L2-1530-E3 Flashcards
1
Q
The nurse is performing a medication history on a patient who reports using phentermine HCl (Suprenza) 15 mg/day for the past 3 months as an appetite suppressant. The nurse will contact the patient’s provider to discuss
a. changing the medication to phentermine-topiramate (Qsymia).
b. increasing the dose to 37.5 mg/day since tolerance has likely occurred.
c. initiating a slow taper of the phentermine.
d. stopping the drug immediately since long-term use is not recommended.
A
c. initiating a slow taper of the phentermine.
The nurse should discuss a gradual taper of the medication with the provider. Patients using anorexiants should not stop taking them abruptly because depression and withdrawal symptoms may occur. Phenterminetopiramate is recommended for short-term use only. Patients should not use these medications longer than 12 weeks, so increasing the dose is not indicated.
2
Q
A patient reports having recurring headaches described as 1 to 2 headaches per day for several weeks. The nurse understands that these headaches are most likely descriptive of which type of headache?
a. Cluster headache
b. Migraine headache
c. Simple headache
d. Tension headache
A
a. Cluster headache
Cluster headaches reoccur 1 to 3 times daily in a period lasting from approximately 2 weeks to 3 months. Migraine headaches are severe and characterized by an aura prior to the headache. Tension headaches are related to stress.
3
Q
The nurse is caring for a patient who has migraine headaches. The patient reports having these headaches more frequently. Which is an appropriate recommendation for this patient?
a. “Avoid chocolate and caffeine.”
b. “Engage in strenuous exercise.”
c. “Have a glass of red wine with dinner.”
d. “Take ibuprofen prophylactically.”
A
a. “Avoid chocolate and caffeine.”
Triggering factors for migraine headache include foods such as chocolate, caffeine, and red wine. Intense physical exertion can trigger migraines. Prophylactic ibuprofen is not indicated.
4
Q
The nurse is caring for a 7-year-old child who has difficulty concentrating and completing tasks and who cannot seem to sit still. Which diagnostic test may be ordered to assist with a diagnosis of attention deficit/hyperactivity disorder (ADHD) in this child?
a. Computerized tomography (CT) of the head
b. Electrocardiogram (ECG)
c. Electroencephalogram (EEG)
d. Magnetic resonance imaging (MRI) of the brain
A
c. Electroencephalogram (EEG)
A child with ADHD may have abnormal EEG findings. CT, MRI, and ECG tests are not diagnostic for ADHD.
5
Q
A patient has been using an amphetamine drug as an anorexiant for several weeks and asks the nurse about long-term adverse effects of this type of medication. The nurse will explain to the patient that these drugs
a. can cause cardiac dysrhythmias.
b. contribute to the development of narcolepsy.
c. do not have severe effects when used properly.
d. will cause orthostatic hypotension.
A
a. can cause cardiac dysrhythmias.
Amphetamines can cause adverse effects in the central nervous, endocrine, gastrointestinal, and cardiovascular
systems even when used as directed. Cardiac dysrhythmias can occur with continued use. Amphetamines do not cause narcolepsy or hypotension.
6
Q
The nurse is teaching a child and a parent about taking methylphenidate (Ritalin) to treat attention deficit/hyperactivity
disorder (ADHD). Which statement by the parent indicates understanding of the teaching?
a. “I should give this drug to my child at bedtime.”
b. “My child should avoid products containing caffeine.”
c. “The drug should be stopped immediately if my child develops aggression.”
d. “We should monitor my child’s weight since weight gain is common.”
A
b. “My child should avoid products containing caffeine.”
Methylphenidate is a stimulant, so other stimulants such as caffeine should be avoided because a high plasma caffeine level can be fatal. The medication should be taken in the morning. Patients should be taught not to stop the drug abruptly to avoid withdrawal symptoms. Weight loss is common.
7
Q
The parent of a child who is taking amphetamine (Adderall) to treat attention deficit/hyperactivity disorder (ADHD) asks the provider to recommend an over-the-counter medication to treat a cold. What will the nurse
tell the parent?
a. “Avoid any products containing pseudoephedrine or caffeine.”
b. “Never give over-the-counter medications with Adderall.”
c. “Sudafed is a safe and effective decongestant.”
d. “Use any over-the-counter medication from the local pharmacy.”
A
a. “Avoid any products containing pseudoephedrine or caffeine.”
Adderall is a stimulant, so other stimulants, such as caffeine and pseudoephedrine, should be avoided because a high plasma caffeine level can be fatal.
8
Q
The nurse is checking an 8-year-old child who has attention deficit/hyperactivity disorder (ADHD) into a clinic for an annual well-child visit. The child takes methylphenidate HCl (Ritalin). Which assessments are especially important for this child?
a. Heart rate, respiratory rate, and oxygen saturation
b. Height, weight, and blood pressure
c. Measures of fine- and gross-motor development
d. Nausea, vomiting, and gastrointestinal upset
A
b. Height, weight, and blood pressure
Methylphenidate may cause growth suppression, so the child’s height and weight should be assessed.
Methylphenidate may also increase blood pressure, so the nurse should pay careful attention to blood
pressure.
9
Q
The parent of an adolescent who has taken methylphenidate 20 mg/day for 6 months for attention deficit/hyperactivity disorder (ADHD) brings the child to clinic for evaluation of a recent onset of nausea, vomiting, and headaches. The parent expresses concern that the child seems less focused and more hyperactive than before. What will the nurse do next?
a. Ask the child whether the drug is being taken as prescribed.
b. Contact the provider to discuss increasing the dose to 30 mg/day.
c. Recommend taking the drug with meals to reduce gastrointestinal side effects.
d. Report signs of drug toxicity to the patient’s provider.
A
a. Ask the child whether the drug is being taken as prescribed.
Nausea, vomiting, and headaches can occur with drug withdrawal, along with a recurrence of symptoms. The nurse should ask the child about drug compliance. Methylphenidate should be taken 30 to 45 minutes before meals, not with meals.
10
Q
The nurse is teaching a parent about methylphenidate (Ritalin) to treat attention deficit/hyperactivity disorder (ADHD). Which statement by the parent indicates understanding of the teaching?
a. “I should consult a pharmacist when giving my child OTC medications.”
b. “I will only give my child diet soft drinks while administering this medication.”
c. “Medication therapy means that behavioral therapy will not be necessary.”
d. “Weight gain is a common side effect of this medication.”
A
a. “I should consult a pharmacist when giving my child OTC medications.”
Since many OTC medications contain stimulants, parents should consult a pharmacist or the provider before giving them with methylphenidate. Diet soft drinks often contain caffeine, a stimulant, and should be avoided with methylphenidate use. Behavioral therapy should still be an essential part of the treatment for ADHD.
Weight loss is common.
11
Q
The parent of an obese 10-year-old child asks the nurse about medications to aid in weight loss. Which response
by the nurse is correct?
a. “Anorexiants are often used to ‘jump start’ a weight loss regimen in children.”
b. “Children are able to use over-the-counter anorexiants on a long-term basis.”
c. “Children under 12 years of age should not use weight loss drugs.”
d. “Side effects of anorexiants occur less often in children.”
A
c. “Children under 12 years of age should not use weight loss drugs.”
Anorexiants should not be given to children under age 12 years.
12
Q
The nurse is working in a neonatal intensive care unit and is caring for an infant who is experiencing multiple periods of apnea and bradycardia. Which drug will the nurse expect to administer?
a. Albuterol (Proventil)
b. Caffeine (Cafcit)
c. Doxapram (Dopram)
d. Methylphenidate (Ritalin)
A
b. Caffeine (Cafcit)
Caffeine is given to newborns that are experiencing apnea spells. The other drugs are not used for this purpose.
13
Q
A college-age student is brought to the emergency department by friends after consuming NoDoz tablets
along with several cups of coffee and a few energy drinks. The patient is complaining of nausea and diarrhea and appears restless. The nurse understands that
a. arrhythmias and convulsions may occur.
b. caffeine dependence does not occur.
c. effects of the substances will wear off shortly.
d. severe adverse effects do not occur.
A
a. arrhythmias and convulsions may occur.
Caffeine and other stimulants can cause cardiac arrhythmias and seizures. Caffeine dependence may occur.
14
Q
A patient is brought to the emergency department with a drug overdose causing respiratory depression. Which drug will the nurse expect to administer?
a. Albuterol (Proventil)
b. Caffeine (Cafcit)
c. Doxapram (Dopram)
d. Methylphenidate (Ritalin)
A
c. Doxapram (Dopram)
Doxapram is given to treat respiratory depression caused by drug overdose.
15
Q
A patient reports difficulty staying awake during the daytime in spite of getting adequate sleep every night.
Which medication will the nurse expect the provider to order for this patient?
a. Caffeine (NoDoz)
b. Methylphenidate (Ritalin)
c. Modafinil (Provigil)
d. Theophylline
A
c. Modafinil (Provigil)
Modafinil is given to treat narcolepsy.
16
Q
A patient describes having vivid dreams to the nurse. The nurse understands that these occur during which
stage of sleep?
a. Rapid eye movement (REM) sleep
b. Stage 2 nonrapid eye movement sleep
c. Stage 3 nonrapid eye movement sleep
d. Stage 4 nonrapid eye movement sleep
A
a. Rapid eye movement (REM) sleep
Vivid dreams occur during REM sleep.
17
Q
Children who experience nightmares have these during which stage of sleep?
a. Early morning sleep
b. Nonrapid eye movement sleep
c. Rapid eye movement sleep
d. Sleep induction
A
b. Nonrapid eye movement sleep
Nightmares that occur in children take place during NREM sleep.
18
Q
A patient reports difficulty falling asleep most nights and is constantly fatigued. The patient does not want to
take medications to help with sleep. What non pharmacologic measure will the nurse recommend?
a. “Exercise in the evening to promote bedtime fatigue.”
b. “Get out of bed at the same time each morning.”
c. “Have a glass of wine at bedtime to help you relax.”
d. “Take daytime naps to minimize daytime fatigue.”
A
b. “Get out of bed at the same time each morning.”
To promote sleep, patients should be advised to arise at the same time each morning to establish a routine. Patients should avoid strenuous exercise before bedtime. Patients should not consume alcohol 6 hours before bedtime. Patients should not take daytime naps.
19
Q
The nurse is caring for a patient who reports being able to fall asleep but has difficulty staying asleep. The
nurse will contact the provider to obtain an order for which medication?
a. Butabarbital (Butisol)
b. Flurazepam (Dalmane)
c. Secobarbital (Seconal)
d. Temazepam (Restoril)
A
a. Butabarbital (Butisol)
Butabarbital is an intermediate-acting barbiturate and is useful as a sleep sustainer to maintain long periods of sleep. They have an onset of 1 hour, so are not useful for those who have trouble falling asleep. Flurazepam and temazepam are benzodiazepines and are used to induce sleep. Secobarbital is used for preoperative sedation.
20
Q
The nurse is teaching a patient who will begin taking butabarbital (Butisol). What information will the nurse
include when teaching this patient?
a. “Avoid alcohol while taking this drug.”
b. “This drug may be used long-term.”
c. “This medication will take effect immediately.”
d. “You will not experience a hangover effect.”
