Midterm Flashcards
1
Q
A patient with asthma is prescribed albuterol (Proventil), 2 puffs 3 times daily. The nurse should teach the pt. to do what?
A
Wait 1 min between puffs from the inhaler
-pts should be taught to wait at least 1 min between puffs. Extra doses should not be taken unless prescribed by the provider. Albuterol is a BETA 2 AGONIST. GLUCOCORTICOID inhalation requires oral rinse to prevent development of dysphonia and oropharyngeal candidiasis. Pts should take adequate amounts of calcium and vitamin D with GLUCOCORTICOID therapy.
2
Q
A pt with asthma is prescribed triamcinolone acetonide (Azmacort). What should the nurse do?
A
Teach the pt to use a spacer to prevent fungal infection.
-acetonide is an inhaled GLUCOCORTICOID. Spacer disperse the meds into the lungs, leaving less in the oropharyngeal mucosa; this reduces the incidence of fungal infection. BETA 2 AGONIST may cause tachycardia and are used to abort an acute asthma attack. Pts taking GLUCOCORTICOIDS should engage in weight bearing activity to prevent osteoporosis. This drug should NOT be used to abort an acute attack.
3
Q
What information should the nurse include when teaching a pt about inhaled glucocorticoids?
A
Use of spacers can minimize side effects
-INHALED glucocorticoids are generally very safe. Their principal side effects are oropharyngeal candidiasis and dysphonia, which can be minimized by using a spacer device during administration and by rinsing the mouth and gargling AFTER use.
4
Q
Which of the following is NOT a serious adverse effect of long-term oral glucocorticoid therapy?
- adrenal suppression
- osteoporosis
- hypoglycemia
- peptic ulcer disease
A
Hypoglycemia
- serious adverse effects of ORAL glucocorticoid therapy include adrenal suppression, osteoporosis, HYPERGLYCEMIA, peptic ulcer disease, and growth suppression
5
Q
Ending in:
-sone/-nide
A
Glucocorticoid
6
Q
Ending in
-kast/-ton
A
Luekotriene modifiers
7
Q
Cromolyn sodium
A
Mast cell stabilizers
8
Q
Omalizumab (Xolair)
A
Monoclonal antibodies
9
Q
Ending in:
-rol
A
Beta 2 agonist (SABA)
10
Q
Ending in:
-rol -ate
A
Beta 2 agonist (LABA)
11
Q
Ending in:
-phylline
A
Methylxanthine
12
Q
Ending in
-tropium or “aclidinium”
A
Anticholinergic drugs
13
Q
Ending in:
-sone/-nide -rol
A
Glucocorticoid/LABA combination
14
Q
Which actions occur in 90% of fatal medication errors? (Select all that apply)
A. confusing drugs with similar packaging
B. Giving drugs IV instead of IM
C. Giving Nasarel instead of Nizoral
D. Using an infusion device that malfunctions
E. Writing a prescription illegibly
A
Giving drugs IV instead if IM
Giving Nasarel instead of Nizoral
Writing a prescription illegibly
15
Q
A pt receives a drug that has a narrow therapeutic range. The nurse administering this medication will expect to do what?
A. Administer the drug at intervals longer than the drug half-life
B. Administer this medication IV
C. Monitor plasma drug levels
D. Teach pt that maximum drug effects will occur within a short period
A
Monitor plasma drug levels
16
Q
The nurse is caring for a child who has ingested a toxic amount of aspirin. The provider orders an IV drug that will increase pH in the blood and urine. The nurse understands that this effect is necessary to:
A. Decrease the gastric absorption of aspirin
B. Decrease the lipid solubility of aspirin
C. Increase the serum protein binding of aspirin
D. Increase the urinary excretion of aspirin
A
Increase the urinary excretion of aspirin
17
Q
A child ingest a parent’s aspirin tablets, and the prescriber orders sodium bicarbonate to block the toxic effects of the aspirin. The nurse caring for this pt knows that sodium bicarbonate is effective against the aspirin because it:
A. accelerates its passage through the intestine
B. Alters urinary pH to enhance renal excretion
C. Induces CYP isoenzymes to increase drug metabolism
D. Raised the pH of intestinal fluid to facilitate passage out of the cells
A
Raises the pH of intestinal fluid to facilitate passage out of the cells
18
Q
A pt has been receiving an antibiotic with a small therapeutic index for 10 days. Upon assessment, the nurse notes an increase in the drugs side effects. What would be the nurse priority action?
A. Call the prescriber and have the antibiotic changed
B. Suspect an allergic reaction and administer a PRN antihistamine
C. Ask the provider to order a plasma drug level
D. Set up oxygen and obtain an order for an antagonist
A
Ask the provider to order a drug plasma level test
19
Q
A pt is receiving digoxin twice daily. When assessing the pt before giving a dose, the nurse counts a pulse of 60 beats/min and learns that the pt is experiencing nausea. The nurse consults a drug manual and verifies that the ordered dose is correct. What should the nurse do?
A. Contact prescriber and report symptoms
B. Delay the dose so the drug can clear from the receptor sites
C. Give the meds as ordered because the dose is correct
D. Request anti nausea meds from the prescriber
A
Contact the prescriber and report symptoms
20
Q
A nurse administers the same medication in the same preparation in the same dose to several pts and notes that some pts have better response to the drug than others. What is most likely that explanation for this phenomenon?
A. Altered bioavailability of the drug
B. Pt compliance with the therapeutic regimen
C. Pharmacogenomic differences among individuals
D. Placebo effects enhancing expectations of drug efficacy
A
Pharmacokinetic differences among individuals
21
Q
The US Food and Drug Administration recommends genetic testing of pts receiving certain meds. Genetic testing helps prescribers:
A. Better establish a drugs index
B. Determine whether a pt is a rapid or slow metabolized of this drug
C. Identify racial characteristics that affect psychosocial variation in drug response
D. Produce a drug that is tailored to an individual pts genetic makeup
A
Determine whether a pt is a rapid or slow metabolizer of this drug
22
Q
What is a desired outcome when a drug is easy to administer?
A. It enhances pt adherence to the drug regimen
B. It is usually relatively inexpensive to produce
C. It can be stored indefinitely without the need for refrigeration
D. It does not interact significantly with other medications
A
It enhances pt adherence to the drug regimen
23
Q
The nurse is caring for a child who has ingested a toxic amount of asprin. The provider orders an IV drug that will increase pH in the blood and urine. The nurse understands that this effect is necessary to:
A. Decrease lipid solubility of aspirin
B. Increase the serum protein binding of aspirin
C. Increase urinary excretion of aspirin
D. Decrease gastric absorption of aspirin
A
Increase the urinary excretion of aspirin
24
Q
A pt is reciving IV gentamicin. A serum drug test reveals toxic levels. The dosing is correct, and this med has been tolerated by the pt in the past, which could be a probable cause of the test result?
