can be taken orally to eliminate fungal infections.|
|e.||Cleanse the oral cavity before applying topical agents.|
|f.||Rinse the mouth with an over the counter (OTC) mouthwash.|
- What will the nurse include when educating a 12-year-old patient about care of a cold sore? (Select all that apply.)
|a.||“Keep the cold sore clean with mild soap.”|
|b.||“Use an astringent to assist in drying the cold sore and promote rapid healing.”|
|c.||“Keep the cold sore moist to prevent cracking.”|
|d.||“Note signs of infection, including the presence of pus. Contact the health care provider if this occurs.”|
|e.||“Oral analgesics may help alleviate pain.”|
- Which assessment information is pertinent to oral health? (Select all that apply.)
|b.||Dental history, visit frequency|
|c.||Presence of halitosis|
|d.||Amount of saliva present|
- A patient who is undergoing bone marrow transplantation has developed severe mucositis. Which treatment option(s) may promote comfort? (Select all that apply.)
|a.||2% viscous lidocaine (Xylocaine) before meals|
|b.||Acetylcysteine (Mucomyst) therapy as needed|
|c.||Commercially prepared mouthwashes|
|d.||Docosanol (Abreva) therapy|
|e.||Milk of Magnesia mouth rinses|
- In addition to discomfort, which are adverse effects of xerostomia? (Select all that apply.)
|a.||Reduced taste and appetite|
|c.||Difficulty chewing and swallowing food|
|d.||Increase in dental caries|
|e.||Difficulty with speech|
|f.||Improved taste and enjoyment of food|
Chapter 33: Drugs Used to Treat Gastroesophageal Reflux and Peptic Ulcer Diseases
- Which medication is used in the treatment of gastric reflux esophagitis and diabetic gastroparesis?
- The nurse is preparing to administer medications and notes that a patient has sucralfate ordered qid. When is the best time to administer this medication?
|a.||1 hour before meals|
|c.||1 hour after meals|
|d.||With a bedtime snack|
- Which is a common adverse effect of magnesium based antacid preparations?
- Cimetidine (Tagamet) is an example of which class of drug?
|b.||Proton pump inhibitor|
|c.||Histamine (H2) receptor antagonist|
- A postoperative appendectomy patient has a nasogastric tube and wonders why the previous nurse told him that he was receiving an IV “ulcer preventing” medication called ranitidine. The patient states that he has never had any stomach problems in his life. Which is the best response by the nurse?
|a.||“This medication will cause the pH in your stomach to drop.”|
|b.||“This medication helps coat your stomach while the nasogastric tube is in place.”|
|c.||“Because you are not eating after surgery, this medication will help reduce the hydrochloric acid your stomach is still secreting.”|
|d.||“The nasogastric tube will cause peptic ulcer disease. This medication will help prevent that.”|
- Which explanation by the nurse is accurate to include when teaching a patient who is beginning therapy for gastroesophageal reflux disease (GERD) with metoclopramide?
|a.||“This medication decreases esophageal muscle tone to reduce reflux.”|
|b.||“Peristalsis is increased, so food is digested more quickly.”|
|c.||“Gastric emptying is delayed, so you may feel full for longer intervals.”|
|d.||“This medication is an antikinetic agent, so you may have difficulty with motor skills.”|
- A patient who is taking NSAIDs to treat arthritis asks the nurse why misoprostol has also been prescribed. Which explanation by the nurse is accurate?
|a.||NSAIDs often cause GI irritation that can result in peptic ulcers.|
|b.||NSAIDs promote the production of prostaglandins and reduce the incidence of gastric irritation.|
|c.||Antiulcer medications eradicate the presence of bacteria in the stomach that cause ulcers.|
|d.||Drug interactions are prevented when antiulcer medications are used in combination with NSAIDs.|
- Which organism or disorder is responsible for many cases of PUD?
- A patient with PUD asks the nurse about the action of prokinetic medications. Which explanation by the nurse is accurate?
|a.||It blocks the formation of hydrochloric acid, reducing irritation of the gastric mucosa.|
|b.||It increases the lower esophageal sphincter muscle pressure and peristalsis.|
|c.||It reduces the secretion of saliva, hydrochloric acid, pepsin, bile, and other enzymatic fluids.|
|d.||It decreases the volume of hydrochloric acid produced, increasing the gastric pH.|
- Which is considered an acceptable time frame for a patient with gastric distress to self medicate with over the counter antacids?
- The nurse is instructing a patient recently diagnosed with GERD. Which statement by the patient indicates a need for further teaching?
|a.||“I will avoid foods high in fat.”|
|b.||“I will eat small frequent meals and have a snack at bedtime.”|
|c.||“Orange juice may aggravate my symptoms.”|
|d.||“I will wait 2 hours after eating lunch before lying down for a nap.”|
- The nurse is planning to administer an antacid to a patient diagnosed with PUD who will receive an H2 antagonist at 8:00 AM. When is the most appropriate time for the nurse to provide the antacid to this patient?
|a.||With the H2 antagonist|
|b.||30 minutes prior to the H2 antagonist|
|c.||2 hours after the H2 antagonist|
|d.||Within an hour after the H2 antagonist|
- A patient taking misoprostol (Cytotec) to treat a gastric ulcer reports recurrent diarrhea. The nurse should encourage this patient to:
|a.||immediately discontinue misoprostol (Cytotec).|
|b.||take with a magnesium containing antacid.|
|c.||omit fresh fruits from diet.|
|d.||take medication with meals.|
- Which factor(s) prevent(s) breakdown of the body’s normal defense barriers that protect against ulcer formation? (Select all that apply.)
- Which are important nursing considerations when administering prokinetic agents? (Select all that apply.)
|a.||These agents are used to treat esophagitis associated with gastric reflux.|
|b.||They are used to treat GERD when lifestyle changes and diet are ineffective.|
|c.||They may be useful in treating nausea associated with chemotherapy treatment.|
|d.||They may be administered intravenously.|
|e.||Administer the medication to diabetic patients after meals.|
- Which factor(s) contribute(s) to the development of PUD? (Select all that apply.)
|d.||Excessive ingestion of milk products|
- Which drug therapy is aimed at reducing gastric acid secretions? (Select all that apply.)
|d.||Proton pump inhibitors|
- Which information will the nurse include when teaching a patient with renal failure about antacid therapy for treatment of heartburn? (Select all that apply.)
|a.||Taking magnesium-based antacids prevents diarrhea.|
|b.||Magnesium-based antacids are preferred for patients with renal failure.|
|c.||Aluminum hydroxide antacids exacerbate constipation.|
|d.||If the patient has coffee ground emesis or bloody stools, the frequency of antacids should be doubled.|
|e.||Antacids neutralize gastric acid.|
- The nurse is discussing dietary and lifestyle changes with a patient diagnosed with GERD. When reviewing necessary modifications, the nurse will include information regarding: (Select all that apply.)
|a.||limiting coffee intake to 2 cups/day.|
|d.||decreasing protein foods.|
|e.||using nonfat milk|
Chapter 34: Drugs Used to Treat Nausea and Vomiting
- A patient is beginning the second round of high dose cisplatin. Severe, chemotherapy induced nausea and vomiting (CINV) occurred following the first treatment, requiring 72 hours of continuous IV hydration. In addition to her chemotherapy regimen, which medication would be best to administer?
|a.||Prochlorperazine (Compazine) suppository daily, on the day of treatment and the next 3 days|
|b.||Anticholinergic agents, such as diphenhydramine or meclizine|
|c.||Parenteral ondansetron 1 hour before chemotherapy, with oral ondansetron to continue for the next 4 days|
|d.||Parenteral ondansetron during chemotherapy, with prochlorperazine suppositories daily for 1 week|
- A patient expresses concerns about motion sickness. Which medication is most effective in preventing motion sickness?
- What is the purpose for the nurse administering metoclopramide (Reglan) IV postoperatively?
|a.||Prolong the effects of anesthesia.|
|b.||Decrease the potential for thrombus formation.|
|c.||Prevent postoperative nausea and vomiting.|
|d.||Decrease postoperative pain.|
- The nurse is assessing a patient with nausea and vomiting. Which additional autonomic symptoms that often accompany vomiting will the nurse observe?
|a.||Bradycardia, diarrhea, and flushing|
|b.||Pallor, sweating, and tachycardia|
|c.||Urinary urgency, chills, and dizziness|
|d.||Fever, hyperventilation, and bradycardia|
- The nurse would expect to administer which drug when treating hyperemesis gravidarum?
- Why does the nurse monitor daily weights prior to the administration of antiemetic medications to chemotherapy patients?
|a.||Antiemetics are calculated according to body surface area.|
|b.||Antiemetics are toxic, and the minimal dosage should be administered.|
|c.||Weight loss is a common adverse effect associated with chemotherapy, and dosages may need to be readjusted.|
|d.||Fluid overload is common, and antiemetic dosages are increased as treatment progresses.|
- What is an advantage of using benzodiazepines as an adjunctive treatment for nausea and vomiting associated with chemotherapy?
|a.||The long half life will prolong the effectiveness of other drugs.|
|b.||They increase a sense of euphoria.|
|c.||The patient will not develop tolerance to the medications as quickly.|
|d.||The antianxiety effect helps, in addition to reducing the frequency of nausea and vomiting.|
- What condition is occurring when a patient experiences nausea immediately on entering the clinic to receive another course of chemotherapy?
|d.||Anticipatory nausea and vomiting|
- Which herb has been used in many cultures to provide relief of nausea associated with pregnancy?
