NCLEX

Question 1

What are potential side effects of administering high doses of a cholinergic-blocking medication? Select all that apply.

1. Disorientation
2. Decreased heart rate
3. Constriction of pupils
4. Decreased gastric secretions
5. Constriction of internal sphincter

Answer 1

Disorientation

Decreased gastric secretions

Constriction of internal sphincter

Higher doses of cholinergic-blocking agents may affect the central nervous system and cause disorientation. Cholinergic blockers decrease gastric secretions by acting on the receptors present in the stomach. Cholinergic blockers affect the genitourinary system and cause constriction of the internal sphincter. Cholinergic blockers cause dilation of pupils, not constriction. Cholinergic blockers do not cause decreased heart rate.

Question 2

The patient is taking a beta blocker drug. The patient tells the nurse that she has been taking antacids frequently. The nurse recognizes that the interaction of the beta blocker and the antacid may have which result?

1. Increased activity of the antacid
2. Decreased activity of the antacid
3. Increased activity of the beta blocker
4. Decreased activity of the beta blocker

Answer 2

Decreased activity of the beta blocker

The interaction of beta blockers and antacids is known to result in decreased beta blocker activity. It will not result in increased activity of the antacid or beta blocker or decreased activity of the antacid.

Question 3

Which drug is contraindicated in patients with chronic obstructive pulmonary disease (COPD)?

1. Zaleplon
2. Diazepam
3. Ramelteon
4. Pentobarbital

Answer 3

Ramelteon

Ramelteon is recommended for the treatment of insomnia. This drug is contraindicated for patients with COPD or sleep apnea. Zaleplon is a nonbenzodiazepine drug used for the treatment of insomnia. It is contraindicated in patients with drug allergy, glaucoma, or pregnancy. Diazepam is a benzodiazepine drug used for the treatment of sleep disorders. It is contraindicated in patients with drug allergy, glaucoma, or pregnancy. Pentobarbital is a barbiturate class of drug used as hypnotic, sedative, and anticonvulsant. It is contraindicated in patients with drug allergy, pregnancy, or severe kidney or liver disease.

Question 4

The primary health care provider has prescribed glycopyrrolate to a patient. Before administration, the nurse assesses the patient’s history. What conditions would be contraindications for the administration of this medication? Select all that apply.

1. Glaucoma
2. Bradycardia
3. Osteoarthritis
4. Ulcerative colitis
5. Gastroesophageal reflux disease

Answer 4

Glaucoma

Ulcerative colitis

Gastroesophageal reflux disease

Glycopyrrolate is an anticholinergic drug that is contraindicated in patients with glaucoma, ulcerative colitis, or gastroesophageal reflux disease, because it can worsen the symptoms of these diseases. Hence, to ensure drug safety, the nurse should determine whether the patient has these conditions before administering glycopyrrolate. Anticholinergic drugs are usually prescribed to patients with sinus bradycardia to increase the heart rate. Anticholinergic drugs do not interfere with the joint structure or function and can be safely prescribed to a patient with arthritis.

Question 5

The patient has been placed on an adrenergic-blocking drug and complains to the nurse of experiencing constipation. The nurse recognizes that this is indicative of which type of drug effect?

1. An anaphylactic reaction to the adrenergic-blocking drug
2. An interaction with another medication that she has taken
3. An expected adverse effect of the adrenergic-blocking drug
4. A reaction to a toxic dosage of the adrenergic-blocking drug

Answer 5

An expected adverse effect of the adrenergic-blocking drug

Constipation is an expected, though adverse, reaction to the adrenergic-blocking drugs. Constipation does not indicate an anaphylactic reaction, a drug interaction, or a toxic dosage of the drug.

Question 6

While completing an admission assessment, the nurse assesses that a patient recently diagnosed with hypertension experiences dizziness when standing. Which question is a priority for the nurse to ask the patient?

1. “How much have you had to drink today?”
2. “What medications are you currently taking?”
3. “Do you have air conditioning in your home?”
4. “Have you been to the sauna in the past 24 hours?”

Answer 6

“What medications are you currently taking?”

Adrenergic-blocking agents can be prescribed for hypertension and have side effects such as dizziness and syncope. Since the patient was recently diagnosed with hypertension, the patient has most likely been prescribed new medication, such as an adrenergic-blocking agent. Assuming the patient has been drinking alcohol is not the most important and relevant question at this point. If the patient has been prescribed an adrenergic-blocking medication, the sauna or excessive heat could exacerbate the symptoms of vasodilation. The nurse should first determine exactly what medications the patient is taking.

Question 7

Which drug is the only muscle relaxant that acts directly on the skeletal muscle?

1. Baclofen
2. Diazepam
3. Dantrolene
4. Cyclobenzaprine

Answer 7

Dantrolene

Dantrolene works directly on the skeletal muscle by suppressing the release of calcium from the sarcoplasmic reticulum to ease contractions. The remaining medications are centrally acting muscle relaxants that work by means of central nervous system depression. Baclofen is considered to be a muscle relaxant that acts in the area of the central nervous system. Diazepam is a type of barbiturate. Cyclobenzaprine falls under the category of tricyclic antidepressants.