A. A loading dose was not given
B. The drug was not completely dissolved in the IV solution
C. The pt is taking another med that binds to serum albumin
D. The med is being given at a frequency that is longer than the half life
A
The pt is taking another med that binds to serum albumin
25
What occurs when a drug binds to a receptor in the body?
A. It increases or decreases the activity of the receptor
B. It give the receptor a new function
C. It prevents the action of the receptor by altering its response to chemical mediators
D, it alters the receptor to become non responsive to its usual endogenous molecules
It increases or decreases the activity of the receptor
26
Two nurses are discussing theories of drug-receptor interaction. Which statements are true regarding the affinity of a drug and its receptor? (Select all that apply)
A. Drugs with low affinity are strongly attracted to their receptors
B. Drugs with high affinity are strongly attracted to their receptors
C. Affinity refers to the strength of the attraction between a drug and its receptor
D. The affinity of a drug for its receptor is reflected in its potency
E. Affinity and intrinsic activity are dependent properties
Drugs with high affinity are strongly attracted to their receptors
Affinity refers to the strength of the attraction between a drug and its receptor
The affinity of a drug for its receptor is reflected in its potency
27
A child ingests a parent’s aspirin tablets, and the prescriber orders sodium bicarbonate to block the toxic effects of the aspirin. The nurse caring for this patient knows that sodium bicarbonate is effective against the aspirin because it:
A. accelerates its passage through the intestine
B. induces CYP isoenzymes to increase drug metabolism.
C. alters urinary pH to enhance renal excretion
D. raises the pH of the interstitial fluid to facilitate passage out of the cells.
Raises the pH of the interstitial fluid to facilitate passage
28
Which statement about food and drug interactions is true?
a.
Foods alter drug absorption and metabolism but not drug action.
b.
Patient discomfort is the food and drug interaction of most concern.
c.
Some foods, such as grapefruit, can inhibit CYP isoenzymes and alter drug metabolism
d.
Medications are best absorbed on an empty stomach.
Some foods such as grapefruit can inhibit CYP isoenzymes and alter drug metabolism
29
A nurse is teaching a patient about a drug that induces P-glycoprotein. The nurse will explain that this drug may cause which effect on other drugs?
Select one:
a.
Increased elimination through the kidneys
b.
Increased brain exposure
c.
Increased absorption in the intestines
d.
Increased fetal absorption
Increase elimination through the kidney
30
The nurse is administering morning medications. The nurse gives a patient multiple medications, two of which compete for plasma albumin receptor sites. As a result of this concurrent administration, the nurse can anticipate that what might occur? (Select all that apply.)
Select one or more:
a.
The increase in free drug will intensify effects.
b.
Plasma levels of free drug will fall.
c.
Plasma levels of free drug will rise.
d.
Binding of one or both agents will be reduced.
e.
The increase in bound drug will intensify effects.
The increase in free drug will intensify effects
Plasma levels of free drug will rise
Binding of one or both agents will be reduced
31
A nursing student is preparing to give a medication that has a "High Alert" or "Black Boxed Warning". The student asks the nurse what this means. What will the nurse explain about boxed warnings?
Select one:
a.
They provide detailed information about the adverse effects of the drug.
b.
They alert prescribers to measures to mitigate potential harm from side effects.
c.
They provide information about antidotes in the event that toxicity occurs.
d.
They indicate that a drug should not be given except in life-threatening circumstances.
They alert prescribers to measure to mitigate potential harm from side effects
32
A postoperative patient who is worried about pain control will be discharged several days after surgery. The nurse providing discharge teaching tells the patient that the prescribed Lortab is not as strong as the morphine the patient was given in the immediate postoperative period. Which response is the patient likely to experience?
Select one:
a.
Optimistic, realistic expectations about the drug
b.
An increased compliance with the drug regimen
c.
A negative placebo effect when taking the medication
d.
A decreased likelihood of filling the prescriptio
A negative placebo effect when taking the medication
33
The U.S. Food and Drug Administration (FDA) recommends genetic testing of patients receiving certain medications. Genetic testing helps prescribers:
Select one:
a.
determine whether a patient is a rapid or slow metabolizer of the drug.
b.
identify racial characteristics that affect psychosocial variation in drug response.
c.
better establish a drug’s therapeutic index.
d.
produce a drug that is tailored to an individual patient’s genetic makeup.
Determine if the pt is a rapid or slow metabolizer of the drug
34
Which groups of people are especially sensitive to medication effects? (Select all that apply.)
Select one or more:
a.
Women
b.
Caucasians
c.
Minorities
d.
Infants
e.
Older Adults
Infants
Older adults
35
Before administering a medication, what does the nurse need to know to evaluate how individual patient variability might affect the patient’s physiologic response to the medication? (Select all that apply.)
Select one or more:
a.
Ease of administration
b.
Chemical stability of the medication
c.
Family medical history
d.
Patient’s age
Pt age
Pt diagnosis
Family medical history
36
The nurse receives an order to give morphine 5 mg IV every 2 hours PRN pain. Which action is not part of the six rights of drug administration?
Select one:
a.
Assessing the patient’s pain level 15 to 30 minutes after giving the medication
b.
Consulting a drug manual to determine whether the amount the prescriber ordered is appropriate
c.
Checking the medication administration record to see when the last dose was administered
d.
Documenting the reason the medication was given in the patient’s electronic medical record
Assessing the pt pain level 15-30 min after giving the medication
37
A nurse is preparing to administer medications. Which patient would the nurse consider to have the greatest predisposition to an adverse reaction?
Select one:
a.
A 50-year-old man with an upper respiratory tract infection
b.
A 9-year-old boy with an ear infection
c.
A 75-year-old woman with cystitis
d.
A 30-year-old man with kidney disease
A 30 yo man with kidney disease
38
Patient is ordered ibuprofen 200 mg, you have enteric-coated tablets, but patient says she can't swallow the pills. What does the RN do?
Select one:
a.
Call the pharmacy and ask for the liquid form of the medication.
b.
Encourage the patient to try to swallow the tablets.
c.
Call the pharmacy and ask for the IM form of the medication.
d.
Crush the tablets and mix them with applesauce or pudding.
Call the pharmacy and ask for a liquid form of the medication
39
A patient receives a drug that has a narrow therapeutic range. The nurse administering this medication will expect to do what?