- The nurse is caring for a 27-year-old patient taking a cannabinoid during chemotherapy. Which consideration will the nurse take into account?
|a.||Antihistamines may potentiate the effects.|
|b.||Monitor the patient for fluid volume excess.|
|c.||Previous use of marijuana requires increased dosage.|
|d.||Inform the patient to avoid the intake of potassium.|
- The recovery room nurse is preparing to assist with the care of several postoperative patients. Which patient would the nurse prioritize care for regarding the potential for postoperative nausea and vomiting (PONV)?
|a.||A 5-year-old child undergoing a closed reduction procedure with regional anesthesia|
|b.||A 50-year-old woman undergoing a total hysterectomy with general anesthesia|
|c.||A 27-year-old man undergoing a middle ear manipulation with general anesthesia|
|d.||An 80-year-old man undergoing a total hip replacement with spinal anesthesia|
- The nurse is administering medications to various patients during morning medication pass. The patient at the lowest risk of having an adverse reaction is the patient receiving:
- What is the role of the chemoreceptor trigger zone (CTZ) in vomiting? (Select all that apply.)
|a.||Initiates or induce vomiting|
|b.||Coordinates the vomiting reflex|
|c.||Activates the vomit center (VC) to induce vomiting|
|d.||Samples blood and spinal fluid for potentially toxic substances|
- Why is drug therapy important for selected causes of nausea and vomiting? (Select all that apply.)
|a.||Relieves the distress associated with nausea and vomiting|
|b.||Prevents aspiration of gastric contents into the lung|
|d.||Prevents electrolyte imbalances|
|e.||Increases intracranial pressure|
- A patient going on vacation asks the nurse what she can give to her 3 year old child who becomes car sick. Which response(s) would be accurate? (Select all that apply.)
|a.||“Positioning techniques such as placing the child facing forward and blocking out scenery through the side windows can be helpful.”|
|b.||“There is no such thing as car sickness.”|
|c.||“If your child does vomit, give over the counter Benadryl.”|
|d.||“I would check with the pharmacist regarding over the counter products available for young children.”|
- A prepared childbirth nurse educator is discussing potential discomforts during pregnancy with a group of women. When relaying information about nausea and vomiting, the nurse will include which statement(s)? (Select all that apply.)
|a.||The majority of pregnant women experience nausea and vomiting.|
|b.||Severe, persistent vomiting during pregnancy is known as anticipatory vomiting.|
|c.||Vomiting during pregnancy is more common among primigravidas.|
|d.||Prior fetal loss puts a woman at higher risk.|
|e.||Nausea and vomiting during pregnancy can occur at any time of the day.|
Chapter 35: Drugs Used to Treat Constipation and Diarrhea
- When the nurse assesses bowel habits in a patient, which is the best example of normal bowel elimination?
|a.||Daily bowel movements|
|b.||Multiple soft stools daily|
|c.||Daily liquid stools|
|d.||Regular bowel elimination pattern of soft stool|
- Which drug would be most effective for an obstetric patient who is complaining of constipation as a result of her enlarging uterus and use of prenatal vitamins?
- The nurse is performing a premedication assessment. For which patient would laxative use be contraindicated?
|a.||Patient with quadriplegia|
|b.||Patient with appendicitis|
|d.||Patient with fractured femur|
- Which is the laxative of choice for an older patient who is in the end stage of Alzheimer’s disease and requires a daily laxative?
- A friend reports using loperamide (Imodium) for continual diarrhea for a week since returning home from a vacation outside the country. Which is the nurse’s best response?
|a.||“There are some other over the counter products available for diarrhea, such as Kaopectate (bismuth subsalicylate).”|
|b.||“I’d stop taking the Imodium and go in to see a health care provider immediately. You may have an infection in your intestinal tract.”|
|c.||“If you’re not running a temperature, I wouldn’t worry. That happens to many people when they travel.”|
|d.||“As long as you can drink plenty of fluids, I’m sure the diarrhea will go away once you’re back in a normal routine.”|
- A patient who has had a myocardial infarction is advised to avoid straining with defecation. Which medication would be prescribed to this patient?
|b.||Bulk forming laxatives|
- An older adult is admitted through the emergency department with complaints of nausea, abdominal tenderness, and continual stooling. On assessment, the nurse notes abdominal distention, smearing of stool on undergarments, and hypoactive bowel sounds LUQ and LLQ. The patient is unable to determine when the last bowel movement was. What is the nurse’s priority assessment?
|a.||Signs and symptoms of an infection|
|c.||A pattern of laxative abuse|
|d.||History of GI disease|
- Which symptom is the patient with a lactase deficiency most likely to exhibit?
- A patient is receiving morphine for pain control. What will the nurse emphasize about preventing constipation?
|a.||Adequate hydration consists of four full glasses of water every day.|
|b.||Laxatives should be given on a daily basis.|
|c.||Stool softeners are taken on a regular basis during opioid use.|
|d.||Enemas should be given on a weekly basis.|
- What is the mechanism of action of a stimulant laxative?
|a.||Draws water into the bowel to facilitate the passage of feces|
|b.||Lubricates the intestinal wall and soften stool|
|c.||Increases bulk and stimulate peristalsis|
|d.||Irritates the intestine directly, promoting peristalsis and evacuation|
- Which effect will the nurse expect when a patient is taking psyllium while on digoxin?
|a.||Decreased effectiveness of the laxative|
|b.||Increased laxative effect|
|c.||Increased absorption of the digoxin|
|d.||Decreased absorption of the digoxin|
- Which instruction will the nurse include in the discharge teaching of a patient taking psyllium?
|a.||“Administer with a full glass of water.”|
|b.||“Limit the intake of high fiber foods.”|
|c.||“Avoid mixing in juice.”|
|d.||“Fat soluble vitamin deficiency is common.”|
- Which instruction by the nurse will assist in the patient’s understanding of lactulose, an osmotic laxative?
|a.||“This medication draws water into the intestine and stimulates defecation.”|
|b.||“There is increased irritability directly on the intestinal wall.”|
|c.||“There is lubrication of the intestinal wall that softens the stool.”|
|d.||“There is an effect on the nerves to increase the peristalsis of the intestinal smooth muscle.”|
- The nurse is caring for a patient receiving palliative care with opioid induced constipation. Laxative therapy has been unsuccessful in treating this patient. Which PRN medication should the nurse provide to best alleviate this type of constipation?
MSC: NCLEX Client Needs Category: Physiological Integrity
- The nurse is assessing a patient taking lactulose to treat chronic constipation. Which adverse effect should the nurse immediately report to the health care provider?
- The nurse is assessing a patient with constipation. Which situation(s) would cause constipation? (Select all that apply.)
|a.||Diet low in fiber and/or residue|
|b.||Excessive fluid intake|
|c.||Diet low in cheese and yogurt|
|e.||Use of morphine|
- Which sign(s) and symptom(s) are consistent with dehydration? (Select all that apply.)
|a.||Increased hemoglobin and hematocrit|
|b.||Decreased urine specific gravity|
|c.||Mental confusion and excessive thirst|
|d.||Periorbital edema and increased blood pressure|
|e.||Nonelastic skin turgor and delayed capillary filling|
- Which treatment(s) would be considered safe for an infant? (Select all that apply.)
|b.||Bulk forming laxatives|
|c.||Malt soup extract|
- The nurse in a long term care facility is preparing to pass medications to the residents. To which of the following residents should the nurse administer an antidiarrheal? (Select all that apply.)
|a.||An 80-year-old woman with diarrhea of sudden onset that has lasted 3 days|
|b.||A 76-year-old man with infectious diarrhea|
|c.||A 92-year-old man with diarrhea secondary to inflammatory bowel disease|
|d.||A 70-year-old woman with a history chronic diarrhea from GI surgery|
|e.||An 88-year-old man that has had two episodes of stress induced diarrhea|
Chapter 36: Drugs Used to Treat Diabetes Mellitus
- A patient received the evening dose of Lispro subcutaneously at 1630. What time will symptoms of hypoglycemia likely occur?
- It is 2:00 PM and a patient who has been NPO since 12 AM for a bronchoscopy is complaining of a headache and shakiness, and is extremely irritable. Vital signs are within normal limits, and a one touch glucose reads 50 mg/dL. Which action is most important for the nurse to take?
|a.||Have the patient eat a snack and drink milk.|
|b.||Administer glucagon subcutaneously.|
|c.||Call the bronchoscopy room to follow up with the delay.|
|d.||Obtain an A1c test.|
- After a blood glucose reading, it is determined that the patient should receive 4 units of Lispro and 8 units of NPH. Which action will the nurse take to administer these medications?
|a.||Draw up each insulin in separate syringes and administer two injections.|
|b.||Draw up the NPH first and then the Lispro using the same syringe.|
|c.||Administer the Lispro before the meal and the NPH after the meal.|
|d.||Draw up the Lispro first and then the NPH using the same syringe.|
- A patient with type 2 diabetes mellitus, which was previously controlled with an oral antidiabetic agent, is hospitalized for treatment of a leg ulcer. The health care provider has ordered sliding scale insulin coverage with regular insulin for hyperglycemia. The nurse brings the injection into the room, and the patient becomes upset, stating “I don’t want to start taking that drug! I’ll need it the rest of my life.” What is the nurse’s best response?
|a.||“This is the same drug as the oral medication you were taking. It’s a stronger dose while you are in the hospital.”|
|b.||“Don’t worry. You shouldn’t need this too often. As you feel better, your blood glucose level will drop.”|
|c.||“Your body is under stress right now, which raises your blood glucose level. This does not mean you will be on this drug permanently. Once you’re feeling better, your provider will determine if your oral medication is all you will need.”|
|d.||“Your disease is progressing and your pancreas is producing less insulin. I know this is a hard time for you. Do you want to talk about it?”|
- What test determines glycemic control over the previous 8 to 10 weeks?
|a.||24 hour glucose clearance test (GTT)|
|c.||Fasting blood sugar (FBS)|
- When is the best time for the nurse to administer Lispro?
|a.||After the patient has started eating|
|b.||Within 10 to 15 minutes of eating|
|c.||30 minutes before a meal|
|d.||45 to 60 minutes before a meal|
- Which is the most important for the successful management of diabetes mellitus?
|a.||A network of community resources|
|b.||The level of self management|
|d.||Frequent follow up with the health care provider|
- What laboratory test is the preferred screening test for diabetes in children and nonpregnant adults?
- The patient asks the nurse how sulfonylureas normalize glucose levels. Which response by the nurse is correct?
|a.||By stimulating pancreatic secretion of insulin|
|b.||By inhibiting secretion of insulin by the pancreas|
|c.||By increasing glucose production in the liver|
|d.||By increasing insulin metabolism in the liver|
- The nurse is instructing a patient about insulin administration. Which statement by the patient indicates a need for further teaching?
|a.||“I may need more insulin if I have surgery.”|
|b.||“Once I open my insulin, I will store it in the refrigerator.”|
|c.||“I will date the insulin bottle when I open it.”|
|d.||“I will keep a spare bottle of insulin on hand.”|
- Which instruction by the nurse is accurate to include when providing teaching to a patient recently diagnosed with diabetes who has been prescribed insulin?
|a.||Beta blockers can mask symptoms of hypoglycemia.|
|b.||Lipodystrophy increases the absorption of insulin.|
|c.||Infection will decrease the need for insulin.|
|d.||Excessive exercise will increase the need for insulin.|
- Which instruction is most important for the nurse to teach a patient with diabetes who is receiving metformin?
|a.||Take the medication before meals.|
|b.||This medication will cause the pancreas to secrete more insulin.|
|c.||Stop taking the drug 24 to 48 hours prior to radiopaque dye procedures.|
|d.||There may be an increase in the triglyceride level.|
- The nurse is caring for a patient with a new diagnosis of type 1 diabetes mellitus. When assisting with the plan of care, which goal set by the patient will require revision?
|a.||Patient will participate in 20 minutes of cardiovascular exercise 5 days a week.|
|b.||Patient will discontinue insulin use within 1 year.|
|c.||Patient will consume 20% of caloric intake from fat.|
|d.||Patient will demonstrate accurate self glucose testing skills.|
- The nurse is administering sulfonylurea drugs to four different patients diagnosed with type 2 diabetes. Which patient should not receive the medication as ordered?