Question 8

A patient is prescribed tolterodine. What should the nurse assess to determine the therapeutic effect of this medication?

1. Increased heart rate
2. Decreased urination
3. Increased blood pressure
4. Decreased bowel movements

Answer 8

Decreased urination

Tolterodine is administered to treat overactive bladder. Decreased urination is a therapeutic effect. Heart rate, blood pressure, and bowel movements are not measures of the therapeutic effect of tolterodine.

Question 9

Which cholinergic medication is prescribed to a patient who is unable to void after surgery?

1. Donepezil
2. Cevimeline
3. Bethanechol
4. Succinylcholine

Answer 9

Bethanechol

Bethanechol is a direct-acting cholinergic drug that is used to treat atony of the bladder. It is the only direct-acting cholinergic drug that is administered orally. Donepezil, cevimeline, and succinylcholine are not used to treat atony of the bladder. Donepezil is an indirect-acting cholinergic drug that is used to treat Alzheimer’s disease. Cevimeline is a direct-acting cholinergic drug used in the treatment of xerostomia (dry mouth) due to Sjögren’s syndrome. Succinylcholine is used in general anesthesia as a neuromuscular blocker.

Question 10

Which medication is used in the treatment of hypertension?

1. Tegretol
2. Tapazole
3. Topamax
4. Toprol-XL

Answer 10

Toprol-XL

The Food and Drug Administration has reported errors in prescribing and dispensing involving a mix-up between Topamax, which is indicated for the treatment of epilepsy and prophylaxis of migraines, and Toprol-XL, which is used for the treatment of hypertension and heart failure, as well as the long-term treatment of angina pectoris. Other errors have occurred when Toprol-XL and Tegretol, a drug used for various types of seizures and trigeminal neuralgia, have been confused. Tapazole is used to treat hyperthyroidism.

Question 11

During a cardiopulmonary resuscitation emergency, the nurse expects to administer which injectable, fast-acting medication?

1. Salmeterol
2. Epinephrine
3. Naphazoline
4. Oxymetazoline

Answer 11

Epinephrine

Epinephrine is administered in emergency situations and is one of the primary vasoactive drugs used in many advanced cardiac life support protocols. Naphazoline and oxymetazoline are administered intranasally to ease congestion. Naphazoline may also be used as an ophthalmic medication. Salmeterol is given via the respiratory tract because of its affinity for beta2 receptors that act on the lungs.

Question 12

The nurse is teaching a group of nursing students about the stages of non–rapid eye movement (non-REM) sleep. Which is the third stage of sleep?

1. Dozing
2. Relaxation
3. Deep sleep
4. Sleepwalking

Answer 12

Deep sleep

Deep sleep is the third stage of sleep. The person finds it difficult to wake, and the respiratory rate, pulse rate, and blood pressure may decrease. Dozing is the first stage of sleep. The person has feelings of drifting off to sleep. Relaxation is the second stage of sleep. The person can easily be awakened. In the fourth stage of sleep, it is very difficult to wake the person up, and sleepwalking may occur during this stage.

Question 13

What is the objective of administering phenylephrine as an adjunct to local anesthesia?

1. Bradycardia
2. Tachycardia
3. Vasodilation
4. Vasoconstriction

Answer 13

Vasoconstriction

Phenylephrine is an alpha1 agonist that is administered to produce vasoconstriction in regional anesthesia in order to slow absorption and prolong the effects of the anesthesia. It is not given for its effects on heart rate.

Question 14

A patient reports unusual sleep patterns and lack of sleep. What is the best nonpharmacologic patient teaching the nurse can provide to reset the patient’s internal clock?

1. Avoiding alcohol at bedtime
2. Avoiding tobacco at bedtime
3. Sleeping more during the day
4. Establishing a set sleep pattern

Answer 14

Establishing a set sleep pattern

Establishing a set sleep pattern with a time to go to bed at night and a regular time to get up in the morning helps reset the internal clock. Consuming alcohol results in fragmented sleep. Using tobacco at bedtime disturbs the sleep pattern. Too much sleep may lead to fragmented sleep patterns and shallow sleep.

Question 15

The patient is currently taking carvedilol. The patient tells the nurse, “Can you double-check the dosage of my medication for me? The doctor has doubled the dose of my medication, and this must be a mistake.” The nurse frames the response to the patient based on which knowledge?

1. The dose of the drug can be increased in increments weekly as tolerated.
2. The dose of the drug should never be changed from the initial starting dose.
3. The dose of the drug can be doubled every 2 weeks to the highest dose tolerated.
4. The dose of the drug can be changed slightly from the starting dose, but very seldom.

Answer 15

The dose of the drug can be doubled every 2 weeks to the highest dose tolerated.

The dose of the medication can be doubled every 2 weeks until the highest tolerated dose is reached for a maximum of 50 mg/day. This can be increased to 100 mg/day if the patient has heart failure and weighs over 85 kg.

