Final Flashcards
1
Q
In caring for a young child with pain, which assessment tool is the most useful?
a.
McGill-Melzack pain questionnaire
b.
Faces pain-rating scale
c.
0-10 numeric pain scale
d.
Simple description pain intensity scale
A
B
2
Q
A first day postoperative client on a PCA pump reports that the pain control is inadequate. What is the first action you should take?
a.
Assess the pain for location, quality, and intensity.
b.
Deliver the bolus dose per standing order.
c.
Contact the physician to increase the dose
d.
Try non-pharmacological comfort measures.
A
A
3
Q
Which client is most likely to receive opioids for extended periods of time?
a.
A client with progressive pancreatic cancer
b.
A client with phantom limb pain
c.
A client with trigeminal neuralgia
d.
A client with fibromyalgia
A
A
4
Q
An older adult patient who has cancer and Alzheimer’s disease is crying but shakes his or her head “no” when asked about pain. The prescriber has ordered morphine sulfate 2 to 4 mg IV every 2 hours PRN pain. It has been 4 hours since a dose has been given. What will the nurse do?
Select one:
a.
Administer 4 mg of morphine and monitor this patient’s verbal and nonverbal responses.
b.
Give 2 mg of morphine for pain to avoid increasing this patient’s level of confusion.
c.
Request an order for a nonopioid analgesic or an antidepressant adjuvant analgesic.
d.
Withhold any analgesic at this time and reassess the patient in 30 to 60 minutes.
A
A
5
Q
A client with diabetic neuropathy reports a burning, electrical-type in the lower extremities that is not responding to NSAIDs. You anticipate that the physician will order which adjuvant medication for this type of pain?
a.
Lorazepam (Ativan)
b.
Amitriptyline (Elavil)
c.
Methylphenidate (Ritalin)
d.
Corticosteroids
A
B
6
Q
A patient is brought to the emergency department by friends, who report finding the patient difficult to awaken. The friends report removing three fentanyl transdermal patches from the patient’s arm. On admission to the emergency department, the patient is slow to respond, has pinpoint pupils and a respiratory rate of 6 breaths per minute. The nurse recognizes the priority intervention as:
Select one:
a.
Obtain an order for a head CT.
b.
Obtain an order for a different opioid analgesic to manage the patient’s pain.
c.
Administration of IV fluids containing glucose.
d.
Administer Naloxone (Narcan) per standing order.
A
D
7
Q
A nurse is planning to administer morphine IV to a client who is postoperative. Which of the following actions should the nurse take?
a.
Protect the client’s skin from the severe diarrhea that occurs with morphine.
b.
Withhold this medication if respiratory rate is less than 10/min
c.
Monitor for seizures and confusion with repeated doses
d.
Give morphine intermittent via IV bolus over 30 seconds or less.
A
B
8
Q
A nurse is administering morphine sulfate to a postoperative patient. Which is NOT an appropriate routine nursing actions when giving this drug?
Select one:
a.
Palpating the patients abdomen twice per shift and monitoring for constipation
b.
Encouraging physical activity and offering increased fluids
c.
Monitoring the patient’s blood pressure closely for hypertension
d.
Monitoring respirations before giving the medication and throughout the course of therapy
A
C
9
Q
Which route of administration is preferred if immediate analgesia and rapid titration are necessary?
a.
Sublingual
b.
Intravenous (IV)
c.
Intraspinal
d.
Intramuscular
A
B
10
Q
A patient who has developed opioid tolerance will experience which effect?
Select one:
a.
increased respiratory depression
b.
decreased analgesic effect
c.
decreased constipation
d.
increased euphoria
A
B
11
Q
A patient with cancer is admitted to the hospital. The nurse obtains an admission history and learns that the patient has been taking oxycodone and a nonsteroidal anti-inflammatory drug (NSAID) for a year. The patient reports a recent increase in the intensity of pain, along with a new pain described as “burning” and “shooting.” The nurse anticipates that the prescriber will order:
Select one:
a.
A combination opioid/NSAID and an adjunctive analgesic.
b.
An increase in the oxycodone and NSAID doses.
c.
Intramuscular morphine sulfate and acetaminophen.
d.
A fentanyl transdermal patch, acetaminophen, and an adjunctive analgesic for nerve pain.
Feedback
A
D
12
Q
Which of the following is NOT a common adverse effect of opioid analgesics?
Select one:
a.
Diarrhea
b.
Nausea
c.
Sedation
d.
Respiratory Depression
A
A
13
Q
A patient asks the nurse what can be given to alleviate severe, chronic cancer pain of several months’ duration. The patient has been taking oxycodone [OxyContin] and states that it is no longer effective. The nurse will suggest discussing which medication with the provider?
Select one:
a.
Fentanyl [Duragesic] transdermal patch
b.
Pentazocine [Talwin] PO
c.
Naloxone (Narcan)
d.
Hydrocodone [Vicodin] PO
A
A
14
Q
What is the best way to schedule medication for a client with chronic constant pain?
a.
IV bolus after pain assessment
b.
Around-the-clock
c.
Prior to painful procedures
d.
PRN at the client’s request
A
B
15
Q
A patient with chronic pain has been receiving morphine sulfate but now has decreased pain. The prescriber changes the medication to ketolorac [Toradol]. The nurse will monitor the patient for:
Select one:
a.
nausea and sweating.
b.
euphoria.
c.
hypotension.
d.
respiratory depression.
A
A
16
Q
A patient who has pancreatitis reports a pain level of 8 on a 1 to 10 pain scale with 10 being the most severe pain. The patient has an order for acetaminophen (Tylenol) as needed for pain, and has been taking it as ordered around the clock. Which action by the nurse is correct?
