E3 Questions

Question 1

What is the antidote for acetaminophen overdose?

Answer 1

Acetylcysteine (Mucomyst)

Question 2

RJ, a 70-year-old male, underwent abdominal surgery for resection of his colon. His surgeon prescribed morphine 10 mg q 3 to 4 hours PRN. RJ has not asked for pain medication. One day post-op you note he is restless, grimacing, and guarding his abdomen. He has refused to use the inspirometer or to cough/deep breathe. His vital signs show increased heart rate and Bp.

What is the significance of the signs & symptoms RJ is presenting?

Answer 2

Restless, grimacing, and guarding
Refused to use the inspirometer
Refused to cough/deep breathe
Increased heart rate and Bp

Question 3

(RJ) What patient education might you offer in order to encourage the patient to use the ordered pain medication?

Answer 3

Addiction risk: actual vs. myth
Therapeutic levels of medication
Positive relationship between healing time and adequate pain control
R.J. would be more comfortable and able to participate in the activities that are necessary to maintain a healthy state, such as deep breathing and coughing
Provide analgesic medication 30 minutes before encouraging R.J. to use the inspirometer

Question 4

Common opioid SE

Answer 4

Nausea and vomiting (particularly in ambulatory patients)
Generalized itching is common
without a rash and not associated with allergy or intolerance
Constipation
Orthostatic hypotension
Sedation
Respiratory depression
Urinary retention

Question 5

Opioid administration nursing assessments/interventions related to side effects

Answer 5

Monitor vital signs, sedation level, UO, pain level, bowel sounds, GI upset;
Use safety measures: siderails up, call light in reach, ambulate with assist
Stool softener
Monitor mental status, especially elderly!

Question 6

Your patient education has been effective! RJ has been requesting morphine every 3-4 hours and his pain level has been effectively managed. Day 3 post-op, the surgeon discontinues the morphine and orders hydrocodone bitartrate and acetaminophen (Norco 5/325) one or two every 4-6 hours PRN pain.
Why was there a pain medication order change?

Answer 6

Opioid orders are changed to prevent opioid dependency. By the third to the fifth day, pain should have lessened, and a less potent opioid or mixed drugs are usually prescribed

Question 7

When are opioid analgesics contraindicated and why?

Answer 7

• Patients with head injuries – may cause an increase in ICP
• Patients with shock – may cause hypotension
• Caution in patients with asthma – opiates decrease respiratory drive while increasing airway resistance
• Caution in patients with renal failure
• Contraindicated vs caution: Asthma and renal failure, can still be used with caution; need labs, assessment, etc.

Question 8

What medication(s) can be used for morphine overdose?

Answer 8

Naloxone (Narcan) is an opioid antagonist used to reverse opioid overdose
Opioid antagonists
Use
Antidote for opiate overdoses
Reverse effects of opiates, including respiratory depression, sedation, hypotension
Respiratory distress, respiratory depression
Opioid addiction: Naltrexone hydrochloride (ReVia)

Question 8

Headaches - What patient education can you provide?
What non-pharmacologic interventions can be done?

Answer 8

Headache Diary
First step in treatment of headaches!
Identifies triggers
Acute pain
Begin treatment at first sign of headache
Limit use of medications for acute pain to 2 days/week
Read Box 33.1 about medication overuse headaches
Non-pharmacologic treatments/interventions
Manage stress
Regular exercise
Meditation
Relaxation
Avoid triggers
Headache diary may help identify
Chocolate
Aged cheese
Red wine
Quiet, dark room
Ice

Question 8

A patient is admitted to the surgical unit after undergoing an exploratory laparotomy. Morphine sulfate has been ordered for pain control. Before administering morphine, it is most important for the nurse to assess the patient for

a. Respiratory disease
b. Hypothermia
c. Allergy to penicillin
d. Hypertension

Answer 8

Answer: respiratory disease
Rationale: Contraindications for morphine include severe respiratory disorders, increased intracranial pressure, and hypotension, inflammatory bowel disease

Question 9

A patient’s pain medication is changed from morphine sulfate to hydromorphone (Dilaudid). Which statement regarding hydromorphone (Dilaudid) does the nurse identify as being true?

a. Hydromorphone (Dilaudid) must be administered orally.
b. Hypertension is a common side effect.
c. Physical dependence does not occur with hydromorphone (Dilaudid) therapy.
d. Hydromorphone (Dilaudid) is more potent than morphine.

