576compfinal Flashcards
1
Q
When given an intravenous medication, the patient says to the nurse, “I usually take pills. Why does this medication have to be given in the arm?” What is the nurse’s best answer?
a.
“The medication will cause fewer adverse effects when given intravenously.”
b.
“The intravenous medication will have delayed absorption into the body’s tissues.”
c.
“The action of the medication will begin sooner when given intravenously.”
d.
“There is a lower chance of allergic reactions when drugs are given intravenously.”
A
ANS: C An intravenous (IV) injection provides the fastest route of absorption. The IV route does not affect the number of adverse effects, nor does it cause delayed tissue absorption (it results in faster absorption). The IV route does not affect the number of allergic reactions.
2
Q
The nurse is administering parenteral drugs. Which statement is true regarding parenteral drugs?
a.
Parenteral drugs bypass the first-pass effect.
b.
Absorption of parenteral drugs is affected by reduced blood flow to the stomach.
c.
Absorption of parenteral drugs is faster when the stomach is empty.
d.
Parenteral drugs exert their effects while circulating in the bloodstream.
A
ANS: A
Drugs given by the parenteral route bypass the first-pass effect. Reduced blood flow to the stomach and the presence of food in the stomach apply to enteral drugs (taken orally), not to parenteral drugs. Parenteral drugs must be absorbed into cells and tissues from the circulation before they can exert their effects; they do not exert their effects while circulating in the bloodstream.
3
Q
When monitoring the patient receiving an intravenous infusion to reduce blood pressure, the nurse notes that the patient’s blood pressure is extremely low, and the patient is lethargic and difficult to awaken. This would be classified as which type of adverse drug reaction? a. Adverse effect b. Allergic reaction c. Idiosyncratic reaction d. Pharmacologic reaction
A
ANS: D
A pharmacologic reaction is an extension of a drug’s normal effects in the body. In this case, the antihypertensive drug lowered the patient’s blood pressure levels too much. The other options do not describe a pharmacologic reaction. An adverse effect is a predictable, well-known adverse drug reaction that results in minor or no changes in patient management. An allergic reaction (also known as a hypersensitivity reaction) involves the patient’s immune system. An idiosyncratic reaction is unexpected and is defined as a genetically determined abnormal response to normal dosages of a drug.
4
Q
The nurse is reviewing pharmacology terms for a group of newly graduated nurses. Which sentence defines a drug’s half-life?
a.
The time it takes for the drug to cause half of its therapeutic response
b.
The time it takes for one half of the original amount of a drug to reach the target cells
c.
The time it takes for one half of the original amount of a drug to be removed from the body
d.
The time it takes for one half of the original amount of a drug to be absorbed into the circulation
A
ANS: C
A drug’s half-life is the time it takes for one half of the original amount of a drug to be removed from the body. It is a measure of the rate at which drugs are removed from the body. The other options are incorrect definitions of half-life.
5
Q
When administering drugs, the nurse remembers that the duration of action of a drug is defined as which of these?
a.
The time it takes for a drug to elicit a therapeutic response
b.
The amount of time needed to remove a drug from circulation
c.
The time it takes for a drug to achieve its maximum therapeutic response
d.
The time period at which a drug’s concentration is sufficient to cause a therapeutic response
A
ANS: D
Duration of action is the time during which drug concentration is sufficient to elicit a therapeutic response. The other options do not define duration of action. A drug’s onset of action is the time it takes for the drug to elicit a therapeutic response. A drug’s peak effect is the time it takes for the drug to reach its maximum therapeutic response. Elimination is the length of time it takes to remove a drug from circulation.
6
Q
When reviewing the mechanism of action of a specific drug, the nurse reads that the drug works by selective enzyme interaction. Which of these processes describes selective enzyme interaction?
a.
The drug alters cell membrane permeability.
b.
The drug’s effectiveness within the cell walls of the target tissue is enhanced.
c.
The drug is attracted to a receptor on the cell wall, preventing an enzyme from binding to that receptor.
d.
The drug binds to an enzyme molecule and inhibits or enhances the enzyme’s action with the normal target cell.
A
ANS: D
With selective enzyme interaction, the drug attracts the enzymes to bind with the drug instead of allowing the enzymes to bind with their normal target cells. As a result, the target cells are protected from the action of the enzymes. This results in a drug effect. The actions described in the other options do not occur with selective enzyme interactions.
7
Q
When administering a new medication to a patient, the nurse reads that it is highly protein bound. Assuming that the patient’s albumin levels are normal, the nurse would expect which result, as compared to a medication that is not highly protein bound?
a.
Renal excretion will be faster.
b.
The drug will be metabolized quickly.
c.
The duration of action of the medication will be shorter.
d.
The duration of action of the medication will be longer.
A
ANS: D
Drugs that are bound to plasma proteins are characterized by longer duration of action. Protein binding does not make renal excretion faster, does not speed up drug metabolism, and does not cause the duration of action to be shorter.
8
Q
The patient is experiencing chest pain and needs to take a sublingual form of nitroglycerin. Where does the nurse instruct the patient to place the tablet? a. Under the tongue b. On top of the tongue c. At the back of the throat d. In the space between the cheek and the gum
A
ANS: A
Drugs administered via the sublingual route are placed under the tongue. Drugs administered via the buccal route are placed in the space between the cheek and the gum; oral drugs are swallowed. The other options are incorrect.
9
Q
The nurse is administering medications to the patient who is in renal failure resulting from end-stage renal disease. The nurse is aware that patients with kidney failure would most likely have problems with which pharmacokinetic phase? a. Absorption b. Distribution c. Metabolism d. Excretion
A
ANS: D
The kidneys are the organs that are most responsible for drug excretion. Renal function does not affect the absorption and distribution of a drug. Renal function may affect metabolism of drugs to a small extent.
10
Q
The patient is complaining of a headache and asks the nurse which over-the-counter medication form would work the fastest to help reduce the pain. Which medication form will the nurse suggest? a. A capsule b. A tablet c. An enteric-coated tablet d. A powder
A
ANS: D
Of the types of oral medications listed, the powder form would be absorbed the fastest, thus having a faster onset. The tablet, the capsule, and, finally, the enteric-coated tablet would be absorbed next, in that order.
11
Q
The nurse will be injecting a drug into the fatty tissue of the patient’s abdomen. Which route does this describe? a. Intradermal b. Subcutaneous c. Intramuscular d. Transdermal
A
ANS: B
Injections into the fatty subcutaneous tissue under the dermal layer of skin are referred to as subcutaneous injections. Injections under the more superficial skin layers immediately underneath the epidermal layer of skin and into the dermal layer are known as intradermal injections. Injections into the muscle beneath the subcutaneous fatty tissue are referred to as intramuscular injections. Transdermal drugs are applied to the skin via an adhesive patch.
12
Q
Which drugs would be affected by the first-pass effect? (Select all that apply.) a. Morphine given by IV push injection b. Sublingual nitroglycerin tablets c. Diphenhydramine (Benadryl) elixir d. Levothyroxine (Synthroid) tablets e. Transdermal nicotine patches f. Esomeprazole (Nexium) capsules g. Penicillin given by IV piggyback infusion
A
ANS: C, D, F
Orally administered drugs (elixirs, tablets, capsules) undergo the first-pass effect because they are metabolized in the liver after being absorbed into the portal circulation from the small intestine. IV medications (IV push and IV piggyback) enter the bloodstream directly and do not go directly to the liver. Sublingual tablets and transdermal patches also enter the bloodstream without going directly to the liver, thus avoiding the first-pass effect.
13
Q
A patient is recovering from abdominal surgery, which he had this morning. He is groggy but complaining of severe pain around his incision. What is the most important assessment data to consider before the nurse administers a dose of morphine sulfate to the patient? a. His pulse rate b. His respiratory rate c. The appearance of the incision d. The date of his last bowel movement
A
ANS: B
One of the most serious adverse effects of opioids is respiratory depression. The nurse must assess the patient’s respiratory rate before administering an opioid. The other options are incorrect.
14
Q
A 78-year-old patient is in the recovery room after having a lengthy surgery on his hip. As he is gradually awakening, he requests pain medication. Within 10 minutes after receiving a dose of morphine sulfate, he is very lethargic and his respirations are shallow, with a rate of 7 per minute. The nurse prepares for which priority action at this time?
a.
Assessment of the patient’s pain level
b.
Immediate intubation and artificial ventilation
c.
Administration of naloxone (Narcan)
d.
Close observation of signs of opioid tolerance
A
ANS: C
Naloxone, an opioid-reversal agent, is used to reverse the effects of acute opioid overdose and is the drug of choice for reversal of opioid-induced respiratory depression. This situation is describing an opioid overdose, not opioid tolerance. Intubation and artificial ventilation are not appropriate because the patient is still breathing at 7 breaths/min. It would be inappropriate to assess the patient’s level of pain.
15
Q
A patient will be discharged with a 1-week supply of an opioid analgesic for pain management after abdominal surgery. The nurse will include which information in the teaching plan?
a.
How to prevent dehydration due to diarrhea
b.
The importance of taking the drug only when the pain becomes severe
c.
How to prevent constipation
d.
The importance of taking the drug on an empty stomach
A
ANS: C
Gastrointestinal (GI) adverse effects, such as nausea, vomiting, and constipation, are the most common adverse effects associated with opioid analgesics. Physical dependence usually occurs in patients undergoing long-term treatment. Diarrhea is not an effect of opioid analgesics. Taking the dose with food may help minimize GI upset.
16
Q
A patient has been treated for lung cancer for 3 years. Over the past few months, the patient has noticed that the opioid analgesic is not helping as much as it had previously and more medication is needed for the same pain relief. The nurse is aware that this patient is experiencing which of these? a. Opioid addiction b. Opioid tolerance c. Opioid toxicity d. Opioid abstinence syndrome
A
ANS: B
Opioid tolerance is a common physiologic result of long-term opioid use. Patients with opioid tolerance require larger doses of the opioid agent to maintain the same level of analgesia. This situation does not describe toxicity (overdose), addiction, or abstinence syndrome (withdrawal).
17
Q
A 38-year-old man has come into the urgent care center with severe hip pain after falling from a ladder at work. He says he has taken several pain pills over the past few hours but cannot remember how many he has taken. He hands the nurse an empty bottle of acetaminophen (Tylenol). The nurse is aware that the most serious toxic effect of acute acetaminophen overdose is which condition? a. Tachycardia b. Central nervous system depression c. Hepatic necrosis d. Nephropathy
A
ANS: C
Hepatic necrosis is the most serious acute toxic effect of an acute overdose of acetaminophen. The other options are incorrect.
18
Q
A patient is receiving gabapentin (Neurontin), an anticonvulsant, but has no history of seizures. The nurse expects that the patient is receiving this drug for which condition? a. Inflammation pain b. Pain associated with peripheral neuropathy c. Depression associated with chronic pain d. Prevention of seizures
A
ANS: B
Anticonvulsants are often used as adjuvants for treatment of neuropathic pain to enhance analgesic efficacy. The other indications listed are not correct.
19
Q
The nurse is assessing a patient who has been admitted to the emergency department for a possible opioid overdose. Which assessment finding is characteristic of an opioid drug overdose? a. Dilated pupils b. Restlessness c. Respiration rate of 6 breaths/min d. Heart rate of 55 beats/min
A
ANS: C
The most serious adverse effect of opioid use is CNS depression, which may lead to respiratory depression. Pinpoint pupils, not dilated pupils, are seen. Restlessness and a heart rate of 55 beats/min are not indications of an opioid overdose.
20
Q
The nurse is assessing a patient for contraindications to drug therapy with acetaminophen (Tylenol). Which patient should not receive acetaminophen?
a.
