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576 Cards in this Set
- Front
- Back
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what are the two organs that are primarily used for medications ADME?
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the liver
the kidney |
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what test is preformed on the liver to make sure it is running good?
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AST - aspartate aminotranferuse
ALT - alanine aminotransferase |
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what test is preformed on the kidney to make sure it is function well?
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B.U.N - blood urea nirtrogen
Creatine |
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what is the BUN and creatine test testing for?
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biliruben
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what type of lasix is toxic to the kidneys?
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Furosemide
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what do you need to give someone medication?
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-liscence
-facility policy -doc order -scope of practice -6 rights |
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if you are asked to give a medication to your patient and you look and notice that it isnt in your scope of practice what do you do?
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find someone who can give it and make sure that you check on YOUR patient bceause they are still your responsibility
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what is Sinemet?
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a combination of Levadop and Capidopa together as a medication given to Parkinson's patients
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is asprine and NSAID's?
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NO
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what is NSAID's?
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a non steroid antinflammatory
-func class- salicylate nonopiod analgesics, antiplatelet (stops from clumping together) |
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what does pain perception mean?
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also known as nociceptor, is a individuals awareness of the feeling or sensation of pain
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what does pain threshold mean?
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is the point at which a iundividual first asknowledges or interprets a painful sensation
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what does pain tolerance mean?
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is the individuals ability to endure pain
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what does the acronym ACE stand for?
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Acute care for elders
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what changes in the older adult do to drug absorption?
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-Decrease in intracellular fluid
-increase in gastric PH -decreased blood flow and mobility -decrease cardiac output and circulation -slower metabolism can slow down drug absorption |
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what changes in the older adult do to drug administration
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-drugs given intramuscular, subcutaneously, orally or rectally are not absorbed as efficiently as drugs that are inhaled, applied topically or instilled intravenously
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what changes in the older adult do to drug Concentration and soluability of a drug
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-drugs that are not highly soluble (e.g aqueous solutions) and in higher concentrations are absorbed with greater speed then less soluble and concentrated drugs
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how does med ADME change with older people with diseases and symptoms from them?
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-conditions such as diabetes mellitus and hypokalemia can increase the absorption of drugs, whereas pain and mucosa edema will slow absorption
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what can the elderly do to aid in the absorption process of drugs?
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-exercise
- use heat and massage like wise to increase blood flow at the absorption site -preventing fluid volume deficit, hypothermia, and hypo-tension is beneficial in facilitating absorption |
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.What can effect distribution in the elderly?
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-Changes in circulation, membrane permeability, body temp and tissue structure can modify this process
-cardiac output can raise the plasma levels of the drugs while decreasing their deposition lecels of drugs while reducing their deposition in reservoirs, this is practicuallrly apparent with water soluable drugs -decrease serum albumin levels can be problematic if several protein-bound drugs are consumed and compete for the same protein molecules (e.g you give a drug. Then you give another one and the last one you gave will knock off the first one you gave making it not work) |
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.what can effect the metabolism in older adults?
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-dehydration
-hyperthermia -immobility -liver disease -drugs can accumulate and create toxic levels and cause a serious reaction -estimated creating clearance must be calculated based on age, weight, and serum cretin levels alone may not reflect a reduced creatine clearance level -the renal system is primarily responsible for the body's excretory functions, and among its activities is the excretion of drugs, drugs follow a path through the kidneys similar to that of most constituent or urine |
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what are some stimulants that irritate the smooth muscles?
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-cascard sagrada
-(laxative)these irritate the smooth smucle of the intesting and pull fluid inot the colon causing peristalsis. -these can take effect in up to 6-8 hours. -Not recommended for older adults |
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what are the nursing guidelines for older adults taking laxatives
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-recognizing that it is a common geriatric risk and to assist older adults in preventing constipation
-when a pt complains of constipation assess carefully before suggesting or administering a laxative Reinforce to older adults and their caregivers that laxatives, although popular, are drugs that can cause side effects and interact with other drugs -good fluid intake my accompany the use of bulk forming laxatives and stool softeners to prevent the accumulation of stool leading of bowel obstruction |
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what can laxatives do to other drugs when you are taking the two?
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- they can reduce the effectiveness of many oral medications by increasing the speed of their passage through the GI system
-chronic mineral use can deplete the bodys fat-soluable vitamins (vitamins A,D,E and k) |
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what is hypertension?
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is a disease characterized by elevation of the systolic blood pressure, the dystolic blood pressure or both
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how can you treat hypertension without OTC medication?
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-hypertension pt are advised to rest
-reduce sodium intake -loose weight -biofeedback -yoga, meditation and relaxation exercises can prove effectiveness in lowering BP *meditation over medication* -Fish oil suppliments can lower BP in pypertensive individuals -a increase in whole grain intake can lower risk of hyper tensive individuals -garlic, hawthorn berries, periwinkcle have a hypotensive effect -herbs such as ginsign and licorise can raise BP |
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what are some OTC drugs used to treat hypertension
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-preferred agents – Diuretics and beta-adrenergic blockers
-althernative agents angiodensin- converting enzyme ACE inibitors -angiotensin 2 receptors -antagonists -ABBA`s -calcium channel blockers -alpha 1 adrenergic blockers |
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what are varicose viens
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caused by lack of exercise, standing to long
-loss of vessel elasticity and strength associated with aging process -Dilated, contour nature of the vein(veins of lower extremities) -experience dull pain and campy of the legs, sever pain can interfere with sleep -dizziness may occur from lying to standing -more susceptible to trauma and infection, promoting development of ulceration, lesions, esp. in obese and diabetic patients |
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what causes pneumonia
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- pneumonia, especially bronchopneumonia is common in older adults (one of the leading causes of death)
-poor chest expansion and more shallow breathing due to age related changes -high prevalence of resp disease that promote cmucou formation bronchial obstruction -lower resistance to infection -lower sensitivity to pharyngeal reflexes that promotes aspiration -decrease mobility and debilitation - nosocomial pneumonia |
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what is the most common type of pneumonia
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streptococcus pneumonia
-some symptoms include slight confusion, fatigue and rapid respiration -confusion, restlessness and behavioral changes- cerebral hypoxia |
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what should nurses observe closely with this pneumonia
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monitor its closely for subtle changes because it can develop complications of paralyticileus
-this can be prevented by be mobile -productive vough, fever, and chest pain may be atypical in older adults because of age realted changes and cause a delayed diagnosis of pneumonia |
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is there anything to prevent pneumonia
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-vaccines are recommended for people 65 years plus
-shouldn’t be administered during febrile illness -vaccines can cause local site reaction lasting several days but no life threatening -concurrent administration with influenza and some other vaccines in acceptable, providing that different injection site |
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what are some common side effects of being vaccinated for pneumonia
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- local redness
-fever -myalagia -malaise |
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nursing considerations with asthma
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-careful assessment of the older asthmatic pt use of aerosol nebulizers is available
-due to the difficulty some older people have in properly using inhalants a spacer of holding chamber may be helpful to allow the inhalant medication to penetrate deep into the lings - these systems consists of areo chambers that trap the medication or holding chamber that collapse and inhale during inhalation and expiration, -specific information is given with each device -precautions to avoid are important -overuse of a symphathomintic bronchodilation nebulizers create a risk for cardiac arrhythmias leading to sudden death |
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COPD -chronic obstructive pulmonary disease
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-the combination of chronic bronchitis (persistent, productive cough, wheezing, recurrent resp. and SOB)
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what is Nitroglycerine and when and what would you give it for?
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it reduces the body's cardiac workload and increases myocardial oxygen supply.
you give it to someone with angina symptoms every 5 minutes three times and if it doesn't work then you call 911 |
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what is angina pectoris?
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Myocardial hypoxia produces angina (chest pain); cerebral hypoxia produces confusion
-a person with angina feels temporary pain, pressure, fullness, or squeezing in the center of the chest or in the neck, shoulder, jaw, upper arm, or upper back |
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what is heparin
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heparin is used to treat prevent the formation of blood clots
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side effects of heparin
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sudden numbness or weakness, especially on one side of the body;
sudden severe headache, confusion, problems with vision, speech, or balance; chest pain, sudden cough, wheezing, rapid breathing, fast heart rate; pain, swelling, warmth, or redness in one or both legs;trouble breathing;(in an infant) extreme drowsiness, weakness, or gasping for breath; or fever, chills, runny nose, or watery eyes |
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what thins the blood?
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Anticoagulants—including aspirin, warfarin, and heparin—thin the blood
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what dissolves blood clots?
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streptokinase, urokinase, and tissue plasminogen.
All these drugs digest clots by increasing the amount of plasmin (plasmin dissolves clots) in the blood |
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what does pharmacokinetics mean?
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what the body does to the drug
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what does pharmocodynamics mean?
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what they drug does to the body
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what are drug actions?
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The action of drugs on the human body is called pharmacodynamics, and what the body does with the drug is called pharmacokinetics. The drugs that enter the human tend to stimulate certain receptors, ion channels, act on enzymes or transporter proteins. As a result, they cause the human body to react in a specific way
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what does adverse reactions mean?
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An adverse drug reaction (abbreviated ADR) is an expression that describes harm associated with the use of given medications at a normal dosage during normal use
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what are some age related factors that can pose risk to the safety and well-being of older adults?
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-altered pharmacokinetics
-higher amounts of medications -adverse effects -poor teeth conditions -altered perception |
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what are the 6 rights of medication administration?
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1.right person
2.right drug 3.right dose 4.right time 5.right route 6. right documentation |
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what do you need to do when you receive a telephone order?
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you need to write down the time that you took down the order and make sure that you get the doctor who ordered it to sign it before 24 hours
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what are some general factors to remember in regards to adverse effects and older adults?
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**-can develop suddenly even with a drug that has been used over a long period of time without problems
- signs and symptoms of an adverse reaction may differ in older adults -it may take for them to show any signs or symptoms of having a adverse effect -may even appear after the medication is excreted |
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what does pharmacokinetics refer to?
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ADME
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what can we do to promote safe and effective administration of medication to the elderly?
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-proper oral hygiene
-ample fluids for assistance with swallowing and mobility -proper positioning -examining the oral cavity after administration will ensure that the patient receives the full benefit of the medication |
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some principals of patient teaching medication self administration to older adults are?
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-the nurse should first asses the pt. for med errors
-color coded dosage schedule(good for people with visual deficits or illiterate) -med labels with large print -caps that can be easily removed -know what meds are and aren't compatible -know when medications expire |
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what are analgesics?
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used for pain management
**not used as a anti-inflammatory** |
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what are antacids?
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commonly used for heartburn, excessive eating and drinking, and PUD
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what is cardiovascular disease?
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it is the major cause of disability and death.
-class of diseases that involve the heart or blood vessels (arteries and veins) -Cardiovascular disease is treatable and reversible, with diet and nutrition |
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what happens to the heart when we old?
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the heart valves increase in thickness and rigidity due to sclerosis and fibrosis
-aorta becomes dilated -reduced cardiac output |
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what can you do to prevent cardiovascular disease?
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-proper nutrition
-adequate exercise -cigarette smoke avoidance -stress management |
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why is hypertension more prevalent in older adults?
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they tend to have high blood pressure arising which produces peripheral resistant
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what is hypertension?
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term used to describe high blood pressure
-sometimes called arterial hypertension, is a chronic medical condition in which the blood pressure in the arteries is elevated. This requires the heart to work harder than normal to circulate blood through the blood vessels |
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what kind of medications are used for hypertension?
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Beta-adrenergic blocking agents (beta blockers)
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what disease can you not take beta blockers with?
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diabetes and those susceptible to hypoglycemia.
Beta blockers further induce the hypoglycemic effects of insulin and reduce the release of insulin in response to hyperglycemia. All beta blockers mask most of the signs and symptoms of acute hypoglycemia. |
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what is a deep vein thrombosis?
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a blood clot that forms in a vein deep in the body. These blood clots occur when blood thickens and clumps together (intravascular clotting)
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what does intravascualr clotting mean?
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when blood clots thicken and clump together in the veins
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what is a thrombolic agent?
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used to dissolve thromboemboli once they form
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what is a antileptic agent?
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aspirin
they are used to prevent or to reduce arterial clot formation (white thrombi) by inhibiting platelet aggregation |
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what are anticoagulants and what are they used for?
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-warfrin,hepatin and heparin derivatives
-they are used to prophetically to prevent the formation of a arterial and venous thrombi on predisposed pts. |
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what is CHF (congestive heart failure)?
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-leading cause of hospitalizations in older adults
-its a potential complication in older adults with arteriovascular heart disease. |
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what is responsible for the most cases of CHF and hypertension?
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coronary artery disease
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what are some symptoms you would find in older adults with CHF?
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-dyspnea(most common finding)
-confusion -insomnia -wandering during the night -agitation -**depression --**bilateral ankle edema -** moist crackles are heard on auscultation -anorexia,nausea -SOB,orthopnea, wheezing -weight gain -***bilateral ankle edema |
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how would you manage CHF in older adults?
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the same in middle age consisting of bed rest
-angiotensin- converting enzyme, -AE inhibitors -beta blockers -digitalis -diuretics and lower sodium intake |
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what can the nurse to do help a pt with CHF symptoms?
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assist patient into wheelchair ,
-provide support while patient is sitting, -observe signs of fatigue and dysnea (shortness of breath) -change in skin color -change in pulse |
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what is a pt with CHF at risk of skin wise?
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-skin breakdown because of edema and poor nutrition of the tissue
-the fragilty of older skin compounds this risk |
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what is postural hypotension?
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a decline in systolic BP of 20mmhg or more after rising and standing for 1 minute
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what are some signs and symptoms of hypertension?
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awakening with a dull headache
-impaired memory -disorientation -confusion -epistasis (nosebleed) - a slow tumor |
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what are some drugs that can be used to treat hypertension?
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diuretics
-beta-bloackers -calcium channel blockers -angiotensin-converting enzymes -ACE inhibitors |
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because older people have a higher risk for adverse reactions from anti hypertensive drugs what should you consider doing with older patients?
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you need to assist them in using non-pharmacological measure to reduce B/P when ever possible
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what are some good non-pharmacological measures that older people can take to help reduce or prevent hypertension?
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-biofeedback
-yoga -meditation -relaxation exercises |
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what are some diseases that can cause hypertension?
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hyperthyroidism
-Parkinson's disease -paget disease -anemia -thiamine deficiency |
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what can we do to promote muscle-skeletal health in older adults?
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-education
-ancouraging persons at all ages to exercise regularly -educating cardiovascular endurance -flexibility -strength training |
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what predisposed a older adult to have a CVA (cardio vascular attack)?
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older persons with hypertension
-sever arteriosclerosis -diabetes -gout -anemia -hypothyroidism -silent MI -TIA -dehydration -smoking |
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what is Rheunatoid arthritis?
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synovial fluid becomes hypertrophied and edematous with projections of synovial tissue protruding into the joint cavity
-joint are very painful,swollen and stiff at times |
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what can you teach the patient to do when they are suffereing from RA?
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rest and provide support to the affected areas
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what would a pt with RA be prescribed?
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anti-inflammatory agents -corticosteroids,
-anti material agents, -gold salts -immune suppressant drugs |
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what is Osteoarthritis?
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a deterioration's and abrasion of the joints cartilage with the formation of new bone at the joints surfaces
-DOESN'T cause inflammation -weight bearing joints are the ones that are the most commonly affected |
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what does disequilibrium between destructive (matrix metalloprotease enzymes-these release cytokines) and synthetic (tissue inhibitors of matrix metalloprotease) element lead to what?
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lack of homeostasis necessary to maintain cartilage, causing the joint changes.
excess use of the joint, trauma, obesity, low vitamin D&C levels and genetic factors may also predipose an individual to this problem |
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true or false
systematic symptoms do not accompany with osteoarthritis |
true
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what is the first drug that you would give to a elderly patient with osteoarthritis?
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acetaminophen, because of its safety over non steroidal anti-inflammatory drugs (NSAID's)
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what is transiient ischemic attacks?
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temporary or intermittent neurological events that can result from any situation that reduces cerebral circulation
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what are some things that can cause cerebral circulation reduction?
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falling asleep in a chair can impair cerebral circulation
-reduced blood pressure resulting from anemia and certain drugs (eg. diuretics and anti hypertensives) -cigaret smoking due to its vasodialation effect -sudden standing from a sitting position |
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what are some signs and symptoms of TIA?
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-hemiparesis (weakness of one side of the body)
-hemianesthesia (anesthesia of one side of the body) -aphasia (trouble speaking) unilateral loss of vision -diplopia (double vision) -vertigo -nausea/vomiting -dyshagia (difficulty swallowing) |
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what does diplopia mean?
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double vision
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what does hemiparesis mean?
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weakness of one side of the body
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what does hemianesthesia mean?
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anesthesia of one side of the body
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how long do the signs of symptoms usually last for TIA's?
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they usually last from minutes to hours and complete recovery is usually within a couple of days
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what is the treatment for TIA's?
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-correction of the underlying cause
-anti-coagulant therapy -vascular reconstruction |
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what is a nursing diagnosis for someone who has already had a TIA?
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they are more at risk then others for having another episode
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what is Gout?
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is a metabolic disorder in which excess uric acid accumulates in the blood. as a result uric acid crystals are deposited in and around the joints causing sever pain and tenderness of the joint
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what are some symptoms of gout?
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-warmth
-redness -swelling of the surrounding tissue |
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how long can Gout attacks last?
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they can last from weeks to months, with long remissions between attacks as possible
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what is the treatment for Gout?
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aims to reduce sodium urate through a low purine diet (e.g avoidance of bacon, turkey, veal, liver, kidney, brain and other fishy meats
-colchicine or phenylbutazone can be used to manage acute attacks |
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true or false
alcohol should be avoided because it increase uric acid production and reduces uric acid excretion |
true
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what would you take to raise the uric acid level in the blood?
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thiazide diuretics
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what are some useful dietary supplements that you can take for Gout?
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-Vitamin E
-Folic acid -eicosapentanoric acid (EPA) |
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what is Osteoporosis?
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metabolic disease of the bone
*********makes a decrease in mass and density of the skeleton |
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what can cause Osteoporosis?
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any health problems associated with inadequate calcium intake, excessive calcium loss or poor calcium absorption can cause osteoporosis
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true or false
Osteoarthritis is called "wear and tear" |
true
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what ages do you usually see rheumatoid arthritis in?
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20-40s, more woman then men
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what is class is heparin in?
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anticoagulant
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what is heparin
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a natural substance extracted from the gut and lung tissue of pigs and cattle
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what does heparin do?
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acts as a catalyst to accelerate the rate of action of a naturally occurring inhibitor of thrombin. anti-thrombin 3 (sometimes called a heparin co-factor)
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true or false
Heparin has NO fibrinolytic activity and cannot lyse established fibrin clots |
true
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what is heparin used for?
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to treat deep thrombosis
-pulmonary embolism -peripheral arterial embolism -myocardial infarction -also used for per-cutaneous coronary interventions -during cardiovascular surgery (post operative) -immobilized patients clot formation and to maintain patency of venous access devices |
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what does APTT mean?
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adequate anticoagulation by heparin
-a test done to check the target range for full anticoadulant (drawn every 4 to 6 hours) and after each dose **do not draw sample from the same arm the dose was given in |
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where would you give a heparin injection?
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into the tissue over the abdomen. DO NOT inject within 2 inches of the abdomen. DO NOT massage injection site before or after injection. Rotate sites of injection to prevent massive hematoma
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what are stimulants?
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irritate the smooth muscle of the intestine and pull fluid into the colon causing peristalsis
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how long does it take for stimulants to work?
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6 - 10 hours.they can cause cramping and excessive fluid evacuation
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what do lubricants do?
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coat fecal materials to facilitate its passage.
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how long does it take for lubricants to work?
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6-8 hours, they are not recommended for older adults
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what are some nursing guidelines for older adults taking laxatives and stimulants?
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-recognize that it is a common geriatric risk assist older adults in peventing constipation
-always assess a patient before giving laxatives -let them and family members know that laxatives are drugs that cause side effects and interact with other drugs -good intake of fluids must always accompany laxatives and stimulants |
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what do you have to watch when taking a laxative and other medications?
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-laxatives can reduce their passage through the GI system by increasing the speed
-chronic mineral oil use can deplete the body's fat-soluble vitamins (A,D,E,K) |
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what is hypertension?
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is a disease characterized by an elevation of the systolic BP
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what are some drugs that are used to treat hypertension?
|
preferred agents are diuretics and beta-adrenergic blockers
-alternative agents- angiotensin 2 receptors, antagonists ABBAs -ACE inhibitors |
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what are some therapeutic things you can remind your patient to do to lower their hypertension?
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-rest
-reduce salt intake -lower weight -biofeedback -yoga,meditation and relaxation -exercising *meditation over medication -fish oil supplements can lower hypertension -increase whole grain intake |
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what causes varicose veins?
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caused by lack of exercise
-standing to long - loss of vessel elasticity and strength associated with aging process -dilated, tortuous natures of the vein in lower extremities |
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what would someone with varicose veins be complaining off?
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-dull pain
-cramping of the legs -sever pain can interfere with sleep -dizziness (orthostatic hypertension) |
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what are people with varicose veins more susceptible to?.
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-trauma
-infection -promoting development of ulceration lesions, especially in obese and diabetic patients |
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what is one of the leading deaths in older people caused from?
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pneumonia, bronchopneumonia
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what are some signs and symptoms someone would have with angina?
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-pain radiating down the left arm
-coughing -synape -sweating with exertions -episodes of confusion |
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what is a affective medication to give with angina?
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Nitrogylcerine
-this prevents and treats attacks |
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what are some nurse precautions you should watch for when giving a older person nitrogycerine?
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-orthostatic hypotension with nitrates resulting from loss of caomotor and baroreceptors reactivity
-tell pt to lay or sit down -prevent swallowing the table and thus blocking its absorption, tell them not to swallow their saliva for several minutes after sublingual administration -avoid factors sucj as cold wine -smotional stress - stranuouse activity -anemia -tachycardia -arrhythmias and hyperthyroidism |
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what type of alternative therapy cause help to decrease the frequency and severity of angina attacks?
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acupuncture
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how do you assess circulation in older adults?
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the nurse can assess the adequacy of tissue circulation in older adults by -reviewing the individuals health history
-taking vitals -inspecting the body |
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what are some signs and symptoms of decrease circulation?
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-decrease elasticity of blood vessels
-increase resistance of peripheral vessles -decrease ni cornonary blood flow -less efficicent cardia o2 usage -decrease in proportion of 02 extracted from arterial blood by the tissues -decrease cardiovascular responsiveness to adrenaline stimulants |
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what is neuropathic pain?
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results from injury to the periphrases or central nervous system pt. to describe pains as stabbing and burning. Phantom limb pain is neuropathic pain experienced by amputees in a body part that is no longer there
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what is nociceptor pain?
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results of a stimulus (eg. chemical, thermal, mechanical)
-described by patients as dull and aching |
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what does somatic pain mean?
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it originates from the skin, bones, joints and muscle or connective tissue (e.g. arthritis pain)
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what does visceral pain mean?
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it originates from abdominal and thoracic organs
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what is nociceptor pain?
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the person is aware of pain presence
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what is the pathway of pain?