Answer 9

D. Hydromorphone (Dilaudid) is a semisynthetic opioid similar to morphine. The analgesic effect is approximately six times more potent than morphine. Patient safety! Check your dose!

Question 10

The nurse assesses a patient receiving morphine via a PCA pump. The patient has a respiratory rate of 8 breaths/min. The nurse anticipates administration of which of the following drugs?

a. Naloxone (Narcan)
b. Sumatriptan (Imitrex)
c. Nalbuphine HCl (Nubain)
d. Hydromorphone (Dilaudid)

Answer 10

A. Naloxone (Narcan)
Naloxone is a opiate antagonist and an antidote for opioid analgesic overdoses. Sumatriptan (Imitrex) is used for the treatment of migraine headaches; nalbuphine HCl (Nubain) and hydromorphone are opiates.

Question 11

The nurse identifies which of the following as a common side effect/adverse effect of morphine therapy?

a. Diarrhea
b. Hypertension
c. Urinary retention
d. Tachypnea

Answer 11

C. Urinary Retention
Urinary retention, constipation, hypotension, and bradypnea are common side effects of morphine. Diarrhea, hypertension, and tachypnea are not common side effects.

Question 12

A patient received morphine sulfate for severe pain. The nurse assesses the patient 20 minutes later. What is the best indication that the medication has been effective?

a. Patient verbalizes pain relief.
b. Patient has an increase in heart rate.
c. Patient is resting.
d. Patient has an increase in blood pressure.

Answer 12

A. patient verbalizes pain relief
Best source of evaluation of pain is the patient

Question 13

A patient who has recurrent migraine headaches is prescribed sumatriptan [Imitrex]. Which aspect of this patient’s history is of concern when taking this drug?
a. Diabetes
b. Asthma
c. Renal Disease
d. Coronary Artery Disease

Answer 13

D. Coronary artery disease
Serotonin receptor agonists can cause vasoconstriction and coronary vasospasm and should not be given to patients with coronary artery disease, current symptoms of angina, or uncontrolled hypertension. There is no contraindication for asthma, diabetes, or renal disease.

Question 14

A prescriber orders sumatriptan [Imitrex] for a patient for a migraine headache. Before administration of this drug, it would be most important for the nurse to assess whether the patient:
a. has taken ergotamine in the past 24 hours.
b. has taken acetaminophen in the past 3 hours.
c. has a family history of migraines.
d. is allergic to sulfa compounds.

Answer 14

A. has taken ergotamine in the past 24 hr
Sumatriptan, other triptans, and ergot alkaloids all cause vasoconstriction and should not be combined, or excessive and prolonged vasospasm could result. Sumatriptan should not be used within 24 hours of an ergot derivative and another triptan. A family history is important, but it is not vital assessment data as it relates to this scenario. Acetaminophen has no drug-to-drug interaction with sumatriptan. Sulfa is not a component of sumatriptan and therefore is not relevant.

Question 15

A patient with schizophrenia has been taking an antipsychotic drug for several days. The nurse enters the patient’s room to administer a dose of haloperidol [Haldol] and finds the patient having facial spasms. The patient’s head is thrust back, and the patient is unable to speak. What will the nurse do?
a. Discuss increasing the haloperidol dose with the provider.
b. Request an order to give levodopa.
c. Administer the haloperidol as ordered.
d. Request an order to give diphenhydramine.

Answer 15

D. Request an order to give diphenhydramine
An early reaction to antipsychotic drugs is acute dystonia. Initial treatment consists of an anticholinergic medication, such as diphenhydramine. Administering more antipsychotic medication would increase the symptoms and could be life threatening. Levodopa is not given for extrapyramidal symptoms, because it could counteract the beneficial effects of antipsychotic treatment.

Question 16

Why do patients who take antipsychotic drugs often take medications also used for Parkinson symptoms?

Answer 16

Many patients who take antipsychotic drugs experience extrapyramidal syndrome (EPS), a chronic neurologic disorder that affects the extrapyramidal motor track, resulting in tremors, masklike facies, rigidity, and shuffling gait. These symptoms result from dopamine being blocked.

