L2-1530-E1

Question 1

1. Which drugs will go through a pharmaceutic phase after it is administered?

a. Intramuscular cephalosporins
b. Intravenous vasopressors
c. Oral analgesics
d. Subcutaneous antiglycemics

Answer 1

ANS: C

c. Oral analgesics

When drugs are administered parenterally, there is no pharmaceutic phase, which occurs when a drug becomes a solution that can cross the biologic membrane.

Question 2

2. The nurse is preparing to administer an oral medication and wants to ensure a rapid drug action. Which form of the medication will the nurse administer?

a. Capsule
b. Enteric-coated pill
c. Liquid suspension
d. Tablet

Answer 2

ANS: C

c. Liquid suspension

Liquid drugs are already in solution, which is the form necessary for absorption in the GI tract. The other forms must disintegrate into small particles and then dissolve before being absorbed.

Question 3

3. The nurse is teaching a patient who will be discharged home with a prescription for an enteric-coated tablet. Which statement by the patient indicates understanding of the teaching?

a. “I may crush the tablet and put it in applesauce to improve absorption.”
b. “I should consume acidic foods to enhance absorption of this medication.”
c. “I should expect a delay in onset of the drug’s effects after taking the tablet.”
d. “I should take this medication with high-fat foods to improve its action.”

Answer 3

ANS: C

c. “I should expect a delay in onset of the drug’s effects after taking the tablet.”

Enteric-coated tablets resist disintegration in the acidic environment of the stomach and disintegrate when they reach the small intestine. There is usually some delay in onset of actions after taking these medications. Enteric-coated tablets should not be crushed or chewed, which would alter the time and location of absorption. Acidic foods will not enhance the absorption of the medication. The patient should not to eat high-fat food before ingesting an enteric-coated tablet, because high-fat foods decrease the absorption rate.

Question 4

4. A patient who is newly diagnosed with type 1 diabetes mellitus asks why insulin must be given by subcutaneous injection instead of by mouth. The nurse will explain that this is because

a. absorption is diminished by the first-pass effects in the liver.
b. absorption is faster when insulin is given subcutaneously.
c. digestive enzymes in the gastrointestinal tract prevent absorption.
d. the oral form is less predictable with more adverse effects.

Answer 4

ANS: C

c. digestive enzymes in the gastrointestinal tract prevent absorption

Insulin, growth hormones, and other protein-based drugs are destroyed in the small intestine by digestive enzymes and must be given parenterally. Because insulin is destroyed by digestive enzymes, it would not make it to the liver for metabolism with a first-pass effect. Subcutaneous tissue has fewer blood vessels, so absorption is slower in such tissue. Insulin is given subcutaneously because it is desirable to have it absorb slowly.

Question 5

5. The nurse is preparing to administer an oral medication that is water-soluble. The nurse understands that this drug

a. must be taken on an empty stomach.
b. requires active transport for absorption.
c. should be taken with fatty foods.
d. will readily diffuse into the gastrointestinal tract.

Answer 5

ANS: B

b. requires active transport for absorption.

Water-soluble drugs require a carrier enzyme or protein to pass through the GI membrane.

Question 6

6. A nurse is preparing to administer an oral drug that is best absorbed in an acidic environment. How will the nurse give the drug?

a. On an empty stomach
b. With a full glass of water
c. With food
d. With high-fat food

Answer 6

ANS: C

c. With food

Food can stimulate the production of gastric acid so medications requiring an acidic environment should be given with a meal. High-fat foods are useful for drugs that are lipid soluble.

Question 7

7. The nurse is preparing an injectable drug and wants to administer it for rapid absorption. How will the nurse give this medication?

a. IM into the deltoid muscle
b. IM into the gluteal muscle
c. SubQ into abdominal tissue
d. SubQ into the upper arm

Answer 7

ANS: A

a. IM into the deltoid muscle

Drugs given IM are absorbed faster in muscles that have more blood vessels, such as the deltoid, rather than those with fewer blood vessels, such as the gluteals. Subcutaneous routes are used when absorption needs to be slower and more sustained.

Question 8

8. The nurse is reviewing medication information with a nursing student prior to administering an oral drug and notes that the drug has extensive first-pass effects. Which statement by the student indicates a need for further teaching about this medication?

a. “The first-pass effect means the drug may be absorbed into systemic circulation from the intestinal lumen.”
b. “The first-pass effect means the drug may be changed to an inactive form and excreted.”
c. “The first-pass effect means the drug may be changed to a metabolite, which may be more active than the original.”
d. “The first-pass effect means the drug may be unchanged as it passes through the liver.”

Answer 8

ANS: A

a. “The first-pass effect means the drug may be absorbed into systemic circulation from the intestinal lumen.”

Drugs that undergo first-pass metabolism are absorbed into the portal vein from the intestinal lumen and go through the liver where they are either unchanged or are metabolized to an inactive or a more active form.

Question 9

9. The nurse prepares to change a patient’s medication from an intravenous to an oral form and notes that the oral form is ordered in a higher dose. The nurse understands that this is due to differences in

a. bioavailability.
b. pinocytosis.
c. protein binding.
d. tachyphylaxis.

Answer 9

ANS: A

a. bioavailability.

Oral drugs may have less bioavailability because a lower percentage of the drug reaches the systemic circulation. Pinocytosis refers to the process by which cells carry a solute across a membrane. Protein binding can occur with both routes. Tachyphylaxis describes a rapid decrease in response to drugs that occurs when tolerance develops quickly.

Question 10

10. The nurse is preparing to administer a drug and learns that it binds to protein at a rate of 90%. The patient’s serum albumin level is low. The nurse will observe the patient for

a. decreased drug absorption.
b. decreased drug interactions.
c. decreased drug toxicity.
d. increased drug effects.

Answer 10

ANS: D

d. increased drug effects.

Drugs that are highly protein-bound bind with albumin and other proteins, leaving less free drug in circulation. If a patient has a low albumin, the drug is not bound, and there is more free drug to cause drug effects. There would be increased absorption, increased interactions with other drugs, and increased toxicity.

Question 11

11. The nurse is administering two drugs to a patient and learns that both drugs are highly protein-bound. The nurse may expect

a. decreased bioavailability of both drugs.
b. decreased drug effects.
c. decreased drug interactions.
d. increased risk of adverse effects.

Answer 11

ANS: D

d. increased risk of adverse effects.

Two drugs that are highly protein-bound will compete for protein-binding sites, leaving more free drug in circulation and an increased risk of adverse effects as well as increased bioavailability, increased drug effects, and increased drug interactions.

Question 12

12. A patient has been taking a drug that has a protein-binding effect of 75%. The provider adds a new medication that has a protein-binding effect of 90%. The nurse will expect

a. decreased drug effects of the first drug.
b. decreased therapeutic range of the first drug.
c. increased drug effects of the first drug.
d. increased therapeutic range of the first drug.

Answer 12

ANS: C

c. increased drug effects of the first drug.

Adding another highly protein-bound drug will displace the first drug from protein-binding sites and release more free drug increasing the drug’s effects. This does not alter the therapeutic range, which is the serum level between drug effectiveness and toxicity

Question 13

13. The nurse gives a medication to a patient with a history of liver disease. The nurse will monitor this patient for

a. decreased drug effects.
b. increased drug effects.
c. decreased therapeutic range.
d. increased therapeutic range.

Answer 13

ANS: B

b. increased drug effects.

Liver diseases such as cirrhosis and hepatitis alter drug metabolism by inhibiting the drug-metabolizing enzymes in the liver. When the drug metabolism rate is decreased, excess drug accumulation can occur and lead to toxicity.

Question 14

14. The nurse gives 800 mg of a drug that has a half-life of 8 hours. How much drug will be left in the body in 24 hours if no additional drug is given?

a. None
b. 50 mg
c. 100 mg
d. 200 mg

Answer 14

ANS: C

c. 100 mg

Eight hours after the drug is given, there will be 400 mg left. Eight hours after that (16 hours), there will be 200 mg left. At 24 hours, there will be 100 mg left.

Question 15

15. If a drug has a half-life of 12 hours and is given twice daily starting at 0800 on a Monday, when will a steady state be achieved?

a. 0800 on Tuesday
b. 0800 on Wednesday
c. 0800 on Thursday
d. 0800 on Friday

Answer 15

ANS: B

b. 0800 on Wednesday

Steady-state levels occur at 3 to 5 half-lives. Wednesday at 0800 is 4 half-lives from the original dose.

Question 16

16. The nurse is preparing to administer a drug that is ordered to be given twice daily. The nurse reviews the medication information and learns that the drug has a half-life of 24 hours. What will the nurse do next?

a. Administer the medication as ordered.
b. Contact the provider to discuss daily dosing.
c. Discuss every-other-day dosing with the provider.
d. Hold the medication and notify the provider.

Answer 16

ANS: B

b. Contact the provider to discuss daily dosing.

A drug with a longer half-life should be given at longer intervals to avoid drug toxicity.

Question 17

17. The nurse is caring for a patient who has taken an overdose of aspirin several hours prior. The provider orders sodium bicarbonate to be given. The nurse understands that this drug is given for which purpose?

a. To counter the toxic effects of the aspirin
b. To decrease the half-life of the aspirin
c. To increase the excretion of the aspirin
d. To neutralize the acid of the aspirin

Answer 17

ANS: C

c. To increase the excretion of the aspirin

Aspirin is a weak acid and is more readily excreted in alkaline urine. Sodium bicarbonate alkalizes the urine. It does not act as an antidote to aspirin, decrease the half-life, or neutralize its pH.

Question 18

18. The nurse is preparing to administer a drug that is eliminated through the kidneys. The nurse reviews the patient’s chart and notes that the patient has increased serum creatinine and blood urea nitrogen (BUN). The nurse will perform which action?

a. Administer the drug as ordered.
b. Anticipate a shorter than usual half-life of the drug.
c. Expect decreased drug effects when the drug is given.
d. Notify the provider and discuss giving a lower dose.

Answer 18

ANS: D

d. Notify the provider and discuss giving a lower dose.

Increased creatinine and BUN indicate decreased renal function so a drug that is eliminated through the kidneys can become toxic. The nurse should discuss a lower dose with the provider. The drug will have a longer half-life and will exhibit increased effects with decreased renal function.

Question 19

19. The nurse understands that the length of time needed for a drug to reach the minimum effective concentration (MEC) is the

a. duration of action.
b. onset of action.
c. peak action time.
d. time response curve.

Answer 19

ANS: B

b. onset of action.

The onset of action is the time it takes to reach the MEC. Duration of action is the length of time a drug has a pharmacologic effect. Peak action time occurs when the drug reaches its highest blood level. The time response curve is an evaluation of the other three measures.

Question 20

20. The nurse administers albuterol to a patient who has asthma. The albuterol acts by stimulating beta2-adrenergic receptors to cause bronchodilation. The nurse understands that albuterol is a beta-adrenergic

a. agonist.
b. antagonist.
c. inhibitor.
d. depressant.

Answer 20

ANS: A

a. agonist.

An agonist medication is one that stimulates a certain type of cell to produce a response.

Question 21

21. The nurse is explaining to the patient why a nonspecific drug has so many side effects. Which statement by the patient indicates a need for further teaching?

a. “Nonspecific drugs can affect specific receptor types in different body tissues.”
b. “Nonspecific drugs can affect a variety of receptor types in similar body tissues.”
c. “Nonspecific drugs can affect hormone secretion as well as cellular functions.”
d. “Nonspecific drugs require higher doses than specific drugs to be effective.”