Select one:
a.
Explain to the patient the importance not exceeding 4000mg of acetaminophen daily
b.
Contact the prescriber and request the addition of an opioid
c.
Administer an additional dose of the acetaminophen (Tylenol) as ordered.
d.
Contact the provider to discuss nonpharmacologic pain measures
A
B
17
Q
Place the examples of drugs in the order of usage according to the World Health Organization (WHO) analgesic ladder. a. Morphine, hydromorphone, acetaminophen and lorazepam b. NSAIDs and corticosteroids c. Codeine, oxycodone and diphenhydramine
a.
C, A, B
b.
B, A, C
c.
A, B, C
d.
B, C, A
A
D
18
Q
A nurse is admitting a client to the hospital following acetaminophen toxicity. Which of the following medications should the nurse expect to administer to this client?
Select one:
a.
Misoprostol
b.
Naltrexone
c.
Acetylcysteine
d.
Naloxone
A
C
19
Q
A nursing student asks the nurse why the provider has ordered a combination product containing an opioid analgesic and an NSAID for a patient who has cancer. Which response by the nurse is correct?
a.
“There are decreased effects of NSAIDs on the GI tract when a combination product is used.”
b.
“There are fewer adverse effects from both drugs when used in a combination product.”
c.
“There is a decreased likelihood of opioid dependence when it is given in combination with an NSAID.”
d.
“There is increased pain relief with the combination than when either product is used alone.”
A
D
20
Q
When titrating an analgesic to manage pain, what is the priority goal?
a.
Administer smallest dose that provides relief with the fewest side effects.
b.
Titrate upward until the client is pain free.
c.
Ensure that the drug is adequate to meet the client’s subjective needs.
d.
Titrate downwards to prevent toxicity.
A
A
21
Q
A nurse is providing teaching to a client who has migraine headache and a new prescription for Ergotamine. For which of the following manifestations indicating a possible adverse reaction should the nurse instruct the client to stop taking the medication and notify the provider? Select all apply:
Select one or more:
a.
positive home pregnancy test
b.
visual disturbance
c.
numbness and tingling in fingers
d.
muscle pain
A
A, c, d
22
Q
A client has just been prescribed with Methotrexate (Trexall) for the treatment of rheumatoid arthritis who did not respond to any other treatment. An important reminder for the client is to?
Select one:
a.
Pregnancy is not contraindicated with the use of the medication.
b.
Clay-colored stool is a normal response of the treatment
c.
Strict hand washing.
d.
Get a daily source of sunlight during the day.
A
C
23
Q
A patient with rheumatoid arthritis is experiencing sudden vision changes. Which medication found in the patient’s medication list can cause retinal damage?
Select one:
a.
Lefluomide (Arava)
b.
Hydroxychloroquine (Plaquenil)
c.
Sulfasalazine (Azulfidine)
d.
Methylprednisolone (Medrol)
A
B
24
Q
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?
a.
“I will take this medication regularly to prevent a migraine headache from occurring.”
b.
“I will take this medication when I feel a migraine headache starting.”
c.
“I will keep a journal to record the headaches I have and how the injections are working.”
d.
“This medication does not reduce the number of migraines I will have.”
A
A
25
A client is taking large doses of acetylsalicylic acid (ASA) for rheumatoid arthritis. Which assessment findings indicate that the client is experiencing ototoxicity as a result of the medication?
a.
Gastrointestinal upset and dizziness
b.
Gastrointestinal bleeding, ecchymosis, and dizziness
c.
Dizziness, sore throat, and purpura
d.
Tinnitus, hearing loss, dizziness, and ataxia
D
26
A patient is beginning therapy with oral methotrexate [Rheumatrex] for rheumatoid arthritis. The nurse will teach this patient about the importance of:
a.
reporting alopecia and rash.
b.
having routine renal and hepatic function tests.
c.
limiting folic acid consumption.
d.
taking the medication on a daily basis.
B
27
The nurse is caring for a client with a diagnosis of gout. Which laboratory value would the nurse expect to note in the client?
Select one:
a.
Calcium level of 9.0 mg/dL
b.
Uric acid level of 9.0 mg/dL
c.
Potassium level of 4.1 mEq/L
d.
Phosphorus level of 3.1 mg/dL
B
28
A patient is taking ibuprofen 800 mg three times a day by mouth as treatment for OA. While taking a health history, the nurse finds out that the patient has a few beers on weekends. What concern would there be with the interaction of the alcohol and ibuprofen?
a.
Reduced anti-inflammatory effects of the NSAID
b.
Increased risk for falls
c.
Increased nephrotoxic effects
d.
Increased chance for GI bleeding
D
29
A patient has had three gouty flare-ups in the past year. Which drug class will the nurse expect the provider to order for this patient?
Select one:
a.
Nonsteroidal anti-inflammatory drugs
b.
Glucocorticoids
c.
Urate-lowering drugs
d.
Colchicine
C
30
A 23 year old woman with a history of depression comes to your clinic seeking relief for a severe migraine headache that began 20 minutes ago. She is currently taking the SSRI (selective serotonin repute inhibitor) Citalopram for her depression and an estrogen/progesterone combined oral contraceptive. What medication would you avoid using for her acute treatment?
a.
Ergotamine (Ergomar)
b.
Topiramate (Topamax)
c.
Morphine
d.
Sumatriptan (Imitrex)
D
31
In monitoring a client's response to disease-modifying antirheumatic drugs (DMARDs), which assessment findings would the nurse consider acceptable responses? Select all that apply.
a.
An increased range of motion in the affected joints 3 months into therapy
b.
