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Flashcards in exam 3 summer pharmacology Deck (168)
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1

A patient who experiences motion sickness when flying asks the nurse the best time to take the medication prescribed to prevent motion sickness for a 0900 flight. The nurse will instruct the patient to take the medication at which time?
a. As needed, at the first sign of nausea
b. At 0700, before leaving for the airport
c. At 0830, just prior to boarding the plane
d. When seated, just prior to takeoff

ANS: C
Motion sickness medication has its onset in 30 minutes. The patient should be instructed to take the medication a half hour prior to takeoff. It is not used as needed.

2

The nurse is performing a medication history on a patient who has glaucoma. The patient cannot remember the name of the drug prescribed but tells the nurse that the drug causes light sensitivity. The nurse knows that the drug is among which class of medications?
a. Alpha-adrenergic agonists
b. Beta-adrenergic blockers
c. Cholinergic agonists
d. Cholinesterase inhibitors

ANS: A
Alpha-adrenergic agonists cause mydriasis, which increases sensitivity to light. Beta-adrenergic blockers cause miosis, which impairs vision in the dark. Cholinergic agonists and cholinesterase inhibitors may cause myopia and will impair vision in the dark.

3

The nurse administers proparacaine HCl (Ophthaine) drops to a patient prior to an eye examination. What sign will the nurse look for to determine when the examination can begin?
a. Absence of the blink reflex
b. Blurred vision
c. Drying of the corneal epithelium
d. Photophobia

ANS: A
Ophthaine is a topical anesthetic for the eye and causes loss of the blink reflex. Drying of the corneal epithelium is a side effect but occurs later as a result of the loss of the blink reflex. Blurred vision and photophobia result from mydriasis and miosis.

4

The nurse is administering timolol (Timoptic) eye drops to a patient who has glaucoma. To prevent bradycardia, the nurse will perform which action?
a. Apply pressure to the lacrimal ducts.
b. Have the patient sit up after instilling the drops.
c. Prepare to administer an alpha-adrenergic agonist.
d. Wait 5 minutes between drops.

ANS: A
Bradycardia is a systemic side effect of timolol. Applying pressure to the lacrimal ducts prevents the medication from being systemically absorbed and causing systemic side effects such as bradycardia

5

A patient has an infection of the eyelash follicles and in the gland on the eyelid margin. The nurse recognizes these symptoms as being consistent with which condition?
a. Blepharitis
b. Chalazion
c. Endophthalmitis
d. Hordeolum

ANS: D
Hordeolum is a local infection of eyelash follicles and glands on the eyelid margin. Blepharitis is an infection of the margins of the eyelid. Chalazion is an infection of the glands of the eyelids that may produce cysts. Endophthalmitis is an infection of the structures of the inner eye.

6

The nurse is preparing to administer atropine sulfate drops as a mydriatic agent. Which assessment would cause the nurse to withhold the drug and notify the provider?
a. Blood pressure of 140/90 mm Hg
b. Heart rate of 60 beats per minute
c. Respiratory rate of 12 breaths per minute
d. Temperature of 37.9° C

ANS: A
Atropine sulfate can cause systemic cardiovascular side effects such as tachycardia and hypertension. An elevated blood pressure warrants holding the drug and notifying the provider.

7

The nurse is preparing to administer olopatadine (Patanol) eyedrops to a patient who has allergic conjunctivitis. The patient tells the nurse that the drops have caused burning and stinging. What action will the nurse take?
a. Administer the drops and reassure the patient that this is a normal side effect.
b. Offer an over-the-counter eye lubricant to minimize this adverse effect.
c. Request an order for antibiotic eyedrops.
d. Withhold the medication and notify the provider.

ANS: A
Burning and stinging are the most common side effects of this class of drugs but do not warrant withholding the medication. An over-the-counter lubricant is not indicated. These symptoms are not an indication of infection.

8

The nurse is providing teaching for a patient who will begin using tobramycin ointment (Nebcin) 0.5 inches 3 times daily. The patient currently uses pilocarpine HCl (Isopto Carpine) drops to treat glaucoma. Which statement by the patient indicates a need for further teaching?
a. “I should apply the third dose of tobramycin at bedtime each day.”
b. “I should instill the drops in the conjunctival sac of the lower eyelid.”
c. “I should not stop the medications without consulting my provider.”
d. “I should put the ointment on first and then instill the eyedrops.”