A
a. “Avoid alcohol while taking this drug.”
Patients who are taking barbiturates should avoid alcohol. Barbiturates are for short-term use. Butabarbital
has a sleep onset time of 1 hour, so it will not help patients fall asleep. Patients who take barbiturates frequently experience a hangover effect.
21
Q
The nurse is caring for a young adult patient who is receiving a first dose of flurazepam (Dalmane) as a sedative- hypnotic medication. What intervention will be included in the nurse’s plan of care for this patient?
a. Instituting a bed alarm system to prevent falls
b. Reassuring the patient that nightmares are not a usual effect
c. Reporting a urine output greater than 1500 mL/day
d. Teaching the patient that this drug may be used for 6 to 8 weeks
A
a. Instituting a bed alarm system to prevent falls
The nurse should use a bed alarm for older patients and younger patients receiving a hypnotic for the first
time. Patients may experience vivid dreams and nightmares. Urine output should be greater than 1500 mL/day, so this does not warrant reporting. This drug should be used short-term.
22
Q
An older adult has difficulty falling asleep. The nurse understands that which sedative hypnotic is appropriate for this patient?
a. Butabarbital (Butisol)
b. Flurazepam (Dalmane)
c. Secobarbital (Seconal)
d. Temazepam (Restoril)
A
d. Temazepam (Restoril)
Short- to intermediate-acting benzodiazepines such as temazepam are recommended for older adults and are considered safer than barbiturates.
23
Q
A patient asks the nurse about taking over-the-counter sleeping aids. The nurse will tell the patient that the
active ingredient in these products is often a(n)
a. antiemetic.
b. antihistamine.
c. barbiturate.
d. benzodiazepine.
A
b. antihistamine.
The primary ingredient in OTC sleep aids is an antihistamine such as diphenhydramine, not barbiturates or benzodiazepines.
24
Q
An older adult patient reports frequent nighttime awakening because of arthritis pain and asks the nurse about taking an over-the-counter product to help with this problem. The nurse will recommend that the patient discuss which medication with the provider?
a. Ibuprofen (Motrin)
b. Nytol
c. Sominex
d. Tylenol PM
A
d. Tylenol PM
The main sleep problem experienced by older adults is frequent nighttime awakening. To alleviate pain and aid sleep, the OTC drug Tylenol PM, which contains diphenhydramine and acetaminophen may be taken. Ibuprofen occasionally helps if it can alleviate the discomfort that hinders sleep.
25
A patient who has been taking butabarbital (Butisol) for several weeks reports being drowsy and having difficulty performing tasks at work most mornings. The nurse suspects that which drug effects have occurred?
a. Dependence
b. Hangover
c. Tolerance
d. Withdrawal
b. Hangover
Intermediate-acting hypnotics, such as butabarbital, are useful for sustaining sleep, but patients often experience
residual drowsiness in the morning, or hangover. Drug dependence occurs when patients develop a need
for the drug. Tolerance refers to a reduced drug effect requiring larger amounts of drug to get the desired effect. Withdrawal occurs when stopping the drug causes symptoms that can only be alleviated by taking the drug.
26
The nurse is providing teaching for a patient who will begin taking zolpidem tartrate (Ambien) 10 mg at bedtime as a sleep aid. Which statement by the patient indicates understanding of the teaching?
a. “I should take this medication with food to avoid stomach upset.”
b. “I will take this medication within 30 minutes of bedtime.”
c. “If this medication is not effective, I may increase the dose to 15 mg.”
d. “Tolerance and drug dependence do not occur with this medication.”
b. “I will take this medication within 30 minutes of bedtime.”
Zolpidem is a nonbenzodiazepine sleep aid. It should be taken 30 minutes before desired sleep. Food decreases the absorption, so it should be taken on an empty stomach. The maximum dose is 10 mg. Tolerance and dependence may occur.
27
A patient who has been taking a benzodiazepine as a sleep aid for several months wishes to stop taking the medication. The nurse will suggest that the patient taper the dose gradually to avoid which effect?
a. Depression
b. Hangover
c. Hypnotic rebound
d. Withdrawal
d. Withdrawal
Benzodiazepines cause tolerance which means that abrupt cessation can result in withdrawal symptoms such
as tremors and muscle twitching. A hangover is residual drowsiness that occurs the day after taking a hypnotic.
28
The nurse is preparing a patient for surgery. The patient received a hypnotic medication the night prior and the nurse is administering midazolam (Versed) and atropine. The patient asks why all of these medications are necessary. The nurse will tell the patient that they are given for which reason?
a. To decrease the amount of general anesthesia needed
b. To minimize post-operative drowsiness
c. To prolong the anesthetized state
d. To speed up anesthesia induction
a. To decrease the amount of general anesthesia needed
Balanced anesthesia includes giving a hypnotic the night prior to surgery, premedication with an opioid analgesic
or benzodiazepine plus an anticholinergic, and then a short-acting barbiturate, an inhaled gas, and a muscle relaxant. One effect of this is to decrease the amount of general anesthetic needed. It may reduce postoperative
nausea and vomiting, but does not decrease drowsiness. It does not affect the duration of anesthesia, which is dependent on the length of time the inhaled gas is given, or the rate of induction.
29
During balanced anesthesia, which type of medication is given while the surgery is performed?
a. Anticholinergics
b. Benzodiazepines
c. Hypnotics
d. Inhaled anesthetic
d. Inhaled anesthetic
An inhaled anesthetic is given to induce anesthesia and is maintained throughout the surgical procedure. The
other medications are given prior to anesthesia induction.
30
The nurse performs a preoperative assessment on a patient and asks about alcohol use. The patient asks
why this information is important. The nurse will explain that patients who consume increased amounts of alcohol
a. may have a prolonged postoperative recovery time.
b. may not be eligible for surgery.
c. may not receive inhaled gases for anesthesia.
d. may require changes in anesthesia drug doses.
d. may require changes in anesthesia drug doses.
The type and amount of anesthetics may need to be adjusted if patients consume large amounts of alcohol as
well as for those who smoke, who are pregnant, or who are obese. These questions are asked prior to surgery so providers can plan for this.
31
The nurse is caring for a patient in the post-anesthesia care unit and notes that the patient received isoflurane (Forane) to induce anesthesia. When will the nurse expect the patient to recover consciousness?
a. Immediately
b. In 15 to 30 minutes
c. In 1 hour
d. In hours
c. In 1 hour
Upon discontinuation of isoflurane, recovery of consciousness usually occurs in 1 hour.
32
The nurse is caring for a patient in the post-anesthesia care unit who has received a spinal anesthetic. Which action will the nurse perform?
a. Ambulate the patient as soon as consciousness returns.
b. Elevate the head of the bed to a semi-Fowler’s position.
c. Have the patient lay flat for 6 to 8 hours after the surgery.
d. Turn the patient from side to side every 15 minutes.
c. Have the patient lay flat for 6 to 8 hours after the surgery.
Patients who have had spinal anesthesia should remain flat for 6 to 8 hours to decrease the likelihood of losing
spinal fluid, causing a headache.
33
A patient is diagnosed with epilepsy and asks the nurse what may have caused this condition. The nurse explains
that epilepsy is most often
a. caused by head trauma.
b. idiopathic in origin.
c. linked to a stroke.
d. related to brain anoxia.
b. idiopathic in origin.
Of all seizure cases, 75% are primary, or idiopathic, with no known cause. The remaining are secondary and may be related to head trauma, stroke, or anoxic events.
34
A patient who has epilepsy will begin an anticonvulsant medication. The patient asks the nurse how long the
medication will be necessary. How will the nurse respond?
a. “The medication is usually taken for a lifetime.”
b. “The medication will be given until you are seizure-free.”
c. “You will need to take the medication for 3 to 5 years.”
d. “You will take the medication as needed for seizure activity.”
a. “The medication is usually taken for a lifetime.”
Anticonvulsants are given to prevent seizures and are usually taken throughout the patient’s lifetime. Stopping
the medication will lead to recurrence of seizures in most patients. Some patients may attempt to stop taking
the medications after 3 to 5 years of no seizure activity. Anticonvulsants are not given as needed.
35
The nurse is providing teaching to the parents of a 5-year-old child who will begin taking phenytoin (Dilantin). What information will the nurse include when teaching these parents about their child’s medication?
a. “Drug interactions are uncommon with phenytoin.”
b. “There are very few side effects associated with this drug.”
c. “The therapeutic range of phenytoin is between 15 and 30 mcg/mL.”
d. “Your child may need a higher dose than expected.”
d. “Your child may need a higher dose than expected.”
Drug dosage for phenytoin is age-related and children, who have a rapid metabolism, may need higher doses than those used for newborns and adults. Phenytoin has many drug interactions and many side effects. The therapeutic range is 10-20 mcg/mL.
36
The nurse is caring for a patient who has a seizure disorder. The nurse notes that the patient has reddened gums that bleed when oral care is given. The nurse recognizes this finding as
a. an adverse effect of the phenytoin.
b. a drug interaction with aspirin.
c. a symptom of hepatotoxicity.
d. a sign of poor self-care.
a. an adverse effect of the phenytoin.
Hydantoins commonly cause gingival hyperplasia, which causes overgrowth of reddened gum tissue that
bleeds easily. It is not a sign of a drug interaction or a symptom of hepatotoxicity. It does not indicate a lack of
self-care.
37
The nurse is preparing to administer phenytoin (Dilantin) to a patient who has a seizure disorder. The patient appears drowsy, and the nurse notes that the last random serum drug level was 18 mcg/mL. What action will the nurse take?
a. Administer the dose since the patient is not toxic.
b. Contact the provider to discuss decreasing the phenytoin dose.
c. Give the drug and monitor closely for adverse effects.
d. Report drug toxicity to the providers.
a. Administer the dose since the patient is not toxic.
Drowsiness is a common side effect of phenytoin and is not cause for alarm. The patient’s drug level is normal, since 10-20 mcg/mL is the therapeutic range. The nurse should administer the dose. It is not necessary to decrease the dose or monitor the patient more closely than usual.
38
The nurse is preparing to administer phenytoin to an 80-year-old patient and notes the following order: IVP
phenytoin 50 mg. The nurse will perform which action?
a. Administer the undiluted drug through a Y-tube over two minutes.
b. Contact the provider to question the route and the dose.
c. Dilute the drug in dextrose solution and infuse over 15 to 20 minutes.
d. Request an order to administer the drug intramuscularly.
a. Administer the undiluted drug through a Y-tube over two minutes.
Intravenous phenytoin should be administered undiluted through a 3-way stopcock or Y-tubing. In older patients
it should be infused at a rate of 25 mcg/min. The dose and the route are appropriate. Phenytoin will precipitate
in dextrose solution. Intramuscular injection is very irritating to tissues and is not used.
39
The nurse is preparing to assist with blood collection on a newly admitted patient who has been taking phenytoin for several years. The provider has ordered a complete blood count and liver function tests. Which other blood test will the nurse discuss with the provider?
a. Blood glucose
b. Coagulation studies
c. Renal function tests
d. Serum electrolytes
a. Patients who have taken hydantoins for long periods might have an elevated blood sugar. The nurse should
discuss this test with the provider.