Normal white blood cell, platelet, and neutrophil counts
c.
Radiological findings that show no progression of joint degeneration
d.
Inflammation and irritation at the injection site 3 days after the injection is given
e.
Control of symptoms during periods of emotional stress
f.
A low-grade temperature on rising in the morning that remains throughout the day
A, b, c, e
32
A client with gout has begun to take allopurinol. The nurse informs the client that which medication may also be necessary during the beginning phase of medication therapy with allopurinol? Select all that apply.
a.
Oxycodone
b.
Indomethacin
c.
Naproxen
d.
Colchicine
e.
Hydromorphone
B, c, d
33
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?
Select one:
a.
osteoarthritis
b.
rheumatoid arthritis
c.
Gout
d.
Systemic lupus erythematosus
C
34
A patient is receiving instructions regarding the use of caffeine for migraine headaches. The nurse shares that caffeine should be used with caution if which of these conditions is present?
a.
Asthma
b.
Tension headache
c.
A history of peptic ulcers
d.
A history of kidney stones
C
35
A patient with gout who has increasingly frequent acute gouty attacks will begin receiving allopurinol [Zyloprim] and colchicine. The nurse will include which statement when teaching the patient about this drug regimen?
Select one:
a.
"The colchicine is given to enhance the effects of the allopurinol.”
b.
“Allopurinol helps reduce the gastrointestinal side effects of colchicine.”
c.
“You will take both drugs initially and then stop taking the colchicine.”
d.
“Allopurinol reduces the likelihood of gouty episodes that usually occur with initial colchicine therapy.”
C
36
A nurse is providing teaching for a client who has gout and a new prescription for Allopurinol. For which of the following adverse reactions should the client be taught to monitor? Select all apply:
Select one or more:
a.
insomnia
b.
rash
c.
nausea
d.
increased gout pain
B, c, d
37
A patient will begin taking hydroxychloroquine [Plaquenil] for rheumatoid arthritis. The patient is currently taking high-dose NSAIDs and methotrexate. What will the nurse teach the patient?
Select one:
a.
That the dose of NSAIDs may be decreased when beginning hydroxychloroquine
b.
That an eye exam is necessary at the beginning of therapy with this drug
c.
To obtain tests of renal and hepatic function while taking this drug
d.
To stop taking methotrexate when starting hydroxychloroquine
Feedback
B
38
A 17 year-old high school athlete with a history of asthma comes to your clinic seeking a preventative medication for migraine headaches. Which of the following would be contraindicated?
a.
Valproate (valproic acid)
b.
Amitriptyline (Axert)
c.
Propranolol (Inderal)
d.
Topiramate (Topamax)
C
39
Jane is a 67 year-old woman with a history of mild hypertension and classic angina pectoris. She is seeking treatment for migraine headaches of moderate intensity. Her headaches are preceeded by bilateral light flashes and dizziness that last about 10 minutes prior to the onset of pain. Her headaches are also frequently accompanied by photophobia, severe nausea and occasional vomiting. What medication would be contraindicated for acute treatment of Jane's headaches?
a.
Sumatriptan
b.
Acetaminophen
c.
Aspirin
d.
Propranolol
e.
Caffeine
A
40
A patient with gout has been treated with allopurinol (Zyloprim) for 2 months. The nurse will monitor laboratory results for which therapeutic effect?
Select one:
a.
decreased uric acid levels
b.
Decreased white blood cell count
c.
Increased hemoglobin and hematocrit levels
d.
Decreased prothrombin time
A
41
The healthcare provider is assessing the glucose level of a patient with a diagnosis of diabetes. Which of these is most helpful in evaluating this patient’s long-term glucose management?
Select one:
a.
Fasting blood glucose level
b.
Hemoglobin A1c (Hgb A1C)
c.
Urine glucose
d.
Urine specific gravity
B
42
A nurse assesses a patient with diabetes mellitus who self-administers subcutaneous insulin. The nurse notes a spongy, swelling area at the site the patient uses most frequently for insulin injection. What action would the nurse take?
Select one:
a.
Assess the patient for other signs of cellulitis.
b.
Consult the provider for a new administration route.
c.
Apply ice to the site to reduce inflammation.
d.
Instruct the patient to rotate sites for insulin injection
D
43
A client with thyroid cancer has just received Iodine-131 ablative therapy. Which statement by the client indicates a need for further teaching?
Select one:
a.
“I need to wash my clothes separately from everyone else’s clothes.”
b.
“I cannot share my toothpaste with anyone.”
c.
"I’m ready to hold my newborn grandson now.”
d.
“I must flush the toilet three times after I use it.”
C
44
A nurse is teaching a client who has diabetes mellitus and receives 25 units of NPH insulin every morning if her blood glucose level is above 200 mg/dL. Which of the following information should the nurse include?
a.
Freeze unopened insulin vials.
b.
Expect the NPH insulin to peak in 6 to 14 hr.
c.
Shake the insulin vigorously before loading the syringe.
d.
Discard the NPH solution if it appears cloudy.
B
45
An unresponsive patient who has diabetes is brought to the emergency department with slow, deep respirations. Additional findings include: blood glucose 450 mg/dL (24.9 mmol/L), arterial pH 7.2 (acidosis), and urinalysis showing presence of ketones and glucose. Which of the following best describes the underlying cause of this patient’s presentation?
Select one:
a.
Diabetic Ketoacidosis (DKA)
b.
Hyperosmolar Hyperglycemic Syndrome (HHS)
c.
Respiratory acidosis
d.