ANS: D
Patients using both drops and ointments should instill the drops prior to applying the ointment. Ointments should be applied at bedtime if possible. Drops should be instilled into the conjunctival sac of the lower lid. Patients should always consult with their provider before discontinuing any medication.

9

The nurse is counseling an adolescent patient who has recurrent otitis externa and who works as a lifeguard in the summer about preventing this condition. The nurse will teach this patient to
a. avoid using ear plugs while swimming.
b. request a prescription for prophylactic antibiotic eardrops.
c. use a hair dryer to dry the ears after swimming.
d. wear a medical alert bracelet.

ANS: C
To help prevent otitis externa, patients should be counseled to use a portable hair dryer to dry the ears after swimming. Ear plugs are recommended. Prophylactic antibiotic eardrops are not indicated. A medical alert bracelet is not necessary.

10

The parent of a toddler asks the nurse what can be done to prevent otitis media. What will the nurse recommend?
a. Administer diphenhydramine when the child has a runny nose.
b. Give phenylephrine (Neo-Synephrine Ophthalmic) to prevent congestion.
c. Keep the child’s immunizations up to date.
d. Remove cerumen with carbamide peroxide (Auro Ear Drops).

ANS: C
The pneumococcal conjugate vaccine (PCV) protects children against S. pneumoniae and should be administered to all children to prevent otitis media. Antihistamines and decongestants have been shown to be ineffective in preventing otitis media. Removing cerumen helps to prevent otitis externa.

11

A patient who experiences motion sickness when flying asks the nurse the best time to take the medication prescribed to prevent motion sickness for a 0900 flight. The nurse will instruct the patient to take the medication at which time?
a. As needed, at the first sign of nausea
b. At 0700, before leaving for the airport
c. At 0830, just prior to boarding the plane
d. When seated, just prior to takeoff

ANS: C
Motion sickness medication has its onset in 30 minutes. The patient should be instructed to take the medication a half hour prior to takeoff. It is not used as needed.

12

The nurse is caring for a patient who has unexplained, recurrent vomiting and who is unable to keep anything down. Until the cause of the vomiting is determined, the nurse will anticipate administering which medications?
a. Antibiotics and antiemetics
b. Intravenous fluids and electrolytes
c. Nonprescription antiemetics
d. Prescription antiemetics

ANS: B
Antiemetics can mask the underlying cause of vomiting and should not be used until the cause is determined unless vomiting is so severe that dehydration and electrolyte imbalance occur. Nonpharmacologic measures, such as fluid and electrolyte replacement, should be used. Antibiotics are only used if an infectious cause is determined.

13

The parent of an 18-month-old toddler calls the clinic to report that the child has vomited 5 times that day. The nurse determines that the child has had three wet diapers in the past 6 hours. What will the nurse recommend for this child?
a. Administering an OTC antiemetic medication such as diphenhydramine
b. Giving frequent, small amounts of Pedialyte
c. Keeping the child NPO until vomiting subsides
d. Taking the child to the emergency department for IV fluids

ANS: B
The child is not dehydrated as evidenced by adequate wet diapers, so nonpharmacologic measures, such as oral fluids, are recommended. Antiemetics are not recommended unless dehydration occurs. Intravenous fluids are given when dehydration is present.

14

The nurse is teaching a patient who is about to take a long car trip about using dimenhydrinate (Dramamine) to prevent motion sickness. What information is important to include when teaching this patient?
a. “Do not drive while taking this medication.”
b. “Dry mouth is a sign of toxicity with this medication.”
c. “Take the medication 1 to 2 hours prior to beginning the trip.”
d. “Take 100 mg up to 6 times daily for best effect.”

ANS: A
Drowsiness is a common side effect of dimenhydrinate, so patients should be cautioned against driving while taking this drug. Dry mouth is a common side effect and not a sign of toxicity. The drug should be taken 30 minutes prior to travel. The maximum recommended dose is 400 mg per day.