A patient with a fever of 101° F (38.3° C)
b.
A patient who is complaining of a mild headache
c.
A patient with a history of liver disease
d.
A patient with a history of peptic ulcer disease
A
ANS: C
Liver disease is a contraindication to the use of acetaminophen. Fever and mild headache are both possible indications for the medication. Having a history of peptic ulcer disease is not a contraindication.
21
Q
A patient arrives at the urgent care center complaining of leg pain after a fall when rock climbing. The x-rays show no broken bones, but he has a large bruise on his thigh. The patient says he drives a truck and does not want to take anything strong because he needs to stay awake. Which statement by the nurse is most appropriate?
a.
“It would be best for you not to take anything if you are planning to drive your truck.”
b.
“We will discuss with your doctor about taking an opioid because that would work best for your pain.”
c.
“You can take acetaminophen, also known as Tylenol, for pain, but no more than 1000 mg per day.”
d.
“You can take acetaminophen, also known as Tylenol, for pain, but no more than 3000 mg per day.”
A
ANS: D
Acetaminophen is indicated for mild-to-moderate pain and does not cause drowsiness, as an opioid would. Currently, the maximum daily amount of acetaminophen is 3000 mg/day. The 1000-mg amount per day is too low. Telling the patient not to take any pain medications is incorrect.
22
Q
Vicodin (acetaminophen/hydrocodone) is prescribed for a patient who has had surgery. The nurse informs the patient that which common adverse effects can occur with this medication? (Select all that apply.) a. Diarrhea b. Constipation c. Lightheadedness d. Nervousness e. Urinary retention f. Itching
A
ANS: B, C, E, F
Constipation (not diarrhea), lightheadedness (not nervousness), urinary retention, and itching are some of the common adverse effects that the patient may experience while taking Vicodin.
23
Q
The nurse is reviewing the therapeutic effects of nonsteroidal anti-inflammatory drugs (NSAIDs), which include which effect? a. Anxiolytic b. Sedative c. Antipyretic d. Antimicrobial
A
ANS: C
NSAIDs have antipyretic effects but not the other effects listed.
24
Q
A mother brings her toddler into the emergency department and tells the nurse that she thinks the toddler has eaten an entire bottle of chewable aspirin tablets. The nurse will assess for which most common signs of salicylate intoxication in children? a. Photosensitivity and nervousness b. Tinnitus and hearing loss c. Acute gastrointestinal bleeding d. Hyperventilation and drowsiness
A
ANS: D
The most common manifestations of chronic salicylate intoxication in adults are tinnitus and hearing loss. Those in children are hyperventilation and CNS effects, such as dizziness, drowsiness, and behavioral changes.
25
A 6-year-old child who has chickenpox also has a fever of 102.9° F (39.4° C). The child’s mother asks the nurse if she should use aspirin to reduce the fever. What is the best response by the nurse?
a.
“It’s best to wait to see if the fever gets worse.”
b.
“You can use the aspirin, but watch for worsening symptoms.”
c.
“Acetaminophen (Tylenol) should be used to reduce his fever, not aspirin.”
d.
“You can use aspirin, but be sure to follow the instructions on the bottle.”
ANS: C
Aspirin is contraindicated in children with flu-like symptoms because the use of this drug has been strongly associated with Reye’s syndrome. This is an acute and potentially life-threatening condition involving progressive neurologic deficits that can lead to coma and may also involve liver damage. Acetaminophen is appropriate for this patient. The other responses are incorrect.
26
```
A patient who has a history of coronary artery disease has been instructed to take one 81-mg aspirin tablet a day. The patient asks about the purpose of this aspirin. Which response by the nurse is correct?
a.
“Aspirin is given reduce anxiety.”
b.
“It helps to reduce inflammation.”
c.
“Aspirin is given to relieve pain.”
d.
“It will help to prevent clot formation.”
```
ANS: D
Aspirin can reduce platelet aggregation; low doses of aspirin (81 to 325 mg once daily) are used for thromboprevention. Higher doses are required for pain relief, reduction of inflammation, and reduction of fever. The other options are incorrect.
27
```
During assessment of a patient with osteoarthritis pain, the nurse knows that which condition is a contraindication to the use of nonsteroidal anti-inflammatory drugs (NSAIDs)?
a.
Renal disease
b.
Diabetes mellitus
c.
Headaches
d.
Rheumatoid arthritis
```
ANS: A
Contraindications to NSAIDs include known drug allergy and conditions that place a patient at risk for bleeding, such as vitamin K deficiency, and peptic ulcer disease. Patients with documented aspirin allergy must not receive NSAIDs. Other common contraindications are those that apply to most drugs, including severe renal or hepatic disease. The other options are not contraindications.
28
```
The nurse is reviewing the history of a patient who has a new order for a nonsteroidal anti-inflammatory drug (NSAID) to treat tendonitis. Which conditions are contraindications to the use of NSAIDs? (Select all that apply.)
a.
Vitamin K deficiency
b.
Arthralgia
c.
Peptic ulcer disease
d.
Neuropathy
e.
Pericarditis
```
ANS: A, C
Contraindications to NSAIDs include known drug allergy as well as conditions that place the patient at risk for bleeding, such as Vitamin K deficiency and peptic ulcer disease. NSAIDs may be used to treat arthralgia and pericarditis. Neuropathy is not a contraindication.
29
```
A 75-year-old woman has been given a nonsteroidal anti-inflammatory drug (an NSAID for the treatment of rheumatoid arthritis. The nurse is reviewing the patient’s medication history and notes that which types of medications could have an interaction with the NSAID? (Select all that apply.)
a.
Antibiotics
b.
Decongestants
c.
Anticoagulants
d.
Beta blockers
e.
Diuretics
f.
Corticosteroids
```
ANS: C, E, F
Anticoagulants taken with NSAIDs may cause increased bleeding tendencies because of platelet inhibition and hypoprothrombinemia. NSAIDs taken with diuretics may cause reduced hypotensive and diuretic effects. NSAIDs taken with corticosteroids may cause increased ulcerogenic effects. See Table 44-5. The other options are incorrect.
30
```
The nurse is aware that adrenergic drugs produce effects similar to which of these nervous systems?
a.
Central nervous system
b.
Somatic nervous system
c.
Sympathetic nervous system
d.
Parasympathetic nervous system
```
ANS: C
| Adrenergic drugs mimic the effects of the sympathetic nervous system.
31
```
When an adrenergic drug stimulates beta1-adrenergic receptors, the result is an increased force of contraction, which is known as what type of effect?
a.
Positive inotropic
b.
Anti-adrenergic
c.
Negative dromotropic
d.
Positive chronotropic
```
ANS: A
| An increased force of contraction is known as a positive inotropic effect.
32
```
The nurse is administering a stat dose of epinephrine. Epinephrine is appropriate for which situation?
a.
Severe hypertension
b.
Angina
c.
Cardiac arrest
d.
Tachycardia
```
ANS: C
Treatment of cardiac arrest is an indication for the use of epinephrine. The other options are not indications for epinephrine.
33
```
The nurse recognizes that adrenergic drugs cause relaxation of the bronchi and bronchodilation by stimulating which type of receptors?
a.
Dopaminergic
b.
Beta1 adrenergic
c.
Beta2 adrenergic
d.
Alpha1 adrenergic
```
ANS: C
| Stimulation of beta2-adrenergic receptors results in bronchodilation. The other choices are incorrect.
34
```
The nurse is presenting information to a class of students about adrenergic drugs. Which are the effects of drugs that stimulate the sympathetic nervous system? (Select all that apply.)
a.
Dilation of bronchioles
b.
Constriction of bronchioles
c.
Decreased heart rate
d.
Increased heart rate
e.
Dilated pupils
f.
Constricted pupils
g.
Glycogenolysis
```
ANS: A, D, E, G
Stimulation of the sympathetic nervous system causes bronchodilation, increased heart rate, pupil dilation, and glycogenolysis as well as many other effects (see Table 18-1). The other responses are effects that occur as a result of the stimulation of the parasympathetic nervous system.
35
During therapy with a beta blocker, the patient notices that she has swollen feet, has gained 3 pounds within 2 days---edema, feels short of breath---pneumonia--- even when walking around the house, and has been dizzy. The nurse suspects that which of these is occurring?
a.
The patient is experiencing an allergic reaction.
b.
The patient may be developing heart failure.
c.
More time is needed for the patient to see a therapeutic response to the drug.
d.
The patient is experiencing expected adverse effects of the drug.
ANS: B
Even though some beta blockers may be used for the treatment of some types of heart failure, the patient needs to be assessed often for the development of heart failure, a potential adverse effect of the drugs. These symptoms do not indicate expected adverse effects, an allergic reaction, or a therapeutic response.
36
A patient is going home with a new prescription for the beta-blocker atenolol (Tenormin). The nurse will include which content when teaching the patient about this drug?
a.
Never stop taking this medication abruptly.
b.
The medication will be stopped once symptoms subside.
c.
If adverse effects occur, stop taking the drug for 24 hours, and then resume.
d.
Be watchful for first-dose hypotension.
ANS: A
Patients need to be weaned off these medications slowly because rebound hypertension and chest pain are possible with abrupt withdrawal. The drugs should never be stopped abruptly nor doses skipped. First-dose hypotension occurs with alpha blockers.
37
A 58-year-old man has had a myocardial infarction (MI), has begun rehabilitation, and is ready for discharge. He is given a prescription for metoprolol (Lopressor) and becomes upset after reading the patient education pamphlet. “I don’t have high blood pressure—why did my doctor give me this medicine?” Which explanation by the nurse is correct?
a.
“This medication will prevent blood clots that may lead to another heart attack.”
b.
“Beta blockers will improve blood flow to the kidneys.”
c.
“This drug is prescribed to prevent the high blood pressure that often occurs after a heart attack.”
d.
“Studies have shown that this medication has greatly increased survival rates in patients who have had a heart attack.”
ANS: D
Beta blockers are frequently given to patients after they have suffered an MI because of their cardioprotective properties. The other responses are incorrect.
38
The teaching for a patient who is taking tamsulosin (Flomax) to reduce urinary obstruction due to benign prostatic hyperplasia will include which of these?
a.
Fluids need to be restricted while on this medication.
b.
Take the medication with breakfast to promote the maximum effects of the drug.
c.
Get up slowly from a sitting or lying position.
d.
Blood pressure must be monitored because the medication may cause hypertension.
ANS: C
This medication is used to relieve impaired urinary flow in men with benign prostatic hyperplasia, but it also can cause orthostatic hypotension when changing positions from sitting or lying positions. Because of these effects, the blood pressure may become dramatically lowered, and lightheadedness may occur, increasing the risk of falling.
39
```
The nurse is screening a patient who will be taking a nonspecific/nonselective beta blocker. Which condition, if present, may cause serious problems if the patient takes this medication?
a.
Angina
b.
Hypertension
c.
Glaucoma
d.
Asthma
```
ANS: D
Nonspecific/nonselective beta-blocking drugs may precipitate bradycardia, hypotension, heart block, heart failure, bronchoconstriction, and/or increased airway resistance. Therefore, any pre-existing respiratory conditions such as asthma might be worsened by the concurrent use of any of these medications.
40
A patient has a new prescription for tamsulosin (Flomax) as treatment for benign prostatic hyperplasia. The nurse is checking his current medication list and will contact the prescriber regarding a potential interaction if the patient is also taking which drug?
a.
Levothyroxine (Synthroid) for hypothyroidism
b.
Sildenafil (Viagra), an erectile dysfunction medication
c.
Omeprazole (Prilosec), a proton pump inhibitor
d.
Low-dose aspirin for stroke prevention
ANS: B
Drugs that interact with alpha blockers such as tamsulosin include erectile dysfunction drugs; additive hypotensive effects may occur. The other drugs do not interact with tamsulosin.