Hypoglycemia
A
46
A client with type 2 diabetes controlled with Metformin is recovering from surgery. The primary health care provider has placed the client on insulin in addition to the metformin. What is the nurse’s best response about why the client needs to take insulin?
Select one:
a.
Stress, such as surgery, increases blood glucose levels. You’ll need insulin to control your blood glucose temporarily.”
b.
“Your diabetes is getting worse, so you will need to take insulin.”
c.
“You must take insulin from now on because the surgery will affect your diabetes.”
d.
“You can’t take your metformin while in the hospital.”
A
47
A nurse is providing teaching for a client who is newly diagnosed with type 2 diabetes mellitus and has a prescription for glipizide(drug class: sulfonylureas) . Which of the following statements by the nurse best describes the action of glipizide?
Select one:
a.
"Glipizide prevents your liver from destroying your insulin."
b.
"Glipizide replaces insulin that is not being produced by your pancreas."
c.
"Glipizide absorbs the excess carbohydrates in your system."
d.
"Glipizide stimulates your pancreas to release insulin."
D
48
A diabetic patient has the following presentation: unresponsive to voice or touch, tachycardia, diaphoresis, and pallor. Which of the following actions by the healthcare provider is the priority?
Select one:
a.
Administer the prescribed insulin
b.
Send blood to the laboratory for analysis
c.
Administer 50% dextrose IV per hypoglycemia protocol
d.
Administer oxygen per nasal cannula
C
49
A nurse cares for a patient who has diabetes mellitus. The nurse administers 6 units of regular insulin and 10 units of NPH insulin at 07:00. At which time would the nurse assess the patient for potential problems related to the NPH insulin?
Select one:
a.
08:00
b.
23:00
c.
16:00
d.
20:00
C
50
A nurse is caring for a client who has diabetes insipidus and is receiving vasopressin. The nurse should identify which of the following findings as an indication that the medication is effective?
Select one:
a.
A decrease in blood sugar
b.
A decrease in urine output
c.
A decrease in specific gravity
d.
A decrease in blood pressure
B
51
A client is taking methimazole (Tapazole) for hyperthyroidism and would like to know how soon this medication will begin working. What is the nurse’s best response?
Select one:
a.
“You will see some effects of this medication within 2 weeks.”
b.
“You will see full effects from this medication within 1 to 2 days.”
c.
“You will see effects of this medication within 1 week.”
d.
“You will see effects of this medication immediately.”
Feedback
A
52
A nurse cares for a patient with diabetes mellitus who is prescribed metformin (Glucophage) and is scheduled for a contrast-enhanced CT. What action should the nurse take first?
Select one:
a.
Administer intravenous fluids to dilute and increase the excretion of dye.
b.
Contact the provider and recommend discontinuing the metformin
c.
Keep the patient NPO for at least 6 hours prior to the examination.
d.
Check the patient’s bedside blood glucose and administer prescribed insulin.
B
53
When considering replacement therapy options for a patient who has Adrenocortical insufficiency, the nurse should recognize that the provider will choose which of the following drugs?
Select one:
a.
Desmopressin
b.
Glucagon
c.
Hydrocortisone
d.
Somatotropin
C
54
A nurse is providing teaching to a female client who has type 2 diabetes and a new prescription for pioglitazone. Which of the following instructions should the nurse include in the teaching? (Select all that apply.)
Select one or more:
a.
Expect urine to be darkened.
b.
Increase calcium intake.
c.
Monitor weight daily.
d.
Use oral contraceptives to avoid pregnancy.
B, c
55
Which of the following insulins have no peak but a duration of 24 hours?
Select one:
a.
Humulin R (Regular insulin)
b.
Lantus (insulin glargine)
c.
Aspart insulin
d.
NPH insulin
B
56
A nurse is teaching about levothyroxine with a client who has primary hypothyroidism. Which of the following statements should the nurse use when teaching the client?
Select one:
a.
"Symptoms improve immediately after starting the medication."
b.
"Take this medication until your symptoms are gone and then discontinue."
c.
"Tremors, nervousness, and insomnia may indicate your dose is too high."
d.
"The medication decreases the overproduction of the thyroid hormone thyroxine."
C
57
The nurse is teaching a client about thyroid replacement therapy. Which statement by the client indicates a need for further teaching?
Select one:
a.
“If I continue to lose weight, I may need an increased dose.”
b.
“If I gain weight and feel tired, I may need an increased dose.”
c.
“I will take the medication every morning.”
d.
“I will have more energy with this medication.”
A
58
A client with type 1 diabetes mellitus received regular insulin at 7:00 a.m. The client will need to be monitored for hypoglycemia at which time?
Select one:
a.
2:00pm
b.
7:30 am
c.
11:00am
d.
7:30pm
C
59
A patient has been prescribed pharmacologic doses of glucocorticoids. It is most important for the nurse to teach the patient to do what?
Select one:
a.
Increase intake of dietary sodium.
b.
Have an eye examination every year.
c.
Take antibiotics to prevent infection.
d.
Never abruptly withdraw therapy.
D
60
A patient is admitted for diabetic ketoacidosis (DKA), and an IV drip titrated to maintain blood glucose levels between 120 and 200 is ordered (intravenous infusion). The only insulin that would be administered IV is:
Select one:
a.
None of the above, insulin cannot be administered IV
b.
NPH insulin
c.
Lantus (Glargine) insulin
d.
Regular insulin
D
61
Which side effect of clindamycin [Cleocin] causes the most concern and may warrant discontinuation of the drug?
Select one:
a.
None of the above
b.
Nausea
c.
Diarrhea
d.
Headache Which side effect of clindamycin [Cleocin] causes the most concern and may warrant discontinuation of the drug?
Select one:
a.