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1. transduction
2.transmission 3.perception 4.modulation |
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what is warfrin?
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it is a potent anticoagulant that acts by inhibiting the activity of vitamin k
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what is vitamin k for?
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vitamin is required for the activation of clotting factors
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what do you use warfrin-coumadin for?
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for treatment and prophylaxis of venous thrombosis , embolism and coronary occulsion. the dosage of warfrin is adjusted based on prolonging the INR
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what does INR stand for?
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international normalized ratio. what is the target rate for the INR is 2-3 when treating atrial fibrillation
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what the therapeutic outcomes for warfrin?
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-prevention and treatment of venous thrombosis and embolism
-prevention and treatment of thrombolic associated with atrial fibrillation -decreases the risk of death, reccurent myocardial infarction and thrombo embolic events such as stroke after myocardial infarction -prevention and treatment of thrombo embolic associated with cardiac value replacement |
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what are some patient teaching for warfrin?
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-administer same time each day to maintain constant blood level
-mangos and papya can increase INR -instruct patient to drink 6 to 8 glasses of liquid daily -wear a medical bracelet -vitamin K as antidote |
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the effects of anticoagulant can be increase by which medication?
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-acetaminophen
-apririn and other NSAID's -mineral oil, some calcium channel blockers |
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anticoagulants can be decreased by which type of medicines?
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-antacids
-barbiturates -anti-thyroid agents -estrogen's -thiazide diuretics -vitamin k |
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what is secretagogues?
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a hormone or another agent that causes of stimulates secretion
-agent that induces exocrine or pancreases secretions |
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what is tar dive dyskinesia?
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is a syndrome of persistent and involuntary hyper kinetic abnormal movements.
-develops in about 20-25% of patients receiving typical anti-psychotic agents on a long term basis (eg. months to years) |
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what is a bulk cathartic?
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stimulates bowel evacuation by increasing fecal volume
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what is lubricant cathartics?
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softening feces with decrease friction between them and the intestinal wall
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what is a saline cathartic?
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increases fluidity of intestinal contents by retention of h20 by osmotic forces and indirect by increase motor activity
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what is a stimulant cathartic?
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directly increases motor activity of the intestinal tract
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what is a ECG (electrocardiogram)
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measures the electrical activity of the heart
- in a ECG test the electrical impulses made while the heart is beating recorded and usually shown on a piece of paper |
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what are some serious side effects of aminoglycosides?
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ototoxicity- damage to the 8th cranial nerve
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what are drug interactions with aminoglycosides?
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vancomyacin and diuretics
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what are some signs and symptoms of dehydration in older adults?
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-dry inelastic skin
-dry brown tongue -skunked cheeks -concentrated urine -blood urea value elevated above60mgldl -and in some cases confusion |
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what can happen when a older person gets a bowel obstruction?
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-can cause high pitched pitched and peristaltic rushes to be heard on auscultation then eventually bowel sounds will be absent
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what are the nursing actions for someone with bowel obstruction?
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-record and eveluate bowel elimination patter
-establish consistent time to toilet bacsed on pattern - have patient lean forward or drop feet on stool to increase intra-abdmonial pressure -if necessary stimulate rectal reflex and with rectal suppository 30 - 45 minutes before bowel schedule |
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what is benign prosthetic hyperplasia?
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enlargement of the prostate
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what are some symptoms of benign prosthetic hyperplasia?
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they progress slowly but continuously
-decrease in urinary stream, frequency and nocturia as result from obstruction of the vesicle neck and compression of the urethra that causes a compensatory hypertrophy of the muscle and subsequent outlet obstruction -dribbling, poor control, overflow incontinence and bleeding |
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what are the treatments for benign prostatic hyperplasia
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-prostate message
-urinary antiseptics -avoidance of diuretics and arrhythmic agents |
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what is a ischemic stroke?
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occurs when a blood vessle that supplies blood to the brain is blocked by a blood clot and the brain cannot get enough 02 and blood. brain cells can die causeing perminent damage
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what is the number one cause for strokes in the elderly?
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high blood pressure
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what are cold sores?
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they are caused by the herpes simplex type 1 virus. and are the most commonly found at the junction of the mucous membrane and the skin of the lips or nostrils but can occur inside the mouth aswee
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what are canker sores?
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the exact cause is unknown. Factors appear to be stress and local trauma. irritation from toothbrush abrasion and irritation from something
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what is candidiasis?
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a fungal infection cause by candida albicans "disease of the diseased"
-predisposing factors are physiologic e.g. early pregnancy, infancy and old age -characterized by white milk curd appearing plaques attached to the oral mucosa |
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what is mucositis?
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general term used to describe a painful inflammation of the mucous membranes of the mouth. commonly associated with chemotherapy and radiation
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A patient who has just begun taking an angiotensin-converting enzyme (ACE) inhibitor calls the nurse and reports feeling very dizzy when standing up, and asks if the medication should be discontinued. What is the nurse’s best response?
A. “Stop taking the medication immediately.” B. “Rise to a sitting or standing position slowly; your symptoms will resolve.” C. “I will schedule you to visit the health care provider today.” D. “Cut the pill in half and take a reduced dosage.” |
B Dizziness is a common initial adverse effect of this medication, which is usually transient. The patient should be instructed to rise from a lying position slowly to avoid orthostatic hypotension and avoid falling.
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Which nursing assessment confirms that the angiotensin II receptor blocker (ARB) that a patient is taking is effective?
A. Weight loss of more than 2 pounds/week B. LDL-cholesterol levels have decreased. C. Urinary output is increased. D. Blood pressure has decreased. |
D The primary therapeutic outcome expected from angiotensin II receptor antagonists is reduction of blood pressure to within a normal range. Angiotensin II receptor antagonists bind angiotensin II receptor sites in the vascular smooth muscle, brain, heart, kidneys, and adrenal gland. The blood pressure–elevating (vasoconstricting) and sodium-retaining effects of angiotensin II are thus blocked.
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how does propranolol (Inderal) control hypertension?
A. Blocks alpha receptors throughout the body B. Increases the diuretic response in the renal tubules C. Reduces the sympathetic stimulation in cardiac muscle D. Inhibits the conversion of angiotensin I to angiotensin II |
C The beta-adrenergic blocking agents block beta receptor stimulation in the heart, which then inhibits cardiac response to sympathetic nerve stimulation. This results in a decrease in heart rate, cardiac output, and blood pressure.
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Which class of antihypertensive agents should be avoided by patients with asthma?
A. ACE inhibitors B. Diuretics C. Aldosterone receptor antagonists D. Beta-adrenergic blocking agents |
D Beta-adrenergic blocking agents can cause bronchoconstriction, which will aggravate asthmatic conditions.
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Which is true about postural hypotension during therapy with direct vasodilators?
A. It indicates a therapeutic effect. B. It gradually resolves with continued medication use. C. It is a dose-limiting complication of drug therapy. D. It is a precursor to hypertensive crisis. |
B Orthostatic hypotension can occur particularly at the initiation of therapy. Patients should be encouraged to change positions slowly. Symptoms generally will resolve as the patient becomes used to the medication.
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The nurse instructs the patient to avoid the sudden discontinuation of beta-adrenergic blockers so as to avoid which symptom?
A. Postural hypotension B. Edema C. Increased angina D. Confusion |
C Sudden discontinuation of beta-adrenergic therapy has caused an exacerbation of anginal symptoms, resulting in cases of myocardial infarction.
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What is mean arterial pressure (MAP)?
A. The difference between the systolic and diastolic pressures B. An indicator of the tone of the arterial blood vessel walls C. The average pressure throughout each cycle of the heartbeat D. The product of the cardiac output and the peripheral vascular resistance |
C The MAP is the average pressure throughout each cycle of the heartbeat and is significant because it is the pressure that actually pushes the blood through the circulatory system.
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Which agents are preferred for the initial treatment of hypertension?
A. ACE inhibitors and angiotensin receptor antagonists B. Calcium-ion agonists and central-acting alpha agonists C. Thiazide diuretics and beta adrenergic blockers D. Direct vasodilators and peripherally acting adrenergic antagonists |
C Preferred agents include diuretics and beta-adrenergic blockers.
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Prior to the administration of a beta-adrenergic blocker, the nurse notes the patient to have a heart rate of 52 beats/min, peripheral edema, crackles in the bases of the lungs, and mottled skin. Which is the priority nursing action?
A. Administer the medication as ordered. B. Reevaluate the patient in 20 minutes. C. Obtain a serum blood level. D. Withhold the medication and notify the health care provider. |
D These symptoms warrant the nurse’s withholding the dose and then notifying the health care provider.
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When displayed by the patient, which symptom would be most indicative to the nurse to withhold a recently prescribed beta-adrenergic blocker?
A. Dizziness B. Peripheral edema C. Hyperglycemia D. Wheezing |
D Wheezing in a patient taking beta-adrenergic blockers could indicate the adverse effect of bronchial constriction.
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The nurse has provided information to a patient with diabetes who has been prescribed a beta-adrenergic blocker. Which statement by the patient indicates a need for further teaching?
A. “If I get dizzy, I will stop taking the medication.” B. “I may not have my usual symptoms of low blood sugars.” C. “My dosage may need adjustment if I start taking any NSAIDs.” D. “I will need to be evaluated in a few weeks to see if my dosage is effective.” |
A Patients should never stop taking beta-adrenergic blocking agents suddenly because this can result in exacerbation of angina symptoms. Dizziness should resolve with therapy and patients should be taught how to manage this side effect safely.
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The nurse is providing instruction to a patient who was recently prescribed an ACE inhibitor for hypertension. Which is an adverse effect of this medication?
A. Constipation B. Chronic cough C. Hypokalemia D. Nervousness |
B Chronic cough may develop in as many as one third of patients receiving ACE inhibitors.
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The nurse is explaining to a patient how ACE inhibitors affect blood pressure. Which statement accurately describes the action of these medications?
A. They increase aldosterone secretion. B. They inhibit vasoconstriction. C. They lower heart rate. D. They promote sodium retention. |
B ACE inhibitors decrease vasoconstriction and aldosterone secretion.
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Which common adverse effect of an angiotensin II receptor antagonist will the nurse expect to assess in a patient?
A. Bradycardia B. Headache C. Hypokalemia D. Insomnia |
B Headache is a common adverse effect of angiotensin II receptor antagonists.
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Which medication lowers blood pressure by directly inhibiting renin?
A. Aliskiren (Tekturna) B. Eplerenone (Inspra) C. Diltiazem (Cardizem) D. Reserpine |
A Aliskiren is a renin-angiotensin antagonist.
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A patient asks the nurse how amlodipine (Norvasc) works to reduce the blood pressure. Which response will the nurse provide?
A. “It causes blood vessel dilation.” B. “It helps you get rid of fluid.” C. “It helps your heart beat stronger.” D. “It slows your heart rate.” |
A The dihydropyridine group (amlodipine) are calcium channel–blocking medications that work by inhibiting the vasoconstricting effects of calcium to cause vasodilation.
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A patient recently prescribed felodipine (Plendil) for treatment of hypertension is experiencing dizziness when rising to a standing position. Which action will the nurse take?
A. Encourage the patient to sit down if feeling faint. B. Advise the patient to increase dietary sodium. C. Inform the patient to discontinue the medication. D. Instruct the patient to monitor weight daily. |
A If faintness or dizziness occurs, the nurse instructs the patient to sit or lie down and to change positions more slowly.
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Which physiological response will the nurse expect to assess in patients taking hydralazine (Apresoline)?
A. Pale skin B. Tachycardia C. Increased urinary output D. Cool extremities |
B With arteriolar smooth muscle relaxation, there is an increase in heart rate.
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Which medication is often administered with hydralazine to reduce reflex physiological responses to the drug?
A. Beta blockers B. Renin inhibitor C. ACE inhibitor D. Angiotensin II receptor blocker |
A Beta blockers are administered with hydralazine to reduce the reflex tachycardia caused by arterial vasodilation. Diuretics may also be administered to promote water and sodium excretion.
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Hydralazine, a direct vasodilator, is used to treat hypertension associated with which condition?
A. Stroke B. Diabetes mellitus C. Myocardial infarction D. Renal disease |
D Hydralazine is used to treat hypertension associated with renal disease.
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Which complications are associated with uncontrolled hypertension? (Select all that apply.)
A. Angina B. Stroke C. Hyperglycemia D. Renal failure E. Heart failure |
ANS: A, B, D, E
Correct- Angina is a complication associated with uncontrolled hypertension. Stroke is a complication associated with uncontrolled hypertension. Renal failure is a complication associated with uncontrolled hypertension. Heart failure is a complication associated with uncontrolled hypertension. Incorrect- Hyperglycemia is not a complication associated with uncontrolled hypertension. |
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The nurse is finished conducting nutritional education with a patient about the DASH (dietary approaches to stop hypertension) diet. The patient would like to complete the breakfast menu for tomorrow. Which foods offered for breakfast would be most appropriate for the patient to choose? (Select all that apply.)
A. Grapefruit B. Bacon C. Whole milk D. Orange juice E. Eggs F. Oatmeal |
ANS: A, D, F
Feedback Correct The DASH eating plan includes a diet rich in fruits; grapefruit would be an appropriate choice. The DASH eating plan includes a diet rich in fruits; orange juice would be an appropriate choice. The DASH eating plan includes a diet rich in fruits, vegetables, and low-fat dairy products; oatmeal would be an appropriate choice. Incorrect Bacon would not be appropriate for a person on the DASH diet. Whole milk would not be appropriate for a person on the DASH diet. Eggs would not be appropriate for a person on the DASH diet. |
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Which statements are true concerning the use of antihypertensive therapy for the treatment of hypertension? (Select all that apply.)
A. Diuretics are the most commonly prescribed antihypertensive agent. B. Diuretics are not used for older adult patients. C. Diuretics are the most expensive of the antihypertensive agents. D. Diuretics are often prescribed in combination therapy with other antihypertensive agents. E. Loop diuretics are considered potassium sparing. |
ANS: A, D
Correct Diuretics are the most commonly prescribed antihypertensive used to treat all classes of hypertension. They are one of the classes of agents that have been shown to reduce cardiovascular morbidity and mortality associated with hypertension. Diuretics are prescribed in combination therapy to potentiate hypotensive activity. Incorrect More potent diuretics are used for older adult patients. Diuretics are low in cost. Diuretics often cause excretion of potassium, with the exception of potassium-sparing diuretics used in combination with thiazide. |
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Which statements about diuretics are true? (Select all that apply.)
A. A mechanism of action for the antihypertensive effects of diuretics includes volume depletion. B. They have been shown to reduce cardiovascular morbidity associated with hypertension. C. Thiazide diuretics are effective only if renal creatinine clearance is less than 30 mL/min. D. Diuretics are sodium-sparing. E. Electrolytes must be evaluated periodically for patients on loop diuretics. |
ANS: A, B, E
Correct Diuretics act as hypertensive agents by causing volume depletion, sodium excretion, and vasodilation of peripheral arterioles. Diuretics are often used to reduce cardiovascular morbidity and mortality rates. Potassium must be monitored in patients taking diuretics that are not potassium sparing. Incorrect When creatinine clearance is higher than 30 mL/min, thiazide diuretics are most effective. Diuretics cause sodium excretion. |
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What is the action of amiodarone (Cordarone), a class III agent used to treat cardiac dysrhythmias?
A. It acts as a myocardial depressant by inhibiting sodium ion movement. B. It prolongs the duration of the electrical stimulation on cells and the refractory time between electrical impulses. C. It acts as a beta-adrenergic agent. D. It slows the rate of electrical conduction and prolongs the time between contractions. |
D Class III agents slow the rate of electrical conduction and prolong the time between contractions.
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How many mg of lidocaine will the nurse administer IV bolus to a 30-year-old patient with ventricular tachycardia who weighs 75 kg after a myocardial infarction?
A. 10 B. 25 C. 50 D. 75 |
D The initial lidocaine bolus is 1 to 1.5 mg/kg, decreased by half in older adults, patients with hepatic disease, and patients with heart failure.
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A patient is taking amiodarone (Cordarone) for hypertrophic cardiomyopathy and begins to complain of dizziness. What will the nurse instruct the patient to do?
A. Discontinue the medication immediately. B. Decrease the medication dosage for 1 week, and then resume the original order. C. Change positions slowly. D. Increase the dosage per health care provider directions. |
C Many adverse effects are dose-related and resolve with reducing the dosage or discontinuing therapy. Patients should be taught to rise slowly from a supine or sitting position and sit or lie down if feeling faint.
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A patient is diagnosed with atrial fibrillation. The nurse anticipates that which drug will be used in the treatment of this dysrhythmia?
A. Disopyramide (Norpace) B. Flecainide (Tambocor) C. Lidocaine (Xylocaine) D. Mexiletine (Mexitil) |
A Disopyramide is used to treat atrial fibrillation.
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A patient who is started on phenytoin (Dilantin), who is also taking amiodarone (Cordarone), should be assessed for what possible effect?
A. CNS depression and sedation B. Decrease in effectiveness of phenytoin C. Respiratory depression D. Increase in serum phenytoin levels |
D Elevation of phenytoin serum levels (200% to 300%) is observed over several weeks. The dosage of phenytoin must be gradually reduced based on patient response.
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Which lidocaine preparation is appropriate for the treatment of cardiac dysrhythmias?
A. 0.1% lidocaine with preservative B. 2% lidocaine for topical use C. Lidocaine patch D. Injectable lidocaine without preservative |
D Lidocaine for IV use is different from lidocaine used as a local anesthetic. The label for lidocaine for IV use should read “lidocaine for dysrhythmias” or “lidocaine without preservatives.”
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Patients who are on neuromuscular blocking agents and lidocaine must be closely observed for which complication?
A. Hyperkalemia B. Respiratory depression C. Neurotoxicity D. Seizures |
B Lidocaine, when administered with neuromuscular blocking agents, may cause respiratory depression. Ventilator-dependent patients may require additional time to be weaned when on these categories of medications.
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Which statement is true regarding the antidysrhythmic agent adenosine (Adenocard)?
A. It is synthesized from petroleum products. B. It is created through recombinant DNA. C. It is extracted from plants. D. It is a naturally occurring chemical in the body. |
D Adenosine is a naturally occurring chemical found in every cell within the body.
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Amiodarone is contraindicated for patients with which condition?
A. Pulmonary edema B. Severe sinus node dysfunction causing bradycardia C. Atrial fibrillation D. Premature ventricular contractions (PVCs) |
B Amiodarone is contraindicated for patients with severe sinus node dysfunction that causes sinus bradycardia, with second- and third-degree AV block, and when episodes of bradycardia have caused syncope (except in the presence of a pacemaker).
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The patient recently prescribed quinidine is at highest risk for which common adverse effect?
A. Chills B. Diarrhea C. Nausea D. Rash |
B Diarrhea is common during initiation of quinidine therapy.
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Which symptom will the nurse encourage the patient taking flecainide to report to the health care provider?
A. Headache B. Dizziness C. Constipation D. Weight gain |
D Flecainide may induce or aggravate preexisting heart failure. Weight gain is a symptom of fluid retention; the patient should be instructed to contact the health care provider for further evaluation.
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The nurse is assessing a patient who was recently admitted to the emergency department with dysrhythmias and shortness of breath. Which baseline nursing assessments are priorities? (Select all that apply.)
A. ECG monitoring B. Medication history C. Oxygen saturation D. Presence of chest pain, dyspnea, fatigue E. Mental status F. Sleep pattern |
ANS: A, B, C, D, E
Baseline nursing assessment of patients with dysrhythmias includes ECG monitoring. Baseline nursing assessment of patients with dysrhythmias includes obtaining medication and medical histories. Baseline nursing assessment of patients with dysrhythmias includes oxygen saturation. Baseline nursing assessment of patients with dysrhythmias includes observation for the six cardinal signs of cardiovascular disease. Baseline nursing assessment of patients with dysrhythmias includes neurologic assessment. |
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The nurse is preparing to administer adenosine to a patient with supraventricular tachycardia. Which considerations should the nurse take into account before administration? (Select all that apply.)
A. Constant ECG monitoring is necessary. B. Initial recommended dosage is 12-mg IV bolus. C. Rapid IV bolus administration is recommended. D. Saline flush following bolus is necessary. E. Long half-life of adenosine may prolong adverse medication effects. |
ANS: A, C, D
Continuous cardiac monitoring is required when administering any IV medications to treat dysrhythmias. Due to the short half-life of adenosine, the IV bolus should be administered rapidly. The initial dosage of adenosine is rapid IV bolus followed by a saline flush. |
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The nurse is preparing to mix a lidocaine infusion for a patient. Which considerations should the nurse take into account before administration? (Select all that apply.)
A. Lidocaine with preservatives should be used. B. Dextrose 5% is the solution to mix with lidocaine. C. Therapeutic blood levels should be 1 to 5 mg/L. D. The rate of administration is 1 to 4 mg/min. E. Monitor for changes in neurological status. |
ANS: B, C, D, E
Lidocaine for infusion should be mixed with dextrose 5% solution Additional nursing considerations include monitoring of therapeutic blood levels (1 to 5 mg/L). Lidocaine administration rate should be 1 to 4 mg/min. Additional nursing considerations include observing for adverse effects to report to the health care provider. |
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Which medication combinations may be beneficial in treating angina pectoris?
A. Antidysrhythmics and platelet-active agents B. ACE inhibitors and statins C. Vasoconstrictors and diuretics D. Analgesics and thrombolytics |
B ACE inhibitors and statins are often combined to treat angina pectoris.
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A patient has been diagnosed with angina pectoris and an elevated LDL cholesterol level. The health care provider has prescribed HMG-CoA reductase inhibitor. What is the primary indication in using this medication?
A. Reduce coronary vessel spasm B. Simplify oxygen requirements of the cardiac cells C. Lower cholesterol levels D. Dilate the coronary arteries |
C HMG-CoA reductase inhibitor, a statin, has become standard therapy to be used with elevated cholesterol levels. This medication prevents added atherosclerotic vessel buildup and further narrowing of the coronary arteries.
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What will the nurse advise the patient to do to avoid the development of tolerance to nitroglycerin?
A. Use the sublingual form only. B. Administer subsequent doses parenterally. C. Allow for a daily 8- to 12-hour nitrate-free period. D. Store the drug in a dark container, free from light and moisture. |
C An 8- to 12-hour nitrate-free period will eliminate the development of tolerance to nitroglycerin.
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Which instruction will the nurse include for a patient prescribed sublingual nitrate PRN for angina?
A. Take a dose routinely at bedtime. B. Place the tablet under the tongue and swallow immediately. C. Take one tablet and then seek medical attention if the pain is not relieved within 5 minutes. D. Take one tablet every 2 to 3 minutes until relief is obtained. |
C The patient should seek medical attention if chest pain is not relieved by one tablet within 5 minutes. Tablets should continue to be taken every 5 minutes, for a total of three tablets in 15 minutes.
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How frequently are nitroglycerin tablets discarded and prescriptions refilled?
A. Monthly B. Every 3 months C. Every 6 months D. Yearly |
C Every 6 months, the nitroglycerin prescription should be refilled and the old tablets safely discarded.
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When are sustained-release nitroglycerin tablets administered?
