exam 2 questions Flashcards
(156 cards)
1
Q
The nurse is monitoring a patient who is experiencing severe ethanol withdrawal. Which are signs and symptoms of severe ethanol withdrawal (Select all that apply.)
Agitation Drowsiness Tremors Systolic blood pressure higher than 200 mm Hg Temperature over 100° F (37.7° C) Pulse rate 110 beats/min
A
Agitation
Tremors
Systolic blood pressure higher than 200 mm Hg
Signs and symptoms of severe ethanol withdrawal (delirium tremens) include systolic blood pressure higher than 200 mm Hg, diastolic blood pressure higher than 140 mm Hg, pulse rate higher than 140 beats/min, temperature above 101° F (38.3° C), tremors, insomnia, and agitation. See Box 17-6 for all signs and symptoms of ethanol withdrawal.
2
Q
The nurse is monitoring drug levels for a patient who is receiving theophylline. The most recent theophylline level was 22 mcg/mL, and the nurse evaluates this level to be:
below the therapeutic level.
at a therapeutic level.
above the therapeutic level.
at a toxic level.
A
above the therapeutic level.
Although the optimal level may vary from patient to patient, most standard references have suggested that the therapeutic range for theophylline blood level is 10 to 20 mcg/mL. However, most clinicians now advise levels between 5 and 15 mcg/mL.
3
Q
A patient with end-stage renal failure has been admitted to the hospital for severe anemia. She is refusing blood transfusions. The nurse anticipates drug therapy with which drug to stimulate the production of red blood cells
Folic acid
Cyanocobalamin (vitamin B12)
Epoetin alfa (Epogen)
Filgrastim (Neupogen)
A
Epoetin alfa (Epogen)
Epoetin alfa is a colony-stimulating factor that is responsible for erythropoiesis, or formation of red blood cells. The other options are incorrect.
4
Q
A patient tells the nurse that she wants to start taking the herbal product goldenseal to improve her health. The nurse will assess for which potential cautions or contraindications to goldenseal (Select all that apply.)
Taking a proton-pump inhibitor Nasal congestion Hypothyroidism Hypertension Sinus infections Pregnancy
A
Taking a proton-pump inhibitor
Hypertension
Pregnancy
Goldenseal is contraindicated in patients with acute or chronic gastrointestinal disorders and during pregnancy (because it has uterine stimulant properties). It should be used with caution by those with cardiovascular disorders. Potential drug interactions may occur with gastric acid suppressors such as antacids, histamine H2 blockers (e.g., ranitidine), and proton pump inhibitors (e.g., omeprazole), theoretically because of their reduced effectiveness resulting from the acid-promoting effect of the herb, and with antihypertensive drugs (because of the vasoconstrictive activity of the herb). Goldenseal is potentially useful for sinus infections and chronic nasal allergies.
5
Q
When educating a patient recently placed on inhaled corticosteroids, the nurse will discuss which potential adverse effects
Fatigue and depression
Anxiety and palpitations
Headache and rapid heart rate
Oral candidiasis and dry mouth
A
Oral candidiasis and dry mouth
Oral candidiasis and dry mouth are two possible adverse effects of inhaled corticosteroids. The other responses are incorrect.
6
Q
The nurse is teaching a patient with iron-deficiency anemia about foods to increase iron intake. Which food may enhance the absorption of oral iron forms
Milk Yogurt Antacids Orange juice .
A
Orange juice
Orange juice contains ascorbic acid, which enhances the absorption of oral iron forms; antacids, milk, and yogurt may interfere with absorption
7
Q
A patient has received an overdose of intravenous heparin, and is showing signs of excessive bleeding. Which substance is the antidote for heparin overdose
Vitamin E
Vitamin K
Protamine sulfate
Potassium chloride
A
Protamine sulfate
Protamine sulfate is a specific heparin antidote and forms a complex with heparin, completely reversing its anticoagulant properties. Vitamin K is the antidote for warfarin (Coumadin) overdose. The other options are incorrect.
8
Q
A patient has been taking an AED for several years as part of his treatment for partial seizures. His wife has called because he ran out of medication this morning and wonders if he can go without it for a week until she has a chance to go to the drugstore. What is the nurse’s best response
“He is taking another antiepileptic drug, so he can go without the medication for a week.”
“Stopping this medication abruptly may cause withdrawal seizures. A refill is needed right away.”
“He can temporarily increase the dosage of his other antiseizure medications until you get the refill.”
“He can stop all medications because he has been treated for several years now.”
A
Stopping this medication abruptly may cause withdrawal seizures. A refill is needed right away.”
Abrupt discontinuation of antiepileptic drugs can lead to withdrawal seizures. The other options are incorrect. The nurse cannot change the dose or stop the medication without a prescriber’s order.
9
Q
A patient has been taking phenobarbital for 2 weeks as part of his therapy for epilepsy. He tells the nurse that he feels tense and that “the least little thing” bothers him now. Which is the correct explanation for this problem
These are adverse effects that usually subside after a few weeks.
The drug must be stopped immediately because of possible adverse effects.
This drug causes the rapid eye movement (REM) sleep period to increase, resulting in nightmares and restlessness.
This drug causes deprivation of REM sleep and may cause the inability to deal with normal stress.
A
This drug causes deprivation of REM sleep and may cause the inability to deal with normal stress.
Barbiturates such as phenobarbital deprive people of REM sleep, which can result in agitation and the inability to deal with normal stress. A rebound phenomenon occurs when the drug is stopped (not during therapy), and the proportion of REM sleep increases, sometimes resulting in nightmares. The other options are incorrect.
10
Q
The nurse has given medication instructions to a patient receiving phenytoin (Dilantin). Which statement by the patient indicates that the patient has an adequate understanding of the instructions
“I will need to take extra care of my teeth and gums while on this medication.”
“I can go out for a beer while on this medication.”
“I can skip doses if the side effects bother me.”
“I will be able to stop taking this drug once the seizures stop.”
A
“I will need to take extra care of my teeth and gums while on this medication.”
Scrupulous dental care is necessary to prevent gingival hypertrophy during therapy with phenytoin. Alcohol and other central nervous system depressants may cause severe sedation. Consistent dosing is important to maintain therapeutic drug levels. Therapy with AEDs usually must continue for life and must not be stopped once seizures stop.
11
Q
A patient is taking intravenous aminophylline for a severe exacerbation of chronic obstructive pulmonary disease. The nurse will assess for which therapeutic response
Increased sputum production
Increased heart rate
Increased respiratory rate
Increased ease of breathing
A
Increased ease of breathing
The therapeutic effects of bronchodilating drugs such as xanthine derivatives include increased ease of breathing. The other responses are incorrect.
12
Q
The nurse notes in a patient’s medication history that the patient is taking allopurinol (Zyloprim). Based on this finding, the nurse interprets that the patient has which disorder
Rheumatoid arthritis
Gout
Osteoarthritis
Systemic lupus erythematosus
A
Gout
Allopurinol is indicated for the treatment of gout but is not indicated for the other disorders listed.
13
Q
A patient has a 9-year history of a seizure disorder that has been managed well with oral phenytoin (Dilantin) therapy. He is to be NPO (consume nothing by mouth) for surgery in the morning. What will the nurse do about his morning dose of phenytoin
Give the same dose intravenously.
Give the morning dose with a small sip of water.
Contact the prescriber for another dosage form of the medication.
Notify the operating room that the medication has been withheld.
A
Contact the prescriber for another dosage form of the medication.
If there are any questions about the medication order or the medication prescribed, contact the prescriber immediately for clarification and for an order of the appropriate dose form of the medication. Do not change the route without the prescriber’s order. There is an increased risk of seizure activity if one or more doses of the AED are missed.
14
Q
A patient has experienced insomnia for months, and the physician has prescribed a medication to help with this problem. The nurse expects which drug to be used for long-term treatment of insomnia
Secobarbital (Seconal), a barbiturate
Diazepam (Valium), a benzodiazepine
Midazolam (Versed), a benzodiazepine
Eszopiclone (Lunesta), a nonbenzodiazepine sleep aid
A
Eszopiclone (Lunesta), a nonbenzodiazepine sleep aid
Eszopiclone (Lunesta) is one of the newest prescription hypnotics to be approved for long-term use in treatment of insomnia. Barbiturates and benzodiazepines are not appropriate for long-term treatment of insomnia; midazolam is used for procedural (moderate) sedation.
15
Q
When giving dextromethorphan, the nurse understands that this drug suppresses the cough reflex by which mechanism of action
Causing depression of the central nervous system
Anesthetizing the stretch receptors
Having direct action on the cough center
Decreasing the viscosity of the bronchial secretions
A
Having direct action on the cough center
Dextromethorphan suppresses the cough reflex through a direct action on the cough center. The other options are incorrect.
16
Q
The nurse notes in the patient’s medication orders that the patient will be starting anticoagulant therapy. What is the primary goal of anticoagulant therapy
Stabilizing an existing thrombus
Dissolving an existing thrombus
Preventing thrombus formation
Dilating the vessel around a clot
A
Preventing thrombus formation
Anticoagulants prevent thrombus formation but do not dissolve or stabilize an existing thrombus, nor do they dilate vessels around a clot.
17
Q
A patient taking entacapone (Comtan) for the first time calls the clinic to report a dark discoloration of his urine. After listening to the patient, the nurse realizes that what is happening in this situation
This is a harmless effect of the drug
.
The patient has taken this drug along with red wine or cheese.
The patient is having an allergic reaction to the drug.
The ordered dose is too high for this patient.
A
This is a harmless effect of the drug
.
COMT inhibitors, including entacapone, may darken a patient’s urine and sweat.
18
Q
The nurse is reviewing new medication orders for a patient who has an epidural catheter for pain relief. One of the orders is for enoxaparin (Lovenox), a low–molecular-weight heparin (LMWH). What is the nurse’s priority action
Give the LMWH as ordered.
Double-check the LMWH order with another nurse, and then administer as ordered.
Stop the epidural pain medication, and then administer the LMWH.
Contact the prescriber because the LMWH cannot be given if the patient has an epidural catheter.
A
Contact the prescriber because the LMWH cannot be given if the patient has an epidural catheter
LMWHs are contraindicated in patients with an indwelling epidural catheter; they can be given 2 hours after the epidural is removed. This is very important to remember, because giving an LMWH with an epidural has been associated with epidural hematoma.
19
Q
The nurse is reviewing herbal therapies. Which is a common use of the herb feverfew
Muscle aches
Migraine headaches
Leg cramps
Incision pain after surgery
A
Migraine headaches
Feverfew is commonly used for migraine headaches, menstrual problems, arthritis, and fever. Possible adverse effects include muscle stiffness and muscle and joint pain.
20
Q
While monitoring a depressed patient who has just started SSRI antidepressant therapy, the nurse will observe for which problem during the early time frame of this therapy
Hypertensive crisis
Self-injury or suicidal tendencies
Extrapyramidal symptoms
Loss of appetite
A
Self-injury or suicidal tendencies
In 2005, the U.S. Food and Drug Administration (FDA) issued special black-box warnings regarding the use of all classes of antidepressants in both adult and pediatric patient populations. Data from the FDA indicated a higher risk for suicide in patients receiving these medications. As a result, current recommendations for all patients receiving antidepressants include regular monitoring for signs of worsening depressive symptoms, especially when the medication is started or the dosage is changed. The other options are incorrect.