Select one:
a.
Monitor plasma drug levels.
b.
Administer the drug at intervals longer than the drug half-life.
c.
Administer this medication intravenously.
d.
Teach the patient that maximum drug effects will occur within a short period.
Monitor plasma drug levels
40
The nurse is preparing to administer penicillin G intramuscularly to a child. The child’s parents ask why the drug cannot be given in an oral liquid form. What is the nurse’s reply?
Select one:
a.
“This drug has a narrow therapeutic range, and the dose must be tightly controlled.”
b.
“This drug would be inactivated by enzymes in the stomach.”
c.
“This drug causes severe gastric upset if given orally.”
d.
“This drug is absorbed much too quickly in an oral form.”
The drug would be inactivated by enzymes in the stomach
41
The nurse is teaching a patient about home administration of insulin to treat diabetes mellitus. As part of the teaching, the patient and nurse identify goals to maintain specific blood glucose ranges. This represents which aspect of the nursing process?
a.
Assessment
b.
Implementation
c.
Evaluation
d.
Planning
Planning
42
A nurse instructs a parent about the administration schedule for Aderall XR (amphetamine/dextroamphetamine mix) to treat the child’s ADHD. The nurse determines that teaching is sucsessful if the parent makes what statement?
A. The drug will be given in the morning before school
B. I will ask the school nurse to administer the drug at lunchtime
C. The best time to give the medication is at bedtime
D. The medicine should be taken 1 hour before a meal
The drug will be given in the morning before school
43
Before giving lithium to a pt. It is most important to assess which lab value?
A. Blood sugar
B. Sodium
C. Urine osmolality
D. Hematocrit
Sodium
- lithium may be toxic to pt with hyponatremia. The sodium level should be assessed in pts reciving lithium to prevent toxicity
44
When pts are taking selective SSRIs for the first time for depression, which is most important to monitor for during the first few weeks?
A. hypertensive crisis
B. Suicidal thoughts
C. Convulsions
D. Orthostatic hypotension
Suicidal thoughts
- some studies have shown higher risk for suicide during the first few weeks of antidepressant therapy
45
When providing teaching for a pt who is prescribed a selective SSRI, which statement will the nurse include?
It may take several weeks to see the therapeutic effects of SSRIs
46
A pt is admitted to the ER with a HR of 112 beats/min. He is sweating and has muscles tenors and is agitated. The pt says, “I was depressed and took more of the pills the doctor gave me so i would feel better.?
1. What does the nurse suspect is happening?
2. What treatments does the nurse expect to implement?
1. Serotonin syndrome
2. discontinue SSRIs and support pt to maintain homeostasis
47
It usually take _____ weeks before you will experience benefits from SSRIs
4-6 weeks
48
Taper discontinuation of SSRIs over the course of _____ months to prevent adverse effects.
1-2 months
49
ADR of SSRIs include…
GI upset, take with food
Sleep disturbances, take in the morning
Worsening depression
50
When monitoring a pt who is taking a low-dose cholinergic, the nurse will monitor for which cardiovascular effect?
Bradycardia
51
When a pt is taking an adrenergic drug, the nurse expects to observe which effect?
Increased HR
52
When pts are taking selective SSRIs for the first time for depression, which is most important to monitor for during the first few weeks?
Suicidal thoughts
53
Which of the following are functions that are primarily regulated by the parasympathetic NS?
A. Body temp
B. Digestive functions
C. Fight or flight response
D. Cardiovascular system
Digestive functions
54
Catecholamines… (select all that apply)
A. … cannot cross the BBB
B. … are metabolized slowly
C. … must be given by parenteral route
D. … are commonly given by enteral route
E. … are cholinergic in their effects
Catecholamines… cannot cross the BBB, and must be given by parenteral route
55
A pt is receiving Inteferon Beta for MS. As the nurse you will stress the importance of
Hand hygiene to avoid infection
56
Adrenergic drugs cause relaxation of the bronchi and bronchodilation by stimulating which type of receptor
Beta 2
57
A nurse is caring for an intubated pt who is receiving pancuranium (Pavulon) for neuromuscular blockade. The pts eyes are closed and is not moving any extremities. The HR is 76 and BP is 110/70. The nurse will do what?
Talk to the pt while giving care and explain all procedures
58
A pt is taking a first gen antipsychotic (FGA) for schizophrenia. The nurse note that the pt has trouble speaking and chewing and observes slow, worm like movements of the tongue. The nurse recognized which adverse effect in this pt
Tardive dyskinesia
59
A nurse recognizes that the actions of benzodiazepines include which findings? (Select all that apply)
A. Relief of general anxiety
B. Development of tardive dyskinesia
C. Suppression of seizures and/or seizure activity
D. Increase muscle spasms
Relive general anxiety
Suppress seizures/seizure activity
60
The nurse is aware that adrenergic drugs produce effects similar to which nervous system?
Sympathetic nervous system
61
A drug that is used for nerve pain (nueuropathy) that is also used as an anti-epileptic agent is
Carbamazepine (tegretol)
Gabapentin (neurontin)
62
Benign prostatic hypertrophy (BPH) symptoms are treated with an adrenergic antagonist such as tamsulosin (flow max) because:
These agents block alpha 1 receptors to reduce contraction of smooth muscle in the bladder neck and prostatic capsule
63
When administering an alpha antagonist for the first time, it is most important for the nurse to assess the patient for the development of what adverse effect?
Hypotension
64
Dopamine is administered to a pt who has been experiencing hypotensive crisis episodes. Other than an increase in BP, which indicator would the nurse use to evaluate a successful response to dopamine?
Increase urine output
65
Your pt is taking levodopa (dopar), and you have been conducting an analysis of the pts diet. You find that she eats three times the recommended amount of protein at each meal. Your best response is
Too much dietary protein can make levodopa less effective
66
A pt is to begin taking phenytoin (Dilantin) for seizures. The pt tells the nurse that she is taking oral contraceptives. What will the nurse tell the pt?
Consider a different form of birth control (condoms, IUD) while taking phenytoin
67
You are working near a war zone and are taking care of a soldier who has been given an irreversible cholinesterase inhibitor during warfare. What action would be best to do first in this situation?
Give the atropine dose that has been ordered
68
The mechanism of action for carbidopa (lodosyn), used in the treatment of Parkinson’s disease is:
Increase availability of levodopa available to the CNS by reducing its breakdown
69
A nurse is teaching parents of a child who has attention-deficit/hyperactivity disorder about methylphenidate (concerta), which statement by the parents indicate understanding of the teaching?