A. Once a day B. At bedtime C. When symptoms of acute angina appear D. Every 8 to 12 hours |
D Sustained-release nitroglycerin tablets are usually taken on an empty stomach every 8 to 12 hours. If gastritis develops, it may be necessary to take these tablets with food.
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Which instruction will the nurse include when teaching a patient about the administration of translingual nitroglycerin spray?
A. Shake the container to disperse the medication evenly. B. Inhale the medication slowly over 1 to 2 minutes. C. Administer the medication under the tongue. D. Close the mouth and “swallow” the spray. |
C Translingual nitroglycerin spray should be sprayed onto or under the tongue. The container should not be shaken because the bubbles formed may slow the release of the medication. The spray should not be inhaled or swallowed.
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Which statement is true regarding the pain associated with angina?
A. It does not subside until treatment is initiated. B. It is highly variable in intensity and location. C. It typically subsides after 1 to 3 minutes. D. It is directly related to the degree of myocardial damage. |
B The presentation of angina pectoris is highly variable. The sensation of discomfort may be described as squeezing, tightness, choking, pressure, burning, or heaviness. Pain or discomfort may radiate to the neck, lower jaw, shoulder, and arm. Attacks can last from 30 seconds to 30 minutes.
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How do beta-adrenergic blocking agents reduce myocardial oxygen demand?
A. By inhibiting the stimulation of norepinephrine and epinephrine B. By increasing the production of dopamine and acetylcholine C. By delaying the destruction of acetylcholinesterase and cholinesterase D. By enhancing the sensitivity of alpha receptors and beta receptors |
A Beta-adrenergic blocking agents prevent the stimulation of epinephrine and norepinephrine, which normally increase heart rate.
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The nurse is teaching a patient about nitroglycerin prior to discharge to home. Which instruction will the nurse provide the patient?
A. “Report any headaches following self-administration to your health care provider.” B. “Carry the medication in a pocket directly next to the body.” C. “Carry the medication with you at all times.” D. “Store nitroglycerin in a clear glass container with a tight lid.” |
C Nonhospitalized patients should carry nitroglycerin at all times.
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What risk is minimized when the smallest dose of nitroglycerin is used to provide satisfactory results?
A. Allergy B. Dependence C. Tolerance D. Nausea |
C Tolerance to nitrates can develop rapidly, particularly if large doses are administered frequently.
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The nurse is performing pain assessment on a patient admitted for evaluation of angina. Which type of angina is precipitated by physical exertion and is relieved by rest?
A. Chronic stable B. Nocturnal C. Unstable D. Variant |
A Chronic stable angina is precipitated by physical exertion or stress, lasts only a few minutes, and is relieved by rest or nitroglycerin.
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What is the rationale behind administering calcium channel blockers to patients with angina?
A. They decrease heart rate. B. They dilate blood vessels. C. They increase cardiac contractility. D. They promote fluid excretion. |
B By inhibiting smooth muscle contraction, the calcium channel blockers dilate blood vessels and decrease resistance to blood flow. Dilation of peripheral vessels reduces the workload of the heart.
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Which action by the nurse is most accurate when administering nitroglycerin ointment to a patient?
A. Spread the ointment on the patient’s legs in a thin, uniform layer. B. Cover the patch with a clear plastic wrap. C. Rub the ointment into the skin in a circular motion. D. Shave the skin prior to application. |
B Covering the area where the patch is placed with a clear plastic wrap and taping it in place is appropriate.
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Which response will the nurse provide when a patient complains of a headache when using sublingual nitroglycerin?
A. “This is a common adverse effect that can be managed with acetaminophen.” B. “Discontinue taking this medication.” C. “Try taking this medication at night to minimize the possibility of headaches.” D. “Lie down after using nitroglycerin to avoid a headache.” |
A The most common adverse effect of nitrate therapy is headache. Analgesics, such as acetaminophen, may be used if needed.
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Which statement about ranolazine (Ranexa), a fatty oxidase enzyme inhibitor, is true?
A. It causes coronary artery vasodilation. B. It causes no gastrointestinal side effects. C. It causes QT interval prolongation. D. It elevates LDL levels. |
C Baseline and follow-up ECGs should be obtained to evaluate the effects on the patient’s QT incorrect interval.
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Which therapies are used in the treatment of angina pectoris? (Select all that apply.)
A. ECG B. Coronary artery bypass C. Coronary angioplasty D. Avoidance of caffeine and emotional stress E. Use of nitrates |
ANS: B, C, D, E
Coronary artery bypass may be standard treatment of angina pectoris, pending medical evaluation. Coronary angioplasty may be standard treatment of angina pectoris, pending medical evaluation. Avoiding caffeine and emotional stress is standard treatment of angina pectoris. Use of nitrates is standard treatment of angina pectoris. |
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Which lifestyle modifications will the nurse include when educating the patient with angina pectoris? (Select all that apply.)
A. Weight reduction therapy B. Low-potassium diet C. Smoking cessation D. Stress management |
ANS: A, C, D
Although medications can control angina attacks, lifestyle changes such as maintaining an ideal weight are important in managing the disease. Smoking cessation is a vital component to include when educating the patient with angina pectoris. Although medications can control angina attacks, lifestyle changes such as managing stress are important in controlling the disease. |
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Which will the nurse include in discharge teaching for patients on nitrate therapy? (Select all that apply.)
A. Increase caffeine in diet B. Relaxation techniques C. Proper storage of medications D. Pain assessment E. Isometric exercise program |
ANS: B, C, D
Lifestyle modifications such as relaxation techniques, are essential for many individuals with angina. Nitrates should be stored in dark, airtight containers. Pain assessment and rating is an important part of nitrate therapy. |
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Which will the nurse include in the teaching plan for a patient with angina who is prescribed a beta-adrenergic blocking agent? (Select all that apply.)
A. Goals include reduced frequency of attacks, reduced nitrate use, and improved exercise tolerance. B. Only some beta blockers are effective in treating angina pectoris. C. Comorbidities, such as diabetes or COPD, influence the product selection of beta blockers to treat angina. D. Cardioselective agents minimize pulmonary and peripheral vascular adverse effects. E. Stress exercise is an effective way to determine the most appropriate dosage. F. Acebutolol, atenolol, and metoprolol must be taken in divided doses to be effective in treating angina. |
ANS: A, C, D, E
Beta blockers are used to reduce the frequency of attacks, reduce nitrate use, and improve exercise tolerance. Comorbidities influence product selection in the angina patient. Cardioselective agents have greater affinity for beta-1 adrenergic receptors (cardiac) than beta-2 adrenergic receptors (bronchi, peripheral blood vessels), thereby reducing the possible pulmonary and vascular adverse effects. Stress exercise is an effective way to determine the most appropriate dosage. |
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The nurse is assessing the patient’s leg for peripheral vascular disease (PVD) and is unable to palpate the pedal pulse in either foot. Which action will the nurse take first?
A. Contact the health care provider for further orders. B. Request x-ray studies of the lower extremities. C. Request that the patient lie flat. D. Obtain a Doppler ultrasound device for auscultation. |
D The Doppler ultrasound device may aid in determining peripheral blood flow.
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What is the action of pentoxifylline (Trental), a hemorheologic agent used to treat chronic occlusive arteriole disease?
A. Vasodilates the peripheral arteries B. Potentiates the blood clotting mechanism C. Increases erythrocyte flexibility D. Increases blood viscosity |
C Pentoxifylline enhances red blood cell (erythrocyte) flexibility, which reduces blood viscosity. This allows for more blood to perfuse into the tissues. Muscle tissues become better oxygenated and intermittent claudication is reduced.
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Which assessment verifies increased blood perfusion to the lower extremities?
A. Toes cool to the touch B. Decreased sensation below the knees C. Increased amplitude of pedal pulses D. Paleness of the foot |
C The pressure of blood as it is pushed against an artery is detected as a pulse. Increased pulse amplitude indicates increased blood flow.
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Which patient statement indicates to the nurse that the patient has a good understanding of peripheral vascular disease?
A. “Symptoms are warning signs of the increased potential to develop diseases.” B. “Pharmacologic treatments can reverse the disease process.” C. “Surgical interventions will cure the disease.” D. “Controlling contributing factors may affect the progression of the disease.” |
D Patients must be taught the interrelationships between the PVD and other related diseases that they may have, such as diabetes, hypertension, angina, and hyperlipidemia. Control or lack of control of the contributing factors of these related diseases will significantly affect the progression of the PVD.
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The nurse is assessing a patient on papaverine therapy and notes tachycardia, which is a compensatory effect of which condition?
A. Hypoventilation B. Hypotension C. Excessive sympathetic stimulation D. Adrenergic suppression |
B An adverse effect of papaverine therapy is hypotension. When blood pressure drops, cardiac output decreases, and there is less available oxygenated blood flowing to the periphery. Baroreceptors trigger the heart to increase the rate, which causes tachycardia to maintain cardiac output and the perfusion of oxygenated blood to the tissues.
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When assessing a client recently prescribed pentoxifylline (Trental), which medication will alert the nurse to monitor closely for adverse effects?
A. Antilipemic B. Antihypertensive C. Antibiotic D. Antipsychotic |
B Patients receiving pentoxifylline frequently display a small reduction in systemic blood pressure. An antihypertensive medication may potentiate this effect. They must be monitored for hypotension, and therapy may have to be reduced to minimize adverse effects.
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The nurse advises a patient taking papaverine to consult the health care provider or pharmacist before taking which over-the-counter (OTC) medication?
A. Laxatives B. Cough and cold remedies C. Vitamin supplements D. Acetaminophen |
B OTC cough and cold preparations may counteract the effects of papaverine.
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A patient has recently been prescribed cilostazol (Pletal). Which statement by the patient indicates that this medication is effective?
A. “I have less leg cramping when I walk.” B. “My pulse rate is more regular.” C. “I have had fewer episodes of angina.” D. “My blood pressure has decreased.” |
A The primary therapeutic outcome expected from cilostazol is improved tissue perfusion, with a reduced frequency of pain, improved tolerance to exercise, and improved peripheral pulses.
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The nurse has completed teaching to a patient recently prescribed cilostazol (Pletal). Which statement by the patient indicates a need for further teaching?
A. “I will sit down if I feel lightheaded or faint.” B. “Because this medication helps my circulation, I will try to quit smoking.” C. “Grapefruit juice will increase the effects of this medication.” D. “Diarrhea may occur but likely will stop with continued therapy.” |
C Grapefruit juice inhibits the metabolism of cilostazol and would decrease the effects of the medication.
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Which are included in the baseline assessment of PVD? (Select all that apply.)
A. History of heart disease B. Smoking and dietary habits C. Current medications D. Weight E. Limb pain F. Mental status |
ANS: A, B, C, D, E
Age, gender, race, family history of incidence of symptoms of PVD, hypertension, and cardiac disease indicate risk factors for developing PVD. Smoking causes vasoconstriction and dietary habits can cause atherosclerosis, predisposing the patient to PVD. Current medications are essential to know so as to prescribe a pharmacological agent without exposing the patient to possible drug interactions. Weight may factor into calculations for prescribing medications to treat PVD. Limb pain is a symptom of PVD and may allow the health care provider to assess the extent of existing disease. |
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The nurse is preparing a teaching plan for a patient with Raynaud’s disease who is soon to be discharged. Which information will be included to improve circulation and prevent complications of this disease? (Select all that apply.)
A. Begin a daily exercise program. B. Keep hands and feet warm. C. Surgery is often the most effective treatment. D. Elevate the lower extremities when reclining. E. Smoking cessation will improve outcomes. |
ANS: A, B, E
Daily exercise promotes circulation and prevents complications. Maintaining extremity warmth promotes circulation and prevents complications. Smoking cessation promotes circulation and prevents complications. |
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Which will the nurse include in the discharge teaching plan for a patient with PVD? (Select all that apply.)
A. Intermittent cold applications to the extremities B. Heat therapy C. Stress reduction techniques D. An exercise program E. Bed positioning techniques |
ANS: C, D, E
Diseases such as diabetes, hypertension, angina, and hyperlipidemia are interrelated with PVDs. Stress reduction techniques will assist patients in reducing blood pressure, smoking, and overeating. A daily exercise program can significantly improve collateral circulation. Bed positioning techniques, such as elevating the bed 12 to 16 inches, improve blood flow to the periphery |
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Which are necessary steps in the assessment of the patient preparing for treatment of PVD with pentoxifylline (Trental)? (Select all that apply.)
A. Check for intolerance to caffeine. B. Obtain baseline data on pain that may be present. C. Obtain test results for PT and aPTT. D. Perform baseline gastrointestinal assessment to determine if the patient has nausea, vomiting, or dyspepsia. E. Ask specifically if the patient has any cardiac symptoms or dizziness. F. Schedule the patient for an exercise stress test. |
ANS: A, B, D, E
Before beginning therapy with pentoxifylline, the nurse should determine intolerance to caffeine. To evaluate therapeutic effects of prescribed medications, a baseline is needed against which to compare future assessments. Before beginning therapy with pentoxifylline, the nurse should determine baseline gastrointestinal symptoms. Before beginning therapy with pentoxifylline, the nurse should assess for cardiac symptoms, pain, and dizziness. |
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A trauma patient arrives in the emergency department via EMS. He is bleeding profusely. A medical alert bracelet indicates that he is on heparin therapy. The nurse will most likely administer which medication that counteracts the action of heparin?
A. Warfarin sodium (Coumadin) B. Enoxaparin (Lovenox) C. Protamine sulfate D. Vitamin K |
C Protamine sulfate is the antidote to heparin. With the patient’s risk of fluid volume deficit as a result of trauma, the primary intervention would be to counteract the effects of heparin to prevent hemorrhage.
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A patient receiving IV heparin therapy for a deep vein thrombosis in his right calf asks why his calf remains painful, edematous, and warm to touch after 2 days of anticoagulant therapy. Which response by the nurse is most accurate?
A. “It takes at least 3 days for the symptoms to resolve once the clot dissolves.” B. “Heparin does not dissolve blood clots, but neutralizes clotting factors, preventing extension of the clot and the possibility of it traveling elsewhere in your body.” C. “I will report this to your health care provider because there may be a need to look at alternative treatments.” D. “You appear anxious. The health care provider will eventually put you on ticlopidine, which allows for an earlier discharge.” |
ANS: B Heparin is used to treat a thromboembolism and promote neutralization of activated clotting factors, preventing the extension of thrombi and the formation of emboli. Heparin will minimize tissue damage by preventing it from developing into an insoluble, stable thrombus.
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A patient is receiving IV heparin therapy. The aPTT is 90; the laboratory control is 30 seconds. Which nursing intervention is most accurate?
A. Document in the nursing notes that these results are within therapeutic range. B. Note the RBC count and wait for the health care provider to make the next round to discuss all laboratory values. C. Stop the heparin drip. D. Assess the patient for signs and symptoms of decreased sensorium. |
C Heparin dosage is considered to be in the normal therapeutic range if the aPTT is 1.5 to 2.5 times the control value. The patient’s aPTT value is above the therapeutic range, which puts her at risk for hemorrhage. The most appropriate nursing action would be to stop the heparin drip.
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Which is an accurate nursing action when administering subcutaneous enoxaparin, a low molecular weight heparin product?
A. Expel the air bubble from the prefilled syringe. B. Leave the needle in place for 10 seconds after injection. C. Administer the medication into the deltoid muscle. D. Massage the site after injection to increase absorption. |
B The needle is left in place for 10 seconds after injection
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A patient is receiving 1400 units of heparin/hour on an IV pump. The aPTT time is 54. The laboratory control is 25. Which action by the nurse is accurate?
A. Bolus the patient with an additional 5000 units of heparin. B. Stop the heparin immediately and notify the health care provider that the patient’s blood level is toxic. C. Administer protamine sulfate stat. D. Continue with the prescribed rate. |
D Therapeutic heparin values are 1.5 to 2.5 times the control value. The therapeutic range of heparin with a control of 25 is 37.5 to 62.5 units/hour. Fifty-four is within the therapeutic range.
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What is the rationale for administering fibrinolytic agents, such as streptokinase, within hours of the onset of myocardial infarction?
A. Enhances myocardial oxygenation B. Lyses the blood clot C. Promotes platelet aggregation D. Inhibits clotting mechanisms |
B Fibrinolytic agents such as streptokinase dissolve or lyse recently formed thrombi. The goals of thrombolytic therapy are to lyse the thrombus during the early stages of clot formation, restore circulation to the areas distal to the thrombus, and reduce morbidity after thromboembolism formation.
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What is the mechanism of action of drugs used to treat thromboembolic disease?
A. Dissolving clots and preventing formation of new clots B. Making platelets more flexible and preventing formation of new clots C. Causing vasodilation and increased blood flow D. Preventing platelet aggregation and inhibiting clot formation |
D The pharmacologic agents used to treat thromboembolic disease act to prevent platelet aggregation or to inhibit a variety of steps in the fibrin clot formation cascade.
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Dipyridamole (Persantine) has been used extensively in combination with warfarin to prevent the formation of thromboembolism after which type of event?
A. Myocardial infarction B. Transient ischemic attack C. Cardiac valve replacement D. Heart transplant |
C Dipyridamole has been used extensively in combination with warfarin to prevent the formation of thromboembolism after cardiac valve replacement.
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Which action will the nurse implement to decrease the risk of clot formation in an older patient on bed rest?
A. Assess peripheral pulses. B. Encourage passive leg exercises. C. Limit fluid intake. D. Position pillows behind the knees. |
B Using active or passive leg exercises for a patient on bed rest will prevent clot formation.
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The nurse is teaching a patient about dietary implications while on warfarin (Coumadin) therapy. Which salad is highest in vitamin K?
A. Fruit B. Pasta C. Potato D. Spinach |
D Green leafy vegetables contain vitamin K.
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The nurse has provided instruction to a patient recently prescribed warfarin (Coumadin). Which statement by the patient indicates to the nurse the need for further teaching?
A. “I will always wear a medical alert bracelet.” B. “I will check with my health care provider before I take any OTC medications.” C. “I will be careful when I use a knife or other sharp objects.” D. “I will rinse my mouth with mouthwash instead of brushing my teeth.” |
D Soft-bristled toothbrushes are acceptable to use for oral care.
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Which symptom is indicative of bleeding in a patient taking warfarin (Coumadin)?
A. Bradycardia B. Petechiae C. Increased urinary output D. Dry skin |
B Petechiae are indicative of bleeding. These pinpoint red spots on the skin indicate intradermal hemorrhage.
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Which medications may safely be administered to a patient on ticlopidine? (Select all that apply.)
A. Acetaminophen (Tylenol) B. Acetylsalicylic acid C. Propranolol (Inderal) D. Cimetidine (Tagamet) E. Furosemide (Lasix) |
ANS: A, C, E
Acetaminophen is safe to administer to patients taking ticlopidine because it does not contribute to bleeding. Inderal is safe to administer to patients taking ticlopidine because it does not contribute to bleeding. Lasix is safe to administer to patients taking ticlopidine because it does not contribute to bleeding. |
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Anticoagulant therapy may be used for which situations? (Select all that apply.)
A. To prevent stroke in patients at high risk B. Following a myocardial infarction C. Following total hip or knee joint replacement surgery D. With deep vein thrombosis E. To prevent thrombosis in immobilized patients F. peptic ulcer disease |
ANS: A, B, C, D, E
Anticoagulant therapy is used to treat patients at high risk for stroke. Anticoagulant therapy is used to treat patients with thromboembolic diseases, such as myocardial infarction. Anticoagulant therapy is used to treat patients at risk of developing thrombus secondary to underlying medical conditions.Anticoagulant therapy is used to treat patients with thromboembolic diseases, such as deep vein thrombosis. Anticoagulant therapy is used to treat patients at risk of developing thrombus secondary to underlying medical disease |
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The nurse is preparing discharge education for a patient who will be receiving warfarin (Coumadin) at home. Which important points will the nurse include? (Select all that apply.)
A. “Do not make any major changes to your diet without discussing it with your health care provider.” B. “Keep outpatient laboratory appointments for monitoring of therapy.” C. “Take the medication after meals.” D. “Report signs of bleeding to your health care provider, including observing skin for bruising, petechiae, blood in emesis, urine, or stools, bleeding gums, cold, clammy skin, faintness, or altered sensorium.” E. “Avoid aspirin products.” |
ANS: A, B, D, E
Although patients on anticoagulant therapy should have knowledge about foods high in vitamin K (green leafy vegetables), they should not make any major changes to their diet without consulting with their health care provider, pharmacist, and/or nutritionist. Patients receiving anticoagulant therapy should maintain regular appointments for assessment of the drug’s therapeutic effects and follow up with the health care provider for regular review of laboratory values and dosage monitoring. Regular self-assessment for signs of bleeding is necessary for patients on anticoagulant therapy. Patients on anticoagulant therapy should avoid aspirin products. |
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Which are accurate nursing interventions when administering heparin subcutaneously? (Select all that apply.)
A. Assessment of recent aPTT levels B. Massaging the site after injection of medication C. Aspirating after needle insertion D. Documentation of ecchymotic areas E. Monitoring of vital signs |
ANS: D, E
Ecchymosis, or bruising, indicates bleeding below the dermis and should be assessed closely. Patients on heparin therapy are prone to bleeding, which would lead to hemorrhagic shock. Vital sign alterations would alert the nurse to internal bleeding. |
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The pharmacologic agents used to treat deep vein thrombosis (DVT) may act in which of the following ways? (Select all that apply.)
A. Prevent platelet aggregation B. Prevent the extension of existing clots C. Inhibit steps in the fibrin clot formation cascade D. Prolong bleeding time E. Lower serum triglycerides |
ANS: A, B, C, D
Agents used to treat DVT may prevent future clotting. Agents used to treat DVT may prevent the extension of clots. Agents used to treat DVT may inhibit steps in the formation of clots. Agents used to treat DVT act to prolong bleeding time. |
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Which drug will be administered to a patient being admitted with severe digoxin intoxication?
A. Amiodarone (Cordarone) B. Spironolactone (Aldactone) C. Digoxin immune Fab (Digibind) D. Digitalis glycoside |
C The antidote for digoxin intoxication is digoxin immune Fab (Digibind).
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The nurse is caring for a 3-year-old girl who has a congenital heart anomaly. The patient’s current medications include digoxin and furosemide (Lasix). The apical pulse rate is 100 beats/min. Which action will the nurse take?
A. Administer the medication. B. Contact the pediatric cardiologist for further orders. C. Hold the digoxin. D. Request that another unit nurse assess the child. |
A A pulse rate of 100 beats/min in a child who is 3 years old is considered acceptable. Administration of the medication is appropriate.
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An older adult male patient with long-term heart failure has presented for an office visit. The nurse obtains information that he has recently begun taking St. John’s wort. What results with the use of this herbal supplement?
A. Digoxin toxicity B. Altered potassium electrolyte balance C. Reduced therapeutic benefits of digoxin D. Enhanced digoxin effectiveness without producing toxicity |
C St. John’s wort is a drug that may reduce therapeutic benefits of digoxin.
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The nurse is to administer digoxin to an 18-month-old patient who weighs 16.5 lb. Guidelines for administration read as follows: 0.0075 mg to 0.010 mg/kg/day. Which is a safe medication dosage?