21
Q
A patient was diagnosed with pancreatic cancer last month, and has complained of a dull ache in the abdomen for the past 4 months. This pain has been gradually increasing, and the pain relievers taken at home are no longer effective. What type of pain is the patient experiencing
Acute pain
Chronic pain
Somatic pain
Neuropathic pain
A
Chronic pain
Chronic pain is associated with cancer and is characterized by slow onset, long duration, and dull, persistent aching. The patient’s symptoms are not characteristics of acute pain, somatic pain, or neuropathic pain.
22
Q
A patient is taking flurazepam (Dalmane) three to four nights a week for sleeplessness. She is concerned that she cannot get to sleep without taking the medication. What nonpharmacologic measures should the nurse suggest to promote sleep for this patient
Providing a quiet environment
Exercising before bedtime to become tired
Consuming heavy meals in the evening to promote sleepiness
Drinking hot tea or coffee just before bedtime
A
Providing a quiet environment
Nonpharmacologic approaches to induce sleep include providing a quiet environment, avoiding heavy exercise before bedtime, avoiding heavy meals late in the evening, and drinking warm decaffeinated drinks, such as warm milk, before bedtime.
23
Q
A 38-year-old male patient stopped smoking 6 months ago. He tells the nurse that he still feels strong cigarette cravings and wonders if he is ever going to feel “normal” again. Which statement by the nurse is correct
“It’s possible that these cravings will never stop.”
“These cravings may persist for several months.”
“The cravings tell us that you are still using nicotine.”
“The cravings show that you are about to experience nicotine withdrawal.”
A
These cravings may persist for several months.”
Cigarette cravings may persist for months after nicotine withdrawal. The other statements are false.
24
Q
Carbidopa-levodopa (Sinemet) is prescribed for a patient with Parkinson’s disease. The nurse informs the patient that which common adverse effects can occur with this medication
Drowsiness, headache, weight loss
Dizziness, insomnia, nausea
Peripheral edema, fatigue, syncope
Heart palpitations, hypotension, urinary retention
A
Heart palpitations, hypotension, urinary retention
Common adverse reactions associated with carbidopa-levodopa include palpitations, hypotension, urinary retention, dyskinesia, and depression. The other effects may occur with other antiparkinson drugs.
25
A patient who started taking orlistat (Xenical) 1 month ago calls the clinic to report some “embarrassing” adverse effects. She tells the nurse that she has had episodes of “not being able to control my bowel movements.” Which statement is true about this situation
These are expected adverse effects that will eventually diminish.
The patient will need to stop this drug immediately if these adverse effects are occurring.
The patient will need to increase her fat intake to prevent these adverse effects.
The patient will need to restrict fat intake to less than 30% to help reduce these adverse effects.
The patient will need to restrict fat intake to less than 30% to help reduce these adverse effects.
Restricting dietary intake of fat to less than 30% of total calories can help reduce some of the GI adverse effects, which include oily spotting, flatulence, and fecal incontinence. The other options are incorrect.
26
A patient in a rehabilitation center is beginning to experience opioid withdrawal symptoms. The nurse expects to administer which drug as part of the treatment
Diazepam (Valium)
Methadone
Disulfiram (Antabuse)
Bupropion (Zyban)
Methadone
Opioid withdrawal can be managed with either methadone or clonidine (Catapres). Diazepam and disulfiram are used for treatment of alcoholism, and bupropion is used to assist with smoking cessation.
27
The nurse is preparing to administer a barbiturate. Which conditions or disorders would be a contraindication to the use of these drugs (Select all that apply.)
```
Gout
Pregnancy
Epilepsy
Severe chronic obstructive pulmonary disease
Severe liver disease
Diabetes mellitus
```
Pregnancy
Severe chronic obstructive pulmonary disease
Severe liver disease
Contraindications to barbiturates include pregnancy, significant respiratory difficulties, and severe liver disease. The other disorders are not contraindications.
28
The barbiturate phenobarbital is prescribed for a patient with epilepsy. While assessing the patient’s current medications, the nurse recognizes that interactions may occur with which drugs (Select all that apply.)
```
Antihistamines
Opioids
Diuretics
Anticoagulants
Oral contraceptives
Insulin
```
Antihistamines
Opioids
Anticoagulants
Oral contraceptives
The co-administration of barbiturates and alcohol, antihistamines, benzodiazepines, opioids, and tranquilizers may result in additive CNS depression. Co-administration of anticoagulants and barbiturates can result in decreased anticoagulation response and possible clot formation. Co-administration of barbiturates and oral contraceptives can result in accelerated metabolism of the contraceptive drug and possible unintended pregnancy. There are no interactions with diuretics and insulin.
29
A patient is taking guaifenesin (Humibid) as part of treatment for a sinus infection. Which instruction will the nurse include during patient teaching
Force fluids to help loosen and liquefy secretions.
Report clear-colored sputum to the prescriber.
Avoid driving a car or operating heavy machinery because of the sedating effects.
Report symptoms that last longer than 2 days.
Force fluids to help loosen and liquefy secretions
Forcing fluids helps to loosen and liquefy secretions. The patient must be fully aware that any fever, chest tightness, change in sputum from clear to colored, difficult or noisy breathing, activity intolerance, or weakness needs to be reported. The patient must also report to the prescriber a fever of higher than 100.4° F (38° C) or symptoms that last longer than 3 to 4 days. Decongestants do not cause sedation, and therefore the patient does not need to avoid driving a car or operating heavy machinery.
30
The nurse is administering intravenous iron dextran for the first time to a patient with anemia. After giving a test dose, how long will the nurse wait before administering the remaining portion of the dose
30 minutes
1 hour
6 hours
24 hours
1 hour
Although anaphylactic reactions usually occur within a few moments after the test dose, it is recommended that a period of at least 1 hour elapse before the remaining portion of the initial dose is given. The other options are incorrect.
31
The nurse is teaching a patient who is taking colchicine for the treatment of gout. Which instruction will the nurse include during the teaching session
“Fluids should be restricted while on colchicine therapy.”
“Take colchicine with meals.”
“The drug will be discontinued when symptoms are reduced.”
“Call your doctor if you have increased pain or blood in the urine.”
“Call your doctor if you have increased pain or blood in the urine.”
Colchicine may cause renal effects; therefore, these symptoms must be reported immediately. The drug is taken on an empty stomach for better absorption, and fluids should be increased unless contraindicated. Successful treatment depends upon continuing the medication as ordered.
32
A nurse is giving instructions to a patient who will be receiving oral iron supplements. Which instructions will be included in the teaching plan
Take the iron tablets with milk or antacids.
Crush the pills as needed to help with swallowing.
Take the iron tablets with meals if gastrointestinal distress occurs.
If black tarry stools occur, report it to the doctor immediately.
Take the iron tablets with meals if gastrointestinal distress occurs.
Although taking iron tablets with food may decrease absorption, doing so helps to reduce gastrointestinal distress. Antacids and milk may cause decreased iron absorption; iron tablets must be taken whole and not crushed. Black, tarry stools are expected adverse effects of oral iron supplements.
33
A patient has been taking the monoamine oxidase inhibitor (MAOI) phenelzine (Nardil) for 6 months. The patient wants to go to a party and asks the nurse, “Will just one beer be a problem” Which advice from the nurse is correct
“You can drink beer as long as you have a designated driver.”
“Now that you’ve had the last dose of that medication, there will be no further dietary restrictions.”
“If you begin to experience a throbbing headache, rapid pulse, or nausea, you’ll need to stop drinking.”
“You need to avoid all foods that contain tyramine, including beer, while taking this medication.”
“You need to avoid all foods that contain tyramine, including beer, while taking this medication.”
Foods containing tyramine, such as beer and aged cheeses, should be avoided while a patient is taking an MAOI. Drinking beer while taking an MAOI may precipitate a dangerous hypertensive crisis. The other options are incorrect.
34
The nurse is teaching a patient how to self-administer triptan injections for migraine headaches. Which statement by the patient indicates that he needs further teaching
“I will take this medication regularly to prevent a migraine headache from occurring.”
“I will take this medication when I feel a migraine headache starting.”
“This medication does not reduce the number of migraines I will have.”
“I will keep a journal to record the headaches I have and how the injections are working.”
“I will take this medication regularly to prevent a migraine headache from occurring.”
Although they may be taken during aura symptoms by patients who have auras with their headaches, these drugs are not indicated for preventive migraine therapy. The medication is intended to relieve the migraine and not to prevent it or to reduce the number of attacks. The triptans do not reduce the number of migraines a person will have. Journal recordings of headaches and the patient’s responses to the medication are helpful.
35
A patient calls the clinic to ask about taking a glucosamine-chondroitin supplement for arthritis. The nurse reviews the medication history and notes that there will be a concern for drug interactions if the patient is also taking medications for which disorder
Type 2 diabetes mellitus
Hypothyroidism
Hypertension
Angina
Type 2 diabetes mellitus
The glucosamine in glucosamine-chondroitin supplements may cause an increase in insulin resistance, necessitating the need for higher doses of oral hypoglycemics or insulin.
36
After receiving a nebulizer treatment with a beta agonist, the patient complains of feeling slightly nervous and wonders if her asthma is getting worse. What is the nurse’s best response
“This is an expected adverse effect. Let me take your pulse.”
“The next scheduled nebulizer treatment will be skipped.”
“I will notify the physician about this adverse effect.”
“We will hold the treatment for 24 hours.”
“This is an expected adverse effect. Let me take your pulse.”
Nervousness, tremors, and cardiac stimulation are possible and expected adverse effects of beta agonists. The other options are incorrect responses.
37
The nurse will teach a patient who is receiving oral iron supplements to watch for which expected adverse effects
Palpitations
Drowsiness and dizziness
Black, tarry stools
Orange-red discoloration of the urine
Black, tarry stools
Black, tarry stools and other gastrointestinal disturbances may occur with the administration of iron preparations. The other options are incorrect.
38
A patient has been treated with antiparkinson medications for 3 months. What therapeutic responses should the nurse look for when assessing this patient
Decreased appetite
Gradual development of cogwheel rigidity
Newly developed dyskinesias
Improved ability to perform activities of daily living
Improved ability to perform activities of daily living
Therapeutic responses to antiparkinson agents include an improved sense of well-being, improved mental status, increased appetite, increased ability to perform activities of daily living and to concentrate and think clearly, and less intense parkinsonian manifestations.
39
The nurse is reviewing medications used for depression. Which of these statements is a reason that selective serotonin reuptake inhibitors (SSRIs) are more widely prescribed today than tricyclic antidepressants
SSRIs have fewer sexual side effects.
Unlike tricyclic antidepressants, SSRIs do not have drug-food interactions.
Tricyclic antidepressants cause serious cardiac dysrhythmias if an overdose occurs.
SSRIs cause a therapeutic response faster than tricyclic antidepressants.
Tricyclic antidepressants cause serious cardiac dysrhythmias if an overdose occurs.
Death from overdose of tricyclic antidepressants usually results from either seizures or dysrhythmias. SSRIs are associated with significantly fewer and less severe systemic adverse effects, especially anticholinergic and cardiovascular adverse effects. The other options are incorrect.
40
The nurse notes in the patient’s medication history that the patient is taking cyclobenzaprine (Flexeril). Based on this finding, the nurse interprets that the patient has which disorder
A musculoskeletal injury
Insomnia
Epilepsy
Agitation
A musculoskeletal injury
Cyclobenzaprine (Flexeril) is the muscle relaxant most commonly used to reduce spasms following musculoskeletal injuries. It is not appropriate for insomnia, epilepsy, or agitation.