The tablet needs to be swallowed whole, not chewed or crushed
70
A pt has received an IV dose of adenosine, and almost immediately the heart monitor shows asystole. What should the nurse do next?
Continue to monitor the pt.
- the half life of adenosine is fast, lasting 10 seconds. Asystole only last a few seconds. The nurse should continue to monitor the pt for therapeutic and adverse effects of the meds
71
A pt in the ER with an unspecified supraventricular dysrythmia is ordered a dose of diltiazem (cardizem) IV push. While the nurse administers the medication through the IV lock, the pt feel something wet spilling on her arm. Her HR is unchanged, what will the nurse do?
Check the IV lock to see if it is functioning properly
- because her HR is unchanged and the pt feels fluid on her arm, the IV lock is probably not working properly. Before anything else is done, the IV lock should be checked for proper functioning. Another dose would be wasted if the IV lock is not working.
72
A pt is receiving oral quinidine. Which assessment findings is of most concern?
Prolonged QT interval
- pts taking quinidine need to be monitored for prolonged QRS and QT intervals, which may be a precursor to more serious dysrhythmia problems
73
A pt is receiving a IV infusion of heparin to treat PE. What lab value will the nurse monitor to evaluate treatment with this medication?
Activated partial thromboplastn time (aPTT)
- the most commonly used lab to monitor the effect of heparin is aPTT
74
Which pt does the nurse identify as most likely needing an increased dose of warfarin (Coumadin) to have the same anticoagulant effect?
A. Pt taking Tylenol for back pain
B. Pt taking cimetidine (Tagamet) to prevent gastric ulcers
C. Pt taking oral contraceptives to prevent pregnancy
D. Pt taking prednisone (deltasone) to for rheumatoid arthritis
Pt taking oral contraceptives
- oral contraceptives decrease the effects of warfarin; therefore, warfarin dose may need to be increased. Acetaminophen and cimetidine increase the effects of warfarin. Prednisone increases the risk of bleeding
75
What is the antidote for heparin
Protamine sulfate
76
During administration of alteplase (activase), the pts IV site starts to ooze blood around the catheter. Which action by the nurse is most appropriate?
Apply direct pressure over the puncture site
- alteplase may cause bleeding, and management depends on severity. Oozing at sites of cutaneous puncture can be controlled with direct pressure or a pressure dressing. If severe bleeding occurs, alteplase should be discontinued. Excessive fibriolysis can be reversed with IV aminocapric acid (amicar), a compound that prevents activation of plasminogen and directly inhibits plasmin.
77
A pt asks how to apply transdermal nitroglycerin, what is the nurses best response?
Apply the patch to hairless areas of the body
78
A pt with angina pectoris is prescribed sublingual nitroglycerin. Which statement made by the pt indicates understanding of the meds?
I may experience a headache as a side effect
- headache is a common side effect of nitroglycerin and is due to vasodilation. If chest pain is not relieved in 5 min, call 911. A sublingual tablet should be placed under the tongue and allowed to dissolve. Sublingual nitroglycerin is used to abort angina attacks and is not a schedule med
79
A pt is prescribed SR oral nitroglycerin capsules for chronic stable angina. The nurse should include which instruction?
Sit or lie down if dizziness or lightheadedness occurs
- pts taking nitroglycerin should be instructed about symptoms of hypotension (dizziness, lightheadeded) and advised to sit or lie down if these occur. Pts should avoid overexertion but should be encouraged to establish a regular program of aerobic exercise. SR nitroglycerin should be swallowed, not placed under the tongue. SR nitroglycerin is prescribed 1-4 times daily, not PRN
80
The nurse teaches a pt diagnosed which chronic stable angina about the mechanism of action of nitroglycerin. The nurse should include which statement?
Nitroglycerin dialates the veins, which decreases the amount of oxygen needed by the heart
- nitroglycerin dilates veins, which decreases venous return, which decreases preload, which decreases oxygen demand
81
The nurse is obtaining a med history on a pt presenting with chest pain. What drug classification would necessitate the nurse informing the provider before beginning the prescribed nitroglycerin?
Phosphodiesterase inhibitor (erectile dysfunction medication)
- phosphodiesterase inhibitor is a potent vasodilator
82
A pt is mowing his lawn on a hot day. He begins to notice chest pain, what should his first action be?
Stop mowing and sit or lie down
- the first action is to sit or lie down before taking a nitroglycerin tablet
83
A pt with extremely high BP is in the ER. The physician will order therapy with nitroglycerin to manage the pts BP. Which form of nitroglycerin is most appropriate?
IV infusion
- IV will have the fastest effect, and the dose can be tilt rated to the pts response
84
A pt with a known history of angina was walking his dog and developed chest pain. The pt immediately stops walking and sits down. He continues to experience chest pain when sitting down. When should he call 911?
If one sublingual tablet does not relive the pain after 5 min
- with sublingual nitroglycerin, the med should be taken at the first sign of chest pain and not delayed if the pain is severe. The pt should sit or lie down and take one sublingual tablet. If chest pain and discomfort id not relieved in 5 min after 1 dose, the pt should call 911. The pt can take another dose while waiting for emergency care and a third tablet 5 min after, but no more than 3 tablets in total. Angina pain that does not respond to nitroglycerin may indicate MI
85
A pt with a new prescription for HMG-CoA (statin) is instructed to take the med with his evening meal or at bedtime. The pt asks why it must be taken at this time. What is the nurses best response?
This timeframe correlated better with the natural diurnal rhythm of cholesterol production
86
A pt has been ordered the powdered form of bile acid sequestrant colestpol. Which of the following does the nurse identify as true?
A. The nurse should have the pt swallow the dose of colestipol powder one tsp at a time
B. The powder should be dissolved and immediately administered
C. The colestipol should be administered 1 hr before and 4-6 hrs after any other oral medication
D. The colestipol should be administered with meals
The colestipol should be administered 1 hr before and 4-6 hrs after any other oral med
- this time frame is important because of the high risk for drug-drug and drug-food interactions. The powder should be dissolved for 1 full min before administration and not taken in the dry form
87
A pt is taking niacin as part of antilipemic therapy. What is the best way to avoid problems with flushing or pruritis?
Start with a low dose and then increase it gradually
-cutaneous flushing may be minimized if the niacin is started at a smaller dose and gradually increased. Premedication with an small dose of aspirin or NSAID 30 mins before taking niacin as well as taking it with meals may help minimize these undesirable effects
88
A pt wants to take garlic tabs to improve his cholesterol levels. Which condition would be a contraindication?