Question 17

Terms to know: Dystonia, parkinsonism, akathisia, tardive dyskinesia

Question 18

What medications can be used to treat the symptoms of EPS? Specifically:
Acute dystonia
Akathisia
Tardive dyskinesia

Answer 18

Acute dystonia: Benztropine (Cogentin) – AntiParkinson’s drug , Diphenhydramine
Parkinsonism: Beztropine (Cogentin), Diphenhydramine, Amantadine
Akathisia: beta blocker (propranolol), benzodiazepine lorazepam (Ativan), Anticholinergic drugs
Tardive Dyskinesia (TD): Stop the antipsychotic, switch to different med (SGA with low risk of TD), Benzodiazepine, Valbenazine – newly approved for TD

Question 19

What is Neuroleptic Malignant Syndrome (NMS)?
What are symptoms?
How is it treated?

Answer 19

Rare, potentially fatal condition, Neuroleptic malignant syndrome is characterized by “lead pipe” rigidity, sudden high fever, and autonomic instability
Symptoms
Altered mental status, seizures
Muscle rigidity, sudden high fever
BP fluctuations, tachycardia, dysrhythmias
Rhabdomyolysis, acute renal failure
Respiratory failure, coma
Treatment: Immediate withdrawal of antipsychotics
Supportive measures: Hydration – IV fluids,
Hypothermic blankets
- Antipyretics, Benzodiazepines
Dantrolene (Dantrium):
Used to relax muscles and reduce heat production
Bromocriptine (Parlodel):
Dopamine receptor agonist, relieves CNS toxicity

Question 20

FGA have which of the following potential side effects? (select all that apply)
a. Dry mouth
b. Urinary urgency
c. Agranulocytosis
d. Prolonged QT Interval
e. Hypertension
f. Hyperactivity

Answer 20

Dry mouth – yes! r/t anticholinergic effect
Urinary urgency – no…urinary retention
Agranulocytosis – yes! Monitor CBC, s&sx of infection
Prolonged QT Interval – yes! EKG & K+ levels required before starting and during treatment with: chlorpromazine (Thorazine), haloperidol (Haldol), and thioridazine (Melleril)
Hypertension – no…postural hypotension
Hyperactivity – no …sedation, especially initially

Question 21

FGA’s more side effects

Answer 21

Sexual dysfunction – major reason for discontinuation; may switch to SGA
Increased Prolactin levels
May increase (not cause) growth of cancers – contraindicated with cancers affected by prolactin
Gynecomastia – men and women
Irregular menstrual cycle
Seizures
Reduces seizure threshold
Seizure medication adjustment may be needed

Question 22

A patient with schizophrenia has been taking an oral FGA for 1 week. The patient has been taking the drug daily in two divided doses. The individual complains of daytime drowsiness. The patient’s family reports a decrease in the person’s hostility and anxiety but states that the patient remains antisocial with disordered thinking. What will the nurse tell the patient and the family?
a. Intramuscular dosing may be needed
b. Some symptoms take months to improve
c. An increased dose of the drug may be needed
d. The entire dose may be taken at bedtime

Answer 22

B. some symptoms take months to improve
When patients begin therapy with antipsychotic medications, some symptoms resolve sooner than others. During the first week, agitation, hostility, anxiety, and tension may resolve, but other symptoms may take several months to improve. It is not necessary to increase the dose in the first week. IM dosing is indicated for patients with severe, acute schizophrenia and for long-term maintenance. Sedation is normal, and once an effective dose has been determined, the entire dose can be taken at bedtime, but not in the initial days of therapy.

Question 23

Why are liquids the preferred oral route for antipsychotics?

Answer 23

Absorption rate is faster with liquid and to avoid cheeking pills

Question 24

What else are benzodiazepines used for? (Klonopin + Restoril) What is given for an overdose?

Answer 24

Klonopin - Seizures
Restoril - Insomnia
Overdose: Flumazenil (romazicon)

Question 25

The nurse realizes more teaching is necessary when the 30-year-old patient taking lorazepam (Ativan) states

a. “I must stop drinking coffee and colas.”
b. “I can stop this drug after 3 weeks if I feel better.”
c. “I must stop drinking alcoholic beverages.”
d. “I should not become pregnant while taking this drug.”

Answer 25

B. “I can stop this drug after 3 weeks if I feel better”
Lorazepam should not be discontinued abruptly, but gradually, over a period of several days. Caffeine and alcohol should be avoided when taking lorazepam, a benzodiazepine. This drug should not be taken during pregnancy because of possible teratogenic effects.