None of the above
b.
Nausea
c.
Diarrhea
d.
Headache
C
62
A patient who has been taking gentamicin for 5 days reports a headache and dizziness. What will the nurse do?
Select one:
a.
Tell the patient to report any tinnitus
b.
Suspect ototoxicity and notify the prescriber
c.
Tell the patient to ask for help with ambulation.
d.
Request an order for a gentamicin peak level
B
63
A nurse is teaching a nursing student what is meant by “generations” of cephalosporins. Which statement by the student indicates understanding of the teaching?
Select one:
a.
“Cephalosporins have increased activity against gram-negative bacteria with each generation.”
b.
“Cephalosporins are assigned to generations based on their relative costs to administer.”
c.
“First-generation cephalosporins have better penetration of the cerebrospinal fluid.”
d.
“Later generations of cephalosporins have lower resistance to destruction by beta-lactamases
A
64
A patient is receiving tobramycin 3 times daily. The provider has ordered a trough level with the 8:00 AM dose. The nurse will ensure that the level is drawn at what time?
Select one:
a.
4:00AM
b.
7:00AM
c.
8:45AM
d.
7:45AM
D
65
The nurse is caring for a patient on a medical-surgical unit who has a fever of unknown origin. The prescriber has ordered a broad-spectrum antibiotic. Which intervention is the priority?
Select one:
a.
Administering the antibiotic immediately
b.
Delaying administration of the antibiotic until the culture results are available
c.
Administering antipyretics as soon as possible
d.
Obtaining all cultures before the antibiotic is administered (not the results of the cultures)
D
66
The nurse is caring for a patient who is receiving vancomycin [Vancocin]. The nurse notes that the patient is experiencing flushing, rash, pruritus, and urticaria. The patient’s heart rate is 120 beats/min, and the blood pressure is 92/57 mm Hg. The nurse understands that these findings are consistent with:
Select one:
a.
Stevens-Johnson syndrome.
b.
serum sickness
c.
rhabdomyolysis.
d.
red man syndrome
D
67
A patient with no known drug allergies is receiving amoxicillin [Amoxil] PO twice daily. Twenty minutes after being given a dose, the patient complains of shortness of breath. The patient’s blood pressure is 100/58 mm Hg. What will the nurse do first?
Select one:
a.
Contact the provider and prepare to administer epinephrine.
b.
Withhold the next dose until symptoms subside.
c.
Request an order for a skin test to evaluate possible PCN allergy.
d.
Notify the provider if the patient develops a rash.
A
68
An older adult patient with chronic obstructive pulmonary disease (COPD) develops bronchitis. The patient has a temperature of 39.5°C. The nurse will expect the provider to:
Select one:
a.
treat symptomatically, because antibiotics are usually ineffective against bronchitis
b.
order empiric antibiotics while waiting for sputum culture results
c.
treat the patient with more than one antibiotic without obtaining cultures.
d.
obtain a sputum culture and wait for the results before prescribing an antibiotic.
B
69
The nurse has been caring for a patient who has been taking antibiotics for 3 weeks. Upon assessing the patient, the nurse notices the individual has developed oral thrush. What describes the etiology of the thrush?
Select one:
a.
community-aquired infection
b.
superinfection
c.
nosocomial infection
d.
Antibiotic resistance
B
70
A child with an ear infection is not responding to treatment with amoxicillin [Amoxil]. The nurse will expect the provider to order:
Select one:
a.
ampicillin
b.
penicillin G
c.
amoxicillin–clavulanic acid [Augmentin].
d.
nafcillin
C
71
A patient is receiving intravenous gentamicin. A serum drug test reveals toxic levels. The dosing is correct, and this medication has been tolerated by this patient in the past. Which could be a probable cause of the test result?
Select one:
a.
The drug was not completely dissolved in the IV solution.
b.
A loading dose was not given.
c.
The patient is taking another medication that binds to serum albumin.
d.
The medication is being given at a frequency that is longer than its half-life.
C
72
The nurse has been caring for a patient who has been taking antibiotics for 3 weeks. Upon assessing the patient, the nurse notices the individual has developed oral thrush. What describes the etiology of the thrush?
Select one:
a.
nosocomial infection
b.
superinfection
c.
community-aquired infection
d.
Antibiotic resistance
B
73
A nurse is caring for a patient who takes an ACE inhibitor and an ARB medication who will begin taking TMP/SMZ to treat a urinary tract infection. Which serum electrolyte will the nurse expect to monitor closely?
Select one:
a.
Potassium
b.
Magnesium
c.
Sodium
d.
Calcium
A
74
A patient is about to begin therapy with ethambutol. The nurse knows that, before initiating treatment with this drug, it is important to obtain which test(s)?
Select one:
a.
Color vision and visual acuity
b.
Hepatic function tests
c.
Complete blood cell (CBC) count
d.
Hearing testing and a tympanogram
A
75
A patient has been taking isoniazid (INH) [Nydrazid] for 4 months for latent tuberculosis. The patient reports bilateral tingling and numbness of the hands and feet, as well as feeling clumsy. The nurse expects the provider to:
Select one:
a.
recheck the tuberculin skin test to see whether it worsens.
b.
order pyridoxine (vitamin B6) 100 mg per day.
c.
discontinue the isoniazid.
d.
lower the isoniazid dose and add rifampin
B
76
A patient has an infection caused by Pseudomonas aeruginosa.The prescriber has ordered piperacillin and amikacin, both to be given intravenously. What will the nurse do?
Select one:
a.
Make sure to administer the drugs at different times using different IV tubing.
b.
Suggest giving larger doses of piperacillin and discontinuing the amikacin.
c.