40
A patient who takes phenytoin reports regular alcohol consumption. The nurse might expect a serum phenytoin
level in this patient to be in which range?
a. 5 to 10 mcg/mL
b. 10 to 20 mcg/mL
c. 20 to 30 mcg/mL
d. 30 to 50 mcg/mL
a. 5 to 10 mcg/mL
Chronic ingestion of alcohol increases hydantoin metabolism, which would decrease serum drug levels. The therapeutic range is 10 to 20 mcg/mL, so a level lower than this may be expected in patients who consume alcohol
regularly.
41
A patient has recently begun taking phenytoin (Dilantin) for a seizure disorder. The nurse notes a reddishbrown
color to the patient’s urine. Which action will the nurse take?
a. Ask the provider to order a serum drug level.
b. Reassure the patient that this is a harmless side effect.
c. Report possible thrombocytopenia to the provider.
d. Request an order for a urinalysis and creatinine clearance.
b. Reassure the patient that this is a harmless side effect.
Reddish-brown urine is a harmless side effect of phenytoin. The nurse should reassure the patient. It is not
necessary to order a serum drug level or renal function studies. It is not a symptom of thrombocytopenia.
42
A female patient who takes phenytoin for epilepsy becomes pregnant. The nurse will notify the patient’s
provider and will anticipate that the provider will take which action?
a. Add valproic acid (Depakote) for improved seizure control.
b. Change the medication to phenobarbital (Luminal).
c. Closely monitor this patient’s serum phenytoin levels.
d. Discontinue all anticonvulsant medications.
b. Change the medication to phenobarbital (Luminal).
Phenytoin has serious teratogenic effects, so women who are pregnant should not take it. Phenobarbital is typically used because possible teratogenic effects are less pronounced. Teratogenicity increases with multiple anticonvulsants.
43
The nurse is caring for a patient who has been diagnosed with petit mal seizures. The nurse will anticipate teaching this patient about which antiepileptic medication?
a. Carbamazepine (Tegretol)
b. Ethosuximide (Zarontin)
c. Phenobarbital (Luminal)
d. Phenytoin (Dilantin)
b. Ethosuximide (Zarontin)
Ethosuximide is used to treat petit mal seizures. The other drugs are not used to treat petit mal seizures.
44
An intubated child is brought to the emergency department while having a seizure that has been progressing for 20 minutes. Which drug will the nurse anticipate administering to this patient?
a. Diazepam (Valium)
b. Phenobarbital (Luminal)
c. Phenytoin (Dilantin)
d. Valproic acid (Depakote)
a. Diazepam (Valium)
Diazepam is given to patients in status epilepticus and is administered IV. The other anticonvulsant medications
do not have a rapid onset and are not used for emergencies.
45
A patient will begin taking the antiepileptic drug ethosuximide (Zarontin) and asks the nurse whether to take the drug with or without food. The nurse will counsel the patient to take this medication
a. at bedtime.
b. 1 hour before meals.
c. 2 hours after meals.
d. with meals.
d. with meals.
Gastric irritation is common with ethosuximide, so patients should be counseled to take it with food. It is given twice daily.
46
A patient has recently begun taking carbamazepine (Tegretol) as an adjunct medication to treat refractory seizures. The patient has a serum carbamazepine level of 18 mcg/mL. What action will the nurse take?
a. Ask the patient about usual dietary preferences.
b. Reassure the patient that this is a therapeutic drug level.
c. Report a subtherapeutic drug dose to the provider.
d. Suspect a drug-drug interaction.
a. Ask the patient about usual dietary preferences.
This patient’s carbamazepine level is high. When taken with grapefruit juice, an interaction may occur that causes toxicity. The nurse should question the patient about food and fluid preferences. The therapeutic level is 5 to 12 mcg/mL. This is a toxic level, not subtherapeutic.
47
The nurse is performing a health history on a patient who is ordered to begin therapy with valproic acid (Depakote) to treat epilepsy. Which aspect of the patient’s medical history will cause the nurse to be concerned?
a. Chronic obstructive pulmonary disease
b. Gastrointestinal disease
c. Liver disease
d. Renal disease
c. Liver disease
Valproic acid can elevate liver enzymes. Patients with a history of liver disease should be monitored closely
while taking this drug.
48
A woman who is pregnant is taking an anticonvulsant medication to treat a seizure disorder. The nurse will
ensure that the patient takes which dietary supplement toward the end of her pregnancy?
a. Folate (folic acid)
b. Iron
c. Vitamin C
d. Vitamin K
d. Vitamin K
Anticonvulsants act as inhibitors of vitamin K and can contribute to hemorrhage in infants shortly after birth.
Women taking these drugs should receive vitamin K within the last week to 10 days of their pregnancies.
49
A parent expresses concern that a 5-year-old child may develop epilepsy because the child experienced a febrile seizure at age 18 months. What will the nurse tell this parent?
a. “A child who has had a febrile seizure is considered to have epilepsy.”
b. “A small percentage of children who have febrile seizures develop epilepsy.”
c. “I recommend discussing prophylactic anticonvulsant drugs with the provider.”
d. “Treat fevers aggressively with aspirin and NSAIDs to prevent seizures.”
b. “A small percentage of children who have febrile seizures develop epilepsy.”
Epilepsy develops in 2.5% of children who have one or more febrile seizures. One febrile seizure does not
cause a diagnosis of epilepsy. Prophylactic anticonvulsants are given to high-risk patients. Children should not receive aspirin for fever because of the risk of Reye’s syndrome.
50
A 25 year-old female patient will begin taking phenytoin for epilepsy. The patient tells the nurse she is taking oral contraceptives (OCPs). Which response will the nurse give?
a. “Continue taking OCPs because phenytoin is not safe during pregnancy.”
b. “You should use a backup method of contraception along with OCPs.”
c. “You should stop taking OCPs because of drug-drug interactions with phenytoin.”
d. “You should take low-dose aspirin while taking these medications to reduce your risk of stroke.”
b. “You should use a backup method of contraception along with OCPs.”
Female patients who take oral contraceptives and anticonvulsants should be advised to use a backup method of contraception because of reduced effectiveness of OCPs. Patients should be cautioned to consult with a provider if considering pregnancy because of the teratogenic effects of anticonvulsants. Patients should not stop taking OCPs and do not need to take precautions against stroke.
51
The nurse provides teaching for a patient who will begin taking phenytoin. Which statement by the patient indicates understanding of the teaching?
a. “If I develop a rash, I should take diphenhydramine to control the itching.”
b. “If I experience bleeding gums, I should stop taking the medication immediately.”
c. “I may develop diabetes while I am taking this medication.”
d. “I should not be alarmed if my urine turns reddish-brown.”
d. “I should not be alarmed if my urine turns reddish-brown.”
Phenytoin will cause reddish-brown colored urine. Patients should be counseled to report a rash to the provider because it could be a serious adverse reaction. Bleeding gums are common, but patients should never
stop taking anticonvulsants abruptly, or they may develop seizures. Changes in blood glucose may occur but
do not necessarily result in diabetes.
52
A parent of a child who has been taking valproic acid (Depakote) for several years calls the clinic to report a
recent recurrence of seizures and states that the child is having 3 or 4 seizures per week. The nurse will perform
which action?
a. Ask the parent about to describe the child’s drug regimen.
b. Request an order for a serum valproic acid level.
c. Suggest that the parent take the child to the emergency department.
d. Tell the parent that the provider will increase the child’s dose of Depakote.
a. Ask the parent about to describe the child’s drug regimen.
Questions pertaining to medication adherence are a no-cost, non-invasive way of troubleshooting cause of decreased drug effect. The serum drug level will be assessed next. Children may need changes in doses as they
grow. The child is not in status epilepticus so does not need to go to the emergency department. The dose will
not be increased until the serum drug level is known.
53
A pregnant woman who is in labor has a blood pressure of 189/110 mm Hg and exhibits muscle contractions followed by jerking of her arms and legs. The nurse will prepare to administer which medication to this patient?
a. Carbamazepine (Tegretol)
b. Diazepam (Valium)
c. Magnesium sulfate
d. Phenobarbital (Luminal)
c. Magnesium sulfate
Magnesium sulfate is used to control seizures during eclampsia.
54
An older patient exhibits a shuffling gait, lack of facial expression, and tremors at rest. The nurse will expect
the provider to order which medication for this patient?
a. Carbidopa-levodopa (Sinemet)
b. Donepezil (Aricept)
c. Rivastigmine (Exelon)
d. Tacrine (Cognex)
a. Carbidopa-levodopa (Sinemet)
This patient is exhibiting signs of Parkinson’s disease and should be treated with carbidopa-levodopa. The other drugs are used to treat Alzheimer’s disease.
55
A nursing student asks the nurse to differentiate the pathology of Alzheimer’s disease from that of Parkinson’s
disease. Which description is correct?
a. Alzheimer’s disease involves a possible excess of acetylcholine and neuritic plaques.
b. Alzheimer’s disease is caused by decreased amounts of dopamine and degeneration of cholinergic neurons.
c. Parkinson’s disease is characterized by an imbalance of dopamine and acetylcholine.
d. Parkinson’s disease involves increased dopamine production and decreased acetylcholine.
c. Parkinson’s disease is characterized by an imbalance of dopamine and acetylcholine.
Parkinson’s disease (PD) is characterized by an imbalance of dopamine (DA) and acetylcholine (ACh) caused by
an unexplained degeneration of the dopaminergic neurons allowing the excitatory response of acetylcholine to
exceed the inhibitory response of dopamine. Alzheimer’s disease (AD) may result from decreased ACh, degeneration of cholinergic neurons, and neuritic plaques. Dopamine does not appear to play a role in Alzheimer’s
disease.
56
The spouse of a patient newly diagnosed with mild, unilateral symptoms of Parkinson’s disease (PD) asks the
nurse what, besides medication, can be done to manage the disease. The nurse will
a. counsel the spouse that parkinsonism is a normal part of the aging process in some people.
b. recommend exercise, nutritional counseling, and group support to help manage the disease.
c. tell the spouse that the disease will not progress if mild symptoms are treated early.
d. tell the spouse that medication therapy can be curative if drugs are begun in time.
b. recommend exercise, nutritional counseling, and group support to help manage the disease.
PD is a progressive disorder. Nonpharmacologic measures can lessen symptoms and help patients and families
cope with the disorder. Although the aging process may contribute to the development of PD, it is not necessarily a normal part of aging. Treatment may slow the progression but does not arrest or cure the disease.
57
A patient who has Parkinson’s disease is being treated with the anticholinergic medication benztropine (Cogentin).
The nurse will tell the patient that this drug will have which effect?
a. Helping the patient to walk faster
b. Improving mental function
c. Minimizing symptoms of bradykinesia
d. Reducing some of the tremors
d. Reducing some of the tremors
Benztropine is given to reduce rigidity and some of the tremors. It does not enhance walking or reduce
bradykinesia or improve mental function.