15

The nurse is caring for a patient who has postoperative nausea and vomiting. The surgeon has ordered promethazine HCl (Phenergan). Which aspect of this patient’s health history would be of concern?
a. Asthma
b. Diabetes
c. GERD
d. Glaucoma

ANS: D
Promethazine is contraindicated in patients with glaucoma since it is an anticholinergic medication. It should be used with caution in patients with asthma. The other two conditions are not concerning with this medication.

16

The nurse is teaching a group of nursing students about the use of antipsychotic drugs for antiemetic purposes. The nurse will explain that, when given as antiemetics, these drugs are given
a. in smaller doses.
b. less frequently.
c. with anticholinergics.
d. with antihistamines.

ANS: A
Antipsychotic medications have antiemetic properties in smaller doses.

17

A patient who is receiving chemotherapy will be given dronabinol (Marinol) to prevent nausea and vomiting. The nurse will tell the patient that this drug will be given at which time?
a. Before and after the chemotherapy
b. During chemotherapy
c. Immediately prior to chemotherapy
d. 24 hours prior to chemotherapy

ANS: A
Cannabinoids are given prior to chemotherapy and for 24 hours after chemotherapy

18

A woman who is 2 months pregnant reports having morning sickness every day and asks if she can take any medications to treat this problem. The nurse will recommend that the patient take which action first?
a. Contact the provider to discuss a possible need for intravenous fluids.
b. Contact the provider to discuss a prescription antiemetic.
c. Use nonpharmacologic measures such as saltines.
d. Take over-the-counter antiemetics such as diphenhydramine.

ANS: C
Pregnant women should avoid antiemetics during the first trimester of pregnancy because of possible teratogenic effects. The nurse should recommend nonpharmacologic measures such as saltines. If this is not effective, intravenous fluids may become necessary. Pregnant women should consult with their provider before taking prescription or over-the-counter antiemetics.

19

The parent of a child who is receiving chemotherapy asks the nurse why metoclopramide (Reglan) is not being used to suppress vomiting. The nurse will explain that, in children, this drug is more likely to cause which effect?
a. Excess sedation
b. Extrapyramidal symptoms
c. Paralytic ileus
d. Vertigo

ANS: B
Metoclopramide can cause extrapyramidal symptoms, and these effects are more likely in children. Children are not more prone to sedative effects, paralytic ileus, or vertigo while taking this drug.

20

The child who is a candidate for treatment with an emetic after ingestion of a toxic substance or overdose is the child who has ingested which substance?
a. Acetaminophen elixir
b. Chlorine bleach
c. Kerosene
d. Toilet cleanser

ANS: A
An emetic, such as Ipecac, should not be given to patients who have ingested caustic substances or petroleum distillates since regurgitation carries a risk of aspiration. Acetaminophen is not a caustic substance or a petroleum distillate. Chlorine bleach and toilet cleanser are caustic substances. Kerosene is a petroleum distillate.

21

The nurse is teaching a group of parents about the use of syrup of ipecac. Which instruction will the nurse provide?
a. “Do not administer ipecac without consulting a poison control center.”
b. “Expect the onset of emesis to be immediate.”
c. “Give ipecac with a glass of milk to increase its emetic effect.”
d. “Use ipecac fluid extract and not ipecac syrup.”

ANS: A
Ipecac should not be used for caustic substances or petroleum distillates. Ipecac should be given only after determining whether it is safe. The onset of emesis is within 15 to 30 minutes. Ipecac should not be given with milk or carbonated beverages. Ipecac syrup should be used.

22

A patient asks the nurse about using loperamide (Imodium) to treat infectious diarrhea. Which response will the nurse give?
a. “Loperamide results in many central nervous system (CNS) side effects.”
b. “Loperamide has no effect on infectious diarrhea.”
c. “Loperamide is taken once daily.”
d. “Loperamide may prolong the symptoms.”

ANS: D
Patients with infectious diarrhea should be cautioned about using loperamide since slowing transit through the intestines may prolong the exposure to the infectious agent. Loperamide causes less CNS depression than other antidiarrheals. It is taken after each loose stool.