Answer 21

ANS: D

d. “Nonspecific drugs require higher doses than specific drugs to be effective.”

Nonspecific drugs can act on one type of receptor but in different body tissues, or a variety of receptor types, or act on hormones to produce effects. Nonspecific drugs do not require higher doses.

Question 22

22. The nurse is preparing to give a dose of gentamicin to a patient and notes that the most recent serum gentamicin trough level was 2 mcg/mL. What will the nurse do next?

a. Administer the drug as ordered.
b. Administer the drug and monitor for adverse effects.
c. Notify the provider to discuss decreasing the dose.
d. Notify the provider to report a toxic drug level.

Answer 22

ANS: D

d. Notify the provider to report a toxic drug level.

The trough drug level for gentamicin should be less than 2 mcg/mL. The nurse should not administer the drug and should notify the provider of the toxic level.

Question 23

23. The nurse is preparing to administer the first dose of digoxin (Lanoxin) to a patient and notes that the dose ordered is much higher than the usual recommended dose. Which action will the nurse perform?

a. Administer the dose as ordered.
b. Give the dose and monitor for toxicity.
c. Hold the dose until reviewing it with the provider.
d. Refuse to give the dose.

Answer 23

ANS: A

a. Administer the dose as ordered.

Digoxin requires a loading dose when first prescribed.

Question 24

24. The nurse administers a narcotic analgesic to a patient who has been receiving it for 1 day after orthopedic surgery. The patient reports no change in pain 30 minutes after the medication is given. The nurse recognizes that this patient is exhibiting

a. drug-seeking behavior.
b. drug tolerance.
c. the placebo effect.
d. tachyphylaxis.

Answer 24

ANS: D

d. tachyphylaxis.

Tachyphylaxis is a rapid decrease in response, or acute tolerance. Tolerance to drug effects can occur with narcotics, requiring increased doses in order to achieve adequate drug effects. Nurses often mistake drug-seeking behavior for drug tolerance. The placebo effect occurs when the patient experiences a response with an inactive drug.

Question 25

1. The nurse is performing a pain assessment on a patient of Asian descent. The patient does not describe the pain when asked to do so and looks away from the nurse. What will the nurse do next?

a. Ask the patient’s family member to evaluate the patient’s pain.
b. Conclude that the patient’s pain is minimal.
c. Evaluate the patient’s non-verbal pain cues.
d. Suspect that the patient is experiencing severe pain.

Answer 25

ANS: C

c. Evaluate the patient’s non-verbal pain cues.

Patients of Asian descent might speak in soft tones and avoid direct eye contact while being comfortable with long silences. It is not correct to ask family members to evaluate pain. Without assessment of non-verbal cues, the nurse cannot determine whether the pain is minimal or severe.

Question 26

2. The nurse is preparing to discuss long-term care needs with a patient newly diagnosed with a chronic disease. The patient is of Latin American descent. The nurse will plan to take which action when teaching this patient?

a. Discussing long-term outcomes associated with compliance of the prescribed regimen
b. Highlighting various traditional healing practices that will not be effective for this patient’s care
c. Providing factual information and answering all questions as they arise
d. Providing teaching in increments, allowing periods of silence to allow assimilation of information

Answer 26

ANS: C

c. Providing factual information and answering all questions as they arise

The nurse should provide factual information and answer questions. Persons of Latin American descent have less dependence on time schedules and do not tend to have a future orientation. They are not comfortable with periods of silence. Nurses should be receptive to traditional healing practices and seek ways to include those in care when they do not hinder safe and effective care; highlighting practices that won’t work may convey a lack of respect for these traditions.

Question 27

3. A Native American patient has just been diagnosed with diabetes mellitus. The nurse preparing a teaching plan for this patient understands that which aspect of the disease and disease management may be most difficult for this patient?

a. Body image changes
b. Management of meal and medication schedules
c. Perception of the disease as punishment from God
d. The sense of dependence on others

Answer 27

ANS: B

b. Management of meal and medication schedules

Non-European cultural groups such as those of Native American descent have less dependence on time schedules. Disease management will likely focus more on present concerns about alleviating current discomfort and less on measures to promote long-term wellness or treat a chronic illness.

Question 28

4. A patient who is of Filipino descent is admitted to the hospital. The nurse goes to the room to start intravenous fluids and to perform an admission assessment and finds several family members in the room. Which action by the nurse is appropriate?

a. Ask the family to wait in the hallway until the admission tasks are completed.
b. Determine which family member is the family patriarch and address questions to him.
c. Invite family members to assist with appropriate tasks during the admission process.
d. Provide chairs for family members and ask them to stay seated during the admission.

Answer 28

ANS: C

c. Invite family members to assist with appropriate tasks during the admission process.

In general, the Filipino culture expects that family members will stay at a patient’s bedside and participate in his or her care. The nurse should include the family in appropriate tasks. It is not correct to ask the family to wait in the hall or to sit in chairs and not participate. Filipino families do not necessarily depend on family patriarchs.

Question 29

5. The nurse is caring for a patient who is a member of the local Native American community. The patient is refusing medications and treatments in spite of repeated attempts to explain the importance of these interventions. Which is an appropriate nursing action?

a. Ask a family member about traditional healing practices that might be better accepted.
b. Enlist the help of a family member to explain the need for the medications and treatments.
c. Find a hospital staff member who is Native American to help provide teaching for this patient.
d. Suggest a Social Work consult to the patient’s provider.

Answer 29

ANS: A

a. Ask a family member about traditional healing practices that might be better accepted.

Members of some cultures may use traditional healers, and this should be accommodated whenever possible. Showing respect for this patient’s culture will help to establish trust and thus greater cooperation. It is important for the nurse not to make generalizations within and among cultural groups, so asking a family member to describe what this particular patient needs is the better choice. Finding a hospital staff member who is Native American assumes that all Native Americans have the same practices. Deferring to a Social Worker is not necessary. Enlisting a family member to explain the need for the medications is just another way of imposing treatments on this person without respecting their cultural needs.

Question 30

6. The nurse is caring for an African-American patient who appears to understand instructions for self-care but does not carry out basic self-care tasks. The nurse understands that the patient may

a. be poorly educated and lack basic comprehension skills.
b. need more time and personal space to assimilate what is taught.
c. require the use of culturally appropriate words and phrases when teaching.
d. view illness as punishment and lack desire to change the outcome.

Answer 30

ANS: C

c. require the use of culturally appropriate words and phrases when teaching.

African Americans may use a common style of speaking. This vernacular English may be quite different in some cases from standard English, so if things are misunderstood, it is possible that vernacular terminology may need to be used. This vernacular English does not mean that patients are poorly educated or uncommunicative. African Americans do not tend to need more space and do not necessarily view illness as punishment.

Question 31

7. The nurse notes that a patient of African American descent who is taking an oral antihypertensive medication continues to have elevated blood pressure three months after beginning the medication regimen. The nurse suspects that the patient may be

a. consuming ethnic foods that interfere with absorption of the drug.
b. discarding the medication.
c. experiencing allergic reactions to the medication.
d. metabolizing the drug differently than expected.

Answer 31

ANS: D

d. metabolizing the drug differently than expected.

Certain classifications of medications have different effects in individuals whose genetic markers are predominantly characteristic of a certain biologic group. African Americans respond poorly to several classes of antihypertensive agents.

Question 32

8. The nurse is caring for a postoperative patient who is of Asian descent. The patient reports little relief from pain even while taking an opioid analgesic containing codeine and acetaminophen. What does the nurse suspect that this patient is exhibiting?

a. Drug-seeking behavior
b. Heightened pain perception
c. Poor understanding of expected drug effects
d. Rapid metabolism of one of the drug’s components

Answer 32

ANS: D

d. Rapid metabolism of one of the drug’s components

Certain classifications of medications have different effects in individuals whose genetic markers are predominantly characteristic of a certain biologic group. Persons of Asian descent may have a decreased response to some drugs because they are more likely to have higher levels of CYP2D6 enzymes.

Question 33

9. The nurse is caring for an African-American patient who is taking warfarin (Coumadin) to prevent blood clots. The nurse will monitor this patient carefully for which effect?

a. Decreased therapeutic effects
b. Heightened risk for hemorrhage
c. Increased risk of hypersensitivity
d. Potential risk of paradoxical effects

Answer 33

ANS: A

a. Decreased therapeutic effects

Certain classifications of medications have different effects in individuals whose genetic markers are predominantly characteristic of a certain biologic group. African-American patients will tend to have a decreased therapeutic effect from warfarin (Coumadin).

Question 34

1. A patient has been taking a drug for several years and tells the nurse it is no longer working. The nurse learns that the patient has recently begun taking an over-the-counter antacid medication. What does the nurse suspect is occurring?

a. An adverse drug reaction
b. A drug interaction
c. Drug incompatibility
d. Drug tolerance

Answer 34

ANS: B

b. A drug interaction

Drug interactions are an altered or modified action or effect of a drug as a result of interaction with one or more other drugs. An adverse drug reaction can occur with one or more drugs and has effects ranging from mild to severe toxicity. Drug incompatibility is a chemical reaction of two or more drugs that occurs in vitro. Drug tolerance is the development of reduced response to a medication over time.

Question 35

2. The nurse is preparing to administer two intravenous medications that should not be given using the same IV tubing. The nurse understands that this is because of drug

a. adverse reactions.
b. incompatibility.
c. interactions.
d. potentiation.

Answer 35

ANS: B

b. incompatibility.

Drugs that are incompatible cannot be mixed together in solution and cannot be mixed in a syringe, IV bag, or other artificial environment. Adverse reactions are symptoms occurring from drug effects. Drug interactions occur in vivo. Potentiation is when one drug causes an enhanced response in another drug.

Question 36

3. The nurse is teaching a patient who will begin taking ciprofloxacin. What instruction will the nurse include when teaching this patient about this drug?

a. “Do not take this medication with oral contraceptive pills.”
b. “Take at least 1 hour after or 2 hours before taking antacids.”
c. “Take in the morning with your multivitamin tablet.”
d. “Take with milk to reduce gastric upset.”

Answer 36

ANS: B

b. “Take at least 1 hour after or 2 hours before taking antacids.”

Dairy products, multivitamins, and antacids should be avoided 1 hour before and 2 hours after taking ciprofloxacin because these products contain divalent cations that form a drug complex that prevents absorption of the ciprofloxacin.

Question 37

4. A patient who takes a drug that undergoes gastric absorption will begin taking an opioid analgesic after sustaining an injury in a motor vehicle accident. The nurse will observe the patient closely for which effects?

a. Decreased effects of the first drug
b. Increased effects of the first drug
c. Decreased effects of the narcotic
d. Increased effects of the narcotic

Answer 37

ANS: B

b. Increased effects of the first drug

Opioids slow gastric emptying, allowing more time for drugs absorbed in the stomach to be absorbed. The nurse should expect increased effects of the first drug.

Question 38

5. The nurse is preparing to administer erythromycin to a patient who takes digoxin. The nurse will plan to monitor the patient for

a. digoxin toxicity.
b. decreased digoxin effects.
c. erythromycin toxicity.
d. decreased erythromycin effects.

Answer 38

ANS: A

a. digoxin toxicity

Intestinal flora have the ability to metabolize digoxin, and any drug that destroys or inhibits growth of these gastrointestinal microflora can increase digoxin levels leading to toxicity.