Watch the patient closely for allergic reactions, because this risk is increased with this combination
d.
Suggest that a fixed-dose combination of piperacillin and tazobactam [Zosyn] be used
A
77
A patient recently began receiving clindamycin [Cleocin] to treat an infection. After 8 days of treatment, the patient reports having 10 to 15 watery stools per day. What will the nurse tell this patient?
Select one:
a.
The provider may increase the clindamycin dose to treat this infection.
b.
The patient should try taking Lomotil or a bulk laxative to minimize the diarrheal symptoms
c.
This is a known side effect of clindamycin, and the patient should consume extra fluids
d.
The patient should stop taking the clindamycin now and contact the provider immediately.
D
78
A nurse is performing a physical assessment on a patient with tuberculosis who takes rifampin [Rifadin]. What would be an expected finding?
Select one:
a.
Crystalluria
b.
Peripheral neuropathy
c.
Myopathy
d.
Red-orange–tinged urine
D
79
A child with otitis media has had three ear infections in the past year. The child has just completed a 10-day course of amoxicillin [Amoxil] with no improvement. The parent asks the nurse why this drug is not working, because it has worked in the past. What will the nurse tell the patient?
Select one:
a.
“The bacteria have developed penicillin-binding proteins (PBPs) that have a low affinity for penicillins.”
b.
“The bacteria have developed a three-layer cell envelope.”
c.
“Amoxicillin is too narrow in spectrum.”
d.
“The bacteria have synthesized penicillinase.”
D
80
A pregnant patient asks the nurse whether she should continue to take her prescription for tetracycline [Sumycin] to clear up her acne. Which response by the nurse is correct?
Select one:
a.
“Tetracycline can be harmful to the baby’s teeth and should be avoided.”
b.
“Tetracycline may cause allergic reactions in pregnant women.”
c.
“Tetracycline will prevent asymptomatic urinary tract infections.”
d.
“Tetracycline is safe to take during pregnancy.”
A
81
A patient who takes nonsteroidal anti-inflammatory drugs (NSAIDs) for arthritis asks a nurse what can be done to prevent ulcers. The nurse will recommend asking the provider about using which medication?
Select one:
a.
Antibiotics
b.
Mucosal protectants
c.
Proton pump inhibitors
d.
Histamine-2 receptor antagonists
C
82
A patient admitted to the hospital has a history of peptic ulcer disease. The patient takes ranitidine [Zantac] and sucralfate [Carafate]. The patient tells the nurse that discomfort is usually controlled but that symptoms occasionally flare up. What will the nurse do?
Select one:
a.
Counsel the patient on non-drug intervention such as avoiding beverages containing alcohol
b.
Contact the provider to discuss serologic testing and an antibiotic.
c.
Ask the provider about ordering an endoscopic examination.
d.
Contact the provider to discuss switching to a proton pump inhibitor.
A
83
When metronidazole [Flagyl] is a component of the H.pylori treatment regimen, the patient must be instructed to do what?
Select one:
a.
Avoid foods containing tyramine.
b.
Take the drug with food.
c.
Take the drug on an empty stomach.
d.
Avoid any alcoholic beverages
D
84
The nurse is providing education to a patient who has been prescribed both an antacid and a cimetidine [Tagamet]. Which instruction should the nurse give the patient about taking the medications?
Select one:
a.
“Take the antacid 1 hour after the cimetidine [Tagamet].
b.
“The antacid and cimetidine [Tagamet]should be taken at the same time for better effect.”
c.
“Stop taking the antacid.”
d.
“Take the antacid 15 minutes before the cimetidine [Tagamet].
A
85
A nurse is caring for four clients who have peptic ulcer disease. The nurse should identify misoprostol is contraindicated for which of the following clients?
Select one:
a.
A client with Osteoarthritis
b.
A client who is pregnant
c.
A client who has Kidney stones
d.
A client with UTI
B
86
A nurse is providing instructions about the use of laxatives to a client who has heart failure. The nurse should tell the client to avoid which of the following laxatives?
Select one:
a.
Polyethylene Glycol
b.
Psyllium
c.
Bisacodyl
d.
sodium phosphate
D
87
Which statement is INCORRECT about Histamine-receptor blockers?
Select one:
a.
“Ranitidine and Famotidine are two types of histamine-receptor blocker medications.”
b.
H2 blockers decrease gastric pH
c.
“Antacids and H2 blockers should not be given together.”
d.
H2 Blockers absorption is slowed if taken with meals
B
88
You are providing discharge teaching to a patient taking Sucralfate (Carafate). Which statement by the patient demonstrates they understand how to take this medication? (Select all that apply)
Select one or more:
a.
"I will continue to take this medication as a preventative therapy"
b.
“I will take this medication once a week.”
c.
“I will always take this medication on an empty stomach.”
d.
“It is best to take this medication with antacids.”
A, c
89
A physician prescribes a Proton-Pump Inhibitor to a patient with a gastric ulcer. Which medication is considered a PPI?
Select one:
a.
Metronidazole
b.
Famotidine
c.
Pantoprazole
d.
Famotidine
C
90
The nurse has administered a dose of docusate. The nurse evaluates that the medication has been effective if the client experiences which finding?
Select one:
a.
Relief of sharp abdominal pain
b.
Decrease in fatty stools
c.
Decreased heartburn
d.
Bowel movement with soft, formed stool
D
91
A client has a new prescription for metoclopramide (Reglan). On review of the chart, the nurse identifies that this medication can be safely administered with which condition?
Select one:
a.
Diverticulitis with perforation
b.
Vomiting following cancer chemotherapy
c.