A. 0.05 mg B. 0.12 mg C. 0.074 mg D. 0.75 mg |
C 16.5 lb converts to 7.5 kg
7.5 kg 0.0075 mg = 0.05625 7.5 kg 0.010 mg = 0.075 mg 0.074 mg is the only answer within the safe dosage range. |
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The nurse monitors a patient receiving digoxin closely for toxicity when which other medication is prescribed?
A. Potassium supplements B. Furosemide (Lasix) C. Acetylsalicylic acid (aspirin) D. Antibiotics |
B Furosemide is a potassium-depleting diuretic. Low potassium levels potentiate digoxin toxicity.
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Which is the initial manifestation of digoxin toxicity in children?
A. Hallucinations B. Weakness C. Atrial dysrhythmia D. Diuresis |
C In children, digoxin toxicity is often first detected by the development of atrial dysrhythmias.
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Which agents stimulate the heart to increase the force of contractions, thereby increasing cardiac output?
A. Inotropic B. Chronotropic C. Isotonic D. Isopropyl |
A Inotropic agents stimulate the heart to increase the force of contractions, thus boosting cardiac output.
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Which drug is used to obtain vasodilation in the treatment of chronic heart failure?
A. ACTH B. ACE inhibitors C. ARBs |
B Angiotensin-converting enzyme (ACE) inhibitors are the mainstays of oral vasodilator therapy for treating chronic heart failure.
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Which action of ACE inhibitors results in effective treatment of heart failure?
A. Increased afterload B. Increased aldosterone C. Increased preload D. Increased cardiac output |
D The therapeutic outcome of ACE inhibitors in heart failure is to improve cardiac output.
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The nurse is providing teaching to a patient with heart failure who has been prescribed nifedipine, a calcium channel blocker. Which statement by the nurse is accurate?
A. “This medication dilates your coronary arteries.” B. “This medication will help your kidneys get rid of fluid.” C. “This medication reduces volume returning to your heart so it doesn’t overstretch.” D. “This medication reduces the resistance your heart has to pump against.” |
D This medication reduces afterload or the resistance against which the heart has to pump.
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Which instruction by the nurse will be included when teaching an adult patient about digoxin (Lanoxin) for management of heart failure?
A. “Report nausea and vomiting to your health care provider.” B. “Decrease the amount of high-potassium foods you eat.” C. “Omit your dose of digoxin if your pulse is 60.” D. “Visual disturbances are common adverse effects.” |
A Nausea and vomiting is a serious adverse effect indicative of toxicity.
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Which action will the nurse implement while providing care to a patient with heart failure?
A. Encourage fluid intake of 2 L/day. B. Ambulate the patient within 1 hour after eating. C. Maintain the patient in the supine position. D. Weigh the patient daily. |
D Daily weights are the best indicator of fluid gain or loss.
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Which nursing assessment is most important to determine fluid status for a patient with heart failure?
A. Auscultation of lungs B. Daily weights C. Intake and output D. Measurement of abdominal girth |
B Daily weights are the best indicator of fluid gain or loss.
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The nurse is assessing an emergency department patient who was recently discharged following a myocardial infarction (MI). Which symptoms would the nurse observe in this patient with left ventricular systolic failure? (Select all that apply.)
A. Reports of recent weight loss B. Complaints of peripheral edema C. Diminished exercise tolerance D. Shortness of breath with activity E. Blood pressure elevation |
ANS: C, D
Early clinical symptoms of left ventricular failure are decreased exercise tolerance and poor perfusion to peripheral tissues. Patients who develop left ventricular systolic failure secondary to MI have acute shortness of breath |
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Before administering digoxin (Lanoxin), the nurse takes the adult patient’s apical pulse for 1 full minute. What additional nursing considerations will be taken before administration of the medication? (Select all that apply.)
A. Review of the digoxin blood level B. Administration of the medication with pulse less than 60 beats/min C. Review of serum electrolytes, liver, and kidney function studies D. Administration of the medication with a pulse of 110 beats/min E. Obtaining baseline patient assessment data, including lung sounds, vital signs, and weight |
ANS: A, C, E
Before administering digoxin, the nurse should review digoxin levels. Before administering digoxin, the nurse should review baseline diagnostic data (electrolytes, and liver and kidney function tests). Before administering digoxin, the nurse should obtain appropriate physical assessments for heart failure patients. |
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Which actions will the nurse take when caring for a patient with heart failure? (Select all that apply.)
A. Administer diuretics at bedtime. B. Assess electrolyte levels. C. Report daily weight fluctuations. D. Encourage sodium intake. E. Maintain skin hygiene. |
ANS: B, C, E
Ongoing assessment of electrolyte levels is critical when caring for a patient with heart failure. Weight gains and losses are the single best indicator of fluid gain or loss. The maintenance of skin care and changing of positions are essential to prevent skin breakdown |
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Which contributing factors to heart failure are modifiable? (Select all that apply.)
A. Hypertension B. Addiction to smoking C. Genetic history D. Exercise tolerance E. Age |
ANS: A, B, D
Hypertension is a contributing factor to atherosclerosis, which can be modified with changes in behavior and the assistance of medications. Smoking is a contributing factor to atherosclerosis, which can be modified with changes in behavior and the assistance of pharmacotherapeutic methods. Diminished exercise tolerance is a contributing factor to atherosclerosis, which can be modified with changes in behavior. |
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A patient with heart failure has been prescribed nesiritide (Natrecor). Which statements are true regarding this medication? (Select all that apply.)
A. It increases preload. B. Cardiac ventricles secrete this hormone in response to fluid overload. C. It suppresses aldosterone. D. It promotes norepinephrine secretion. E. It causes vasodilation. |
ANS: B, C, E
Nesiritide is a hormone normally secreted by the cardiac ventricles in response to fluid and pressure overload. Nesiritide suppresses aldosterone. Nesiritide causes vasodilation. |
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Which are true statements about vasodilators? (Select all that apply.)
A. They reduce systemic vascular resistance. B. They increase afterload. C. They reduce preload. D. They decrease pulmonary congestion. E. They increase tissue perfusion to muscles and organs. F. They increase the volume of blood returning to the heart. |
ANS: A, C, D, E
Vasodilators reduce systemic vascular resistance (afterload). Vasodilators decrease preload. Vasodilators relieve pulmonary congestion. Vasodilators increase tissue perfusion to muscles and vital organs. |
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Which condition would alert the nurse of the need to use beta-adrenergic blockers cautiously?
A. Hypertension B. Raynaud’s phenomenon C. Emphysema D. Cardiac dysrhythmias |
C Beta-adrenergic blockers can produce severe bronchoconstriction.
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A patient with chronic obstructive pulmonary disease (COPD) reports having insomnia and a racing heart after starting terbutaline therapy. Which explanation by the nurse is most accurate?
A. “The symptoms are usual and indicate that the medication is at a therapeutic level.” B. “The symptoms will tend to resolve with continued therapy.” C. “The symptoms are unusual and need to be reported to the health care provider immediately.” D. “The symptoms are indicative of toxicity.” |
B Terbutaline, an adrenergic agent effective for bronchodilation, can cause excessive CNS stimulation. Adverse effects such as palpitations, tachycardia, flushed skin, dizziness, and tremors tend to be mild and resolve with continued therapy.
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What is the primary response to alpha-1 receptor stimulation?
A. Bronchodilation B. Tachycardia C. Vasoconstriction D. Uterine relaxation |
C Stimulation of the alpha-1 receptors causes vasoconstriction of all blood vessels throughout the body.
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Which category of medications is used for peripheral vascular diseases characterized by excessive vasoconstriction, such as Raynaud’s disease?
A. Adrenergic agents B. Alpha-adrenergic blocking agents C. Beta-adrenergic blocking agents D. Cholinergic agents |
B Alpha-adrenergic–blocking agents interfere with the stimulation of alpha-1 and alpha-2 receptors. Because the primary action of alpha-receptor stimulation is vasoconstriction, alpha-adrenergic blocking agents are indicated for patients with diseases associated with vasoconstriction.
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Why are beta blockers used cautiously in patients with respiratory conditions?
A. They mask the signs and symptoms of acute hypoglycemia. B. They cause extensive vasodilation and cardiac overload. C. They may produce severe bronchoconstriction. D. They increase hypertensive episodes. |
C Nonselective beta blockers, such as Inderal, and larger doses of selective beta antagonists will readily affect the beta-2 receptors of the bronchi, causing bronchoconstriction. Therefore, beta blockers must be used with extreme caution in patients with respiratory conditions such as bronchitis, emphysema, asthma, or allergic rhinitis.
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A patient with Parkinson’s disease asks the nurse why anticholinergics are used in the treatment. Which response by the nurse is most accurate?
A. “These drugs help you urinate.” B. “These drugs will decrease your eye pressure.” C. “These drugs inhibit the action of acetylcholine.” D. “These drugs will assist in lowering your heart rate.” |
C Anticholinergic agents inhibit the action of acetylcholine in the parasympathetic nervous system. These drugs occupy receptor sites at the parasympathetic nerve endings, preventing the action of acetylcholine. Inhibition of acetylcholine facilitates stimulation of the dopaminergic receptors, which relieves the symptoms associated with Parkinson’s disease.
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Before the initiation of anticholinergic medications, it is important for the nurse to screen patients for which condition?
A. Hypertension B. Infectious diseases C. Diabetes D. Closed-angle glaucoma. |
D The inhibition of cholinergic activity (anticholinergic effects) causes pupil dilation, which increases intraocular pressure in patients with glaucoma. In patients with closed-angle glaucoma, anticholinergic medications can precipitate an acute attack.
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Which nerve endings liberate norepinephrine?
A. Cholinergic B. Adrenergic C. Anticholinergic D. Muscarinic |
B Nerve endings that secrete norepinephrine are called adrenergic fibers.
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The autonomic nervous system can be subdivided into which types of adrenergic receptors?
A. Nicotinic and muscarinic B. Afferent and efferent C. Alpha and beta D. Agonists and antagonists |
C The autonomic nervous system can be subdivided into alpha- and beta-adrenergic receptors.
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Prior to the administration of metoprolol, a beta-adrenergic blocking agent, which is most important for the nurse to assess?
A. Blood pressure B. Lung sounds C. Mental status D. Urine output |
A Beta- adrenergic–blocking agents cause vasodilation and decreased heart rate, resulting in lowering of the blood pressure. A premedication assessment is to take baseline heart rate and blood pressure.
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A patient with a history of type 1 diabetes after myocardial infarction has been placed on a beta-adrenergic blocking agent. Which statement by the patient indicates a need for further teaching?
A. “This medication should not be discontinued suddenly.” B. “This medication lowers my blood pressure by helping me get rid of fluid.” C. “I may not have my usual symptoms of a hypoglycemic reaction while on this drug.” D. “This medication may take a few weeks to work.” |
B Beta-adrenergic blocking agents decrease the heart rate and dilate blood vessels to lower blood pressure.
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An older adult patient is to receive atenolol, a beta-adrenergic blocking agent. Prior to administration of the drug, the nurse assesses an apical pulse rate of 58 and notes ankle edema. Which action will the nurse take first?
A. Determine the therapeutic blood level. B. Encourage the patient to decrease water intake. C. Elevate the patient’s legs. D. Withhold the medication. |
D These signs and symptoms are indicative of serious adverse effects, and the medication should be held or discontinued until the patient is evaluated by a health care provider.
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Which adverse effects are common when a patient is receiving a cholinergic agent? (Select all that apply.)
A. Nausea B. Hypertension C. Dizziness D. Bradycardia E. Constipation |
ANS: A, C, D
Cholinergic agents produce effects similar to those of acetylcholine. Cholinergic actions increase GI motility and secretions that can cause nausea, vomiting, diarrhea, and abdominal cramping. Gastrointestinal symptoms tend to be dose-related and may be controlled by decreasing the dosage. Dizziness is a common adverse effect and can be minimized by rising slowly from a sitting or supine position. Cholinergic agents slow the heart rate. |
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Which statements are true about efferent nerves? (Select all that apply.)
A. They transmit signals to the spinal cord and brain. B. They leave the CNS to carry impulses to other body parts. C. They are part of the peripheral nervous system. D. They transmit signals that control contractions of smooth and skeletal muscle. E. They transmit signals that control contractions of some glandular secretions. |
ANS: B, C, D, E
Efferent nerves leave the CNS and carry impulses to other body parts that control contractions of smooth and skeletal muscles, as well as some glandular secretions. The efferent nerves, together with afferent nerves, make up the peripheral nervous system. Efferent nerves leave the CNS and carry impulses to other body parts that control contractions of smooth and skeletal muscles. Efferent nerves leave the CNS and carry impulses to other body parts that control some glandular secretions. |
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Which instructions given by the nurse will assist a patient to cope with the common adverse effects of anticholinergic medications? (Select all that apply.)
A. “Take the medication with meals.” B. “Increase fluids daily.” C. “Decrease fiber in the diet.” D. “Suck on candy or ice chips.” E. “Monitor blood sugars.” |
ANS: B, D
Anticholinergic medications cause dryness of mucous membranes. Increasing fluids helps alleviate the dryness of the mouth, nose, and throat. Anticholinergic medications cause dryness of mucous membranes. Sucking on candy or ice chips, or chewing gum, helps alleviate the dryness of the mouth, nose, and throat. |
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Which body functions are controlled by the autonomic nervous system? (Select all that apply.)
A. Blood pressure B. Skeletal muscle contraction C. GI secretion D. Body temperature E. Urination |
ANS: A, C, D, E
Blood pressure is a body function controlled by the autonomic nervous system. GI secretion is a body function controlled by the autonomic nervous system. Body temperature is a body function controlled by the autonomic nervous system. Urinary bladder function is controlled by the autonomic nervous system. |
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A patient is being discharged on an adrenergic bronchodilator. Which common adverse effects will the nurse include in discharge teaching? (Select all that apply.)
A. Palpitations B. Dizziness C. Orthostatic hypotension D. Hypoglycemia E. Tremors F. Bradycardia |
ANS: A, B, C, E
A common adverse effect of adrenergic agents is palpitations and rapid heart rate. A common adverse effect of adrenergic agents is dizziness. A common adverse effect of adrenergic agents is orthostatic hypotension. A common adverse effect of adrenergic agents is tremors. |
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Which are examples of neurotransmitters? (Select all that apply.)
A. Gamma amino-butyric acid B. Acetylcholine C. Serotonin D. Glucose E. Histamine F. Epinephrine |
ANS: A, B, C, E, F
The CNS is composed of systems of different types of neurons that secrete separate neurotransmitters. Gamma-aminobutyric acid is an example. The CNS is composed of systems of different types of neurons that secrete separate neurotransmitters. Acetylcholine is an example. The CNS is composed of systems of different types of neurons that secrete separate neurotransmitters. Serotonin is an example. The CNS is composed of systems of different types of neurons that secrete separate neurotransmitters. Histamine is an example. The CNS is composed of systems of different types of neurons that secrete separate neurotransmitters. Epinephrine is an example. |
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Which are indications for the use of anticholinergic agents? (Select all that apply.)
A. Glaucoma B. Benign prostatic hypertrophy C. Bradycardia D. Parkinson’s disease E. Preparation for surgery F. Stimulation of the vagus nerve |
ANS: C, D, E
Anticholinergic drugs are used to treat bradycardia. Anticholinergic drugs are used to treat Parkinson’s disease. Anticholinergic drugs are used as drying agents in preparation for surgery and anesthetic administration. |
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Which reaction occurs as a result of prescribing carbidopa-levodopa?
A. Idiosyncratic B. Additive C. Hypersensitivity D. Tolerance |
B An additive reaction occurs when two medications are prescribed together with the knowledge that combining these medications will produce a therapeutic benefit unavailable if each were prescribed alone.
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Which adverse effects associated with levodopa therapy would support the nursing diagnosis Risk for Injury?
A. Nausea and vomiting B. Orthostatic hypotension C. Anorexia and depression D. Tachycardia and palpitations |
B When initiating levodopa therapy, orthostatic hypotension may occur. Although generally mild, patients may experience dizziness and weakness. Symptoms usually resolve within 1 or 2 weeks once tolerance is developed to the levodopa therapy. Orthostatic hypotension increases the risk for injury in Parkinson’s patients because they are also experiencing alterations in gait patterns.
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Which vitamin will reduce the therapeutic effects of levodopa?
A. A B. B6 C. C D. D |
B Pyridoxine (vitamin B6) will reduce the therapeutic effects of levodopa in oral doses of 5 to 10 mg or more. Generally, diets typically have less than 1 mg of vitamin B6 and therefore are not restricted. The ingredients in multivitamins, however, must be assessed.
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Which cholinergic symptoms of Parkinson’s disease are reduced with anticholinergic drugs?
A. Cognitive impairments B. Rigidity C. Tremors and drooling D. Postural abnormalities |
C Anticholinergic drugs will reduce the severity of tremors and drooling in patients with Parkinson’s disease. Anticholinergics are most useful when used in combination with levodopa.
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What is the pharmacologic action of entacapone, a potent catechol-O-methyl transferase (COMT) inhibitor?
A. Slows the deterioration of dopaminergic nerve cells B. Inhibits the relative excess of dopaminergic activity C. Reduces the destruction of dopamine in peripheral tissues D. Enhances the cholinergic symptoms of Parkinson’s disease |
C Entacapone, a COMT inhibitor, reduces dopamine destruction in peripheral tissues. This significantly increases the amount of dopamine available to reach the brain. Entacapone, when used with carbidopa-levodopa therapy, results in more constant dopaminergic stimulation. Entacapone is not effective when used alone.
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The nurse is teaching a patient with Parkinson’s disease about levodopa. Which statement by the nurse is accurate regarding drug administration?
A. “Take this medication in between meals.” B. “Take this medication at bedtime to prevent dizziness.” C. “Take this medication when your tremors get worse.” D. “Take this medication with food or antacids to reduce GI upset.” |
D Levodopa causes nausea, vomiting, and anorexia. Therefore, administration should be in divided doses with food or antacids to decrease gastrointestinal irritation.
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Dopamine agonists have been linked with which adverse effects in patients with Parkinson’s disease?
A. Oculogyric crisis B. Tardive dyskinesia C. Sudden sleep events D. Akathisia |
C Sleep episodes have been reported with the dopamine agonists bromocriptine, pergolide, pramipexole, and ropinirole. These are described as “sleep attacks,” including daytime sleep.
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What is the rationale for administering levodopa for treatment of Parkinson’s disease instead of dopamine?
A. Dopamine does not cross the blood-brain barrier when administered orally. B. Levodopa is much less expensive. C. The half-life of dopamine is too short. D. Dopamine has too many reactions with other medications. |
A When administered orally, dopamine does not enter the brain. Levodopa does cross into the brain and is metabolized into dopamine.
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The nurse is providing education to a patient recently placed on selegiline disintegrating tablets. Which statement by the patient indicates a need for further teaching?
A. “This medication will help slow the development of symptoms.” B. “I will place the tablet on my tongue before breakfast.” C. “I may need to use a stool softer for constipation.” D. “I should not push the tablet through the foil.” |
B Selegiline orally disintegrating tablets should be taken in the morning before breakfast, without liquid.
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The nurse is providing information to a patient recently prescribed entacapone. Which statement is correct?
A. This medication is not to be taken with carbidopa-levodopa. B. Dosage is adjusted according to the patient’s response. C. There will be fewer incidences of dopaminergic effects, such as confusion. D. This medication increases the production of dopamine in the brain. |
B Dosage must be adjusted according to the patient’s response and tolerance.
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The nurse is assessing an older patient with Parkinson’s disease who was started on entacapone 1 week ago. The patient has a history of coronary artery disease and takes an antihypertensive and aspirin. Which information would support the need for a reduction in medication dosage by the health care provider?
A. Constipation B. Brownish orange urine C. Drowsiness D. Dizziness |
D Dizziness is a symptom of orthostatic hypotension; dosages may need to be altered.
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Which are characteristic symptoms of Parkinson’s disease? (Select all that apply.)
A. Muscle tremors B. Posture alterations C. Muscle flaccidity D. Tachycardia E. Slow body movement |
ANS: A, B, E
Symptoms of Parkinson’s disease include muscle tremors. Symptoms of Parkinson’s disease include posture and equilibrium alterations. Symptoms of Parkinson’s disease include slow body movement or bradykinesia. |
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What points should be included when teaching a patient about the use of apomorphine for treatment of Parkinson’s disease? (Select all that apply.)
A. The restoration of function resulting from stimulation of dopamine receptors is permanent. B. Apomorphine may be administered intravenously for rapid relief. C. Apomorphine does not have any opioid activity. D. A multidose injector pen is commonly used to administer apomorphine. E. You may experience nausea and vomiting, which can be treated with trimethobenzamide (Tigan). F. You may experience sleep attacks or episodes of daytime sleepiness. |
ANS: C, D, E, F
Apomorphine has no opioid activity. Apomorphine is commonly injected by a reusable multidose pen. Apomorphine may cause nausea and vomiting. Apomorphine may cause sleepiness. |
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Which condition is associated with hydantoin therapy?
A. Postictal state B. Atonia C. Seizure threshold reduction D. Gingival hyperplasia |
D Encouraging good oral hygiene practices is indicated when a patient is on hydantoin therapy because its use contributes to gingival hyperplasia.
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The nurse is preparing discharge instructions for a patient with a history of diabetes who has just been diagnosed with seizure disorder. The patient has been prescribed hydantoin therapy. Which will the patient most likely experience?
A. Hunger B. Hyperglycemia C. Diarrhea D. Pupil dilation |
B Hydantoins may elevate blood sugar levels.
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Which is a guideline for the nurse when administering phenytoin (Dilantin) intravenously?
A. Deliver rapidly. B. Monitor for signs of tachycardia. C. Assess for hypertensive crisis. D. Administer without mixing with other medications. |
D Phenytoin should not be mixed in the same syringe with other medications or added to other IV solutions because a precipitate will form.
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For which condition may carbamazepine (Tegretol) be used?
A. Tardive dyskinesia B. Psychotic episodes C. Trigeminal neuralgia pain D. Sedation |
C Carbamazepine has been used successfully to treat pain associated with trigeminal neuralgia and for bipolar disorders when lithium therapy has not been optimal.
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Which is the drug of choice when treating a generalized tonic-clonic seizure?
A. Diazepam (Valium) B. Haloperidol (Haldol) C. Valproic acid (Depakene) D. Risperidone (Risperdal) |
C Anticonvulsant therapy should start with the use of a single agent selected from a group of first-line agents based on the type of seizure. Valproic acid is indicated for generalized tonic-clonic seizures.
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Which response by the nurse is accurate when a patient who has been on lamotrigine (Lamictal) for seizure control reports a skin rash and urticaria?
A. Reassure the patient that this is a common adverse effect of the medication and not to worry. B. Instruct the patient to discontinue use of the drug immediately. C. Instruct the patient to decrease the dosage of the medication until the rash disappears. D. Advise the patient that this adverse effect usually resolves but should be reported to the health care provider. |
D The nurse is not authorized to recommend dosage changes to the patient.
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Which medication is used to control seizures or prevent migraine headaches?
A. Topiramate (Topamax) B. Zonisamide (Zonegran) C. Valproic acid (Depakene) D. Tiagabine (Gabitril) |
A Topiramate has been approved for adults in the prevention (but not treatment) of migraine headaches.