A. Hypertension
B. Bowel obstruction
C. Sinus infection
D. Scheduled surgery
Scheduled surgery
- garlic has antiplatelet activity and is contraindicated in pts undergoing surgery within 2 weeks or those with immunodeficiency virus, infection, or disease
89
What pt history would the nurse recognize as a contraindication for beginning niacin therapy?
Gout
- withy niacin, pt assessment include noting contraindications such as liver disease, peptic ulcer disease, gout, hypertension, and active bleeding.
90
A pt is prescribed lovostatin (mevacopr). The nurse will teach the pt to take the med at what time?
With the evening meal
- lovastatin should be taken with the evening meal to increased absorption. Cholesterol synthesis normally increases during the nigh; statins ate most effective when given in the evening
91
The nurse will teach a pt who is prescribes niacin (niacor) to prevent flushing by doing what?
A. Drinking water with the med
B. Taking 325 mg of aspirin 30 min before each dose
C. Eat before administration
D. Increase dietary fiber before and after each dose
Taking 325 mg of aspirin 30 mins before each dose
- aspirin reduces flushing by preventing the synthesis of prostaglandins, which mediate the flushing response
92
Cholestryamine has been prescribed for a pt. Which instructions should the nurse include in pt teaching?
A. Cholestyramine can impair absorption of fat-solvable vitamins (ADEK)
B. Stop taking drug if constipation occurs
C. Take drug with other drugs to enhance abosorption
D. Do not take meds if formula is cloudy after mixing with water
Cholestyamine can impair the absorption of fat-solvable vitamins (ADEK)
-this drug is a bile acid sequenstrant. It can impair the absorption of fat solvable vitamins (ADEK) and supplements may be required. It may cause constipation, effects can be minimized by increasing dietary fiber and water. A mild laxative may be used if needed. Notify provider if constipation becomes bothersome. This drug can bind with other drugs and prevent absorption, administer other meds 1 hr before or 4 hrs after cholerstyamine. Powder should be mixed with water, juice, or pulpy fruits (applesauce) to prevent esophageal irritation. Powder is not water solvable so mixture will be cloudy.
93
A patient with angina is being discharged with a prescription for nitroglycerin sublingual tablets. Which instruction should the nurse include?
Select one:
a.
"Effects of sublingual nitroglycerin begin in 10-15 minutes.
b.
“The tablets are only good for 1 month after the container is opened.”
c.
“Sublingual nitroglycerin tablets are also effective when swallowed whole.”
d.
“Store the tablets in the original container and tightly close it after use.”
Store tabs in the original container and tightly close it after use
94
The nurse is overseeing a nursing student who is administering medications to a group of clients receiving treatment for pulmonary embolism. The nurse recognizes the student understands safety and administration of anticoagulant therapy when the student makes which of these statements?
Select one:
a.
“Therapy with warfarin (Coumadin) is effective when the INR is between 2 and 3.”
b.
“If bleeding develops, we will give platelets to reverse the anticoagulant.”
c.
“Once the health care provider orders warfarin (Coumadin), the intravenous heparin can be discontinued.”
d.
“The client will receive a dose of enoxaparin (Lovenox) intramuscularly for 3 days.”
Therapy with warfarin (Coumadin) is effective when the INR is between 2 and 3
- The nursing student correctly understands safety and effectiveness of Coumadin therapy when the student states that the international normalized ratio or INR reflects a therapeutic level when between 2 and 3. The INR is the diagnostic test used to measure effectiveness of anticoagulation with warfarin. Subtherapeutic levels below 2 pose a risk for clots to develop; values above 3 pose a risk for bleeding.
Enoxaparin (Lovenox) is a low-molecular-weight heparin that is given by the subcutaneous, not intramuscular route. Heparin and warfarin are overlapped until the INR is in the therapeutic range, then the heparin can be discontinued. Fresh-frozen plasma is used as an antidote for anticoagulant therapy, not platelets.
95
The nurse is caring for a patient with atrial fibrillation (AF). In addition to an antidysrhythmic, what medication does the nurse plan to administer?
Select one:
a.
Magnesium sulfate
b.
Heparin
c.
Atropine
d.
Dobutamine
Heparin
- The nurse plans to administer heparin in addition to the antidysrhythmic. AF is the loss of coordinated atrial contractions that can lead to pooling of blood, resulting in thrombus formation. The patient is at high risk for pulmonary and systemic embolism. Heparin and other anticoagulants (e.g., enoxaparin [Lovenox], warfarin [Coumadin], and novel oral anticoagualants, when nonvalvular, such as dabigatran [Pradaxa], rivaroxaban [Xarelto], apixaban [Eliquis], or edoxaban [Savaysa]) are used to prevent thrombus development in the atrium, leading to the risk of embolization (i.e., stroke).
Atropine is used to treat bradycardia and not rapid heart rate associated with AF. Dobutamine is an inotropic agent used to improve cardiac output; it may cause tachycardia, thereby worsening atrial fibrillation. Although electrolyte levels are monitored in clients with dysrhythmia, magnesium sulfate is not used unless depletion is noted
96
A client on anticoagulant therapy is being discharged. Which statement by the client indicates an understanding of the anticoagulants drug action?
Select one:
a.
“It should prevent my blood from clotting.”
b.
“It will make my blood less sticky".
c.
“It is used to dissolve blood clots.”
d.
“It might cause me to get injured more often.”
It should prevent my blood from clotting
- The statement that shows the client understands anticoagulant drug action is, “it will prevent my blood from clotting.” Anticoagulants work by interfering with one or more steps involved in the blood clotting cascade. Thus, these agents prevent new clots from forming and limit or prevent extension of formed clots.
Anticoagulants do not cause any change in the thickness or viscosity of the blood.
Anticoagulants do not dissolve clots, fibrinolytics do. Anticoagulants do not cause more injuries but may cause more bleeding and bruising when the client is injured.
97
A nurse prepares to administer a scheduled dose of digoxin. The nurse finds a new laboratory report showing a plasma digoxin level of 0.7 ng/mL. What action should the nurse take?
Select one:
a.
Administer Digibind to counteract the toxicity.
b.
Check the patient’s apical pulse, and if it is within a safe range, administer the digoxin
c.
Withhold the drug for an hour and reassess the level.
d.
Withhold the drug and notify the prescriber immediately
Check the pts apical pulse, and if it is within a safe range, administer the digoxin
98
Intravenous heparin therapy is prescribed for a client. While implementing this prescription, the nurse ensures that which medication is available on the nursing unit?
Select one:
a.
Protamine sulfate
b.
Potassium chloride
c.
Aminocaproic acid
d.