Question 39

6. A young adult female patient who takes a combination oral contraceptive (OCP) will begin taking an antibiotic. When teaching the patient about this medication, the nurse will

a. recommend using a backup method of contraception.
b. suggest that she switch to an injectable form of contraception.
c. tell her that the antibiotic is less effective if she is taking OCPs.
d. tell her the antibiotic has a greater risk for toxicity while taking OCPs.

Answer 39

ANS: A

a. recommend using a backup method of contraception.

Gut bacteria are necessary to hydrolyze estrogen conjugates into free estrogens. Concurrent antibiotic administration can alter these bacteria and prevent the optimal absorption and effectiveness of OCPs. A backup contraceptive method is recommended.

Question 40

7. A patient has been taking warfarin (Coumadin), which is highly protein-bound. The patient will begin taking gemfibrozil, which is also highly protein-bound. The nurse will observe the patient closely for

a. decreased effects of warfarin.
b. increased effects of warfarin.
c. decreased effects of gemfibrozil.
d. decreased effects of both drugs.

Answer 40

ANS: B

b. increased effects of warfarin.

The addition of a highly protein-bound drug will compete with warfarin for protein- binding sites, releasing more free warfarin into the system, increasing drug effects and increasing the chance of toxicity.

Question 41

8. A patient is taking phenytoin to prevent seizures. The nurse knows that phenytoin is highly protein-bound and has sedative side effects. The nurse reviews the patient’s chart and notes a low serum albumin. The nurse will notify the provider and observe the patient for which effects?

a. Decreased sedative effects
b. Increased sedative effects
c. Increased seizures
d. No change in effects

Answer 41

ANS: B

b. Increased sedative effects

Phenytoin is protein-bound. When patients have a low serum albumin, there are fewer protein-binding sites, leaving more free drug in the system. The nurse should expect an increase in sedative side effects.

Question 42

9. A patient who takes the anticoagulant warfarin will begin taking the anticonvulsant drug carbamazepine. The nurse reviews the drug information for these drugs and learns that carbamazepine is a hepatic enzyme inducer. The nurse anticipates that the provider will make which dosage adjustment?

a. Decrease the dose of carbamazepine
b. Increase the dose of carbamazepine
c. Decrease the dose of warfarin
d. Increase the dose of warfarin

Answer 42

ANS: D

d. Increase the dose of warfarin

Carbamazepine is a hepatic enzyme inducer, which can increase drug metabolism. Patients taking both drugs usually need a larger dose of warfarin.

Question 43

10. The nurse is caring for a patient who receives theophylline, which has a narrow therapeutic index. The patient has been receiving cimetidine but will stop taking that drug in 2 days. In 2 days, the nurse will observe the patient closely for

a. decreased effectiveness of theophylline.
b. increased effectiveness of theophylline.
c. decreased toxicity of theophylline.
d. prolonged effectiveness of theophylline.

Answer 43

ANS: B

b. increased effectiveness of theophylline.

Cimetidine is an enzyme inhibitor that decreases the metabolism of drugs such as theophylline. If the cimetidine is discontinued, the theophylline dose should be decreased to avoid toxicity. The nurse should observe the patient for increased theophylline effects.

Question 44

11. The nurse is caring for a patient who takes digoxin to treat heart failure. The provider orders furosemide to treat edema. The nurse will monitor the patient for digitalis toxicity because of

a. adverse drug reactions caused by giving these drugs in combination.
b. altered hepatic blood flow caused by the furosemide.
c. changes in reabsorption of water and electrolytes in the kidneys.
d. additive effects of these two drugs given together.

Answer 44

ANS: C

c. changes in reabsorption of water and electrolytes in the kidneys.

Diuretics such as furosemide promote water and sodium excretion from the renal tubules, especially sodium and potassium. Hypokalemia can result, and this will enhance the action of digoxin, and digitalis toxicity can occur.

Question 45

12. A patient will receive penicillin to treat an infection. The provider orders probenecid (Probalan), a medication to treat gout, even though the patient does not have gout. Which action by the nurse is correct?

a. Administer the drug since the provider ordered it.
b. Recognize that it is being given prophylactically.
c. Refuse to administer the medication since it is not indicated.
d. Verify that it is being given for its secondary action.

Answer 45

ANS: D

d. Verify that it is being given for its secondary action.

Two or more drugs with the same route of excretion may compete with each other for elimination. Probenecid is given because it inhibits the excretion of penicillin, which may be desirable when the provider wants to prolong the plasma concentration of penicillin. The nurse should always verify an order that may not be clear.

Question 46

13. The nurse is preparing to administer meperidine (Demerol), which is an opioid analgesic, and promethazine (Phenergan), which is an antiemetic and antihistamine. The nurse understands that these drugs are given in combination for which reason?

a. They have antagonistic effects to reduce nausea.
b. They have additive effects to enhance analgesia.
c. They have potentiating effects to decrease an allergic response.
d. They have synergistic effects to increase sedation.

Answer 46

ANS: D

d. They have synergistic effects to increase sedation.

Meperidine and promethazine have a synergistic effect on each other with a clinical effect that is substantially greater than the combined effect of the two.

Question 47

14. The provider has ordered amoxicillin with clavulanate (Augmentin) for a child who has otitis media. The child’s parent asks why this drug is necessary when amoxicillin is less expensive. The nurse will explain that clavulanate is added to amoxicillin because it

a. binds with albumin to increase the amount of available amoxicillin.
b. broadens the spectrum of amoxicillin by inhibiting bacterial enzymes.
c. inhibits hepatic blood flow, leading to increased serum drug levels of amoxicillin.
d. inhibits the excretion of amoxicillin by interfering with renal function.

Answer 47

ANS: B

b. broadens the spectrum of amoxicillin by inhibiting bacterial enzymes.

Clavulanate is a bacterial enzyme inhibitor, specifically beta-lactamase, which inactivates amoxicillin. When added to amoxicillin, it broadens the antibacterial spectrum.

Question 48

15. The nurse assesses a patient who is receiving morphine sulfate intravenously using a patient-controlled analgesia pump. The nurse notes somnolence and respiratory depression, which are signs of morphine toxicity. The nurse will prepare to administer naloxone (Narcan) because it

a. has synergistic effects with morphine.
b. is a narcotic agonist.
c. is a narcotic antagonist.
d. potentiates narcotic effects.

Answer 48

ANS: C

c. is a narcotic antagonist.

Naloxone is a narcotic antagonist, meaning that it reverses the effects of morphine by blocking morphine receptor sites.

Question 49

16. The nurse is teaching a patient about a drug that causes photosensitivity. Which statement by the patient indicates a need for further teaching?

a. “I should apply sunscreen with a sun protection factor greater than 15.”
b. “I should avoid sunlight when possible while taking this drug.”
c. “I will wear protective clothing when I am outdoors.”
d. “I will wear sunglasses even while I am indoors.”

Answer 49

ANS: D

d. “I will wear sunglasses even while I am indoors.”

Drugs that cause photosensitivity make sunburn more likely, so patients should stay out of the sun, wear protective clothing, and use sunscreen with an SPF greater than 15. It is not necessary to wear sunglasses indoors.

Question 50

17. A patient asks the nurse about using over-the-counter (OTC) medications. The nurse will tell the patient that OTC medications

a. are not as effective as prescription medications.
b. are not as safe as prescription medications.
c. have fewer side effects and drug interactions than prescription medications.
d. should be included when listing any medications taken by the patient.

Answer 50

ANS: D

d. should be included when listing any medications taken by the patient.

OTC medications should always be included when listing medications because they can cause drug interactions. OTC medications can be as effective and as safe as prescription medications and have as many side effects and adverse reactions.

Question 51

18. A patient who takes warfarin (Coumadin) asks the nurse about taking a medication for headaches. The nurse will recommend which medication?

a. Acetaminophen
b. Aspirin
c. Ibuprofen
d. No medication

Answer 51

ANS: A

a. Acetaminophen

Aspirin and NSAIDs can increase the risk of hemorrhage in patients taking anticoagulants. Acetaminophen is safe and may be recommended.

Question 52

19. The nurse is educating the parent of a 20-month-old toddler about over-the-counter (OTC) products to treat cold symptoms. Which statement by the parent indicates understanding of the teaching?

a. “I should check with the provider for proper dosing instructions.”
b. “OTC medications are less potent and have minimal side effects.”
c. “OTC medications can be given to children younger than 2 years old.”
d. “Using OTC medications may prevent accurate diagnosis of respiratory illness.”

Answer 52

ANS: D

d. “Using OTC medications may prevent accurate diagnosis of respiratory illness.”

OTC cold medications can mask symptoms and prevent accurate diagnosis of potentially serious illnesses. Their use in children is not recommended.

Question 53

1. Which patients are at high risk for drug interactions? (Select all that apply.)

a. Patients who are acutely ill
b. Patients who are taking multiple medications
c. Patients who see several specialists
d. Patients who take supplements and OTC medications
e. Patients who use one pharmacy for several medications

Answer 53

ANS: B, C, D

b. Patients who are taking multiple medications
c. Patients who see several specialists
d. Patients who take supplements and OTC medications

Patients who have chronic health conditions, take multiple medications, see more than one provider, and use supplements and OTC medications are at higher risk for drug interactions.

Question 54

1. The nurse is preparing to administer a medication to a 6-month-old infant. The nurse will monitor closely for signs of drug toxicity based on the knowledge that, compared to adults, infants have

a. an increased percentage of total body fat.
b. immature hepatic and renal function.
c. more protein receptor sites.
d. more rapid gastrointestinal transit time.

Answer 54

ANS: B

b. immature hepatic and renal function.

The liver and kidneys are the primary organs for metabolism and excretion and are immature in infants. This allows drugs to accumulate and increases the risk for drug toxicity. Infants have a lower proportion of body fat than adults and fewer protein receptors. They do have more rapid gastrointestinal transit time, but this decreases the amount of drug absorbed.

Question 55

2. The nurse reviews information about a drug and learns that it is best absorbed in an acidic environment. When giving this drug to a 1-year-old patient, the nurse will expect to administer a dose that will be

a. equal to an adult dose.
b. less than an adult dose.
c. more than an adult dose.
d. twice the usual adult dose.

Answer 55

ANS: C

c. more than an adult dose.

Because the child’s gastric pH is more alkaline than the adult’s, less drug will be absorbed. Therefore, the dose should be increased.

Question 56

3. The nurse assumes care for an infant who is showing signs of drug toxicity to a drug given several hours prior. The nurse checks the dose and confirms that the dose is consistent with standard dosing guidelines. Which characteristic of the drug will likely explain this response in this patient?

a. It is acidic.
b. It is highly protein-bound.
c. It is not fat-soluble.
d. It is water-soluble.

Answer 56

ANS: B

b. It is highly protein-bound.

With fewer protein-binding sites, there is more active drug available. This requires a reduction in the dose for infants. Drugs that are acidic are not as readily absorbed in infants, since their gastric pH tends to be more alkaline. Infants have a lower proportion of body fat; fat-soluble drugs would need to be decreased to prevent toxicity. Until about age 2 years of age, pediatric patients require larger than usual doses of water-soluble drugs to achieve therapeutic effects.

Question 57

4. The parent is concerned about giving a child medication because of the lack of knowledge about the effects of drugs on children. The nurse discusses legislation passed in 2002 and 2003 about pediatric pharmacology. Which is true about these laws?

a. They forbid providers from prescribing medications unless they have been FDA- approved for use in children.
b. They mandate consistent, evidence-based dosing guidelines for use in children.
c. They provide federal grants to fund pediatric pharmaceutical research.
d. They require drug manufacturers to study pediatric medication use.

Answer 57

ANS: D

d. They require drug manufacturers to study pediatric medication use.