Question 16

The patient has been ordered two drugs of the same class to be used for treatment of asthma. The patient asks the nurse, “Why do I have to use more than one medication to treat this? Isn’t one enough?” What is the nurse’s most appropriate response?

1. “You need to ask your health care provider questions like that.”
2. “I will arrange for the pharmacist to do a presentation for you.”
3. “No, in this case, one drug is not enough to do what’s needed for you.”
4. “Sometimes use of more than one drug will give a combined therapeutic effect.”

Answer 16

“Sometimes use of more than one drug will give a combined therapeutic effect.”

Although the patient can gain information from both the health care provider and the pharmacist, the nurse should explain that a better therapeutic response can be gained from use of more than one drug.

Question 17

Which drug is used as an antidote for overdose of oral benzodiazepine or excessive intravenous sedation?

1. Flumazenil
2. Olanzapine
3. Furosemide
4. Activated charcoal

Answer 17

Flumazenil

An antidote is a medication given to reduce the symptoms of drug overdose or toxicity. Flumazenil slightly reverses the adverse effects of benzodiazepines. Olanzapine may interact with benzodiazepines when administered simultaneously. However, olanzapine is not an antidote for benzodiazepines. Furosemide is commonly used to eliminate barbiturates by promoting diuresis. Activated charcoal is administered for an overdose of barbiturates. It prevents liver damage by quickly eliminating the barbiturates from the body.

Question 18

What are the uses of cholinesterase inhibitors? Select all that apply.

1. To diagnose and treat myasthenia gravis
2. To be used as an antidote in biochemical warfare
3. To relieve severe constriction of the bronchioles
4. To be used as an antidote to tricyclic antidepressant toxicity
5. To treat a patient with a prolonged history of sleep deprivation

Answer 18

To diagnose and treat myasthenia gravis

To be used as an antidote in biochemical warfare

To be used as an antidote to tricyclic antidepressant toxicity

When used therapeutically, cholinesterase inhibitors, such as physostigmine, affect the muscarinic receptors and nicotinic receptors of the neuromuscular junction, thereby helping restore acetylcholine to the level needed for nerve impulse transmission. Because patients with myasthenia gravis lack sufficient release of acetylcholine at the neuromuscular junction, administration of physostigmine helps improve muscle strength by decreasing the destruction of acetylcholine. Due to its capacity to restore the acetylcholine level, this medication is useful as an antidote to biochemical warfare involving anticholinergic agents, as well as in tricyclic antidepressant toxicity. Physostigmine therapy is contraindicated in patients with insomnia or bronchoconstriction.

Question 19

Which medication is a noncholinergic drug used in the treatment of Alzheimer’s disease?

1. Atropine
2. Memantine
3. Donepezil
4. Rivastigmine

Answer 19

Memantine

Memantine is a noncholinergic drug that is used in the treatment of Alzheimer’s disease. It helps by blocking the stimulation of the N-methyl-D-aspartate receptors. Atropine, donepezil, and rivastigmine are all cholinergic drugs. Atropine is a competitive antagonist to the acetylcholine receptor; it is used as the treatment for cholinergic overdose. Donepezil is usually prescribed for Alzheimer’s patients. It inhibits acetylcholinesterase and increases the levels of acetylcholine. Rivastigmine is also a cholinesterase inhibitor that causes an increase in acetylcholine levels.

Question 20

A patient with multiple sclerosis participates in a rehabilitation program. The patient takes baclofen to help manage muscle spasticity. How will the baclofen interfere with the patient’s rehabilitation activities?

1. By causing gastrointestinal distress
2. By impairing coordinated movements
3. By increasing pain associated with activities
4. By producing drowsiness, lethargy, and blurred vision

Answer 20

By producing drowsiness, lethargy, and blurred vision

Baclofen falls under the barbiturates category, and drowsiness, lethargy, and blurred vision are adverse effects of baclofen, which will make it difficult for this patient to participate actively in rehabilitation activities. Gastrointestinal distress is one of the adverse effects of niacin, which is an antilipemic drug. Another adverse effect of antilipemic drugs is increased muscle pain associated with activity. Impaired physical mobility is an adverse effect related to antiemetic and antinausea drugs.

Question 21

Which are contraindications for administration of cholinergic-blocking medications? Select all that apply.

1. Renal failure
2. Peptic ulcers
3. Down syndrome
4. Bronchial asthma
5. Recent heart surgery

Answer 21

Renal failure

Down syndrome

Recent heart surgery

Cholinergic-blocking medications are contraindicated in patients with renal failure, Down syndrome, or recent heart surgery. They may increase urinary retention and may further worsen renal failure. Cholinergic-blocking drugs act on the muscarinic receptors and cause delusions and decreased muscle rigidity. This may further worsen the symptoms of Down syndrome. In patients with a recent heart surgery, anticholinergics alter the heart rate, which in turn increases the workload on the heart. Anticholinergics are beneficial for patients with peptic ulcers and bronchial asthma, because they decrease the gastric secretions and dilate the bronchioles.

