Units 5 & 7 Exam

Question 1

The nurse knows patient teaching has been successful when the patient states which of the following? Select all that apply

1) I should avoid taking with food even if my stomach is upset
2) I should let someone know if I get dizzy or have ringing in my ears
3) Diarrhea is common unless it is excessive, watery or bloody
4) Having mouth pain with white patches isn’t any cause for concer
5) I should report dizziness and palpitations as soon as possible

Answer 1

Answer: 2, 3, 5

Reasoning: Dizziness and tinnitus are symptoms of ototoxicity and should be reported; excessive, watery or bloody diarrhea can indicate suprainfection psuedomembranous colitis; dizziness and palpitations can indicate cardiac symptoms; macrolides can be taken with food to reduce GI symptoms; mouth pain with white patches indicates suprainfection with candidiasis

Question 2

A patient taking erythromycin complains of difficulty hearing, palpitations and excessive diarrhea. Which of the factors in her history may be a factor in her symptoms?

1) she takes her medication with a high protein supplement
2) she has a glass of grapefruit juice with her morning medications
3) she drinks a full glass of water before taking any medications
4) she likes to have green tea several times a day

Answer 2

Answer: She has a glass of grapefruit juice with her morning medications

Reasoning: grapefruit and grapefruit juice can increase adverse effects of macrolides

Question 3

Erythromycin is often used for:

1) Penicillin allergic patients
2) penicillin resistant pathogens
3) penicillin caused suprainfections
4) penicillin that has to be taken frequenty

Answer 3

Answer: Penicillin allergic patients

Question 4

Two patients taking antibiotics are both exhibiting similar symptoms of- severe headaches and dizziness. Both have hypotension. What is the most likely cause of these symptoms?

1) drinking alcohol
2) Cross allergy
3) Vomiting and diarrhea
4) viral infection

Answer 4

Answer: Drinking alcohol

Reasoning: these are symptoms of disulfiram-like reaction caused by ingesting alcohol while taking cephalosporins or sulfonamides

Question 5

You have just initiated an IV infusion of a cephalosporin when the patient begins to complain of difficulty breathing. What should the nurse to first?

1) Palpate the pateint’s abdomen
2) listen to breath sounds
3) call the charge nurse
4) contact the physician

Answer 5

Answer: Listen to breath sounds

Reasoning: Assessment data should always be obtained before further action can be taken

Question 6

A newly admitted patient has a history of hepatitis C and is currently on renal dialysis. Amoxicillin has been ordered. What is the nurses best response?

1) administer the medication as ordered
2) clarify the order with the pharmicist
3) contact the provider about the history
4) assess the patient’s renal lab work

Answer 6

Answer: contact the provider about the history

Reasoning: it would be appropriate to verify the order with the physician

Question 7

A patient taking a sulfonamide and oral birth control should be instructed to:

1) quit taking birth control pills asap
2) avoid pregnancy at all cost
3) double up on her birth control pills
4) use another form of birth control

Answer 7

Answer: Use another form of birth control

Reasoning: antibiotics decrease effectiveness of oral contraceptives

Question 8

You have just removed an IV from a patient, in preparation for discharge, who had been receiving a sulfonamide and the IV site took a long time to quit bleeding. What is your initial action?

1) Review the patient’s lab work
2) Continue the discharge instructions
3) Report the incident to the physician
4) ask if the IV site had been bumped recently

Answer 8

Answer: Review the patient’s lab work

Reasoning: lab work may indicate a decrease in platelet count as a result of blood dyscrasias caused by sulfonamides

Question 9

A patient taking sulfonamides reports a rash. What question would elicit the most useful information?

1) How long have you had the rash?
2) Where is the rash located
3) What does the rash look like
4) Is there any pain or itching

Answer 9

Answer: What does the rash look like

Reasoning: “What does the rash look like?” will help differentiate between a rash from a typical allergy vs a blistery rash representing Steven’s Johnson Syndrome. This will allow the nurse to determine a course of action. While both require reporting to the physician, SJS is an emergency!

Question 10

A patient taking vancomycin begins to demonstrate a decrease in urine output. Which assessment should the nurse perform first?

1) Have the physician order renal labwork
2) Determine the patient’s fluid intake
3) Discontinue the medication asap
4) Start an IV infusion

Answer 10

Answer: Determine the patient’s fluid intake

Reasoning: while vancomycin can be nephrotoxic, a thorough assessment should be done to determine the cause of the patient’s decreased output. A decrease in intake due to illness would be the simplest cause.