41
```
A beta blocker is prescribed for a patient with angina. The nurse reviews the orders for other drugs that may interact with the beta blocker. Which drugs or drug classes are known to have an interaction with a beta blocker? (Select all that apply.)
a.
Diuretics
b.
Anticholinergics
c.
Penicillins
d.
Oral hypoglycemics
e.
Alcohol
f.
Anticoagulants
```
ANS: A, B, D, E
When taken with beta blockers, diuretics and alcohol may cause additive hypotensive effects; oral hypoglycemic medications may cause the blood glucose to decrease; and anticholinergics may cause decreased beta-blocker effects. Penicillins and anticoagulants are not known to interact with beta blockers.
42
```
When monitoring a patient who is taking a low-dose cholinergic drug, the nurse will watch for which cardiovascular effect?
a.
Bradycardia
b.
Tachycardia
c.
Vasoconstriction
d.
Palpitations
```
ANS: A
The cardiovascular effects of low doses of cholinergic drugs are decreased heart rate (not tachycardia) and vasodilation. Palpitations are not effects of cholinergic drugs.
43
```
A patient has had an overdose of an intravenous cholinergic drug. The nurse expects to administer which drug as an antidote?
a.
Atenolol (Tenormin)
b.
Bethanechol (Urecholine)
c.
Dobutamine
d.
Atropine sulfate
```
ANS: D
Prompt administration of atropine sulfate can reverse a toxic dose of cholinergic drugs. The other drugs listed are not antidotes to cholinergic toxicity.
44
```
The nurse is reviewing the mechanism of action of cholinergic drugs. The undesired effects of cholinergic drugs come from the stimulation of which receptors?
a.
Muscarinic
b.
Nicotinic
c.
Cholinergic
d.
Ganglionic
```
ANS: B
Many of the undesirable adverse effects are due to nicotinic receptor stimulation. The desired effects come from muscarinic receptor stimulation. The other options are incorrect.
45
```
A cholinergic drug is prescribed for a patient. The nurse checks the patient’s medical history, knowing that this drug is contraindicated in which disorders? (Select all that apply.)
a.
Bladder atony
b.
Gastrointestinal obstruction
c.
Bradycardia
d.
Alzheimer’s disease
e.
Hypotension
f.
Chronic obstructive pulmonary disease
```
ANS: B, C, E, F
Contraindications to the use of cholinergic drugs include gastrointestinal or genitourinary obstruction, bradycardia, hypotension, and chronic obstructive pulmonary disease. The other options are possible indications for cholinergic drugs.
46
```
The nurse is about to administer a stat dose of intravenous atropine sulfate to a patient who is experiencing a symptomatic cardiac dysrhythmia. During administration of this drug, the nurse will monitor the patient closely for which adverse effect?
a.
Tachycardia
b.
Bradycardia
c.
Ectopic beats
d.
Cardiac standstill
```
ANS: A
Cardiovascular effects of cholinergic blockers include increased heart rate and dysrhythmias. One indication for use is the treatment of sinus bradycardia accompanied by hemodynamic compromise. The other options are incorrect.
47
```
A patient has received an accidental overdose of intravenous atropine. Which drug will the nurse prepare to administer?
a.
Atenolol (Tenormin)
b.
Bethanechol (Urecholine)
c.
Dicyclomine (Bentyl)
d.
Physostigmine (Antilirium)
```
ANS: D
Physostigmine salicylate is the antidote to an atropine overdose in patients who show extreme delirium or agitation and could inflict injury to themselves. Its routine use as an antidote for cholinergic-blocker overdose is controversial, however. The other options are incorrect choices.
48
A 72-year-old man has a new prescription for an anticholinergic drug. He is an active man and enjoys outdoor activities, such as golfing and doing his own yard work. What will the nurse emphasize to him during the teaching session about his drug therapy?
a.
Drowsiness may interfere with his outdoor activities.
b.
Increased salivation may occur during exercise and outside activities.
c.
Fluid volume deficits may occur as a result of an increased incidence of diarrhea.
d.
He will need to take measures to reduce the occurrence of heat stroke during his activities.
ANS: D
Elderly patients who take an anticholinergic drug need to be reminded that they are at a greater risk for suffering heat stroke because of decreased sweating and loss of normal heat-regulating mechanisms.
49
```
The nurse will monitor for which adverse effect when administering an anticholinergic drug?
a.
Excessive urination
b.
Diaphoresis
c.
Dry mouth
d.
Pupillary constriction
```
ANS: C
Anticholinergic drugs commonly cause the adverse effects of dry mouth, blurred vision, constipation, and urinary retention. They also cause mydriasis (pupillary dilation).
50
```
The nurse is reviewing a patient’s medication history and notes that the patient is taking the cholinergic blocker tolterodine (Detrol). Which is an indication for this medication?
a.
Irritable bowel disease
b.
Induction of mydriasis
c.
Urge incontinence
d.
Reduction of secretions preoperatively
```
ANS: C
Tolterodine (Detrol) is used for urinary frequency, urgency, and urge incontinence caused by bladder (detrusor) overactivity. The conditions in the other options are not indications.
51
The nurse is reviewing the indications for atropine sulfate. Atropine is appropriate for which of these patients? (Select all that apply.)
a.
A patient who has suddenly developed symptomatic bradycardia with a heart rate of 32 beats/min
b.
A patient who has suddenly developed symptomatic tachycardia with a heart rate of 180 beats/min
c.
A patient with severe narrow-angle glaucoma
d.
A patient who is about to have surgery
e.
A patient newly diagnosed with myasthenia gravis
f.
A patient with anticholinesterase inhibitor poisoning
ANS: A, D, F
Anticholinergic drugs are used for symptomatic bradycardia and certain other cardiac conditions. It is given preoperatively to control secretions during surgery and is used as an antidote for anticholinesterase inhibitor poisoning. The other options are contraindications to the use of atropine.
52
A patient is in an urgent care center with an acute asthma attack. The nurse expects that which medication will be used for initial treatment?
a.
An anticholinergic such as ipratropium (Atrovent)
b.
A short-acting beta2 agonist such as albuterol (Proventil)
c.
A long-acting beta2 agonist such as salmeterol (Serevent)
d.
A corticosteroid such as fluticasone (Flovent)
ANS: B
The short-acting beta2 agonists are commonly used during the acute phase of an asthmatic attack to reduce airway constriction quickly and to restore airflow to normal levels. The other drugs listed are not appropriate for acute asthma attacks. Anticholinergic drugs and long-acting beta2 agonists are used to prevent attacks; corticosteroids are used to reduce airway inflammation.
53
A patient has prescriptions for two inhalers. One inhaler is a bronchodilator, and the other is a corticosteroid. Which instruction regarding these inhalers will the nurse give to the patient?
a.
“Take the corticosteroid inhaler first.”
b.
“Take the bronchodilator inhaler first.”
c.
“Take these two drugs at least 2 hours apart.”
d.
“It does not matter which inhaler you use first.”
ANS: B
An inhaled bronchodilator is used before the inhaled corticosteroid to provide bronchodilation before administration of the anti-inflammatory drug.
54
```
When educating a patient recently placed on inhaled corticosteroids, the nurse will discuss which potential adverse effects?
a.
Fatigue and depression
b.
Anxiety and palpitations
c.
Headache and rapid heart rate
d.
Oral candidiasis and dry mouth
```
ANS: D
Oral candidiasis and dry mouth are two possible adverse effects of inhaled corticosteroids. The other responses are incorrect.
55
```
The nurse is reviewing medications for the treatment of asthma. Which drugs are used for acute asthma attacks? (Select all that apply.)
a.
Salmeterol (Serevent) inhaler
b.
Albuterol (Proventil) nebulizer solution
c.
Epinephrine
d.
Montelukast (Singulair)
e.
Fluticasone (Flovent) Rotadisk inhaler
```
ANS: B, C
Albuterol (a short-acting beta2 agonist) and epinephrine (a beta1 and beta2 agonist) are used for acute bronchospasms. Salmeterol is a long-acting beta2 agonist that is indicated for maintenance treatment, not acute episodes. Fluticasone is an inhaled corticosteroid; montelukast is a leukotriene receptor antagonist (LTRA). These types of medications are used for asthma prophylaxis.
56
The nurse is providing instructions to a patient who has a new prescription for a corticosteroid metered-dose inhaler. Which statement by the patient indicates that further instruction is needed? (Select all that apply.)
a.
“I will rinse my mouth with water after using the inhaler and then spit out the water.”
b.
“I will gargle after using the inhaler and then swallow.”
c.
“I will clean the plastic inhaler casing weekly by removing the canister and then washing the casing in warm soapy water. I will then let it dry before reassembling.”
d.
“I will use this inhaler for asthma attacks.”
e.
“I will continue to use this inhaler, even if I am feeling better.”
f.
“I will use a peak flow meter to measure my response to therapy.”
ANS: B, D
The inhaled corticosteroid is a maintenance drug used to prevent asthma attacks; it is not indicated for acute asthma attacks. Rinsing the mouth with water is appropriate and necessary to prevent oral fungal infections; the water is not to be swallowed after rinsing. The patient needs to be given instructions about keeping the inhaler clean, including removing the canister from the plastic casing weekly and washing the casing in warm soapy water. Once the casing is dry, the canister and mouthpiece may be put back together and the cap applied. The glucocorticoid may predispose the patient to oral fungal overgrowth, thus the need for implicit instructions about cleaning inhaling devices. Use of a peak flow meter assists in monitoring the patient’s response to therapy. The medication needs to be taken as ordered every day, regardless of whether the patient is feeling better.
57
```
A patient is receiving an aluminum-containing antacid. The nurse will inform the patient to watch for which possible adverse effect?
a.
Diarrhea
b.
Constipation
c.
Nausea
d.
Abdominal cramping
```
ANS: B
Aluminum-based antacids have a constipating effect as well as an acid-neutralizing capacity. The other options are incorrect.
58
```
When reviewing the health history of a patient who will be receiving antacids, the nurse recalls that antacids containing magnesium need to be used cautiously in patients with which condition?
a.
Peptic ulcer disease
b.
Renal failure
c.
Hypertension
d.
Heart failure
```
ANS: B
Both calcium- and magnesium-based antacids are more likely to accumulate to toxic levels in patients with renal disease and are commonly avoided in this patient group. The other options are incorrect.
59
A patient is taking omeprazole (Prilosec) for the treatment of gastroesophageal reflux disease (GERD). The nurse will include which statement in the teaching plan about this medication?
a.
“Take this medication once a day after breakfast.”
b.
“You will be on this medication for only 2 weeks for treatment of the reflux disease.”
c.
“The medication may be dissolved in a liquid for better absorption.”
d.
“The entire capsule must be taken whole, not crushed, chewed, or opened.”
ANS: D
Omeprazole needs to be taken before meals, and an entire capsule must be taken whole, not crushed, chewed, opened, or dissolved in liquid when treating GERD. This medication is used on a long-term basis to maintain healing.
60
```
A 75-year-old woman comes into the clinic with complaints of muscle twitching, nausea, and headache. She tells the nurse that she has been taking sodium bicarbonate five or six times a day for the past 3 weeks. The nurse will assess for which potential problem that may occur with overuse of sodium bicarbonate?
a.
Constipation
b.
Metabolic acidosis
c.
Metabolic alkalosis
d.
Excessive gastric mucus
```
ANS: C
| Excessive use of sodium bicarbonate may lead to systemic alkalosis. The other options are incorrect.
61
```
A patient will be taking a 2-week course of combination therapy with omeprazole (Prilosec) and another drug for a peptic ulcer caused by Helicobacter pylori. The nurse expects a drug from which class to be ordered with the omeprazole?
a.