Question 22

Why is diazepam used for the treatment and prevention of alcohol withdrawal symptoms?

1. Because of its amnesic properties
2. Because of its inhibition of nerve impulse transmission
3. Because of its suppression of gamma-aminobutyric acid (GABA) receptors
4. Because of the presence of benzodiazepine receptors adjacent to the receptors responsible for alcohol addiction

Answer 22

Because of the presence of benzodiazepine receptors adjacent to the receptors responsible for alcohol addiction

Benzodiazepine receptors in the central nervous system (CNS) are present in the same area as the receptors responsible for alcohol addiction. Diazepam blocks the receptors responsible for alcohol addiction and helps treat and prevent alcohol withdrawal symptoms. Benzodiazepines, not diazepam, have amnesic properties that are used for moderate sedation. Barbiturates such as pentobarbital inhibit the transmission of nerve impulses. Diazepam does not to inhibit nerve impulse transmission. Benzodiazepines, not diazepam, suppress the activity of GABA receptors to facilitate sleep during the treatment of insomnia.

Question 23

The nurse recognizes that which condition is an indication for the use of norepinephrine?

1. Asthma
2. Anaphylaxis
3. Hypertension
4. Cardiogenic shock

Answer 23

Cardiogenic shock

Norepinephrine is directly metabolized to dopamine and is used primarily in the treatment of hypotension and shock. The beta2 agonists are helpful in treating conditions such as asthma. Hypertension is a contraindication to the use of norepinephrine. Epinephrine is used in the treatment of anaphylaxis.

Question 24

Which assessment finding should the nurse interpret as a therapeutic effect of atropine?

1. Lethargy
2. Hypertension
3. Increased heart rate
4. Constriction of pupils

Answer 24

Increased heart rate

Atropine, a muscarinic antagonist, works primarily on the heart, exocrine glands, smooth muscle, and eyes; it produces an increased heart rate. Atropine is likely to cause mydriasis. Lethargy is not a therapeutic effect of atropine. Because there is no parasympathetic innervation to muscarinic receptors in blood vessels, atropine has no effect on vascular smooth muscle tone and therefore no effect on blood pressure.

Question 25

Before administering an adrenergic agonist, what is the most important assessment for the nurse to complete?

1. Skin integrity
2. Temperature
3. Blood pressure
4. Respiratory rate

Answer 25

Blood pressure

An adrenergic agonist causes vasoconstriction, leading to high blood pressure. Blood pressure is the most important assessment because of the detrimental effects of high blood pressure, such as stroke, which can be life threatening. Skin integrity, temperature, and respiratory rate are not directly affected by adrenergic agonists.

Question 26

Which drug may be administered to a patient who has a tricyclic antidepressant overdose?

1. Tacrine
2. Carbachol
3. Memantine
4. Physostigmine

Answer 26

Physostigmine

Physostigmine is an indirect-acting anticholinesterase drug that can be used to treat a tricyclic antidepressant overdose condition. Tacrine is an indirect-acting drug that is used to treat Alzheimer’s disease. Carbachol is a direct-acting drug that is used to lower intraocular pressure. Memantine is used to treat Alzheimer’s dementia.

Question 27

The patient verbalizes understanding of the nurse’s teaching of adrenergic-blocking medication side effects when what statement is made?

1. “I’ll tell my health care provider if I feel tired in the evenings.”
2. “I will notify the health care provider if I gain 5 pounds in a week.”
3. “I should report to urgent care if I feel dizzy when I stand up too fast.”
4. “I’ll call my health care provider if I lose more than 1 pound in a month.”

Answer 27

“I will notify the health care provider if I gain 5 pounds in a week.”

While taking adrenergic-blocking medications, encourage the patient to contact the prescriber if he experiences palpitations, chest pain, confusion, weight gain (2 or more pounds in 24 hours or 5 pounds or more in 1 week), dyspnea, nausea, or vomiting. Other problems to report include swelling in the feet and ankles, shortness of breath, excessive fatigue, dizziness, and syncope. Excessive fatigue should be reported, not just feeling tired in the evenings. The patient should be taught to change positions slowly to avoid dizziness, which is a side effect, but not one that requires urgent care.

Question 28

What are the side effects of scopolamine? Select all that apply.

1. Dry mouth
2. Drowsiness
3. Blurred vision
4. Altered mental status
5. Respiratory depression

Answer 28

Dry mouth

Drowsiness

Blurred vision

Scopolamine is a cholinergic blocker that reduces secretions and causes dry mouth. Scopolamine affects the central nervous system and causes drowsiness. The muscles in the pupil dilate from the cholinergic-blocking effect of scopolamine, resulting in blurred vision. An altered mental status and respiratory depression are not effects of scopolamine.

Question 29

What instructions should the nurse give a patient who has constipation from prolonged use of anticholinergic medications? Select all that apply.

1. “Get adequate rest.”
2. “Increase your daily intake of fluids.”
3. “Include nuts and legumes in your diet.”
4. “Increase the amount of fiber in your diet.”
5. “Take fiber supplements such as psyllium.”