23

A child is brought to the emergency department after ingestion of a toxic substance. The child is alert and conscious and is reported to have ingested kerosene 20 minutes prior. The nurse will anticipate administering
a. activated charcoal.
b. an anticholinergic antiemetic.
c. gastric lavage.
d. syrup of ipecac.

ANS: A
Activated charcoal is used when patients have ingested a caustic substance or a petroleum distillate in a patient who is alert and awake. Gastric lavage is no longer used as therapy. Syrup of ipecac is not recommended.

24

A patient who is taking diphenoxylate with atropine (Lomotil) to treat diarrhea asks the nurse why it contains atropine. The nurse will explain that atropine is added to
a. decrease abdominal cramping.
b. increase intestinal motility.
c. minimize nausea and vomiting.
d. provide analgesia.

ANS: A
Atropine is added to decrease abdominal cramping and intestinal motility. It does not affect nausea and vomiting or pain.

25

The nurse is caring for an older adult who is receiving diphenoxylate with atropine (Lomotil) to treat severe diarrhea. The nurse will monitor this patient closely for which effect?
a. Bradycardia
b. Fluid retention
c. Nervousness and tremors
d. Respiratory depression

ANS: D
Diphenoxylate is an opium agonist and can cause respiratory depression. Children and older adults are more susceptible to this effect. It contains atropine, so it will increase heart rate. It does not contribute to fluid retention. Lomotil causes central nervous system depression and will not cause nervousness and tremors.

26

A patient asks the nurse the best way to prevent traveler’s diarrhea. The nurse will provide which recommendation to the patient?
a. “Ask your provider for prophylactic antibiotics.”
b. “Drink bottled water and eat only well-cooked meats.”
c. “Eat fresh, raw fruits and vegetables.”
d. “Take loperamide (Imodium) every day.”

ANS: B
Patients traveling to areas with potential traveler’s diarrhea should be taught to drink bottled water and eat meats that are well cooked. Prophylactic antibiotics are not recommended. Patients should eat cooked, washed fruits and vegetables. Loperamide can increase exposure to pathogens by slowing motility.

27

An appropriate goal when teaching a patient who has diarrhea is that the patient
a. will have less frequent, more formed stools.
b. will not have a stool for 1 to 2 days.
c. will receive adequate intravenous fluids.
d. will receive appropriate antibiotic therapy.

ANS: A
An appropriate goal is that patients will have formed less frequent stools, not an absence of stools. Receiving adequate intravenous fluids or antibiotic therapy are interventions, not goals.

28

A patient reports having three to four stools, which are sometimes hard, per week. The nurse will perform which action?
a. Recommend increased fluids and dietary fiber.
b. Request an order for a laxative as needed.
c. Request an order for a stool softener.
d. Suggest discussing chronic constipation with the provider.

ANS: A
This patient is having stools that are within the normal range for frequency. Nonpharmacologic measures should be used first to help soften stools.

29

The nurse is instructing a patient who will take psyllium (Metamucil) to treat constipation. What information will the nurse include when teaching this patient?
a. The importance of consuming adequate amounts of water
b. The need to monitor for systemic side effects
c. The onset of action of 30 to 60 minutes after administration
d. The need to use the dry form of Metamucil to prevent cramping

ANS: A
Insufficient fluid intake can cause the drug to solidify in the gastrointestinal tract. Psyllium is not digestible, so it does not have systemic side effects. Onset of action for psyllium is between 10 and 24 hours. The dry form can cause cramping.

30

A 50-year-old male patient reports having decreased libido and testicular atrophy. The nurse will anticipate that the provider may order which medication to treat these symptoms?
a. Testosterone (Androderm)
b. Finasteride (Proscar)
c. Gonadotropin-releasing hormone (Gn-RH)
d. Sildenafil (Viagra)

ANS: A
Testosterone is given patients who have low testosterone, evidenced by decreased libido and testicular atrophy in adult men. Finasteride is given to treat benign prostatic hypertrophy. Gn-RH is used to inhibit testosterone production. Sildenafil is used to treat erectile dysfunction.