41
A patient has been taking haloperidol (Haldol) for 3 months for a psychotic disorder, and the nurse is concerned about the development of extrapyramidal symptoms. The nurse will monitor the patient closely for which effects
Increased paranoia
Drowsiness and dizziness
Tremors and muscle twitching
Dry mouth and constipation
Tremors and muscle twitching
Extrapyramidal symptoms are manifested by tremors and muscle twitching, and the incidence of such symptoms is high during haloperidol therapy. The other options are incorrect.
42
The nurse is conducting a smoking-cessation program. Which statement regarding drugs used in cigarette-smoking–cessation programs is true
Rapid chewing of the nicotine gum releases an immediate dose of nicotine.
Quick relief from withdrawal symptoms is most easily achieved by using a transdermal patch.
Compliance with treatment is higher with use of the gum rather than the transdermal patch.
The nicotine gum can be used only up to six times per day.
Rapid chewing of the nicotine gum releases an immediate dose of nicotine.
Quick or acute relief from withdrawal symptoms is most easily achieved with the use of the gum because rapid chewing of the gum produces an immediate dose of nicotine. However, treatment compliance is higher with the use of the transdermal patch system. Nicotine gum can be used whenever the patient has a strong urge to smoke.
43
The nurse is reviewing the food choices of a patient who is taking a monoamine oxidase inhibitor ( MAOI). Which food choice would indicate the need for additional teaching
Orange juice
Fried eggs over-easy
Salami and Swiss cheese sandwich
Biscuits and honey
Salami and Swiss cheese sandwich
Aged cheeses, such a Swiss or cheddar cheese, and Salami contain tyramine. Patients who are taking MAOIs need to avoid tyramine-containing foods because of a severe hypertensive reaction that may occur. Orange juice, eggs, biscuits, and honey do not contain tyramine.
44
Vicodin (acetaminophen/hydrocodone) is prescribed for a patient who has had surgery. The nurse informs the patient that which common adverse effects can occur with this medication (Select all that apply.)
```
Diarrhea
Constipation
Lightheadedness
Nervousness
Urinary retention
Itching
```
Constipation
Lightheadedness
Urinary retention
Itching
Constipation (not diarrhea), lightheadedness (not nervousness), urinary retention, and itching are some of the common adverse effects that the patient may experience while taking Vicodin.
45
A patient who has a history of coronary artery disease has been instructed to take one 81-mg aspirin tablet a day. The patient asks about the purpose of this aspirin. Which response by the nurse is correct
“Aspirin is given reduce anxiety.”
“It helps to reduce inflammation.”
“Aspirin is given to relieve pain.”
“It will help to prevent clot formation.”
“It will help to prevent clot formation.”
Aspirin can reduce platelet aggregation; low doses of aspirin (81 to 325 mg once daily) are used for thromboprevention. Higher doses are required for pain relief, reduction of inflammation, and reduction of fever. The other options are incorrect.
46
A 6-year-old child who has chickenpox also has a fever of 102.9° F (39.4° C). The child’s mother asks the nurse if she should use aspirin to reduce the fever. What is the best response by the nurse
“It’s best to wait to see if the fever gets worse.”
“You can use the aspirin, but watch for worsening symptoms.”
“Acetaminophen (Tylenol) should be used to reduce his fever, not aspirin.”
“You can use aspirin, but be sure to follow the instructions on the bottle.”
“Acetaminophen (Tylenol) should be used to reduce his fever, not aspirin.”
Aspirin is contraindicated in children with flu-like symptoms because the use of this drug has been strongly associated with Reye’s syndrome. This is an acute and potentially life-threatening condition involving progressive neurologic deficits that can lead to coma and may also involve liver damage. Acetaminophen is appropriate for this patient. The other responses are incorrect.
47
A patient will be discharged with a 1-week supply of an opioid analgesic for pain management after abdominal surgery. The nurse will include which information in the teaching plan
How to prevent dehydration due to diarrhea
The importance of taking the drug only when the pain becomes severe
How to prevent constipation
The importance of taking the drug on an empty stomach
How to prevent constipation
Gastrointestinal (GI) adverse effects, such as nausea, vomiting, and constipation, are the most common adverse effects associated with opioid analgesics. Physical dependence usually occurs in patients undergoing long-term treatment. Diarrhea is not an effect of opioid analgesics. Taking the dose with food may help minimize GI upset.
48
A mother brings her toddler into the emergency department and tells the nurse that she thinks the toddler has eaten an entire bottle of chewable aspirin tablets. The nurse will assess for which most common signs of salicylate intoxication in children
Photosensitivity and nervousness
Tinnitus and hearing loss
Acute gastrointestinal bleeding
Hyperventilation and drowsiness
Hyperventilation and drowsiness
The most common manifestations of chronic salicylate intoxication in adults are tinnitus and hearing loss. Those in children are hyperventilation and CNS effects, such as dizziness, drowsiness, and behavioral changes.
49
An 18-year-old basketball player fell and twisted his ankle during a game. The nurse will expect to administer which type of analgesic
Synthetic opioid, such as meperidine (Demerol)
Opium alkaloid, such as morphine sulfate
Opioid antagonist, such as naloxone HCL (Narcan)
Nonopioid analgesic, such as indomethacin (Indocin)
Nonopioid analgesic, such as indomethacin (Indocin)
Somatic pain, which originates from skeletal muscles, ligaments, and joints, usually responds to nonopioid analgesics such as nonsteroidal anti-inflammatory drugs (NSAIDs). The other options are not the best choices for somatic pain.
50
The wife of a patient who has been diagnosed with depression calls the office and says, “It’s been an entire week since he started that new medicine for his depression, and there’s no change! What’s wrong with him” What is the nurse’s best response
“The medication may not be effective for him. He may need to try another type.”
“It may take up to 6 weeks to notice any therapeutic effects. Let’s wait a little longer to see how he does.”
“It sounds like the dose is not high enough. I’ll check about increasing the dosage.”
“Some patients never recover from depression. He may not respond to this therapy.”
.
“It may take up to 6 weeks to notice any therapeutic effects. Let’s wait a little longer to see how he does.”
Patients and family members need to be told that antidepressant drugs commonly require several weeks before full therapeutic effects are noted. The other answers are incorrect
51
A 50-year-old man who has been taking phenobarbital for 1 week is found very lethargic and unable to walk after eating out for dinner. His wife states that he has no other prescriptions and that he did not take an overdose—the correct number of pills is in the bottle. The nurse suspects that which of these may have happened
He took a multivitamin.
He drank a glass of wine.
He took a dose of aspirin.
He developed an allergy to the drug.
He drank a glass of wine.
Alcohol has an additive effect when combined with barbiturates and causes central nervous system (CNS) depression. Multivitamins and aspirin do not interact with barbiturates, and this situation does not illustrate an allergic reaction.
52
A 38-year-old man has come into the urgent care center with severe hip pain after falling from a ladder at work. He says he has taken several pain pills over the past few hours but cannot remember how many he has taken. He hands the nurse an empty bottle of acetaminophen (Tylenol). The nurse is aware that the most serious toxic effect of acute acetaminophen overdose is which condition
Tachycardia
Central nervous system depression
Hepatic necrosis
Nephropathy
Hepatic necrosis
Hepatic necrosis is the most serious acute toxic effect of an acute overdose of acetaminophen. The other options are incorrect.
53
The drug nalbuphine (Nubain) is an agonist-antagonist (partial agonist). The nurse understands that which is a characteristic of partial agonists
They have anti-inflammatory effects.
They are given to reverse the effects of opiates.
They have a higher potency than agonists.
They have a lower dependency potential than agonists.
They have a lower dependency potential than agonists.
Partial agonists such as nalbuphine are similar to the opioid agonists in terms of their therapeutic indications; however, they have a lower risk of misuse and addiction. They do not have anti-inflammatory effects, nor are they given to reverse the effects of opiates. They do not have a higher potency than agonists.
54
During a routine checkup, a patient states that she is unable to take the prescribed antihistamine because of one of its most common adverse effects. The nurse suspects that which adverse effect has been bothering this patient
Constipation
Abdominal cramps
Drowsiness
Decreased libido
Drowsiness
Drowsiness is usually the chief complaint of people who take antihistamines.
55
Chlorpromazine (Thorazine) is prescribed for a patient, and the nurse provides instructions to the patient about the medication. The nurse includes which information
The patient needs to avoid caffeine while on this drug.
The patient needs to wear sunscreen while outside because of photosensitivity.
Long-term therapy may result in nervousness and excitability.
The medication may be taken with an antacid to reduce gastrointestinal upset.
The patient needs to wear sunscreen while outside because of photosensitivity.
Sun exposure and tanning booths need to be avoided with conventional antipsychotics because of the adverse effect of photosensitivity. Instruct the patient to apply sunscreen liberally and to wear sun-protective clothing and hats.
56
A patient has used enteric aspirin for several years as treatment for osteoarthritis. However, the symptoms are now worse and she is given a prescription for a nonsteroidal anti-inflammatory drug and misoprostol (Cytotec). The patient asks the nurse, “Why am I now taking two pills for arthritis” What is the nurse’s best response
“Cytotec will also reduce the symptoms of your arthritis.”
“Cytotec helps the action of the NSAID so that it will work better.”
“Cytotec reduces the mucous secretions in the stomach, which reduces gastric irritation.”
“Cytotec may help to prevent gastric ulcers that may occur in patients taking NSAIDs.”
Cytotec may help to prevent gastric ulcers that may occur in patients taking NSAIDs.”
Cytotec inhibits gastric acid secretions and stimulates mucous secretions; it has proved successful in preventing the gastric ulcers that may occur in patients taking NSAIDs.
57
A patient has been taking iron supplements for anemia for 2 months. During a follow-up assessment, the nurse will observe for which therapeutic response
Decreased weight
Increased activity tolerance
Decreased palpitations
Increased appetite
Increased activity tolerance
Absence of fatigue, increased activity tolerance and well-being, and improved nutrition status are therapeutic responses to iron supplementation. The other options are incorrect.
58
The nurse is reviewing the therapeutic effects of nonsteroidal anti-inflammatory drugs (NSAIDs), which include which effect
Anxiolytic
Sedative
Antipyretic
Antimicrobial
Antipyretic
NSAIDs have antipyretic effects but not the other effects listed.
59
A 10-year-old patient will be started on methylphenidate hydrochloride (Ritalin) therapy. The nurse will perform which essential baseline assessment before this drug is started
Eye examination
Height and weight
Liver function studies
Hearing test
Height and weight
Assessment of baseline height and weight is important before beginning Ritalin therapy because it may cause a temporary slowing of growth in prepubertal children. The other studies are not as essential at this time.
60
A 29-year-old male patient is admitted to the intensive care unit with the following symptoms: restlessness, hyperactive reflexes, talkativeness, confusion and periods of panic and euphoria, tachycardia, and fever. The nurse suspects that he may be experiencing the effects of taking which substance
Opioids
Alcohol
Stimulants
Depressants
Stimulants
The adverse effects listed may occur with use of stimulants and are commonly an extension of their therapeutic effects. Opioids, alcohol, and depressants do not have these effects.
61
A patient is receiving thrombolytic therapy, and the nurse monitors the patient for adverse effects. What is the most common undesirable effect of thrombolytic therapy
Dysrhythmias
Nausea and vomiting
Anaphylactic reactions
Internal and superficial bleeding
Internal and superficial bleeding
Bleeding, both internal and superficial, as well as intracranial, is the most common undesirable effect of thrombolytic therapy. The other options list possible adverse effects of thrombolytic drugs, but they are not the most common effects.