Answer 29

“Increase your daily intake of fluids.”

“Increase the amount of fiber in your diet.”

“Take fiber supplements such as psyllium.”

Constipation may be managed by the increased dietary intake of fluids and fiber and/or the use of over-the-counter fiber-containing supplements, such as psyllium products. Adequate water intake helps to lubricate the feces and aid its movement through the intestines. High intake of fiber-rich foods such as vegetables and fruits also relieves constipation, because they help to stimulate the bowels. Psyllium products have high fiber content and are thus recommended for constipation. The nurse should not advise the patient to rest and should instead advise the patient to do regular exercise. The nurse should not advise the patient to eat nuts and legumes, because they cause bloating and constipation.

Question 30

Which is a side effect of the nonbenzodiazepine drug zolpidem?

1. Bedwetting
2. Sleepwalking
3. Increased perspiration
4. Increased body weight

Answer 30

Sleepwalking

Benzodiazepines induce daytime sleeping in a few cases. To reduce the daytime sleep, these patients may be prescribed zolpidem, which is a nonbenzodiazepine drug. This drug is known to cause sleepwalking (somnambulation) as a side effect. Bedwetting is more related to neurologic problems and is not an effect of nonbenzodiazepines. Perspiration and body weight are not affected by nonbenzodiazepine therapy.

Question 31

Which medication is used in the treatment of angina?

1. Propofol
2. Pravastatin
3. Propranolol
4. Propoxyphene

Answer 31

Propranolol

Propranolol may be used to treat angina. Propofol is a central nervous system depressant that is used in inducing or maintaining anesthesia. Pravastatin is used for hyperlipidemia. Propoxyphene is an opioid that is used to treat mild to moderate pain.

Question 32

Which medication is an example of a direct-acting sympathomimetic?

1. Ephedrine
2. Epinephrine
3. Amphetamine
4. Phenylephrine

Answer 32

Epinephrine

Epinephrine is a direct-acting sympathomimetic. Ephedrine is a mixed-acting adrenergic drug. Amphetamine is an indirect-acting sympathomimetic. Phenylephrine is a selective agonist.

Question 33

The nurse should recognize that a 68-year-old man taking tamsulosin is at risk for developing severe hypotension if he does what?

1. Continues his daily exercise routine
2. Also takes medication for erectile dysfunction
3. Sits at the bedside for 1 minute before standing
4. Consumes his usual one alcoholic beverage a day

Answer 33

Also takes medication for erectile dysfunction

Flomax is an alpha blocker that results in vasodilation and increased urinary flow. Medications for erectile dysfunction also cause vasodilation, which can result in severe hypotension. Changing positions slowly is appropriate when taking a medication that causes vasodilation. Continuing daily exercise and consuming one alcoholic beverage a day are not as concerning as risks for severe hypotension.

Question 34

What should the nurse teach a patient about potential effects of a newly prescribed cholinergic-blocking drug?

1. “The drug will decrease muscle rigidity.”
2. “The drug will cause a very slow heart rate.”
3. “You may have problems with urinary retention.”
4. “You will have increased saliva production and sweating.”

Answer 34

“You may have problems with urinary retention.”

Cholinergic-blocking drugs relax the bladder detrusor muscle and increase constriction of the internal sphincter; these two effects may result in urinary retention. When given in small doses, the anticholinergics decrease muscle rigidity and tremors and thus are prescribed for patients with Parkinson’s disease. These drugs inhibit the vagus nerve, increasing the heart rate. Anticholinergic drugs inhibit the parasympathetic nervous system, and thereby decrease salivation and sweating.

Question 36

Which is the characteristic feature of rapid eye movement (REM) rebound sleep?

1. Bedwetting
2. Sleepwalking
3. Vivid dreams
4. Daytime fatigue

Answer 36

Vivid dreams

REM rebound is an abnormally large amount of REM sleep that often leads to frequent and vivid dreams. Bedwetting and sleepwalking may occur in stage 4 non-REM sleep. At this stage, it is very difficult to wake a person. Daytime fatigue occurs in cases of REM interference, which is a reduction in the cumulative amount of REM sleep as a result of prolonged sedative-hypnotic use.

Question 37

The nurse recognizes that the patient who is taking an adrenergic-blocking drug understands the importance of avoiding other substances that may interact with the medication when the patient makes which statement?

1. “I should limit my fluid intake while taking this medication.”
2. “I should avoid drinking my morning coffee while taking this drug.”
3. “There’s no need to stop eating chocolate while I’m on this medication.”
4. “One glass of red wine with meals will not interfere with the medication.”

Answer 37

“I should avoid drinking my morning coffee while taking this drug.”

Caffeine, such as that in coffee and chocolate, should be avoided while on the medication. Alcohol ingestion should be avoided because it causes vasodilation, increasing the risk of hypotension. Caffeine should be avoided because it can further irritate the cardiac and central nervous systems. The patient should increase her fluid intake to prevent constipation.