58
The nurse is preparing to administer a first dose of benztropine (Cogentin) to a patient diagnosed with
parkinsonism. The nurse would notify the patient’s provider if the patient had a history of which condition?
a. Asthma
b. Glaucoma
c. Hypertension
d. Irritable bowel disease
b. Glaucoma
Patients with a history of glaucoma should not take anticholinergic medications. Anticholinergics are not contraindicated in patients who have asthma, hypertension, or irritable bowel disease.
59
The nurse is caring for a patient who is receiving trihexyphenidyl (Artane) to treat parkinsonism. The patient reports having a dry mouth, and the nurse notes a urine output of 300 mL in the past 8 hours. Which action will the nurse perform?
a. Encourage increased oral fluids.
b. Obtain an order for intravenous fluids.
c. Report the urine output to the provider.
d. Request an order for renal function tests.
c. Report the urine output to the provider.
Urinary retention can occur with anticholinergic medications. Dry mouth is a harmless side effect. The nurse should report the lower than expected urine output to the provider. Increasing fluid intake will not increase
urine output in the patient with urinary retention. Renal function tests are not indicated since this is a neuromuscular
problem of the bladder caused by the medication.
60
A nursing student asks the nurse why patients who have parkinsonism receive a combination of carbidopa
and levodopa. The nurse will explain that the combination product
a. allows larger doses of levodopa to be given without causing increased adverse reactions.
b. causes more levodopa to be converted to dopamine before crossing the blood-brain barrier.
c. eliminates almost all drug side effects of both levodopa and carbidopa.
d. reduces peripheral side effects by inhibiting decarboxylase in the peripheral nervous system.
d. reduces peripheral side effects by inhibiting decarboxylase in the peripheral nervous system.
Without carbidopa, about 99% of levodopa is converted to dopamine before crossing the blood-brain barrier, causing peripheral adverse effects. When carbidopa is added, the enzyme decarboxylase is inhibited, allowing levodopa to cross into the brain before being converted to the active metabolite dopamine. The result is less levodopa required to achieve the desired effect. The drug still has many side effects, but the peripheral effects are lessened.
61
Which antiviral medication improves symptoms of Parkinson’s disease in some patients?
a. Acyclovir (Zovirax)
b. Amantadine HCl (Symmetrel)
c. Interferon (INF)
d. Zanamivir (Relenza)
b. Amantadine HCl (Symmetrel)
Amantadine is an antiviral drug that acts on dopamine receptors and is sometimes used to treat Parkinson’s
disease (PD). The other drugs listed do not work for PD patients.
62
A patient who has parkinsonism has been taking carbidopa-levodopa and has shown improvement in symptoms but develops dystonic movements, nausea, and vomiting. Which medication will the nurse expect the
provider to order for this patient to replace carbidopa-levodopa?
a. Amantadine HCl (Symmetrel)
b. Benztropine (Cogentin)
c. Bromocriptine mesylate (Parlodel)
d. Tacrine (Cognex)
c. Bromocriptine mesylate (Parlodel)
Bromocriptine is often used for patients who do not tolerate carbidopa-levodopa. Amantadine is useful for
treating Parkinson’s disease but does not have sustained effects. Benztropine is given to reduce muscle rigidity
and some tremors. Tacrine is used to treat Alzheimer’s disease.
63
A patient who has parkinsonism will begin taking selegiline HCl (Eldepryl) to treat symptoms. What information
will the nurse include when teaching this patient about this drug?
a. “Avoid consuming foods that are high in tyramine.”
b. “This drug will prevent the need to take levodopa.”
c. “You may have red wine with dinner on occasion.”
d. “You will not have serious drug interactions with this drug.”
a. “Avoid consuming foods that are high in tyramine.”
Selegiline (Eldepryl) inhibits monoamine oxidase-B, and it has similar adverse reactions to other monoamine oxidase inhibitors. Patients should be cautioned against consuming foods containing tyramine because of the risk of hypertensive crisis. Red wine is high in tyramine. Use of this drug may delay, but will not prevent, the need for levodopa. Severe adverse drug interactions may occur between this drug and tricyclic antidepressants.
64
A patient who has parkinsonism will begin taking carbidopa-levodopa. What information will the nurse include when teaching this patient about this medication?
a. “Call your health care provider immediately if your urine or perspiration turn a dark color.”
b. “Rise slowly from your bed or your chair to avoid dizziness and falls.”
c. “Take the drug with foods high in protein to improve drug delivery.”
d. “Discontinue the drug if you experience insomnia.”
b. “Rise slowly from your bed or your chair to avoid dizziness and falls.”
Carbidopa-levodopa can cause orthostatic hypotension, so patients should be taught to take care when getting
out of bed or a chair. Darkening of the urine and perspiration is a harmless side effect. Patients should take the drug with low-protein foods to improve drug transport to the CNS. Carbidopa-levodopa should not be discontinued
abruptly because rebound parkinsonism may occur; insomnia is an expected adverse effect of the drug,
and the patient should report this effect to his or her health care provider.
65
The nurse is teaching a patient who has Parkinson’s disease about the side effects of carbidopa-levodopa.
Which statement by the patient indicates a need for further teaching?
a. “I may experience urinary retention, dry mouth, and constipation.”
b. “I may feel dizzy at first, but this side effect will go away with time.”
c. “I should report nightmares and mental disturbances to my provider.”
d. “I should take the drug with food to increase absorption.”
d. “I should take the drug with food to increase absorption.”
Taking carbidopa-levodopa with food decreases absorption of the drug, although gastrointestinal distress may decrease when the medication is taken with food. Cholinergic side effects are common. Orthostatic hypotension occurs early and will resolve over time. Nightmares and mental disturbances should be reported.
66
A patient is taking entacapone (Comtan) along with carbidopa-levodopa to treat parkinsonism. The nurse notes that the patient’s urine is orange in color. The nurse will
a. notify the provider of possible drug toxicity.
b. reassure the patent that this is a harmless side effect.
c. request an order for liver function tests.
d. request an order for a urinalysis.
b. reassure the patent that this is a harmless side effect.
Entacapone can cause the urine to be dark yellow to orange. It does not indicate drug toxicity, liver effects, or
changes in renal function.
67
The nurse is caring for an 80-year-old patient who has Alzheimer’s disease who will begin taking rivastigmine
(Exelon). What will the nurse include in the plan of care for this patient?
a. Administer the drug once daily.
b. Assist the patient to stand and walk.
c. Give the drug with food to increase absorption.
d. Use nonsteroidal anti-inflammatory drugs (NSAIDs) instead of acetaminophen for pain.
b. Assist the patient to stand and walk.
Patients taking rivastigmine for Alzheimer’s disease are at risk for falls and loss of balance. Caregivers should
assist with standing and walking. The drug is taken twice daily, and it should be taken on an empty stomach.
NSAIDs increase gastrointestinal side effects.
68
The nurse is providing teaching for the family of a patient who has been newly diagnosed with Alzheimer’s disease (AD). Which statement by the family member indicates understanding of the teaching?
a. “Alzheimer’s disease is a chronic, progressive condition.”
b. “Alzheimer’s disease affects memory but not personality.”
c. “The onset of Alzheimer’s disease is usually between 65 and 75 years.”
d. “With proper treatment, symptoms of this disease can be arrested.”
a. “Alzheimer’s disease is a chronic, progressive condition.”
AD is chronic and progressive, and there is no cure. It affects memory and personality. The onset is usually between
45 and 65 years. Symptoms cannot be arrested but may be slowed with treatment.
69
The nurse is teaching a family member about an elderly parent’s new prescription for tacrine (Cognex) to treat Alzheimer’s disease (AD). The family member asks what to expect from this drug. The nurse will respond that the patient will
a. demonstrate improved ambulation.
b. have reversal of all symptoms.
c. have decreased deterioration of cognition.
d. show improved communication ability.
c. have decreased deterioration of cognition.
Tacrine can help to increase cognitive function for patients with mild to moderate AD. For the most part, drugs to treat AD do not result in improvement of symptoms but help slow the progress.
70
The nurse is helping to develop a plan of care for a patient who has advanced Alzheimer’s disease. The patient
will be taking a new medication. Which is a realistic goal for this patient?
a. Demonstrate improved cognitive function.
b. Exhibit improved ability to provide self-care.
c. Receive appropriate assistance for care needs.
d. Show improved memory for recent events.
c. Receive appropriate assistance for care needs.
For the most part, drugs to treat AD do not result in improvement of symptoms but help slow the progress.
The most realistic care plan for a patient with advanced AD is that they will receive appropriate and safe care.
71
The nurse is caring for a patient who has begun taking chlorpromazine HCl (Thorazine) 75 mg BID to treat schizophrenia. A family member tells the nurse that the patient’s agitation, hallucinations, and delusional symptoms have improved, but the patient continues to withdraw from social interaction and won’t bathe unless reminded to do so. The nurse will tell the family member that
a. all symptoms will eventually resolve over time with this medication.
b. the patient may need an increased dose of the antipsychotic medication.
c. these results may indicate that the patient does not have schizophrenia.
d. they should consider discussing adding another medication.
d. they should consider discussing adding another medication.
```
Chlorpromazine is a typical antipsychotic medication; drugs in this class manage positive symptoms rather
than the negative symptoms of withdrawal and poor self-care. It is not likely that the negative symptoms will improve over time with this medication. Increasing the dose will not improve control of negative symptoms. This patient exhibits signs of schizophrenia.
```
72
The nurse is assessing a young adult patient with schizophrenia who recently began taking fluphenazine (Prolixin). The patient is exhibiting spasms of facial muscles along with grimacing, and the nurse notes upward eye movements. The nurse suspects which side effect?
a. Acute dystonia
b. Akathisia
c. Pseudoparkinsonism
d. Tardive dyskinesia
a. Acute dystonia
Acute dystonia can occur within days of taking typical antipsychotics, and facial muscle spasms, grimacing, and upward eye movements are characteristic of this side effect. Akathisia is characterized by restlessness, pacing, and difficulty standing still. Pseudoparkinsonism is characterized by stooped posture, pill-rolling, shuffling gait, and tremors at rest. Tardive dyskinesia manifests as protrusion and rolling of the tongue, smacking of the lips,
and involuntary movement of the body and extremities.
73
The nurse is preparing to administer loxapine (Loxitane) 50 mg to a patient who has schizophrenia. The patient
has been taking this medication twice daily for 15 months. The nurse notes smacking lip movements and involuntary movements of all extremities. Which action by the nurse is correct?
a. Administer the medication as ordered to treat these symptoms of psychosis.
b. Hold the dose and notify the provider of these medication adverse effects.
c. Request an order for an anticholinergic medication such as benztropine (Cogentin).
d. Suggest that the provider increase the dose to 125 mg twice daily.
b. Hold the dose and notify the provider of these medication adverse effects.
Tardive dyskinesia manifests as protrusion and rolling of the tongue, smacking of the lips, and involuntary movement of the body and extremities and is a serious adverse effect of antipsychotic medications. The
provider should be notified, so the drug can be stopped and a different medication ordered. These are not symptoms of psychosis. Anticholinergic medications are used to combat acute dystonia. Increasing the dose of
this medication would only exacerbate these adverse effects.