In 2003, a law known as the Pediatric Research Equity Act joined the Best Pharmaceuticals Act of 2002 to require drug manufacturers to study pediatric medication use and offer incentives for pediatric pharmacology research. Providers are not forbidden to prescribe drugs in children that are not FDA-approved. The laws do not mandate the use of evidence-based guidelines and do not provide grants to fund research.

Question 58

5. The nurse will administer an intravenous medication to an adolescent patient. When preparing the adolescent for the IV insertion, which is an appropriate action by the nurse?

a. Allowing the patient to verbalize concerns about the procedure
b. Covering the insertion site with a bandage after the procedure is completed
c. Explaining any possible adverse drug reactions
d. Reassuring the patient that only one body part will be used

Answer 58

ANS: A

a. Allowing the patient to verbalize concerns about the procedure

Allowing the adolescent to verbalize concerns about the medication and its regimen may offer opportunities to clarify misconceptions and teach new information. Preschool-age children may have concerns about harm to their body and need to have sites covered. Adolescents still have a present focus, so discussing future adverse reactions is not especially helpful. Preschool and school-age children fear bodily harm and require reassurance that only one body part will be affected.

Question 59

6. An infant will receive a topical medication. What instruction will the nurse include when teaching the parents how to administer the medication?

a. “Apply a thin layer to the affected area.”
b. “Apply liberally to the skin on and around the area.”
c. “Use the medication less frequently than what is recommended for adults.”
d. “Use the medication more frequently than what is recommended for adults.”

Answer 59

ANS: A

a. “Apply a thin layer to the affected area.”

Topical medications may be altered by skin tissue condition. Children have thinner, more porous skin and have a proportionately higher skin surface area than adults and thus absorb topical medications more readily. Caregivers should be advised to use only a thin layer on the affected body part. This difference in skin does not affect the frequency of administering topical medications.

Question 60

7. The provider has ordered that vitamin D drops be given to a newborn. Based on the knowledge of drug distribution in infants, the nurse understands that the infant may need

a. a higher dose.
b. a lower dose.
c. less frequent dosing.
d. more frequent dosing.

Answer 60

ANS: B

b. a lower dose.

Neonates and young infants tend to have less body fat than older children, meaning that they need less of fat-soluble medications since these medications won’t be bound in fat tissue. Higher doses would lead to drug toxicity. Body fat does not affect the frequency of dosing.

Question 61

8. The nurse is caring for a 5-year-old child. The child is taking a drug that has a known therapeutic range in adults, and the nurse checks that the ordered dose is correct and notes that the child’s serum drug level is within normal limits. The child complains of a headache, which is a common sign of toxicity for this drug. Which action will the nurse take?

a. Administer the drug since the drug levels are normal.
b. Attribute the headache to non-drug causes.
c. Hold the next dose and contact the provider.
d. Request an order for an analgesic medication.

Answer 61

ANS: C

c. Hold the next dose and contact the provider.

The therapeutic ranges established for many drug levels are based on adult studies, so it is important for the nurse to assess pediatric patients in conjunction with monitoring drug levels. The nurse should notify the provider of the reaction. Because headaches are a symptom of toxicity for this drug, the nurse should not ignore the symptom.

Question 62

9. The nurse is preparing to give a 7-year-old child a bitter-tasting oral medication. The child asks the nurse if the medicine tastes bad. To help the child take this medication, which action will the nurse take?

a. Allow the child to delay taking the medication until the parent arrives.
b. Enlist the assistance of other staff to help restrain the child.
c. Tell the child that it doesn’t taste bad if it is swallowed quickly.
d. Tell the child that it tastes bad and offer a choice of beverages to drink afterwards.

Answer 62

ANS: D

d. Tell the child that it tastes bad and offer a choice of beverages to drink afterwards.

School-age children should be permitted more control, involvement in the process, and honest information. The nurse should tell the child the truth and offer the child a choice about what to drink to wash down the medicine. Medications must be given on schedule, so allowing the child a choice about when to take a medication is not acceptable. Restraining a child should not be used unless other methods have failed. Telling the child the medication doesn’t taste bad is not honest and will reduce the child’s trust in the nurse.

Question 63

10. The nurse is preparing to administer an oral liquid medication to an 11-month-old child who is fussy and uncooperative. Which action will the nurse take to facilitate giving this medication?

a. Adding honey to the medication to improve the taste
b. Putting the medication in the infant’s formula
c. Requesting an injectable form of the medication
d. Using a syringe and allowing the parent to give the medication

Answer 63

ANS: D

d. Using a syringe and allowing the parent to give the medication

When possible, family members or caregivers should be solicited to assist in medication administration. Infants should not receive honey because of the risk of botulism. A syringe allows more control over the amount of medication in the infant’s mouth and should be used. Mixing the medication in a bottle requires ensuring that the infant takes the entire bottle in order to get the medication dose. Using an injectable form of medication is more traumatic and should be used only when an oral route is not possible or is contraindicated.

Question 64

11. A 2-year-old child will receive several doses of an intramuscular medication. The nurse caring for this child will use which intervention to help the child cope with this regimen?

a. Allowing the child to give “pretend” shots to a doll with an empty syringe
b. Allowing the child to select a Band-Aid to wear after each medication is given
c. Ensuring privacy while giving the medication
d. Explaining that the medicine will help the child to feel better

Answer 64

ANS: A

a. Allowing the child to give “pretend” shots to a doll with an empty syringe

Simple explanations, a firm approach, and enlisting the imagination of a toddler through play may enhance cooperation. Allowing the child to practice on a doll may help the toddler tolerate the injections. Preschool and school-age children fear bodily injury, and Band-Aids are important with those age groups. Adolescents need privacy, and school-age children and adolescents can understand the use of a medication in relation to future outcomes.

Question 65

12. A preschool-age child has moderate dehydration and needs a rapid bolus of fluids. To provide atraumatic care and administer fluids most effectively, what action will the nurse take?

a. Apply a eutectic mixture of local anesthetic (EMLA) just before inserting an intravenous line.
b. Ask the child’s parents to restrain the child during venipuncture so fluids may be administered.
c. Request an order for nasogastric (NG) fluids to avoid the trauma of venipuncture.
d. Use a powdered lidocaine preparation prior to insertion of the intravenous needle.

Answer 65

ANS: D

d. Use a powdered lidocaine preparation prior to insertion of the intravenous needle.

One method to ensure atraumatic care is through the use of topical analgesics before IV injections. Powdered lidocaine preparations are effective in reducing the pain and fear associated with invasive procedures, such as venipuncture. EMLA is useful only if applied 1 to 2.5 hours prior to IV insertion. Asking parents to restrain the child for a painful procedure can cause stress and anxiety for both the child and the parents. NG fluids are traumatic and are uncomfortable long past the insertion of the NG tube.

Question 66

13. The nurse is preparing to administer an intramuscular medication to a 4-year-old child who starts to cry and screams, “I don’t want a shot!” What is the nurse’s next action?

a. Acknowledge that shots hurt and tell the child to be brave.
b. Engage the child in a conversation about preschool and favorite activities.
c. Enlist the assistance of another nurse to help restrain the child.
d. Explain to the child that it will only hurt for a few seconds.

Answer 66

ANS: B

b. Engage the child in a conversation about preschool and favorite activities.

Distraction may be used for pain and anxiety control in this age group. Engaging the child in a conversation may distract the child from the anxiety of the imminent injection. It is not correct to tell the child to be brave since this belittles the feelings expressed by the child. Preschool children have a limited sense of time, so telling the child that the pain will only last a few seconds may not be effective. Restraining the child with other staff should be used last after other methods have failed.

Question 67

14. A 14-year-old female who has type 1 diabetes mellitus that has been well-controlled for several years is admitted to the hospital for treatment of severe hyperglycemia. The patient’s lab values indicate poor glycemic control for the past 3 months. The nurse caring for this patient will suspect which cause for the change in diabetic control?

a. Adolescent rebellion and noncompliance
b. Changes in cognitive function
c. Hormonal fluctuations
d. Possible experimentation with drugs or alcohol

Answer 67

ANS: C

c. Hormonal fluctuations

In adolescence, hormonal changes and growth spurts may necessitate changes in medication dosages; many children with chronic illness require dosage adjustments in the early teen years.

Question 68

15. The nurse is teaching a 15-year-old female patient and her parents about an antibiotic the adolescent will begin taking. The drug is known to decrease the effectiveness of oral contraceptive pills (OCPs). The nurse will

a. ask the adolescent and her parents whether she is taking OCPs.
b. tell her parents privately that pregnancy may occur if she is taking OCPs.
c. tell her privately that the medication may decrease the effectiveness of OCPs.
d. warn her and her parents that she may get pregnant if she is relying on OCPs.

Answer 68

ANS: C

c. tell her privately that the medication may decrease the effectiveness of OCPs.

When soliciting adolescent health histories, the nurse should consider issues related to sexual practices and should provide privacy when asking sensitive questions or giving sensitive information. The other actions do not allow for patient privacy.

Question 69

1. The nurse is caring for an older adult patient who is receiving multiple medications. When monitoring this patient for potential drug toxicity, the nurse should review which lab values closely?

a. Complete blood count and serum glucose levels
b. Pancreatic enzymes and urinalysis
c. Serum creatinine and liver function tests (LFTs)
d. Serum lipids and electrolytes

Answer 69

ANS: C

c. Serum creatinine and liver function tests (LFTs)

With liver and kidney dysfunction, the efficacy of drugs is generally increased and may cause toxicity. The nurse should review serum creatinine levels to monitor renal function and LFTs to monitor hepatic function. The other lab tests may be ordered for specific drugs if they affect those body systems.

Question 70

2. An older patient who reports a 2- to 3-year history of upper gastrointestinal symptoms will begin taking ranitidine (Zantac) to treat this disorder. The patient has completed a health history form. The nurse notes that the patient answered “no” when asked if any medications were being taken. Which action will the nurse take next?

a. Ask whether the patient uses over-the-counter (OTC) medications.
b. Obtain a careful dietary history for the past two weeks.
c. Recommend that the patient take antacid tablets.
d. Suggest that the patient add high-potassium foods to the diet.

Answer 70

ANS: A

a. Ask whether the patient uses over-the-counter (OTC) medications.

Many patients do not think of OTC products as medications and often do not list them when asked about medication use. A patient who takes ranitidine along with an OTC antacid could be duplicating medications. A dietary history is important as well but would not be the most important action in this case. The nurse should not recommend antacid tablets or high-potassium foods.

Question 71

3. To assist an older, confused patient to adhere to a multidrug regimen, the nurse will provide which recommendation?

a. Avoid the use of over-the-counter medications.
b. Bring all medications to each clinic visit.
c. Review the manufacturer’s information insert about each medication.
d. Save money by getting each drug at the pharmacy with the lowest price.

Answer 71

ANS: B

b. Bring all medications to each clinic visit.

Patients who take multiple medications should be advised to bring medications to each clinic visit. Patients may take OTC medications as long as those are included in the list of medications reviewed by the provider. Manufacturers’ inserts provide an overwhelming amount of information. Patients should be advised to use only one pharmacy.

Question 72

4. The nurse is caring for an older patient who is taking 25 mg per day of hydrochlorothiazide. The nurse will closely monitor which lab value in this patient?

a. Coagulation studies
b. White blood count
c. Liver function tests
d. Serum potassium

Answer 72

ANS: D

d. Serum potassium

Older patients who take doses of hydrochlorothiazide between 25 to 50 mg/day have increased risk of electrolyte imbalances, so potassium should be monitored closely.