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Which condition would indicate to the nurse that a patient has phenytoin (Dilantin) toxicity?
A. Oculogyric crisis B. Nystagmus C. Strabismus D. Amblyopia |
B Nystagmus (involuntary rhythmic, uncontrollable movements of one or both eyes) may be a sign of phenytoin toxicity.
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Which information would be most important for the nurse to provide to a patient when teaching about the adverse effects of succinamide therapy?
A. Nausea, vomiting, and indigestion are common during the initiation of therapy. B. Avoid taking the medication with food or milk to minimize adverse effects. C. Sedation, drowsiness, and dizziness tend to worsen with continued therapy. D. Reducing the dosage of medication will relieve symptoms of nausea. |
A Nausea, vomiting, and indigestion are common during initiation of therapy.
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Which dose is within the acceptable range for administering IV phenytoin (Dilantin) to a patient with a seizure disorder?
A. 5 mg/min B. 30 mg/min C. 60 mg/min D. 100 mg/min |
B Phenytoin is administered slowly at a rate of 25 to 50 mg/min.
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The nurse is providing discharge teaching to a patient prescribed phenytoin (Dilantin) for management of a seizure disorder. Which patient statement indicates a need for further teaching?
A. “I need to avoid or limit caffeine intake.” B. “I will check with the pharmacist before taking over-the-counter medication.” C. “If I develop enlarged gums, I will stop taking the medication.” D. “It is important for me to take my medicine at the same time daily.” |
C Medications are not discontinued unless approved by the health care provider. Gingival hyperplasia is a common adverse effect that can be reduced by oral hygiene.
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Which premedication assessment by the nurse is most important prior to the initiation of carbamazepine (Tegretol) therapy?
A. Determine patient’s ancestry. B. Monitor blood pressure lying, sitting, and standing. C. Auscultate lung sounds. D. Obtain smoking history. |
A The nurse needs to review the patient's history to exclude Asian ancestry, including South Asian Indians. If the patient does have this ancestry, bring it to the prescriber’s attention so that genetic testing may be completed.
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The nurse is providing education to a patient recently prescribed pregabalin (Lyrica). Which statement by the patient indicates a need for further instruction?
A. “I may feel tired at first, but this should improve with continued use.” B. “Once my pain improves, I will stop taking this medication.” C. “Taking sleeping aids will increase the sedative effect of this medication.” D. “This drug may affect my mental alertness, so I need to be careful around machinery.” |
B When discontinuing therapy, taper over at least 1 week to minimize the potential for withdrawal symptoms.
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What is included in the nursing management of the patient with generalized tonic-clonic seizure activity? (Select all that apply.)
A. Restraining the patient’s arms to avoid further injury B. Placing padding around or under the patient’s head C. Attempting to insert a tongue depressor into the patient’s mouth. D. Positioning the patient on the side once the relaxation stage is entered to allow oral secretions to drain E. Requesting additional assistance and/or necessary equipment in case the patient does not begin breathing spontaneously when the seizure is over |
ANS: B, D, E
Managing a patient during a seizure includes protecting the patient from further injury; placing padding around or under the head may help prevent head injury. Managing a patient during a seizure includes placing the patient in the recovery position to facilitate respiratory effort. Managing a patient during a seizure includes clearing the airway and initiating ventilations should the patient lack spontaneous respirations postseizure. |
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The health care provider orders diazepam (Valium) 10 mg IV stat for a patient who was admitted with status epilepticus. What are important nursing considerations associated with administration of this medication IV? (Select all that apply.)
A. Apply a cardiac monitor to the patient to assess for continuous heart rate, if not already done. B. Administer the prescribed dosage over 1 minute. C. Mix diazepam in a primary IV solution to avoid overdosing. D. Continuously assess the patient’s airway. E. Obtain the correct dose (10 mg) and administer over slow IV push. |
ANS: A, D, E
It is important to monitor the patient for bradycardia during administration of diazepam. During a seizure of any type, it is important to assess for airway patency continuously. When administering diazepam IV, give slowly at a rate of no more than 5 mg/min. |
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Patients taking phenytoin (Dilantin) for control of seizures must be aware of the risk for which of the following adverse effects? (Select all that apply.)
A. Blood dyscrasias B. Hyperglycemia C. Urinary retention D. Gingival hyperplasia E. Insomnia F. sedation |
ANS: A, B, D, F
Correct Phenytoin may cause blood dyscrasias. Phenytoin may elevate blood glucose levels, especially if higher doses are used. Phenytoin may cause gingival hyperplasia. Phenytoin may cause sedation. |
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The nurse is completing an assessment on a nonverbal adult patient. Which type of pain scale assessment tool is the most accurate to use?
A. TPPPS B. FLACC C. POCIS D. MOPS |
B The FLACC scale would be used to assess pain in the nonverbal patient.
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Which action will the nurse take when a patient receiving morphine sulfate via PCA has a shallow, irregular respiratory rate of 6/min?
A. Elevate the patient’s head of bed to facilitate lung expansion. B. Increase the patient’s primary IV flow rate. C. Complete the FLACC scale. D. Notify the health care provider and prepare to administer naloxone (Narcan). |
D The patient is exhibiting signs of respiratory depression. Administration of the antidote naloxone would be the most appropriate nursing intervention.
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Which patient assessment would indicate to the nurse that salicylate toxicity is occurring?
A. Gastrointestinal bleeding B. Increased bleeding times C. Tinnitus D. Occasional nausea |
C Symptoms of salicylism include ringing in the ears (tinnitus), impaired hearing, dimming of vision, sweating, fever, lethargy, dizziness, mental confusion, nausea, and vomiting.
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What is the advantage of taking an NSAID that is a COX-2 inhibitor?
A. The medication is cheaper than aspirin. B. There are fewer gastrointestinal adverse effects. C. They are more effective than COX-1 inhibitors. D. They have no known adverse effects. |
B COX-2 inhibitor NSAIDs have fewer gastrointestinal adverse effects than salicylates or COX-1 inhibitors.
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An 86-year-old patient who was admitted with gastrointestinal bleeding secondary to salicylate therapy is being discharged. As the nurse reviews the discharge medication list, the patient states that she doesn’t understand why Tylenol doesn’t work as well as the aspirin she had been taking. What would be the nurse’s best response?
A. “Tylenol and aspirin are chemically the same drug.” B. “Tylenol is appropriate for only minor pain.” C. “Tylenol does not help with inflammatory discomfort.” D. “A therapeutic blood level must be established with Tylenol.” |
C Acetaminophen (Tylenol) is effective as an analgesic or antipyretic. Tylenol does not possess any anti-inflammatory activity and is therefore ineffective in relieving symptoms related to inflammation.
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What term is used to define an awareness of pain?
A. Tolerance B. Threshold C. Perception D. Sensation |
C Pain perception, also known as nociception, is an individual’s awareness of the feeling of pain.
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Which statement is true about neuropathic pain?
A. This pain is the result of a stimulus to pain receptors. B. Patients describe it as dull and aching. C. It commonly originates in the abdominal region. D. The pain is a result of nerve injury. |
D Neuropathic pain results from injury to the peripheral or central nervous system, such as trigeminal neuralgia.
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How long after the administration of a parenteral pain medication will the nurse complete the next pain assessment to evaluate the effectiveness of the medication?
A. 10 minutes B. 30 minutes C. 1 hour D. 2 hours |
B Evaluation of pain effectiveness of parenteral pain medications needs to occur within 15 to 30 minutes of administration.
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Which sign or symptom displayed by a patient would be indicative of opiate withdrawal?
A. Bradycardia B. Diarrhea C. Lethargy D. Hypothermia |
B Symptoms of opiate withdrawal include muscular spasms, severe aches in the back, abdomen, and legs, abdominal and muscle cramps, hot and cold flashes, insomnia, nausea, vomiting, and diarrhea, severe sneezing, and increases in body temperature, blood pressure, and respiratory and heart rate.
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Which medication is contraindicated when a patient is taking warfarin (Coumadin)?
A. Aspirin B. Acetaminophen (Tylenol) C. Propoxyphene (Darvon) D. Morphine (Roxanol) |
A Salicylates enhance the anticoagulant effect of warfarin.
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What is the best way for the nurse to evaluate the effectiveness of the patient’s opiate agonist?
A. Ability of the patient to tolerate more activity B. Increased sleep time throughout the night C. Reduction of respiratory rate from 24 to 18 breaths/min D. Verbal report of 2 on a 1 to 10 scale |
D A verbal report is the best indicator because pain is individually perceived and using a pain rating scale is a consistent manner of assessment.
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Which medication would the nurse administer to a patient who is rating the pain at 8 on a 0 to 10 scale?
A. Acetaminophen (Tylenol) B. Morphine (Roxanol) C. Oxycodone (OxyContin) D. Oxycodone and aspirin (Percodan) |
B Severe pain is treated with an opiate agonist (i.e., morphine).
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In which case would the nurse be correct in withholding an opiate agonist?
A. Evidence of postural hypotension B. Presence of constipation C. Pain rating of 7 on a 0 to 10 scale D. Respiratory rate of 10 breaths/min |
D The nurse would withhold the medication if respirations are less than 12 breaths/min.
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Which information is most accurate regarding the nurse’s understanding of pain management?
A. Older patients have difficulty describing their pain level. B. Encourage patients to report pain before the pain becomes too severe. C. Use the smallest dose of medication possible to control pain. D. Pain medication administration ordered PRN will maintain a constant blood level. |
B Even though pain medicine administration may be scheduled, encourage the patient to request pain medication before the pain escalates and becomes severe. Although the smallest dose possible to control the pain is the goal of therapy, it is also important that the dose be sufficient to provide adequate relief.
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The nurse is assessing a patient’s pain. When the patient describes his pain as cramping and burning, which component of the pain history is being addressed?
A. Depth B. Location C. Quality D. Severity |
C The actual sensation of the pain is often described as stabbing, dull, cramping, sore, burning, or a combination of these.
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Which additional nursing intervention(s) would be effective with pain management in the pediatric population? (Select all that apply.)
A. Provide diversional activities such as coloring, puzzles, and games. B. Allow uninterrupted sleep and rest. C. Perform hygiene measures. D. Encourage parental participation with caregiving to diminish the child’s anxiety. E. With the health care provider’s approval, encourage the child to drink 8 to 10 8-ounce glasses of fluid daily. |
ANS: A, B, C, D
Diversional activities are an alternative nursing intervention that may be used in pain management. Adequate sleep is an alternative nursing intervention that may be used in pain management. Comfort measures, such as hygiene, may be used in pain management. Parental participation with care is an alternative nursing intervention that may be used in pain management |
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A surgical patient is being discharged on propoxyphene (Darvon), a synthetic opiate agonist. Which discharge instructions will the nurse include? (Select all that apply.)
A. Greater pain relief may be obtained if taken with acetaminophen or aspirin. B. There is no danger of physiological or psychological dependency. C. This drug should be taken when pain becomes intolerable. D. Dizziness and gastric irritation are common adverse effects. E. Uncontrolled pain should be reported to the physician. |
ANS: A, D, E
Unless contraindicated, greater pain relief may be obtained if taken with acetaminophen or aspirin. Dizziness and gastric irritation are common adverse effects. GI irritation can be minimized if the medication is taken with food or milk. Uncontrolled pain indicates that the therapeutic outcome is not being met and should be reported to the physician. |
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Which are common adverse effects associated with opiate agonists? (Select all that apply.)
A. Dizziness B. Orthostatic hypotension C. Respiratory depression D. Confusion E. Diarrhea F. Urinary urgency |
ANS: A, B, C, D
Correct Dizziness is a adverse effect associated with opiate agonists. Orthostatic hypotension is an adverse effect associated with opiate agonists. Respiratory depression is an adverse effect associated with opiate agonists. Confusion is an adverse effect associated with opiate agonists. |
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which conditions may be managed by salicylates? (Select all that apply.)
A. Migraine headache B. Swollen joints C. Fever D. Muscle aches E. Myocardial infarction |
ANS: B, C, D, E
Salicylates inhibit prostaglandins that produce the signs and symptoms of inflammation. Salicylates inhibit the synthesis and release of prostaglandins in the brain that cause the elevation of body temperature. Salicylates inhibit the formation of prostaglandins that sensitize pain receptors, providing analgesia. Salicylates inhibit platelet aggregation and decrease the risk of clot development. |
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When teaching a patient who is starting therapy with NSAIDs, the nurse must be sure to mention drug interactions with which of the following? (Select all that apply.)
A. Warfarin (Coumadin) B. Lithium (Eskalith) C. Hydroxyzine (Vistaril) D. Insulin E. Diuretics F. Digitalis (Digoxin) |
ANS: A, B, E
NSAIDs may enhance the effects of warfarin. NSAIDs may enhance the effects of lithium. NSAIDs may enhance the effects of diuretics. |
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A patient who has undergone a lengthy surgical procedure under general anesthesia is unable to breathe on his own following the procedure. Which drug will the nurse expect to be administered as an antidote to the neuromuscular blocking agent?
A. Dantrolene (Dantrium) B. Neostigmine methylsulfate (Prostigmin) C. Ether D. Baclofen (Lioresal) |
B Neostigmine methylsulfate is an antidote to neuromuscular blocking agents. Additional measures to implement include artificial respirations with oxygen and atropine sulfate for bradycardia and hypotension.
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What is the reason for paraplegic patient to receive baclofen (Lioresal)?
A. It interrupts reflexes at the level of the spinal cord. B. It acts directly on the skeletal muscles to reduce spasticity. C. It interrupts transmission of impulses from motor nerves to muscles at the skeletal neuromuscular junction. D. It produces generalized mild weakness of skeletal muscles and decreases the force of reflex muscle contractions. |
A Baclofen is a gamma-aminobutyric acid derivative that interrupts polysynaptic reflexes at the level of the spinal cord.
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A patient taking antipsychotic medication for schizophrenia is admitted with a temperature of 106 F. The admitting diagnosis is neuroleptic malignant syndrome secondary to antipsychotic medication. Which drug is indicated in treatment of this condition?
A. Edrophonium (Tensilon) B. Dantrolene (Dantrium) C. Baclofen (Lioresal) D. Metaxolone (Skelaxin) |
B Dantrolene, a direct-acting skeletal muscle relaxant, is used to treat neuroleptic malignant syndrome associated with the use of antipsychotic agents.
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In the intensive care unit, the nurse is taking care of a patient who is on a ventilator and is receiving succinylcholine (Anectine). Which is a priority nursing diagnosis for this patient?
A. Pain B. Disturbed Body Image C. Risk for Injury D. Self-Care Deficit |
A Pain is the highest priority, according to Maslow’s hierarchy of needs. Succinylcholine, a neuromuscular blocking agent, is used to paralyze muscles while a patient is on a ventilator. Neuromuscular blocking agents do not relieve pain.
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The patient’s family asks why neuromuscular blocking agents are used before electroconvulsive therapy. Which explanation by the nurse is most accurate?
A. “They stimulate respirations while therapy is delivered.” B. “They prevent aspiration of respiratory secretions during the therapy.” C. “They decrease intracranial pressure secondary to therapy.” D. “They reduce the risk of injury during therapy.” |
D Neuromuscular blocking agents are used before electroconvulsive therapy to paralyze the skeletal muscles and reduce the risk of fractures during therapy.
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Which laboratory values will the nurse review prior to beginning medication therapy for skeletal and muscle disorders?
A. Sodium, magnesium, and chloride B. C-reactive protein (CRP), human leukocyte antigen (HLA), and liver function tests C. Arterial blood gases (ABGs), complete blood count (CBC), and electrolytes D. Glucose, high-density lipoproteins (HDL), and prothrombin time (PT) |
B Examine laboratory reports associated with the disease process present (e.g., calcium, phosphorus, lupus testing, rheumatoid factor, uric acid level, C-reactive protein, human leukocyte antigen, aldolase, aspartate, creatine kinase).
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Which medication will be prescribed for a patient complaining of muscle spasms secondary to a back injury?
A. Acetaminophen (Tylenol) B. Morphine sulfate C. Bethanechol (Urecholine) D. Cyclobenzaprine (Flexeril) |
D Cyclobenzaprine is a centrally acting skeletal muscle relaxant, which is a group of drugs used to relieve acute muscle spasms. Their exact mechanism of action is unknown, except that they depress central nervous system function. All the centrally acting skeletal muscle relaxants produce some degree of relaxation, and health care providers maintain that the benefits from the sedative effects may exceed the benefits from actual muscle relaxation.
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Which symptoms will be most important for the nurse to assess for early signs of respiratory distress in the patient who has been given a neuromuscular blocking agent?
A. Nasal flaring and retraction of intercostal muscles B. Dyspnea, increased respiratory rate, and cyanosis C. Restlessness, anxiety, and lethargy D. Pallor, stridor, and diaphoresis |
C The signs of restlessness, anxiety, lethargy, decreased mental alertness, and headache are early, subtle clues to respiratory distress.
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Which common adverse effects occur with neuromuscular blocking agents?
A. Fever B. Flushing C. Nausea D. Ataxia |
B Neuromuscular blocking agents cause histamine release, which may cause bronchospasm, bronchial and salivary secretions, flushing, edema, and urticaria. Ensure that the airway is patent and that secretions are suctioned regularly to prevent obstruction. Report evidence of bronchospasm, edema, and urticaria immediately.
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Which assessment is most important for the nurse to obtain when a patient is being treated with a neuromuscular blocking agent?
A. Skin assessment for rash and urticaria B. Blood pressure assessment for orthostatic hypotension C. Respiratory assessment for patent airway D. Assessment for fluid volume overload |
C Histamine release caused by these drugs may produce increased salivation. In patients who are paralyzed or who have incomplete return of control over swallowing, coughing, and deep breathing, these secretions may obstruct the airway.
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Which drug interaction may occur when an aminoglycoside or tetracycline is given in conjunction with neuromuscular blocking agents?
A. Deep sedation B. Decreased effectiveness of antibiotics C. Increased neuromuscular blocking activity D. Sensitivity to antibiotics and possible allergic reaction |
C Question antibiotic orders that prescribe aminoglycosides or tetracycline when neuromuscular blockers have been used. These drugs may potentiate the neuromuscular blocking activity.
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Patients with which conditions must be carefully assessed to determine whether they would tolerate treatment with a neuromuscular blocking agent? (Select all that apply.)
A. Pregnancy B. Hepatic disease C. Pulmonary disease D. Renal disease E. Neurologic disorders F. Psychiatric disorders |
ANS: B, C, D, E
Patients with hepatic disease must be fully evaluated to assess their ability to tolerate neuromuscular blocking agents. Patients with pulmonary disease must be fully evaluated to assess their ability to tolerate neuromuscular blocking agents. Patients with renal disease must be fully evaluated to assess their ability to tolerate neuromuscular blocking agents. Patients with neurologic disorders such as myasthenia gravis, spinal cord injury, or multiple sclerosis must be fully evaluated to assess their ability to tolerate neuromuscular blocking agents. |
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The nurse is examining a patient in the emergency department whose chief complaint is a dislocated shoulder. Which assessment data is needed to evaluate the patient? (Select all that apply.)
A. Details related to the mechanism of injury B. Degree of impairment C. Pain level D. Inspection of the affected part for swelling, capillary refill, bruising, redness, localized tenderness, deformities, and paresthesia E. Elevation of the affected extremity |
ANS: A, B, C, D
Correct Important nursing assessment of a musculoskeletal injury includes mechanism of injury. Important nursing assessment of a musculoskeletal injury includes degree of impairment. Important nursing assessment of a musculoskeletal injury includes pain level. Important nursing assessment of a musculoskeletal injury includes observing for obvious deformity and neurovascular assessment. |
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An employee at a factory has not been to work because of low back muscle spasms. His wife contacts the occupational health nurse to report that her spouse is on a centrally acting skeletal muscle relaxant and is having problems with sleepiness. Based on the medication action, what will the nurse tell her? (Select all that apply.)
A. “The health care provider should be notified because these drugs are contraindicated in the treatment of low back pain.” B. “Your husband should avoid activities requiring alertness, such as driving or operating power equipment.” C. “I need additional and specific information regarding the amount of your husband’s sedation.” D. “I will review baseline laboratory studies, discuss your husband’s status with the health care provider, and call you back.” E. “Sedation is an adverse effect of these medications and tends to resolve with continued therapy.” |
ANS: B, C, D, E
Patients should be instructed to avoid activities that require alertness, such as driving or operating heavy machinery, for safety. When obtaining patient information regarding adverse effects, additional information may be needed to fully assess the degree of adverse effects the patient may be experiencing. Review of baseline liver and kidney function and complete blood count laboratory data is necessary. Centrally acting skeletal muscle relaxants are used to relieve acute muscle spasm. They act on the central nervous system and sedation may be an adverse effect associated with usage. This tends to be mild and will resolve with continued use. |
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What are the reasons that neuromuscular blocking agents are used? (Select all that apply.)
A. Alleviation of pain B. Reducing the use and adverse effects of general anesthetics C. Easing endotracheal intubation and prevent laryngospasm D. Producing amnesia during painful procedures E. Decreasing muscular activity in electroshock therapy |
ANS: B, C, E
Neuromuscular blocking agents are used to produce adequate muscle relaxation during anesthesia to reduce the use (and adverse effects) of general anesthesia. Neuromuscular blocking agents are used to ease endotracheal intubation and prevent laryngospasm. Neuromuscular blocking agents are used to decrease muscular activity in electroshock therapy |
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Which medication combinations may be beneficial in treating angina pectoris?
A. Antidysrhythmics and platelet-active agents B. ACE inhibitors and statins C. Vasoconstrictors and diuretics D. Analgesics and thrombolytics |
B ACE inhibitors and statins are often combined to treat angina pectoris.
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A patient has been diagnosed with angina pectoris and an elevated LDL cholesterol level. The health care provider has prescribed HMG-CoA reductase inhibitor. What is the primary indication in using this medication?
A. Reduce coronary vessel spasm B. Simplify oxygen requirements of the cardiac cells C. Lower cholesterol levels D. Dilate the coronary arteries |
C HMG-CoA reductase inhibitor, a statin, has become standard therapy to be used with elevated cholesterol levels. This medication prevents added atherosclerotic vessel buildup and further narrowing of the coronary arteries.
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What will the nurse advise the patient to do to avoid the development of tolerance to nitroglycerin?
A. Use the sublingual form only. B. Administer subsequent doses parenterally. C. Allow for a daily 8- to 12-hour nitrate-free period. D. Store the drug in a dark container, free from light and moisture. |
C An 8- to 12-hour nitrate-free period will eliminate the development of tolerance to nitroglycerin.
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Which instruction will the nurse include for a patient prescribed sublingual nitrate PRN for angina?
A. Take a dose routinely at bedtime. B. Place the tablet under the tongue and swallow immediately. C. Take one tablet and then seek medical attention if the pain is not relieved within 5 minutes. D. Take one tablet every 2 to 3 minutes until relief is obtained. |
C The patient should seek medical attention if chest pain is not relieved by one tablet within 5 minutes. Tablets should continue to be taken every 5 minutes, for a total of three tablets in 15 minutes.
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How frequently are nitroglycerin tablets discarded and prescriptions refilled?
A. Monthly B. Every 3 months C. Every 6 months D. Yearly |
C Every 6 months, the nitroglycerin prescription should be refilled and the old tablets safely discarded.