74
A patient who takes loxapine (Loxitane) to treat schizophrenia is noted to be restless and fidgety and is pacing around the room. The nurse caring for this patient will perform which action?
a. Contact the provider to discuss changing to benztropine (Cogentin).
b. Notify the provider of these symptoms and request an order for lorazepam (Ativan).
c. Question the patient about adherence to the drug regimen.
d. Recognize these signs of a serious adverse drug reaction and notify the provider.
b. Notify the provider of these symptoms and request an order for lorazepam (Ativan).
The patient is exhibiting signs of akathisia and should be treated with an antianxiety drug. Benztropine is an
anticholinergic used to combat acute dystonia side effects. These are not signs of psychosis, so it is not necessary to question whether or not the patient is taking the medication. These side effects are not as serious as those with tardive dyskinesia.
75
A patient arrives in the emergency department with dehydration. The patient reports taking fluphenazine
(Prolixin) to treat schizophrenia. The nurse notes rigid muscles and an altered mental status. The patient has a
temperature of 103.6° F, a heart rate of 98 beats per minute, and a blood pressure of 90/58 mm Hg. The nurse
will anticipate administering which medication?
a. Dantrolene (Dantrium)
b. Haloperidol (Haldol)
c. Propranolol (Inderal)
d. Tetrabenazine (Xenazine)
a. Dantrolene (Dantrium)
The patient is exhibiting signs of neuroleptic malignant syndrome. Muscle relaxants, such as dantrolene, are
usually given. Haloperidol is used to treat psychosis. Propranolol is used for treating akathisia. Tetrabenazine is sometimes used to treat symptoms of tardive dyskinesia.
76
The parent of a young adult who has schizophrenia is concerned that the patient spits out pills that are given.
The nurse will suggest contacting the patient’s provider to discuss which intervention?
a. Changing to a liquid form of the mediation
b. Providing a home health nurse to supervise
medication administration
c. Teaching the patient the importance of taking the medication
d. Weekly intramuscular injections of the medication
a. Changing to a liquid form of the mediation
Noncompliance is common with antipsychotic medications. If patients spit out or hide pills, a liquid form can be used. A home health nurse is costly and unnecessary. Teaching the patient the importance of the medication is essential, but not always effective if the patient does not want to comply. Weekly intramuscular injections may be used if using the liquid form is not effective.
77
The nurse is preparing to administer intramuscular haloperidol (Haldol) to a patient who has schizophrenia.
What action will the nurse perform?
a. Massage the site after injecting the medication to ensure complete absorption.
b. Teach the patient to return every week to receive medication doses.
c. Use a small bore needle when injecting the medication.
d. Use the Z-track method and inject the medication into deep muscle tissue.
d. Use the Z-track method and inject the medication into deep muscle tissue.
Haloperidol is a viscous liquid and should be injected deep into muscle tissue using a Z-track method. The injection
site should not be massaged. Injections of long-term preparations of haloperidol are given every 2 to 4
weeks. Nurses should use a large-bore needle when injecting haloperidol.
78
The nurse is teaching a patient who will be discharged home on a typical antipsychotic medication to treat schizophrenia. Which statement by the patient indicates a need for further teaching?
a. “I should not drink alcohol while taking this medication.”
b. “I should use a heating pad to treat muscle spasms while taking this medication.”
c. “I should use sunscreen while taking this medication.”
d. “I will need frequent blood tests while taking this medication.”
b. “I should use a heating pad to treat muscle spasms while taking this medication.”
Dystonia can cause muscle spasms and should be reported to the provider who can prescribe medications to
treat this adverse effect. Patients should not drink alcohol, should use sunscreen, and will need close monitoring
of lab values while taking these medications.
79
A patient who is about to begin taking the atypical antipsychotic medication clozapine (Clozaril) is concerned about side effects. What information will the nurse include when teaching the patient about this medication?
a. “You are more likely to experience dry mouth, constipation, and urinary retention.”
b. “You may experience weight gain, drowsiness, and headaches.”
c. “You will not experience extrapyramidal side effects with this medication.”
d. “You will not need frequent lab work while taking this medication.”
b. “You may experience weight gain, drowsiness, and headaches.”
Weight gain, drowsiness, and headaches are common side effects of non-typical antipsychotic medications. Anticholinergic side effects are less likely than with typical antipsychotics. Extrapyramidal side effects can occur,
even though they are less likely. Clozapine can cause agranulocytosis, so patients who are taking this drug require frequent monitoring.
80
A family member of a patient who has been taking fluphenazine (Prolixin) for 3 months calls to report that
the patient is exhibiting agitation and restlessness. The nurse learns that the patient’s delusional thinking and
hallucinations have stopped since taking the medication. The nurse will perform which action?
a. Reassure the family member that tolerance to these side effects will subside over time.
b. Remind the family member that complete drug effects may not occur for several more weeks.
c. Suggest that the family member contact the provider to discuss an order for a benzodiazepine.
d. Tell the family member to withhold the medication and notify the patient’s provider.
c. Suggest that the family member contact the provider to discuss an order for a benzodiazepine.
The patient is exhibiting signs of akathisia and should receive a benzodiazepine. Patients usually do not experience tolerance to these drug side effects. The patient is experiencing resolution of symptoms. Discontinuing
antipsychotics abruptly may lead to withdrawal symptoms.
81
A patient has been taking risperidone (Risperdal) for 2 weeks. The patient reports drowsiness and headache. What will the nurse do?
a. Counsel the patient to request changing to aripiprazole (Abilify).
b. Reassure the patient that these are common side effects of the medication.
c. Suggest that the patient have serum glucose testing.
d. Suggest that these may be signs of agranulocytosis.
b. Reassure the patient that these are common side effects of the medication.
Drowsiness and headaches are common side effects of atypical antipsychotics. Changing to aripiprazole will
not improve the symptoms, since this drug is in the same drug class. These symptoms do not indicate altered
serum glucose levels or agranulocytosis.
82
The nurse is performing a medication history on a patient who reports taking lorazepam (Ativan) for the past 6 months to treat an anxiety disorder. The patient states that the medication is not working as well as previously. The nurse will
a. contact the provider to discuss changing to another benzodiazepine.
b. notify the provider and discuss increasing the dose of lorazepam.
c. suspect worsening of the anxiety disorder.
d. understand that the patient has developed tolerance to this drug.
d. understand that the patient has developed tolerance to this drug.
It is recommended that benzodiazepines be prescribed no longer than 3 or 4 months since the effectiveness lessens after 4 months as patients develop tolerance to the drug. Changing to another benzodiazepine will not
change this. Increasing the dose is not indicated. This does not indicate worsening of the underlying disorder.
83
A patient who is taking chlorpromazine calls the clinic to report having reddish-brown urine. What action will the nurse take?
a. Notify the provider and request orders for creatinine clearance and BUN levels.
b. Reassure the patient that this is a harmless side effect
of this medication.
c. Tell the patient to come to the clinic for a urinalysis.
d. Tell the patient to discard any drug on hand and request a new prescription.
b. Reassure the patient that this is a harmless side effect of this medication.
Aliphatic phenothiazines, such as chlorpromazine, can cause a harmless pink or red-brown urine discoloration.
There is no need to evaluate renal function with creatinine clearance, BUN, or urinalysis. The discoloration
does not indicate that the medication has expired.
84
A patient has begun taking buspirone hydrochloride (BuSpar) 7.5 mg twice daily to treat acute anxiety and
calls 1 week later to report little change in symptoms. What will the nurse tell the patient?
a. “Therapeutic effects may not be evident for another week.”
b. “The provider may need to increase the dose to 15 mg twice daily.”
c. “Notify the provider and request an order for another anxiolytic.”
d. “Stop taking the drug and notify the provider that it doesn’t work.”
a. “Therapeutic effects may not be evident for another week.”
Buspirone hydrochloride may not be effective until 1 to 2 weeks after continuous use. It is not necessary to increase
the dose at this time.
85
A patient who is taking fluphenazine (Prolixin) to treat psychosis is experiencing symptoms of acute dystonia.
While performing a medication history, the nurse learns that the patient takes herbal medications. Which
herbal supplement would be of concern?
a. Ginkgo
b. Ginseng
c. Kava kava
d. St. John’s wort
c. Kava kava
Kava kava may increase the risk and severity of dystonia when taken with phenothiazines.
86
A patient is brought to the emergency department with decreased respirations and somnolence. The nurse
notes a heart rate of 60 beats per minute and a blood pressure of 80/58 mm Hg. The patient is known to take
alprazolam (Xanax) to treat anxiety. Which medication will the nurse anticipate the provider to order?
a. Benztropine (Cogentin)
b. Flumazenil (Romazicon)
c. Lorazepam (Ativan)
d. Propranolol (Inderal)
b. Flumazenil (Romazicon)
Flumazenil is the recommended benzodiazepine antagonist to treat overdose of benzodiazepines. This patient
is unconscious and has bradycardia and hypotension, so the antagonist medication is indicated. Benztropine is an anticholinergic used to treat acute dystonia in patients taking phenothiazines. Lorazepam is a benzodiazepine and would only intensify the symptoms. Propranolol is a beta blocker used to treat akathisia in patients taking phenothiazines.
87
A patient arrives in the emergency department complaining of difficulty breathing, dizziness, sweating, and heart palpitations. The patient reports having had similar episodes previously. The nurse will expect the
provider to order which medication?
a. Flumazenil (Romazicon)
b. Haloperidol (Haldol)
c. Lorazepam (Ativan)
d. Propranolol (Inderal)
c. Lorazepam (Ativan)
The patient is exhibiting signs of acute anxiety, so the anxiolytic lorazepam will be given. Flumazenil is a benzodiazepine antagonist, given for overdose of benzodiazepines. Haloperidol is given for acute psychosis. Propranolol is a beta blocker, used to treat akathisia in patients taking phenothiazines.
88
The nurse is teaching a patient about taking an anxiolytic agent to treat grief-related anxiety. Which statement by the patient indicates understanding of the teaching?
a. “I may have wine with dinner to help with relaxation.”
b. “I may need to take this medication for up to a year.”
c. “I may stop taking the medication when my symptoms go away.”
d. “I should try psychotherapy or a support group in addition to the medication.”
d. “I should try psychotherapy or a support group in addition to the medication.”
Psychotherapy or support groups should be part of therapy, with anxiolytics added as needed. Patients taking
anxiolytic medications should not consume alcohol. Anxiolytic medications are generally given for a maximum
of 3 to 4 months. Patients should not stop the medications abruptly.
89
A nurse performs a medication history on a newly admitted patient. The patient reports taking amitriptyline
(Elavil) 75 mg at bedtime for 6 weeks to treat depression. The patient reports having continued fatigue, lack of
energy, and depressed mood. The nurse will contact the provider to discuss which intervention?
a. Beginning to taper the amitriptyline
b. Changing to a morning dose schedule
c. Giving the amitriptyline twice daily
d. Increasing the dose of amitriptyline
a. Beginning to taper the amitriptyline
The response to tricyclic antidepressants (TCAs) should occur after 2 to 4 weeks of therapy. If there is no improvement
at this time, the TCA should be gradually withdrawn and an SSRI prescribed. TCAs should never be
stopped abruptly. TCAs cause fatigue and drowsiness, so they should be given at bedtime. Changing the dose
or the dosing schedule are not indicated.