Question 38

The nurse knows that which is an effect of beta1-adrenergic receptor stimulation?

1. Mydriasis
2. Ejaculation
3. Vasoconstriction
4. Increased renin secretion

Answer 38

Increased renin secretion

Beta1-adrenergic receptor stimulation causes increased renin secretion. Mydriasis, ejaculation, and vasoconstriction are the result of alpha 1-adrenergic receptor stimulation.

Question 39

Before starting therapy with pyridostigmine, the nurse assesses the patient’s history for which conditions? Select all that apply.

1. Asthma
2. Emphysema
3. Hypothyroidism
4. Psoriatic arthritis
5. Coronary artery disease

Answer 39

Asthma

Coronary artery disease

Contraindications to the drugs used to treat myasthenia gravis include known drug allergy, prior severe cholinergic reactions, asthma, gangrene, hyperthyroidism, cardiovascular disease, and mechanical obstruction of the gastrointestinal (GI) or gastrourinary tracts. Adverse effects include GI upset and excessive salivation. Interacting drugs include the anticholinergic drugs, which counteract the therapeutic effects of indirect-acting cholinergic drugs. The nurse does not need to assess for emphysema, hypothyroidism, and psoriatic arthritis before starting therapy with pyridostigmine.

Question 40

What happens when beta blockers are coadministered with anticholinergics?

1. Reduced beta blocker effect
2. Increased blood glucose levels
3. Enhanced effect of anticholinergics
4. Prolonged neuromuscular blockade

Answer 40

Reduced beta blocker effect

When beta blockers are coadministered with anticholinergics, antagonism occurs, leading to a reduced beta blocker effect. Anticholinergics do not affect blood glucose levels. Beta blockers do not enhance the effect of anticholinergics. A prolonged neuromuscular blockade occurs when beta blockers interact with neuromuscular-blocking drugs.

Question 41

Which medication is beneficial for reducing presurgery anxiety and decreasing the patient’s ability to remember an uncomfortable medical procedure?

1. Ramelteon
2. Midazolam
3. Alprazolam
4. Eszopiclone

Answer 41

Midazolam

Midazolam has the ability to induce amnesia, which temporarily reduces the patient’s memory. Ramelteon and eszopiclone are nonbenzodiazepine drugs that correct irregular sleep patterns but do not cause amnesia. Alprazolam is a benzodiazepine that reduces sleep irregularities but does not cause amnesia.

Question 42

A patient is to receive a total parenteral nutrition infusion over the next 24 hours. The bag contains 2000 mL. At what rate will the nurse program the infusion pump when setting up the infusion? ___ mL/hr

Answer 42

2000 mL ÷ 24 hours = 83.3, which rounds to 83 mL/hr. Infusion pumps deliver mL per hour.

Question 43

The nurse is teaching the patient about bismuth subsalicylate. What instruction is appropriate? Select all that apply.

1. “Your gums may turn blue.”
2. “Observe your stools for a change in color.”
3. “This medication may cause urinary retention.”
4. “If you feel dizzy, this is a potential side effect.”
5. “Call the health care provider if you have ringing in the ears.”

Answer 43

“Your gums may turn blue.”

“Observe your stools for a change in color.”

“Call the health care provider if you have ringing in the ears.”

Bismuth subsalicylate may cause increased bleeding time and cause the stools to become dark. The medication may cause the gums to turn blue. Tinnitus may also happen, as well as confusion, constipation, and a metallic taste. Urinary retention, headache, and dizziness may be caused by atropine, but not bismuth subsalicylate.

Question 44

The primary health care provider prescribes aprepitant to a pregnant patient to treat nausea and vomiting. After assessment, the nurse finds that the patient is taking warfarin. What will the nurse assess from the laboratory test reports in this situation?

1. Red blood cell count
2. Clotting time of blood
3. White blood cell count
4. Hemoglobin concentrations

Answer 44

Clotting time of blood

The nurse should assess clotting time from the laboratory test reports, based on which the international normalized ratio is established. In this situation, aprepitant interacts with warfarin and increases the clotting time of blood. Red blood cell count and hemoglobin concentrations should be assessed when pregnant patients are anemic. White blood cell count is assessed when pregnant patients are susceptible to infections.

Question 45

What is an appropriate guideline for the administration of peripheral parenteral nutrition?

1. The patient is dehydrated.
2. The patient needs high concentrations of dextrose.
3. The patient needs more than 2000 kcal/day of nutrients.
4. The patient will need supplementation for less than 2 weeks.

Answer 45

The patient will need supplementation for less than 2 weeks.

Peripheral parenteral nutrition (PPN) supplementation is utilized instead of central administration when the patient requires nutritional support for 14 days or less. Due to the size of the vein, the osmolarity of the fluid has to be low, and thus the patient cannot receive high-dextrose-containing formulas or high-caloric formulas. Dehydration is not an indication for PPN.

Question 46

Which medication can be prescribed for the treatment of hyperemesis gravidarum?