Vitamin K
Protamine sulfate
- The antidote to heparin is protamine sulfate; it should be readily available for use if excessive bleeding or hemorrhage should occur. Vitamin K is an antidote for warfarin sodium. Potassium chloride is administered for a potassium deficit. Aminocaproic acid is the antidote for thrombolytic therapy.
99
A patient with chronic congestive heart failure has repeated hospitalizations in spite of ongoing treatment with hydrochlorothiazide [HydroDIURIL] (diuretic). The prescriber has ordered spironolactone [Aldactone] (diuretic) to be added to this patient’s drug regimen, and the nurse provides education about this medication. Which statement by the patient is correct?
Select one:
a.
“I can expect improvement within a few hours after taking this drug.”
b.
“I should watch closely for dehydration.”
c.
“I should use salt substitutes to prevent toxic side effects.”
d.
“I need to stop taking potassium supplements.”
I need to stop taking potassium supplements
100
Prior to administering a client's daily dose of digoxin, the nurse reviews the client's laboratory data and notes the following results:
serum calcium 10 mg/dL
serum magnesium 2.0 mEq/L
serum potassium 3.3 mEq/L
serum creatinine 0.9 mg/dL
Which result should alert the nurse that the client is at risk for digoxin toxicity?
Select one:
a.
Serum magnesium level
b.
Serum creatinine level
c.
Serum potassium level
d.
Serum calcium level
Serum potassium
- An increased risk of toxicity exists in clients with hypercalcemia, hypokalemia, hypomagnesemia, hypothyroidism, and impaired renal function. The calcium, creatinine, and Magnesium levels are all within normal limits. The normal range for potassium is 3.5 to 5.1 mEq/L and the results in the correct option are reflective of hypokalemia
101
During therapy with a beta blocker, the patient notices that she has swollen feet, has gained 3 pounds within 2 days, feels short of breath even when walking around the house, and has been dizzy. The nurse suspects that which of these is occurring?
Select one:
a.
The patient is experiencing an allergic reaction.
b.
More time is needed for the patient to see a therapeutic response to the drug.
c.
The patient is experiencing expected adverse effects of the drug.
d.
The patient may be developing heart failure
The pt may be developing heart failure
102
A nurse administers quinidine sulfate to a patient with atrial fibrillation. The nurse should assess the electrocardiogram (ECG) tracing knowing that quinidine sulfate has what effect on the ECG?
Select one or more:
a.
Narrowing of the QRS complex
b.
Tall, peaked T waves
c.
Prolongation of the PR interval
d.
Prolongation of the QT interval
Prolongation of the QT interval
- Quinidine sulfate has two pronounced effects on the electrocardiogram (ECG): it widens the QRS complex and prolongs the QT interval.
103
A client with diarrhea for 3 days and inability to eat or drink well is brought to the emergency department (ED) by her family. She states she has been taking her diuretics for congestive heart failure (CHF). What nursing actions are indicated at this time? (Select all that apply.)
Select one or more:
a.
Administer the ordered diuretic.
b.
Assess for orthostatic hypotension.
c.
Initiate cardiac monitoring
d.
Evaluate the electrolyte levels.
e.
Place the client on bed rest.
Place client on bed rest
Evaluate electrolyte levels
Assess for orthostatic hypotension
Initiate cardiac monitoring
- Nursing actions indicated at this time include: placing the client on bedrest and assisting the client out of bed, evaluating electrolyte levels, assessing for orthostatic hypotension, and applying a cardiac monitor. Safety is required to prevent falls due to weakness from a likely fluid volume deficit and electrolyte imbalance. The nurse should review the laboratory and diagnostic results to detect likely loss of sodium, potassium, and magnesium secondary to diarrhea and diuretic us. Fluid volume deficit is likely with diarrhea and diuretic use and leads to fluid and electrolyte imbalances, especially hypokalemia. Assessing for orthostatic changes will confirm presence of volume deficit. Monitoring for inverted T wave or presence of U wave on the ECG as well as dysrhythmias is indicated when hypokalemia is anticipated.
Diuretics increase loss of fluids and electrolytes. The nurse would question this order in the presence of assessment data indicating fluid loss from the diuretics and diarrhea.
104
A patient with a new prescription for a HMG-CoA (statin) drug is instructed to take the medication with the evening meal or at bedtime. The patient asks why it must be taken at this time of day. What is the nurses’ best response?
Select one:
a.
“The medication is better absorbed at this time.”
b.
“There will be fewer adverse effects if taken at night instead of with the morning meal.”
c.
“This timeframe correlates better with the natural diurnal rhythm of cholesterol production.”
d.
“This timing reduces the incidence of myopathy
This timeframe correlates better with the natural diurnal Rothy’s of cholesterol production
105
A patient with a history of heart failure and hypertension is in the clinic for a follow-up visit. The patient is on lisinopril (Prinivil) and warfarin (Coumadin). The patient reports new-onset cough. What action by the nurse is most appropriate initial intervention?
Select one:
a.
Instruct the patient on another antihypertensive.
b.
Assess the patient’s lung sounds and oxygenation.
c.
Obtain a set of vital signs and document them.
d.
Remind the patient that cough is a side effect of Prinivil.
Asses the pts lung sounds and oxygenation
- This patient could be having an exacerbation of heart failure or experiencing a side effect of lisinopril (and other angiotensin-converting enzyme inhibitors). The nurse would assess the patient’s lung sounds and other signs of oxygenation first. The patient may or may not need to switch antihypertensive medications. Vital signs and documentation are important, but the nurse would assess the respiratory system first. If the cough turns out to be a side effect, reminding the patient is appropriate, but then more action needs to be taken.
106
The prescriber’s order says to administered the diuretic Lasix 40 mg IV twice a day. The patient has bilateral lower extremity edema and complains of leg pain. The patient has the following morning labs: Na+ 148, K+ 2.9, and BUN 10. Which of the following is a nursing priority?
Select one:
a.
Notify the prescriber of the Na+ level
b.
Administer Lasix as ordered
c.
Assess the patient's lung sounds
d.
Hold the Lasix dose and notify the prescriber of the potassium level
Hold the lasix dose and notify the prescriber of the potassium level
107
A nurse assesses a patient after administering a prescribed beta-blocker. Which assessment would the nurse expect to find?
Select one:
a.
Respiratory rate decreased from 25 to 14 breaths/min
b.
Oxygen saturation increased from 88% to 96%
c.
Pulse decreased from 100 to 80 beats/min
d.
Blood pressure increased from 98/42 to 132/60 mm Hg
Pulse decreased from 100 to 80 beats/min
108
A patient has a long history of hypertension. Which category of medications would the nurse expect to be ordered to avoid chronic kidney disease (CKD)?