90
The nurse is teaching a patient who will begin taking doxepin (Sinequan) to treat depression. Which statement
by the patient indicates a need for further teaching?
a. “I should expect results within 2 to 4 weeks.”
b. “I should increase fluids and fiber while taking this medication.”
c. “I should take care when rising from a sitting to standing position.”
d. “I will take the medication in the morning before breakfast.”
d. “I will take the medication in the morning before breakfast.”
```
Tricyclic antidepressants (TCAs) should begin to show effects within 1 to 4 weeks. Tricyclic antidepressants are
known to cause orthostatic hypotension and constipation, so patients should be counseled on how to minimize
these effects. TCAs should be taken at bedtime because of their tendency to cause drowsiness.
```
91
A patient who is taking amitriptyline (Elavil) reports constipation and dry mouth. The nurse will give the patient
which instruction?
a. Increase fluid intake.
b. Notify the provider.
c. Request another antidepressant.
d. Stop taking the medication immediately.
a. Increase fluid intake.
Constipation and dry mouth are common side effects of tricyclic antidepressants (TCAs), and patients should
be taught to manage these symptoms. There is no need to notify the provider or to switch medications unless
the side effects become too uncomfortable. Patients should not stop taking TCAs abruptly.
92
A patient who has had a loss of interest in most activities, weight loss, and insomnia is diagnosed with a major
depressive disorder and will begin taking fluoxetine (Prozac) daily. The patient asks about the weekly dosing
that a family member follows. What will the nurse tell the patient about a weekly dosing regimen?
a. It can be used after daily maintenance dosing proves effective and safe.
b. It is used after a trial of tricyclic antidepressant medication fails.
c. It is not effective for this type of depression and its symptoms.
d. It will cause more adverse effects than daily dosing regimens.
a. It can be used after daily maintenance dosing proves effective and safe.
Before weekly dosing is begun, the patient should respond to a daily maintenance dose of 20 mg/day without
serious effects. It is not necessary to undergo a trial of tricyclic antidepressants (TCAs). Weekly dosing is used
for this type of depression, and although it may have some adverse effects, these are not more common than
with daily dosing.
93
A patient has been taking sertraline (Zoloft) 20 mg/mL oral concentrate, 1 mL daily for several weeks and reports
being unable to sleep well. What will the nurse do next?
a. Ask the patient what time of day the medication is taken.
b. Counsel the patient to take the medication at bedtime.
c. Recommend asking the provider about weekly dosing.
d. Suggest that the patient request a lower dose.
a. Ask the patient what time of day the medication is taken.
Selective serotonin reuptake inhibitors (SSRIs) cause nervousness and insomnia. Patients can minimize these
effects by taking the drug in the morning. The nurse should assess this with this patient. Taking the medication
at bedtime will only increase the insomnia. Requesting a lower dose or changing to weekly dosing are not
recommended.
94
A patient has been taking paroxetine (Paxil) 20 mg per day for 2 weeks and reports headaches, nervousness,
and poor appetite. Which action will the nurse take?
a. Counsel the patient to take the medication with food.
b. Reassure the patient that these side effects will decrease over time.
c. Suggest that the patient discuss a lower dose with the provider.
d. Tell the patient to stop taking the drug and contact the provider.
b. Reassure the patient that these side effects will decrease over time.
These are common side effects of SSRIs and will subside over time. Taking the medication with food will not affect these side effects. Lowering the dose is not indicated. Patients should not abruptly stop taking SSRIs.
95
A patient who has been diagnosed with social anxiety disorder will begin taking venlafaxine (Effexor). The
nurse who performs a medication and dietary history will be concerned about ingestion of which substance or
drug?
a. Coffee
b. Grapefruit juice
c. Oral hypoglycemic drug
d. St. John’s wort
d. St. John’s wort
The concurrent interaction of venlafaxine and St. John’s wort may increase the risk of serotonin syndrome and
neuroleptic malignant syndrome. Oral hypoglycemic drugs are concerning for patients who take lithium. Coffee and grapefruit juice is to be avoided by patients who take monoamine oxidase inhibitors
96
A male patient has been taking venlafaxine (Effexor) 37.5 mg daily for 2 weeks and reports ejaculation dysfunction
and urinary retention. What action will the nurse take?
a. Contact the provider to discuss decreasing the dose.
b. Reassure the patient that these are common side effects.
c. Report potential serious adverse effects to the provider.
d. Withhold the dose until the provider is notified.
b. Reassure the patient that these are common side effects.
Venlafaxine can cause ejaculation dysfunction and urinary retention, and these side effects tend to be transient and treatable. Decreasing the dose is not indicated, and these are not serious adverse effects. Withholding the dose is not indicated.
97
A patient who has been taking a monoamine oxidase (MAO) inhibitor for several months will begin taking amoxapine (Asendin) instead of the MAO inhibitor. The nurse will counsel the patient to begin taking the
amoxapine
a. along with the MAO inhibitor for several months.
b. at least 14 days after discontinuing the MAO inhibitor.
c. the day after the last dose of the MAO inhibitor.
d. while withdrawing the MAO inhibitor over several weeks.
b. at least 14 days after discontinuing the MAO inhibitor.
Amoxapine is an atypical antidepressant that should not be taken with MAO inhibitors and should not be used
within 14 days of taking an MAO inhibitor.
98
A patient who has been diagnosed with depression asks why the provider has not ordered a monoamine
oxidase (MAO) inhibitor to treat the disorder. The nurse will explain to the patient that MAO inhibitors
a. are more expensive than other antidepressants.
b. are no longer approved for treating depression.
c. can cause profound hypotension.
d. require strict dietary restrictions.
d. require strict dietary restrictions.
MAO inhibitors have many food and drug interactions that can be fatal, and patients must adhere to strict dietary
restrictions while taking these drugs. They are not more expensive than the newer antidepressants. They
remain approved for treating depression. MAO inhibitors cause profound hypertension.
99
A patient who takes a monoamine oxidase (MAO) inhibitor asks the nurse about taking over-the-counter
medications to treat cold symptoms. Which medication will the nurse counsel the patient to avoid while taking
an MAO inhibitor?
a. Diphenhydramine
b. Guaifenesin
c. Pseudoephedrine
d. Saline nasal spray
c. Pseudoephedrine
MAO inhibitors can cause hypertensive crises, which can be fatal when taken with sympathomimetic drugs
such as pseudoephedrine.
100
A patient who has a major depressive disorder has been taking fluoxetine (Prozac) 20 mg daily for 3 months and reports improved mood, less fatigue, and an increased ability to concentrate. The patient’s side effects have diminished. What will the nurse counsel this patient to discuss with the provider?
a. Changing to once-weekly dosing
b. Decreasing the dose to 10 mg daily
c. Discontinuing the medication
d. Increasing the dose to 30 mg daily
a. Changing to once-weekly dosing
Once patients have demonstrated control of symptoms with decreased side effects on the maintenance dose of 20 mg daily, patients may begin once-weekly dosing. The 20-mg dose is maintenance dosing, so decreasing or increasing the dose is not indicated. Patients should not stop taking the medication abruptly.
101
A patient who has been diagnosed with a major depression disorder has been ordered to take doxepin
(Sinequan). The nurse will contact the provider if the patient’s medical history reveals a history of which condition?
a. Asthma
b. Glaucoma
c. Hypertension
d. Hypoglycemia
b. Glaucoma
Antidepressants, such as doxepin, that cause anticholinergic-like symptoms are contraindicated if the patient has glaucoma.
102
The nurse is preparing to administer a dose of lithium (Lithibid) to a patient who has been taking the drug
as maintenance therapy to treat bipolar disorder. The nurse assesses the patient and notes tremors and confusion.
The patient’s latest serum lithium level was 2 mEq/L. Which action will the nurse take?
a. Administer the dose.
b. Hold the dose and notify the provider.
c. Request an order for a higher dose.
d. Request an order for a lower dose.
b. Hold the dose and notify the provider.
The patient has symptoms of lithium toxicity, and the serum drug level is in toxic range. The nurse should hold
the dose and notify the provider.
103
The nurse assesses a patient who is taking lithium (Lithibid) and notes a large output of clear, dilute urine.
The nurse suspects which cause for this finding?
a. Cardiovascular complications
b. Expected lithium side effects
c. Increased mania
d. Lithium toxicity
d. Lithium toxicity
An increased output of dilute urine is a sign of lithium toxicity.
104
The nurse provides teaching for a patient who will begin taking lithium (Lithibid). Which statement by the patient indicates understanding of the teaching?
a. “I may drink tea or cola but not coffee.”
b. “I may stop taking the drug when mania symptoms subside.”
c. “I should consume a sodium-restricted diet.”
d. “I should drink 2 to 3 liters of fluid each day.”
d. “I should drink 2 to 3 liters of fluid each day.”
Patients taking lithium should be encouraged to maintain adequate fluid intake of 2 to 3 L/day initially and then 1 to 2 L/day as maintenance. Patients should not drink any caffeine-containing drinks, including tea and cola. Patients must continue taking lithium even when symptoms subside, or else symptoms will recur. It is not necessary to consume a sodium-restricted diet.
105
A patient who has recently begun taking lithium (Lithibid) calls the clinic to report nausea, vomiting, anorexia, and drowsiness. What will the nurse do next?
a. Contact the provider to obtain an order for a serum lithium level.
b. Reassure the patient that these symptoms are common and transient.
c. Tell the patient that the lithium dose is probably too low.
d. Tell the patient to stop taking the medication immediately.
a. Contact the provider to obtain an order for a serum lithium level.
Early symptoms of lithium toxicity include nausea and vomiting, anorexia, and drowsiness. The nurse should
obtain an order for a lithium level to evaluate this. Patients should be encouraged to report these symptoms if
they occur. Patients should never be counseled to stop the medication abruptly.
106
The nurse is preparing to administer paroxetine HCl (Paxil) to a 70-year-old patient. The nurse understands
that this patient may require
a. a decreased dose.
b. an increased dose.
c. every other day dosing.
d. more frequent dosing.
a. a decreased dose.
Older adults usually need a lower dose of antidepressants.
107
A patient who has a history of migraine headaches is diagnosed with bipolar disorder. The nurse might expect
the provider to order which medication for this patient?
a. Carbamazapine (Tegretol)
b. Divalproex (Valproate)
c. Lamotrigine (Lamictal)
d. Lithium citrate (Eskalith)
b. Divalproex (Valproate)
All of these medications may be used to treat bipolar disorder, but divalproex is also indicated for migraine
prophylaxis.
108
The nurse is teaching a patient about foods to avoid when taking isocarboxazid (Marplan). Which foods will the nurse instruct the patient to avoid? (Select all that apply.)
a. Bananas
b. Bread
c. Eggs
d. Red wine
e. Sausage
f. Yogurt
a. Bananas
d. Red wine
e. Sausage
f. Yogurt
Aged cheeses and wines are the chief foods that are prohibited. Any food containing tyramine, which has sympathomimetic effects, can cause a hypertensive crisis. This includes bananas, sausage, and yogurt.