Question 73

5. The nurse is caring for an 82-year-old patient who takes digoxin to treat chronic atrial fibrillation. When caring for this patient, to monitor for drug side effects, what will the nurse will carefully assess?

a. Blood pressure
b. Heart rate
c. Oxygen saturation
d. Respiratory rate

Answer 73

ANS: B

b. Heart rate

Most of digoxin is eliminated by the kidneys, so a decline in kidney function can cause digoxin accumulation, which can cause bradycardia. Digoxin should not be given to any patient with a pulse less than 60 beats per minute.

Question 74

6. The nurse is caring for an 80-year-old patient who is taking warfarin (Coumadin). Which action does the nurse understand is important when caring for this patient?

a. Encouraging the patient to rise slowly from a sitting position
b. Initiating a fall-risk protocol
c. Maintaining strict intake and output measures
d. Monitoring blood pressure frequently

Answer 74

ANS: B

b. Initiating a fall-risk protocol

Patients who take anticoagulants have an increased risk of hemorrhage. Older patients have an increased risk of falls that can lead to bleeding complications. Initiating a fall-risk protocol is important. Warfarin does not affect blood pressure and would not cause orthostatic hypotension. Warfarin does not alter urine output.

Question 75

7. An 80-year-old patient is being treated for an infection. An order for which type of antibiotic would cause concern for the nurse caring for this patient?

a. Aminoglycoside
b. Cephalosporin
c. Penicillin
d. Sulfonamide

Answer 75

ANS: A

a. Aminoglycoside

Penicillins, cephalosporins, tetracyclines, and sulfonamides are normally considered safe for the older adult. Aminoglycosides are excreted in the urine and are not usually prescribed for patients older than 75 years.

Question 76

8. A 75-year-old patient will be discharged home with a prescription for an opioid analgesic. To help the patient minimize adverse effects, what will the nurse recommend for this patient?

a. Sucking on lozenges to moisten oral mucosa
b. Taking an antacid with each dose
c. Taking the medication on an empty stomach
d. Using a stool softener

Answer 76

ANS: D

d. Using a stool softener

Opioid analgesics can cause constipation. Stool softeners can help minimize this effect. Opioids do not cause dry mouth. Drug absorption may be decreased with an antacid. Opioid analgesics should be taken with food or milk to decrease gastrointestinal irritation.

Question 77

9. A 75-year-old patient is readmitted to the hospital to treat recurrent pneumonia. The patient had been discharged home with a prescription for antibiotics 5 days prior. The nurse admitting this patient will take which initial action?

a. Ask the patient about over-the-counter drug use.
b. Ask the patient how many doses of the antibiotic have been taken.
c. Discuss increasing the antibiotic dose with the provider.
d. Obtain an order for a creatinine clearance test.

Answer 77

ANS: B

b. Ask the patient how many doses of the antibiotic have been taken

There are many reasons for non-adherence to a drug regimen in an older patient, so if a patient is readmitted, the nurse should first ascertain whether or not the medications have been used. Asking the patient how many doses have been taken will help to assess this. If it is determined that the patient is taking the drug as ordered, the other steps may be taken.

Question 78

10. The nurse is performing an admission assessment on an 80-year-old patient who has frequent hospital admissions. The patient appears more disoriented and confused than usual. Which action by the nurse is correct?

a. Asking about medication doses
b. Asking for a neurologist consult
c. Requesting orders for liver function tests
d. Suspecting impaired renal function

Answer 78

ANS: A

a. Asking about medication doses

An initial sign of drug toxicity in elderly patients may be confusion or changes in behavior. The nurse should ask about drug doses and notify the provider of the behaviors. The provider may order further evaluation based on examination of the patient.

Question 79

11. An older patient takes ibuprofen for arthritis pain. The patient tells the nurse that the ibuprofen causes gastrointestinal (GI) upset. Which action will the nurse take with this patient?

a. Ask the provider about having the patient take a different medication.
b. Instruct the patient to cut the ibuprofen dose in half to avoid GI upset.
c. Explain that all drugs have adverse effects.
d. Explore options to help decrease the drug side effects.

Answer 79

ANS: D

d. Explore options to help decrease the drug side effects.

Older adults are more likely to experience drug side effects, and nurses should be aware of measures that may decrease these side effects and thus improve adherence.

Question 80

12. The nurse is caring for a 78-year-old patient who lives independently. The patient will begin a new drug regimen that requires taking multiple drugs at various times per day. Which intervention is appropriate for the nurse to implement with this patient?

a. Ask the patient’s family members to monitor the patient’s drug regimen.
b. Develop a log to record the times each drug will be taken.
c. Reinforce the need to take the drugs as scheduled.
d. Write the medication administration times on each prescription label.

Answer 80

ANS: B

b. Develop a log to record the times each drug will be taken.

The patient should be advised to keep a medication record of drugs and when they will be taken. The patient is independent, and this helps maintain independence. Family member support is essential when older patients are confused. Reinforcing information without providing a means to keep track of the medications does not necessarily improve compliance. Writing medication times on prescription labels does not help to organize the medication schedule.

Question 81

1. The nurse is preparing an 80-year-old patient for discharge home from the hospital. The patient will receive several new medications. The patient lives alone but has several family members who stop by every day. Which suggestions will the nurse make for this family? (Select all that apply.)

a. Ask the pharmacy for non-childproof medication bottles.
b. Ask the patient to record all medications and the times they are taken.
c. Place the pills in an organizer container.
d. Provide the patient with the drug manufacturer information sheets.
e. Put water bottles near pills for convenience.

Answer 81

ANS: A, C, E

a. Ask the pharmacy for non-childproof medication bottles.
c. Place the pills in an organizer container.
e. Put water bottles near pills for convenience.

To help older patients with compliance, medications should be convenient and easy to open. Asking the pharmacist for non-childproof containers will help make medications easier to get. Using an organizer container helps patients remember which drugs should be taken at what time. Placing water bottles nearby eliminates a step in the process and increases the likelihood that a medication will be taken on time.

Question 82

2. Which drug properties are problematic for older patients? (Select all that apply.)

a. Drugs with anticholinergic effects
b. Drugs that are highly protein-bound
c. Drugs with a short half-life
d. Drugs that undergo hepatic conjugation
e. Drugs with a narrow therapeutic range

Answer 82

ANS: A, B, E

a. Drugs with anticholinergic effects
b. Drugs that are highly protein-bound
e. Drugs with a narrow therapeutic range

Older patients are more susceptible to drug side effects, especially those that cause anticholinergic effects. Older patients have a loss of protein-binder sites for drugs, so those that are highly protein-bound will have higher than usual serum levels and can cause toxicity. Drugs with a narrow therapeutic range require closer monitoring in all patients, but especially in older patients. Drugs with a short half-life are preferred because older patients have a decreased ability to metabolize and excrete drugs. Hepatic conjugation is usually not influenced by older age, liver diseases, or drug interaction.

Question 83

1. The nurse provides teaching about the sedative side effects of a medication ordered to be given at 8:00 PM daily. The patient works a 7:00 PM to 7:00 AM shift. The nurse explores options including taking the medication at 8:00 AM instead of in the evening. Which QSEN competency do the nurse’s actions best demonstrate?

a. Collaboration and teamwork
b. Evidence-based practice
c. Patient-centered care
d. Patient safety

Answer 83

ANS: C

c. Patient-centered care

Patient-centered care recognizes the patient as the source of control and provides care based on respect for the patient’s preferences, values, and needs.

Question 84

2. The nurse learns that a patient cannot afford a prescribed medication and enlists the assistance of the social worker and an outside agency to provide medications at a lower cost. Which QSEN competency do the nurse’s actions best demonstrate?

a. Collaboration and teamwork
b. Evidence-based practice
c. Patient-centered care
d. Quality improvement

Answer 84

ANS: A

a. Collaboration and teamwork

Collaboration and teamwork involve interprofessional communication and shared decision-making to provide patient care.

Question 85

3. A 5-year-old child with type 1 diabetes mellitus has repeated hospitalizations for episodes of hyperglycemia related to poor control. The parents tell the nurse that they can’t keep track of everything that has to be done to care for their child. The nurse reviews medications, diet, and symptom management with the parents and draws up a daily checklist for the family to use. This is an example of the principles outlined in

a. Guiding Principles of Patient Engagement.
b. National Alliance for Quality Care.
c. Nursing Process.
d. Quality and Safety Education for Nurses.

Answer 85

ANS: A

a. Guiding Principles of Patient Engagement

Guiding Principles of Patient Engagement address the dynamic partnership among patients, families, and health care providers.

Question 86

4. The nurse is preparing to administer a medication and reviews the patient’s chart for drug allergies, serum creatinine, and blood urea nitrogen (BUN) levels. The nurse’s actions are reflective of which phase of the nursing process?

a. Assessment
b. Evaluation
c. Implementation
d. Planning

Answer 86

ANS: A

a. Assessment

Assessment involves gathering information about the patient and the drug, including any previous use of the drug.

Question 87

5. Which assessment is categorized as objective data?

a. A list of herbal supplements regularly used
b. Lab values associated with drugs the patient is taking
c. The ages and relationship to the patient of all household members
d. Usual dietary patterns and intake

Answer 87

ANS: B

b. Lab values associated with drugs the patient is taking

Objective data are measured and detected by another person and would include lab values. The other examples are subjective data.

Question 88

6. The nurse reviews a patient’s database and learns that the patient lives alone, is forgetful, and does not have an established routine. The patient will be sent home with three new medications to be taken at different times of day. The nurse develops a daily medication chart and enlists a family member to put the patient’s pills in a pill organizer. This is an example of which phase of the nursing process?

a. Assessment
b. Evaluation
c. Implementation
d. Planning

Answer 88

ANS: C

c. Implementation

The implementation phase involves education and patient care in order to assist the patient to accomplish the goals of treatment.

Question 89

7. A patient who is hospitalized for chronic obstructive pulmonary disease wants to go home. The nurse and the patient discuss the patient’s situation and decide that the patient may go home when able to perform self-care without dyspnea and hypoxia. This is an example of which phase of the nursing process?

a. Assessment
b. Evaluation
c. Implementation
d. Planning

Answer 89

ANS: D

d. Planning

Planning involves goal-setting which, for this patient, means being able to perform self-care activities without dyspnea and hypoxia.

Question 90

8. A patient will be sent home with a metered-dose inhaler, and the nurse is providing teaching. Which is a correctly written goal for this process?

a. The nurse will demonstrate correct use of a metered-dose inhaler to the patient.
b. The nurse will teach the patient how to administer medication with a metered-dose inhaler.
c. The patient will know how to self-administer the medication using the metered-dose inhaler.
d. The patient will independently administer the medication using the metered-dose inhaler at the end of the session.

Answer 90

ANS: D

d. The patient will independently administer the medication using the metered-dose inhaler at the end of the session.

Goals must be patient-centered and clearly state the outcome with a reasonable deadline and should identify components for evaluation.

Question 91

9. The nurse is developing a plan of care for a patient who has chronic lung disease and hypoxia. The patient has been admitted for increased oxygen needs above a baseline of 2 L/min. The nurse develops a goal stating, “The patient will have oxygen saturations of > 95% on room air at the time of discharge from the hospital.” What is wrong with this goal?

a. It cannot be evaluated.
b. It is not measurable.
c. It is not patient-centered.
d. It is not realistic.

Answer 91

ANS: D

d. It is not realistic.

This goal is not realistic because the patient is not usually on room air and should not be expected to attain that goal by discharge from this hospitalization.