Question 26

A young woman is being treated for psychosis with fluphenazine (Prolixin). Which sign would indicate the need to add an anticholinergic to the patient’s medication regimen?

a. A decrease in pulse and respiratory rate
b. Facial grimacing and tongue spasms
c. An increase in hallucinations
d. A decrease in the patient’s level of orientation

Answer 26

B. Facial grimacing and tongue spasms
Rationale: Pseudoparkinsonism, which resembles symptoms of Parkinson’s disease, is a major side effect of typical antipsychotic drugs such as fluphenazine (Prolixin). Anticholinergic medications may be used to control this side effect.

Question 27

A patient on risperidone (Risperdal) may be at increased risk for injury due to

a. increased potential for aspiration due to sedation.
b. increased risk for falls due to orthostatic hypotension.
c. increased risk for infection due to neutropenia.
d. increased risk for suicide due to changes in thought processes.

Answer 27

B. increased risk for falls die to orthostatic hypotension
Rationale: Orthostatic hypotension is one of the most common adverse reaction seen in patients treated with risperidone (Risperdal).

Question 28

Assessment findings for a patient with neuroleptic malignant syndrome (NMS) include

a. bradycardia.
b. hypothermia.
c. muscle weakness.
d. rhabdomyolysis.

Answer 28

D. Rhabdomyolysis
Rationale: NMS symptoms include muscle rigidity, sudden high fever, altered mental status, blood pressure fluctuations, tachycardia, dysrhythmias, seizures, rhabdomyolysis, acute renal failure, respiratory failure, and coma.

Question 29

Which statement by a patient indicates that more teaching on FGA therapy for the treatment of psychosis is needed?

a. “It might take 6 weeks or more for the drug to take effect.”
b. “I will get up slowly from a seated position.”
c. “When I start to feel better, I will cut the dose of my medication in half.”
d. “I will avoid exposure to direct sunlight.”

Answer 29

C. When I start to feel better, I will cut the dose of my medication in half
Rationale: The drug should be taken exactly as ordered. Antipsychotics do not cure the mental illness but do alleviate symptoms. Compliance with drug regimen is extremely important.

Question 30

In the care of the person without diabetes mellitus who is started on therapy with an atypical antipsychotic, glucose evaluation should take place at baseline and after ______ weeks of medication use.

A. 4–8
B. 8–12
C. 12–16
D. 16–20

Answer 30

C. 12-16 wks

Question 31

A patient is taking an FGA for schizophrenia. The nurse notes that the patient has trouble speaking and chewing and observes slow, worm-like movements of the patient’s tongue. The nurse recognizes which adverse effect in this patient?
a. Acute dystonia
b. Akathisia
c. Parkinsonism
d. Tardive dyskinesia

Answer 31

D. Tardive dyskinesia
Tardive dyskinesia can occur in patients during long-term therapy with FGAs. This patient shows signs of this adverse effect. Acute dystonia is characterized by severe spasm of muscles in the face, tongue, neck, or back and by opisthotonus. Akathisia is characterized by constant motion. Parkinsonism is characterized by bradykinesia, drooling, tremor, rigidity, and a shuffling gait.

Question 32

What is given for benzodiazepine overdose

Answer 32

Flumazenil (Romazicon)

Question 33

The nurse realizes more teaching is necessary when the 30-year-old patient taking lorazepam (Ativan) states

a. “I must stop drinking coffee and colas.”
b. “I can stop this drug after 3 weeks if I feel better.”
c. “I must stop drinking alcoholic beverages.”
d. “I should not become pregnant while taking this drug.”

Answer 33

B. I can stop this drug after 3 weeks if I feel better
Rationale: Lorazepam should not be discontinued abruptly, but gradually, over a period of several days. Caffeine and alcohol should be avoided when taking lorazepam, a benzodiazepine. This drug should not be taken during pregnancy because of possible teratogenic effects.

Question 34

A young woman is being treated for psychosis with fluphenazine (Prolixin). Which sign would indicate the need to add an anticholinergic to the patient’s medication regimen?

a. A decrease in pulse and respiratory rate
b. Facial grimacing and tongue spasms
c. An increase in hallucinations
d. A decrease in the patient’s level of orientation

Answer 34

B. Facial grimacing and tongue spasms
Rationale: Pseudoparkinsonism, which resembles symptoms of Parkinson’s disease, is a major side effect of typical antipsychotic drugs such as fluphenazine (Prolixin). Anticholinergic medications may be used to control this side effect.

Question 35

A patient on risperidone (Risperdal) may be at increased risk for injury due to

a. increased potential for aspiration due to sedation.
b. increased risk for falls due to orthostatic hypotension.
c. increased risk for infection due to neutropenia.
d. increased risk for suicide due to changes in thought processes.