Select one:
a.
Angiotensin-converting enzyme (ACE) inhibitor
b.
Antibiotic
c.
Histamine blocker
d.
Bronchodilator
ACE inhibitor
- ACE inhibitors stop the conversion of angiotensin I to the vasoconstrictor angiotensin II. This category of medication also blocks bradykinin and prostaglandin, increases renin, and decreases aldosterone, which promotes vasodilation and perfusion to the kidney. Antibiotics fight infection, histamine blockers decrease inflammation, and bronchodilators increase the size of the bronchi; none of these medications helps slow the progression of CKD in patients with hypertension.
109
Loop diuretics have all of the following potential adverse effects except:
Select one:
a.
Hyponatremia
b.
Hypokalemia
c.
Urinary Retention
d.
Hypotension
Urinary retention
110
A patient is admitted with severe hypertensive crisis(220/110 mm Hg). The nurse will anticipate administering which medication?
Select one:
a.
Minoxidil (Loniten)20 mg PO
b.
Captopril(Captopen) PO
c.
Sodium nitroprusside [Nitropress] IV
d.
Hydralazine [Apresoline] 25 mg PO
Sodium nitroprusside (nitropress) IV
111
A client with a clot in the right atrium is receiving a heparin sodium infusion at 1000 units/hour and warfarin sodium 7.5 mg at 5:00 p.m. daily. The morning laboratory results are as follows: activated partial thromboplastin time (aPTT), 32 seconds; international normalized ratio (INR), 1.3. The nurse should take which action based on the client's laboratory results?
Select one:
a.
Collaborate with the HCP to withhold the warfarin sodium since the client is receiving a heparin infusion and the aPTT is within the therapeutic range.
b.
Collaborate with the health care provider (HCP) to discontinue the heparin infusion and administer the warfarin sodium as prescribed.
c.
Collaborate with the HCP to continue the heparin infusion at the same rate and to discuss use of dabigatran (Pradaxa) in place of warfarin sodium.
d.
Collaborate with the HCP to obtain a prescription to increase the heparin infusion and administer the warfarin sodium as prescribed.
Collaborate with the provider to obtain a prescription to increase the heparin infusion and administer the warfarin sodium as prescribed
- When a client is receiving warfarin for clot prevention due to atrial fibrillation, an INR of 2 to 3 is appropriate for most clients. Until the INR has achieved a therapeutic range, the client should be maintained on a continuous heparin infusion with the aPTT ranging between 60 and 80 seconds. Therefore, the nurse should collaborate with the HCP to obtain a prescription to increase the heparin infusion and to administer the warfarin as prescribed.
112
The nurse is caring for a client who is receiving a loop diuretic for treatment of heart failure. Which of these actions will be included in the plan of care? (Select all that apply.)
Select one or more:
a.
Assess daily weights.
b.
Monitor serum potassium.
c.
Encourage consumption of citrus fruits and greens.
d.
Weigh the client weekly.
Assess daily weight
Encourage consumption of fruits and greens
Monitor serum potassium
- Actions for the nurse to include when caring for a client taking a loop diuretic for heart failure include: assessing daily weights, encouraging consumption of citrus fruits, and monitoring the client’s serum potassium. High-ceiling (loop) diuretics remove excess fluid and are potassium-depleting drugs. Consuming citrus fruit, green leafy vegetables, cantaloupe, tomato, and other food with potassium is indicated while receiving this type of diuretic to compensate for urinary loss of potassium.
The client must be weighed at the same time each day, using the same scale and wearing approximately the same amount of clothes. Green leafy vegetables such as spinach contain potassium and are encouraged. The diuretic itself has no effect on the heart rate, however potassium depletion caused by the diuretic may cause cardiac irritability with a weak and thready pulse.
113
A nurse and a nursing student are reviewing the care of a 30-kg patient who will receive intravenous aminophylline. Which statement by the student indicates an understanding of the administration of this medication?
Select one:
a.
“Theophylline works by reducing the inflammatory response and mucus production"
b.
"Serum theophylline levels should be maintained between 30-40mcg/dl.”
c.
“If the patient’s serum theophylline level is less than 15 mcg/mL, the rate should be reduced.”
d.
“Dosing is titrated based on the serum theophylline levels.”
Dosing is based on the serum theophylline levels
114
A patient with asthma will be using a metered-dose inhaler (MDI) for delivery of an inhaled medication. The provider has ordered 2 puffs to be given twice daily. It is important for the nurse to teach this patient that:
Select one:
a.
the patient should store the MDI in the refrigerator between doses.
b.
the patient should inhale suddenly to receive the maximum dose
c.
the patient should activate the device and then inhale.
d.
the patient should wait 1 minute between puffs.
The pt should wait 1 min between puffs
115
A nurse administers medications to a patient who has asthma. Which medication classification is paired correctly with its physiologic response to the medication?
Select one:
a.
Cholinergic antagonist—causes bronchodilation by inhibiting the parasympathetic nervous system
b.
Corticosteroid (Glucocorticoid)—relaxes bronchiolar smooth muscles by binding to and activating pulmonary beta2 receptors
c.
Cromolyn—disrupts the production of pathways of inflammatory mediators
d.
Bronchodilator—stabilizes the membranes of mast cells and prevents the release of inflammatory mediators
Cholinergic antagonist—caused bronchodilation by inhibiting the parasympathetic nervous system
116
A patient who has been newly diagnosed with asthma is referred to an asthma clinic. The patient reports daily symptoms requiring short-acting beta2-agonist treatments for relief. The patient has used oral glucocorticoids three times in the past 3 months and reports awakening at night with symptoms about once a week. The nurse will expect this patient to be started on which regimen?
Select one:
a.
Continue current medication regimen as is
b.
Daily low-dose inhaled glucocorticoid/LABA with a SABA as needed
c.
No daily medications; just a SABA as needed
Daily low dose inhaled glucocorticoid/LABA with a SABA as needed
117
A nurse is teaching a client who has a prescription for long‑term use of oral prednisone for treatment of chronic asthma. The nurse should instruct the client to monitor for which of the following manifestations as an adverse effect of this medication?
Select one:
a.
Nervousness
b.
Bradycardia
c.
Hyperglycemia
d.
Constipation
Hyperglycemia
118
A patient with persistent, frequent asthma exacerbations asks a nurse about a long-acting beta2-agonist medication. What will the nurse tell this patient?
Select one:
a.
LABAs can be used on an as-needed basis to treat symptoms.
b.