Antibiotic
b.
Nonsteroidal anti-inflammatory drug
c.
Antacid
d.
Antiemetic
```
ANS: A
The antibiotic clarithromycin is active against H. pylori and is used in combination with omeprazole to eradicate the bacteria. First-line therapy against H. pylori includes a 10- to 14-day course of a proton pump inhibitor such as omeprazole, plus the antibiotics clarithromycin and either amoxicillin or metronidazole, or a combination of a proton pump inhibitor, bismuth subsalicylate, and the antibiotics tetracycline and metronidazole. Many different combinations are used.
62
A patient is asking advice about which over-the-counter antacid is considered the most safe to use for heartburn. The nurse explains that the reason that calcium antacids are not used as frequently as other antacids is for which of these reasons?
a.
Their use may result in kidney stones.
b.
They cause decreased gastric acid production.
c.
They cause severe diarrhea.
d.
Their use may result in fluid retention and edema.
ANS: A
Calcium antacids are not used as frequently as other antacids because their use may lead to the development of kidney stones; they also cause increased gastric acid production. The other options are incorrect.
63
At 0900, the nurse is about to give morning medications, and the patient has asked for a dose of antacid for severe heartburn. Which schedule for the antacid and medications is correct?
a.
Give both the antacid and medications at 0900.
b.
Give the antacid at 0900, and then the medications at 0930.
c.
Give the medications at 0900, and then the antacid at 1000.
d.
Give the medications at 0900, and then the antacid at 0915.
ANS: C
Medications are not to be taken, unless prescribed, within 1 to 2 hours of taking an antacid because of the impact on the absorption of many medications in the stomach.
64
During an admission assessment, the patient tells the nurse that he has been self-treating his heartburn for 1 year with over-the-counter Prilosec OTC (omeprazole, a proton pump inhibitor). The nurse is aware that this self-treatment may have which result?
a.
No serious consequences
b.
Prevention of more serious problems, such as an ulcer
c.
Chronic constipation
d.
Masked symptoms of serious underlying diseases
ANS: D
Long-term self-medication with antacids may mask symptoms of serious underlying diseases, such as bleeding ulcer or malignancy. Patients with ongoing symptoms need to undergo regular medical evaluations, because additional medications or other interventions may be needed.
65
```
An older adult patient had gastric surgery due to a gastrointestinal bleed 3 days ago, and he has been stable since the surgery. This evening, his daughter tells the nurse, “He seems to be more confused this afternoon. He’s never been like this. What could be the problem?” The nurse reviews the patient’s medication record and suspects that which drug could be the cause of the patient’s confusion?
a.
Cimetidine (Tagamet)
b.
Pantoprazole (Protonix)
c.
Clarithromycin (Biaxin)
d.
Sucralfate (Carafate)
```
ANS: A
Sometimes H2 receptor antagonists such as cimetidine may cause adverse effects related to the central nervous system in the older adult, including confusion and disorientation. The nurse needs to be alert for mental status changes when giving these drugs, especially if the changes are new to the patient.
66
The nurse is teaching a patient who will be taking a proton pump inhibitor as long-term therapy about potential adverse effects. Which statement is correct?
a.
Proton pump inhibitors can cause diarrhea.
b.
These drugs can cause nausea and anorexia.
c.
Proton pump inhibitors cause drowsiness.
d.
Long-term use of these drugs may contribute to osteoporosis.
ANS: D
New concerns have arisen over the potential for long-term users of proton pump inhibitors (PPIs) to develop osteoporosis. This is thought to be due to the inhibition of stomach acid, and it is speculated that PPIs speed up bone mineral loss. The other options are incorrect.
67
```
A patient in the intensive care unit has a nasogastric tube and is also receiving a proton pump inhibitor (PPI). The nurse recognizes that the purpose of the PPI is which effect?
a.
Prevent stress ulcers
b.
Reduce bacteria levels in the stomach
c.
Reduce gastric gas formation (flatulence)
d.
Promote gastric motility
```
ANS: A
Stress-related mucosal damage is an important issue for critically ill patients. Stress ulcer prophylaxis (or therapy to prevent severe gastrointestinal [GI] damage) is undertaken in almost every critically ill patient in an intensive care unit and for many patients on general medical surgical units. Procedures performed commonly in critically ill patients, such as passing nasogastric tubes, placing patients on ventilators, and others, predispose patients to bleeding of the GI tract. Guidelines suggest that all such patients receive either a histamine receptor-blocking drug or a proton pump inhibitor. The other options are incorrect.
68
The nurse is providing patient teaching about antacids. Which statements about antacids are accurate? (Select all that apply.)
a.
Antacids reduce the production of acid in the stomach.
b.
Antacids neutralize acid in the stomach.
c.
Rebound hyperacidity may occur with calcium-based antacids.
d.
Aluminum-based antacids cause diarrhea.
e.
Magnesium-based antacids cause diarrhea.
ANS: B, C, E
Antacids neutralize acid in the stomach. Magnesium-based antacids cause diarrhea, and aluminum-based antacids cause constipation. Calcium-based antacids often cause rebound hyperacidity.
69
A patient with severe liver disease is receiving the angiotensin-converting enzyme (ACE) inhibitor, captopril (Capoten). The nurse is aware that the advantage of this drug for this patient is which characteristic?
a.
Captopril rarely causes first-dose hypotensive effects.
b.
Captopril has little effect on electrolyte levels.
c.
Captopril is a prodrug and is metabolized by the liver before becoming active.
d.
Captopril is not a prodrug and does not need to be metabolized by the liver before becoming active.
ANS: D
The physician would examine the fundus of a patient’s eyes during antihypertensive therapy because it is a more reliable indicator than blood pressure readings of the long-term effectiveness of treatment.
70
```
The nurse is reviewing drug therapy for hypertension. According to the JNC-8 guidelines, antihypertensive drug therapy for a newly diagnosed hypertensive African-American patient would most likely include which drug or drug classes?
a.
Vasodilators alone
b.
ACE inhibitors alone
c.
Calcium channel blockers with thiazide diuretics
d.
Beta blockers with thiazide diuretics
```
ANS: C
According to the JNC-8 guidelines, calcium channel blockers and diuretics are recommended as first-line therapy for management of hypertension in African-American patients. The other drugs are not recommended as first-line drugs for this group.
71
```
A patient who has been taking antihypertensive drugs for a few months complains of having a persistent dry cough. The nurse knows that this cough is an adverse effect of which class of antihypertensive drugs?
a.
Beta blockers
b.
Angiotensin-converting enzyme (ACE) inhibitors
c.
Angiotensin II receptor blockers (ARBs)
d.
Calcium channel blockers
```
ANS: B
ACE inhibitors cause a characteristic dry, nonproductive cough that reverses when therapy is stopped. The other drug classes do not cause this cough.
72
```
A patient with type 2 diabetes mellitus has been found to have trace proteinuria. The prescriber writes an order for an angiotensin-converting enzyme (ACE) inhibitor. What is the main reason for prescribing this class of drug for this patient?
a.
Cardioprotective effects
b.
Renal protective effects
c.
Reduces blood pressure
d.
Promotes fluid output
```
ANS: B
ACE inhibitors have been shown to have a protective effect on the kidneys because they reduce glomerular filtration pressure. This is one reason that they are among the cardiovascular drugs of choice for diabetic patients. The other drugs do not have this effect.
73
```
The nurse is reviewing the orders for a patient and notes a new order for an angiotensin-converting enzyme (ACE) inhibitor. The nurse checks the current medication orders, knowing that this drug class may have a serious interaction with what other drug class?
a.
Calcium channel blockers
b.
Diuretics
c.
Nonsteroidal anti-inflammatory drugs
d.
Nitrates
```
ANS: C
Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen can reduce the antihypertensive effect of ACE inhibitors. In addition, the use of NSAIDs and ACE inhibitors may also predispose patients to the development of acute renal failure.
74
When the nurse is administering topical nitroglycerin ointment, which technique is correct?
a.
Apply the ointment on the skin on the forearm.
b.
Apply the ointment only in the case of a mild angina episode.
c.
Remove the old ointment before new ointment is applied.
d.
Massage the ointment gently into the skin, and then cover the area with plastic wrap.
ANS: C
The old ointment should be removed before a new dose is applied. The ointment should be applied to clean, dry, hairless skin of the upper arms or body, not below the elbows or below the knees. The ointment is not massaged or spread on the skin, and it is not indicated for the treatment of acute angina.
75
A patient has been diagnosed with angina and will be given a prescription for sublingual nitroglycerin tablets. When teaching the patient how to use sublingual nitroglycerin, the nurse will include which instruction?
a.
Take up to 5 doses at 15-minute intervals for an angina attack.
b.
If the tablet does not dissolve quickly, chew the tablet for maximal effect.
c.
If the chest pain is not relieved after one tablet, call 911 immediately.
d.
Wait 1 minute between doses of sublingual tablets, up to 3 doses.
ANS: C
According to current guidelines, if the chest pain or discomfort is not relieved in 5 minutes, after 1 dose, the patient (or family member) must call 911 immediately. The patient may take one more tablet while awaiting emergency care and may take a third tablet 5 minutes later, but no more than a total of three tablets. The sublingual dose is placed under the tongue, and the patient needs to avoid swallowing until the tablet has dissolved.
76
```
A patient arrives in the emergency department with severe chest pain. The patient reports that the pain has been occurring off and on for a week now. Which assessment finding would indicate the need for cautious use of nitrates and nitrites?
a.
Blood pressure of 88/62 mm Hg
b.
Apical pulse rate of 110 beats/min
c.
History of renal disease
d.
History of a myocardial infarction 2 years ago
```
ANS: A
Hypotension is a possible contraindication to the use of nitrates because the medications may cause the blood pressure to decrease. The other options are incorrect.
77
A calcium channel blocker (CCB) is prescribed for a patient, and the nurse provides instructions to the patient about the medication. Which instruction is correct?
a.
Chew the tablet for faster release of the medication.
b.
To increase the effect of the drug, take it with grapefruit juice.
c.
If the adverse effects of chest pain, fainting, or dyspnea occur, discontinue the medication immediately.
d.
A high-fiber diet with plenty of fluids will help prevent the constipation that may occur.
ANS: D
Constipation is a common effect of CCBs, and a high-fiber diet and plenty of fluids will help to prevent it. Grapefruit juice decreases the metabolism of CCBs. Extended-release tablets must never be chewed or crushed. These medications should never be discontinued abruptly because of the risk for rebound hypertension.
78
When applying transdermal nitroglycerin patches, which instruction by the nurse is correct?
a.
“Rotate application sites with each dose.”
b.
“Use only the chest area for application sites.”
c.
“Temporarily remove the patch if you go swimming.”
d.
“Apply the patch to the same site each time.”
ANS: A
Application sites for transdermal nitroglycerin patches need to be rotated. Apply the transdermal patch to any nonhairy area of the body; the old patch should first be removed. The patch may be worn while swimming, but if it does come off, it should be replaced after the old site is cleansed.
79
What action is often recommended to help reduce tolerance to transdermal nitroglycerin therapy?
a.
Omit a dose once a week.
b.
Leave the patch on for 2 days at a time.
c.
Cut the patch in half for 1 week until the tolerance subsides.
d.
Remove the patch at bedtime, and then apply a new one in the morning.
ANS: D
To prevent tolerance, remove the transdermal patch at night for 8 hours, and apply a new patch in the morning. Transdermal patches must never be cut or left on for 2 days, and doses must not be omitted.
80
```
While assessing a patient who is taking a beta blocker for angina, the nurse knows to monitor for which adverse effect?
a.
Nervousness
b.
Hypertension
c.