62
A patient is taking gabapentin (Neurontin), and the nurse notes that there is no history of seizures on his medical record. What is the best possible rationale for this medication order
The medication is used for the treatment of neuropathic pain.
The medication is helpful for the treatment of multiple sclerosis.
The medication is used to reduce the symptoms of Parkinson’s disease.
The medical record is missing the correct information about the patient’s history of seizures.
The medication is used for the treatment of neuropathic pain
Gabapentin (Neurontin) is commonly used to treat neuropathic pain. The other options are incorrect.
63
A patient will be receiving a thrombolytic drug as part of the treatment for acute myocardial infarction. The nurse explains to the patient that this drug is used for which purpose
To relieve chest pain
To prevent further clot formation
To dissolve the clot in the coronary artery
To control bleeding in the coronary vessels
To dissolve the clot in the coronary artery
Thrombolytic drugs lyse, or dissolve, thrombi. They are not used to prevent further clot formation or to control bleeding. As a result of dissolving of the thrombi, chest pain may be relieved, but that is not the primary purpose of thrombolytic therapy.
64
A patient is taking a xanthine derivative as part of treatment for chronic obstructive pulmonary disease. The nurse will monitor for which adverse effects associated with the use of xanthine derivatives
Diarrhea
Palpitations
Bradycardia
Drowsiness
Palpitations
The common adverse effects of the xanthine derivatives include nausea, vomiting, and anorexia. In addition, gastroesophageal reflux has been observed to occur during sleep in patients taking these drugs. Cardiac adverse effects include sinus tachycardia, extrasystole, palpitations, and ventricular dysrhythmias. Transient increased urination and hyperglycemia are other possible adverse effects.
65
A patient will be taking oral iron supplements at home. The nurse will include which statements in the teaching plan for this patient (Select all that apply.)
Take the iron tablets with meals.
Take the iron tablets on an empty stomach 1 hour before meals.
Take the iron tablets with an antacid to prevent heartburn.
Drink 8 ounces of milk with each iron dose.
Taking iron supplements with orange juice enhances iron absorption.
Stools may become loose and light in color.
Take the iron tablets with meals.
Taking iron supplements with orange juice enhances iron absorption.
Iron tablets need to be taken with meals to reduce gastrointestinal distress, but antacids and milk interfere with absorption. Orange juice enhances the absorption of iron. Stools may become black and tarry in patients who are on iron supplements. Tablets need to be taken whole, not crushed, and the patient needs to be encouraged to eat foods high in iron.
66
When a patient is receiving a second-generation antipsychotic drug, such as risperidone (Risperdal), the nurse will monitor for which therapeutic effect
Fewer panic attacks
Decreased paranoia and delusions
Decreased feeling of hopelessness
Improved tardive dyskinesia
Decreased paranoia and delusions
The therapeutic effects of the antipsychotic drugs include improvement in mood and affect, and alleviation or decrease in psychotic symptoms (decrease in hallucinations, paranoia, delusions, garbled speech). Tardive dyskinesia is a potential adverse effect of these drugs. The other options are incorrect.
67
A patient wants to take a ginseng dietary supplement. The nurse instructs the patient to look for which potential adverse effect
Drowsiness
Palpitations and anxiety
Dry mouth
Constipation.
Palpitations and anxiety
Elevated blood pressure, chest pain or palpitations, anxiety, insomnia, headache, nausea, vomiting, and diarrhea are potential adverse effects of ginseng. Drowsiness, difficulty with urination, and constipation are not potential adverse effects of ginseng
68
The nurse is assessing the medication history of a patient with a new diagnosis of Parkinson’s disease. Which condition is a contraindication for the patient, who will be taking tolcapone (Tasmar)
Glaucoma
Seizure disorder
Liver failure
Benign prostatic hyperplasia
Liver failure
Tolcapone is contraindicated in patients who have shown a hypersensitivity reaction to it, and it should be used with caution in patients with pre-existing liver disease. The other conditions listed are not contraindications.
69
During a routine appointment, a patient with a history of seizures is found to have a phenytoin (Dilantin) level of 23 mcg/mL. What concern will the nurse have, if any
The patient is at risk for seizures because the drug level is not at a therapeutic level.
The patient’s seizures should be under control because this is a therapeutic drug level.
The patient’s seizures should be under control if she is also taking a second antiepileptic drug.
The drug level is at a toxic level, and the dosage needs to be reduced.
The drug level is at a toxic level, and the dosage needs to be reduced.
Therapeutic drug levels for phenytoin are usually 10 to 20 mcg/mL (see Table 14-6). The other options are incorrect.
70
The nurse is developing a care plan for a patient who is taking an anticholinergic drug. Which nursing diagnosis would be appropriate for this patient
Diarrhea
Urinary retention
Risk for infection
Disturbed sleep pattern
Urinary retention
Patients receiving anticholinergic drugs are at risk for urinary retention and constipation, not diarrhea. The other nursing diagnoses are not applicable to anticholinergic drugs.
71
A patient is receiving heparin therapy as part of the treatment for a pulmonary embolism. The nurse monitors the results of which laboratory test to check the drug’s effectiveness
Bleeding times
Activated partial thromboplastin time (aPTT)
Prothrombin time/international normalized ratio (PT/INR)
Vitamin K levels
Activated partial thromboplastin time (aPTT)
Ongoing aPTT values are used to monitor heparin therapy. PT/INR is used to monitor warfarin therapy. The other two options are not used to monitor anticoagulant therapy.
72
The nurse is reviewing the use of central nervous system stimulants. Which of these are indications for this class of drugs (Select all that apply.)
```
Narcolepsy
Depression
Panic attacks
Neonatal apnea
Attention deficit hyperactivity disorder (ADHD)
Appetite suppression
```
Narcolepsy
Neonatal apnea
Attention deficit hyperactivity disorder (ADHD)
Appetite suppression
Central nervous system stimulants can be used for narcolepsy, neonatal apnea, ADHD, and appetite suppression in the treatment of obesity. They are not used for depression and panic attacks.
73
The nurse will instruct patients about a possible systemic effect that may occur if excessive amounts of topically applied adrenergic nasal decongestants are used. Which systemic effect may occur
Heartburn
Bradycardia
Drowsiness
Palpitations
Palpitations
Although a topically applied adrenergic nasal decongestant can be absorbed into the bloodstream, the amount absorbed is usually too small to cause systemic effects at normal dosages. Excessive dosages of these medications, however, are more likely to cause systemic effects elsewhere in the body. These may include cardiovascular effects, such as hypertension and palpitations, and central nervous system effects such as headache, nervousness, and dizziness. The other options are incorrect.
74
When admitting a patient with a suspected diagnosis of chronic alcohol use, the nurse will keep in mind that chronic use of alcohol might result in which condition
Renal failure
Cerebrovascular accident
Korsakoff’s psychosis
Alzheimer’s disease
Korsakoff’s psychosis
A variety of serious neurologic and mental disorders, such as Korsakoff’s psychosis and Wernicke’s encephalopathy, as well as cirrhosis of the liver, may occur with chronic use of alcohol. Renal failure, cerebrovascular accident, and Alzheimer’s disease are not associated directly with chronic use of alcohol.
75
A patient who has been anticoagulated with warfarin (Coumadin) has been admitted for gastrointestinal bleeding. The history and physical examination indicates that the patient may have taken too much warfarin. The nurse anticipates that the patient will receive which antidote
Vitamin E
Vitamin K
Protamine sulfate
Potassium chloride
Vitamin K
Vitamin K is given to reverse the anticoagulation effects of warfarin toxicity. Protamine sulfate is the antidote for heparin overdose. The other options are incorrect.
76
When assessing the medication history of a patient with a new diagnosis of Parkinson’s disease, which conditions are contraindications for the patient who will be taking carbidopa-levodopa (Select all that apply.)
```
Angle-closure glaucoma
History of malignant melanoma
Hypertension
Benign prostatic hyperplasia
Concurrent use of monoamine oxidase inhibitors (MAOIs)
```
Angle-closure glaucoma
History of malignant melanoma
Concurrent use of monoamine oxidase inhibitors (MAOIs)
Angle-closure glaucoma, a history of melanoma or other undiagnosed skin conditions, and concurrent use of MAOIs are contraindications to the use of carbidopa-levodopa. The other options are incorrect.
77
When evaluating a patient who is taking orlistat (Xenical), which is an intended therapeutic effect
Increased wakefulness
Increased appetite
Decreased weight
Decreased hyperactivity
Decreased weight
Orlistat (Xenical) is a nonstimulant drug that is used as part of a weight loss program. The other options are incorrect.
78
While a patient is receiving drug therapy for Parkinson’s disease, the nurse monitors for dyskinesia, which is manifested by which finding
Rigid, tense muscles
Difficulty in performing voluntary movements
Limp extremities with weak muscle tone
Confusion and altered mental status
Difficulty in performing voluntary movements
Dyskinesia is the difficulty in performing voluntary movements that is experienced by some patients with Parkinson’s disease. The other options are incorrect.
79
A patient is receiving gabapentin (Neurontin), an anticonvulsant, but has no history of seizures. The nurse expects that the patient is receiving this drug for which condition
Inflammation pain
Pain associated with peripheral neuropathy
Depression associated with chronic pain
Prevention of seizures
Pain associated with peripheral neuropathy
Anticonvulsants are often used as adjuvants for treatment of neuropathic pain to enhance analgesic efficacy. The other indications listed are not correct.
80
During assessment of a patient with osteoarthritis pain, the nurse knows that which condition is a contraindication to the use of nonsteroidal anti-inflammatory drugs (NSAIDs)
Renal disease
Diabetes mellitus
Headaches
Rheumatoid arthritis
Renal disease
Contraindications to NSAIDs include known drug allergy and conditions that place a patient at risk for bleeding, such as vitamin K deficiency, and peptic ulcer disease. Patients with documented aspirin allergy must not receive NSAIDs. Other common contraindications are those that apply to most drugs, including severe renal or hepatic disease. The other options are not contraindications.
81
The nurse is providing instructions to a patient who has a new prescription for a corticosteroid metered-dose inhaler. Which statement by the patient indicates that further instruction is needed (Select all that apply.)
“I will rinse my mouth with water after using the inhaler and then spit out the water.”
“I will gargle after using the inhaler and then swallow.”
“I will clean the plastic inhaler casing weekly by removing the canister and then washing the casing in warm soapy water. I will then let it dry before reassembling.”
“I will use this inhaler for asthma attacks.”
“I will continue to use this inhaler, even if I am feeling better.”
“I will use a peak flow meter to measure my response to therapy.”
“I will gargle after using the inhaler and then swallow.”
“I will use this inhaler for asthma attacks.”
The inhaled corticosteroid is a maintenance drug used to prevent asthma attacks; it is not indicated for acute asthma attacks. Rinsing the mouth with water is appropriate and necessary to prevent oral fungal infections; the water is not to be swallowed after rinsing. The patient needs to be given instructions about keeping the inhaler clean, including removing the canister from the plastic casing weekly and washing the casing in warm soapy water. Once the casing is dry, the canister and mouthpiece may be put back together and the cap applied. The glucocorticoid may predispose the patient to oral fungal overgrowth, thus the need for implicit instructions about cleaning inhaling devices. Use of a peak flow meter assists in monitoring the patient’s response to therapy. The medication needs to be taken as ordered every day, regardless of whether the patient is feeling better.