|a.||A 42-year-old man with hypertension|
|b.||A 50-year-old woman with shingles|
|c.||An 80-year-old woman with an allergy to sulfa|
|d.||A 37-year-old man with a blood glucose level of 140|
- A third subclass of diabetes mellitus includes additional types of diabetes that are part of other diseases having features not generally associated with the diabetic state. Which disorder(s) may have an associated diabetic component? (Select all that apply.)
|a.||Patients receiving high dose corticosteroid therapy for disease maintenance|
- A 65-year-old man is diagnosed with type 2 diabetes mellitus. Which patient symptom(s) would indicate type 1 diabetes mellitus, and not type 2? (Select all that apply.)
|b.||Increased thirst over the past week|
|c.||A 10-pound weight loss within the past month|
- Which dietary control measures are used in the management of diabetes mellitus? (Select all that apply.)
|a.||Specific daily caloric requirements|
|b.||Consistent carbohydrate diabetes meal plan|
|c.||50% intake of carbohydrates daily|
|d.||Adjustments to daily meals according to age, metabolic stress, pregnancy, and advanced age and/or older adults|
|e.||20% intake of proteins daily|
- Which statement(s) regarding type 2 diabetes mellitus would be correct? (Select all that apply.)
|a.||Type 2 diabetes is more prevalent in overweight people older than 45 years.|
|b.||A genetic predisposition exists for the development of type 2 diabetes mellitus.|
|c.||Type 2 diabetes requires lifelong insulin replacement.|
|d.||Type 2 diabetes is often diagnosed after complications have resulted.|
|e.||Women have a higher incidence of type 2 diabetes.|
- Which statement(s) regarding gestational diabetes would be true? (Select all that apply.)
|a.||It is diagnosed in about 2% of all pregnancies in the United States.|
|b.||It includes diabetic women who become pregnant.|
|c.||Fetal development may be complicated as a result of gestational diabetes.|
|d.||The risk of developing diabetes after pregnancy is increased.|
|e.||Most women with gestational diabetes have normal glucose tolerance postpartum.|
|f.||Women need to be re evaluated postpartum to determine their classification with respect to glucose tolerance.|
- The nurse is educating a patient with diabetes mellitus regarding urine testing for ketones. Information provided will include that ketone testing should be done: (Select all that apply.)
|a.||when illness occurs.|
|c.||before and after physical exercise.|
|d.||when blood glucose is above usual range.|
|e.||every morning upon awakening.|
Chapter 37: Drugs Used to Treat Thyroid Disease
- Which medication is used to treat hyperthyroidism?
- A patient with a history of heart failure has been diagnosed with hypothyroidism. The drug interaction with glycosides and thyroid replacement therapy will most likely require which change in therapy?
|a.||Decrease in the daily digoxin dosage|
|b.||Gradual increase in the daily glycoside dosage|
|c.||Inability to begin thyroid replacement therapy because of the underlying heart condition|
|d.||Increased thyroid replacement dosage|
- Which nursing diagnosis may be identified for a patient with hyperthyroidism?
|a.||Imbalanced nutrition: more than body requirements|
|c.||Disturbed sleep pattern|
|d.||Ineffective airway clearance|
- The nurse is providing instruction to a patient recently prescribed a radioactive iodine isotope. Which is the correct action of this medication?
|a.||Stimulates the synthesis of T3 and T4 hormones|
|b.||Increases the storage of thyroxine before thyroid surgery|
|c.||Destroys hyperactive thyroid tissue|
|d.||Replaces deficient thyroid hormone|
- Which patient would be a candidate for radioactive iodine therapy?
|a.||A 17-year-old woman with Graves’ disease|
|b.||A 64-year-old woman with hypothyroidism|
|c.||A 46-year-old man with heart disease and thyroid cancer|
|d.||An 82-year-old man with myxedema crisis|
- Which medication is used in the treatment of hypothyroidism?
- A patient with myxedema complains to the nurse that he has a “hangover” the next morning after taking a pain medication at night. Which explanation by the nurse is the most accurate?
|a.||“You have increased sensitivity to the medicine because of your thyroid condition.”|
|b.||“Because you haven’t been sleeping, you have increased fatigue and should increase the analgesic.”|
|c.||“You are not taking enough thyroid medication and you should increase the dosage.”|
|d.||“The pain medication is incompatible with your thyroid medication and you should find another analgesic to take.”|
- Which condition can occur if congenital hypothyroidism is not treated?
- What is the mechanism of action of propylthiouracil?
|a.||Blocks reuptake of thyroid hormone in the liver|
|b.||Destroys hormone in the thyroid gland|
|c.||Increases synthesis of hormone in the thyroid gland|
|d.||Blocks synthesis of hormone in the thyroid gland|
- When assisting with the care of a patient with hyperthyroidism, the nurse will:
|a.||provide a cool environment.|
|b.||anticipate ordering a low calorie diet.|
|c.||limit daily caffeine intake.|
|d.||encourage intake of bran products.|
- The nurse transcribes a new order for liothyronine for a patient diagnosed with hypothyroidism. When educating the patient about this medication, the nurse will include that:
|a.||the onset of action is slower than that of levothyroxine.|
|b.||it is safe for patients with cardiovascular disease to take.|
|c.||adverse effects may occur up to 3 weeks after changes in therapy have been initiated.|
|d.||symptoms of adverse effects include tachycardia and weight gain.|
- Medications ordered on a patient with hypothyroidism include liotrix and cholestyramine. The nurse administers the dose of liotrix at 0800. When is the best time for the nurse to administer the cholestyramine?
- A patient recently completed radiation treatment for throat cancer and presents to the health care provider’s office with symptoms indicating possible hypothyroidism. Which symptom(s) would most likely be exhibited and/or reported? (Select all that apply.)
|a.||Inability to sleep|
- What is characteristic of antithyroid drugs that act on the thyroid gland? (Select all that apply.)
|a.||They are a physiologic hormone replacement.|
|b.||They block synthesis of T3 and T4 in the thyroid gland.|
|c.||They destroy T3 and T4.|
|d.||Immediate improvement is observed.|
|e.||They may be used before subtotal thyroidectomy.|
- A postoperative total thyroidectomy patient is started on levothyroxine (Synthroid) daily. What information will the nurse include in discharge teaching? (Select all that apply.)
|a.||“Close follow up with your health care provider is important.”|
|b.||“Notify your health care provider if you experience any palpitations or tachycardia.”|
|c.||“A variation in emotions and personality is normal during this adjustment period.”|
|d.||“Synthroid may be stopped as soon as the thyroid gland resumes functioning.”|
|e.||“When energy levels have returned, Synthroid will be gradually tapered.”|
- Which clinical manifestation(s) would the nurse assess in a patient with hypothyroidism? (Select all that apply.)
|a.||Cold intolerance, weight gain|
|c.||Increased susceptibility to infection|
- Which clinical symptom(s) would the nurse observe in a patient with thyrotoxicosis? (Select all that apply.)
|a.||Decreased metabolic rate|
|b.||Decreased heart rate|
|c.||Decreased body temperature|
Chapter 38: Corticosteroids
- A patient has been on high dose corticosteroid therapy for the treatment of lupus erythematosus. In addition to monitoring electrolyte levels, which laboratory studies will the nurse monitor?
|a.||Complete blood count|
|b.||Partial thromboplastin time|
|c.||Liver function panel|
|d.||Blood glucose levels|
- A patient who has been taking glucocorticoids over the past 3 months for Crohn’s disease comes in for a follow up visit. On assessment, the nurse notes facial edema, thinning extremities, and a fatty deposition (buffalo hump) on the scapular area. The patient reports the symptoms of the Crohn’s disease are “somewhat better.” What will the nurse expect the treatment to be?
|a.||Decrease the steroid dosage by one half.|
|b.||Increase the steroid dosage.|
|c.||Maintain the steroid dosage.|
|d.||Immediately stop the steroid dosage.|
- What is the rationale for administering glucocorticoid therapy as an adjunct to chemotherapeutic agents?
|a.||Assists with pain control|
|b.||Raises blood sugar to meet the increased metabolic needs|
|c.||Produces immunosuppression effects|
- A patient with type 1 diabetes was prescribed a glucocorticoid for chronic obstructive pulmonary disease. Which will the nurse expect in the treatment plan?
|a.||A decrease in the amount of insulin needed|
|b.||No change in the amount of insulin needed|
|c.||An increase in the need for carbohydrates|
|d.||An increase in the insulin needed|
- Which condition would require mineralocorticoid replacement?
- Which fluid replacement method will the nurse identify for a patient on a fluid restriction?
|a.||Freely throughout the day and evening shift|
|b.||One third of the allowed volume on each shift|
|c.||Half the volume with meals and the remainder divided among shifts|
|d.||As the patient desires|
- Which will the nurse include in the teaching plan for a patient asking about the use of salt substitutes while on a sodium restricted diet?
|a.||Salt substitutes may be high in potassium and should be used sparingly.|
|b.||Salt substitutes are safe for unlimited use.|
|c.||The salty flavor is reduced, so additional amounts are needed for desired flavor.|
|d.||Salt substitutes may interact with the patient’s medications.|
- A patient on a high dosage of corticosteroids over a period of time may develop which type of psychiatric complication?
- What is the rationale for monitoring vital signs of patients receiving corticosteroids?
- The nurse is assessing a patient for adverse effects of long term glucocorticoid therapy. Which condition would most likely be present?
- The nurse transcribes a new order for a patient for a fludrocortisone. When planning the time of administration, the nurse will schedule this medication to be given:
|a.||with breakfast and dinner.|
|b.||once daily in the evening.|
- Which statement(s) made by a patient on a corticosteroid medication show(s) a need for further education?
|a.||“I should increase my potassium intake.”|
|b.||“I may have to decrease my fluid intake.”|
|c.||“I will avoid weight bearing measures.”|
|d.||“I will change position frequently.”|
- The nurse is instructing a patient about adverse effects associated with corticosteroid therapy. What information would be important to include? (Select all that apply.)
|a.||Avoid crowds or people with an infection.|
|b.||Monitor and care for your skin daily; change positions frequently.|
|c.||Take medication on an empty stomach.|
|d.||During periods of physical or psychological stress, higher doses of corticosteroids are necessary. Contact your health care provider.|
|e.||Follow a diet low in sodium.|
- What are functions of glucocorticoids? (Select all that apply.)
|a.||Maintain fluid and electrolyte balance|
|b.||Have anti inflammatory activities|
|c.||Regulate protein, carbohydrate, and fat metabolism|
|d.||Provide relief of rheumatoid arthritis|
- A patient has been diagnosed with rheumatoid arthritis and will begin daily oral corticosteroid treatment. Which baseline assessment(s) would be important for a patient receiving corticosteroids? (Select all that apply.)
|c.||Complete blood cell count (CBC)|
- Which measure(s) for monitoring hydration and fluid balance would be inappropriate for the patient on steroid therapy? (Select all that apply.)
|b.||Abdominal girth measurements|
|c.||Reports of thirst|
|e.||Assessment for alteration in skin integrity|
- What would be primary therapeutic outcome(s) expected from fludrocortisone (Florinef) therapy? (Select all that apply.)
|c.||Blood pressure control|
|d.||Restored fluid and electrolyte balance|
- A patient with type 2 diabetes is being discharged on glucocorticoid (prednisone) therapy for rheumatoid arthritis. Which information will the nurse include in discharge teaching? (Select all that apply.)
|a.||“Daily, single dose therapy should be taken in the morning.”|
|b.||“The metabolic needs of your body will be increased.”|
|c.||“Steroids should never be discontinued abruptly.”|
|d.||“Signs and symptoms of infections may not be evident.”|
|e.||“Blood glucose levels will be elevated on corticosteroid therapy.”|
- A patient has just received a new prescription for a corticosteroid medication. The nurse is educating a patient on symptoms to report to the health care provider. When providing this education, the nurse will inform the patient to report: (Select all that apply.)