109
The parents of an 11-year-old boy ask about growth hormone therapy for their child who is shorter than his 10-year-old sister. The nurse will tell the parents that growth hormone
a. does not affect other hormones when given.
b. is available as an oral tablet to be taken once daily.
c. is given after tests prove that it is necessary.
d. may be given until the child’s desired height is reached.
c. is given after tests prove that it is necessary.
Growth hormone is given only when growth hormone deficiency is determined. It cannot be given orally. It antagonizes insulin secretion and thus can lead to the development of diabetes mellitus. It cannot be given after the epiphyses are fused.
110
The nurse is caring for a patient who is receiving growth hormone. Which assessment will the nurse monitor
daily?
a. Complete blood count
b. Height and weight
c. Renal function
d. Serum glucose
d. Serum glucose
Growth hormone antagonizes insulin secretion, so serum glucose should be monitored.
111
The parents of a 16-year-old boy who plays football want their child to receive growth hormone to improve
muscle strength. What will the nurse tell the parents?
a. “Growth hormone may be used to improve strength in young athletes.”
b. “If the epiphyses are not fused, growth hormone may be an option.”
c. “Small doses of growth hormone may be used indefinitely for this purpose.”
d. “Using growth hormone to build muscle mass is not recommended.”
d. “Using growth hormone to build muscle mass is not recommended.”
Athletes should be advised not to take growth hormone to build muscle because of its effects on blood sugar
and other side effects.
112
Which would be a contraindication for hormone therapy with somatropin (Genotropin) in a school-age child?
a. Asthma
b. Dwarfism
c. Enuresis
d. Prader-Willi syndrome
d. Prader-Willi syndrome
Fatalities associated with risks of taking growth hormone with Prader-Willi syndrome have been reported, so it is contraindicated in patients with this syndrome. It is not contraindicated in patients with asthma or enuresis.
Dwarfism is an indication for hormone therapy.
113
A child exhibits acromegaly caused by a tumor that cannot be destroyed with radiation. Which medication
will most likely be used to treat this child?
a. Bromocriptine mesylate (Parlodel)
b. Octreotide acetate (Sandostatin)
c. Somatrem (Protropin)
d. Somatropin (Genotropin)
a. Bromocriptine mesylate (Parlodel)
Bromocriptine is a prolactin-release inhibitor and is used to inhibit release of growth hormone from the pituitary
gland if the tumor cannot be destroyed by radiation. Octreotide may be used as well, but it is expensive
and is typically used as adjunct therapy to radiation. Somatrem and somatropin are used to treat growth hormone
deficiency and would make acromegaly worse.
114
The nurse is caring for a patient who has hypothyroidism. To assist in differentiating between primary and
secondary hypothyroidism, the nurse will expect the provider to order which drug?
a. Liothyronine sodium (Cytomel)
b. Liotrix (Thyrolar)
c. Methimazole (Tapazole)
d. Thyrotropin (Thytropar)
d. Thyrotropin (Thytropar)
Thyrotropin is a purified extract of thyroid-stimulating hormone and is used as a diagnostic agent to differentiate between primary and secondary hypothyroidism. Liothyronine and liotrix are thyroid replacement drugs. Methimazole is used to decrease thyroid hormone secretion.
115
The nurse administers intravenous corticotropin (Acthar) to a patient. A serum cortisol level drawn 60 minutes
later shows no change in serum cortisol levels from prior to the dose. What is the nurse’s first action?
a. Notify the provider to discuss a possible non-functioning adrenal gland.
b. Recognize the need for an increased dose to treat pituitary insufficiency.
c. Request an order for a second dose of corticotropin to treat cortisone deficiency.
d. Request an order to repeat the serum cortisol level in 1 to 2 hours.
a. Notify the provider to discuss a possible non-functioning adrenal gland.
Corticotropin is given to diagnose adrenal gland disorders as well as to treat adrenal gland insufficiency. When given intravenously, the serum cortisol level should increase within 30 to 60 minutes if the adrenal gland is
functioning. The nurse should report adrenal gland dysfunction. The provider will determine how to treat.
Since the levels should increase in 30 to 60 minutes, there is no need to repeat the test in 1 to 2 hours.
116
The nurse provides teaching for a patient receiving corticotropin. The nurse will instruct the patient to contact
the provider if which condition occurs?
a. Bruising
b. Constipation
c. Myalgia
d. Nausea
a. Bruising
Ecchymosis is an adverse reaction to corticotropin and should be reported. Constipation and nausea are
known side effects but are not serious. Myalgia is not common.
117
The nurse is caring for a patient who has experienced head trauma in a motor vehicle accident. The patient
is having excessive output of dilute urine. The nurse will notify the provider and will anticipate administering
which medication?
a. Calcifediol (Calderol)
b. Corticotropin (Acthar)
c. Prednisolone (AK-Pred)
d. Vasopressin (Pitressin)
d. Vasopressin (Pitressin)
The posterior pituitary gland secretes antidiuretic hormone (ADH) (vasopressin). When there is a deficiency of
ADH, sometimes caused by head trauma, patients excrete large amounts of dilute urine. ADH replacement is
necessary to prevent fluid imbalance. Calcifediol is used to treat parathyroid disorders. Corticotropin and prednisolone
do not prevent diuresis.
118
The nurse is preparing to administer piperacillin to a patient to treat an infection caused by pseudomonas.
The nurse learns that the patient receives corticotropin to treat multiple sclerosis. The nurse will request an order
for
a. a different antibiotic.
b. blood glucose monitoring.
c. cardiac monitoring.
d. serum electrolytes.
d. serum electrolytes.
Corticotropin can interact with piperacillin to cause hypokalemia, so serum electrolytes should be monitored. It is not necessary to change the antibiotic. Blood glucose monitoring and cardiac monitoring are not indicated.
119
The nurse is caring for a patient who is receiving desmopressin acetate (DDAVP). Which assessments are important while caring for this patient?
a. Blood pressure and serum potassium
b. Heart rate and serum calcium
c. Lung sounds and serum magnesium
d. Urine output and serum sodium
d. Urine output and serum sodium
Desmopressin is an antidiuretic hormone. The nurse should monitor intake and output as well as serum sodium levels.
120
A 35-year-old woman reports lethargy, difficulty remembering things, facial edema, dry skin, and cessation of menses. The nurse notes a heart rate of 60 beats per minute and a weight increase of 5 pounds from a previous visit. The nurse will notify the provider of which possible condition?
a. Cretinism
b. Early menopause
c. Hyperthyroidism
d. Myxedema
d. Myxedema
Myxedema is severe hypothyroidism characterized by this woman’s symptoms. Cretinism is congenital hypothyroidism. Early menopause is not characterized by memory loss, facial edema, dry skin, or bradycardia. Hyperthyroidism would include tachycardia and weight loss.
121
A patient is admitted to the hospital to treat hypothyroidism. For rapid improvement in symptoms, the nurse will expect to administer which medication?
a. Levothyroxine sodium (Synthroid)
b. Liothyronine (Cytomel)
c. Liotrix (Thyrolar)
d. Thyroid desiccated (Armour Thyroid)
b. Liothyronine (Cytomel)
Liothyronine has a short half-life and rapid onset of action and is not recommended for maintenance therapy
but is used as initial therapy for severe myxedema. Levothyroxine is the drug of choice for replacement therapy. Liotrix is a second-line drug. Thyroid desiccated is used for hypothyroidism to reduce goiter size.
122
A patient who takes warfarin (Coumadin) and digoxin (Lanoxin) develops hypothyroidism and will begin taking levothyroxine (Synthroid). The nurse anticipates which potential adjustments in dosing for this patient?
a. Decreased digoxin and decreased warfarin
b. Decreased digoxin and increased warfarin
c. Increased digoxin and decreased warfarin
d. Increased digoxin and increased warfarin
c. Increased digoxin and decreased warfarin
Thyroid preparations increase the effect of oral anticoagulants, so the warfarin dose may need to be decreased.
Levothyroxine can decrease the effectiveness of digoxin, so this dose may need to be increased.
123
A patient who takes the oral antidiabetic agent metformin (Glucophage) will begin taking levothyroxine (Synthroid). The nurse will teach this patient to monitor for
a. hyperglycemia.
b. hypoglycemia.
c. hyperkalemia.
d. hypokalemia.
a. hyperglycemia.
Insulin and oral antidiabetic drugs may need to be increased in patients taking levothyroxine. Patients should
be taught to monitor for hyperglycemia, because of the reduced effects of these drugs.
124
A patient who has hyperthyroidism will begin treatment with an antithyroid medication. The patient asks
the nurse about dietary requirements. The nurse will counsel the patient to avoid which food(s)?
a. Fava beans
b. Foods high in purine
c. Grapefruit
d. Shellfish
d. Shellfish
Patients should be advised about the effects of iodine and its presence in foods such as shellfish. There is no
need to avoid fava beans, purine, or grapefruit.
125
The nurse is caring for a patient who is being treated for hypothyroidism. The patient reports insomnia,
nervousness, and flushing of the skin. Before notifying the provider, the nurse will perform which action?
a. Assess serum glucose to evaluate possible hypoglycemia.
b. Check the patient’s heart rate to assess for
tachycardia.
c. Perform an assessment of hydration status.
d. Take the patient’s temperature to evaluate for infection.
b. Check the patient’s heart rate to assess for tachycardia.
The patient has signs of a thyroid crisis, which can occur with excess ingestion of thyroid hormone. The nurse
should evaluate heart rate before notifying the provider. These are not symptoms of hypoglycemia. The symptoms
are not indicative of infection.
126
A patient with Graves disease exhibits tachycardia, heat intolerance, and exophthalmos. Prior to surgery,
which drug is used to alter thyroid hormone levels?
a. Liotrix (Thyrolar)
b. Propranolol (Inderal)
c. Propylthiouracil (PTU)
d. Thyroid (Thyrotab)
c. Propylthiouracil (PTU)
Propylthiouracil is a potent antithyroid drug used in preparation for a subtotal thyroidectomy. Liotrix and thyroid are used as thyroid replacement. Propranolol is used to treat hypertension associated with
hyperthyroidism.
127
A patient has hypocalcemia caused by parathyroid hormone deficiency. Which medication will the nurse
anticipate giving to this patient?
a. Calcitonin
b. Calcitriol
c. Calcium
d. Vitamin D
b. Calcitriol
Calcitriol is given for management of hypocalcemia caused by parathyroid hormone deficiency. Calcitonin is
used to treat hyperparathyroidism. Calcium and vitamin D are not useful in parathyroid deficiency.
128
A patient is receiving a glucocorticoid medication to treat an inflammatory condition, and the provider has
ordered a slow taper in order to discontinue this medication. The nurse explains to the patient that this is done to prevent which condition?
a. Acromegaly
b. Adrenocortical insufficiency
c. Hypertensive crisis
d. Thyroid storm
b. Adrenocortical insufficiency
Patients receiving glucocorticoids stop making their own cortisol. These drugs should be tapered slowly to allow the body to resume making this hormone. Acromegaly is associated with growth hormone hypersecretion.