Answer 35

B. Increased risk for falls due to orthostatic hypotension
Rationale: Orthostatic hypotension is one of the most common adverse reactions to patients treated with risperidone (Risperdal)

Question 36

A patient is taking an FGA for schizophrenia. The nurse notes that the patient has trouble speaking and chewing and observes slow, worm-like movements of the patient’s tongue. The nurse recognizes which adverse effect in this patient?
a. Acute dystonia
b. Akathisia
c. Parkinsonism
d. Tardive dyskinesia

Answer 36

D. Tardive dyskinesia
Tardive dyskinesia can occur in patients during long-term therapy with FGAs. This patient shows signs of this adverse effect. Acute dystonia is characterized by severe spasm of muscles in the face, tongue, neck, or back and by opisthotonus. Akathisia is characterized by constant motion. Parkinsonism is characterized by bradykinesia, drooling, tremor, rigidity, and a shuffling gait.

Question 37

A middle-aged adult is diagnosed with tuberculosis. Which is true of treatment for this diagnosis?

a. Treatment may take about 10 days to 2 weeks.
b. Usually two to four agents are needed.
c. The bacteria is usually resistant to treatment therapy.
d. Treatment for tuberculosis is usually without side effects.

Answer 37

B. Usually 2-4 agents are needed
Single-drug therapy for TB is not effective. High incidence of drug resistance
Usually two to four drugs are needed.
The total treatment plan is usually 6-9 months, 20-26 months for multidrug-resistant TB, 32 months for extensively drug-resistant
Although unusual, resistance to multi-drug regimen can occur.
The patient should be taught methods to prevent and report side effects and adverse reactions to therapy.

Question 38

When teaching a patient about isoniazid (INH) and rifampin drug therapy, which statement will the nurse include?

a. “Take isoniazid every six hours.”
b. “Double the amount of vitamin C in your diet to prevent the peripheral neuropathy associated with isoniazid therapy.”
c. “Notify the primary health care provider immediately if your urine turns a red-orange color.”
d. “Avoid exposure to direct sunlight.”

Answer 38

D. avoid exposure to direct sunlight
Rationale: The patient should be taught to avoid direct sunlight.
There are several regimens for INH: daily, 3x/week, 2x/week, and weekly
Pyridoxine (vitamin B6) is used with INH therapy to decrease peripheral neuropathy.
Rifampin use causes the urine to turn a red-orange color.

Question 39

A patient treated with acyclovir (Zovirax) for genital herpes should be instructed that

a. breast cancer is more common in patients with a history of genital herpes.
b. antiviral medications provide a cure for genital herpes.
c. women with genital herpes should have a Pap test done.
d. the medication must be taken on an empty stomach

Answer 39

C. Women with gential herpes should have a pap test done
Cervical cancer is more prevalent in women with genital herpes
Acyclovir (Zovirax) does not cure the virus but rather interferes with viral synthesis of DNA
It can be taken with food.

NOTE: women diagnosed with HSV-2 face no additional risk if they are not also infected with human papillomavirus (HPV)

Question 40

Your patient has fungal pneumonia
Order: 400 mg fluconazole IV once daily, to be given over 90 minutes
Available: fluconazole 200 mg in 100 mL 0.9% NaCl
How many total mL will you give, how many mL/hr will you give

Answer 40

Total: 200 mL
mL/hr: 200 mL/90 min X 60 min/hr = 133 mL/hr

Question 41

Which nursing intervention is the priority when a patient is receiving antiviral agents?

a. Promoting hydration
b. Enhancing bowel function
c. Increasing tidal volume
d. Promoting circulation

Answer 41

A. Promoting hydration
Antiviral drugs can affect renal function. Patients taking antiviral drugs should be advised to maintain adequate fluid intake to ensure sufficient hydration for drug therapy and to increase urine output.

Question 42

A patient is diagnosed with a Candida infection in the mouth. The nurse anticipates that the patient will be treated with

a. metronidazole (Flagyl).
b. amphotericin B (Fungizone).
c. isoniazid (INH).
d. nystatin (Mycostatin).

Answer 42

D. Nystatin (Mycostatin)

Rationale: Nystatin in oral suspension is commonly used to treat Candida infection in the mouth.