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When are sustained-release nitroglycerin tablets administered?
A. Once a day B. At bedtime C. When symptoms of acute angina appear D. Every 8 to 12 hours |
D Sustained-release nitroglycerin tablets are usually taken on an empty stomach every 8 to 12 hours. If gastritis develops, it may be necessary to take these tablets with food.
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Which instruction will the nurse include when teaching a patient about the administration of translingual nitroglycerin spray?
A. Shake the container to disperse the medication evenly. B. Inhale the medication slowly over 1 to 2 minutes. C. Administer the medication under the tongue. D. Close the mouth and “swallow” the spray. |
C Translingual nitroglycerin spray should be sprayed onto or under the tongue. The container should not be shaken because the bubbles formed may slow the release of the medication. The spray should not be inhaled or swallowed.
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Which statement is true regarding the pain associated with angina?
A. It does not subside until treatment is initiated. B. It is highly variable in intensity and location. C. It typically subsides after 1 to 3 minutes. D. It is directly related to the degree of myocardial damage. |
B The presentation of angina pectoris is highly variable. The sensation of discomfort may be described as squeezing, tightness, choking, pressure, burning, or heaviness. Pain or discomfort may radiate to the neck, lower jaw, shoulder, and arm. Attacks can last from 30 seconds to 30 minutes.
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How do beta-adrenergic blocking agents reduce myocardial oxygen demand?
A. By inhibiting the stimulation of norepinephrine and epinephrine B. By increasing the production of dopamine and acetylcholine C. By delaying the destruction of acetylcholinesterase and cholinesterase D. By enhancing the sensitivity of alpha receptors and beta receptors |
A Beta-adrenergic blocking agents prevent the stimulation of epinephrine and norepinephrine, which normally increase heart rate.
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The nurse is teaching a patient about nitroglycerin prior to discharge to home. Which instruction will the nurse provide the patient?
A. “Report any headaches following self-administration to your health care provider.” B. “Carry the medication in a pocket directly next to the body.” C. “Carry the medication with you at all times.” D. “Store nitroglycerin in a clear glass container with a tight lid.” |
C Nonhospitalized patients should carry nitroglycerin at all times.
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What risk is minimized when the smallest dose of nitroglycerin is used to provide satisfactory results?
A. Allergy B. Dependence C. Tolerance D. Nausea |
C Tolerance to nitrates can develop rapidly, particularly if large doses are administered frequently.
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The nurse is performing pain assessment on a patient admitted for evaluation of angina. Which type of angina is precipitated by physical exertion and is relieved by rest?
A. Chronic stable B. Nocturnal C. Unstable D. Variant |
A Chronic stable angina is precipitated by physical exertion or stress, lasts only a few minutes, and is relieved by rest or nitroglycerin.
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What is the rationale behind administering calcium channel blockers to patients with angina?
A. They decrease heart rate. B. They dilate blood vessels. C. They increase cardiac contractility. D. They promote fluid excretion. |
B By inhibiting smooth muscle contraction, the calcium channel blockers dilate blood vessels and decrease resistance to blood flow. Dilation of peripheral vessels reduces the workload of the heart.
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Which action by the nurse is most accurate when administering nitroglycerin ointment to a patient?
A. Spread the ointment on the patient’s legs in a thin, uniform layer. B. Cover the patch with a clear plastic wrap. C. Rub the ointment into the skin in a circular motion. D. Shave the skin prior to application. |
B Covering the area where the patch is placed with a clear plastic wrap and taping it in place is appropriate.
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Which response will the nurse provide when a patient complains of a headache when using sublingual nitroglycerin?
A. “This is a common adverse effect that can be managed with acetaminophen.” B. “Discontinue taking this medication.” C. “Try taking this medication at night to minimize the possibility of headaches.” D. “Lie down after using nitroglycerin to avoid a headache.” |
A The most common adverse effect of nitrate therapy is headache. Analgesics, such as acetaminophen, may be used if needed.
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Which statement about ranolazine (Ranexa), a fatty oxidase enzyme inhibitor, is true?
A. It causes coronary artery vasodilation. B. It causes no gastrointestinal side effects. C. It causes QT interval prolongation. D. It elevates LDL levels. |
C Baseline and follow-up ECGs should be obtained to evaluate the effects on the patient’s QT incorrect interval.
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Which therapies are used in the treatment of angina pectoris? (Select all that apply.)
A. ECG B. Coronary artery bypass C. Coronary angioplasty D. Avoidance of caffeine and emotional stress E. Use of nitrates |
ANS: B, C, D, E
Coronary artery bypass may be standard treatment of angina pectoris, pending medical evaluation. Coronary angioplasty may be standard treatment of angina pectoris, pending medical evaluation. Avoiding caffeine and emotional stress is standard treatment of angina pectoris. Use of nitrates is standard treatment of angina pectoris |
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Which lifestyle modifications will the nurse include when educating the patient with angina pectoris? (Select all that apply.)
A. Weight reduction therapy B. Low-potassium diet C. Smoking cessation D. Stress management E. Independent exercise |
ANS: A, C, D
Although medications can control angina attacks, lifestyle changes such as maintaining an ideal weight are important in managing the disease. Smoking cessation is a vital component to include when educating the patient with angina pectoris. Although medications can control angina attacks, lifestyle changes such as managing stress are important in controlling the disease |
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Which will the nurse include in discharge teaching for patients on nitrate therapy? (Select all that apply.)
A. Increase caffeine in diet B. Relaxation techniques C. Proper storage of medications D. Pain assessment E. Isometric exercise program |
ANS: B, C, D
Lifestyle modifications such as relaxation techniques, are essential for many individuals with angina. Nitrates should be stored in dark, airtight containers. Pain assessment and rating is an important part of nitrate therapy |
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Which will the nurse include in the teaching plan for a patient with angina who is prescribed a beta-adrenergic blocking agent? (Select all that apply.)
A. Goals include reduced frequency of attacks, reduced nitrate use, and improved exercise tolerance. B. Only some beta blockers are effective in treating angina pectoris. C. Comorbidities, such as diabetes or COPD, influence the product selection of beta blockers to treat angina. D. Cardioselective agents minimize pulmonary and peripheral vascular adverse effects. E. Stress exercise is an effective way to determine the most appropriate dosage. F. Acebutolol, atenolol, and metoprolol must be taken in divided doses to be effective in treating angina. |
ANS: A, C, D, E
Beta blockers are used to reduce the frequency of attacks, reduce nitrate use, and improve exercise tolerance. Comorbidities influence product selection in the angina patient. Cardioselective agents have greater affinity for beta-1 adrenergic receptors (cardiac) than beta-2 adrenergic receptors (bronchi, peripheral blood vessels), thereby reducing the possible pulmonary and vascular adverse effects. Stress exercise is an effective way to determine the most appropriate dosage. |
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What would the nurse anticipate if a patient with a history of type 2 diabetes is prescribed a thiazide diuretic?
A. No change in the antidiabetic regimen B. Decreased need for antidiabetic medication C. Increased blood sugar levels D. Less frequent monitoring of blood sugar level |
C The thiazides may induce hyperglycemia and aggravate cases of preexisting diabetes mellitus. Regular assessment for glycosuria is indicated. Dosages of oral hypoglycemics and insulin may need adjustment in patients with diabetes mellitus.
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When teaching a patient who is taking thiazide diuretics, the nurse will encourage the patient to increase the intake of which electrolyte?
A. Calcium B. Sodium C. Potassium D. Magnesium |
C Thiazide diuretics cause a decrease in the level of potassium.
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On admission, a patient with a history of cardiac insufficiency complains of shortness of breath. The nurse auscultates the lungs and notes bilateral crackles throughout both fields. In addition, there is bilateral +2 edema of the lower extremities. Which medication does the nurse anticipate that the health care provider will prescribe?
A. Allopurinol (Zyloprim) B. Diphenhydramine (Benadryl) C. Mannitol D. Furosemide (Lasix) |
D Diuretics, such as furosemide, are the mainstays of treatment in heart failure and hypertension.
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Which medication is a potassium-sparing diuretic?
A. Acetazolamide (Diamox) B. Spironolactone (Aldactone) C. Furosemide (Lasix) D. Bumetanide (Bumex) |
B Spironolactone is a potassium-sparing diuretic that blocks the sodium-retaining and potassium- and magnesium-excreting properties of aldosterone. This results in loss of water, with increased sodium excretion and retention of potassium.
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How soon will diuresis be expected to occur after the nurse has administered 20 mg of furosemide (Lasix) intravenously to a patient with heart failure?
A. As soon as injected B. Within 10 minutes C. After 2 hours D. After 4 hours |
B The onset of diuresis following IV furosemide administration is 5 to 10 minutes after administration. The diuretic effect peaks within 30 minutes and lasts approximately 2 hours.
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Which foods will the nurse recommend for a patient taking loop diuretics?
A. Protein-rich foods such as poultry, whole grains, and fish B. Fiber-rich foods such as yellow vegetables, nuts, and lentils C. Potassium-rich foods such as raisins, figs, and bananas D. Sodium-rich foods such as canned vegetables and processed foods |
C Loop diuretics deplete potassium. Potassium-rich foods include raisins, figs, bananas, peaches, kiwis, dates, apricots, oranges, prunes, melons, broccoli, and potatoes.
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Which condition warrants the use of acetazolamide (Diamox) as a diuretic?
A. Increased intracranial pressure B. Increased extravascular fluid pressure C. Increased intraocular pressure D. Periorbital edema |
C Acetazolamide is used to reduce intraocular pressure associated with glaucoma.
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The nurse would expect to assess which serum potassium level in a patient who has severe vomiting and diarrhea?
A. Less than 3.5 mEq/L B. Between 3.5 mEq/L and 4.5 mEq/L C. Between 4.6 mEq/L and 5 mEq/L D. Higher than 5.5 mEq/L |
A Serum potassium (K+) levels would be less than 3.5 mEq/L. Hypokalemia is especially likely to occur when a patient exhibits vomiting, diarrhea, or heavy diuresis.
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Which medication, if administered with spironolactone (Aldactone), will alert the nurse to assess the patient for signs and symptoms of hyperkalemia?
A. Propranolol (Inderal) B. Captopril (Capoten) C. Furosemide (Lasix) D. Ibuprofen (Motrin) |
B ACE inhibitors, such as captopril, inhibit aldosterone and thus may contribute to the development of hyperkalemia.
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The nurse has provided patient teaching about potassium-sparing diuretic therapy. Which statement by the patient indicates a need for further teaching?
A. “I will take my medication in the morning.” B. “I will report a weight gain of 2 pounds in 2 days.” C. “I will rise slowly when I get up from a sitting position.” D. “I will use a salt substitute because I limit my salt intake.” |
D Salt substitutes are potentially dangerous because of being high in potassium.
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Which patient assessment would alert the nurse to withhold a loop diuretic?
A. Crackles in the lung bases B. +2 pitting peripheral edema C. Serum potassium of 2.6 mEq/L D. Weight gain of 2 pounds in 2 days |
C The level indicates hypokalemia and could worsen with the administration of a loop diuretic; therefore, the dose should be withheld.
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A patient who has heart failure and difficulty breathing is being admitted. Which physical assessments indicate fluid volume excess? (Select all that apply.)
A. Rapid, bounding, irregular pulse rate B. Clear lung sounds C. 3+ pitting ankle edema D. Neck vein engorgement E. Shortness of breath |
ANS: A, C, D, E
The patient with overhydration caused by heart failure often presents with a rapid, irregular pulse rate. The patient with overhydration caused by heart failure often presents with peripheral and abdominal edema. The patient with overhydration caused by heart failure often presents with distended neck veins. The patient with overhydration caused by heart failure often presents with dyspnea. |
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Which premedication assessments are important for the nurse to obtain prior to the initiation of bumetanide (Bumex)? (Select all that apply.)
A. Serum potassium B. Bowel sounds C. Lung sounds d. orientation level e. blood pressure |
ANS: A, C, D, E
Correct Serum potassium levels may be altered because of bumetanide therapy and therefore need to be assessed. Lung sounds need to be assessed prior to initiation of therapy. Orientation level needs to be assessed prior to initiation of therapy. Vital signs need to be assessed prior to initiation of therapy. |
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Which are common signs and symptoms of dehydration? (Select all that apply.)
A. Furrowed tongue B. Decreased intake and output levels C. Bounding pulse rate D. Mental confusion E. Elastic skin turgor |
ANS: A, B, D
Furrowed tongue is a sign of dehydration. Signs of dehydration and hyponatremia include decreased intake and output, or output greater than intake. Signs of dehydration may include possible mental confusion. |
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Which nursing interventions are performed for a patient who is on diuretic therapy? (Select all that apply.)
A. Auscultation of lung sounds B. Assessment of skin turgor C. Initiation of electrolyte supplements D. Positioning techniques E. Monitoring of intake and output |
ANS: A, B, D, E
Lungs should be auscultated to detect the presence of fluid secondary to heart failure. Skin turgor is directly related to the degree of hydration. Skin that is well hydrated is elastic and rapidly returns to a flat position after being pinched together. In dehydrated patients, the skin remains in a peaked or pinched position and returns very slowly to the flat, normal position. Positioning techniques are essential to avoid skin breakdown secondary to edema or dehydration. Assessment of intake and output will assist in determining the effectiveness of diuretic therapy. |
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Which signs and symptoms of dehydration may occur secondary to a diuretic? (Select all that apply.)
A. Decreased urine specific gravity B. Skin remains peaked on turgor assessment C. Bounding peripheral pulses D. Neck vein engorgement E. Soft, sunken eyeballs |
ANS: B, E
A sign of dehydration is skin that is nonelastic or doesn’t return to normal position when pulled taught on assessment. A sign of dehydration is eyeballs that appear soft or sunken. |
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Which medical conditions may contribute to fluid volume excess? (Select all that apply.)
A. Hypertension B. Liver disease C. Pregnancy D. Use of corticosteroids E. Skin disorders |
ANS: A, B, C, D
Hypertension may contribute to fluid volume excess. Underlying medical diseases of the liver may contribute to fluid volume excess. Pregnancy may contribute to fluid volume excess. Use of corticosteroids may contribute to fluid volume excess |
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Which individuals are particularly susceptible to the development of electrolyte disturbances during diuretic therapy? (Select all that apply.)
A. History of cardiac disease B. History of renal disease C. History of hormonal disorders D. History of psychiatric illness E. Massive trauma F. Serious burns G. Overhydration |
ANS: A, B, C, E, F
Patients with cardiac disease are at risk for developing electrolyte imbalance during diuresis therapy. Patients with renal disease are at risk for developing electrolyte imbalance during diuresis therapy. Patients with hormonal disorders are at risk for developing electrolyte imbalance during diuresis therapy. Patients with massive trauma are at risk for developing electrolyte imbalance during diuresis therapy. Patients with serious burns are at risk for developing electrolyte imbalance during diuresis therapy. |
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A patient with COPD uses a corticosteroid inhaler bid. Which adverse effect is associated with this medication?
A. Mucositis B. Plaque C. Xerostomia D. Candidiasis |
D Medications that predispose a patient to candidiasis are those that suppress the immune system, including immunosuppressants, corticosteroids, cytotoxics, and broad-spectrum antibiotics. Educating patients on the importance of oral hygiene following prescribed inhalation dosages will assist in decreasing this complication.
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The nurse is assessing a patient’s mouth and notes white, milk curd–appearing plaques attached to the oral mucosa. Which condition is present?
A. Thrush B. Canker sores C. Cold sores D. Mucositis |
A Thrush is characterized by white, milk curd–appearing plaques that are attached to the oral mucosa.
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What is the primary pharmacologic therapy for Candida albicans?
A. Steroids B. Antifungal agents C. Topical anesthetics D. Topical anti-inflammatory agents |
B Candida albicans is the most common oral infection appearing in extremely debilitated patients. Medications that predispose a person to C. albicans infections are those that depress the immune system and those that cause xerostomia. C. albicans is a fungus and therefore is treated with antifungal agents such as nystatin (Mycostatin).
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Which condition is treated by saliva substitutes?
A. Caries B. Mucositis C. Xerostomia D. Halitosis |
C Xerostomia, or lack of saliva, originates from nonoral causes. Xerostomia is treated by discontinuing medications that dry the mucous membranes or by artificial saliva products.
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Which information will the nurse include when teaching a patient about cold sores?
A. Use of drying agents prevents the spread of secretions. B. Erupted lesions are not contagious. C. Eruptions are related to breaks in personal hygiene. D. Pus-filled lesions indicate a secondary bacterial infection. |
D Cold sore lesions first become visible as small red papules that later develop into 1- to 3-mm diameter fluid-filled blisters. Over the following 10 to 14 days, a crust develops as the vesicles that burst coalesce into larger lesions. The liquid from the vesicles contains the live virus that can be transferred to other people by direct contact. The base of the lesions is erythematous. If pus develops in the vesicles or under the crust of a cold sore, a secondary bacterial infection may be present and the patient should seek medical attention.
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Which local anesthetic is used for inflammation of oral mucous membranes?
A. Chlorhexidine (Peridex) B. 2% viscous lidocaine C. Nystatin (Mycostatin) D. Hydrogen peroxide |
B Two percent viscous lidocaine is used as a topical anesthetic for pain associated with oral inflammation. Care must be taken so that the patient does not accidentally burn himself or herself because the drug anesthetizes the entire mouth and throat.
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Which medication helps prevent or reduce mucositis in patients undergoing chemotherapy or radiation treatment?
A. Amlexanox paste (Aphthasol) B. Palifermin (Kepivance) C. Docosanol (Abreva) D. Nystatin (Mycostatin) |
B Palifermin is a recombinant human keratinocyte growth factor approved specifically for preventing and treating the mucositis that develops in leukemia or lymphoma patients undergoing chemotherapy before bone marrow transplantation.
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What infection is often called the “disease of the diseased” because it appears in debilitated patients?
A. Aspergillosis B. Candidiasis C. Trichomoniasis D. Brucellosis |
B Candidiasis is a fungal infection caused by Candida albicans, the most common organism associated with oral infections. It is often called the disease of the diseased because it appears in debilitated patients and patients taking a variety of medicines.
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What is the most common cause of most tooth, gum, and periodontal disease?
A. Sugar B. Halitosis C. Plaque D. Smoking |
C Plaque is the primary cause of most tooth, gum (gingiva), and periodontal disease. Plaque, the whitish yellow substance that builds up on teeth and gum lines, is thought to originate from saliva. Plaque forms a sticky meshwork that traps bacteria and food particles. If not removed regularly, it thickens, and bacteria proliferate.
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Which instruction by the nurse is most important when educating a patient about using viscous lidocaine (Xylocaine) for mucositis?
A. “Cleanse the oral cavity after using.” B. “This medication can be used as a gargle.” C. “After using, wait for 30 minutes before eating.” D. “Your sense of taste will be diminished.” |
C Caution the patient not to take food or drink for approximately 30 minutes after the medication because of the risk of aspiration from the absence of the gag reflex.
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The nurse is completing education for a patient who will be undergoing chemotherapy next week. In anticipation of adverse effects associated with oral mucositis secondary to chemotherapy, which information will the nurse include in the teaching plan? (Select all that apply.)
A. Avoid acidic and spicy foods. B. Using docosanol (Abreva) will decrease the pain. C. Milk of Magnesia can be used to rinse the mouth and coat mucous membranes. D. Nystatin liquid can be taken orally to eliminate fungal infections. E. Cleanse the oral cavity before applying topical agents. F. Rinse the mouth with an OTC mouthwash. |
ANS: A, C, D, E
Spicy and acidic foods should be avoided to prevent irritation to mucous membranes. Viscous lidocaine 2%, Milk of Magnesia, diluted bismuth subsalicylate (Kaopectate), and sucralfate suspensions may be used for topical application. Oral candidal infections are often adverse effects of chemotherapy, and nystatin liquid, an antifungal agent, may be prescribed. Directions for using this agent include swishing the medication in the oral cavity for approximately 1 minute before swallowing, or sucking on lozenges (troches) to reduce candidal oral infections. Pain medication applied topically must come into contact with mucous membranes to be effective. Therefore, it is advisable to clean the oral cavity before application. |
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Which will the nurse include when educating a 12-year-old patient about care of a cold sore? (Select all that apply.)
A. “Keep the cold sore clean with mild soap.” B. “Use of an astringent will assist in drying the cold sore and promote rapid healing.” C. “Keep the cold sore moist to prevent cracking.” D. “Note signs of infection, including the presence of pus. Contact the health care provider if this occurs.” E. “Oral analgesics may help alleviate pain.” |
ANS: A, C, D, E
To reduce the possibility of further infection with bacteria, the area should be kept clean. Cold sores should be kept moist to prevent cracking and the development of secondary bacterial infection. With secondary infection, application of antibiotic ointment would be indicated. Application of docosanol, local anesthetics, and UV blockers or oral analgesics may be prescribed |
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Which assessment information is pertinent to oral health? (Select all that apply.)
A. Medication history B. Dental history, visit frequency C. Presence of halitosis D. Amount of saliva present E. Bowel sounds |
ANS: A, B, C, D
Pertinent history for oral health includes current drug therapy. Pertinent history for oral health includes dental history and frequency. Halitosis may indicate poor oral hygiene or the presence of infection in the oral cavity. Reduced amount of saliva is a risk factor for injury and infection in the oral cavity. |
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A patient who is undergoing bone marrow transplantation has developed severe mucositis. Which treatment options may promote comfort? (Select all that apply.)
A. 2% viscous lidocaine (Xylocaine) before meals B. Acetylcysteine (Mucomyst) therapy as needed C. Commercially prepared mouthwashes D. Docosanol (Abreva) therapy E. Milk of Magnesia mouth rinses |
ANS: A, E
The pain with mucositis can be extremely severe. Viscous lidocaine 2% anesthetizes the entire mouth and throat. Used before meals, it facilitates patient eating. Care must be taken that the patient does not burn himself or herself because sensation is diminished. Milk of Magnesia can also be used as a mouth rinse to coat the mucous membranes. |
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In addition to discomfort, which are adverse effects of xerostomia? (Select all that apply.)
A. Reduced taste and appetite B. Excessive salivation C. Difficulty chewing and swallowing food D. Increase in dental caries E. Difficulty with speech F. Improved taste and enjoyment of food |
ANS: A, C, D, E
Xerostomia causes loss of taste. Xerostomia causes difficulty in chewing and swallowing food. Xerostomia increases tooth decay. Xerostomia causes difficulty in talking |
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Which medication is used in the treatment of gastric reflux esophagitis and diabetic gastroparesis?
A. Metoclopramide B. Misoprostol C. Pantoprazole D. Ranitidine |
A Metoclopramide is a gastric stimulant used to relieve the symptoms of gastric reflux esophagitis and diabetic gastroparesis, aid in small bowel intubation, and stimulate gastric emptying and intestinal transit of barium after radiologic examination of the upper GI tract.
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The nurse is preparing to administer medications and notes that a patient has sucralfate ordered qid. When is the best time to administer this medication?
A. 1 hour before meals B. With meals C. 1 hour after meals D. With a bedtime snack |
A This medication should be administered on an empty stomach.
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Which is a common adverse effect of magnesium-based antacid preparations?