Bradycardia
d.
Dry cough
```
ANS: C
Adverse effects of beta blockers include bradycardia, hypotension, dizziness, lethargy, impotence, and several other effects, but not dry cough or nervousness.
81
```
When teaching a patient who has a new prescription for transdermal nitroglycerin patches, the nurse tells the patient that these patches are most appropriately used for which situation?
a.
To prevent low blood pressure
b.
To relieve shortness of breath
c.
To prevent the occurrence of angina
d.
To keep the heart rate from rising too high during exercise
```
ANS: C
Transdermal dosage formulations of nitroglycerin are used for the long-term prophylactic management (prevention) of angina pectoris. Transdermal nitroglycerin patches are not appropriate for the relief of shortness of breath, to prevent palpitations, or to control the heart rate during exercise.
82
The nurse is providing education about the use of sublingual nitroglycerin tablets. She asks the patient, “What would you do if you experienced chest pain while mowing your yard? You have your bottle of sublingual nitroglycerin with you.” Which actions by the patient are appropriate in this situation? (Select all that apply.)
a.
Stop the activity, and lie down or sit down.
b.
Call 911 immediately.
c.
Call 911 if the pain is not relieved after taking one sublingual tablet.
d.
Call 911 if the pain is not relieved after taking three sublingual tablets in 15 minutes.
e.
Place a tablet under the tongue.
f.
Place a tablet in the space between the gum and cheek.
g.
Take another sublingual tablet if chest pain is not relieved after 5 minutes, up to three total.
ANS: A, C, E, G
With sublingual forms, the medication is taken at the first sign of chest pain, not delayed until the pain is severe. The patient needs to sit down or lie down and take one sublingual tablet. According to current guidelines, if the chest pain or discomfort is not relieved in 5 minutes, after 1 dose, the patient (or family member) must call 911 immediately. The patient can take one more tablet while awaiting emergency care and may take a third tablet 5 minutes later, but no more than a total of three tablets. These guidelines reflect the fact that angina pain that does not respond to nitroglycerin may indicate a myocardial infarction. The sublingual dose is placed under the tongue, and the patient needs to avoid swallowing until the tablet has dissolved. Placing a tablet between the gum and cheek is the buccal route.
83
Furosemide (Lasix) is prescribed for a patient who is about to be discharged, and the nurse provides instructions to the patient about the medication. Which statement by the nurse is correct?
a.
“Take this medication in the evening.”
b.
“Avoid foods high in potassium, such as bananas, oranges, fresh vegetables, and dates.”
c.
“If you experience weight gain, such as 5 pounds or more per week, be sure to tell your physician during your next routine visit.”
d.
“Be sure to change positions slowly and rise slowly after sitting or lying so as to prevent dizziness and possible fainting because of blood pressure changes.”
ANS: D
Orthostatic hypotension is a possible problem with diuretic therapy. Foods high in potassium should be eaten more often, and the drug needs to be taken in the morning so that the diuretic effects do not interfere with sleep. A weight gain of 5 pounds or more per week must be reported immediately.
84
When reviewing the mechanisms of action of diuretics, the nurse knows that which statement is true about loop diuretics?
a.
They work by inhibiting aldosterone.
b.
They are very potent, having a diuretic effect that lasts at least 6 hours.
c.
They have a rapid onset of action and cause rapid diuresis.
d.
They are not effective when the creatinine clearance decreases below 25 mL/min.
ANS: C
The loop diuretics have a rapid onset of action; therefore, they are useful when rapid onset is desired. Their effect lasts for about 2 hours, and a distinct advantage they have over thiazide diuretics is that their diuretic action continues even when creatinine clearance decreases below 25 mL/min.
85
```
When monitoring a patient who is taking hydrochlorothiazide (HydroDIURIL), the nurse notes that which drug is most likely to cause a severe interaction with the diuretic?
a.
Digitalis
b.
Penicillin
c.
Potassium supplements
d.
Aspirin
```
ANS: A
There is an increased risk for digitalis toxicity in the presence of hypokalemia, which may develop with hydrochlorothiazide therapy. Potassium supplements are often prescribed with hydrochlorothiazide therapy to prevent hypokalemia. The other options do not have interactions with hydrochlorothiazide.
86
```
A patient is started on a diuretic for antihypertensive therapy. The nurse expects that a drug in which class is likely to be used initially?
a.
Loop diuretics
b.
Osmotic diuretics
c.
Thiazide diuretics
d.
Potassium-sparing diuretics
```
ANS: C
The Eighth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC-8) guidelines reaffirmed the role of thiazide diuretics as one of the first-line treatment for hypertension. The other drug classes are not considered first-line treatments.
87
```
When assessing a patient who is receiving a loop diuretic, the nurse looks for the manifestations of potassium deficiency, which would include what symptoms? (Select all that apply.)
a.
Dyspnea
b.
Constipation
c.
Tinnitus
d.
Muscle weakness
e.
Anorexia
f.
Lethargy
```
ANS: D, E, F
Symptoms of hypokalemia include anorexia, nausea, lethargy, muscle weakness, mental confusion, and hypotension. The other symptoms are not associated with hypokalemia.
88
A patient about to receive a morning dose of digoxin has an apical pulse of 53 beats/min. What will the nurse do next?
a.
Administer the dose.
b.
Administer the dose, and notify the prescriber.
c.
Check the radial pulse for 1 full minute.
d.
Withhold the dose, and notify the prescriber.
ANS: D
Digoxin doses are held and the prescriber notified if the apical pulse is 60 beats/min or lower or is higher than 100 beats/min. The other options are incorrect.
89
A patient is taking digoxin (Lanoxin) and a loop diuretic daily. When the nurse enters the room with the morning medications, the patient states, "I am seeing a funny yellow color around the lights." What is the nurse's next action?
a.
Assess the patient for symptoms of digoxin toxicity.
b.
Withhold the next dose of the diuretic.
c.
Administer the digoxin and diuretic together as ordered.
d.
Document this finding, and reassess in 1 hour.
ANS: A
Seeing colors around lights is one potential indication of developing digoxin toxicity. If a patient complains of this, the nurse needs to assess for other signs and symptoms of digoxin toxicity including bradycardia, headache, dizziness, confusion, nausea, and blurred vision, and then notify the prescriber. Administering the drug or withholding the diuretic are incorrect options.
90
A patient has been taking digoxin at home but took an accidental overdose and has developed toxicity. The patient has been admitted to the telemetry unit, where the physician has ordered digoxin immune Fab (Digifab). The patient asks the nurse why the medication is ordered. What is the nurse’s best response?
a.
“It will increase your heart rate.”
b.
“This drug helps to lower your potassium levels.”
c.
“It helps to convert the irregular heart rhythm to a more normal rhythm.”
d.
“This drug is an antidote to digoxin and will help to lower the blood levels.”
ANS: D
Digoxin immune Fab (Digifab) is the antidote for a severe digoxin overdose. It is given intravenously. The other options are incorrect.
91
```
A patient has a digoxin level of 1.1 ng/mL. Which interpretation by the nurse is correct?
a.
It is below the therapeutic level.
b.
It is within the therapeutic range.
c.
It is above the therapeutic level.
d.
It is at a toxic level.
```
ANS: B
| The normal therapeutic drug level of digoxin is between 0.5 and 2 ng/mL. The other options are incorrect.
92
```
The nurse is reviewing discharge teaching for a patient who will be taking digoxin (Lanoxin) therapy. The nurse will teach the patient to avoid which foods when taking the digoxin?
a.
Leafy green vegetables
b.
Dairy products
c.
Grapefruit juice
d.
Bran muffins
```
ANS: D
Bran, in large amounts, may decrease the absorption of oral digitalis drugs. The other foods do not affect digoxin levels.
93
When a patient is experiencing digoxin toxicity, which clinical situation would necessitate the use of digoxin immune Fab (Digifab)? (Select all that apply.)
a.
The patient reports seeing colorful halos around lights.
b.
The patient’s serum potassium level is above 5 mEq/L.
c.
The patient is experiencing nausea and anorexia.
d.
The patient is experiencing severe sinus bradycardia that does not respond to cardiac pacing.
e.
The patient has received an overdose of greater than 10 mg of digoxin.
f.
The patient reports fatigue and headaches.
ANS: B, D, E
Clinical situations that would require the use of digoxin immune Fab in a patient with digoxin toxicity include serum potassium level above 5 mEq/L, severe sinus bradycardia that does not respond to cardiac pacing, or an overdose of more than 10 mg of digoxin. Seeing colorful halos around lights and experiencing nausea, anorexia, fatigue, and headaches are potential adverse effects of digoxin therapy but are not necessarily reasons for digoxin immune Fab treatment.
94
Which drug classes are considered first-line treatment for heart failure? (Select all that apply.)
a.
Angiotensin-converting enzyme (ACE) inhibitors
b.
Angiotensin II receptor blockers (ARBs)
c.
Digoxin (cardiac glycoside)
d.
Beta blockers
e.
Nesiritide (Natrecor), the B-type natriuretic peptide
ANS: A, B, D
ACE inhibitors, ARBs, and beta blockers are now considered the first-line treatments for heart failure. Digoxin is used when the first-line treatments are not successful; nesiritide is considered a last-resort treatment.
95
```
A patient with elevated lipid levels has a new prescription for nicotinic acid (niacin). The nurse informs the patient that which adverse effects may occur with this medication?
a.
Pruritus, cutaneous flushing
b.
Tinnitus, urine with a burnt odor
c.
Myalgia, fatigue
d.
Blurred vision, headaches
```
ANS: A
Possible adverse effects of nicotinic acid include pruritus, cutaneous flushing, and gastrointestinal distress. Tinnitus, urine with a burnt odor, and headaches are possible adverse effects of bile acid sequestrants. Headaches are also possible adverse effects of HMG-CoA reductase inhibitors, as are myalgia and fatigue.
96
A patient reports having adverse effects with nicotinic acid (niacin). The nurse can suggest performing which action to minimize these undesirable effects?
a.
Take the drug on an empty stomach.
b.
Take the medication every other day until the effects subside.
c.
Take an aspirin tablet 30 minutes before taking the drug.
d.
Take the drug with large amounts of fiber.
ANS: C
The undesirable effects of nicotinic acid can be minimized by starting with a low initial dose, taking the drug with meals, and taking small doses of aspirin with the drug to minimize cutaneous flushing. Fiber intake has no effect on niacin’s adverse effects, and it is not within the nurse’s scope of practice to suggest a change of medication dosage.
97
A patient who has recently started therapy on a statin drug asks the nurse how long it will take until he sees an effect on his serum cholesterol. Which statement would be the nurse’s best response?
a.
“Blood levels return to normal within a week of beginning therapy.”
b.
“It takes 6 to 8 weeks to see a change in cholesterol levels.”
c.
“It takes at least 6 months to see a change in cholesterol levels.”
d.
“You will need to take this medication for almost a year to see significant results.”
ANS: B
The maximum extent to which lipid levels are lowered may not occur until 6 to 8 weeks after the start of therapy. The other responses are incorrect.
98
Antilipemic drug therapy is prescribed for a patient, and the nurse is providing instructions to the patient about the medication. Which instructions will the nurse include? (Select all that apply.)
a.
Limit fluid intake to prevent fluid overload.
b.
Eat extra servings of raw vegetables and fruit.
c.
Report abnormal or unusual bleeding or yellow discoloration of the skin.
d.
Report the occurrence of muscle pain immediately.
e.
Drug interactions are rare with antilipemics.
f.
Take the drug 1 hour before or 2 hours after meals to maximize absorption.