1. Ondansetron
2. Dronabinol
3. Dimenhydrinate
4. Diphenhydramine

Answer 46

Ondansetron

Vomiting and nausea during pregnancy is called hyperemesis gravidarum. Ondansetron is a serotonin blocker that blocks serotonin receptors in the vomiting center in the medulla and prevents emesis. It is prescribed for the treatment of hyperemesis gravidarum. Dronabinol, a tetrahydrocannabinoid class of drug, inhibits the activity of the reticular formation in the thalamus and cerebral cortex. It is prescribed for the treatment of nausea and vomiting induced by anticancer drugs. Diphenhydramine and dimenhydrinate are H1 receptor blockers preventing acetylcholine from binding to receptors in the vestibular nuclei. They are not generally prescribed to treat hyperemesis gravidarum.

Question 47

A patient with hypertension reports pain in the abdomen, for which the primary health care provider plans to prescribe antacids. Which assessment in the patient is most important in planning the medication regimen?

1. Duration of abdominal pain
2. Activity level of the patient
3. Previous and current prescriptions
4. Patient’s adherence to the treatment regimen

Answer 47

Previous and current prescriptions

The list of previous and current prescriptions may help the primary health care provider treat the gastrointestinal problem with drugs that have few or no interactions with the antihypertensive or other drugs being taken. The duration of abdominal pain would help assess the severity of the condition. The activity level of the patient would help determine the severity of the symptoms. The patient’s adherence to the treatment regimen will be an added advantage in treatment.

Question 48

Which complication does the nurse expect in a patient who is using calcium antacids for a prolonged period?

1. Diarrhea
2. Urticaria
3. Impotence
4. Kidney stone

Answer 48

Kidney stone

Prolonged use of calcium antacids may cause accumulation of calcium and result in a kidney stone. Antacids containing magnesium may cause diarrhea. H2 receptor antagonists may cause urticaria and impotence.

Question 49

A patient admitted with head and facial trauma is started on peripheral parenteral nutrition. What is the rationale for this route of therapy?

1. It is the quickest type of nutritional support.
2. It is the most comfortable type of nutritional support.
3. No order is necessary for this type of nutritional support.
4. It is being utilized because nasogastric intubation should not be utilized.

Answer 49

It is being utilized because nasogastric intubation should not be utilized.

When possible, the gastric route of nutrition is utilized for patients with an intact gastric system. In this case, a nasogastric tube cannot be utilized due to head and facial trauma. Peripheral parenteral nutrition is the next desired route of short-term nutritional support. It is not being used because it is quick, comfortable, or does not require an order.

Question 50

Which category of laxatives is contraindicated in elderly patients?

1. Emollient laxatives
2. Stimulant laxatives
3. Bulk-forming laxatives
4. Hyperosmotic laxatives

Answer 50

Hyperosmotic laxatives

With hyperosmotic laxatives (e.g., polyethylene glycol, lactulose, sorbitol, glycerin), assess baseline fluid and electrolyte levels to identify any deficits before use. Older adult patients react more adversely to this class of laxatives, so their use is to be avoided. Emollient, stimulant and bulk-forming laxatives are not contraindicated in elderly patients.

Question 51

An infant receiving nutritional supplements has diarrhea. What is the nurse’s best action?

1. Instruct the parents to stop the feedings.
2. Instruct the parents to increase water intake.
3. Ask the health care provider to change supplements.
4. Ask the health care provider to order antidiarrheal medication.

Answer 51

Ask the health care provider to change supplements.

The most common adverse effect of nutritional supplements is gastrointestinal intolerance, manifesting as diarrhea. Infant nutritional formulationsare most commonly associated with allergies and digestive intolerance. The nurse should ask the health care provider to change the supplement, because the infant could be allergic to the product. The parents should not stop the feedings or increase the water intake without notifying the health care provider. An antidiarrheal medication would not be the first choice for administration, because it would not stop the cause of the diarrhea.

Question 52

Which drug’s effect is reduced with concomitant administration of antacids?

1. Sulfonylureas
2. Benzodiazepines
3. Sympathomimetics
4. Quinolone antibiotics

Answer 52

Quinolone antibiotics

Antacids react with quinolone antibiotics and their gastrointestinal absorption is reduced. Antacids increase the gastric pH and increase the activity of sulfonylureas, benzodiazepines, and sympathomimetics.

Question 53

How do H2 receptor antagonists reduce the secretion of acids?

1. By blocking the H2 receptors
2. By stimulating gastrin receptors
3. By blocking acetylcholine receptors
4. By stimulating acetylcholine receptors

Answer 53

By blocking the H2 receptors

H2 receptor antagonists block H2 receptors and stop the secretion of acids by parietal cells. H2 receptor antagonists do not block acetylcholine receptors. They make parietal cells unresponsive to the stimulation of acetylcholine and gastrin receptors. H2 receptor antagonists do not directly affect gastrin and acetylcholine receptors.

Question 54

What is the reason for administering total parenteral nutrition through an intravenous route rather than administering enteral nutrition through a nasogastric tube?