82
A patient is to receive acetylcysteine (Mucomyst) as part of the treatment for an acetaminophen (Tylenol) overdose. Which action by the nurse is appropriate when giving this medication
Giving the medication undiluted for full effect
Avoiding the use of a straw when giving this medication
Disguising the flavor with soda or flavored water
Preparing to give this medication via a nebulizer
Disguising the flavor with soda or flavored water
Acetylcysteine has the flavor of rotten eggs and so is better tolerated if it is diluted and disguised by mixing with a drink such as cola or flavored water to help increase its palatability. The use of a straw helps to minimize contact with the mucous membranes of the mouth and is recommended. The nebulizer form of this medication is used for certain types of pneumonia, not for acetaminophen overdose.
83
When teaching a patient who will be receiving antihistamines, the nurse will include which instructions (Select all that apply.)
“Antihistamines are generally safe to take with over-the-counter medications.”
“Take the medication on an empty stomach to maximize absorption of the drug.”
“Take the medication with food to minimize gastrointestinal distress.”
“Drink extra fluids if possible.”
“Antihistamines may cause restlessness and disturbed sleep.”
“Avoid activities that require alertness until you know how adverse effects are tolerated.”
“Take the medication with food to minimize gastrointestinal distress.”
“Drink extra fluids if possible.”
“Avoid activities that require alertness until you know how adverse effects are tolerated.”
Antihistamines should be taken with food, even though this slightly reduces the absorption of the drug, so as to minimize the gastrointestinal upset that can occur. Over-the-counter medications must not be taken with an antihistamine unless approved by the physician because of the serious drug interactions that may occur. Drinking extra fluids will help to ease the removal of secretions, and activities that require alertness, such as driving, must not be engaged in until the patient knows how he or she responds to the sedating effects of antihistamines.
84
Phenytoin (Dilantin) has a narrow therapeutic index. The nurse recognizes that this characteristic indicates which of these
The safe and the toxic plasma levels of the drug are very close to each other.
The phenytoin has a low chance of being effective.
There is no difference between safe and toxic plasma levels.
A very small dosage can result in the desired therapeutic effect.
The safe and the toxic plasma levels of the drug are very close to each other.
Having a “narrow therapeutic index” means that there is a small difference between safe and toxic drug levels. These drugs require monitoring of therapeutic plasma levels. The other options are incorrect.
85
The nurse is monitoring a patient who has been taking carbamazepine (Tegretol) for 2 months. Which effects would indicate that autoinduction has started to occur
The drug levels for carbamazepine are higher than expected.
The drug levels for carbamazepine are lower than expected.
The patient is experiencing fewer seizures.
The patient is experiencing toxic effects from the drug.
The drug levels for carbamazepine are lower than expected.
With carbamazepine, autoinduction occurs and leads to lower than expected drug concentrations. Therefore, the dosage may have to be adjusted with time. The other options are incorrect.
86
A patient asks the nurse about the uses of echinacea. Which use will the nurse include in the response
Memory enhancement
Boosting the immune system
Improving mood
Promoting relaxation
Boosting the immune system
Common uses of echinacea include stimulation of the immune system, antisepsis, treatment of viral infections and influenza-like respiratory tract infections, and promotion of the healing of wounds and chronic ulcerations. The other options are incorrect.
87
A patient is being treated for ethanol alcohol abuse in a rehabilitation center. The nurse will include which information when teaching him about disulfiram (Antabuse) therapy
He should not smoke cigarettes while on this drug.
He needs to know about the common over-the-counter substances that contain alcohol.
This drug will cause the same effects as the alcohol did, without the euphoric effects.
Mouthwashes and cough medicines that contain alcohol are safe because they are used in small amounts.
He needs to know about the common over-the-counter substances that contain alcohol.
The use of disulfiram (Antabuse) with alcohol-containing over-the-counter products will elicit severe adverse reactions. As little as 7 mL of alcohol may cause symptoms in a sensitive person. Cigarette smoking does not cause problems when taking disulfiram. Disulfiram does not have the same effects as alcohol.
88
A nurse is providing teaching for a patient who will be taking varenicline (Chantix) as part of a smoking-cessation program. Which teaching points are appropriate for a patient taking this medication (Select all that apply.)
This drug is available as a chewing gum that can be taken to reduce cravings.
Use caution when driving because drowsiness may be a problem.
There have been very few adverse effects reported for this drug.
Notify the prescriber immediately if feelings of sadness or thoughts of suicide occur.
Avoid caffeine while on this drug.
Use caution when driving because drowsiness may be a problem.
Notify the prescriber immediately if feelings of sadness or thoughts of suicide occur.
Patients taking varenicline have reported drowsiness, which has prompted the U.S. Food and Drug Administration (FDA) to recommend caution when driving and engaging in other potentially hazardous activities until the patient can determine how the drug affects his or her mental status. In addition, the FDA has warned about psychiatric symptoms including agitation, depression, and suicidality. Varenicline is an oral tablet, and common adverse effects include nausea, vomiting, headache, and insomnia. There are no cautions about taking caffeine while on this drug.
89
The nurse is reviewing medications for the treatment of asthma. Which drugs are used for acute asthma attacks (Select all that apply.)
```
Salmeterol (Serevent) inhaler
Albuterol (Proventil) nebulizer solution
Epinephrine
Montelukast (Singulair)
Fluticasone (Flovent) Rotadisk inhaler
```
Albuterol (Proventil) nebulizer solution
Epinephrine
Albuterol (a short-acting beta2 agonist) and epinephrine (a beta1 and beta2 agonist) are used for acute bronchospasms. Salmeterol is a long-acting beta2 agonist that is indicated for maintenance treatment, not acute episodes. Fluticasone is an inhaled corticosteroid; montelukast is a leukotriene receptor antagonist (LTRA). These types of medications are used for asthma prophylaxis.
90
The nurse is assessing a patient who has been admitted to the emergency department for a possible opioid overdose. Which assessment finding is characteristic of an opioid drug overdose
Dilated pupils
Restlessness
Respiration rate of 6 breaths/min
Heart rate of 55 beats/min
Respiration rate of 6 breaths/min
The most serious adverse effect of opioid use is CNS depression, which may lead to respiratory depression. Pinpoint pupils, not dilated pupils, are seen. Restlessness and a heart rate of 55 beats/min are not indications of an opioid overdose.
91
A patient arrives at the urgent care center complaining of leg pain after a fall when rock climbing. The x-rays show no broken bones, but he has a large bruise on his thigh. The patient says he drives a truck and does not want to take anything strong because he needs to stay awake. Which statement by the nurse is most appropriate
“It would be best for you not to take anything if you are planning to drive your truck.”
“We will discuss with your doctor about taking an opioid because that would work best for your pain.”
“You can take acetaminophen, also known as Tylenol, for pain, but no more than 1000 mg per day.”
“You can take acetaminophen, also known as Tylenol, for pain, but no more than 3000 mg per day.”
You can take acetaminophen, also known as Tylenol, for pain, but no more than 3000 mg per day.”
Acetaminophen is indicated for mild-to-moderate pain and does not cause drowsiness, as an opioid would. Currently, the maximum daily amount of acetaminophen is 3000 mg/day. The 1000-mg amount per day is too low. Telling the patient not to take any pain medications is incorrect.
92
A patient has been given a prescription for levodopa-carbidopa (Sinemet) for her newly diagnosed Parkinson’s disease. She asks the nurse, “Why are there two drugs in this pill” The nurse’s best response reflects which fact
Carbidopa allows for larger doses of levodopa to be given.
Carbidopa prevents the breakdown of levodopa in the periphery.
There are concerns about drug-food interactions with levodopa therapy that do not exist with the combination therapy.
Carbidopa is the biologic precursor of dopamine and can penetrate into the central nervous system.
Carbidopa prevents the breakdown of levodopa in the periphery.
When given in combination with levodopa, carbidopa inhibits the breakdown of levodopa in the periphery and thus allows smaller doses of levodopa to be used. Lesser amounts of levodopa result in fewer unwanted adverse effects. Levodopa, not carbidopa, is the biologic precursor of dopamine and can penetrate into the CNS.
93
A patient with the diagnosis of schizophrenia is hospitalized and is taking a phenothiazine drug. Which statement by this patient indicates that he is experiencing a common adverse effect of phenothiazines
“I can’t sleep at night.”
“I feel hungry all the time.”
“Look at how red my hands are.”
“My mouth has been so dry lately.”
“My mouth has been so dry lately.”
Phenothiazines produce anticholinergic-like adverse effects of dry mouth, urinary hesitancy, and constipation
94
The nurse is administering liquid oral iron supplements. Which intervention is appropriate when administering this medication
Have the patient take the liquid iron with milk.
Instruct the patient to take the medication through a plastic straw.
Have the patient sip the medication slowly.
Have the patient drink the medication, undiluted, from the unit-dose cup.
Instruct the patient to take the medication through a plastic straw.
Liquid oral forms of iron need to be taken through a plastic straw to avoid discoloration of tooth enamel. Milk may decrease absorption.
95
The nurse is giving an intravenous dose of phenytoin (Dilantin). Which action is correct when administering this drug
Give the dose as a fast intravenous (IV) bolus.
Mix the drug with normal saline, and give it as a slow IV push.
Mix the drug with dextrose (D5W), and give it as a slow IV push.
Mix the drug with any available solution as long as the administration rate is correct.
Mix the drug with normal saline, and give it as a slow IV push.
Intravenous phenytoin is given only with normal saline solution to prevent precipitation formation caused by incompatibilities. The IV push dose must be given slowly (not exceeding 50 mg/min in adults), and the patient must be monitored for bradycardia and decreased blood pressure.
96
A patient has prescriptions for two inhalers. One inhaler is a bronchodilator, and the other is a corticosteroid. Which instruction regarding these inhalers will the nurse give to the patient
“Take the corticosteroid inhaler first.”
“Take the bronchodilator inhaler first.”
“Take these two drugs at least 2 hours apart.”
“It does not matter which inhaler you use first.”
“Take the bronchodilator inhaler first.”
An inhaled bronchodilator is used before the inhaled corticosteroid to provide bronchodilation before administration of the anti-inflammatory drug.
97
A patient has been taking temazepam (Restoril) for intermittent insomnia. She calls the nurse to say that when she takes it, she sleeps well, but the next day she feels “so tired.” Which explanation by the nurse is correct
“Long-term use of this drug results in a sedative effect.”
“If you take the drug every night, this hangover effect will be reduced.”
“These drugs affect the sleep cycle, resulting in daytime sleepiness.”
“These drugs increase the activity of the central nervous system, making you tired the next day.”
These drugs affect the sleep cycle, resulting in daytime sleepiness.”
Benzodiazepines suppress REM sleep to a degree (although not as much as barbiturates) and, thus, result in daytime sleepiness (a hangover effect). The other statements are incorrect.
98
A patient is recovering from a minor automobile accident that occurred 1 week ago. He is taking cyclobenzaprine (Flexeril) for muscular pain and goes to physical therapy three times a week. Which nursing diagnosis would be appropriate for him
Risk for injury related to decreased sensorium
Risk for addiction related to psychologic dependency
Decreased fluid volume related to potential adverse effects
Disturbed sleep pattern related to the drug’s interference with REM sleep
Risk for injury related to decreased sensorium
Musculoskeletal relaxants have a depressant effect on the CNS; thus, the patient needs to be taught the importance of taking measures to minimize self-injury and falls related to decreased sensorium. “Risk for addiction” is not a NANDA nursing diagnosis. The other nursing diagnoses are not appropriate for this situation.
99
When treating patients with medications for Parkinson’s disease, the nurse knows that the wearing-off phenomenon occurs for which reason
There are rapid swings in the patient’s response to levodopa.
The patient cannot tolerate the medications at times.
The medications begin to lose effectiveness against Parkinson’s disease.