A. Heartburn B. Rebound indigestion C. Constipation D. Diarrhea |
D Magnesium oxide, magnesium hydroxide, and magnesium trisilicate are used in antacid preparations. All magnesium products can cause diarrhea. Milk of Magnesia is often taken for constipation.
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Cimetidine (Tagamet) is an example of which class of drug?
A. Protokinetic agent B. Proton pump inhibitor C. Histamine (H2) receptor antagonist D. Coating agent |
C All H2 receptor antagonists end in “-dine.” Examples in this category include cimetidine, ranitidine, famotidine, and nizatidine.
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A postoperative appendectomy patient has a nasogastric tube and wonders why the previous nurse told him that he was receiving an IV “ulcer-preventing” medication called ranitidine. The patient states that he has never had any stomach problems in his life. Which is the best response by the nurse?
A. “This medication will cause the pH in your stomach to drop.” B. “This medication helps coat your stomach while the nasogastric tube is in place.” C. “Because you are not eating after surgery, this medication will help reduce the hydrochloric acid your stomach is still secreting.” D. “The nasogastric tube will cause peptic ulcer disease. This medication will help prevent that.” |
C Patients who are not eating still secrete hydrochloric acid from the stomach’s parietal cells. H2 receptor antagonists block the H2 receptors, resulting in a decrease in the amount of acid secreted. The pH of the stomach contents then becomes less acidic, which reduces the stress of the mucosal lining of the stomach.
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Which explanation by the nurse is accurate to include when teaching a patient who is beginning therapy for gastroesophageal reflux disease (GERD) with metoclopramide?
A. “This medication decreases esophageal muscle tone to reduce reflux.” B. “Peristalsis is increased, so food is digested more quickly.” C. “Gastric emptying is delayed, so you may feel full for longer intervals.” D. “This medication is an antikinetic agent, so you may have difficulty with motor skills.” |
B Prokinetic agents increase the lower esophageal sphincter muscle pressure and peristalsis, hastening emptying of the stomach to reduce reflux.
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A patient who is taking NSAIDs to treat arthritis asks the nurse why misoprostol has also been prescribed. Which explanation by the nurse is accurate?
A. NSAIDs often cause GI irritation that can result in peptic ulcers. B. NSAIDs promote the production of prostaglandins and reduce the incidence of gastric irritation. C. Antiulcer medications eradicate the presence of bacteria in the stomach that cause ulcers. D. Drug interactions are prevented when antiulcer medications are used in combination with NSAIDs. |
A Misoprostol, a gastrointestinal prostaglandin, is used to prevent and treat gastric ulcers caused by NSAIDs. Prostaglandin inhibition is effective in reducing pain and inflammation, especially in arthritis, but makes the patient more predisposed to peptic ulcers.
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Which organism or disorder is responsible for many cases of peptic ulcer disease?
A. H. pylori B. Candida albicans C. Escherichia coli D. Herpes zoster |
A Various combinations of antibiotics (e.g., amoxicillin, tetracycline, metronidazole, clarithromycin), bismuth, and antisecretory agents (e.g., H2 antagonists, proton pump inhibitors) are used to eradicate H. pylori.
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A patient with PUD asks the nurse about the action of prokinetic medications. Which explanation by the nurse is accurate?
A. It blocks the formation of hydrochloric acid, reducing irritation of the gastric mucosa. B. It increases the lower esophageal sphincter muscle pressure and peristalsis. C. It reduces the secretion of saliva, hydrochloric acid, pepsin, bile, and other enzymatic fluids. D. It decreases the volume of hydrochloric acid produced, increasing the gastric pH. |
B Prokinetic agents increase the lower esophageal sphincter muscle pressure and peristalsis, hastening emptying of the stomach to reduce reflux.
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Which is considered an acceptable time frame for a patient with gastric distress to self-medicate with over-the-counter antacids?
A. Hours B. Days C. Weeks D. Months |
C For indigestion, antacids should not be administered for more than 2 weeks. If after this time the patient is still experiencing discomfort, a health care provider should be contacted.
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The nurse is instructing a patient recently diagnosed with GERD. Which statement by the patient indicates a need for further teaching?
A. “I will avoid foods high in fat.” B. “I will eat small frequent meals and have a snack at bedtime.” C. “Orange juice may aggravate my symptoms.” D. “I will wait 2 hours after eating lunch before lying down for a nap.” |
B Late-night snacks need to be avoided to reduce increased gastric secretions.
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Which factors prevent breakdown of the body’s normal defense barriers that protect against ulcer formation? (Select all that apply.)
A. Stomach pH B. Prostaglandins C. Intrinsic factor D. Mucous cells E. Hydrochloric acid |
ANS: B, D
Correct Prostaglandins play a major role in protecting the stomach walls from injury by stomach acids and enzymes. They inhibit gastric acid secretion, maintain blood flow, and stimulate mucous and bicarbonate production. Mucous cells secrete mucus that coats the stomach wall and protects the stomach wall from hydrochloric acid and the digestive enzyme pepsin. |
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Which are important nursing considerations when administering prokinetic agents? (Select all that apply.)
A. These agents are used to treat esophagitis associated with gastric reflux. B. They are used to treat GERD when lifestyle changes and diet are ineffective. C. They may be useful in treating nausea associated with chemotherapy treatment. D. They may be administered intravenously. E. Administer the medication to diabetic patients after meals. |
ANS: A, B, C, D
Metoclopramide is used to relieve the symptoms of gastric reflux esophagitis. This agent is used to treat GERD when lifestyle and diet modifications are ineffective. Metoclopramide is used as an antiemetic in conjunction with chemotherapy. Prokinetic agents may be administered intravenously |
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Which factors contribute to the development of PUD? (Select all that apply.)
A. Cigarette smoking B. Stress C. Genetics D. Excessive ingestion of milk products E. Helicobacter pylori |
ANS: A, C, E
Cigarette smoking increases acid secretion and alters blood flow to the stomach. In addition, cigarette smoking interferes with prostaglandin synthesis, which compromises defense mechanisms. A genetic predisposition seems to exist for the development of PUD. Infection by H. pylori is thought to be associated with as many as 90% of duodenal and 70% of gastric ulcers |
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Which drug therapy is aimed at reducing gastric acid secretions? (Select all that apply.)
A. Prokinetic agents B. Antacids C. H2 antagonists D. Proton pump inhibitors E. Coating agents |
ANS: C, D
H2 antagonists are used to reduce gastric acid secretion. Proton pump inhibitors are used to reduce gastric acid secretion. |
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Which information will the nurse include when teaching a patient with renal failure about antacid therapy for treatment of heartburn? (Select all that apply.)
A. Taking magnesium-based antacids prevents diarrhea. B. Magnesium-based antacids are preferred for patients with renal failure. C. Aluminum hydroxide antacids exacerbate constipation. D. If the patient has coffee ground emesis or bloody stools, the frequency of antacids should be doubled. E. Antacids neutralize gastric acid. |
ANS: C, E
Correct Constipation is an adverse effect of aluminum-based antacids. Antacids lower the acidity of gastric secretions by neutralizing the acid |
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A patient is beginning the second round of high-dose cisplatin. Severe, chemotherapy-induced nausea and vomiting (CINV) occurred following the first treatment, requiring 72 hours of continuous IV hydration. In addition to her chemotherapy regimen, which medication would be best to administer?
A. Prochlorperazine (Compazine) suppository daily, the day of treatment, and the next 3 days B. Anticholinergic agents, such as diphenhydramine or meclizine C. Parenteral ondansetron 1 hour before chemotherapy, with oral ondansetron to continue for the next 4 days D. Parenteral ondansetron during chemotherapy, with prochlorperazine suppositories daily for 1 week |
C With the patient’s first treatment history and the emetogenic chemotherapy agent, cisplatin, ondansetron has shown to be the most effective for prevention of severe nausea and vomiting.
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A patient expresses concerns about motion sickness. Which medication is most effective in preventing motion sickness?
A. Serotonin antagonists B. Phenothiazines C. Corticosteroids D. Anticholinergics |
D Anticholinergic agents are used to treat motion sickness by counterbalancing the excessive amounts of acetylcholine present.
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What is the purpose for the nurse administering metoclopramide (Reglan) IV postoperatively?
A. Prolong the effects of anesthesia. B. Decrease the potential for thrombus formation. C. Prevent postoperative nausea and vomiting. D. Decrease postoperative pain. |
C Metoclopramide (Reglan) is an antiemetic and antagonist of dopamine and serotonin receptors. In addition to acting on receptor sites in the brain, metoclopramide increases sphincter tone in the gastrointestinal tract, which reduces nausea and vomiting.
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The nurse is assessing a patient with nausea and vomiting. Which additional autonomic symptoms that often accompany vomiting will the nurse observe?
A. Bradycardia, diarrhea, and flushing B. Pallor, sweating, and tachycardia C. Urinary urgency, chills, and dizziness D. Fever, hyperventilation, and bradycardia |
B Autonomic symptoms of pallor, sweating, and tachycardia cause additional discomfort associated with vomiting.
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The nurse would expect to administer which drug when treating hyperemesis gravidarum?
A. THC (Marinol) B. Haloperidol (Haldol) C. Dexamethasone (Prednisone) D. Metoclopramide (Reglan) |
D Metoclopramide is the drug of choice when treating hyperemesis gravidarum because no teratogenic effects have been reported with the use of this drug.
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Why does the nurse monitor daily weights prior to the administration of antiemetic medications to chemotherapy patients?
A. Antiemetics are calculated according to body surface area. B. Antiemetics are toxic, and the minimal dosage should be administered. C. Weight loss is a common adverse effect associated with chemotherapy, and dosages may need to be readjusted. D. Fluid overload is common, and antiemetic dosages are increased as treatment progresses. |
C Patients receiving chemotherapy are prone to weight loss secondary to nausea and vomiting. As with any drug therapy, the safe dosage per weight parameters should be assessed daily to avoid potential overmedication when patients are losing significant weight.
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What is an advantage of using benzodiazepines as an adjunctive treatment for nausea and vomiting associated with chemotherapy?
A. The long half-life will prolong the effectiveness of other drugs. B. They increase a sense of euphoria. C. The patient will not develop tolerance to the medications as quickly. D. The antianxiety effect helps, in addition to reducing the frequency of nausea and vomiting. |
D Benzodiazepines (e.g., diazepam, lorazepam, midazolam) are effective in reducing not only the frequency of nausea and vomiting, but also the anxiety often associated with chemotherapy.
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What condition is occurring when a patient experiences nausea immediately on entering the clinic to receive another course of chemotherapy?
A. Psychogenic B. Chemotherapy-induced C. Hyperemesis gravidarum D. Anticipatory nausea and vomiting |
D Anticipatory nausea and vomiting is a conditioned response triggered by the sight or smell of the clinic or hospital or by the knowledge that treatment is imminent.
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Which herb has been used in many cultures to provide relief of nausea associated with pregnancy?
A. Mint B. Hyssop C. Echinacea D. Ginger |
D Ginger is an herb used in many cultures to treat pregnancy-induced nausea and vomiting.
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The nurse is caring for a 27-year-old patient taking a cannabinoid during chemotherapy. Which consideration will the nurse take into account?
A. Antihistamines may potentiate the effects. B. Monitor the patient for fluid volume excess. C. Previous use of marijuana requires increased dosage. D. Inform the patient to avoid the intake of potassium. |
A Antihistamines, alcohol, analgesics, benzodiazepines, barbiturates, antidepressants, muscle relaxants, and sedative-hypnotics increase toxic effects.
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What is the role of the chemoreceptor trigger zone (CTZ) in vomiting? (Select all that apply.)
A. Initiates or induce vomiting B. Coordinates the vomiting reflex C. Activates the vomit center (VC) to induce vomiting D. Samples blood and spinal fluid for potentially toxic substances |
ANS: C, D
The CTZ stimulates the VC to produce vomiting. The CTZ samples blood and spinal fluid for potentially toxic substances. |
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Why is drug therapy important for selected causes of nausea and vomiting? (Select all that apply.)
A. Relieves the distress associated with nausea and vomiting B. Prevents aspiration of gastric contents into the lung C. Prevents dehydration D. Prevents electrolyte imbalances E. Increases intracranial pressure |
ANS: A, B, C, D
Correct Promoting comfort is a goal of treating nausea and vomiting. Aspiration can lead to severe respiratory complications. Dehydration is a common consequence of vomiting and can cause disturbances in electrolyte balances. Electrolytes are salts that the body needs to function well and stay healthy. |
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Which are important nursing assessments for monitoring the hydration status of infants? (Select all that apply.)
A. Monitor oral mucous membranes, vital signs, and skin turgor twice each shift. B. Monitor intake and output every shift. C. Weigh every other day. D. Monitor electrolyte and specific gravity laboratory values. E. Provide diversional activities during hospitalization. |
ANS: A, B, D
Assessment of hydration in the infant includes monitoring mucous membranes, vital signs, skin turgor, and fontanels at least every 4 hours. Assessment of hydration in the infant includes monitoring intake and output. Significant laboratory values to monitor include electrolytes, RBC, HCT, HGB, and specific gravity. |
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A patient going on vacation asks the nurse what she can give to her 3-year-old child who becomes car sick. Which responses are accurate? (Select all that apply.)
A. “Positioning techniques such as placing the child facing forward and blocking out scenery through the side windows can be helpful.” B. “There is no such thing as car sickness.” C. “If your child does vomit, there is some over-the-counter Benadryl you can administer.” D. “I would check with the pharmacist regarding over-the-counter products available for young children.” |
ANS: A, D
Positioning techniques that help block out the rapid peripheral movement assist young children who suffer from motion sickness. Over-the-counter products are available to medicate a young child. A health care provider should recommend dosages and evaluate other medications being currently given. |
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Then the nurse assesses bowel habits in a patient, which is the best example of normal bowel elimination?
A. Daily bowel movements B. Multiple soft stools daily C. Daily liquid stools D. Regular bowel elimination pattern of soft stool |
D Normal bowel habits are stools that are soft and occur on a regular schedule of elimination for that particular patient.
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Which drug would be most effective for an obstetric patient who is complaining of constipation secondary to her enlarging uterus and use of prenatal vitamins?
A. Saline laxative B. Lubricant laxative C. Stimulant laxative D. Mineral oil |
B Lubricant and bulk-forming laxatives may be used in the pregnant patient because little cramping accompanies their use.
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The nurse is performing a premedication assessment. For which patient would laxative use be contraindicated?
A. Patient with quadriplegia B. Patient with appendicitis C. Geriatric patient D. Patient with fractured femur |
B Patients who have a history of an inflammation of the GI tract, including gastritis, colitis, Crohn’s disease, ulcerative colitis, and appendicitis, should not take laxatives and should be referred to a health care provider.
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Which is the laxative of choice for an older patient who is in the end stage of Alzheimer’s disease and requires a daily laxative?
A. Emollient B. Stimulant C. Fecal softener D. Bulk-forming |
C Fecal softeners are not laxatives.
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A friend reports using loperamide (Imodium) for continual diarrhea for a week since returning home from a vacation outside the country. Which is the nurse’s best response?
A. “There are some other over-the-counter products available for diarrhea, such as Kaopectate (bismuth subsalicylate).” B. “I’d stop taking the Imodium and go in to see a health care provider immediately. You may have an infection in your intestinal tract.” C. “If you’re not running a temperature, I wouldn’t worry. That happens to many people when they travel.” D. “As long as you can drink plenty of fluids, I’m sure the diarrhea will go away once you’re back in a normal routine.” |
B Diarrhea may be a defense mechanism to rid the body of infecting organisms or irritants. Diarrhea is usually self-limiting and should not be suppressed with over-the-counter products. It is safest for people who are suffering from diarrhea after traveling outside the country to visit their health care provider, who can determine whether an infection is present.
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A patient who has had a myocardial infarction is advised to avoid straining with defecation. Which medication would be prescribed to this patient?
A. Stool softeners B. Bulk-forming laxatives C. Stimulants D. Emollients |
A Stool softeners are routinely used for the prevention of constipation or to prevent straining with defecation (e.g., in patients recovering from myocardial infarction or abdominal surgery).
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An older adult is admitted through the emergency department with complaints of nausea, abdominal tenderness, and continual stooling. On assessment, the nurse notes abdominal distention, smearing of stool on undergarments, and hypoactive bowel sounds LUQ and LLQ. The patient is unable to determine when the last bowel movement was. What is the nurse’s priority assessment?
A. Signs and symptoms of an infection B. An impaction C. A pattern of laxative abuse D. History of gastrointestinal disease |
B A nursing priority is to determine basic needs such as last bowel movement, constipation, and pain control. The symptoms presented do not indicate an infection as a priority. Frequent stooling indicated by the history and smearing on the undergarments is a sign of an impaction, or an area of hardened stool. Laxative abuse or a history of gastrointestinal disease may be contributing factors that the health care provider will review.
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Which symptom is the patient with a lactase deficiency most likely to exhibit?
A. Constipation B. Excessive salivation C. Diarrhea D. Vomiting |
C Patients with deficiencies of digestive enzymes such as lactase or amylase have difficulty digesting certain foods. Diarrhea usually develops because of irritation from undigested food.
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A patient is receiving morphine for pain control. What will the nurse emphasize about preventing constipation?
A. Adequate hydration consists of four full glasses of water every day. B. Laxatives should be given on a daily basis. C. Stool softeners are taken on a regular basis during opioid use. D. Enemas should be given on a weekly basis. |
C When codeine or morphine is used regularly for pain control in cancer patients, it is imperative that the individual know that stool softeners should be initiated and continued as long as constipating medicines are being taken.
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What is the mechanism of action of a stimulant laxative?
A. Draws water into the bowel to facilitate the passage of feces B. Lubricates the intestinal wall and soften stool C. Increases bulk and stimulate peristalsis D. Irritates the intestine directly, promoting peristalsis and evacuation |
D Stimulant laxatives act directly on the intestine, causing an irritation that promotes peristalsis and evacuation.
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Which effect will the nurse expect when a patient is taking psyllium while on digoxin?
A. Decreased effectiveness of the laxative B. Increased laxative effect C. Increased absorption of the digoxin D. Decreased absorption of the digoxin |
D Do not administer products containing psyllium (e.g., Metamucil) at the same time as salicylates, nitrofurantoin, or digoxin glycosides. The psyllium may inhibit absorption. Administer these medications at least 1 hour before or 2 hours after psyllium.
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Which instruction will the nurse include in the discharge teaching of a patient taking psyllium?
A. “Administer with a full glass of water.” B. “Limit the intake of high-fiber foods.” C. “Avoid mixing in juice.” D. “Fat-soluble vitamin deficiency is common.” |
A It is important that bulk-forming laxatives be dispersed in a full glass of water or juice before administration.
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Which instruction by the nurse will assist in the patient’s understanding of lactulose, an osmotic laxative?
A. “This medication draws water into the intestine and stimulates defecation.” B. “There is increased irritability directly on the intestinal wall.” C. “There is lubrication of the intestinal wall that softens the stool.” D. “There is an effect on the nerves to increase the peristalsis of the intestinal smooth muscle.” |
A Osmotic laxatives (e.g., magnesium hydroxide, magnesium sulfate, magnesium citrate, sodium phosphate, lactulose, polyethylene glycol) are hypertonic compounds that draw water into the intestine from surrounding tissues.
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The nurse is assessing a patient with constipation. Which are causes of constipation? (Select all that apply.)
A. Diet low in fiber and/or residue B. Excessive fluid intake C. Diet low in cheese and yogurt D. Iron supplements E. Use of morphine |
ANS: A, D, E
Constipation can be caused by diets lacking in adequate residue and/or fiber and fluids. Iron has a constipating effect. Constipation can be caused by the use of constipating medicines (morphine, codeine, anticholinergic agents). |
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Which signs and symptoms are consistent with dehydration? (Select all that apply.)
A. Increased hemoglobin and hematocrit B. Decreased urine specific gravity C. Mental confusion and excessive thirst D. Periorbital edema and increased blood pressure E. Nonelastic skin turgor and delayed capillary filling |
ANS: A, C, E
Blood work of dehydrated patients will show falsely elevated hemoglobin and hematocrit levels as a result of decreased capillary fluid. Dehydrated patients may become confused secondary to electrolyte imbalances and often complain of thirst. Older patients may not complain of thirst as a result of perceptual changes. Dehydration is evident by nonelastic skin turgor and delayed capillary filling. |
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Which treatments are considered safe for an infant? (Select all that apply.)
A. Saline laxatives B. Bulk-forming laxative C. Malt soup extract D. Stimulant laxatives |
ANS: B, C
Constipation in infants can be treated with a bulk-forming laxative. Constipation in infants can be treated with malt soup extract. |
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Which drug will the health care provider prescribe to soften the cervix of a woman who is at 42 weeks of gestation?
A. Methylergonovine (Methergine) B. Dinoprostone (Prepidil) C. Betamethasone (Celestone) D. Terbutaline (Brethine) |
B Dinoprostone is a natural chemical in the body that causes uterine and gastrointestinal smooth muscle stimulation. It plays a role in cervical softening and dilation unrelated to uterine muscle stimulation. It is used to start and continue cervical ripening at term.
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For which reason will betamethasone IM be administered to the mother in premature labor?
A. To stop uterine contractions B. To prevent precipitous labor C. To stimulate lung maturity in the fetus D. To stimulate prolactin to enhance breast-feeding |
C Glucocorticoids may be administered IM to accelerate fetal lung maturation to minimize respiratory distress syndrome.
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A 26-year-old patient with preeclampsia is receiving IV magnesium sulfate. The 1400 assessment includes blood pressure, 100/70 mm Hg, respiration, 10, fetal heart tone, 100/min, urine output 20 mL/hour, absent patellar reflex. Which is the priority nursing action?
A. Decrease IV magnesium sulfate to half the dose and reassess the patient and fetus in 15 minutes. B. Stop the IV magnesium sulfate and contact the health care provider. C. Place the patient on her left side and administer oxygen. D. Stop the IV magnesium sulfate and administer calcium gluconate 5 mEq IV over 3 minutes. |
D The patient is exhibiting signs of magnesium sulfate toxicity, including respiratory depression. The infusion should be stopped at once. The antidote, calcium gluconate, should be administered.
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Which drug is administered after delivery to reduce the risk of postpartum hemorrhage after the placenta has been delivered?
A. Oxytocin (Pitocin) B. Magnesium sulfate C. Vitamin K D. Dopamine |
A Uterine stimulants, primarily oxytocin, given in low-dose infusions after delivery of the fetus and placenta, help stimulate firm uterine contractions to reduce the risk of postpartum hemorrhage from an atonic uterus.
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A 36-week primigravida patient has been admitted to the unit with a blood pressure of 200/120 mm Hg, severe headache, and edema. Which medication does the nurse anticipate that the health care provider will order?
A. Nifedipine (Procardia) B. Furosemide (Lasix) C. Magnesium sulfate D. Terbutaline (Brethine) |
C Magnesium sulfate depresses the central nervous system and blocks peripheral nerve transmission, which produces anticonvulsant effects and smooth muscle relaxation. In cases of preeclampsia or eclampsia, magnesium sulfate is used to control seizure activity. Hypertension, headache, and edema are signs of preeclampsia in a pregnant woman.
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Which drug is administered when a patient is experiencing premature labor?