Intestinal obstruction
d.
Peptic ulcer with melena (bloody stool)
B
92
The nurse determines the client needs further instruction on cimetidine (Tagamet) if which statements were made? Select all that apply.
Select one or more:
a.
"Some of my blood levels will need to be monitored closely since I also take warfarin for atrial fibrillation."
b.
"I will take the cimetidine with my meals."
c.
"Taking the cimetidine with an antacid will increase its effectiveness."
d.
"My episodes of heartburn will decrease if the medication is effective."
e.
"I will notify my health care provider if I become depressed or anxious."
f.
"I'll know the medication is working if my diarrhea stops."
B, c, f
93
The nurse is preparing to administer prescribed medications to a client with hepatic encephalopathy. The nurse anticipates that the health care provider's prescriptions will include which medication?
Select one:
a.
Bisacodyl suppository (a stimulant laxative)
b.
Magnesium hydroxide (saline laxative)
c.
Psyllium hydrophilic mucilloid (a bulk laxative)
d.
Lactulose (an osmotic laxative)
D
94
To answer this GI question, think back on the neuro content....!
A client with gastrointestinal hypermotility has a prescription to receive atropine sulfate. The nurse should withhold the medication and question the prescription if the client has a history of which disease process?
Select one:
a.
Sinus bradycardia
b.
Narrow-angle glaucoma
c.
Peptic ulcer disease
d.
Biliary colic
B
95
A patient has a prescription to take a powdered form of psyllium after discharge. The nurse should plan to include which information when teaching the client about this medication?
Select one:
a.
Mix the medication with a full glass of water or juice.
b.
Decrease fluid intake following administration of the medication.
c.
Decrease the amount of fiber in the diet when taking this medication.
d.
Mix the medication with applesauce.
A
96
A client has received a dose of dimenhydrinate (Dramamine), The nurse should observe relief of what sign or symptom to evaluate that the medication has been effective?
Select one:
a.
Buzzing sound in the ears
b.
Headache
c.
Nausea and vomiting
d.
Chills
C
97
Think back on the neuro content to answer this GI question...
A client receives a dose of scopolamine for nausea from motion sickness. The nurse determines that which sign or symptom later displayed by the client is a result of medication side and adverse effects?
Select one:
a.
Dry mouth
b.
Excessive urination
c.
Diaphoresis
d.
Pupillary constriction
A
98
A client with peptic ulcer disease asks the nurse what medications they might be prescribed for this problem. The nurse tells the client that which medications will be prescribed? Select all that apply.
Select one or more:
a.
Proton Pump Inhibitors
b.
Histamine H2-receptor blockers
c.
Antacids
d.
Antibiotics
e.
Nonsteroidal antiinflammatory drugs (NSAIDs)
A, b, c, d
99
A client reports frequent use of sodium bicarbonate to relieve heartburn after meals. The nurse should monitor the client for which condition that the client is at risk for with long-term frequent use of this medication?
Select one:
a.
Urinary calculi
b.
Chronic bronchitis
c.
Respiratory acidosis
d.
Metabolic alkalosis
D
100
A nurse is planning to administer ondansetron(Zofran) to a client. For which of the following adverse effects of Ondansetron should the nurse monitor? Select all apply
a.
diarrhea
b.
headache
c.
prolonged QT interval
d.
shortened PR interval
e.
hyperglycemia
A, b, c
101
A nurse is teaching a client who experiences migraine headaches and is prescribed a beta-blocker. Which statement would the nurse include in this client’s teaching?
A. “Take this drug only when you have prodromal symptoms indicating the onset of a migraine headache.”
B. “Take this drug as prescribed, even when feeling well, to prevent vascular changes associated with migraine headaches.”.
C. “This drug will relieve the pain during the aura phase soon after a headache has started.”
D. “This medication will have no effect on your heart rate or blood pressure because you are taking it for migraines.”
B
102
A client receiving propranolol (Inderal) as a preventative for migraine headaches is experiencing side effects after taking the drug. Which side effect is of greatest concern to the nurse?
A. Dry mouth
B. Slow heart rate
C. Tingling feelings
D. Warm sensation
B
103
A nurse obtains a health history on a client prior to administering prescribed sumatriptan succinate (Imitrex), a serotonin agonist or triptan, for migraine headaches. Which condition would alert the nurse to hold the medication and contact the healthcare provider?
A. Bronchial asthma
B. Angina
C. Diabetes mellitus
D. Chronic kidney disease
B
104
A hospitalized older client with rheumatoid arthritis needs to increase activity, but is unsteady and complains of dizziness with activity. The nurse establishes the nursing diagnosis of Activity Intolerance. Which action by the nurse is most important to implement next?
A.Reassure the client that someone will help with ambulation.
B.Evaluate the client’s medications.
C.Ask the client if he or she is just afraid of falling.
D.Perform lower extremity strength testing.
B
105
Which statement about enteracept (Enbrel), a Biologic non-TNF) Inhibitors, does the nurse identify as true?
A.The patient should stop taking the drug if redness appears at the injection site.
B.Enteracept can cause liver injury.
C.Live vaccines can be administered with enteracept.
D.Enteracept is used to treat CNS demyelinating disorders.
B
106
A patient with acute gouty arthritis requests information on the preferred drug to take to treat a painful flare-up. The nurse should recommend which medication?
A.Allopurinol
B.Febuxostat
C.Probenecid
D.Naproxen
D
107
A patient is prescribed allopurinol for chronic tophaceous gout. The patient develops a rash. What is the priority intervention by the nurse?
u
A.Stop the medication and assess the patient for liver and kidney failure.
B.Instruct the patient to avoid exposing the skin to sunlight.