Hypertensive crisis and thyroid storm are associated with thyroid replacement.
129
A patient is taking prednisolone and fludrocortisone (Florinef). When teaching this patient about dietary intake, the nurse will instruct the patient to consume a diet
a. high in carbohydrates.
b. high in fat.
c. high in protein.
d. low in potassium.
c. high in protein.
Patients receiving fludrocortisone are at risk for negative nitrogen balance and should consume a high-protein diet.
130
A patient who takes high-dose aspirin to treat arthritis will need to take prednisone to treat an acute flare of symptoms. What action will the nurse perform?
a. Observe the patient for hypoglycemia.
b. Monitor closely for increased urine output.
c. Observe the patient for hypotension.
d. Request an order for enteric-coated aspirin.
d. Request an order for enteric-coated aspirin.
Glucocorticoids can increase gastric distress, so an enteric-coated aspirin product is indicated. Glucocorticoids
increase the risk of hypoglycemia, fluid retention, and hypertension.
131
The nurse is teaching a group of nursing students about diabetes. The nurse explains that which type of diabetes
is the most common?
a. Type 1 diabetes mellitus
b. Type 2 diabetes mellitus
c. Diabetes insipidus
d. Secondary diabetes
b. Type 2 diabetes mellitus
Type 2 diabetes mellitus is the most common type of diabetes.
132
A patient develops type 2 diabetes mellitus. The nurse will explain that this type of diabetes
a. is generally triggered by medications.
b. is not as common as type 1 diabetes.
c. is often related to heredity and obesity.
d. will not require insulin therapy.
c. is often related to heredity and obesity.
Type 2 diabetes is often caused by obesity and hereditary factors. Secondary diabetes is triggered by medications. Type 2 diabetes is the most common type of diabetes. Patients with type 2 diabetes may become insulindependent.
133
A patient who is overweight is being evaluated for diabetes. The patient has a blood glucose level of 160 mg/dL and a hemoglobin A1c of 5.8%. The nurse understands that this patient has which condition?
a. Diabetes mellitus
b. Hypoglycemia
c. Normal blood levels
d. Prediabetes
d. Prediabetes
Patients with a hemoglobin A1c between 5.7% and 6.4% are considered to have prediabetes. A level of 6.5% or
more indicates diabetes. The patient is hyperglycemic.
134
The nurse is teaching a patient who is newly diagnosed with type 1 diabetes mellitus about insulin administration.
Which statement by the patient indicates a need for further teaching?
a. “I may use a chosen site daily for up to a week.”
b. “I should give each injection a knuckle length away from a previous injection.”
c. “I will not be concerned about a raised knot under my skin from injecting insulin.”
d. “Insulin is absorbed better from subcutaneous sites on my abdomen.
c. “I will not be concerned about a raised knot under my skin from injecting insulin.”
Lipohypertrophy is a raised lump or knot on the skin surface caused by repeated injections into the same site,
and this can interfere with insulin absorption. Patients are encouraged to use the same site for a week, giving
each injection a knuckle length away from the previous injection. Insulin absorption is greater when given in
abdominal areas.
135
The nurse is teaching a patient how to administer insulin. The patient is thin with very little body fat. The nurse will suggest injecting insulin
a. by pinching up the skin and injecting straight down.
b. in the abdomen only with the needle at a 90-degree angle.
c. subcutaneously with the needle at a 45- to 60-degree angle.
d. using the thigh and buttocks areas exclusively.
c. subcutaneously with the needle at a 45- to 60-degree angle.
In a thin person, with little fatty tissue, the needle is inserted at a 45- to 60-degree angle. In other patients, a 45- to 90-degree angle is acceptable. There is no recommendation for preferring one site over another.
136
The nurse receives the following order for insulin: IV NPH (Humulin NPH) 10 units. The nurse will perform
which action?
a. Administer the dose as ordered.
b. Clarify the insulin type and route.
c. Give the drug subcutaneously.
d. Question the insulin dose.
b. Clarify the insulin type and route.
Only regular insulin can be given intravenously. The nurse should clarify the order. It is not correct to give Humulin NPH insulin IV. The nurse should not administer the drug by a different route without first discussing
with the provider.
137
The nurse will administer parenteral insulin to a patient who will receive a mixture of NPH (Humulin NPH) and regular (Humulin R). The nurse will give this medication via which route?
a. Intradermal
b. Intramuscular
c. Intravenous
d. Subcutaneous
d. Subcutaneous
Insulin is given by the subcutaneous route. Only regular insulin may be given IV.
138
The nurse is teaching a patient about home administration of insulin. The patient will receive regular (Humulin R) and NPH (Humulin NPH) insulin at 0700 every day. What is important to teach this patient?
a. “Draw up the medications in separate syringes.”
b. “Draw up the NPH insulin first.”
c. “Draw up the regular insulin first.”
d. “Draw up the medications after mixing them in a vial.”
c. “Draw up the regular insulin first.”
Patients should be instructed to draw up regular insulin first so that NPH is not mixed into the vial of regular insulin. It is not necessary to use separate syringes. Patients do not mix the medications in a vial.
139
A patient is ordered to receive insulin lispro at mealtimes. The nurse will instruct this patient to administer the medication at which time?
a. 5 minutes before eating
b. 15 minutes after eating
c. 30 minutes before eating
d. 10 minutes after eating
a. 5 minutes before eating
Lispro acts faster than other insulins, and patients should be taught to give this medication not more than 5
minutes before eating.
140
The parent of a junior high-school child who has type 1 diabetes asks the nurse if the child can participate in sports. The nurse will tell the parent
a. that strenuous exercise is not recommended for children with diabetes.
b. that the child must be monitored for hyperglycemia while exercising.
c. to administer an extra dose of regular insulin prior to exercise.
d. to send a snack with the child to eat just prior to exercise.
d. to send a snack with the child to eat just prior to exercise.
Patients generally need less insulin with increased exercise, so the child should consume a snack to prevent hypoglycemia. Exercise is an integral part of diabetes management. Hypoglycemia is more likely to occur, and extra insulin is not indicated.
141
A patient has administered regular insulin 30 minutes prior but has not received a breakfast tray. The patient
is experiencing nervousness and tremors. What is the nurse’s first action?
a. Administer glucagon.
b. Give the patient orange juice.
c. Notify the kitchen to deliver the tray.
d. Perform bedside glucose testing.
b. Give the patient orange juice.
The patient is symptomatic and has hypoglycemia. The nurse should give orange juice. Glucagon is given for patients unable to ingest carbohydrates. The kitchen should be notified, and bedside glucose testing should be performed, but only after the patient is given carbohydrates.
142
A patient who has type 1 diabetes mellitus asks the nurse about using a combination insulin product such as Humalog 75/25. The nurse will tell the patient that use of this product
a. depends on individual insulin needs.
b. is useful for patient with insulin resistance.
c. means less rotation of injection sites.
d. requires refrigeration at all times.
a. depends on individual insulin needs.
Combination products are convenient because the patient does not have to mix insulin, but the products depend on individual needs, since the doses are fixed. They are not used for patients with insulin resistance. Patients must continue to rotate injection sites. They do not require refrigeration after first use.
143
The patient asks the nurse about storing insulin. Which response by the nurse is correct?
a. “All insulin vials must be refrigerated.”
b. “Insulin will last longer if kept in the freezer.”
c. “Opened vials of insulin must be discarded.”
d. “Some combination pens do not require refrigeration.”
d. “Some combination pens do not require refrigeration.”
Some combination pens do not require refrigeration after first use. Storing insulin in the freezer is not recommended. Opened vials may either be kept at room temperature for a month or refrigerated for 3 months.
144
A patient who has insulin-dependent diabetes mellitus must take a glucocorticoid medication for osteoarthritis.
When teaching this patient, the nurse will explain that there may be a need to
a. decrease the glucocorticoid dose.
b. decrease the insulin dose.
c. increase the glucocorticoid dose.
d. increase the insulin dose.
d. increase the insulin dose.
Glucocorticoids can cause hyperglycemia, so the insulin dose may need to be increased. Changing the glucocorticoid dose is not recommended. Decreasing the insulin dose will only compound the hyperglycemic effects.
145
Which statement by a patient who will begin using an external insulin pump indicates understanding of this
device?
a. “I will have an increased risk for hypoglycemia.”
b. “I will leave this on when bathing or swimming.”
c. “I will not need to count carbohydrates anymore.”
d. “I will still need to monitor serum glucose.”
d. “I will still need to monitor serum glucose.”
Patients using an insulin pump will still monitor serum glucose and count carbohydrates. The advantage of the pump is that it is programmed to deliver continuous rapid-acting insulin in varying amounts at different times throughout the day. Changes in food intake can alter the risk for hypoglycemia if the pump is not adjusted accordingly. They must be removed when bathing or swimming.
146
A patient who is unconscious and has a pulse is brought to the emergency department. The patient is wearing a Medic-Alert bracelet indicating type 1 diabetes mellitus. The nurse will anticipate an order to administer
a. cardiopulmonary resuscitation (CPR).
b. glucagon.
c. insulin.
d. orange juice.
b. glucagon.
This patient is most likely hypoglycemic and will need a carbohydrate. Glucagon is given parenterally if patients
are unable to ingest a carbohydrate, such as orange juice. CPR is not indicated. Insulin will compound the
hypoglycemia.
147
A patient who has type 2 diabetes mellitus asks the nurse why the provider has changed the oral antidiabetic agent from tolbutamide (Orinase) to glipizide (Glucotrol). The nurse will explain that glipizide
a. has a longer duration of action.
b. has fewer gastrointestinal side effects.
c. may be taken on an as-needed basis.
d. results in less hypoglycemic potential.
a. has a longer duration of action.
Glipizide is a second-generation oral antidiabetic agent. It has a longer duration of action than the first-generation antidiabetic agents such as tolbutamide. It has many gastrointestinal side effects. It is taken once daily, not as needed. It has greater hypoglycemic activity than first-generation antidiabetics.
148
A patient who has been taking a sulfonylurea antidiabetic medication will begin taking metformin (Glucophage). The nurse understands that this patient is at increased risk for which condition?
a. Hypoglycemia
b. Hyperglycemia
c. Renal failure
d. Respiratory distress
c. Renal failure
Metformin can lead to renal failure. It does not produce hypoglycemia or hyperglycemia. It does not increase the risk of respiratory distress.
149
A 45-year-old patient who is overweight has had a diagnosis of type 2 diabetes for 2 years. The patient uses 20 units of insulin per day. The patient’s fasting blood glucose (FBG) is 190 mg/dL. The patient asks the nurse about using an oral anti-diabetic agent. The nurse understands that oral anti-diabetic agents
a. cannot be used if the patient is overweight.
b. cannot be used once a patient requires insulin.
c. may be used since this patient meets criteria.
d. may not be used since this patient’s fasting blood glucose is too high.
c. may be used since this patient meets criteria.
Patients who require less than 40 units of insulin per day and who have a fasting blood glucose less than or equal to 200 mg/dL are candidates for oral anti-diabetic agents. Being overweight is an indication, not a contraindication.