ANS: B, C, D
Instructions need to include preventing constipation by encouraging a diet that is plentiful in raw vegetables, fruit, and bran. Forcing fluids (up to 3000 mL/day unless contraindicated) may also help to prevent constipation. Notify the prescriber if there are any new or troublesome symptoms, abnormal or unusual bleeding, yellow discoloration of the skin, or muscle pain. These drugs are highly protein bound; therefore, they interact with many drugs. Taking these drugs with food may help to reduce gastrointestinal distress.
99
A patient has been prescribed warfarin (Coumadin) in addition to a heparin infusion. The patient asks the nurse why he has to be on two medications. The nurse’s response is based on which rationale?
a.
The oral and injection forms work synergistically.
b.
The combination of heparin and an oral anticoagulant results in fewer adverse effects than heparin used alone.
c.
Oral anticoagulants are used to reach an adequate level of anticoagulation when heparin alone is unable to do so.
d.
Heparin is used to start anticoagulation so as to allow time for the blood levels of warfarin to reach adequate levels.
ANS: D
This overlap therapy is required in patients who have been receiving heparin for anticoagulation and are to be switched to warfarin so that prevention of clotting is continuous. This overlapping is done purposefully to allow time for the blood levels of warfarin to rise, so that when the heparin is eventually discontinued, therapeutic anticoagulation levels of warfarin will have been achieved. Recommendations are to continue overlap therapy of the heparin and warfarin for at least 5 days; the heparin is stopped after day 5 when the international normalized ratio (INR) is above 2.
100
```
A patient who has been anticoagulated with warfarin (Coumadin) has been admitted for gastrointestinal bleeding. The history and physical examination indicates that the patient may have taken too much warfarin. The nurse anticipates that the patient will receive which antidote?
a.
Vitamin E
b.
Vitamin K
c.
Protamine sulfate
d.
Potassium chloride
```
ANS: B
Vitamin K is given to reverse the anticoagulation effects of warfarin toxicity. Protamine sulfate is the antidote for heparin overdose. The other options are incorrect.
101
A patient has been instructed to take one enteric-coated low-dose aspirin a day as part of therapy to prevent strokes. The nurse will provide which instruction when providing patient teaching about this medication?
a.
Aspirin needs to be taken on an empty stomach to ensure maximal absorption.
b.
Low-dose aspirin therapy rarely causes problems with bleeding.
c.
Take the medication with 6 to 8 ounces of water and with food.
d.
Coated tablets may be crushed if necessary for easier swallowing.
ANS: C
Enteric-coated aspirin is best taken with 6 to 8 ounces of water and with food to help decrease gastrointestinal upset. Enteric-coated tablets should not be crushed. Risk for bleeding increases with aspirin therapy, even at low doses.
102
A patient will be receiving a thrombolytic drug as part of the treatment for acute myocardial infarction. The nurse explains to the patient that this drug is used for which purpose?
a.
To relieve chest pain
b.
To prevent further clot formation
c.
To dissolve the clot in the coronary artery
d.
To control bleeding in the coronary vessels
ANS: C
Thrombolytic drugs lyse, or dissolve, thrombi. They are not used to prevent further clot formation or to control bleeding. As a result of dissolving of the thrombi, chest pain may be relieved, but that is not the primary purpose of thrombolytic therapy.
103
A patient is receiving heparin therapy as part of the treatment for a pulmonary embolism. The nurse monitors the results of which laboratory test to check the drug’s effectiveness?
a.
Bleeding times
b.
Activated partial thromboplastin time (aPTT)
c.
Prothrombin time/international normalized ratio (PT/INR)
d.
Vitamin K levels
ANS: B
Ongoing aPTT values are used to monitor heparin therapy. PT/INR is used to monitor warfarin therapy. The other two options are not used to monitor anticoagulant therapy.
104
```
The nurse notes in the patient’s medication orders that the patient will be starting anticoagulant therapy. What is the primary goal of anticoagulant therapy?
a.
Stabilizing an existing thrombus
b.
Dissolving an existing thrombus
c.
Preventing thrombus formation
d.
Dilating the vessel around a clot
```
ANS: C
Anticoagulants prevent thrombus formation but do not dissolve or stabilize an existing thrombus, nor do they dilate vessels around a clot.
105
A patient has had recent mechanical heart valve surgery and is receiving anticoagulant therapy. While monitoring the patient’s laboratory work, the nurse interprets that the patient’s international normalized ratio (INR) level of 3 indicates that:
a.
the patient is not receiving enough warfarin to have a therapeutic effect.
b.
the patient’s warfarin dose is at therapeutic levels.
c.
the patient’s intravenous heparin dose is dangerously high.
d.
the patient’s intravenous heparin dose is at therapeutic levels.
ANS: B
A normal INR (without warfarin) is 1.0. A therapeutic INR for patients who have had mechanical heart valve surgery ranges from 2.5 to 3.5, with a middle value of 3.
106
```
A patient has received an overdose of intravenous heparin, and is showing signs of excessive bleeding. Which substance is the antidote for heparin overdose?
a.
Vitamin E
b.
Vitamin K
c.
Protamine sulfate
d.
Potassium chloride
```
ANS: C
Protamine sulfate is a specific heparin antidote and forms a complex with heparin, completely reversing its anticoagulant properties. Vitamin K is the antidote for warfarin (Coumadin) overdose. The other options are incorrect.
107
```
A patient who has received some traumatic news is panicking and asks for some medication to help settle down. The nurse anticipates giving which drug that is most appropriate for this situation?
a.
Diazepam (Valium)
b.
Zolpidem (Ambien)
c.
Phenobarbital
d.
Cyclobenzaprine (Flexeril)
```
ANS: A
Benzodiazepines such as diazepam are used as anxiolytics, or sedatives. Zolpidem is used as a hypnotic for sleep. Phenobarbital is not used as an anxiolytic but is used for seizure control. Cyclobenzaprine is a muscle relaxant and is not used to reduce anxiety.
108
A patient is recovering from a minor automobile accident that occurred 1 week ago. He is taking cyclobenzaprine (Flexeril) for muscular pain and goes to physical therapy three times a week. Which nursing diagnosis would be appropriate for him?
a.
Risk for injury related to decreased sensorium
b.
Risk for addiction related to psychologic dependency
c.
Decreased fluid volume related to potential adverse effects
d.
Disturbed sleep pattern related to the drug’s interference with REM sleep
ANS: A
Musculoskeletal relaxants have a depressant effect on the CNS; thus, the patient needs to be taught the importance of taking measures to minimize self-injury and falls related to decreased sensorium. “Risk for addiction” is not a NANDA nursing diagnosis. The other nursing diagnoses are not appropriate for this situation.
109
```
The nurse notes in the patient’s medication history that the patient is taking cyclobenzaprine (Flexeril). Based on this finding, the nurse interprets that the patient has which disorder?
a.
A musculoskeletal injury
b.
Insomnia
c.
Epilepsy
d.
Agitation
```
ANS: A
Cyclobenzaprine (Flexeril) is the muscle relaxant most commonly used to reduce spasms following musculoskeletal injuries. It is not appropriate for insomnia, epilepsy, or agitation.
110
The nurse has given medication instructions to a patient receiving phenytoin (Dilantin). Which statement by the patient indicates that the patient has an adequate understanding of the instructions?
a.
“I will need to take extra care of my teeth and gums while on this medication.”
b.
“I can go out for a beer while on this medication.”
c.
“I can skip doses if the side effects bother me.”
d.
“I will be able to stop taking this drug once the seizures stop.”
ANS: A
Scrupulous dental care is necessary to prevent gingival hypertrophy during therapy with phenytoin. Alcohol and other central nervous system depressants may cause severe sedation. Consistent dosing is important to maintain therapeutic drug levels. Therapy with AEDs usually must continue for life and must not be stopped once seizures stop.
111
When teaching a patient about taking a newly prescribed antiepileptic drug (AED) at home, the nurse will include which instruction?
a.
“Driving is allowed after 2 weeks of therapy.”
b.
“If seizures recur, take a double dose of the medication.”
c.
“Antacids can be taken with the AED to reduce gastrointestinal adverse effects.”
d.
“Regular, consistent dosing is important for successful treatment.”
ANS: D
Consistent dosing, taken regularly at the same time of day, at the recommended dose, and with meals to reduce the common gastrointestinal adverse effects, is the key to successful management of seizures when taking AEDs. Noncompliance is the factor most likely to lead to treatment failure.
112
A patient has a 9-year history of a seizure disorder that has been managed well with oral phenytoin (Dilantin) therapy. He is to be NPO (consume nothing by mouth) for surgery in the morning. What will the nurse do about his morning dose of phenytoin?
a.
Give the same dose intravenously.
b.
Give the morning dose with a small sip of water.
c.
Contact the prescriber for another dosage form of the medication.
d.
Notify the operating room that the medication has been withheld.
ANS: C
If there are any questions about the medication order or the medication prescribed, contact the prescriber immediately for clarification and for an order of the appropriate dose form of the medication. Do not change the route without the prescriber’s order. There is an increased risk of seizure activity if one or more doses of the AED are missed.
113
The nurse is monitoring a patient who has been taking carbamazepine (Tegretol) for 2 months. Which effects would indicate that autoinduction has started to occur?
a.
The drug levels for carbamazepine are higher than expected.
b.
The drug levels for carbamazepine are lower than expected.
c.
The patient is experiencing fewer seizures.
d.
The patient is experiencing toxic effects from the drug.
ANS: B
With carbamazepine, autoinduction occurs and leads to lower than expected drug concentrations. Therefore, the dosage may have to be adjusted with time. The other options are incorrect.
114
The nurse is giving an intravenous dose of phenytoin (Dilantin). Which action is correct when administering this drug?
a.
Give the dose as a fast intravenous (IV) bolus.
b.
Mix the drug with normal saline, and give it as a slow IV push.
c.
Mix the drug with dextrose (D5W), and give it as a slow IV push.
d.
Mix the drug with any available solution as long as the administration rate is correct.
ANS: B
Intravenous phenytoin is given only with normal saline solution to prevent precipitation formation caused by incompatibilities. The IV push dose must be given slowly (not exceeding 50 mg/min in adults), and the patient must be monitored for bradycardia and decreased blood pressure.
115
```
A patient is experiencing status epilepticus. The nurse prepares to give which drug of choice for the treatment of this condition?
a.
Diazepam (Valium)
b.
Midazolam (Versed)
c.
Valproic acid (Depakote)
d.
Carbamazepine (Tegretol)
```
ANS: A
Diazepam (Valium) is considered by many to be the drug of choice for status epilepticus. Other drugs that are used are listed in Table 14-3 and do not include the drugs listed in the other options.
116
Phenytoin (Dilantin) has a narrow therapeutic index. The nurse recognizes that this characteristic indicates which of these?
a.
The safe and the toxic plasma levels of the drug are very close to each other.
b.
The phenytoin has a low chance of being effective.
c.
There is no difference between safe and toxic plasma levels.
d.
A very small dosage can result in the desired therapeutic effect.
ANS: A
Having a “narrow therapeutic index” means that there is a small difference between safe and toxic drug levels. These drugs require monitoring of therapeutic plasma levels. The other options are incorrect.
117
During a routine appointment, a patient with a history of seizures is found to have a phenytoin (Dilantin) level of 23 mcg/mL. What concern will the nurse have, if any?
a.
The patient is at risk for seizures because the drug level is not at a therapeutic level.
b.
The patient’s seizures should be under control because this is a therapeutic drug level.
c.
The patient’s seizures should be under control if she is also taking a second antiepileptic drug.
d.
The drug level is at a toxic level, and the dosage needs to be reduced.
ANS: D
| Therapeutic drug levels for phenytoin are usually 10 to 20 mcg/mL (see Table 14-6). The other options are incorrect.