Question 11

Thirty minutes after an infusion of vancomycin has begun, the patient complains of feeling flushed and faint. What is the nurses best action?

1) Stop the infusion at once
2) Decrease the rate of the infusion
3) Get an order for a different antibiotic
4) administer a vasoconstrictor to brin up the blood pressure

Answer 11

Answer: Decrease the rate of the infusion

Reasoning: rapid infusion is the cause of the symptoms of red-person syndrome, decreasing the rate should resolve the symptoms

Question 12

A patient using acyclovir for herpes complains of increased burning and itching at the lesion site. What is the best instruction to give to the patient?

1) applying ice to the site will help
2) report the symptoms to the physician
3) these symptoms are usually temporary
4) be sure to use gloves to apply the medication

Answer 12

Answer: these symptoms are usually temporary

Reasoning: these are common and temporary symptoms, ice could be helpful or could cause tissue damage, the physician does not need to be apprised of the symptoms unless the do not go away, using gloves is necessary but does not contribute to symptoms

Question 13

Metronidazole, while commonly used for protazoal infections of the genitourinary system, may also be used for?

1) psuedomembranous colitis
2) candidiasis albacans
3) helicobacter pylorus
4) meningococcal meningitis

Answer 13

Answer: psuedomembranous colitis

Question 14

Which of the following are patient teaching needs for metronidazole? Select all that apply

1) Report seizures immediately
2) Report darkening of the urine
3) Take the medication between meals
4) avoid the use of alcohol

Answer 14

Answer: 1, 3, 4

Question 15

A patient taking ketaconazole should be instructed to take antacids when:

1) 2 hours after
2) at the same time
3) avoid antacids
4) take with food instead

Answer 15

Answer: 2 hours after

Reasoning: antacids greatly reduce the absorption of ketoconazole and should be taken 2 hours after ketaconazole

Question 16

A patient taking rifampin should be asked about: Select all that apply

1) Use of soft contacts
2) contraceptive use
3) history of alcoholism
4) allergy to penicillin

Answer 16

Answer: 1, 2, 3

Question 17

A patient taking isoniazid complains of right upper abdominal pain and numbness, tingling of the hands and feet. What are appropriate nursing responses to these complaints? Select all that apply

1) Report dizziness and ataxia to provider
2) inquire about alcohol intake over last few months
3) encourage patient to report symptoms to physician
4) Instruct that a pyridoxine supplement may help with numbness/tingling
5) tell patient to increase fiber and fluid

Answer 17

Answer: 2, 3, 4

Reasoning: while all are appropriate for patients taking isoniazid, reporting dizziness/ataxia and increasing fiber/fluid will not impact liver damage or peripheral neuropathy

Question 18

Appropriate teaching for a patient taking prednisone would include: Select all that apply

1) increase intake of sodium
2) take with food or milk
3) never stop abruptly
4) report edema

Answer 18

Answer: 2, 3, 4

Reasoning: patients taking prednisone, a glucocorticoid, are at risk for hypernatremia and so excess sodium is not needed. Ask yourself why the others are true.

Question 19

Your patient taking prednisone asks why he needs to do weight bearing exercises and take extra calcium. What is you best response?

1) prednisone can cause bones to demineralize
2) prednisone can cause increased cavities
3) prednisone can cause muscle wasting
4) prednisone can cause cramping

Answer 19

Answer: prednisone can cause bones to demineralize

Question 20

Instructions to reduce side effects of moon face, adipose tissue build up between the scapula and truncal obesity would include: Select all that apply

1) use alternate day dosing
2) take lowest possible dose
3) stop abruptly when symptoms start
4) take dose in the evening before bed

Answer 20

Answer: 1, 2

Reasoning: these are symptoms of Cushings syndrome and result from over use of glucocorticoids

Question 21

Which of the following are results of prednisone use? select all that apply

1) hyperglycemia
2) hyperkalemia
3) hypercalcemia
4) hypernatremia

Answer 21

Answer: 1, 4

Question 22

A young adult female is taking phenytoin. What is the most important instruction to give?

1) keep scheduled appointments for lab
2) use a soft bristled tooth brush
3) report excessive drowsiness
4) avoid pregnancy

Answer 22

Answer: avoid pregnancy

Reasoning: all are appropriate instructions, phenytoin is pregnancy class D and so pregnancy should be avoided.