Question 92

10. The nurse is developing a teaching plan for an elderly patient who will begin taking an antihypertensive drug that causes dizziness and orthostatic hypotension. Which nursing diagnosis is appropriate for this patient?

a. Deficient knowledge related to drug side effects
b. Ineffective health maintenance related to age
c. Readiness for enhanced knowledge related to medication side effects
d. Risk for injury related to side effects of the medication

Answer 92

ANS: D

d. Risk for injury related to side effects of the medication

This patient has an increased risk for injury because of drug side effects, so this is an appropriate nursing diagnosis.

Question 93

11. An older patient must learn to administer a medication using a device that requires manual dexterity. The patient becomes frustrated and expresses lack of self-confidence in performing this task. Which action will the nurse perform next?

a. Ask the patient to keep trying until the skill is learned.
b. Provide written instructions with illustrations showing each step of the skill.
c. Schedule multiple sessions and practice each step separately.
d. Teach the procedure to family members who can administer the medication for the patient.

Answer 93

ANS: C

c. Schedule multiple sessions and practice each step separately.

Nurses should be sensitive to patient’s level of frustration when teaching skills. In this case, breaking the steps down into individual parts will help with this patient’s frustration level.

Question 94

12. A school-age child will begin taking a medication to be administered 5 mL three times daily. The child’s parent tells the nurse that, with a previous use of the drug, the child repeatedly forgot to bring the medication home from school, resulting in missed evening doses. What will the nurse recommend?

a. Asking the provider if the medication may be taken before school, after school, and at bedtime
b. Putting a note on the child’s locker to encourage the child to take responsibility for medication administration
c. Asking the provider if 7.5 mL may be taken in the morning and 7.5 mL may be taken in the evening so that the correct amount is given daily
d. Taking the noon dose to school every day and giving it to the school nurse to administer

Answer 94

ANS: C

c. Asking the provider if 7.5 mL may be taken in the morning and 7.5 mL may be taken in the evening so that the correct amount is given daily

For busy families with school-age children, it may be necessary to adjust the medication schedule to one that fits their schedule. The nurse should ask the provider if a revised schedule is possible. In this case, the revised schedule would involve not taking the medication while at school. Putting a note on the locker is not likely to be effective. It is not correct to adjust the dose.

Question 95

13. A high-school student regularly forgets to use a twice-daily inhaled corticosteroid to prevent asthma flares and is repeatedly admitted to the hospital. The child’s parent tells the nurse that the child has been told that forgetting to take the medication causes frequent hospitalizations. The nurse will

a. encourage the child to take responsibility for taking the medication.
b. reinforce the need to take prescribed medications to avoid hospitalizations.
c. suggest putting the inhaler with the child’s toothbrush to use before brushing teeth.
d. suggest that the child’s parents administer the medication to increase compliance.

Answer 95

ANS: C

c. suggest putting the inhaler with the child’s toothbrush to use before brushing teeth.

It is important to empower patients to take responsibility for managing medications. Putting the medication with the toothbrush can help this child remember to use it. Telling the child to take medications and reminding the child that failure to do so results in hospitalization is not working. Asking the child’s parents to administer the medication does not empower the adolescent to take responsibility.

Question 96

14. An adolescent patient who has acne is given a regimen of topical medications and an oral antibiotic that generally clears up lesions to fewer than 10 within 6 to 8 weeks. At a 2-month follow-up, the patient continues to have more than 25 lesions. The child’s parent affirms that the child is using the medications as prescribed. Which evaluation statement is correct for this patient?

a. “Goal of fewer than 10 lesions in 6 to 8 weeks is not met.”
b. “Goal that the medication will be effective is not met.”
c. “Goal that the patient will take medications as prescribed is not met.”
d. “Goal that the patient understands the medication regimen is not met.”

Answer 96

ANS: A

a. “Goal of fewer than 10 lesions in 6 to 8 weeks is not met.”

All indications are that this patient is taking the medications and they are not effective. The first statement is correct because it identifies a measurable goal and a specific time frame.

Question 97

1. When the nurse practices the “5-plus-5” rights of medication administration, what does it ensure?

a. Adequate information is given
b. Cost-effective use of medications
c. Informed consent for drug administration
d. Safe administration of medications

Answer 97

ANS: D

d. Safe administration of medications

The “5-plus-5” rights ensure that the nurse has considered all of the details of safe medication administration. Giving information to patients and obtaining informed consent are part of the 5-plus-5 rights. Cost effectiveness is not part of the 5-plus-5 rights.

Question 98

2. In order to ensure that a medication is given to the right patient, the nurse must perform which action?

a. Ask the patient to spell their last name.
b. Match the patient with a photo ID.
c. Swipe a bar code on the patient’s ID bracelet.
d. Verify the patient using two identifiers.

Answer 98

ANS: D

d. Verify the patient using two identifiers.

The Joint Commission requires two forms of identification before medication administration. Patients are asked to state their name and date of birth. Some, but not all institutions, use photos and bar codes to aid in identification.

Question 99

3. A health care provider calls a nursing unit to leave a telephone order for a PRN antipyretic medication for a child. The provider tells the nurse to “give PO acetaminophen for a fever greater than 101° F per protocol.” What will the nurse do next?

a. Ask the provider to verify how many mg per kg per dose and how frequently to give the medication.
b. Look up the protocol in the unit manual and write the drug order for the provider to sign.
c. Provide the child’s weight to the hospital pharmacist to write the order based on the protocol.
d. Transcribe the verbal order to the order sheet as “give PO acetaminophen for a fever greater than 101° F per protocol.”

Answer 99

ANS: A

a. Ask the provider to verify how many mg per kg per dose and how frequently to give the medication.

The components of a drug order include drug name, dose, route, frequency, and any instructions for dosing. A nurse receiving a telephone order should “read back” the order from the provider that includes this information. The provider, and not the nurse or the pharmacist, is responsible for writing the order with all components.

Question 100

4. The pediatric nurse reviews a hand-written medication order which reads, “09/16/2013, acetaminophen 160 mg (5 mL) PO q4h for fever.” What will the nurse do next?

a. Administer the drug when indicated.
b. Ask the provider to confirm if dose is correct for the patient’s age.
c. Clarify the nursing assessments necessary for giving a dose.
d. Contact the provider to request patient allergy information.

Answer 100

ANS: C

c. Clarify the nursing assessments necessary for giving a dose.

This order contains all components except the level of temperature necessary to justify a dose of an antipyretic. The patient’s age and allergy information are part of the medical record data base.

Question 101

5. The nurse is caring for a 20-kg child who is ordered to receive amoxicillin 400 mg PO TID for 10 days. The nurse reviews the drug information and notes that the correct dose of amoxicillin is 40 to 50 mg/kg/day in two to three divided doses. Which action by the nurse is correct?

a. Adjust the drug dose based on drug manufacturer dosing information.
b. Administer the medication as ordered.
c. Ask the pharmacist to double-check that the dose is correct.
d. Contact the provider and ask whether the drug should be given BID instead of TID.

Answer 101

ANS: D

d. Contact the provider and ask whether the drug should be given BID instead of TID.

The correct range for this drug for this child is 800 to 1000 mg per day. If 400 mg were administered TID, it would result in 1200 mg per day being administered. Twice daily (BID) dosing would be in the correct range.

Question 102

6. The nurse is preparing to administer a medication from a unit-dose system. The nurse verifies that the medication, dose, and time are correct and that the expiration date was the day prior. Which action is correct?

a. Administer the medication and observe for adequate drug effects.
b. Notify the pharmacist and provider of a medication error.
c. Return the medication to the pharmacy to be replaced.
d. Verify the right patient and administer the medication.

Answer 102

ANS: C

c. Return the medication to the pharmacy to be replaced.

If a drug expiration date has passed, it should be returned to the pharmacy or discarded, never used. A medication error would occur only if the medication was given.

Question 103

7. The nurse is preparing to administer a chewable tablet to a preschool-age child. The child’s parent reports always crushing the tablet and mixing it with pudding when giving it at home. What is the nurse’s next action?

a. Ask the pharmacist if the drug may be crushed.
b. Crush the tablet and mix it with pudding.
c. Insist that the tablet must be chewed as ordered.
d. Request a liquid form of the medication from the pharmacy.

Answer 103

ANS: A

a. Ask the pharmacist if the drug may be crushed.

Nurses should not crush or mix medications in other substances without consultation with a pharmacist or a reliable drug reference. Even if the family has been doing this at home, the nurse must still determine safety and efficacy. If the medication cannot be crushed or mixed into another substance, the nurse may need to insist on the child taking the dose as ordered or may need to ask the provider to prescribe a different form of the medication.

Question 104

8. The nurse is caring for a patient who will have surgery that morning. The patient usually takes an antihypertensive medication every morning. The patient has been NPO since midnight. What action will the nurse perform?
   a. Ask the patient to swallow the pill without water.
   b. Give the medication with a small sip of water.
   c. Consult the provider and surgeon about giving the medication.
   d. Hold the medication until after the patient’s surgery.

Answer 104

ANS: C

c. Consult the provider and surgeon about giving the medication.

The patient’s provider or surgeon should determine the importance of giving the medication along with the safety of administering it prior to anesthesia. The nurse should not give the medication with or without water without the provider’s permission.

Question 105

9. The nurse is caring for a patient who has asthma. The provider has ordered an albuterol metered-dose inhaler (MDI), 2 puffs q4 to 6h PRN wheezing. The patient’s last dose was 4 hours ago. What is the nurse’s next action?

a. Administer 2 puffs of albuterol with the MDI.
b. Auscultate the patient’s lung sounds.
c. Give the albuterol if the patient reports wheezing.
d. Give the medication and evaluate its effectiveness.

Answer 105

ANS: B

b. Auscultate the patient’s lung sounds.

The albuterol is to be given PRN if the patient is wheezing. The nurse should assess breath sounds and give the medication if the patient is wheezing. Even if the patient reports wheezing, the nurse should make and document an assessment.

Question 106

10. The nurse assumes care of a patient who had surgery that morning. The provider has ordered hydrocodone (Lortab) every 4 hours for mild to moderate pain and morphine sulfate for moderate to severe pain. The nurse reviews the patient’s record and notes the patient has received two doses of hydrocodone 4 hours apart for a pain level of 7 to 8 on a scale of 1 to 10 and has reported a decrease in pain to a level of 6 to 7 after 30 minutes. It has been 4 hours since the last dose, and the patient reports a pain level of 7. What will the nurse do?

a. Administer the hydrocodone.
b. Administer morphine.
c. Ask the patient which drug to give.
d. Notify the provider of the patient’s current pain level.

Answer 106

ANS: B

b. Administer morphine.

The previous nurse has documented a poor response to pain medication given for mild to moderate pain. The nurse should administer the medication ordered for moderate to severe pain. Hydrocodone has not been effective and should not be given. The nurse bases the drug selection on the patient’s evaluation of pain, not on which drug the patient wants. The provider has written an order with nursing evaluations specified, so there is no need for the nurse to notify the provider.

Question 107

11. The nurse is caring for a patient who will begin taking a thiazide diuretic to treat hypertension. The patient says, “I know this will lower my blood pressure, but how does it work?” How will the nurse respond?

a. “It can cause orthostatic hypotension, so be careful.”
b. “It reduces the volume of fluid in your blood stream to lower blood pressure.”
c. “The actions are complicated, but it’s an effective drug.”
d. “Your provider should explain this medication to you.”

Answer 107

ANS: B

b. “It reduces the volume of fluid in your blood stream to lower blood pressure.”