The patient’s liver is no longer able to metabolize the drug.
The medications begin to lose effectiveness against Parkinson’s disease.
The wearing-off phenomenon occurs when antiparkinson medications begin to lose their effectiveness, despite maximal dosing, as the disease progresses. The other options are incorrect.
100
The nurse is reviewing antiepileptic drug (AED) therapy. Which statements about AED therapy are accurate (Select all that apply.)
AED therapy can be stopped when seizures are stopped.
AED therapy is usually lifelong.
Consistent dosing is the key to controlling seizures.
A dose may be skipped if the patient is experiencing adverse effects.
Do not abruptly discontinue AEDs because doing so may cause rebound seizure activity.
AED therapy is usually lifelong.
Consistent dosing is the key to controlling seizures.
Do not abruptly discontinue AEDs because doing so may cause rebound seizure activity.
Patients need to know that AED therapy is usually lifelong, and compliance (with consistent dosing) is important for effective seizure control. Abruptly stopping AED therapy may cause withdrawal (or rebound) seizure activity.
101
Ramelteon (Rozerem) is prescribed for a patient with insomnia. The nurse checks the patient’s medical history, knowing that this medication is contraindicated in which disorder
Coronary artery disease
Renal insufficiency
Liver disease
Anemia
Liver disease
Ramelteon is contraindicated in cases of severe liver dysfunction. The other conditions are not contraindications.
102
The nurse is reviewing the medical record of a patient before giving a new order for iron sucrose (Venofer). Which statement regarding the administration of iron sucrose is correct
The medication is given with food to reduce gastric distress.
Iron sucrose is contraindicated if the patient has renal disease.
A test dose will be administered before the full dose is given.
The nurse will monitor the patient for hypotension during the infusion.
The nurse will monitor the patient for hypotension during the infusion.
Iron sucrose (Venofer) is an injectable iron product indicated for the treatment of iron-deficiency anemia in patients with chronic renal disease. It is also used for patients without kidney disease. Its risk of precipitating anaphylaxis is much less than that of iron dextran, and a test dose is not required. Hypotension is the most common adverse effect and appears to be related to infusion rate. Low-weight elderly patients appear to be at greatest risk for hypotension.
103
A patient tells the nurse that he likes to drink kava herbal tea to help him relax. Which statement by the patient indicates that additional teaching about this herbal product is needed
“I will not drink wine with the kava tea.”
“If I notice my skin turning yellow, I will stop taking the tea.”
“I will not take sleeping pills if I have this tea in the evening.”
“I will be able to drive my car after drinking this tea.”
“I will be able to drive my car after drinking this tea.”
Patients should not drive after drinking this tea because it may cause sedation. Kava tea may cause skin discoloration (with long-term use). In addition, it must not be taken with alcohol, barbiturates, and psychoactive drugs.
104
A woman who is planning to become pregnant should ensure that she receives adequate levels of which supplement to reduce the risk for fetal neural tube defects
Vitamin B12
Vitamin D
Iron
Folic acid
Folic acid
It is recommended that administration of folic acid be begun at least 1 month before pregnancy and continue through early pregnancy to reduce the risk for fetal neural tube defects.
105
Which statements are true regarding the selective serotonin reuptake inhibitors (SSRIs) (Select all that apply.)
Avoid foods and beverages that contain tyramine.
Monitor the patient for extrapyramidal symptoms.
Therapeutic effects may not be seen for about 4 to 6 weeks after the medication is started.
If the patient has been on an MAOI, a 2- to 5-week or longer time span is required before beginning an SSRI medication.
These drugs have anticholinergic effects, including constipation, urinary retention, dry mouth, and blurred vision.
Cogentin is often also prescribed to reduce the adverse effects that may occur.
Therapeutic effects may not be seen for about 4 to 6 weeks after the medication is started.
If the patient has been on an MAOI, a 2- to 5-week or longer time span is required before beginning an SSRI medication.
During SSRI medication, therapeutic effects may not be seen for 4 to 6 weeks. To prevent the potentially fatal pharmacodynamic interactions that can occur between the SSRIs and the MAOIs, a 2- to 5-week washout period is recommended between uses of these two classes of medications. The other options apply to other classes of psychotherapeutic drugs, not SSRIs.
106
A patient who has received some traumatic news is panicking and asks for some medication to help settle down. The nurse anticipates giving which drug that is most appropriate for this situation
Diazepam (Valium)
Zolpidem (Ambien)
Phenobarbital
Cyclobenzaprine (Flexeril)
Diazepam (Valium)
Benzodiazepines such as diazepam are used as anxiolytics, or sedatives. Zolpidem is used as a hypnotic for sleep. Phenobarbital is not used as an anxiolytic but is used for seizure control. Cyclobenzaprine is a muscle relaxant and is not used to reduce anxiety.
107
A patient is to receive iron dextran injections. Which technique is appropriate when the nurse is administering this medication
Intravenous administration mixed with 5% dextrose
Intramuscular injection in the upper arm
Intramuscular injection using the Z-track method
Subcutaneous injection into the abdomen
Intramuscular injection using the Z-track method
Intramuscular iron is given using the Z-track method deep into a large muscle mass. If given intravenously, it is given with normal saline, not 5% dextrose.
108
A patient who has been taking a selective serotonin reuptake inhibitor (SSRI) is complaining of “feeling so badly” when he started taking an over-the-counter St. John’s wort herbal product at home. The nurse suspects that he is experiencing serotonin syndrome. Which of these are symptoms of serotonin syndrome (Select all that apply.)
```
Agitation
Drowsiness
Tremors
Bradycardia
Sweating
Constipation
```
Agitation
Tremors
Sweating
Common symptoms of serotonin syndrome include delirium, agitation, tachycardia, sweating, hyperreflexia, shivering, coarse tremors, and others. See Box 16-1 for a full list of symptoms.
109
A 6-year-old boy has been started on an extended-release form of methylphenidate hydrochloride (Ritalin) for the treatment of attention deficit hyperactivity disorder (ADHD). During a follow-up visit, his mother tells the nurse that she has been giving the medication at bedtime so that it will be “in his system” when he goes to school the next morning. What is the nurse’s appropriate evaluation of the mother’s actions
She is giving him the medication dosage appropriately.
The medication should not be taken until he is at school.
The medication should be taken with meals for optimal absorption.
The medication should be given 4 to 6 hours before bedtime to diminish insomnia.
The medication should be given 4 to 6 hours before bedtime to diminish insomnia.
Central nervous system stimulants should be taken 4 to 6 hours before bedtime to decrease insomnia. Generally speaking, once-a-day dosing is used with extended-release or long-acting preparations. These formulations eliminate the need to take this medication at school.
110
A patient is being discharged on anticoagulant therapy. The nurse will include in the patient-education conversation that it is important to avoid herbal products that contain which substance
Valerian
Ginkgo
Soy
Saw palmetto
Ginkgo
Capsicum pepper, feverfew, garlic, ginger, ginkgo, St. John’s wort, and ginseng are some herbals that have potential interactions with anticoagulants, especially with warfarin.
111
A patient has been admitted to the emergency department with a suspected overdose of a tricyclic antidepressant. The nurse will prepare for what immediate concern
Hypertension
Renal failure
Cardiac dysrhythmias
Gastrointestinal bleeding
Cardiac dysrhythmias
Tricyclic antidepressant overdoses are notoriously lethal. The primary organ systems affected are the central nervous system and the cardiovascular system, and death usually results from either seizures or dysrhythmias.
112
A patient has had recent mechanical heart valve surgery and is receiving anticoagulant therapy. While monitoring the patient’s laboratory work, the nurse interprets that the patient’s international normalized ratio (INR) level of 3 indicates that:
the patient is not receiving enough warfarin to have a therapeutic effect.
the patient’s warfarin dose is at therapeutic levels.
the patient’s intravenous heparin dose is dangerously high.
the patient’s intravenous heparin dose is at therapeutic levels.
the patient’s warfarin dose is at therapeutic levels.
A normal INR (without warfarin) is 1.0. A therapeutic INR for patients who have had mechanical heart valve surgery ranges from 2.5 to 3.5, with a middle value of 3.
113
A patient has been taking naltrexone (ReVia) as part of the treatment for addiction to heroin. The nurse expects that the naltrexone will have which therapeutic effect for this patient
Naltrexone prevents the cravings for opioid drugs.
Naltrexone works as a safer substitute for the heroin until the patient completes withdrawal.
The patient will experience flushing, sweating, and severe nausea if he takes heroin while on naltrexone.
If opioid drugs are used while taking naltrexone, euphoria is not produced; thus, the opioid’s desired effects are lost.
If opioid drugs are used while taking naltrexone, euphoria is not produced; thus, the opioid’s desired effects are lost.
Naltrexone works to eliminate the euphoria that occurs with opioid drug use; therefore, the reinforcing effect of the drug is lost.
114
A patient is recovering from abdominal surgery, which he had this morning. He is groggy but complaining of severe pain around his incision. What is the most important assessment data to consider before the nurse administers a dose of morphine sulfate to the patient
His pulse rate
His respiratory rate
The appearance of the incision
The date of his last bowel movement
His respiratory rate
One of the most serious adverse effects of opioids is respiratory depression. The nurse must assess the patient’s respiratory rate before administering an opioid. The other options are incorrect.
115
A 22-year-old patient has been taking lithium for 1 year, and the most recent lithium level is 0.9 mEq/L. Which statement about the laboratory result is correct
The lithium level is therapeutic.
The lithium level is too low.
The lithium level is too high.
Lithium is not usually monitored with blood levels.
The lithium level is therapeutic.
Desirable long-term maintenance lithium levels range between 0.6 and 1.2 mEq/L. The other responses are incorrect.
116
The nurse is reviewing the history of a patient who has a new order for a nonsteroidal anti-inflammatory drug (NSAID) to treat tendonitis. Which conditions are contraindications to the use of NSAIDs (Select all that apply.)
```
Vitamin K deficiency
Arthralgia
Peptic ulcer disease
Neuropathy
Pericarditis
```
Vitamin K deficiency
Peptic ulcer disease
Contraindications to NSAIDs include known drug allergy as well as conditions that place the patient at risk for bleeding, such as Vitamin K deficiency and peptic ulcer disease. NSAIDs may be used to treat arthralgia and pericarditis. Neuropathy is not a contraindication.
117
A patient is taking the nonsteroidal anti-inflammatory drug indomethacin (Indocin) as treatment for pericarditis. The nurse will teach the patient to watch for which adverse effect
Tachycardia
Nervousness
Nausea and vomiting
Dizziness
Nausea and vomiting
Gastrointestinal effects include dyspepsia, heartburn, epigastric distress, nausea, vomiting, anorexia, abdominal pain, and others. See Table 44-2 for the other adverse effects of nonsteroidal anti-inflammatory drugs (NSAIDs). The other options are not adverse effects of NSAIDs.
118
A patient is in an urgent care center with an acute asthma attack. The nurse expects that which medication will be used for initial treatment
An anticholinergic such as ipratropium (Atrovent)
A short-acting beta2 agonist such as albuterol (Proventil)
A long-acting beta2 agonist such as salmeterol (Serevent)
A corticosteroid such as fluticasone (Flovent)
A short-acting beta2 agonist such as albuterol (Proventil
The short-acting beta2 agonists are commonly used during the acute phase of an asthmatic attack to reduce airway constriction quickly and to restore airflow to normal levels. The other drugs listed are not appropriate for acute asthma attacks. Anticholinergic drugs and long-acting beta2 agonists are used to prevent attacks; corticosteroids are used to reduce airway inflammation.