Chapter 39: Gonadal Hormones
- A female patient with a history of endometriosis presents with bilateral lower quadrant pain reportedly at midcycle. Which gonadal drug is indicated for treating symptoms of endometriosis?
- What is the rationale for using an androgen as part of breast cancer treatment?
|a.||For maintenance of fat stores|
|b.||To promote nutrition|
|c.||To prevent wasting resulting from cancer growth|
|d.||For palliative treatment to suppress cancer cell growth|
- The health of a patient receiving androgen therapy for breast cancer declines and she becomes bed bound. Which condition will this patient be at risk of developing?
- Which patient on oral contraceptive therapy will be at greatest risk for heart attack?
|a.||A 34-year-old woman with a history of osteoporosis|
|b.||A 28-year-old woman with a history of eczema|
|c.||A 36-year-old woman who smokes half a pack per day|
|d.||A 36-year-old woman who has a history of abnormal Pap smears|
- Which is most important for the nurse to remember when instructing the patient about treatment with gonadal hormones?
|a.||Dosage, schedule, and adverse effects|
|b.||Cost, storage, and route of administration|
|c.||Drug interactions and food interactions|
|d.||Scheduling follow up appointments and lab studies|
- The nurse is teaching a young woman about birth control pills. For which situation will the patient need to seek immediate follow up with the health care provider?
|d.||Light menstrual flow|
- Which statement is true regarding androgen therapy?
|a.||Androgen use may cause hyperglycemia.|
|b.||Androgen should be administered with food or milk to avoid gastric irritation.|
|c.||Signs of masculinization will appear and are reversible.|
|d.||Electrolyte imbalances are extremely rare.|
- Which is the most potent of the natural estrogenic hormones produced in the ovaries?
- Which information will the nurse include when teaching a patient with seizures about estrogen therapy?
|a.||Phenytoin reduces the effectiveness of estrogen.|
|b.||Estrogen reduces the effectiveness of phenytoin.|
|c.||Phenytoin may inhibit the metabolism of estrogen.|
|d.||Estrogen may inhibit the metabolism of phenytoin.|
- When preparing a female patient for the endocrine changes that may occur as a result of androgen changes, the nurse will include information regarding:
- What is progestin therapy used for? (Select all that apply.)
|d.||Abnormal uterine bleeding|
- The nurse is completing discharge teaching to a new mother who will begin oral contraceptives. Which common adverse effect(s) should be expected? (Select all that apply.)
|a.||Elevated blood pressure|
- Why is estrogen therapy used in postmenopausal women? (Select all that apply.)
|a.||To meet contraceptive needs|
|b.||To treat acne|
|c.||To prevent osteoporosis|
|d.||To treat hot flashes|
|e.||To maintain hormonal balance|
- Which condition(s) would be of special concern when evaluating a patient for treatment with gonadal hormones? (Select all that apply.)
|a.||Sexually transmitted disease|
|d.||Cancer of the reproductive organs|
- When teaching a patient about estrogen therapy, which drug(s) will the nurse identify as causing drug interactions? (Select all that apply.)
- The nurse is discussing estrogen therapy with a patient education group. When relaying information, the nurse may explain that therapeutic outcomes of estrogen therapy include: (Select all that apply.)
|c.||treatment of severe facial acne.|
|e.||prevention of heart disease.|
- The nurse is preparing to administer an estrogen containing medication to a patient. This medication will be held if the nurse assesses that the patient: (Select all that apply.)
|a.||may be pregnant.|
|b.||has a blood pressure of 130/70.|
|c.||has a history of phlebitis.|
|d.||reports breast tenderness.|
|e.||is taking thyroid hormones.|
Chapter 40: Drugs Used in Obstetrics
- Which drug will the health care provider prescribe to soften the cervix of a woman who is at 42 weeks of gestation?
- For which reason will betamethasone IM be administered to the mother in premature labor?
|a.||To stop uterine contractions|
|b.||To prevent precipitous labor|
|c.||To stimulate lung maturity in the fetus|
|d.||To stimulate prolactin to enhance breastfeeding|
- A 26-year-old patient with preeclampsia is receiving IV magnesium sulfate. The 1400 assessment includes blood pressure, 100/70 mm Hg; respiration, 10; fetal heart tone, 100/min; urine output, 20 mL/hr; and absent patellar reflex. Which is the priority nursing action?
|a.||Decrease IV magnesium sulfate to half the dose and reassess the patient and fetus in 15 minutes.|
|b.||Stop the IV magnesium sulfate and contact the health care provider.|
|c.||Place the patient on her left side and administer oxygen.|
|d.||Stop the IV magnesium sulfate and administer calcium gluconate 5 mEq IV over 3 minutes.|
- Which drug is administered after delivery to reduce the risk of postpartum hemorrhage after the placenta has been delivered?
- A 36-week primigravida patient has been admitted to the unit with a blood pressure of 200/120 mm Hg, severe headache, and edema. Which medication does the nurse anticipate that the health care provider will order?
- Which drug is administered when a patient is experiencing premature labor?
- A patient is a gravida 1, Rh-negative woman at a 28 weeks’ gestation. The father of her child is Rh positive. The mother is asking the nurse about the effect on her unborn child of RhoGAM that has been ordered. What is the nurse’s best reply?
|a.||“Your child will do well after birth once transfusions are administered.”|
|b.||“If the baby is Rh negative at birth, he or she will need RhoGAM also.”|
|c.||“RhoGAM kills antibodies you make, so your child will be protected.”|
|d.||“Your baby may be Rh positive and cause you to make antibodies. These won’t affect this baby, but could affect future children if RhoGAM isn’t given.”|
- Which drug will the nurse administer to prevent neonatal conjunctivitis in the newborn?
- Which emergency drug must be available when caring for a patient receiving magnesium sulfate?
- Which test would the nurse anticipate to be done to determine if preterm labor is present in a patient whose symptoms are questionable?
|b.||Fetal fibronectin test|
- Which is characterized by seizures?
|a.||Pregnancy induced hypertension|
|d.||Premature rupture of membranes|
- Which medication is used to treat a patient with atonic uterus?
- A woman is 32 weeks pregnant and has been examined by the health care provider on June 1. She is scheduling her next appointment. The most appropriate day for the nurse to schedule the appointment is:
- The nurse administers hydralazine IV to control the blood pressure of a woman diagnosed with preeclampsia. If the nurse administered this medication at 0800, the next assessment of blood pressure should occur at:
- When caring for the neonate immediately following delivery, the priority nursing diagnosis will be:
|a.||risk for bleeding.|
|b.||altered body temperature.|
|c.||ineffective airway clearance.|
|d.||risk for infection.|
- Which assessment(s) will the nurse complete during routine pregnancy visits? (Select all that apply.)
|d.||Fetal heart sounds|
|e.||Glucose tolerance test (GTT)|
- A patient at 33 weeks’ gestation is admitted to the obstetric unit in active labor with symptoms associated with pregnancy induced hypertension (PIH). Which action(s) will the nurse implement? (Select all that apply.)
|a.||Vital signs hourly|
|b.||Administration of IV pitocin|
|c.||Administration of magnesium sulfate IV|
|d.||Fetal stress test|
|e.||Assessment of deep tendon reflexes|
- What will the nurse include when teaching a postpartum patient about expected adverse effects of Rho(D) immune globulin? (Select all that apply.)
Chapter 41: Drugs Used in Men’s and Women’s Health
- A female patient has developed leukorrhea since being on oral broad spectrum antibiotics for the past week for a lower respiratory infection. Which organism causes leukorrhea?
|c.||Human papillomavirus (HPV)|
- A patient states that she has a difficult time remembering when to resume her triphasic contraceptive pills following her menses. Which alternative plan will the nurse suggest that she discuss with her health care provider?
|a.||Changing to the 28-day packet|
|b.||Using the inert pills every other month|
|c.||Changing her prescription to the mini pill|
|d.||Calling the health care provider whenever she forgets to get appropriate instruction|
- Which is more likely to be experienced by women taking the mini pill as an oral contraceptive?
|a.||Ovulation, dysmenorrhea, and break-through bleeding|
|b.||Excessive weight gain and breast tenderness|
|c.||Increased estrogen related adverse effects|
|d.||Difficulty breastfeeding after pregnancy|
- The nurse is obtaining a history on a patient who is seeking oral contraceptives. Which condition would contraindicate the use of oral contraceptives?
|a.||Sexually transmitted diseases (STDs)|
- A patient diagnosed with benign prostatic hypertrophy asks why tamsulosin (Flomax), an alpha1 adrenergic blocking agent, has been prescribed. Which explanation by the nurse is most accurate?
|a.||It inhibits the action of testosterone.|
|b.||It improves sexual function.|
|c.||It reduces the size of the prostate.|
|d.||It increases urinary flow.|
- Which type of drug is most effective in the treatment of erectile dysfunction (ED)?
|d.||Alpha 1 adrenergic blocking agents|
- The nurse is teaching a patient beginning therapy with dutasteride (Avodart). How long will it take before the patient can expect results?