1. It is less expensive.
2. It is easier to administer.
3. Nutrients are absorbed better.
4. It bypasses the gastrointestinal tract.

Answer 54

It bypasses the gastrointestinal tract.

Total nutrition through a central or peripheral line is administered to patients whose gastrointestinal system must be bypassed. Parenteral nutritional supplementation (intravenous administration) is the preferred method for patients who are unable to tolerate and/or maintain adequate enteral or oral intake. Instead of administration of partially digested nutrients into the gastrointestinal tract (as in enteral nutrition), vitamins, minerals, amino acids, dextrose, and lipids are administered intravenously directly into the circulatory system. This effectively bypasses the entire gastrointestinal system, which eliminates the need for absorption, metabolism, and excretion. It is not preferred because of decreased expense, ease of administration, or better nutrient absorption.

Question 55

Which antidiarrheal drug causes potential side effects of dry mouth, tachycardia, abdominal pain, and blurred vision?

1. Diphenoxylate with atropine
2. Cholestyramine with glipizide
3. Oral anticoagulant warfarin with adsorbents
4. Anticholinergics with opiates such as loperamide

Answer 55

Diphenoxylate with atropine

The combination of diphenoxylate and atropine in larger doses results in extreme anticholinergic effects such as dry mouth, abdominal pain, tachycardia, and blurred vision. Cholestyramine with glipizide results in decreased hypoglycemic effects. Oral anticoagulant warfarin with adsorbents causes increased bleeding time and bruises. Anticholinergics with opiates are used in severe cases of diarrhea.

Question 56

The nurse is caring for a patient who has a urinary tract infection. The primary health care provider prescribes ciprofloxacin and cimetidine for this patient. What instruction will the nurse give to this patient?

1. Take ciprofloxacin and cimetidine together.
2. Take ciprofloxacin first because it is the priority.
3. Take cimetidine first because it gives immediate relief.
4. Take ciprofloxacin and cimetidine at least 2 hours apart.

Answer 56

Take ciprofloxacin and cimetidine at least 2 hours apart.

Cimetidine is known to reduce the absorption of ciprofloxacin, thereby reducing its effects. Therefore the nurse should advise the patient to maintain a gap of at least 2 hours between the administration of these drugs. Treating only the infection with ciprofloxacin will still result in discomfort for the patient because of acidity. Taking both the drugs together would reduce the effect of ciprofloxacin and prolong the infection. Cimetidine will relieve acidity, but the more serious problem of the infection is still left untreated.

Question 57

Which drug works by blocking serotonin in the gastrointestinal tract, vomiting center, and chemoreceptor trigger zone?

1. Metoclopramide
2. Meclizine
3. Droperidol
4. Ondansetron

Answer 57

Ondansetron

Ondansetron is a serotonin blocker. Metoclopramide is a prokinetic drug, meclizine is an antihistamine, and droperidol is an antidopaminergic drug.

Question 58

A patient with a gastric ulcer is prescribed omeprazole 20 mg/day for 8 weeks. After an 8-week course of this drug, the patient reports having diarrhea. What could be the most likely cause of diarrhea in this patient?

1. Reduced appetite
2. Severe dehydration
3. Gastrointestinal bleeding
4. Gastrointestinal infection

Answer 58

Gastrointestinal infection

Prolonged use of omeprazole reduces the levels of gastric acids and increases the rate of infection, leading to diarrhea. A reduced appetite may lead to dietary deficiencies in the patient, but does not cause diarrhea. Diarrhea may cause dehydration; dehydration does not cause diarrhea. Gastrointestinal bleeding is associated with gastric ulcers, but does not cause diarrhea.

Question 59

What is the route of administration of glycerin, a hyperosmotic laxative?

1. Oral
2. Rectal
3. Intravenous
4. Intramuscular

Answer 59

Rectal

Glycerin suppositories are given rectally. These medications are not given via the oral, intramuscular, or intravenous routes because they may not show the desired therapeutic effect due to impaired absorption of the drug into the blood. They may also damage the gastric mucosa if given via the oral route.

Question 60

Which drug is utilized for patients with diarrhea?

1. Senna
2. Bisacodyl
3. Loperamide
4. Docusate sodium

Answer 60

Loperamide

Loperamide is an antidiarrheal drug. It acts by inhibiting both peristalsis in the intestinal wall and intestinal secretion, thereby decreasing the number of stools and their water content. Senna and bisacodyl are laxatives that are prescribed for patients with constipation. Docusate is used to soften stools.

Question 61

The nurse is caring for a patient who has been prescribed scopolamine for motion sickness. Which site is appropriate for application of the patch?

1. On the chest
2. On the shoulder
3. On the irritated skin
4. On a hairless area behind the ear

Answer 61

On a hairless area behind the ear

The scopolamine transdermal patch should be applied on an area of intact skin on the head behind the ear after cleaning and drying the area to reduce secretions. The patch may be dislodged if applied to irritated skin, the shoulder, or the chest. If the patch becomes dislodged, residual drug must be washed off and a fresh patch must be placed to produce the desired effect.