118
A patient is taking gabapentin (Neurontin), and the nurse notes that there is no history of seizures on his medical record. What is the best possible rationale for this medication order?
a.
The medication is used for the treatment of neuropathic pain.
b.
The medication is helpful for the treatment of multiple sclerosis.
c.
The medication is used to reduce the symptoms of Parkinson’s disease.
d.
The medical record is missing the correct information about the patient’s history of seizures.
ANS: A
| Gabapentin (Neurontin) is commonly used to treat neuropathic pain. The other options are incorrect.
119
A patient has been given a prescription for levodopa-carbidopa (Sinemet) for her newly diagnosed Parkinson’s disease. She asks the nurse, “Why are there two drugs in this pill?” The nurse’s best response reflects which fact?
a.
Carbidopa allows for larger doses of levodopa to be given.
b.
Carbidopa prevents the breakdown of levodopa in the periphery.
c.
There are concerns about drug-food interactions with levodopa therapy that do not exist with the combination therapy.
d.
Carbidopa is the biologic precursor of dopamine and can penetrate into the central nervous system.
ANS: B
When given in combination with levodopa, carbidopa inhibits the breakdown of levodopa in the periphery and thus allows smaller doses of levodopa to be used. Lesser amounts of levodopa result in fewer unwanted adverse effects. Levodopa, not carbidopa, is the biologic precursor of dopamine and can penetrate into the CNS.
120
```
A patient has been treated with antiparkinson medications for 3 months. What therapeutic responses should the nurse look for when assessing this patient?
a.
Decreased appetite
b.
Gradual development of cogwheel rigidity
c.
Newly developed dyskinesias
d.
Improved ability to perform activities of daily living
```
ANS: D
Therapeutic responses to antiparkinson agents include an improved sense of well-being, improved mental status, increased appetite, increased ability to perform activities of daily living and to concentrate and think clearly, and less intense parkinsonian manifestations.
121
```
Carbidopa-levodopa (Sinemet) is prescribed for a patient with Parkinson’s disease. The nurse informs the patient that which common adverse effects can occur with this medication?
a.
Drowsiness, headache, weight loss
b.
Dizziness, insomnia, nausea
c.
Peripheral edema, fatigue, syncope
d.
Heart palpitations, hypotension, urinary retention
```
ANS: D
Common adverse reactions associated with carbidopa-levodopa include palpitations, hypotension, urinary retention, dyskinesia, and depression. The other effects may occur with other antiparkinson drugs.
122
```
The nurse is developing a care plan for a patient who is taking an anticholinergic drug. Which nursing diagnosis would be appropriate for this patient?
a.
Diarrhea
b.
Urinary retention
c.
Risk for infection
d.
Disturbed sleep pattern
```
ANS: B
Patients receiving anticholinergic drugs are at risk for urinary retention and constipation, not diarrhea. The other nursing diagnoses are not applicable to anticholinergic drugs.
123
When treating patients with medications for Parkinson’s disease, the nurse knows that the wearing-off phenomenon occurs for which reason?
a.
There are rapid swings in the patient’s response to levodopa.
b.
The patient cannot tolerate the medications at times.
c.
The medications begin to lose effectiveness against Parkinson’s disease.
d.
The patient’s liver is no longer able to metabolize the drug.
ANS: C
The wearing-off phenomenon occurs when antiparkinson medications begin to lose their effectiveness, despite maximal dosing, as the disease progresses. The other options are incorrect.
124
```
When assessing the medication history of a patient with a new diagnosis of Parkinson’s disease, which conditions are contraindications for the patient who will be taking carbidopa-levodopa? (Select all that apply.)
a.
Angle-closure glaucoma
b.
History of malignant melanoma
c.
Hypertension
d.
Benign prostatic hyperplasia
e.
Concurrent use of monoamine oxidase inhibitors (MAOIs)
```
ANS: A, B, E
Angle-closure glaucoma, a history of melanoma or other undiagnosed skin conditions, and concurrent use of MAOIs are contraindications to the use of carbidopa-levodopa. The other options are incorrect.
125
```
The nurse is administering insulin lispro (Humalog) and will keep in mind that this insulin will start to have an effect within which time frame?
a.
15 minutes
b.
1 to 2 hours
c.
80 minutes
d.
3 to 5 hours
```
ANS: A
The onset of action for insulin lispro is 15 minutes. The peak plasma concentration is 1 to 2 hours; the elimination half-life is 80 minutes; and the duration of action is 3 to 5 hours.
126
```
When teaching about hypoglycemia, the nurse will make sure that the patient is aware of the early signs of hypoglycemia, including:
a.
hypothermia and seizures.
b.
nausea and diarrhea.
c.
confusion and sweating.
d.
fruity, acetone odor to the breath.
```
ANS: C
Early symptoms of hypoglycemia include the central nervous system manifestations of confusion, irritability, tremor, and sweating. Hypothermia and seizures are later symptoms of hypoglycemia. The other options are incorrect.
127
The nurse is teaching a group of patients about self-administration of insulin. What content is important to include?
a.
Patients need to use the injection site that is the most accessible.
b.
If two different insulins are ordered, they need to be given in separate injections.
c.
When mixing insulins, the cloudy (such as NPH) insulin is drawn up into the syringe first.
d.
When mixing insulins, the clear (such as regular) insulin is drawn up into the syringe first.
ANS: D
If mixing insulins in one syringe, the clear (regular) insulin is always drawn up into the syringe first. Patients always need to rotate injection sites. Mixing of insulins may be ordered.
128
When monitoring a patient’s response to oral antidiabetic drugs, the nurse knows that which laboratory result would indicate a therapeutic response?
a.
Random blood glucose level 180 mg/dL
b.
Blood glucose level of 50 mg/dL after meals
c.
Fasting blood glucose level between 92 mg/dL
d.
Evening blood glucose level below 80 mg/dL
ANS: C
The American Diabetes Association recommends a fasting blood glucose level of between 80 and 130 mg/dL for diabetic patients. The other options are incorrect.
129
A 75-year-old woman with type 2 diabetes has recently been placed on glipizide (Glucotrol), 10 mg daily. She asks the nurse when the best time would be to take this medication. What is the nurse’s best response?
a.
“Take this medication in the morning, 30 minutes before breakfast.”
b.
“Take this medication in the evening with a snack.”
c.
“This medication needs to be taken after the midday meal.”
d.
“It does not matter what time of day you take this medication.”
ANS: A
Glipizide is taken in the morning, 30 minutes before breakfast. When taken at this time, it has a longer duration of action, causing a constant amount of insulin to be released. This may be beneficial in controlling blood glucose levels throughout the day.
130
```
The nurse is reviewing instructions for a patient with type 2 diabetes who also takes insulin injections as part of the therapy. The nurse asks the patient, “What should you do if your fasting blood glucose is 47 mg/dL?” Which response by the patient reflects a correct understanding of insulin therapy?
a.
“I will call my doctor right away.”
b.
“I will give myself the regular insulin.”
c.
“I will take an oral form of glucose.”
d.
“I will rest until the symptoms pass.”
```
ANS: C
Hypoglycemia can be reversed if the patient eats glucose tablets or gel, corn syrup, or honey, or drinks fruit juice or a nondiet soft drink or other quick sources of glucose, which must always be kept at hand. She should not wait for instructions from her physician, nor delay taking the glucose by resting. The regular insulin would only lower her blood glucose levels more.
131
The nurse is teaching patients about self-injection of insulin. Which statement is true regarding injection sites?
a.
Avoid the abdomen because absorption there is irregular.
b.
Choose a different site at random for each injection.
c.
Give the injection in the same area each time.
d.
Rotate sites within the same location for about 1 week before rotating to a new location.
ANS: D
Patients taking insulin injections need to be instructed to rotate sites, but to do so within the same location for about 1 week (so that all injections are rotated in one area—for example, the right arm—before rotating to a new location, such as the left arm). Also, each injection needs to be at least 1/2
to 1 inch away from the previous site.
132
Which action is most appropriate regarding the nurse’s administration of a rapid-acting insulin to a hospitalized patient?
a.
Give it within 15 minutes of mealtime.
b.
Give it after the meal has been completed.
c.
Administer it once daily at the time of the midday meal.
d.
Administer it with a snack before bedtime.
ANS: A
Rapid-acting insulins, such as insulin lispro and insulin aspart, are able to mimic closely the body’s natural rapid insulin output after eating a meal; for this reason, both insulins are usually administered within 15 minutes of the patient’s mealtime. The other options are incorrect.
133
A patient in the emergency department was showing signs of hypoglycemia and had a fingerstick glucose level of 34 mg/dL. The patient has just become unconscious. What is the nurse’s next action?
a.
Have the patient eat glucose tablets.
b.
Have the patient consume fruit juice, a nondiet soft drink, or crackers.
c.
Administer intravenous glucose (50% dextrose).
d.
Call the lab to order a fasting blood glucose level.
ANS: C
Intravenous glucose raises blood glucose levels when the patient is unconscious and unable to take oral forms of glucose.
134
The nurse is preparing to administer insulin intravenously. Which statement about the administration of intravenous insulin is true?
a.
Insulin is never given intravenously.
b.
Only regular insulin can be administered intravenously.
c.
Insulin aspart or insulin lispro can be administered intravenously, but there must be a 50% dose reduction.
d.
Any form of insulin can be administered intravenously at the same dose as that is ordered for subcutaneous administration.
ANS: B
Regular insulin is the usual insulin product to be dosed via intravenous bolus, intravenous infusion, or even intramuscularly. These routes, especially the intravenous infusion route, are often used in cases of diabetic ketoacidosis, or coma associated with uncontrolled type 1 diabetes
135
A patient with a history of chronic obstructive pulmonary disease (COPD) and type 2 diabetes has been treated for pneumonia for the past week. The patient has been receiving intravenous corticosteroids as well as antibiotics as part of his therapy. At this time, the pneumonia has resolved, but when monitoring the blood glucose levels, the nurse notices that the level is still elevated. What is the best explanation for this elevation?
a.
The antibiotics may cause an increase in glucose levels.
b.
The corticosteroids may cause an increase in glucose levels.
c.
His type 2 diabetes has converted to type 1.
d.
The hypoxia caused by the COPD causes an increased need for insulin.
ANS: B
Corticosteroids can antagonize the hypoglycemic effects of insulin, resulting in elevated blood glucose levels. The other options are incorrect.
136
A patient has been diagnosed with metabolic syndrome and is started on the biguanide metformin (Glucophage). The nurse knows that the purpose of the metformin, in this situation, is which of these?
a.
To increase the pancreatic secretion of insulin
b.
To decrease insulin resistance
c.
To increase blood glucose levels
d.
To decrease the pancreatic secretion of insulin
ANS: B
Metformin decreases glucose production by the liver; decreases intestinal absorption of glucose; and improves insulin receptor sensitivity in the liver, skeletal muscle, and adipose tissue, resulting in decreased insulin resistance. The other options are incorrect.
137
When administering morning medications for a newly admitted patient, the nurse notes that the patient has an allergy to sulfa drugs. There is an order for the sulfonylurea glipizide (Glucotrol). Which action by the nurse is correct?
a.
Give the drug as ordered 30 minutes before breakfast.
b.
Hold the drug, and check the order with the prescriber.
c.
Give a reduced dose of the drug with breakfast.
d.
Give the drug, and monitor for adverse effects.
ANS: B
There is a potential for cross-allergy in patients who are allergic to sulfonamide antibiotics. Although such an allergy is listed as a contraindication by the manufacturer, most clinicians do prescribe sulfonylureas for such patients. The order needs to be clarified.
138
The nurse is teaching a group of patients about management of diabetes. Which statement about basal dosing is correct?
a.
“Basal dosing delivers a constant dose of insulin.”
b.