Question 43

A patient has developed active tuberculosis and is prescribed isoniazid and rifampin. Which information will the nurse include in teaching the patient about taking these drugs? (Select all that apply.)

a. Two to four medications are required to treat TB
b. Have periodic eye examinations as ordered by the health care provider.
c. Compliance with drug regimen is essential.
d. Report numbness, tingling, and burning of hands and feet.
e. Warn patient that rifampin may turn body fluids a harmless green color.

Answer 43

A, B, C, D
Rationale:
Multi-drug regimen is required to treat Tb
Periodic eye examinations should be done as these drugs may cause visual disturbances.
Compliance with drug regimen is essential to prevent drug resistance.
Numbness, tingling, or burning of hands and feet should be reported.
Rifampin may turn body fluids a harmless reddish orange color.

Question 44

T.B. is going to Haiti for 3 months. Since malaria is endemic to the area, the travel clinic nurse is creating a travel health plan for T.B. and includes chloroquine 500 mg.

The patient has heard that taking chloroquine causes upset stomach. What will the nurse tell the patient?

Answer 44

Answer: The nurse will tell the patient to be sure to take the medication with food.
Chloroquine does cause stomach upset. Taking the medication with food will lessen the gastrointestinal distress.

Question 45

A nurse is teaching a patient who is preparing to travel for a month-long missionary trip to Africa. The provider has ordered chloroquine [Aralen Phosphate] as suppressive therapy. Which statement by the patient indicates a need for further teaching?
a. “I should take the first dose 1 week before leaving for Africa.”
b. “I should take 500 mg of this drug once each week.”
c. “This drug is also used for mild to moderate attacks of P. vivax and P. falciparum”
d. “I should continue taking the drug for 2 weeks after returning home.”

Answer 45

D. “I should continue taking the drug for 2 weeks after returning home.”

Patients taking chloroquine as suppressive therapy should take the medication for 4 weeks, not 2 weeks, after returning from an area where infection is likely. The patient is correct to state that 500 mg of the drug should be taken weekly, that the first dose should be taken 1 week before travel, and that the drug should be taken with meals.

Question 46

A patient has been treated for an acute attack of P. vivax malaria. For relapse prevention, the nurse expects the provider to order which medication?
a. Quinine [Qualaquin]
b. Doxycycline [Vibramax]
c. Chloroquine [Aralen Phosphate]
d. Primaquine phosphate

Answer 46

D. Primaquine phospate
The agent of choice for preventing relapse of P. vivax malaria is primaquine, which is highly active against the hepatic forms of P. vivax.
Chloroquine is the drug of choice for treating mild to moderate acute attacks of either type of malaria.
For patients with P. vivax treatment with chloroquine will NOT prevent relapse but will provide clinical cure (vs. radical cure)

Question 47

R.B. has been struggling with ulcers for many years. He smokes and drinks 4 to 5 cups of coffee per day. R.B. recently lost his job and is now in the clinic with more concerns about an ulcer. He notes that he ran out of his “stomach pill” and is tired of taking Tums. The patient’s wife is with him and concerned because the health care provider prescribed an antibiotic called metronidazole (Flagyl).

What will the nurse tell the patient and his wife to explain why the client is taking metronidazole, an antibiotic, for the ulcer?

Answer 47

The nurse will tell R.B. and his wife that this medication is used to treat a common cause of peptic ulcers, a bacterium called Helicobacter pylori.
Metronidazole is used in conjunction with other medications to treat Helicobacter pylori.

Question 48

What precautions will the nurse cover with the patient who is taking metronidazole?

Answer 48

The nurse will advise the patient not to consume any alcohol while taking the medication. Alcohol can produce a disulfiram reaction (facial flushing, severe headache, tachycardia, palpitations, hypotension, dyspnea, sweating, slurred speech, abdominal cramps, nausea, and vomiting) in the client taking metronidazole.
The nurse should also tell the patient not to be alarmed that his urine may turn brown.
Additional: headache, nausea, weakness, vertigo, insomnia, dry mouth, paresthesia (withhold medication)

Question 49

The nurse is aware that a patient is receiving metronidazole (Flagyl). Reasons for taking this medication include being treated for infections of the (select all that apply)

a. Urinary tract
b. Respiratory system
c. Gastrointestinal system
d. Circulatory system
e. Reproductive system

Answer 49

A, C, E
Metronidazole (Flagyl) acts by impairing DNA function of susceptible bacteria. It is prescribed to treat intestinal amebiasis, trichomoniasis, inflammatory bowel disease, anaerobic infections, and bacterial vaginosis and is used as perioperative prophylaxis (prevention of infection) in colorectal surgery. Patients should be advised to avoid drinking alcohol while taking this medication, because it may cause a disulfiram-like reaction. Darkening of the urine may occur but does not warrant discontinuing the drug. The drug is mutagenic for fetuses and should be avoided before and/or during pregnancy. Vertigo and headaches are side effects but are not signs of toxicity.