119
A patient has been taking disulfiram (Antabuse) as part of his rehabilitation therapy. However, this evening, he attended a party and drank half a beer. As a result, he became ill and his friends took him to the emergency department. The nurse will look for which adverse effects associated with acetaldehyde syndrome (Select all that apply.)
```
Euphoria
Severe vomiting
Diarrhea
Pulsating headache
Difficulty breathing
Sweating
```
Severe vomiting
Pulsating headache
Difficulty breathing
Sweating
Acetaldehyde syndrome results when alcohol is taken while on disulfiram (Antabuse) therapy. Adverse effects include CNS effects (pulsating headache, sweating, marked uneasiness, weakness, vertigo, others); GI effects (nausea, copious vomiting, thirst); and difficulty breathing. Cardiovascular effects also occur; see Table 17-2. Euphoria and diarrhea are not adverse effects associated with acetaldehyde syndrome
120
A patient has a new order for a catechol ortho-methyltransferase (COMT) inhibitor as part of treatment for Parkinson’s disease. The nurse recognizes that which of these is an advantage of this drug class
It has a shorter duration of action.
It causes less gastrointestinal distress.
It has a slower onset than traditional Parkinson’s disease drugs.
It is associated with fewer wearing-off effects.
It is associated with fewer wearing-off effects.
COMT inhibitors are associated with fewer wearing-off effects and have prolonged therapeutic benefits. They have a quicker onset, and they prolong the duration of action of levodopa.
121
The nurse is assessing a patient for contraindications to drug therapy with acetaminophen (Tylenol). Which patient should not receive acetaminophen
A patient with a fever of 101° F (38.3° C)
A patient who is complaining of a mild headache
A patient with a history of liver disease
A patient with a history of peptic ulcer disease
A patient with a history of liver disease
Liver disease is a contraindication to the use of acetaminophen. Fever and mild headache are both possible indications for the medication. Having a history of peptic ulcer disease is not a contraindication.
122
The nurse is providing instructions about the Advair inhaler (fluticasone propionate and salmeterol). Which statement about this inhaler is accurate
It is indicated for the treatment of acute bronchospasms.
It needs to be used with a spacer for best results.
Patients need to avoid drinking water for 1 hour after taking this drug.
It is used for the prevention of bronchospasms.
It is used for the prevention of bronchospasms.
Salmeterol is a long-acting beta2 agonist bronchodilator, while fluticasone is a corticosteroid. In combination, they are used for the maintenance treatment of asthma and COPD. As a long-acting inhaler, Advair is not appropriate for treatment of acute bronchospasms. The other statements are incorrect.
123
The prescriber has changed the patient’s medication regimen to include the leukotriene receptor antagonist (LTRA) montelukast (Singulair) to treat asthma. The nurse will emphasize which point about this medication
The proper technique for inhalation must be followed.
The patient needs to keep it close by at all times to treat acute asthma attacks.
It needs to be taken every day on a continuous schedule, even if symptoms improve.
When the asthma symptoms improve, the dosage schedule can be tapered and eventually discontinued.
It needs to be taken every day on a continuous schedule, even if symptoms improve.
These drugs are indicated for chronic, not acute, asthma and are to be taken every day on a continuous schedule, even if symptoms improve. These drugs are taken orally.
124
The U.S. Food and Drug Administration has issued a warning for users of antiepileptic drugs. Based on this report, the nurse will monitor for which potential problems with this class of drugs
Increased risk of suicidal thoughts and behaviors
Signs of bone marrow depression
Indications of drug addiction and dependency
Increased risk of cardiovascular events, such as strokes
Increased risk of suicidal thoughts and behaviors
In December 2008, the U.S. Food and Drug Administration (FDA) required black box warnings on all antiepileptic drugs regarding the risk of suicidal thoughts and behaviors. Patients being treated with antiepileptic drugs for any indication need to be monitored for the emergence or worsening of depression, suicidal thoughts or behavior, or any unusual changes in mood or behavior. The other options are incorrect.
125
A patient is suffering from tendonitis of the knee. The nurse is reviewing the patient’s medication administration record and recognizes that which adjuvant medication is most appropriate for this type of pain
Antidepressant
Anticonvulsant
Corticosteroid
Local anesthesia
Corticosteroid
Corticosteroids have an anti-inflammatory effect, which may help to reduce pain. The other medications do not have anti-inflammatory properties.
126
A patient is brought to the emergency department for treatment of a suspected overdose. The patient was found with an empty prescription bottle of a barbiturate by his bedside. He is lethargic and barely breathing. The nurse would expect which immediate intervention
Starting an intravenous infusion of diluted bicarbonate solution
Administering medications to increase blood pressure
Implementing measures to maintain the airway and support respirations
Administrating naloxone (Narcan) as an antagonist
Implementing measures to maintain the airway and support respirations
There are no antagonists/antidotes for barbiturates. Treatment supports respirations and maintains the airway. The other interventions are not appropriate.
127
A patient has been treated for lung cancer for 3 years. Over the past few months, the patient has noticed that the opioid analgesic is not helping as much as it had previously and more medication is needed for the same pain relief. The nurse is aware that this patient is experiencing which of these
Opioid addiction
Opioid tolerance
Opioid toxicity
Opioid abstinence syndrome
Opioid tolerance
Opioid tolerance is a common physiologic result of long-term opioid use. Patients with opioid tolerance require larger doses of the opioid agent to maintain the same level of analgesia. This situation does not describe toxicity (overdose), addiction, or abstinence syndrome (withdrawal).
128
A patient with gout has been treated with allopurinol (Zyloprim) for 2 months. The nurse will monitor laboratory results for which therapeutic effect
Decreased uric acid levels
Decreased prothrombin time
Decreased white blood cell count
Increased hemoglobin and hematocrit levels
Decreased uric acid levels
Treatment of gout with allopurinol should result in decreased uric acid levels. The other options are incorrect
129
A gardener needs a decongestant because of seasonal allergy problems and asks the nurse whether he should take an oral form or a nasal spray. Which of these is a benefit of orally administered decongestants
Immediate onset
A more potent effect
Lack of rebound congestion
Shorter duration
Lack of rebound congestion
Drugs administered by the oral route produce prolonged decongestant effects, but the onset of action is more delayed and the effect less potent than those of decongestants applied topically. However, the clinical problem of rebound congestion associated with topically administered drugs is almost nonexistent with oral dosage forms.
130
A patient will be taking dabigatran (Pradaxa) as part of treatment for chronic atrial fibrillation. Which statements about dabigatran are true (Select all that apply.)
The dose of dabigatran is reduced in patients with decreased renal function.
Bleeding is the most common adverse effect.
Potassium chloride is given as an antidote in cases of overdose.
Dabigatran levels are monitored by measuring prothrombin time/international normalized ratio (PT/INR) results.
This drug is a prodrug and becomes activated in the liver.
The dose of dabigatran is reduced in patients with decreased renal function.
Bleeding is the most common adverse effect.
This drug is a prodrug and becomes activated in the liver.
Dabigatran is excreted extensively in the kidneys, and the dose is dependent upon renal function. The normal dose is 150 mg twice daily, but it must be reduced to 75 mg twice daily if creatinine clearance is less than 30 mL/min. The most common and serious side effect is bleeding. Dabigatran is a prodrug that becomes activated in the liver. There is no antidote to dabigatran. The other options are incorrect.
131
The nurse is presenting a substance-abuse lecture for teenage girls and is asked about “roofies.” The nurse recognizes that this is the slang term for which substance
Cocaine
Flunitrazepam
Secobarbital
Methamphetamine
Flunitrazepam
Flunitrazepam is a benzodiazepine that has recently gained popularity as a recreational drug and is commonly called roofies (the “date-rape” drug). The other drugs are not known as roofies.
132
A 57-year-old woman being treated for end-stage breast cancer has been using a transdermal opioid analgesic as part of the management of pain. Lately, she has been experiencing breakthrough pain. The nurse expects this type of pain to be managed by which of these interventions
Administering NSAIDs
Administering an immediate-release opioid
Changing the opioid route to the rectal route
Making no changes to the current therapy
Administering an immediate-release opioid
If a patient is taking long-acting opioid analgesics, breakthrough pain must be treated with an immediate-release dosage form that is given between scheduled doses of the long-acting opioid. The other options are not appropriate actions.
133
The nurse is administering folic acid to a patient with a new diagnosis of anemia. Which statement about treatment with folic acid is true
Folic acid is used to treat any type of anemia.
Folic acid is used to treat iron-deficiency anemia.
Folic acid is used to treat pernicious anemia.
The specific cause of the anemia needs to be determined before treatment.
The specific cause of the anemia needs to be determined before treatment.
Folic acid should not be used to treat anemias until the underlying cause and type of anemia have been identified. Administering folic acid to a patient with pernicious anemia may correct the hematologic changes of anemia, but the symptoms of pernicious anemia (which is due to a vitamin B12 deficiency, not a folic acid deficiency) may be deceptively masked. The other options are incorrect.
134
A patient has been taking selegiline (Eldepryl), 20 mg/day for 1 month. Today, during his office visit, he tells the nurse that he forgot and had a beer with dinner last evening, and “felt awful.” What did the patient most likely experience
Hypotension
Hypertension
Urinary discomfort
Gastrointestinal upset
Hypertension
At doses that exceed 10 mg/day, selegiline becomes a nonselective monoamine oxidase inhibitor (MAOI), contributing to the development of the cheese effect, so-called because it interacts with tyramine-containing foods (cheese, red wine, beer, and yogurt) and can cause severe hypertension.
135
An oral iron supplement is prescribed for a patient. The nurse would question this order if the patient’s medical history includes which condition
Decreased hemoglobin
Hemolytic anemia
Weakness
Concurrent therapy with erythropoietics
Hemolytic anemia
Hemolytic anemia is a contraindication to the use of iron supplements. Decreased hemoglobin and weakness are related to iron-deficiency anemia. Iron supplements are given with erythropoietic drugs to aid in the production of red blood cells.
136
A 75-year-old woman has been given a nonsteroidal anti-inflammatory drug (an NSAID for the treatment of rheumatoid arthritis. The nurse is reviewing the patient’s medication history and notes that which types of medications could have an interaction with the NSAID (Select all that apply.)
```
Antibiotics
Decongestants
Anticoagulants
Beta blockers
Diuretics
Corticosteroids
```
Anticoagulants
Diuretics
Corticosteroids
Anticoagulants taken with NSAIDs may cause increased bleeding tendencies because of platelet inhibition and hypoprothrombinemia. NSAIDs taken with diuretics may cause reduced hypotensive and diuretic effects. NSAIDs taken with corticosteroids may cause increased ulcerogenic effects. See Table 44-5. The other options are incorrect.
137
A patient has been instructed to take one enteric-coated low-dose aspirin a day as part of therapy to prevent strokes. The nurse will provide which instruction when providing patient teaching about this medication
Aspirin needs to be taken on an empty stomach to ensure maximal absorption.
Low-dose aspirin therapy rarely causes problems with bleeding.
Take the medication with 6 to 8 ounces of water and with food.
Coated tablets may be crushed if necessary for easier swallowing.
Take the medication with 6 to 8 ounces of water and with food.
Enteric-coated aspirin is best taken with 6 to 8 ounces of water and with food to help decrease gastrointestinal upset. Enteric-coated tablets should not be crushed. Risk for bleeding increases with aspirin therapy, even at low doses.
138
When teaching a patient about taking a newly prescribed antiepileptic drug (AED) at home, the nurse will include which instruction
“Driving is allowed after 2 weeks of therapy.”