- Why must caution be used when taking a phosphodiesterase inhibitor to enhance male sexual function?
|a.||It can become habit forming.|
|b.||Life-threatening consequences can occur with cardiovascular disorders.|
|c.||It is an ineffective treatment.|
|d.||It is expensive and available only by special prescription.|
- What is the mechanism whereby estrogen functions as a contraceptive?
|a.||Inhibiting luteinizing hormone (LH), blocking release of ovum from a follicle|
|b.||Thinning cervical mucus, which inhibits sperm migration|
|c.||Trapping the ovum in the endometrial wall, preventing its growth|
|d.||Blocking follicle-stimulating hormone (FSH), thereby preventing release of ovum|
- The nurse is instructing a patient on use of a transdermal contraceptive. When evaluating the patient’s understanding of the information provided, the nurse identifies a need for further education when the patient states:
|a.||“Apply the first patch during the first 24 hours of the menstrual period.”|
|b.||“Use a backup contraceptive concurrently for the first 7 days of the first cycle.”|
|c.||“Fold the used patch over on itself before discarding.”|
|d.||“Trim the patch carefully prior to application.”|
- A woman using the NuvaRing vaginal ring informs the nurse that the ring was accidentally expelled a day ago. The nurse will instruct this patient to:
|a.||rinse the ring in cool water and reinsert as soon as possible.|
|b.||rinse the ring in hot water and reinsert as soon as possible.|
|c.||rinse the ring in lukewarm water, reinsert, and use a nonhormonal back up contraceptive.|
|d.||insert a new ring.|
- The health care provider has instructed a patient to use over the counter miconazole (Monistat) cream to treat her vaginal yeast infection. What information is important to include in patient education? (Select all that apply.)
|a.||Wash the genital area thoroughly before inserting the vaginal cream.|
|b.||Wash the applicator before usage.|
|c.||Wear a minipad to catch remaining discharge following vaginal administration.|
|d.||Wash hands before and after administration.|
|e.||The sexual partner may require treatment as well.|
- A nurse working at the community health clinic receives a call from a teen patient who reports that she has missed one of her birth control pills. Which response by the nurse is accurate? (Select all that apply.)
|a.||Take the missed pill now.|
|b.||Take the next pill at the regularly scheduled time.|
|c.||Come into the clinic for a pregnancy test.|
|d.||Start with the next month’s pill packet at day 1.|
|e.||Take the missed pill and the next pill together at the next regularly scheduled time.|
- The nurse is completing a female reproductive history on a 16 year old. What important assessment(s) should be included? (Select all that apply.)
|a.||Breast self-examination (BSE) routine|
|b.||Age of menarche and pattern of menses|
|c.||Smoking and blood pressure history when seeking a prescription for oral contraceptive pills (OCPs)|
|d.||Sexual orientation and number of partners|
|e.||Number of pregnancies, live births, miscarriages, and abortions|
|f.||Nutritional intake of carbohydrates|
- The nurse is giving instructions to a young female at an outpatient clinic regarding combination OCP therapy. What information will the nurse include? (Select all that apply.)
|a.||Medication should be taken at approximately the same time daily.|
|b.||A back up birth control method should be used for the first 6 months.|
|c.||Medication should be discontinued 1 year before attempting pregnancy.|
|d.||Headaches, dizziness, and chest or abdominal pain should be reported immediately.|
|e.||If a pill is missed, take it immediately and remain on schedule for the next dosage.|
- The nurse will teach the patient beginning therapy with alfuzosin, an alpha 1 adrenergic blocking agent, to expect which common (and usually self limiting) adverse effect(s)? (Select all that apply.)
- The nurse at an outpatient clinic is educating a group of young adults regarding prevention of the spread of sexually transmitted infections. Information will include: (Select all that apply.)
|a.||the use of hormonal contraceptives.|
|b.||the use of latex condoms when infection is present.|
|d.||frequent use of nonoxynol 9.|
|e.||the importance of “partner services.”|
Chapter 42: Drugs Used to Treat Disorders of the Urinary System
- What is the action of urinary antimicrobial agents?
|a.||Reduce pain associated with bladder spasms caused by the infection|
|b.||Enhance output enough to flush out the infection from the urinary tract|
|c.||Eliminate urinary retention|
|d.||Have an antiseptic effect on the urine and the urinary tract|
- A patient is complaining of moderate bladder pain and spasms secondary to a UTI. Which drug would assist in relieving symptoms?
|c.||Phenazopyridine hydrochloride (Pyridium)|
|d.||Oxybutynin chloride (Ditropan)|
- A 42-year-old woman is admitted with complaints of dysuria, frequency, and lower back pain. The urinalysis report is positive for red blood cells, and the blood work shows an elevated white blood cell count. Which medication will the nurse anticipate that the health care provider will order?
|b.||Bethanechol chloride (Urecholine)|
- How often is fosfomycin (Monurol) usually administered when used in the treatment of UTIs?
|a.||In a one-time dose|
|b.||Once per day|
|c.||Once per week|
- After undergoing prostate surgery, a patient is discharged on the medication phenazopyridine hydrochloride (Pyridium) to assist with urinary catheter discomfort. What information will the nurse include in the discharge teaching?
|a.||Urine will have a foul smell while taking this medication.|
|b.||Diarrhea and abdominal cramping are expected adverse effects.|
|c.||The sclera of the eye is yellow while on therapy.|
|d.||Urine will appear reddish orange.|
- A 14-year-old male is taking tolterodine (Detrol). What is the action of this drug?
|a.||Restores bladder tone and function|
|b.||Decreases the urge to void|
|c.||Prevents urinary retention|
- Which condition will neostigmine be used to treat?
|c.||Postoperative or postdelivery urinary retention|
|d.||Benign prostatic hypertrophy|
- Which organism causes most UTIs?
- What may become discolored by phenazopyridine (Pyridium) in addition to the urine?
- The nurse is teaching a patient about the anticholinergic agent prescribed for urinary retention. Which statement by the patient indicates a need for further teaching?
|a.||“I will chew gum to relieve dry mouth.”|
|b.||“I will limit my fluid intake.”|
|c.||“I will eat fresh fruits.”|
|d.||“I will not drive if I develop blurred vision.”|
- The nurse is preparing to administer a single dose packet of fosfomycin to a patient diagnosed with a UTI. When preparing this medication, the nurse will:
|a.||pour contents into a souffle cup and administer by mouth.|
|b.||mix with 3 mL of normal saline and inject subcutaneously.|
|c.||pour contents into 90 mL of juice, stir, and administer by mouth.|
|d.||mix contents with 120 mL of water and administer by mouth.|
- When obtaining urine for analysis on a patient in the labor and birth unit, the nurse assesses the urine to appear frothy. The nurse interprets this as a sign of possible:
- A patient has been taking an antimicrobial agent prescribed to treat a UTI for 2 days. She contacts the health care provider’s office to report persistence of symptoms. In evaluating the medication effectiveness, which assessment(s) would be important? (Select all that apply.)
|a.||Complete emptying of the bladder|
|b.||Amount of pain with urination as well as frequency|
|c.||Amount of daily fluid intake and output|
|d.||GI symptom complaints|
|e.||Bleeding with urination|
|f.||Persistence of nocturia|
- The nurse is assisting with postpartum care for a mother who has given birth to her fourth child. She reports a moderate amount of urinary incontinence since the birth of the third child and is concerned that this problem will worsen. Which instruction(s) may facilitate management of incontinence? (Select all that apply.)
|a.||Instruction of proper wiping techniques to prevent bacterial infection|
|b.||Education on bladder training and Kegel exercises|
|c.||Information on personal hygiene measures to prevent perianal breakdown|
|d.||Information of incontinence products and appliances|
|e.||Importance of establishing a regular toileting schedule|
|f.||Importance of increasing fluid intake|
- The nurse is reviewing the urinalysis results of an older adult patient admitted with elevated temperature and incontinence. Which urinalysis properties are indicative of an infection? (Select all that apply.)
|d.||pH of 8.2|
|e.||Specific gravity of 1.014|
- Which intervention(s) will help stimulate urination when a patient is experiencing postoperative urinary retention? (Select all that apply.)
|a.||Reinforcing Kegel exercises|
|b.||Administration of bethanechol chloride (Urecholine)|
|c.||Pouring warm water over the perineum|
|d.||Increasing IV fluids|
- Fluoxetine, erythromycin, clarithromycin, ketoconazole, itraconazole, miconazole, vinblastine, ritonavir, and nefazodone may inhibit the metabolism of which drugs? (Select all that apply.)
- The nurse is caring for a patient taking Pyridium for the diagnosis of UTI. What should the nurse report to the health care provider? (Select all that apply.)
|a.||Orange colored urine|
|c.||Flushing of the skin|
|e.||Increased pain and burning|
Chapter 43: Drugs Used to Treat Glaucoma and Other Eye Disorders
- The nurse is preparing a patient for an ophthalmic examination. Which action occurs when the nurse instills eye drops to produce mydriasis?
|a.||Drying of tears in the eyes|
|b.||Extreme dilation of the pupil|
|c.||Opening of the canal of Schlemm|
|d.||Paralysis of the ciliary muscle|
- Which type of medication would be used to dilate the pupils before an eye examination?
|c.||Beta adrenergic agent|
- Which medication is used to produce miosis following a diagnostic procedure?
|c.||Atropine (Isopto Atropine)|
- Which discharge instruction will the nurse include for a patient sent home from the clinic who is taking an adrenergic ophthalmic solution for an acute inflammation?
|a.||Headaches and eye pain are adverse effects to be reported to the health care provider immediately.|
|b.||Mouth dryness should be reported immediately.|
|c.||Avoid driving or operating machinery until blurring subsides.|
|d.||“Halos” or yellow rings around objects will be seen while taking this medication.|
- What is the action of timolol maleate (Timoptic), a beta adrenergic blocking agent?
|a.||Draws aqueous humor from the eye into the circulatory network|
|b.||Increases the production of aqueous humor|
|c.||Increases the outflow of aqueous humor|
|d.||Decreases the production of aqueous humor|
- What is the mechanism of action of osmotic agents when used to decrease IOP?
|a.||Promoting outflow of the aqueous humor into the tear ducts|
|b.||Increasing plasma osmolarity and drawing extracellular fluid into the blood|
|c.||Blocking production of aqueous humor|
|d.||Decreasing viscosity of the tears and allowing fluid to drain away from the eye|
- Which is a potential serious adverse effect associated with mannitol (Osmitrol)?
- The nurse is caring for a patient immediately following a right sided trabeculectomy. When positioning this patient, the nurse will encourage a _____ position.
|b.||right side lying|
|c.||left side lying|
- The nurse is assisting with applanation tonometry on a patient at the ophthalmologist’s office. The results indicate the patient’s reading to be 15 mm Hg. The nurse interprets this result as _____ IOP.