“With basal dosing, you can eat what you want and then give yourself a dose of insulin.”
c.
“Glargine insulin is given as a bolus with meals.”
d.
“Basal-bolus dosing is the traditional method of managing blood glucose levels.”
ANS: A
Basal-bolus therapy is the attempt to mimic a healthy pancreas by delivering basal insulin constantly as a basal, and then as needed as a bolus. Glargine insulin is used as a basal dose, not as a bolus with meals. Basal-bolus therapy is a newer therapy; historically, sliding-scale coverage was implemented.
139
When teaching a patient who is starting metformin (Glucophage), which instruction by the nurse is correct?
a.
“Take metformin if your blood glucose level is above 150 mg/dL.”
b.
“Take this 60 minutes after breakfast.”
c.
“Take the medication on an empty stomach 1 hour before meals.”
d.
“Take the medication with food to reduce gastrointestinal (GI) effects.”
ANS: D
| The GI adverse effects of metformin can be reduced by administering it with meals. The other options are incorrect.
140
```
A patient is taking a sulfonylurea medication for new-onset type 2 diabetes mellitus. When reviewing potential adverse effects during patient teaching, the nurse will include information about which of these effects? (Select all that apply.)
a.
Hypoglycemia
b.
Nausea
c.
Diarrhea
d.
Weight gain
e.
Peripheral edema
```
ANS: A, B, D
The most common adverse effect of the sulfonylureas is hypoglycemia, the degree to which depends on the dose, eating habits, and presence of hepatic or renal disease. Another predictable adverse effect is weight gain because of the stimulation of insulin secretion. Other adverse effects include skin rash, nausea, epigastric fullness, and heartburn.
141
```
A patient, newly diagnosed with hypothyroidism, receives a prescription for a thyroid hormone replacement drug. The nurse assesses for which potential contraindication to this drug?
a.
Infection
b.
Diabetes mellitus
c.
Liver disease
d.
Recent myocardial infarction
```
ANS: D
Contraindications to thyroid preparations include known drug allergy to a given drug product, recent myocardial infarction, adrenal insufficiency, and hyperthyroidism. The other options are incorrect.
142
A patient with hypothyroidism is given a prescription for levothyroxine (Synthroid). When the nurse explains that this is a synthetic form of the thyroid hormone, he states that he prefers to receive more “natural” forms of drugs. What will the nurse explain to him about the advantages of levothyroxine?
a.
It has a stronger effect than the natural forms.
b.
Levothyroxine is less expensive than the natural forms.
c.
The synthetic form has fewer adverse effects on the gastrointestinal tract.
d.
The half-life of levothyroxine is long enough to permit once-daily dosing.
ANS: D
One advantage of levothyroxine over the natural forms is that it can be administered only once a day because of its long half-life. The other options are incorrect.
143
The order reads, “Give levothyroxine (Synthroid), 200 mg, PO once every morning.” Which action by the nurse is correct?
a.
Give the medication as ordered.
b.
Change the dose to 200 mcg because that is what the prescriber meant.
c.
Hold the drug until the prescriber returns to see the patient.
d.
Question the order because the dose is higher than 200 mcg.
ANS: D
Levothyroxine is dosed in micrograms. A common medication error is to write the intended dose in milligrams instead of micrograms. If not caught, this error would result in a thousandfold overdose. Doses higher than 200 mcg need to be questioned in case this error has occurred. The other options are incorrect.
144
A patient who is taking propylthiouracil (PTU) for hyperthyroidism wants to know how this medicine works. Which explanation by the nurse is accurate?
a.
It blocks the action of thyroid hormone.
b.
It slows down the formation of thyroid hormone.
c.
It destroys overactive cells in the thyroid gland.
d.
It inactivates already existing thyroid hormone in the bloodstream.
ANS: B
Propylthiouracil impedes the formation of thyroid hormone but has no effect on already existing thyroid hormone. The other options are incorrect.
145
A 19-year-old student was diagnosed with hypothyroidism and has started thyroid replacement therapy with levothyroxine (Synthroid). After 1 week, she called the clinic to report that she does not feel better. Which response from the nurse is correct?
a.
“It will probably require surgery for a cure to happen.”
b.
“The full therapeutic effects may not occur for 3 to 4 weeks.”
c.
“Is it possible that you did not take your medication as instructed?”
d.
“Let’s review your diet; it may be causing absorption problems.”
ANS: B
Patients need to understand that it may take up to 3 to 4 weeks to see the full therapeutic effects of thyroid drugs. The other options are incorrect.
146
```
When reviewing the laboratory values of a patient who is taking antithyroid drugs, the nurse will monitor for which adverse effect?
a.
Decreased glucose levels
b.
Decreased white blood cell count
c.
Increased red blood cell count
d.
Increased platelet count
```
ANS: B
Antithyroid drugs may cause bone marrow suppression, resulting in agranulocytosis, leukopenia, thrombocytopenia, and other problems. The other options are incorrect.
147
A patient has been taking levothyroxine (Synthroid) for more than one decade for primary hypothyroidism. Today she calls because she has a cousin who can get her the same medication in a generic form from a pharmaceutical supply company. Which is the nurse’s best advice?
a.
“This would be a great way to save money.”
b.
“There’s no difference in brands of this medication.”
c.
“This should never be done; once you start with a certain brand, you must stay with it.”
d.
“It’s better not to switch brands unless we check with your doctor.”
ANS: D
Switching brands of levothyroxine during treatment can destabilize the course of treatment. Thyroid function test results need to be monitored more carefully when switching products.
148
A 19-year-old woman has been diagnosed with hypothyroidism and has started thyroid replacement therapy with levothyroxine (Synthroid). After 6 months, she calls the nurse to say that she feels better and wants to stop the medication. Which response by the nurse is correct?
a.
“You can stop the medication if your symptoms have improved.”
b.
“You need to stay on the medication for at least 1 year before a decision about stopping it can be made.”
c.
“You need to stay on this medication until you become pregnant.”
d.
“Medication therapy for hypothyroidism is usually lifelong, and you should not stop taking the medication.”
ANS: D
These medications must never be abruptly discontinued, and lifelong therapy is usually the norm. The other options are incorrect.
149
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Levothyroxine (Synthroid) has been prescribed for a patient with hypothyroidism. The nurse reviews the patient’s current medications for potential interactions. Which of these drugs or drug classes interact with levothyroxine? (Select all that apply.)
a.
Phenytoin (Dilantin)
b.
Estrogens
c.
Beta blockers
d.
Warfarin (Coumadin)
e.
Penicillins
f.
Iron supplements
```
ANS: A, B, D, F
Drug interactions with thyroid preparations include phenytoin, cholestyramine, antacids, calcium salts, iron products, estrogens, and warfarin (see Table 31-3). The other options are not correct.
150
The nurse is administering adrenal drugs to a patient. Which action by the nurse is appropriate for this patient?
a.
Administering oral drugs on an empty stomach to maximize absorption
b.
Rinsing the oral cavity after using corticosteroid inhalers
c.
Administering the corticosteroids before bedtime to minimize adrenal suppression
d.
Discontinuing the medication immediately if weight gain of 5 pounds or more in 1 week occurs
ANS: B
After the patient has used the corticosteroid inhalers, cleaning the oral cavity helps to prevent possible oral fungal infections from developing. Adrenal drugs need be taken with meals to minimize gastrointestinal upset and in the mornings to minimize adrenal suppression, and they need to be discontinued by weaning, not abruptly.
151
```
A patient will be starting therapy with a corticosteroid. The nurse reviews the patient’s orders and notes that an interaction may occur if the corticosteroid is taken with which of these drug classes?
a.
Nonsteroidal anti-inflammatory drugs
b.
Antibiotics
c.
Opioid analgesics
d.
Antidepressants
```
ANS: A
The use of corticosteroids with aspirin, other NSAIDs, and other ulcerogenic drugs produces additive gastrointestinal effects and an increased chance for the development of gastric ulcers. The other options are incorrect.
152
```
A patient is concerned about the body changes that have resulted from long-term prednisone therapy for the treatment of asthma. Which effect of this drug therapy would be present to support the nursing diagnosis of disturbed body image?
a.
Weight loss
b.
Weight gain
c.
Pale skin color
d.
Hair loss
```
ANS: B
Facial erythema, weight gain, hirsutism, and “moon face” (characteristic of Cushing’s syndrome) are possible body changes that may occur with long-term prednisone therapy.
153
A patient is taking fludrocortisone (Florinef) for Addison’s disease, and his wife is concerned about all of the problems that may occur with this therapy. When teaching them about therapy with this drug, the nurse will include which information?
a.
It may cause severe postural hypotension.
b.
It needs to be taken with food or milk to minimize gastrointestinal upset.
c.
The medication needs to be stopped immediately if nausea or vomiting occurs.
d.
Weight gain of 5 pounds or more in 1 week is an expected adverse effect.
ANS: B
Patients receiving fludrocortisone need to take it with food or milk to minimize gastrointestinal upset; weight gain of 5 pounds or more in 1 week needs to be reported to the physician; abrupt withdrawal is not recommended because it may precipitate an adrenal crisis. Adverse effects are related to the fluid retention and may include heart failure and hypertension.
154
```
When monitoring a patient who is taking a systemically administered glucocorticoid, the nurse will monitor for signs of which condition?
a.
Dehydration
b.
Hypokalemia
c.
Hyponatremia
d.
Hypoglycemia
```
ANS: B
Systemic glucocorticoid drugs may cause potassium depletion, hyperglycemia, and hypernatremia. The other options are incorrect.
155
```
A glucocorticoid is prescribed for a patient. The nurse checks the patient’s medical history knowing that glucocorticoid therapy is contraindicated in which disorder?
a.
Cerebral edema
b.
Peptic ulcer disease
c.
Tuberculous meningitis
d.
Chronic obstructive pulmonary disease
```
ANS: B
Contraindications to the administration of glucocorticoids include drug allergy and may include cataracts, glaucoma, peptic ulcer disease, mental health problems, and diabetes mellitus. The other options are indications for glucocorticoids.
156
```
A patient who has been on long-term corticosteroid therapy has had surgery to correct an abdominal hernia. The nurse keeps in mind that which potential effect of this medication may have the most impact on the patient’s recovery?
a.
Hypotension
b.
Delayed wound healing
c.
Muscle weakness
d.
Osteoporosis
```
ANS: B
Muscle weakness and osteoporosis may also result from long-term therapy, but delayed wound healing would have the most impact on the patient’s recovery from abdominal surgery at this time. Hypertension, not hypotension, may result from long-term corticosteroid therapy.
157
```
The nurse is reviewing therapy with glucocorticoid drugs. Which conditions are indications for glucocorticoid drugs? (Select all that apply.)
a.
Glaucoma
b.
Cerebral edema
c.
Chronic obstructive pulmonary disease and asthma
d.
Organ transplantation
e.
Varicella
f.
Septicemia
```
ANS: B, C, D
Cerebral edema, chronic obstructive pulmonary disease, asthma, and organ transplantation are indications for glucocorticoid therapy. Glaucoma, varicella, and septicemia are all contraindications to glucocorticoid therapy.
158
```
The nurse expects that a patient is experiencing undersecretion of adrenocortical hormones when which conditions are found upon assessment? (Select all that apply.)
a.
Dehydration
b.
Weight loss
c.
Steroid psychosis
d.
Increased potassium levels
e.
Increased blood glucose levels
f.
Decreased serum sodium levels
```
```
ANS: A, B, D, F
The undersecretion (hyposecretion) of adrenocortical hormones causes a condition known as Addison’s disease, which is associated with decreased blood sodium and glucose levels, increased potassium levels, dehydration, and weight loss. Steroid psychosis is an effect of glucocorticoid excess.
```