C.Administer diphenhydramine (Benadryl) with the dose of allopurinol.
D.Monitor the patient for respiratory depression.
A
108
Which drug does the nurse associate with the development of potentially life-threatening skin adverse effects of exfoliative dermatitis, Stevens-Johnson syndrome, and toxic epidermal necrolysis?
A.Probenecid
B.Colchicine
C.Febuxostat (Uloric)
D.Allopurinol (Zyloprim)
D
109
A patient with gout has not experienced relief with oral urate-lowering therapy. The nurse anticipates which agent will be prescribed for the patient?
A.Pegloticase
B.Allopurinol
C.Probenecid
D.Solu-Medrol
A
110
The nurse instructs a patient about taking levothyroxine [Synthroid]. Which statement by the patient indicates the teaching has been effective?
A.“To prevent an upset stomach, I will take the drug with food.”
B.“If I have chest pain or insomnia, I should call my doctor.”
C.“This medication can be taken with an antacid.”
D.“The drug should be taken before I go to bed at night.”
B
111
A patient with hyperthyroidism is taking propylthiouracil (PTU). It is most important for the nurse to assess the patient for which adverse effects?
A.Gingival hyperplasia and dysphagia
B.Dyspnea and a dry cough
C.Blurred vision and nystagmus
D.Fever and sore throat
D
112
A patient takes levothyroxine (Synthroid) 0.75 mcg every day. It is most appropriate for the nurse to monitor which laboratory test to determine whether a dose adjustment is needed?
A.Thyrotropin-releasing hormone (TRH)
B.Thyroid-stimulating hormone (TSH)
C.Serum free T4 test
D.Serum iodine level
B
113
A child with type 1 diabetes mellitus is diagnosed with growth hormone deficiency and is started on somatropin (Humatrope). It is most appropriate for the nurse to monitor the child for which condition?
A.Renal insufficiency
B.Hypertension
C.Hyperglycemia
D.Hypothyroidism
C
114
A patient with a urinary creatinine clearance of 55 mL/min is prescribed desmopressin (DDAVP). It is most important for the nurse to assess the patient for what? Normal creatine clearance is 88-137mL/min.
A.Irritability, muscle weakness, and back pain
B.Drowsiness, listlessness, and headache
C.Fever, tachycardia, and hypotension
D.Decreased skin turgor, weight loss, and dry skin
B
115
A patient with systemic lupus erythematosus is prescribed prednisone. It is most important for the nurse to monitor the patient for what?
A.Hypotension
B.Elevated potassium levels
C.Neck and back pain
D.Hypoglycemia
C
116
A patient has been prescribed pharmacologic doses of glucocorticoids. It is most important for the nurse to teach the patient to do what?
A.Increase intake of dietary sodium.
B.Take antibiotics to prevent infection.
C.Never abruptly withdraw therapy.
D.Have an eye examination every year.
C
117
A patient is diagnosed with onychomycosis. The nurse anticipates use of which medication for the treatment of this condition?
A.Terbinafine (Lamisil)
B.Voriconazole (Vfend)
C.Fluconazole (Diflucan)
D.Amphotericin B (Amphocin, Fungizone)
A
118
Fifteen minutes after an infusion of amphotericin B was started, the patient begins to complain of fever, chills, muscle pain, and nausea. His heart rate has increased slightly, but his blood pressure is down to 100/68 mm Hg. What is the nurse’s priority?
A.Notify the prescriber immediately.
B.Recognize an impending anaphylactic reaction and stop the infusion.
C.Assess for other symptoms of this expected infusion-related reaction.
D.Slow the infusion to reduce these adverse effects.
C
119
A patient is prescribed cimetidine [Tagamet] and aluminum hydroxide [Maalox] for the treatment of peptic ulcer disease. What should the nurse teach the patient to do?
A.Drink an 8-ounce glass of water when taking these medications.
B.Take the medications together to enhance their effectiveness.
C.Take the Tagamet 2 hours before the Maalox.
D.Wait at least 1 hour between administration of the two medications.
D
120
A patient is prescribed amoxicillin and tetracycline to treat peptic ulcer disease. The nurse will instruct the patient that these medications will do what?
A.Prevent GI infections that cause gastric bleeding.
B.Destroy the bacteria in the stomach that are causing ulceration.
C.Reduce gastric acid production and alkalize the stomach fluids.
D.Reduce the secretion of pepsin in the stomach.
B
121
Which medication is used to promote gastric ulcer healing by providing a protective barrier?
A.Cimetidine
B.Misoprostol
C.Omeprazole
D.Sucralfate
D
122
The nurse identifies which of the following as the most common type of laxative abused by the general public?
A.Magnesium hydroxide [Milk of Magnesia]
B.Docusate sodium [Colace]
C.Bisacodyl [Dulcolax]
D.Polyethylene glycol [MiraLax]
C
123
A patient who has been taking a long-acting morphine to treat severe pain for a few months complains of constipation. The nurse anticipates which of the following will be prescribed for the patient?
Polycarbophil [FiberCon]
Mineral oil
Psyllium [Metamucil]
Senna [Senokot]
D
124
A patient is prescribed bisacodyl. Which of the following should the nurse include in patient teaching?
A.Your urine will turn yellow-brown when taking this medication.
B.Crush the bisacodyl tablet and sprinkle it on your food.
C.Chew the bisacodyl tablet.
D.Do not take the bisacodyl with an antacid.
D
125
The nurse identifies which of the following laxatives as having the added response of ridding the body of ammonia?
A. Polyethylene glycol
B. Lactulose
C. Lubiprostone
D. Mineral oil
B