- Which statement(s) about aqueous humor is/are true? (Select all that apply.)
|a.||Bathes and feeds the lens, posterior surface of the cornea, and iris|
|b.||Maintains the iris color|
|c.||Drains out of the eye through drainage channels located near the junction of the cornea and sclera|
|d.||Manufactures fluid for tear production|
|e.||Flows out of the canal of Schlemm into the venous system of the eye|
- A factory worker had a chemical inadvertently splashed into his right eye. An eyewash was used at the work site. Which nursing assessment(s) would be important to include? (Select all that apply.)
|b.||Presence of pain, blurred or halo vision, or lack of vision|
|c.||Type of chemical|
|d.||Presence of nystagmus|
|e.||Presence of contacts or use of eyeglasses|
- What information will the nurse include when instructing a patient on the correct method of instilling eye drops? (Select all that apply.)
|a.||With an infection, prevent cross contamination and use a separate source of medication and droppers for each eye.|
|b.||Wash hands before and after administration.|
|c.||Place the lid on the surface area as instructed to avoid contamination.|
|d.||Never touch the tip of the dropper or opening of the ointment container.|
|e.||Wipe eye from the outer to inner canthus.|
- A patient recently diagnosed with glaucoma is to begin drug therapy with carbonic anhydrase inhibitors. For which assessment(s) would the nurse need to contact the health care provider? (Select all that apply.)
|b.||Any signs of gastric symptoms before initiating drug therapy|
|c.||Allergy to sulfonamides|
|d.||Patient history of menopause|
|e.||Elevated IOP levels|
- What is the purpose of administering a cycloplegic agent? (Select all that apply.)
|a.||Facilitate examination of the eye|
|b.||Facilitate surgery on the eye|
|c.||Cause pupillary dilation|
|d.||Paralyze the ciliary muscle|
|e.||Decrease the production of aqueous humor|
- Which are important teaching points for the nurse to review with a patient recently diagnosed with open angle glaucoma? (Select all that apply.)
|a.||The disease will cause damage to the optic disc if left untreated.|
|b.||Symptoms are sudden and painful when the disease begins.|
|c.||Loss of peripheral vision is a common trigger for diagnosis.|
|d.||Total blindness may result if the glaucoma is not treated.|
|e.||Glaucoma is not a serious disease and will cause only mild inconvenience to the patient.|
|f.||Treatment is only necessary when symptoms are bothersome.|
- What information will the nurse include when teaching the patient and family about postoperative care for a trabeculectomy? (Select all that apply.)
|a.||Use aseptic technique for all dressing changes and medication administration.|
|b.||Place the patient on the operated side.|
|c.||Avoid heavy lifting.|
|d.||Redness in the eye, pain, and swelling are common occurrences after surgery.|
|e.||Avoid straining on defecation.|
- The nurse is educating a patient about a newly prescribed cholinergic agent. When relaying common adverse effects of this type of medication, the nurse will include information about: (Select all that apply.)
Chapter 44: Drugs Used for Cancer Treatment
- The nurse is educating a patient with cancer about combination chemotherapy. Which is an accurate statement?
|a.||“Combination chemotherapy is the administration of an antineoplastic drug that will be toxic during a specific phase of cellular growth.”|
|b.||“Combination chemotherapy is the administration of an antineoplastic drug that is active throughout the cell cycle.”|
|c.||“Combination chemotherapy is the administration of antineoplastic drugs that change the way the body responds to cancer or strengthens the immune system.”|
|d.||“Combination chemotherapy is the administration of antineoplastic drugs, which results in cell death during different phases of the cell cycle.”|
- The cell cycle–specific agent vincristine sulphate (Oncovin) acts in which phase of the cell’s life cycle?
- What is the importance of correlating the dosage schedule with cell cycle–specific drug therapy?
|a.||Ongoing proliferation of neoplastic tissue|
|b.||The known cellular kinetics of the neoplasm|
|c.||The hormonal requirements of the patient|
|d.||The body’s response in strengthening the immune system|
- When are cancer cells most sensitive to chemotherapy?
- What is the advantage of combination therapy using cell cycle–specific and cell cycle–nonspecific agents?
|a.||Decreased expense and time needed for administration|
|b.||Decreased toxicity to patients and the nurses who administer the drug|
|c.||Increased cell death in various cycles and decreased toxicity|
|d.||Increased rate of treatment success|
- Why is a patient with prostate cancer prescribed an estrogen?
|a.||To achieve hormonal balance|
|b.||To decrease the rate of production for malignant cells|
|c.||To soften prostatic tissue|
|d.||To suppress prostate gland function|
- Which assessment by the nurse would be a sign of neurotoxicity related to chemotherapy?
- Which symptom is the patient who is receiving bleomycin (Blenoxane) therapy most likely to exhibit?
|a.||Increased respiratory rate and cough|
|b.||Weight gain and peripheral edema|
|c.||Numbness and tingling of hands and feet|
|d.||Lethargy and orthostatic hypotension|
- What is the purpose of administering filgrastim (Neupogen) to a patient who is post–bowel resection resulting from cancer?
|a.||Decrease the gastrointestinal (GI) toxicity resulting from chemotherapeutic agents|
|b.||Suppress the immune response|
|c.||Work as an antiemetic and stimulate his appetite|
|d.||Increase the white blood cell (WBC) counts|
- What is the intended outcome of the chemoprotective drug amifostine (Ethyol)?
|a.||Decreased nausea and vomiting|
|b.||Increased effectiveness of the chemotherapy|
|c.||Maintenance of body weight|
|d.||Decreased renal toxicity|
- Why are bone marrow stimulants used in the treatment of cancer?
|a.||To increase uptake of the chemotherapy from the interior of the bones|
|b.||To strengthen bones weakened by pathologic processes|
|c.||To enhance the patient’s immune system during treatment|
|d.||To protect the bone marrow from destructive actions from the cancer treatment|
- The nurse is providing education about chemotherapy to a patient who is being discharged. Which statement by the patient indicates a need for further teaching?
|a.||“I will shave with an electric razor.”|
|b.||“I will take aspirin for a headache.”|
|c.||“I will wash my laundry separate from other family members.”|
|d.||“I will flush the toilet twice after using.”|
- The nurse is caring for a patient diagnosed with breast cancer. The patient reports that she has been experiencing frequent watery stools following chemotherapy treatment. When educating the patient regarding dietary guidelines to help relieve symptoms the nurse will encourage:
|a.||eliminating spicy foods.|
|b.||eating low protein foods.|
|c.||implementing a high roughage diet.|
|d.||eating high fat foods.|
- The nurse is preparing to administer medroxyprogesterone acetate as prescribed to a patient diagnosed with endometrial carcinoma. When gathering supplies to provide this medication, the nurse will obtain a(n):
|a.||plastic medication cup.|
|c.||subcutaneous needle and syringe.|
|d.||intramuscular (IM) needle and syringe.|
- Major chemotherapeutic agents include: (Select all that apply.)
- Which nursing consideration(s) would be taken into account prior to the administration of cisplatin IV? (Select all that apply.)
|a.||Review of laboratory data for presence of myelosuppression and hepatic and renal parameters|
|b.||Administration of IV hydration as prescribed|
|c.||Administration of epoetin alfa (Epogen)|
|d.||Administration of prechemotherapy mesna (Mesnex)|
|e.||Assessment for dermatologic conditions|
- Which sign(s) and symptom(s) assessed by the nurse would indicate thrombocytopenia? (Select all that apply.)
|a.||Pinpoint red rash|
|b.||Casts in urine|
|c.||Brown, fatty stools|
|d.||Increase in menstrual flow|
|e.||Coffee ground emesis|
- Which treatment(s) may be used alone or in combination for the treatment of cancer? (Select all that apply.)
- When educating the patient on chemotherapy regarding skin care, the nurse will include: (Select all that apply.)
|a.||vigorously drying the skin with a bath towel.|
|c.||using mild soap.|
|e.||bathing in lukewarm water.|
Chapter 45: Drugs Used to Treat the Muscular System
- A patient who has undergone a lengthy surgical procedure under general anesthesia is unable to breathe on his own following the procedure. Which drug will the nurse expect to be administered as an antidote to the neuromuscular-blocking agent?
|b.||Neostigmine methylsulfate (Prostigmin)|
- What is the reason for paraplegic patient to receive baclofen (Lioresal)?
|a.||It interrupts reflexes at the level of the spinal cord.|
|b.||It acts directly on the skeletal muscles to reduce spasticity.|
|c.||It interrupts transmission of impulses from motor nerves to muscles at the skeletal neuromuscular junction.|
|d.||It produces generalized mild weakness of skeletal muscles and decreases the force of reflex muscle contractions.|
- A patient taking antipsychotic medication for schizophrenia is admitted with a temperature of 106° F. The admitting diagnosis is neuroleptic malignant syndrome resulting from antipsychotic medication. Which drug is indicated in treatment of this condition?
- In the intensive care unit, the nurse is taking care of a patient who is on a ventilator and is receiving succinylcholine (Anectine). Which is a priority nursing diagnosis for this patient?
|b.||Disturbed body image|
|c.||Risk for injury|
|d.||Self care deficit|
- The patient’s family asks why neuromuscular blocking agents are used before electroconvulsive therapy. Which explanation by the nurse is most accurate?
|a.||“They stimulate respirations while therapy is delivered.”|
|b.||“They prevent aspiration of respiratory secretions during the therapy.”|
|c.||“They decrease intracranial pressure resulting from therapy.”|
|d.||“They reduce the risk of injury during therapy.”|
- Which laboratory values will the nurse review prior to beginning medication therapy for skeletal and muscle disorders?
|a.||Sodium, magnesium, and chloride|
|b.||C-reactive protein (CRP), human leukocyte antigen (HLA), and liver function tests|
|c.||Arterial blood gases (ABGs), complete blood count (CBC), and electrolytes|
|d.||Glucose, high density lipoproteins (HDL), and prothrombin time (PT)|
- Which medication will be prescribed for a patient complaining of muscle spasms resulting from a back injury?
- Which symptoms will be most important for the nurse to assess for early signs of respiratory distress in the patient who has been given a neuromuscular-blocking agent?
|a.||Nasal flaring and retraction of intercostal muscles|
|b.||Dyspnea, increased respiratory rate, and cyanosis|
|c.||Restlessness, anxiety, and lethargy|
|d.||Pallor, stridor, and diaphoresis|
- Which common adverse effects occur with neuromuscular-blocking agents?
- Which assessment is most important for the nurse to obtain when a patient is being treated with a neuromuscular-blocking agent?
|a.||Skin assessment for rash and urticaria|
|b.||Blood pressure assessment for orthostatic hypotension|
|c.||Respiratory assessment for patent airway|
|d.||Assessment for fluid volume overload|
- Which drug interaction may occur when an aminoglycoside or tetracycline is given in conjunction with neuromuscular-blocking agents?
|b.||Decreased effectiveness of antibiotics|
|c.||Increased neuromuscular-blocking activity|
|d.||Sensitivity to antibiotics and possible allergic reaction|
- A patient taking a neuromuscular blocking agent is assessed to have a heart rate of 120 and blood pressure of 80/50. The nurse will anticipate the physician writing an order for:
|b.||blood glucose level.|
|d.||liver function tests.|
- The nurse receives a conscious patient from the postoperative unit after administration of a neuromuscular blocker. Once the patient’s vital signs are stable, the best position for the nurse to assist the patient into is _____ position.
- Patients with which conditions must be carefully assessed to determine whether they would tolerate treatment with a neuromuscular-blocking agent? (Select all that apply.)