Question 50

Metronidazole - What disorders/diagnosis can it be used to treat?

Answer 50

Bugs of GI, IBS, pre-op prophylaxis, H Pylori, bacterial vaginosis, UTI

Question 51

Which is the most appropriate nursing intervention for a patient who is taking chloroquine?

a. Collect a stool specimen.
b. Assess the patient’s hearing.
c. Advise the patient to take showers, not baths.
d. Encourage female patients to have a Pap test every 6 months.

Answer 51

B. Assess the patient hearing
Hearing should be assessed because antimalarials may lead to eighth cranial nerve damage and ototoxicity. Monitoring stools and taking showers are not necessary with antimalarials but are appropriate for anthelmintics. Pap tests are not related to antimalarials but necessary for female patients with genital herpes.

Question 52

Travelers visiting malaria-infested countries are instructed to

a. avoid mosquitoes in these countries.
b. receive immunizations before travel.
c. visit these countries only while in good health.
d. begin prophylactic medication before traveling.

Answer 52

D. begin prophylactic medication before traveling
Patients traveling to malaria-infested countries should receive prophylactic doses of antimalarial drug before leaving, during the visit, and upon return. There are no immunizations available for malaria.

Question 53

Which information will the nurse include when teaching a patient about anthelmintic therapy?

a. Take the medication 1 hour before meals.
b. Take a bath at least once a day.
c. Change your sheets every other day.
d. Be aware that drowsiness may occur.

Answer 53

D. Be aware that drowsiness may occur - should avoid operating a car or machinery
The patient should be encouraged to change sheets, bedclothes, towels, and underwear daily.
The patient should be advised to take daily showers and not baths.
Anthelmintics should be administered after meals to prevent or minimize occurrence of GI distress.

Question 54

Bumetanide (Bumex) 1.5 mg IV daily. The label on the vial reads 0.25mg/mL. How many milliliters will you administer?

Answer 54

mL = mL/0.25mg x 1.5mg = 6mL

Question 55

Which drug is associated with disulfiram reaction?

a. Atovaquone (Mepron)
b. Streptomycin
c. Metronidazole (Flagyl)
d. Amphotericin B

Answer 55

C. Metronidazole (Flagyl)
Rationale: The patient taking metronidazole should avoid alcohol and alcohol-containing medications for at least 48 hours after treatment is completed. Drug interaction with alcohol may produce a disulfiram reaction (facial flushing, severe headache, tachycardia, palpitations, hypotension, dyspnea, sweating, slurred speech, abdominal cramps, nausea, and vomiting)

Question 56

A patient presents to the emergency department with complaints of chills, severe flank pain, dysuria, and urinary frequency. The patient has a temperature of 102.9°F, a pulse of 92 beats/min, respirations of 24 breaths per minute, and a blood pressure of 119/58 mm Hg. The nurse would be correct to suspect that the patient shows signs and symptoms of:
a. Prostatitis
b. Acute cystitis
c. Urinary tract infection
d. Pyelonephritis

Answer 56

D. pyelonephritis
The nurse should suspect pyelonephritis. Pyelonephritis is characterized by fever, chills, severe flank pain, dysuria, urinary urgency and frequency, and pyuria and bacteriuria. Clinical manifestations of acute cystitis include dysuria, urinary urgency and frequency, suprapubic discomfort, pyuria, and bacteriuria. Urinary tract infections (UTIs) are very general and are classified by their location. These symptoms are specific to pyelonephritis. Prostatitis is manifested by high fever, chills, malaise, myalgia, localized pain, and various UTI symptoms but not by severe flank pain.

Question 57

A female patient has been diagnosed with a lower urinary tract infection caused by E. coli. The patient has been prescribed nitrofurantoin (Macrodantin). Which information will the nurse include when teaching the patient about nitrofurantoin therapy?

a. Take the medication with an antacid.
b. Tell the patient to inform the health care provider immediately if her urine turns brown.
c. Advice taking the medication with meals
d. Teach patient to crush tablets and open capsules to facilitate absorption of the drug.