Patients have a right to understand how the drugs they are taking work and to know about side effects. The nurse should explain how the medication can cause orthostatic hypotension after addressing the patient’s current question. Telling the patient that the drug actions are complicated is disrespectful. Nurses are responsible for educating patients about medications.

Question 108

12. A patient who is diagnosed with atrial fibrillation is to begin taking warfarin (Coumadin). The patient refuses to take the medication because “it is rat poison.” After the nurse provides teaching, the patient still refuses. What action will the nurse take?

a. Hold the dose and document the patient’s refusal.
b. Hold the dose, notify the provider of the situation, and document these actions.
c. Put the medication in the patient’s food.
d. Tell the patient that the drug is necessary for treatment.

Answer 108

ANS: B

b. Hold the dose, notify the provider of the situation, and document these actions.

Patients have a right to refuse medications, but the provider should be notified if omitting the medication can have serious effects. According to the principle of autonomy, it is unethical to put a medication in a patient’s food without their knowledge.

Question 109

13. Which is a violation of a nurse’s right when administering medications?

a. A hospital policy for off-label drug uses
b. A medication preparation area at the unit secretary’s desk
c. A multiple-dose drug vial requiring the nurse to calculate and measure the dose
d. A new drug ordered that the nurse must look up in a drug manual

Answer 109

ANS: B

b. A medication preparation area at the unit secretary’s desk

Nurses have a right to administer drugs safely and have the right to stop, think, and be vigilant when administering medications. Another worker’s desk will be noisy, with many distractions. Many drugs are used for off-label purposes; having a hospital policy helps ensure safety. Single-dose vials are more convenient and help to reduce calculation errors, but multi-dose vials are often used; nurses unsure of calculations should check their work with another nurse. Nurses frequently have to look up information on new drugs, and hospitals should offer reasonable access to current information.

Question 110

1. The nurse is caring for a patient who has asthma and administers a selective beta2-adrenergic agonist to treat bronchospasm. The nurse will expect this drug to also cause which side effect

a. Increased blood glucose
b. Increased blood pressure
c. Increased heart rate
d. Increased gastrointestinal (GI) motility

Answer 110

ANS: A

a. Increased blood glucose

Drugs that act on beta2 receptors activate glyconeogenesis in the liver causing increased blood glucose. Selective beta2 drugs act on beta2 receptors only and not on beta1 receptors, so they do not cause increased blood pressure or increased heart rate. Adrenergic agonists cause decreased GI motility.

Question 111

2. A patient who has asthma is diagnosed with hypertension. The nurse understands that which drug will be safe to give this patient?

a. Pindolol (Visken)
b. Metoprolol (Lopressor)
c. Nadolol (Corgard)
d. Propranolol (Inderal)

Answer 111

ANS: B

b. Metoprolol (Lopressor)

Metoprolol is a selective adrenergic blocker that has a greater affinity for receptors that decrease heart rate and blood pressure and is less likely to cause bronchospasm. The other adrenergic blockers are not selective and can cause bronchoconstriction.

Question 112

3. The nurse administers subcutaneous epinephrine to a patient who is experiencing an anaphylactic reaction. The nurse should expect to monitor the patient for which symptom?

a. Bradycardia
b. Decreased urine output
c. Hypotension
d. Nausea and vomiting

Answer 112

ANS: B

b. Decreased urine output

Epinephrine can cause renal vasoconstriction and thereby reduce renal perfusion and decrease urinary output. Epinephrine causes tachycardia and elevates blood pressure. Nausea and vomiting are not expected to occur.

Question 113

4. An adult patient is brought to the emergency department for treatment of an asthma exacerbation. The patient uses inhaled albuterol as needed to control wheezing. The nurse notes expiratory wheezing, tremors, restlessness, and a heart rate of 120 beats per minute. The nurse suspects that the patient has

a. over-used the albuterol.
b. not been using albuterol.
c. taken a beta-adrenergic blocker.
d. taken a monoamine oxidase (MAO) inhibitor.

Answer 113

ANS: A

a. over-used the albuterol.

High doses of albuterol may affect beta1 receptors, causing an increase in heart rate. Patients having an asthma exacerbation may over-use their albuterol inhalers when seeking relief. Patients may have wheezing and increased heart rate during an untreated asthma exacerbation, but they will not have tremors and restlessness.

Question 114

5. The nurse is caring for a patient who is receiving intravenous dopamine (Intropin). The nurse notes erythema and swelling at the IV insertion site. What is the nurse’s initial action?

a. Apply warm soaks to the area.
b. Monitor the patient closely for hypertension.
c. Obtain an order for an electrocardiogram.
d. Notify the provider of a need for phentolamine mesylate (Regitine).

Answer 114

ANS: D

d. Notify the provider of a need for phentolamine mesylate (Regitine).

Extravasation of dopamine causes tissue necrosis; if extravasation occurs, the antidote phentolamine mesylate should be infiltrated into the area.

Question 115

6. The nurse is teaching a patient how to use phenylephrine HCl (Neo-Synephrine) nasal spray to treat congestion from a viral upper respiratory infection. What instruction will the nurse give the patient?

a. Stop using the medication after 3 days.
b. Spray the medication into the nose while lying supine.
c. Use frequently since systemic side effects do not occur.
d. Use the medication with any other over-the-counter medications

Answer 115

ANS: A

a. Stop using the medication after 3 days.

Nurses should explain to patients that continuous use of nasal sprays containing adrenergic agonists may result in rebound nasal congestion; these sprays should not be used more than 3 days. To avoid systemic absorption, spray should be administered while the patient is in an upright position. The medication may cause systemic side effects and should not be routinely used with other OTC cold medications.

Question 116

7. The nurse is caring for a patient who will begin taking atenolol (Tenormin). What information will the nurse include when teaching the patient about taking this medication?

a. The drug must be taken twice daily.
b. The patient must rise slowly from a chair or bed.
c. The medication is safe to take during pregnancy.
d. Use NSAIDs as needed for mild to moderate pain.

Answer 116

ANS: B

b. The patient must rise slowly from a chair or bed.

The side effects commonly associated with beta blockers include bradycardia, hypotension, and dizziness. Patients should be instructed to use caution when rising from a sitting or lying position to avoid orthostatic hypotension. Atenolol may be taken once daily. Atenolol is contraindicated in the pregnant patient. NSAIDs decrease the effects of beta blockers and should be avoided.

Question 117

8. The nurse is caring for a patient who has recently begun taking atenolol (Tenormin) to treat hypertension. The patient reports dizziness, nausea, vomiting, and decreased libido since beginning the medication. What will the nurse do?

a. Hold the next dose until the provider can be notified of these side effects.
b. Reassure the patient that these symptoms are common and not worrisome.
c. Recommend that the patient discuss these effects with the provider.
d. Suggest that the patient request a different beta-adrenergic blocker.

Answer 117

ANS: C

c. Recommend that the patient discuss these effects with the provider.

Beta-adrenergic blockers can cause these side effects, which are often dose-related. Patients experiencing these side effects should be encouraged to discuss them with their providers. Beta blockers should not be discontinued abruptly, or rebound symptoms may occur. Since symptoms may be dose-related, reassuring the patient is not correct. All beta blockers have similar side effects.

Question 118

9. A patient will begin taking albuterol (Proventil) to treat asthma. When teaching the patient about this drug, the nurse will make which recommendation?

a. Report rapid or irregular heart rate.
b. Drink 8 to 16 extra ounces of fluid each day.
c. Monitor serum glucose daily.
d. Take a calcium supplement.

Answer 118

ANS: A

a. Report rapid or irregular heart rate.

High dosages of albuterol may affect beta1 receptors, causing an increase in heart rate that could be dangerous. It is not necessary to consume extra fluids or take a calcium supplement while using this drug. Serum glucose may be elevated slightly, but this is not a concern in non-diabetic patients.

Question 119

10. A patient is taking doxazosin mesylate (Cardura) 1 mg per day to treat hypertension. The nurse notes a blood pressure of 110/72 mm Hg and a heart rate of 92 beats per minute. The nurse will contact the provider to discuss which change to the drug regimen?

a. Changing to a beta-adrenergic blocker
b. Decreasing the drug dose
c. Increasing the drug dose
d. Adding a diuretic

Answer 119

ANS: A

a. Changing to a beta-adrenergic blocker

Alpha-adrenergic blockers can cause orthostatic hypotension and reflex tachycardia. Beta blockers do not cause reflex tachycardia. Decreasing or increasing the drug dose is not recommended. Diuretics are added if blood pressure is not well-controlled.

Question 120

11. A patient who has Raynaud’s disease will begin taking an alpha-adrenergic blocker. The patient asks the nurse how the drug works to treat symptoms. The nurse explains that alpha-adrenergic blockers treat Raynaud’s disease by causing

a. decreased peripheral vascular resistance.
b. orthostatic hypotension.
c. reflex tachycardia.
d. vasodilation.

Answer 120

ANS: D

d. vasodilation.

Alpha-adrenergic blockers can be used to treat peripheral vascular disease because they cause vasodilation.

Question 121

12. A nurse is teaching a patient how to use phenylephrine (Neo-Synephrine) nasal spray. To avoid systemic absorption, the nurse teaches the patient to perform which action?

a. Apply pressure to the nose after spraying.
b. Administer the spray while in the supine position.
c. Insert the spray while sitting up.
d. Exhale deeply while injecting the nasal spray.

Answer 121

ANS: C

c. Insert the spray while sitting up.

The patient should insert the spray while sitting up to avoid it being absorbed systemically.

Question 122

13. A patient will be discharged on beta blockers. Which skill is essential for the nurse to teach the patient’s family?

a. How to prepare a low-sodium diet
b. Assessments to detect fluid retention
c. How to monitor heart rate and blood pressure
d. Early signs of changing level of consciousness

Answer 122

ANS: C

c. How to monitor heart rate and blood pressure

Because of the action and side effects of beta blockers, heart rate and blood pressure should be monitored frequently.

Question 123

14. The nurse is caring for a patient whose provider has just ordered a switch from atenolol (Tenormin) to reserpine. When preparing the patient to take this medication, what will the nurse do?

a. Ask about herbal supplements.
b. Counsel that NSAIDs are safe to take with reserpine.
c. Teach about potential side effects of mood elevation and euphoria.
d. Tell the patient to expect immediate therapeutic effects.

Answer 123

ANS: A

a. Ask about herbal supplements.

St. John’s wort may antagonize hypotensive effects of reserpine. Reserpine should not be taken with NSAIDs. Side effects include depression, not mood elevation. Therapeutic effects may take 2 to 3 weeks.

Question 124

15. The patient has been started on a treatment regimen that includes atenolol (Tenormin) and complains to the nurse of feeling weak. Which is the best response from the nurse?

a. “I will hold your next dose of the medication.”
b. “You may need an increase in your next dose of the medication.”
c. “This is an adverse reaction to the medication. I will stop the drug.”
d. “This is a side effect of the medication. I will notify your physician.”

Answer 124

ANS: D

d. “This is a side effect of the medication. I will notify your physician.”

Weakness can be a side effect of atenolol. Beta blockers should not be stopped abruptly.

Question 125

16. The nurse is performing an admission assessment on a patient who has recently begun taking reserpine. The patient reports using St. John’s wort. The nurse anticipates that the patient will have

a. hypotension.
b. hypertension.
c. bradycardia.
d. tachycardia.

Answer 125

ANS: B

b. hypertension.

St. John’s wort antagonizes the hypotensive effects of reserpine, causing hypertension.