- The nurse is examining a patient in the emergency department whose chief complaint is a dislocated shoulder. Which assessment data are needed to evaluate the patient? (Select all that apply.)
|a.||Details related to the mechanism of injury|
|b.||Degree of impairment|
|d.||Inspection of the affected part for swelling, capillary refill, bruising, redness, localized tenderness, deformities, and paresthesia|
|e.||Elevation of the affected extremity|
- An employee at a factory has not been to work because of low back muscle spasms. His wife contacts the occupational health nurse to report that her spouse is on a centrally acting skeletal muscle relaxant and is having problems with sleepiness. Based on the medication action, what will the nurse tell her? (Select all that apply.)
|a.||“The health care provider should be notified because these drugs are contraindicated in the treatment of low back pain.”|
|b.||“Your husband should avoid activities requiring alertness, such as driving or operating power equipment.”|
|c.||“I need additional and specific information regarding the amount of your husband’s sedation.”|
|d.||“I will review baseline laboratory studies, discuss your husband’s status with the health care provider, and call you back.”|
|e.||“Sedation is an adverse effect of these medications and tends to resolve with continued therapy.”|
- Why are neuromuscular-blocking agents used? (Select all that apply.)
|a.||Alleviation of pain|
|b.||Reducing the use and adverse effects of general anesthetics|
|c.||Easing endotracheal intubation and prevent laryngospasm|
|d.||Producing amnesia during painful procedures|
|e.||Decreasing muscular activity in electroshock therapy|
- When assessing a patient for signs and symptoms of early respiratory depression immediately after leaving the postoperative area, the nurse will be alert for signs of what? (Select all that apply.)
|d.||Increased mental alertness|
Chapter 46: Antimicrobial Agents
- A patient allergic to penicillin is being evaluated for a gram-negative infection. Which antimicrobial drug class would the health care provider be cautious in prescribing because of a possible cross sensitivity and/or allergic reaction?
- The health care provider has prescribed penicillin and probenecid for a patient with a sexually transmitted disease. What is the purpose of combining these medications?
|a.||To accelerate the excretion of the penicillin|
|b.||To inhibit the absorption of penicillin to allow the drug to remain in the transport phase|
|c.||To inhibit the excretion of the penicillin|
|d.||To reduce toxic effects associated with penicillin|
- An older adult who has septicemia is receiving IV aminoglycoside therapy. Which symptom is most important for the nurse to monitor?
|a.||Bone marrow suppression|
|c.||Gastrointestinal (GI) distress|
- On what is the selection of an antimicrobial agent based?
|a.||Sensitivity of the microorganism to the drug|
|b.||Half life of the medication|
|c.||Therapeutic levels of the drug|
|d.||Bioavailability of the drug|
- A patient is scheduled to take tetracycline and aluminum hydroxide (Amphojel) at the same time. When will the nurse administer the medications to achieve the optimal effects?
|a.||Both medications together|
|b.||Amphojel 30 minutes before tetracycline|
|c.||Tetracycline with orange juice|
|d.||Tetracycline 1 hour before Amphojel|
- Which conditions may occur with the administration of broad spectrum antibiotics over an extended period of time?
- A patient is admitted with glomerulonephritis. IV gentamicin therapy is started after cultures indicate gram negative bacilli in the blood. The patient also receives IV furosemide (Lasix). The nurse will monitor for signs and symptoms of toxicity related to which organ?
- Which drug is the cornerstone of treatment for prophylaxis and treatment of tuberculosis (TB)?
|a.||Amphotericin B (Abelcet)|
- A patient indicates during the nursing assessment that he is currently taking zidovudine (Retrovir). For which condition is the patient being treated?
- Which drug is incompatible with heparin?
- What adverse effect may manifest as dizziness, tinnitus, and progressive hearing loss?
- The nurse will monitor patients on cephalosporins and loop diuretics for which adverse effect?
- The nurse is caring for a patient being treated with an antimicrobial agent for the diagnosis of a sexually transmitted infection. Which statement made by the patient shows a need for further education?
|a.||“I will use a barrier method when having sexual intercourse during therapy.”|
|b.||“I will increase fluid intake to 2000 to 3000 mL/day.”|
|c.||“I will increase protein in my diet.”|
|d.||“I will rest frequently.”|
- Which patient can safely be treated with a fluoroquinolone medication?
|a.||A 40 year old on steroid therapy|
|b.||A 15 year old with a sore throat|
|c.||A 70 year old with a gait abnormality|
|d.||A 30 year old with a fractured tibia|
- An older adult with a history of asthma, rhinitis, and no known drug allergies has been admitted to receive IV antimicrobial therapy for bronchitis. The patient has received the oral form of the antimicrobial agent in the past. Which factors increase the risk for an allergic reaction? (Select all that apply.)
|a.||Medical history of asthma|
|b.||The patient’s age|
|c.||IV antimicrobial therapy|
|d.||Medical history of rhinitis|
|e.||Subsequent use of the same antimicrobial therapy|
- A patient has been receiving home health care and IV antimicrobial therapy for osteomyelitis (infection of the bone) of the lower right leg for the past 4 weeks. What will the nurse assess to evaluate the effectiveness of the antimicrobial agent? (Select all that apply.)
|a.||Pain of the right leg|
|c.||Presence of edema, redness, or swelling in the right lower leg|
|d.||Culture and sensitivity parameters at the drug completion|
|e.||Complete blood count (CBC) and sedimentation rate laboratory values|
- Which drugs may reach toxic blood levels if administered with macrolide antibiotics? (Select all that apply.)
|d.||HMG CoA reductase inhibitors|
- The nurse is planning to administer ertapenem IV to a patient in the intensive care unit. When preparing this medication, the nurse will consider reconstituting it with: (Select all that apply.)
|c.||0.9% sodium chloride.|
Chapter 47: Nutrition
- Which meal contains the best sources of dietary fiber?
|a.||Eggs, bacon, orange juice|
|b.||Salad, whole wheat toast, sliced peach|
|c.||Roast beef, mashed potatoes with gravy, corn, milk|
|d.||Grilled hamburger on a bun, fresh carrot sticks, potato chips|
- A patient who is 8 weeks’ postpartum would like to begin a moderate intensity exercise program to lose the remaining 20 lb she gained during her pregnancy. Which exercise regimen will the nurse recommend to accomplish this goal best?
|a.||Walking 2 miles daily in 1 hour, four times weekly|
|b.||Jogging 4 miles in 20 minutes, three times weekly|
|c.||Walking 4 miles in 1 hour daily|
|d.||Jogging 2 miles in 20 minutes, twice weekly|
- Which food is a good source of vitamin A?
|d.||Whole grain bread|
- Which dietary fats are cardioprotective?
- A patient is receiving continuous tube feedings at 100 mL/hr. At 1400, the nurse determines that there is 175 mL of residual volume. Which action will the nurse take?
|a.||Continue the feedings as ordered.|
|b.||Reduce the feeding by 50%.|
|c.||Stop the feeding and notify the health care provider.|
|d.||Aspirate and dispose of the residual and restart the feeding.|
- What is the average daily dietary intake level sufficient to meet the nutrient requirements of most healthy individuals in a group?
|a.||Dietary Reference Intake (DRI)|
|b.||Tolerable Upper Intake Level (UL)|
|c.||Estimated Average Requirements (EAR)|
|d.||Adequate Intake (AI)|
- Which is a macronutrient that is a separate factor necessary for complete nutrition and wellness?
|b.||A trace mineral|
- A newly admitted patient asks the nurse why the physician has ordered the DASH diet for him. The nurse informs the patient that this diet is ordered to encourage healthy eating specifically for the diagnosis of:
- A patient presents at the physician’s office with reports of frequent nosebleeds and delayed clotting. The physician diagnoses this patient with a vitamin deficiency. To treat this type of deficiency, the nurse will encourage the patient to consume foods high in vitamin:
- What provide(s) energy sources for body activities and metabolism? (Select all that apply.)
- A patient is receiving total parenteral nutrition. Which action(s) will the nurse perform? (Select all that apply.)
|a.||Assess for electrolyte imbalance.|
|b.||Check residual volume qid.|
|c.||Position the patient in a high Fowler’s position.|
|d.||Monitor blood glucose levels.|
|e.||Discard the solution every 24 hours.|
- A patient is being discharged on psyllium (Metamucil). Which explanation(s) by the nurse would be accurate regarding fiber intake? (Select all that apply.)
|a.||It adds bulk to fecal content.|
|b.||It enhances gastric emptying.|
|c.||It decreases blood cholesterol concentration.|
|d.||It decreases postprandial blood glucose concentration.|
|e.||It stimulates the appetite.|
- What can be directly absorbed from the GI tract into the bloodstream? (Select all that apply.)
- How are essential fatty acids used in the body? (Select all that apply.)
|a.||Building cell membranes|
|d.||Catalyzing metabolic reactions|
|f.||Stimulation of growth hormone|
- A patient is being treated for symptoms of alcohol withdrawal and has been identified to have a thiamine deficiency. When performing physical assessment on this patient specific to thiamine deficiency, the nurse will focus on: (Select all that apply.)
|a.||level of consciousness.|
|c.||sensitivity to light.|
|d.||risk for diarrhea.|
Chapter 48: Herbal and Dietary Supplement Therapy
- What is black cohosh used for?
|a.||Preventing miscarriage during the first trimester|
|b.||Reducing symptoms of premenstrual syndrome|
|c.||Providing antispasmodic activity of the gastrointestinal (GI) system|
|d.||Controlling migraine headaches|
- Which herbal medicine may improve a patient’s short term memory loss and cognitive function?
|d.||Ginkgo biloba extract|
- Which statement about dietary supplements is true?
|a.||Dietary supplements are considered safe and effective.|
|b.||Dietary supplements have not been tested for safety or efficacy.|
|c.||There are no serious adverse effects to taking dietary supplements.|
|d.||Dietary supplements have full FDA and USP approval.|
- Which dietary supplement should be used with extreme caution if the patient is on a platelet inhibitor?
- What is St. John’s wort used to treat?
- Which is a therapeutic effect of valerian?
|a.||Lower high-density lipoproteins (HDLs) and raise low-density lipoprotein (LDLs)|
|c.||Promote relaxation and sleep|
- Which herb is used to stimulate the innate immune system?
- The use of which medication would alert the nurse to educate the patient about using ginkgo biloba cautiously?
- A patient diagnosed with diabetes, hypertension, chronic obstructive pulmonary disease, and angina reports to the nurse that she is taking an aloe juice drink to treat constipation. When assessing this patient for adverse interactions, the nurse will prioritize:
|d.||blood glucose monitoring.|
- The nurse is caring for a 36 year old male patient newly diagnosed with multiple sclerosis (MS). The patient asks if he can continue to take echinacea to help boost his immune system. The nurse’s best response is:
|a.||“Limit use to no more than 8 weeks at a time”|
|b.||“Echinacea use is not recommended for patients with autoimmune diseases”|
|c.||“What other medications are you taking?”|
|d.||“That is a decision that you will need to make independently”|
- Aloe gel for topical use has been marketed to treat which conditions? (Select all that apply.)
|d.||Pain and inflammation|
MSC: NCLEX Client Needs Category: Physiological Integrity
- Which symptom(s) would be consistent with a paradoxical response associated with melatonin use? (Select all that apply.)