Question 23

Which of the following are instructions related to safety concerns in the use of carbamazepine? Select all that apply

1) give as much of dose as possible at night
2) avoid grapfruit and grapefruit juice
3) report any rash to provider
4) instruct on use of sunscreen
5) encourage daily walks

Answer 23

Answer: 1,2,3,4

Reasoning: giving dose at night will reduce daytime drowsiness, grapefruit will increase drug levels increasing side effects, there is a great risk of severe skin reactions and photosensitivity could lead to severe burns

Question 24

Which action by the patient taking selegiline requires the nurse to intervene?

1) taking the medication with the noon meal
2) contacts provider before taking new medications
3) takes time getting out of bed
4) avoids bananas, avocados and pepperoni

Answer 24

Answer: Taking the medication with the noon meal

Reasoning: selegiline should be taken before the morning meal without food or drink for 5 minutes before and after

Question 25

What is the best response when a patient complains of little benefit of the levodopa/carbidopa they have been taking for 3 months?

1) there is probably something about the way you are taking it
2) Levodopa doesn’t work for everyone and maybe not for you
3) Maybe you should take it all at once rather than in divided doses
4) It often takes 6 months for full response to be seen

Answer 25

Answer: It often takes 6 months for full response to be seen

Question 26

The wife of a patient taking levodopa/carbidopa states the patient has recently been having tics in his face and of his lips and tongue. The nurse’s best response is:

1) Ask when symptoms start in relation to time dosage taken
2) Instruct the wife that this is most likely advancement of the disease
3) the dosage of levodopa/carbidopa probably needs to be increased
4) encourage the patient to begin a relaxation technique when symptoms start

Answer 26

Answer: Ask when symptoms start in relation to time dosage taken

Reasoning: these “tics” are dyskinesias most likely caused by the levodopa. knowing when they start in relation to time of levodopa dose can assist in determining if levodopa is the cause and possible actions. altered movement in Parkinson’s is more of the limbs and exhibited as tremors. since it is caused by levodopa increasing the dose would not be appropriate. because the movements are involuntary, relaxation techniques will not be effective

Question 27

Which of the following nursing interventions reduce the risk of falls in the patient taking pramipexole? select all that apply

1) Monitor blood pressure
2) Monitor for muscle weakness
3) monitor for nausea
4) monitor for sleep attacks

Answer 27

Answer: 1, 2, 4

Reasoning: orthostatic hypotension, muscle weakness and sleep attacks all increase risk for falls

Question 28

Which of the following should be done prior to administration of calcitonin? select all that apply

1) Intradermal allergy test
2) assess nostrils for irritation
3) have patient assume a side lying position
4) calcium free diet for two weeks before starting

Answer 28

Answer: 1, 2

Reasoning: hypersensitivity reactions/anaphylaxis is a life threatening concern so allergy testing must be done before starting calcitonin. Nasal irritation will alter absorption and so should be assessed for before each use. position should be upright for nasal spray and can be any for subcutaneous. patients taking calcitonin need a diet high in calcium and vit D

Question 29

Patients taking calcitonin and not getting enough calcium in their diet will exhibit which of the following?

1) dyskinesias and unsteady gait
2) flaccid muscles and severe pain
3) seizures and numbness of the mouth
4) muscle spasms and tingling of fingers

Answer 29

Answer: muscle spasms and tingling of fingers

Reasoning: muscle spasms and tingling of the fingers/toes/mouth indicate hypocalcemia, a side effect of calcitonin since it moves calcium out of the blood and in to the bones

Question 30

Which of the following actions taken by a patient on alendronate would require further teaching by the nurse?

1) Lying down immediately after taking the medication
2) refusing an antacid at the same time as the medication
3) drinking a full glass of water with the medication
4) reading a pamphlet on the medication

Answer 30

Answer: Lying down immediately after taking the medication

Reasoning: patients taking alendronate need to be able to sit or stand for 30 minutes after taking the medication; antacids and milk (calcium) should be avoided at the same time as the alendronate; the medication should be taken with a full glass of water; by reading a pamphlet the patient is demonstrating there are no visual changes

Question 31

The patient taking dantrolene has been experiencing frequent falls. Which side effect of dantrolene is most likely the cause?

1) muscle weakness
2) visual changes
3) hearing loss
4) vertigo

Answer 31

Answer: muscle weakness

Reasoning: muscle weakness is the only side effect of dantrolene listed