Answer 57

C. advise taking the medication with meals
Taking with meals will reduce GI effects
Encourage patient to avoid antacids because they interfere with drug absorption.
Alert patient that urine may turn a harmless brown color.
The patient should be taught not to crush tablets or open capsules.

Question 58

Consider the common side effects/adverse reactions, nursing interventions and assessments you should consider in regards to nitrofurantoin (Macrodantin)

Answer 58

Obtain urine sample before initiation of drug therapy to treat UTI.
Teach patient not to crush tablet or open capsule.
Advise patient to rinse mouth because the drug can stain teeth (liquid form).
Avoid antacids.
Warn patient that the drug may cause drowsiness.
Inform patient that urine may turn brown.
Review side effects and adverse reactions: GI disturbances, pulmonary reactions
Tingling of the fingers can indicate peripheral neuropathy, which can be an irreversible side effect of nitrofurantoin
Patient Safety!

Question 59

In addition, the patient is ordered phenazopyridine hydrochloride (Pyridium). The most likely rationale for administration of this agent is

a. treatment of the bacterial infection.
b. increase of bladder tone.
c. relief of urinary pain and burning.
d. increase of urinary output.

Answer 59

Answer: C relief of urinary pain and burning
Phenazopyridine hydrochloride (Pyridium), an azo dye, is a urinary analgesic (relieves urinary pain, frequency, and burning).

Question 60

When caring for the patient taking phenazopyridine hydrochloride (Pyridium), the nurse will

a. obtain a rectal body temperature for accuracy.
b. use results of blood tests to monitor glucose levels.
c. measure the urinary output once a day.
d. send all urine samples for culture and sensitivity.

Answer 60

Answer: B use results of blood tests to monitor glucose levels
Phenazopyridine can alter the glucose urine test (Clinitest), causing false positive; therefore, a blood test should be used to monitor glucose levels. Rectal temperatures are not indicated; the urine output should be measured more than once a day. Not all urine samples need to have a culture and sensitivity. Usually the first urine culture has C&S performed with others as needed.

Question 61

Patients taking methenamine (Hiprex) for urinary tract infections are counseled to drink cranberry juice in order to

a. ensure a brisk urine flow.
b. increase the alkalinity of the urine.
c. decrease urinary retention.
d. lower the pH of the urine.

Answer 61

D. lower the pH of the urine
Drinking cranberry juice, eating plums, or taking vitamin C is encouraged for patients taking methenamine (Urex) to keep the urine acidic.

Question 62

Which statement by the patient indicates that more teaching on nitrofurantoin (Macrodantin) therapy is needed?

a. “I’ll rinse my mouth after taking the medication because it can stain my teeth.”
b. “I will not take this medication at bedtime because it causes insomnia.”
c. “I will take this drug with food.”
d. “My urine may turn a brown color, which is expected.”

Answer 62

B “I will not take this medication at bedtime because it causes insomnia.”

Use of nitrofurantoin (Macrodantin) may cause drowsiness. Caution when driving, using heavy equipment, safety-sensitive jobs

Question 63

A patient with an urinary tract infection is complaining of pain with urination. The nurse would anticipate the patient’s receiving which medication to relieve this symptom?

a. norfloxacin (Noroxin).
b. ciprofloxacin (Cipro).
c. methenamine mandelate (Mandelamine).
d. phenazopyridine (Pyridium).

Answer 63

D phenazopyridine (Pyridium)
The other drugs are antiseptics and urinary antiinfectives.

Question 64

Which medication is indicated in the treatment of hypotonic or atonic bladder?

a. Bethanechol (Urecholine)
b. Oxybutynin (Ditropan)
c. Tolterodine (Detrol)
d. Solifenacin (VESIcare)

Answer 64

A Bethanechol (Urecholine)

Bethanechol (Urecholine) is a urinary stimulant used for atonic and hypotonic bladder.
Oxybutynin (Ditropan), tolterodine (Detrol) and solifenacin (VESIcare) are antimuscarinic/anticholinergic drugs used to treat overactive bladder.

Question 65

A patient entering the medical clinic has been diagnosed with an overactive bladder. Which medication would the nurse expect to be ordered?

a. Ciprofloxacin (Cipro)
b. TMP-SMZ (Bactrim)
c. Bethanechol (Urecholine)
d. Tolterodine tartrate (Detrol)

Answer 65

D Tolterodine tartrate (Detrol)

Ciprofloxacin is a fluoroquinolone antibiotic;
bethanechol is a urinary stimulant