- A high school male athlete reports that he is taking creatine supplements to enhance his athletic performance and bulk up his muscles. Which important teaching point(s) and/or recommendation(s) should be made for this supplement? (Select all that apply.)
|a.||Adverse effects may include muscle cramping, dehydration, GI bloating, and diarrhea.|
|b.||Inform the health care provider of usage, should future nephrotoxic medicines be prescribed.|
|c.||It is important to limit fluid.|
|d.||Creatine causes a weight gain of 3 to 6 lb because of water retention.|
|e.||Recommended dosage is 5 to 6 g four times daily for 5 to 7 days, followed by doses of 2 g/day.|
- A patient calls inquiring about herbal treatment of hypercholesterolemia and other nonpharmaceutical measures to lower his cholesterol level. Which important concept(s) should be included in the response to this patient? (Select all that apply.)
|a.||Maintain daily dose of black cohosh.|
|b.||Drink one to four cups of green tea daily.|
|c.||Ingest one fresh clove of garlic daily.|
|d.||Maintain daily aspirin dose.|
|e.||Avoid concurrent use of garlic with ginkgo, ginger, feverfew, and ginseng.|
- Which effect(s) can be attributed to green tea? (Select all that apply.)
|b.||Lower triglycerides and LDLs|
|d.||Lower blood glucose|
|e.||Preventing calcium loss|
|f.||Preventing viral infection|
- The nurse at a health care clinic is educating a patient regarding the use of the supplement ginseng. What information should be conveyed by the nurse? (Select all that apply.)
|a.||Research has confirmed that ginseng increases the body’s resistance to stress.|
|b.||Ginseng is available in tablet form.|
|c.||Insomnia can result from ginseng intake.|
|d.||Ginseng is an aphrodisiac.|
|e.||Ginseng may affect blood coagulation.|
Chapter 49: Substance Abuse
- A 16-year-old male has been referred to the community mental health center following legal charges of driving under the influence. Which screening tests would be appropriate to use on this patient?
|a.||Drug Abuse Screening Test (DAST)|
|b.||Adolescent Alcohol Involvement Scale (AAIS)|
|c.||Adolescent Drug Abuse Diagnosis (ADAD)|
|d.||Minnesota Multiphasic Personality Inventory (MMPI 2)|
- A patient admitted 48 hours ago has a diagnosis of gastrointestinal (GI) bleeding and is receiving IV hydration and transfusions. When making rounds, the nurse observes the patient to be having a tonic clonic seizure. What may be the cause of the seizure?
|a.||Low blood counts as a result of bleeding|
- Which theory views addiction as a maladaptive habit that can be examined and changed the same way as other habits?
|d.||Family system theory|
- A nurse working the night shift suspects that a colleague is abusing alcohol. Which action by the nurse is most important?
|a.||“Good faith” reporting is unfaithful to a colleague.|
|b.||Reporting will result in loss of the colleague’s license.|
|c.||It is not of concern, and the nurse won’t be penalized for refusing to get involved.|
|d.||State guidelines may mandate to report substance abuse.|
- What does a urinalysis that is positive for the drug tested indicate?
|a.||It indicates illegal drug use.|
|b.||It verifies drug dependency.|
|c.||It is a violation of the individual’s constitutional rights.|
|d.||It verifies whether the drug is present in the specimen.|
- What will the nurse instruct patients who are on daily disulfiram (Antabuse) to avoid?
|a.||All forms of cough syrup|
- Which protects individuals who have been successfully rehabilitated from substance abuse from discrimination related to past addiction?
|a.||Americans with Disabilities Act (ADA)|
|b.||National Council on Alcoholism and Drug Dependence|
|c.||Bureau of Alcohol, Tobacco, Firearms and Explosives (ATF)|
|d.||American Medical Association (AMA)|
- What must be administered before glucose infusions for a patient in alcohol withdrawal to prevent Wernicke’s encephalopathy?
- What effect will occur if a patient being treated with naltrexone (ReVia) for substance abuse ingests opioids or alcohol?
|b.||Nausea, vomiting, and diarrhea|
|d.||An absence of the “high” associated with drugs|
- A patient is admitted into a substance abuse treatment center and is withdrawing from alcohol. Which statement made by the patient’s family member shows a need for further education?
|a.||“Withdrawal symptoms can begin within a few hours of discontinuation of drinking.”|
|b.||“Withdrawal symptoms will improve within 24 hours.”|
|c.||“Less than 1% of patients develop delirium tremens.”|
|d.||“Benzodiazepines are commonly used for detoxification.”|
- The nurse is assisting with the development of care plan for a patient withdrawing from cocaine. What would be the first nursing diagnosis priority for this patient?
|a.||Altered nutrition; less than body requirements|
|b.||Risk for altered peripheral tissue perfusion|
|c.||Risk for fluid volume deficit|
|d.||High risk for self directed violence|
- The nurse is transcribing an order for disulfiram on a patient in alcohol rehabilitation. When planning the time of day to administer this medication the nurse will document that disulfiram be given:
- Which patient assessment will the nurse expect to observe when a patient has ingested alcohol while on disulfiram (Antabuse)?
- What is the rationale for administering acamprosate (Campral)?
|a.||Withdrawal from alcohol addiction|
|b.||Maintenance of sobriety|
|c.||Improvement of renal function|
|d.||Correction of electrolyte imbalances|
- What important point(s) of patient education should be included about disulfiram (Antabuse) therapy? (Select all that apply.)
|a.||The patient should return for liver function tests in 10 to 14 days following initiation of therapy.|
|b.||Headache, fatigue, and a metallic taste are common adverse effects that usually resolve.|
|c.||Avoid alcohol ingestion to prevent a reaction.|
|d.||Carefully read all labels for possible alcohol content, including perfumes, and over the counter (OTC) medications such as cough syrups.|
|e.||Report to the health care provider any allergic symptoms, such as hives or pruritus.|
- What does the biologic model theory of substance abuse hypothesize? (Select all that apply.)
|a.||A predisposition to substance abuse based on a hereditary condition|
|b.||Alcoholic individuals as fixated at the oral stage of development, needing satisfaction through oral behaviors such as drinking|
|c.||Genetic aberrations that block feelings of well being, resulting in anxiety, anger, low self esteem, and other negative feelings, leaving a craving for a substance that will suppress the bad feelings|
|d.||That genes may play a role in alteration of metabolic enzyme systems in the body that enhance or detract from pleasurable responses to chemical substances|
|e.||That it is a person’s choice of whether to use drugs, which drugs to use, how much to use, and to seek treatment for substance abuse|
- A health professional colleague is suspected of having a substance abuse problem because of the person’s frequent absenteeism, mood swings when at work, diminished alertness, and poor patient care. Which action(s) will the nurse take? (Select all that apply.)
|a.||Confront the individual.|
|b.||Document specific examples of inappropriate actions.|
|c.||Avoid assigning this individual to patients with narcotic medication orders or high acuities.|
|d.||Notify law enforcement of the suspicions.|
|e.||Submit a confidential report to an appropriate supervisor.|
- A patient has completed substance abuse treatment for alcoholism. What will assist in long-term goal attainment and promote abstinence? (Select all that apply.)
|b.||Regular attendance at NA|
|c.||Regular contact with his program sponsor|
|d.||Following the 12 step program of AA|
|e.||Diazepam therapy to reduce the likelihood of DTs|
- Which psychological trait(s) is/are linked to substance abuse? (Select all that apply.)
|b.||Ability to relax|
- Clonidine (Catapres) is used in treating which opioid withdrawal symptom(s)? (Select all that apply.)
Chapter 50: Miscellaneous Agents
- The nurse is caring for a patient diagnosed with gout who has elevated uric acid levels. Which medication will likely be administered?
- The nurse is providing information to a patient with chronic gout arthritis who is prescribed probenecid. Which information by the nurse is accurate regarding the action of this drug?
|a.||It prevents uric acid crystal formation.|
|b.||It promotes uric acid excretion.|
|c.||It provides analgesia.|
|d.||It treats acute gout attacks.|
- The nurse receives an order to administer colchicine 0.6 mg every 1 to 2 hours until the patient exhibits adverse effects. The nurse will monitor for which adverse effect?
|b.||Diarrhea or nausea|
|d.||Decrease in erythema|
- Which laboratory test result would the nurse observe when a patient has hepatotoxicity?
|c.||Decreased alkaline phosphatase|
|d.||Increased alanine aminotransferase (ALT)|
- A patient with early Alzheimer’s disease is started on tacrine (Cognex), an acetylcholinesterase inhibitor. How will the nurse evaluate that the drug has been effective?
|a.||Decrease in the patient’s agitation|
|b.||Improvement in the patient’s cognitive skills|
|c.||Slowing of disease progression by using a standardized tool|
|d.||Less frequent repetitive behaviors|
- What condition is allopurinol (Zyloprim) used to treat?
|a.||Gout resulting from antineoplastic therapy|
|b.||Acute attacks of gouty arthritis|
|d.||First time gout attacks|
- What is the mechanism of action of memantine (Namenda)?
|a.||Increases production of dopamine|
|b.||Decreases production of serotonin|
|c.||Blocks N-methyl-D-aspartate (NMDA) receptors in the central nervous system (CNS)|
|d.||Enhances reuptake of central neurotransmitters|
- Which nursing action is accurate when administering colchicine?
|a.||Administer the medication subcutaneously.|
|b.||Maintain fluid intake of at least eight 8 ounce glasses daily.|
|c.||Increase fiber in the diet to prevent constipation.|
|d.||Inform the patient that pain will be alleviated in 2 weeks.|
- Which common adverse effect will the nurse expect to assess in a patient recently prescribed tacrine (Cognex)?
- The nurse is caring for a patient with a new prescription for donepezil (Aricept) for symptoms of mild dementia. Which symptom exhibited by the patient should the nurse report to the physician immediately?
- A patient is prescribed memantine (Namenda) 10 mg by mouth daily in liquid form. When preparing this medication, the nurse observes that memantine (Namenda) oral solution has 2 mg/mL in 360 mL. How many milliliters will the nurse prepare?
- A nurse working in a long term care facility is caring for a resident diagnosed with moderate dementia. The physician recently started the resident on tacrine (Cognex). Baseline serum ALT levels were completed. The nurse will ensure that follow up ALT levels will be done:
|a.||every other week for 16 weeks, then monthly.|
|b.||once a month then yearly.|
|c.||every 6 months.|
|d.||once a year.|
- Which condition(s) and/or circumstance(s) warrant caution when colchicine is used for a patient with gout? (Select all that apply.)
- A patient is admitted to the Alzheimer’s unit with moderate dementia. Before beginning tacrine (Cognex) therapy, which baseline nursing assessment(s) should be completed? (Select all that apply.)
|a.||CBC, differential, and uric acid level|
|b.||Gastrointestinal (GI) assessment|
|c.||Liver function tests|
|d.||Blood pressure, pulse, respirations|
- A patient recently diagnosed with Alzheimer’s disease is placed on memantine (Namenda). The family asks why this medication is given. Which explanation(s) by the nurse are accurate? (Select all that apply.)
|a.||Memantine prevents the neurodegeneration of the disease.|
|b.||Memantine improves word recall.|
|c.||Memantine increases the ability to do tasks.|
|d.||Memantine improves sleep.|
|e.||Memantine increases appetite.|