Question 126

17. The patient has been ordered to receive Sudafed to treat nasal congestion. The nurse performing an admission assessment learns that the patient has diabetes mellitus. What action is appropriate for the nurse to take?

a. Administer the medication as ordered.
b. Contact the provider to discuss a lower dose.
c. Give the medication and monitor serum glucose closely.
d. Hold the medication and contact the provider.

Answer 126

ANS: D

d. Hold the medication and contact the provider.

Sympathetic drugs should not be taken by patients with diabetes. The medication should not be given.

Question 127

1. The nurse caring for a patient who is taking an adrenergic agent will expect which side effects? (Select all that apply.)
   a. Dilated pupils
   b. Increased heart rate
   c. Increase gastrointestinal motility
   d. Vasodilation
   e. Bronchospasm
   f. Relaxed uterine muscles

Answer 127

ANS: A, B, F

a. Dilated pupils
b. Increased heart rate
f. Relaxed uterine muscles

Adrenergic agents stimulate the sympathetic nervous system, evoking the “fight or flight” response. This response increases those functions needed to respond to stress (increased heart rate to perfuse muscles, bronchodilation to increase oxygen exchange). Adrenergic drugs shunt blood away from the reproductive tract and gastrointestinal organs as these functions are not needed during a fight or flight response.

Question 128

1. The nurse is preparing to administer a drug and learns that it is an indirect-acting cholinergic agonist. The nurse understands that this drug

a. acts on muscarinic receptors.
b. acts on nicotinic receptors.
c. inhibits cholinesterase.
d. inhibits cholinergic receptors.

Answer 128

ANS: C

c. inhibits cholinesterase.

Agents that inhibit cholinesterase, which is the enzyme that destroys acetylcholine, indirectly enhance the actions of acetylcholine.

Question 129

2. A nursing student asks why a direct-acting cholinergic agonist drug that is selective to muscarinic receptors is described as being non-specific. The nurse will explain that this is because

a. muscarinic receptors are present in many different tissues.
b. the action of cholinesterase alters the bioavailability at different sites.
c. these drugs can also affect nicotinic receptors.
d. they vary in their reversible and irreversible effects.

Answer 129

ANS: A

a. muscarinic receptors are present in many different tissues.

Although drugs classified as direct-acting cholinergic agonists are primarily selective for muscarinic receptors, they are non-specific because muscarinic receptors are located in different sites, causing actions in various organs. They are not affected differently by cholinesterase activity and have negligible actions on nicotinic receptors.

Question 130

3. The nurse is preparing to administer bethanechol (Urecholine) to a patient who is experiencing urinary retention. The nurse notes that the patient has a blood pressure of 90/60 mm Hg and a heart rate of 98 beats per minute. The nurse will perform which action?

a. Administer the drug and monitor urine output.
b. Administer the medication and monitor vital signs frequently.
c. Give the medication and notify the provider of the increased heart rate.
d. Hold the medication and notify the provider of the decreased blood pressure.

Answer 130

ANS: D

d. Hold the medication and notify the provider of the decreased blood pressure.

Side effects of this medication are a decrease in the pulse rate and vasodilation, which can exacerbate bradycardia and hypotension. The nurse should hold the drug and notify the provider.

Question 131

4. The nurse administers bethanechol (Urecholine) to a patient to treat urinary retention. After 30 minutes, the patient voids 800 mL of urine and reports having a loose stool but no cramping or gastrointestinal pain. The patient’s blood pressure is 110/70 mm Hg. The nurse will perform which action?

a. Notify the provider of bethanechol adverse effects.
b. Record the urine output and the blood pressure and continue to monitor.
c. Request an order for intravenous atropine sulfate.
d. Suggest another dose of bethanechol to the provider.

Answer 131

ANS: B

b. Record the urine output and the blood pressure and continue to monitor.

The patient is exhibiting desired effects and mild side effects of bethanechol, so the nurse should record information and continue to monitor the patient. There is no need to notify the provider, give an antidote, or repeat the dose.

Question 132

5. The nurse is teaching a patient who will begin taking bethanechol (Urecholine). Which statement by the patient indicates a need for further teaching?

a. “Excessive sweating is a normal reaction to this medication.”
b. “Excess salivation is a serious side effect.”
c. “I should get out of bed slowly while taking this drug.”
d. “I will not take the drug if my heart rate is less than 60 beats per minute.”

Answer 132

ANS: A

a. “Excessive sweating is a normal reaction to this medication.”

Patients taking bethanechol should be instructed to report increased salivation and diaphoresis since they can be early signs of overdosing. They should also be taught to rise slowly to avoid orthostatic hypotension and to hold the drug if their heart rate is low.

Question 133

6. The nurse is caring for a male patient with myasthenia gravis who will begin taking ambenonium chloride (Mytelase). When performing a health history, the nurse will be concerned about a history of which condition in this patient?

a. Benign prostatic hypertrophy
b. Chronic constipation
c. Erectile dysfunction
d. Upper respiratory infection

Answer 133

ANS: A

a. Benign prostatic hypertrophy

This drug is a reversible cholinesterase inhibitor and is given to increase muscle strength. Cholinesterase inhibitors are contraindicated in patients with urinary tract obstruction.

Question 134

7. The nurse is preparing to administer the anticholinergic medication benztropine (Cogentin) to a patient who has Parkinson’s disease. The nurse understands that this drug is used primarily for which purpose?
   a. To decrease drooling and excessive salivation
   b. To improve mobility and muscle strength
   c. To prevent urinary retention
   d. To suppress tremors and muscle rigidity

Answer 134

ANS: D

d. To suppress tremors and muscle rigidity

Antiparkinson-anticholinergic drugs are used mainly to reduce tremors and muscle rigidity.

Question 135

8. The nurse is caring for a postoperative patient and notes that the patient received atropine sulfate preoperatively. Which assessment finding would prompt the nurse to notify the provider?

a. Absent bowel sounds
b. Drowsiness
c. Dry mouth
d. Heart rate of 78 beats per minute

Answer 135

ANS: A

a. Absent bowel sounds

These are all side effects of atropine. Absent bowel sounds can indicate a paralytic ileus. The other side effects are not harmful.

Question 136

9. A patient who has irritable bowel syndrome would most likely receive which type of drug to treat this condition?

a. An anticholinergic
b. A cholinergic esterase inhibitor
c. A muscarinic agent
d. A nicotinic agent

Answer 136

ANS: A

a. An anticholinergic

Anticholinergic drugs are used to treat peptic ulcers and intestinal spasticity because of their actions to decrease gastric secretions and gastrointestinal spasms.

Question 137

10. The nurse is teaching a patient about the use of an anticholinergic medication. What information will the nurse include when teaching this patient about this medication?

a. “Check your heart rate frequently to monitor for bradycardia.”
b. “Drink extra fluids while you are taking this medication.”
c. “Rise from a chair slowly to avoid dizziness when taking this drug.”
d. “Use gum or lozenges to decrease dry mouth caused by this drug.”

Answer 137

ANS: D

d. “Use gum or lozenges to decrease dry mouth caused by this drug.”

Anticholinergic medications cause dry mouth, so patients should be advised to use gum or lozenges to counter this side effect. Anticholinergics cause increased heart rate and increased blood pressure. Anticholinergics can cause urinary retention so patients should not increase fluid intake.

Question 138

11. Which cholinesterase inhibitor would be prescribed for a patient who has Alzheimer’s disease?

a. Ambenonium chloride (Myletase)
b. Benztropine (Cogentin)
c. Donepezil HCl (Aricept)
d. Neostigmine methylsulfate (Prostigmin)

Answer 138

ANS: C

c. Donepezil HCl (Aricept)

Donepezil is used to treat Alzheimer’s disease. Ambenonium and neostigmine are used to treat myasthenia gravis. Benztropine is used to treat Parkinson’s disease.

Question 139

12. The nurse is teaching a patient who is going on a cruise about the use of transdermal scopolamine . What information will the nurse include when teaching this patient?

a. “Apply the patch as needed for nausea and vomiting.”
b. “Apply the patch to your upper arm.”
c. “Change the patch every 3 days.”
d. “Restrict fluids while using this patch.”

Answer 139

ANS: C

c. “Change the patch every 3 days.”

The transdermal scopolamine patch is designed to last for 72 hours. The patient should be taught to change it every 3 days. It works best when worn at all times and not just for symptomatic relief. The patch should be applied behind the ear. Patients should not restrict fluids.

Question 140

13. The nurse is preparing to administer benztropine (Cogentin) to a patient who has Parkinson’s disease. When performing an assessment, which aspect of the patient’s history would cause the nurse to hold the medication and notify the provider?

a. Asthma
b. Glaucoma
c. Irritable bowel syndrome
d. Motion sickness

Answer 140

ANS: B

b. Glaucoma

Patients who have glaucoma should not take anticholinergic medications.

Question 141

14. The nurse is caring for a patient in the post-anesthesia recovery unit. The nurse notes that the patient received atropine sulfate 2 mg 30 minutes prior to anesthesia induction. The patient has received 1,000 mL of intravenous fluids and has 700 mL of urine in the urinary catheter bag. The patient reports having a dry mouth. The nurse notes a heart rate of 82 beats per minute. What action will the nurse perform?

a. Administer a fluid bolus.
b. Give the patient ice chips.
c. Palpate the patient’s bladder.
d. Reassess the patient in 15 minutes.

Answer 141

ANS: C

c. Palpate the patient’s bladder.

Atropine can cause urinary retention. The patient’s urine output is less than the fluid intake, so the nurse should palpate the bladder to assess for distension. Dry mouth is an expected side effect and does not indicate dehydration.

Question 142

15. A patient who has Parkinson’s disease will begin treatment with benztropine (Cogentin). Which symptom of Parkinson’s disease would be a contraindication for this drug?

a. Drooling
b. Muscle rigidity
c. Muscle weakness
d. Tardive dyskinesia

Answer 142

ANS: D

d. Tardive dyskinesia

Tardive dyskinesia is a contraindication for this drug.

Question 143

16. A patient who is intubated develops bradycardia because of vagal stimulation. Which medication will the nurse anticipate administering to treat this symptom?

a. Atropine sulfate (Atropine)
b. Benztropine (Cogentin)
c. Bethanechol chloride (Urecholine)
d. Metoclopramide (Reglan)

Answer 143

ANS: A

a. Atropine sulfate (Atropine)

Atropine is used to treat bradycardia caused by vagal stimulation.

Question 144

17. The nurse is preparing to administer tolterodine tartrate (Detrol LA) to a patient who has incontinence. Which symptom would be a contraindication for this drug?

a. Decreased bowel sounds
b. Drooling
c. Gastric upset
d. Pain

Answer 144

ANS: A

a. Decreased bowel sounds

A decrease in bowel sounds could signal the beginning of paralytic ileus. Detrol is contraindicated in patients with paralytic ileus.

Question 145

1. Cholinergic drugs have specific effects on the body. What are the actions of cholinergic medications? (Select all that apply.)
   a. Dilate pupils
   b. Decrease heart rate
   c. Stimulate gastric muscle
   d. Dilate blood vessels
   e. Dilate bronchioles
   f. Increase salivation
   g. Constrict pupils

Answer 145

ANS: B, C, D, F, G

b. Decrease heart rate
c. Stimulate gastric muscle
d. Dilate blood vessels
f. Increase salivation
g. Constrict pupils

Decreasing heart rate, stimulating gastric muscles, dilating blood vessels, increasing salivation, and constricting pupils are actions of the cholinergic drugs.