“If seizures recur, take a double dose of the medication.”
“Antacids can be taken with the AED to reduce gastrointestinal adverse effects.”
“Regular, consistent dosing is important for successful treatment.”
“Regular, consistent dosing is important for successful treatment.”
Consistent dosing, taken regularly at the same time of day, at the recommended dose, and with meals to reduce the common gastrointestinal adverse effects, is the key to successful management of seizures when taking AEDs. Noncompliance is the factor most likely to lead to treatment failure.
139
A 78-year-old patient is in the recovery room after having a lengthy surgery on his hip. As he is gradually awakening, he requests pain medication. Within 10 minutes after receiving a dose of morphine sulfate, he is very lethargic and his respirations are shallow, with a rate of 7 per minute. The nurse prepares for which priority action at this time
Assessment of the patient’s pain level
Immediate intubation and artificial ventilation
Administration of naloxone (Narcan)
Close observation of signs of opioid tolerance
Administration of naloxone (Narcan)
Naloxone, an opioid-reversal agent, is used to reverse the effects of acute opioid overdose and is the drug of choice for reversal of opioid-induced respiratory depression. This situation is describing an opioid overdose, not opioid tolerance. Intubation and artificial ventilation are not appropriate because the patient is still breathing at 7 breaths/min. It would be inappropriate to assess the patient’s level of pain.
140
A patient has been taking the selective serotonin reuptake inhibitor (SSRI) sertraline (Zoloft) for about 6 months. At a recent visit, she tells the nurse that she has been interested in herbal therapies and wants to start taking St. John’s wort. Which response by the nurse is appropriate
“That should be no problem.”
“Good idea! Hopefully you’ll be able to stop taking the Zoloft.”
“Be sure to stop taking the herb if you notice a change in side effects.”
“Taking St. John’s wort with Zoloft may cause severe interactions and is not recommended.”
“Taking St. John’s wort with Zoloft may cause severe interactions and is not recommended.”
The herbal product St. John’s wort must not be used with SSRIs. Potential interactions include confusion, agitation, muscle spasms, twitching, and tremors. The other responses by the nurse are inappropriate.
141
The nurse reads in the patient’s medication history that the patient is taking buspirone (BuSpar). The nurse interprets that the patient may have which disorder
Anxiety disorder
Depression
Schizophrenia
Bipolar disorder
Anxiety disorder
Buspirone is indicated for the treatment of anxiety disorders, not depression, schizophrenia, or bipolar disorder.
142
When a patient is taking an anticholinergic such as benztropine (Cogentin) as part of the treatment for Parkinson’s disease, the nurse should include which information in the teaching plan
Minimize the amount of fluid taken while on this drug.
Discontinue the medication if adverse effects occur.
Take the medication on an empty stomach to enhance absorption.
Use artificial saliva, sugarless gum, or hard candy to counteract dry mouth.
Use artificial saliva, sugarless gum, or hard candy to counteract dry mouth.
Dry mouth can be managed with artificial saliva through drops or gum, frequent mouth care, forced fluids, and sucking on sugar-free hard candy. Anticholinergics should be taken with or after meals to minimize GI upset and must not be discontinued suddenly. The patient must drink at least 3000 mL/day unless contraindicated. Drinking water is important, even if the patient is not thirsty or in need of hydration, to prevent and manage the adverse effect of constipation.
143
The nurse is reviewing the dosage schedule for several different antiepileptic drugs (AEDs). Which antiepileptic drug allows for once-a-day dosing
Levetiracetam (Keppra)
Phenobarbital
Valproic acid (Depakote)
Gabapentin (Neurontin)
Phenobarbital
Phenobarbital has the longest half-life of all standard AEDs, including those listed in the other options, so it allows for once-a-day dosing.
144
A patient is receiving instructions regarding the use of caffeine. The nurse shares that caffeine should be used with caution if which of these conditions is present
A history of peptic ulcers
Migraine headaches
Asthma
A history of kidney stones
A history of peptic ulcers
Caffeine should be used with caution by patients who have histories of peptic ulcers or cardiac dysrhythmias or who have recently had myocardial infarctions. The other conditions are not contraindications to the use of caffeine.
145
A patient has been advised to add a nasal spray (an adrenergic decongestant) to treat a cold. The nurse will include which instruction
“You won’t see effects for at least 1 week.”
“Limit use of this spray to 3 to 5 days.”
“Continue the spray until nasal stuffiness has resolved.”
“Avoid use of this spray if a fever develops.”
Limit use of this spray to 3 to 5 days.”
Frequent, long-term, or excessive use of adrenergic nasal decongestants may lead to rebound congestion if used beyond the recommended time. The other instructions are incorrect.
146
A patient has been receiving epoetin alfa (Epogen) for severe iron-deficiency anemia. Today, the provider changed the order to darbepoetin (Aranesp). The patient questions the nurse, “What is the difference in these drugs” Which response by the nurse is correct
“There is no difference in these two drugs.”
“Aranesp works faster than Epogen to raise your red blood cell count.”
“Aranesp is given by mouth, so you will not need to have injections.”
“Aranesp is a longer-acting form, so you will receive fewer injections.”
“Aranesp is a longer-acting form, so you will receive fewer injections.”
Darbepoetin (Aranesp) is longer-acting than epoetin alfa (Epogen); therefore, fewer injections are required. The other options are incorrect.
147
A patient with a tracheostomy has difficulty removing excessive, thick mucus from the respiratory tract. The nurse expects that which drug will be ordered to aid in the removal of mucus
Guaifenesin (Humibid)
Benzonatate (Tessalon Perles)
Diphenhydramine (Benadryl)
Dextromethorphan (Robitussin DM)
Guaifenesin (Humibid)
Expectorants such as guaifenesin work to loosen and thin sputum and the bronchial secretions, thereby indirectly diminishing the tendency to cough. The other drugs listed do not have this effect.
148
A 22-year-old nursing student has been taking NoDoz (caffeine) tablets for the past few weeks to “make it through” the end of the semester and exam week. She is in the university clinic today because she is “exhausted.” What nursing diagnosis may be appropriate for her
Noncompliance
Impaired physical mobility
Disturbed sleep pattern
Imbalanced nutrition: less than body requirements
Disturbed sleep pattern
The main ingredient in NoDoz, caffeine, is a central nervous system stimulant that can be used to increase mental alertness. Restlessness, anxiety, and insomnia are common adverse effects. Thus, disturbed sleep pattern is the most appropriate nursing diagnosis of those listed.
149
A patient has been prescribed warfarin (Coumadin) in addition to a heparin infusion. The patient asks the nurse why he has to be on two medications. The nurse’s response is based on which rationale
The oral and injection forms work synergistically.
The combination of heparin and an oral anticoagulant results in fewer adverse effects than heparin used alone.
Oral anticoagulants are used to reach an adequate level of anticoagulation when heparin alone is unable to do so.
Heparin is used to start anticoagulation so as to allow time for the blood levels of warfarin to reach adequate levels.
Heparin is used to start anticoagulation so as to allow time for the blood levels of warfarin to reach adequate levels.
This overlap therapy is required in patients who have been receiving heparin for anticoagulation and are to be switched to warfarin so that prevention of clotting is continuous. This overlapping is done purposefully to allow time for the blood levels of warfarin to rise, so that when the heparin is eventually discontinued, therapeutic anticoagulation levels of warfarin will have been achieved. Recommendations are to continue overlap therapy of the heparin and warfarin for at least 5 days; the heparin is stopped after day 5 when the international normalized ratio (INR) is above 2.
150
When administering heparin subcutaneously, the nurse will follow which procedure
Aspirating the syringe before injecting the medication
Massaging the site after injection
Applying heat to the injection site
Using a 1/2 - to 5/8 -inch 25- to 28-gauge needle
Using a 1/2 - to 5/8 -inch 25- to 28-gauge needle
A 1/2 - to 5/8 -inch 25- to 28-gauge needle is the correct needle to use for a subcutaneous heparin injection. The other options would encourage hematoma formation at the injection site.
151
A patient has a new prescription for phentermine (Ionamin) as part of the treatment for weight loss. Which information will the nurse include when teaching this patient about a stimulant such as phentermine (Select all that apply.)
Take this medication after meals.
Take this medication in the morning.
This drug is taken along with supervised exercise and suitable diet.
Use mouth rinses, sugarless gum, or hard candies to minimize dry mouth.
Avoid foods that contain caffeine, such as coffee, tea, and colas.
Take this medication in the morning.
This drug is taken along with supervised exercise and suitable diet.
Use mouth rinses, sugarless gum, or hard candies to minimize dry mouth.
Avoid foods that contain caffeine, such as coffee, tea, and colas.
This drug should be taken in the morning to avoid interference with sleep, and the patient should also be on a supervised exercise and dietary regime. Caffeine-containing products should be avoided because of possible additional stimulation. Dry mouth can be minimized by the use of mouth rinses, sugarless gum, or hard candy. The other option is incorrect.
152
During therapy with the hematopoietic drug epoetin alfa (Epogen), the nurse instructs the patient about adverse effects that may occur, such as:
anxiety.
drowsiness.
hypertension.
constipation.
hypertension.
Hypertension is an adverse effect of hematopoietic drugs, along with headache, fever, pruritus, rash, nausea, vomiting, arthralgia, cough, and injection site reaction. The other options are incorrect.
153
A patient is experiencing status epilepticus. The nurse prepares to give which drug of choice for the treatment of this condition
Diazepam (Valium)
Midazolam (Versed)
Valproic acid (Depakote)
Carbamazepine (Tegretol)
Diazepam (Valium)
Diazepam (Valium) is considered by many to be the drug of choice for status epilepticus. Other drugs that are used are listed in Table 14-3 and do not include the drugs listed in the other options.
154
When evaluating a patient’s use of a metered-dose inhaler (MDI), the nurse notes that the patient is unable to coordinate the activation of the inhaler with her breathing. What intervention is most appropriate at this time
Notify the doctor that the patient is unable to use the MDI.
Obtain an order for a peak flow meter.
Obtain an order for a spacer device.
Ask the prescriber if the medication can be given orally.
Obtain an order for a spacer device.
The use of a spacer may be indicated with metered-dose inhalers, especially if success with inhalation is limited. The other options are not appropriate interventions.
155
A cancer patient is receiving drug therapy with epoetin alfa (Epogen). The nurse knows that the medication must be stopped if which laboratory result is noted
White blood cell count of 550 cells/mm3
Hemoglobin level of 12 g/dL
Potassium level of 4.2 mEq/L
Glucose level of 78 mg/dL
Hemoglobin level of 12 g/dL
If epoetin is continued when hemoglobin levels are above 11 g/dL, patients may experience serious adverse events, including heart attack, stroke, and death. Guidelines now recommend that the drug be stopped when the hemoglobin level reaches 10 g/dL for cancer patients. For renal patients, the target hemoglobin level is 11 g/dL for patients on dialysis and 10 g/dL for chronic renal patients not on dialysis.
156
Before beginning a patient’s therapy with selective serotonin reuptake inhibitor (SSRI) antidepressants, the nurse will assess for concurrent use of which medications or medication class
Aspirin
Anticoagulants
Diuretics
Nonsteroidal anti-inflammatory drugs
Anticoagulants
Use of selective serotonin reuptake inhibitor (SSRI) antidepressants with warfarin results in an increased anticoagulant effect. SSRI antidepressants do not interact with the other drugs or drug classes listed. See Table 16-6 for important drug interactions with SSRIs.