LABAs are safer than short-acting beta2 agonists.
c.
LABAs should be combined with an inhaled glucocorticoid.
d. LABAs reduce the risk of asthma-related deaths
LABAs should be combined with an inhaled glucocorticoid
119
Which medication should be used for asthma patients as part of step 1 management?
Select one:
a.
Inhaled low-dose glucocorticoids
b.
Short-acting beta2 agonists
c.
Combination inhaled glucocorticoids/long-acting beta2 agonists
d.
Long-acting beta2 agonists
Short acting beta agonist
120
A patient with stable COPD is prescribed a bronchodilator medication for maintenance. Which type of bronchodilator is preferred for this patient?
Select one:
a.
A long-acting inhaled beta2 agonist
b.
An intravenous methylxanthine
c.
A short-acting beta2 agonist
d.
An oral beta2 agonist
Long acting inhaled beta agonist
121
A child is receiving a combination albuterol/ipratropium [DuoNeb] inhalation treatment. The patient complains of a dry mouth and sore throat. What will the nurse do?
Select one:
a.
Contact the provider to report systemic anticholinergic side effects.
b.
Notify the provider of a possible allergic reaction.
c.
Reassure the patient that these are expected side effects.
d.
Discontinue the aerosol treatment immediately.
Reassure the pt that these are expected side effects
122
What are the results of using glucocorticoid drugs to treat asthma? (Select all that apply.)
Select one or more:
a.
Reduced number of bronchial beta2 receptors
b.
Increased responsiveness to beta2-adrenergic agonists
c.
Increased synthesis of inflammatory mediators
d.
Reduced edema of the airway
e.
Reduced bronchial hyperreactivity
Increase responsiveness to beta 2 agonist
Reduce edema of the airway
Reduce bronchial hyperreactivity
123
A nurse is providing instructions to a client who has a new prescription for albuterol and beclomethasone inhalers for the control of asthma. Which of the following instructions should the nurse include in the teaching?
Select one:
a.
Use beclomethasone if experiencing an acute episode.
b.
Avoid shaking the beclomethasone before use.
c.
Administer the albuterol inhaler prior to using the beclomethasone inhaler.
d.
Take the albuterol at the same time each day
Administer the albuterol inhaler prior to using the beclomethasone inhaler
124
The nurse instructs a patient on how to correctly use an inhaler with a spacer. In which order would these steps occur?
1. “Press down firmly on the canister to release one dose of medication.”
2. “Breathe in slowly and deeply.”
3. “Shake the whole unit vigorously three or four times.”
4. “Insert the mouthpiece of the inhaler into the nonmouthpiece end of the spacer.”
5. “Place the mouthpiece into your mouth, over the tongue, and seal your lips tightly around the mouthpiece.”
6. “Remove the mouthpiece from your mouth, keep your lips closed, and hold your breath for at least 10 seconds.”
4, 3, 5, 1, 2, 6
125
A patient with stable COPD receives prescriptions for an inhaled glucocorticoid and an inhaled short acting beta2-adrenergic agonist. Which statement by the patient indicates understanding of this medication regimen?
Select one:
a.
“I should use the glucocorticoid as needed when symptoms flare.”
b.
“The glucocorticoid is used as prophylaxis to prevent exacerbations.”
c.
“I will need to use the beta2-adrenergic agonist drug daily.”
d.
“The beta2-adrenergic agonist suppresses the synthesis of inflammatory mediators.”
The glucocorticoid is used as a prophylaxis to prevent exacerbations
126
A patient who takes oral theophylline [Theochron] twice daily for chronic stable asthma develops an infection and will take ciprofloxacin(Fluoroquinolones). The nurse will contact the provider to discuss:
Select one:
a.
giving theophylline once daily.
b.
changing to a different antibiotic.
c.
reducing the theophylline dose.
d.
switching from theophylline to a LABA.
Reducing the theophylline dose
127
A patient who uses an inhaled glucocorticoid for chronic asthma calls the nurse to report hoarseness. What will the nurse do next?
Select one:
a.
Suggest that the patient be tested for a bronchial infection.
b.
Request an order for an antifungal medication.
c.
Ask whether the patient is rinsing the mouth after each dose.
d.
Tell the patient to discontinue use of the glucocortic
Ask whether the pt is rinsing the mouth after each dose
128
Which drugs are used to treat COPD? (Select all that apply.)
Select one or more:
a.
Glucocorticoids
b.
Monoclonal antibodies
c.
Leukotriene modifiers
d.
Anticholinergic medications
e.
Long-acting beta2 agonists
Glucocorticoids
Anticholinergic meds
Long acting beta 2 agonists
129
A patient with asthma is admitted to an emergency department with a respiratory rate of 22 breaths per minute, a prolonged expiratory phase, tight wheezes, and an oxygen saturation of 90% on room air. The patient reports using fluticasone [Flovent HFA] 110 mcg twice daily and has used 2 puffs of albuterol [Proventil HFA], 90 mcg/puff, every 4 hours for 2 days. The nurse will expect to administer which drug?
Select one:
a.
Intravenous glucocorticoids, nebulized albuterol and ipratropium, and oxygen
b.
Intravenous theophylline, oxygen, and fluticasone (Flovent HFA) 220 mcg
c.
Intramuscular glucocorticoids and salmeterol by metered-dose inhaler
d.
Four puffs of albuterol, oxygen, and intravenous theop
IV glucocorticoids, nebulized albuterol and ipratropium, and oxygen
130
A patient has been prescribed pharmacologic doses of glucocorticoids. It is most important for the nurse to teach the patient to do what?
Select one:
a.
Never abruptly withdraw therapy.
b.
Take antibiotics to prevent infection.
c.
Increase intake of dietary sodium.
d.
Have an eye examination every year.
Never abruptly withdraw therapy
131
A nurse is providing instructions to a client who has a new prescription for albuterol, PO. Which of the following instructions should the nurse include?
Select one:
a.
“Tremors are an adverse effect of this medication".
b.
“Prolonged use of this medication can cause hyperglycemia.”
c.
“This medication can slow skeletal growth rate.”
d.
“You can take this medication to abort an acute asthma attack.
Thermos are an adverse effect of this medication
132
A young adult woman will begin using an inhaled glucocorticoid(ICS) to treat asthma. The nurse will teach this patient about the importance of which action?
Select one:
a.
Using two reliable forms of birth control to prevent pregnancy
b.
Stopping ICS during times of stress
c.
Participating in weight-bearing exercises on a regular basis
d.
Lowering her calcium intake and increasing her vitamin D intake
Participation in weight bearing exercises on a regular basis