A. Magnesium sulfate B. Oxytocin (Pitocin) C. Levonorgestrel (Mirena) D. Terbutaline (Brethine) |
D Terbutaline is a beta-adrenergic receptor stimulant, which acts primarily on the beta-2 receptors. Stimulation of beta-1 receptors produces uterine relaxation and relaxation of the bronchial and vascular smooth muscle. In higher doses, terbutaline will stimulate the beta-1 receptors, which raises heart rate.
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A patient is a gravida 1, 28 weeks’ gestation, Rh-negative woman. The father of her child is Rh-positive. The mother is asking the nurse about the effect on her unborn child of RhoGAM that has been ordered. What is the nurse’s best reply?
A. “Your child will do well after birth once transfusions are administered.” B. “If the baby is Rh-negative at birth, he or she will need RhoGAM also.” C. “RhoGAM kills antibodies you make, so your child will be protected.” D. “Your baby may be Rh-positive and cause you to make antibodies. These won’t affect this baby, but could affect future children if RhoGAM isn’t given.” |
D An Rh-negative mother and an Rh-positive father have the potential for an Rh-positive baby. At birth or during any time that the uterus ruptures, fetal blood circulation can mix with maternal circulation, causing the mother to produce antibodies (active immunity) against Rh-positive blood. This would cause Rh hemolytic disease in children of future pregnancies. Rho(D) immune globulin suppresses the stimulation of active immunity by Rh-positive foreign red blood cells that enter maternal circulation at the time of delivery, at the termination of pregnancy, or during a transfusion of inadequately typed blood.
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Which drug will the nurse administer to prevent neonatal conjunctivitis in the newborn?
A. Silver nitrate B. Dexamethasone C. Erythromycin D. Vitamin K |
C Erythromycin or tetracyclines are the drugs of choice because they prevent neonatal conjunctivitis from Neisseria gonorrhoeae and chlamydial ophthalmia neonatorum from Chlamydia trachomatis.
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Which emergency drug must be available when caring for a patient receiving magnesium sulfate?
A. Naloxone B. Calcium gluconate C. Dextrose D. Dopamine |
B Calcium gluconate is the antidote for magnesium sulfate and should always be available when magnesium sulfate is administered.
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Which test would the nurse anticipate to be done to determine if preterm labor is present in a patient whose symptoms are questionable?
A. Sonogram B. Fetal fibronectin test C. Amniocentesis D. Doppler study |
B A fetal fibronectin test may be ordered to assess the presence of preterm labor in patients whose presenting symptoms are questionable, so that early intervention (e.g., tocolytic therapy, corticosteroids, transport to a tertiary center) can be initiated when indicated.
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Which is characterized by seizures?
A. Pregnancy-induced hypertension B. Preeclampsia C. Eclampsia D. Premature rupture of membranes |
C Eclampsia (convulsions accompanying preeclampsia) is characterized by seizures.
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Which medication is used to treat a patient with atonic uterus?
A. Estradiol B. Ergonovine C. Ergotamine D. Egophony |
B Continued intravenous infusions of low-dose oxytocin or intramuscular injections of ergonovine or methylergonovine may be used to stimulate firm uterine contractions to reduce the risk of postpartum hemorrhage from an atonic uterus.
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Which assessments will the nurse complete during routine pregnancy visits? (Select all that apply.)
A. Blood pressure B. Hemoglobin C. Weight D. Fetal heart sounds E. Glucose tolerance test (GTT) |
ANS: A, C, D
Assessments during routine pregnancy visits include blood pressure. Assessments during routine pregnancy visits include weight. Assessments during routine pregnancy visits include fetal heart sounds. |
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A patient at 33 weeks’ gestation is admitted to the obstetric unit in active labor with symptoms associated with pregnancy-induced hypertension (PIH). Which actions will the nurse implement? (Select all that apply.)
A. Vital signs hourly B. Administration of IV pitocin C. Administration of magnesium sulfate IV D. Fetal stress test E. Assessment of deep tendon reflexes |
ANS: A, C, D, E
Important nursing assessments and/or interventions include monitoring of vital signs and level of consciousness continuously. IV magnesium sulfate is often prescribed for patients with PIH. Important nursing assessments and/or interventions include continuous fetal monitoring with stress tests and external or internal fetal monitoring. Important nursing assessments and/or interventions include assessment of deep tendon reflexes. |
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Which will the nurse include when teaching a postpartum patient about expected adverse effects of Rho(D) immune globulin? (Select all that apply.)
A. Nausea B. Constipation C. Fever D. Insomnia E. Aches F. Diarrhea G. Anorexia |
ANS: C, E
Fever is a common adverse effect of treatment with this drug. Generalized aches and pains are common adverse effects of treatment with this drug |
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A female patient has developed leukorrhea since being on oral broad-spectrum antibiotics for the past week for a lower respiratory infection. Which organism causes leukorrhea?
A. Herpes simplex B. Mycoplasma hominis C. Human papillomavirus D. Candida albicans |
D C. albicans infections of the mouth, gastrointestinal tract, or vagina may develop as secondary infections during the use of broad-spectrum antibiotics, such as penicillins, tetracyclines, and cephalosporins.
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A patient states that she has a difficult time remembering when to resume her triphasic contraceptive pills following her menses. Which alternative plan will the nurse suggest that she discuss with her health care provider?
A. Changing to the 28-day packet B. Using the inert pills every other month C. Changing her prescription to the minipill D. Calling the health care provider whenever she forgets to get appropriate instruction |
A Using the 28-day packet would allow her to continue with the same type of combination oral contraception. The 28-day packet would allow her to continue daily pills and eliminate the need to recall.
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Which is more likely to be experienced by women taking the minipill as an oral contraceptive?
A. Ovulation, dysmenorrhea, and break-through bleeding B. Excessive weight gain and breast tenderness C. Increased estrogen-related adverse effects D. Difficulty breast-feeding after pregnancy |
A The minipill is made up of progestin, which inhibits ovulation. This form of contraception is an alternative for women particularly susceptible to adverse effects caused by estrogen therapy. Thirty percent to 40% of women continue to ovulate with this form of contraception, however, and there is a slightly higher incidence of uterine and tubal pregnancies. Dysmenorrhea, manifested by irregular or infrequent menses and spotting between cycles, is common in women taking the minipill.
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The nurse is obtaining a history on a patient who is seeking oral contraceptives. Which condition would contraindicate the use of oral contraceptives?
A. Sexually transmitted diseases (STDs) B. Hypothyroidism C. Varicose veins D. Thromboembolic disease |
D Women who have a history of thromboembolic disease must consult with a health care provider before obtaining a prescription for an oral contraceptive. Serious adverse effects include embolisms and thrombus formation, cardiac abnormalities, seizures, and severe depression.
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A patient diagnosed with benign prostatic hypertrophy asks why tamsulosin (Flomax), an alpha-1 adrenergic blocking agent, has been prescribed. Which explanation by the nurse is most accurate?
A. It inhibits the action of testosterone. B. It improves sexual function. C. It reduces the size of the prostate. D. It increases urinary flow. |
D Alpha-1 adrenergic blocking agents are used to relax the smooth muscle of the bladder and prostate. Tamsulosin specifically blocks alpha-1 receptors on the prostate gland and certain areas of the bladder neck, causing muscle relaxation and increased urine flow in men with enlarged prostate glands.
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Which type of drug is most effective in the treatment of erectile dysfunction (ED)?
A. Phosphodiesterase inhibitors B. Antiandrogen agents C. Sympathomimetic agents D. Alpha-1 adrenergic blocking agents |
A Sildenafil (Viagra), a phosphodiesterase inhibitor, increases cyclic guanosine monophosphate (cGMP) concentrations in the corpus cavernosum, which results in smooth muscle relaxation and greater blood flow into the corpus cavernosum, producing an erection.
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The nurse is teaching a patient beginning therapy with dutasteride (Avodart). How long will it take before the patient can expect results?
A. 24 hours B. 2 weeks C. 1 month D. 6 months |
D Longer than 6 to 12 months of treatment may be necessary to assess whether a therapeutic response has been achieved.
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Why must caution be used when taking a phosphodiesterase inhibitor to enhance male sexual function?
A. It can become habit-forming. B. Life-threatening consequences can occur with cardiovascular disorders. C. It is an ineffective treatment. D. It is expensive and available only by special prescription. |
B The patient must consult with a health care provider before using a phosphodiesterase inhibitor. People with cardiovascular disorders are particularly susceptible to life-threatening consequences with its use.
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What is the mechanism whereby estrogen functions as a contraceptive?
A. Inhibiting LH, blocking release of ovum from a follicle B. Thinning cervical mucus, which inhibits sperm migration C. Trapping the ovum in the endometrial wall, preventing its growth D. Blocking FSH, thereby preventing release of ovum |
D Estrogens block pituitary release of follicle-stimulating hormone (FSH), preventing the ovaries from developing a follicle from which the ovum is released.
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The health care provider has instructed a patient to use over-the-counter miconazole (Monistat) cream to treat her vaginal yeast infection. Which information is important to include in patient education? (Select all that apply.)
A. Wash the genital area thoroughly before inserting the vaginal cream. B. Wash the applicator before usage. C. Wear a minipad to catch remaining discharge following vaginal administration. D. Wash hands before and after administration. E. The sexual partner may require treatment as well. |
ANS: A, C, D, E
It is imperative that proper cleansing of the genital area be done regularly using soap and water; rinse and dry well. A minipad should be worn to catch remaining discharge. Hands should be washed before and after medication insertion and before and after toileting. Both partners in a sexual relationship require treatment. The male partner may require oral anti-infectives |
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A nurse working at the community health clinic receives a call from a teen client who reports that she has missed one of her birth control pills. Which response by the nurse is accurate? (Select all that apply.)A. Take the missed pill now.
B. Take the next pill at the regularly scheduled time. C. Come into the clinic for a pregnancy test. D. Start with the next month’s pill packet at day 1. E. Take the missed pill and the next pill together at the next regularly scheduled time. |
ANS: A, B
Correct If a patient misses one pill she should take the missed pill immediately. Even if a patient misses one pill, she should take the next pill for that day on time after taking the missed pill immediately. |
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The nurse is completing a female reproductive history on a 16-year-old. Which are important assessments to include? (Select all that apply.)
A. Breast self-examination routine B. Age of menarche and pattern of menses C. Smoking and blood pressure history when seeking a prescription for OCPs D. Sexual orientation and number of partners E. Number of pregnancies, live births, miscarriages, and abortions F. Nutritional intake of carbohydrates |
ANS: A, B, C, D, E
Correct All women of reproductive age should do regular BSEs. Onset and pattern of menses provide baseline assessments for future comparison. OCPs are contraindicated in women who smoke or have hypertension. Sexual orientation and number of partners provide a baseline assessment for future STD assessments. Gestational history provides baseline information for future pregnancies. |
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The nurse is giving instructions to a young female at an outpatient clinic regarding combination oral contraceptive therapy. Which information will the nurse include? (Select all that apply.)
A. Medication should be taken at approximately the same time daily. B. A back-up birth control method should be used for the first 6 months. C. Medication should be discontinued 1 year before attempting pregnancy. D. Headaches, dizziness, and chest or abdominal pain should be reported immediately. E. If a pill is missed, take it immediately and remain on schedule for the next dosage. |
ANS: A, D, E
Medications should be taken at approximately the same time daily. Headaches, dizziness, and chest or abdominal pain should be reported immediately to the health care provider because these may be symptoms of a serious adverse effect. If one pill is missed, patients are directed to take it as soon as possible and continue with their normal schedule. If more than one pill is missed and a period is skipped, patients should return to their health care provider for a pregnancy test before restarting contraception |
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The nurse will teach the patient beginning therapy with alfuzosin, an alpha-1 adrenergic blocking agent, to expect which common adverse effects, which tend to be self-limiting? (Select all that apply.)
A. Nausea B. Insomnia C. Dizziness D. Headache E. Lethargy F. Anorexia |
ANS: C, D, E
Dizziness is an adverse effect of treatment with alfuzosin. Headache is an adverse effect of treatment with alfuzosin. Lethargy is an adverse effect of treatment with alfuzosin. |
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What is the action of urinary antimicrobial agents?
A. Reduce pain associated with bladder spasms caused by the infection B. Enhance output enough to flush out the infection from the urinary tract C. Eliminate urinary retention D. Have an antiseptic effect on the urine and the urinary tract |
D This is the action of urinary antimicrobial agents.
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A patient is complaining of moderate bladder pain and spasms secondary to a urinary tract infection. Which drug would assist in relieving symptoms?
A. Tolterodine (Detrol) B. Nitrofurantoin (Furadantin) C. Phenazopyridine hydrochloride (Pyridium) D. Oxybutynin chloride (Ditropan) |
C.Phenazopyridine relieves burning pain, urgency, and frequency associated with UTIs
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A 42-year-old woman is admitted with complaints of dysuria, frequency, and lower back pain. The urinalysis report is positive for red blood cells, and the blood work shows an elevated white blood cell count. Which medication will the nurse anticipate that the health care provider will order?
A. Meperidine (Demerol) B. Bethanechol chloride (Urecholine) C. Ciprofloxacin (Cipro) |
C Dysuria, frequency, lower back pain, hematuria, and leukocytosis are indicators of a UTI. A variety of antimicrobial agents, including ciprofloxacin, are used to treat UTIs.
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How often is fosfomycin (Monurol) usually administered when used in the treatment of urinary tract infections?
A. In a one-time dose B. Once per day C. Once per week D. Monthly |
A Fosfomycin is the first antibiotic to be approved for administration in a single-treatment dose for the treatment of UTIs. Fosfomycin is used to treat females with uncomplicated acute cystitis caused by susceptible strains of Escherichia coli and Enterococcus faecalis. Fosfomycin is not used in the treatment of kidney infections.
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After undergoing prostate surgery, a patient is discharged on the medication phenazopyridine hydrochloride (Pyridium) to assist with urinary catheter discomfort. Which information will the nurse include in the discharge teaching?
A. Urine will have a foul smell while taking this medication. B. Diarrhea and abdominal cramping are expected adverse effects. C. The sclera of the eye is yellow while on therapy. D. Urine will appear reddish orange. |
D Phenazopyridine hydrochloride is used to produce a local anesthetic effect on the mucosa of the ureters and bladder. Patients should be instructed that phenazopyridine causes urine to become reddish orange, which is not a cause for alarm. Other secretions may also be reddish orange and contact lenses may become stained.
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A 14-year-old male is taking tolterodine (Detrol). What is the action of this drug?
A. Restores bladder tone and function B. Decreases the urge to void C. Prevents urinary retention D. Acidifies urine |
B Tolterodine is used to reduce the urgency and frequency of bladder contractions and delay the initial desire to void in patients with an overactive bladder.
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Which condition will neostigmine be used to treat?
A. Overactive bladder B. Urinary tract infection C. Postoperative or postdelivery urinary retention D. Benign prostatic hypertrophy |
C Neostigmine is an anticholinesterase agent that binds to cholinesterase, preventing the destruction of acetylcholine. The acetylcholine accumulates at cholinergic synapses, and its effects become prolonged and exaggerated. This produces a general cholinergic response manifested by miosis, increased tone of intestinal, skeletal, and bladder muscles, bradycardia, stimulation of secretions of the salivary and sweat glands, and constriction of the bronchi and ureters.
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Which organism causes most urinary tract infections?
A. Proteus mirabilis B. Klebsiella pneumoniae C. Escherichia coli D. Pseudomonas aeruginosa |
C Gram-negative aerobic bacilli from the gastrointestinal tract cause most UTIs. E. coli accounts for about 80% of noninstitutionally acquired uncomplicated UTIs.
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What may become discolored by phenazopyridine (Pyridium) in addition to the urine?
A. Feces B. Sclera C. Sputum D. Saliva |
B The urinary analgesic phenazopyridine hydrochloride will commonly turn the urine reddish orange. It may also affect the skin or sclera, in which case the health care provider should be contacted.
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The nurse is teaching a patient about the anticholinergic agent prescribed for urinary retention. Which statement by the patient indicates a need for further teaching?
A. “I will chew gum to relieve dry mouth.” B. “I will limit my fluid intake.” C. “I will eat fresh fruits.” D. “I will not drive if I develop blurred vision.” |
B Adequate fluid intake will help prevent constipation, which is a common adverse effect of urinary retention.
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A patient has been taking an antimicrobial agent prescribed to treat a urinary tract infection for 2 days. She contacts the health care provider’s office to report persistence of symptoms. In evaluating the medication effectiveness, which assessments would be important to inquire about? (Select all that apply.)
A. Complete emptying of the bladder B. Amount of pain with urination as well as frequency C. Amount of daily fluid intake and output D. GI symptom complaints E. Bleeding with urination F. Persistence of nocturia |
ANS: A, B, C, D, E
Focused assessment of UTI symptoms includes assessing for urinary retention. Focused assessment of UTI symptoms includes assessing frequency and pain and/or burning with urination. Focused assessment of UTI symptoms includes assessing intake and output. Focused assessment of UTI symptoms includes assessing for GI symptoms. Focused assessment of UTI symptoms includes assessing for bleeding with urination. |
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The nurse is assisting with postpartum care for a mother who has given birth to her fourth child. She reports a moderate amount of urinary incontinence since the birth of the third child and is concerned that this problem will worsen. Which instructions may facilitate management of incontinence? (Select all that apply.)
A. Instruction of proper wiping techniques to prevent bacterial infection B. Education on bladder training and Kegel exercises C. Information on personal hygiene measures to prevent perianal breakdown D. Information of incontinence products and appliances E. Importance of establishing a regular toileting schedule F. Importance of increasing fluid intake |
ANS: A, B, C, D, E
Patient education for incontinence includes proper wiping technique to prevent infection. Patient education for incontinence includes teaching Kegel and bladder training exercises. Patient education for incontinence includes instruction of personal hygiene measures to prevent perianal breakdown. Patient education for incontinence includes information about incontinence products and appliances for personal use. Patient education for incontinence includes the importance of responding to the urge to void and maintain a regular toilet schedule. |
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The nurse is reviewing the urinalysis results of an older adult patient admitted with elevated temperature and incontinence. Which urinalysis properties are indicative of an infection? (Select all that apply.)
A. Straw color B. Foul odor C. Trace glucose D. pH of 8.2 E. Specific gravity of 1.014 |
ANS: B, D
Urinalysis properties indicating infection include a foul odor. Urinalysis properties indicating infection include a pH > 8.0. |
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Which interventions help stimulate urination when a patient is experiencing postoperative urinary retention? (Select all that apply.)
A. Reinforcing Kegel exercises B. Administration of bethanechol chloride (Urecholine) C. Pouring warm water over the perineum D. Increasing IV fluids E. Urinary catheterization |
ANS: B, C
Administration of bethanechol chloride stimulates the parasympathetic nerve, causing contraction of the detrusor urinae muscle in the bladder, usually resulting in urination. Placing the patient in the proper position to void, pouring warm water over the perineum, and running water in the sink is a technique used to assist with voiding. |
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Fluoxetine, erythromycin, clarithromycin, ketoconazole, itraconazole, miconazole, vinblastine, retonavir, and nefazodone may inhibit the metabolism of which drugs? (Select all that apply.)
A. Warfarin B. Tolterodine C. Phenytoin D. Darifenacin E. Heparin F. Solifenacin |
ANS: B, D, F
These agents inhibit the metabolism of tolterodine. These agents inhibit the metabolism of darifenacin. These agents inhibit the metabolism of solifenacin. |
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A patient received the evening dose of Lispro subcutaneously at 1630. What time will symptoms of hypoglycemia likely occur?
A. 1900 B. 1830 C. 0130 D. 0600 |
B The most rapid-acting insulin, Lispro, peaks within 1 to 2 hours after administration. The peak time of insulin is when patients would most likely exhibit symptoms of hypoglycemia, particularly if they have inadequate dietary intake.
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It is 1400 and a patient who has been NPO since 12 AM for a bronchoscopy is complaining of a headache and shakiness, and is extremely irritable. Vital signs are within normal limits, and a one-touch glucose reads 50 mg/dL. Which action is most important for the nurse to take?
A. Have the patient eat a snack and drink milk. B. Administer glucagon subcutaneously. C. Call the bronchoscopy room to follow up with the delay. D. Obtain an A1c test. |
B Irritability, nervousness, headache, tremors, dizziness, apprehension, sweating, cold and clammy skin, and hunger are symptoms of hypoglycemia. The patient has not eaten since the prior day. A blood glucose of 50 mg/dL is true hypoglycemia and needs to be dealt with immediately. Glucagon is preferred over PO intake given that an endoscopy is scheduled.
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After a blood glucose reading, it is determined that the patient should receive 4 units of Lispro and 8 units of NPH. Which action will the nurse take to administer these medications?
A. Draw up each insulin in separate syringes and administer two injections. B. Draw up the NPH first and then the Lispro using the same syringe. C. Administer the Lispro before the meal and the NPH after the meal. D. Draw up the Lispro first and then the NPH using the same syringe. |
D Lispro, an insulin analogue, is the most rapid-acting insulin. Insulin analogues are compatible with intermediate (NPH) or long-acting insulin. When combining two types of insulin, the short-acting insulin is drawn up before the intermediate-acting insulin.
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A patient with type 2 diabetes mellitus, which was previously controlled with an oral antidiabetic agent, is hospitalized for treatment of a leg ulcer. The health care provider has ordered sliding scale insulin coverage with regular insulin for hyperglycemia. The nurse brings the injection into the room, and the patient becomes upset, stating “I don’t want to start taking that drug! I’ll need it the rest of my life.” What is the nurse’s best response?
A. “This is the same drug as the oral medication you were taking. It’s a stronger dose while you are in the hospital.” B. “Don’t worry. You shouldn’t need this too often. As you feel better, your blood glucose level will drop.” C. “Your body is under stress right now, which raises your blood glucose level. This does not mean you will be on this drug permanently. Once you’re feeling better, your provider will determine if your oral medication is all you will need.” D. “Your disease is progressing and your pancreas is producing less insulin. I know this is a hard time for you. Do you want to talk about it?” |
C Type 2 diabetes mellitus patients normally controlled with oral hypoglycemics may require insulin during situations of increased physiologic and psychological stress. The stress response stimulates epinephrine and norepinephrine, which raises the blood glucose level. Examples of stressors include pregnancy, surgery, and infections.
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What test determines glycemic control over the previous 8 to 10 weeks?
A. 24-hour glucose clearance test B. Fructosamine test C. Fasting blood sugar D. A1c test |
D The A1c test measures the percentage of hemoglobin that has been irreversibly glycosylated because of high blood sugar levels. This test reflects the average blood sugar level attained over the past 8 to 10 weeks.
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When is the best time for the nurse to administer Lispro?
A. After the patient has started eating B. Within 10 to 15 minutes of eating C. 30 minutes before a meal D. 45 to 60 minutes before a meal |
B Insulin analogues, such as Lispro and Aspart, are the most rapid-acting insulins. The onset of these insulins is within 10 minutes of the injection, they peak within 1 to 2 hours, and their duration is 3 to 5 hours. Patients should be eating their meal within 10 to 15 minutes of the injection.
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Which is the most important for the successful management of diabetes mellitus?
A. A network of community resources B. The level of self-management C. Preventative education D. Frequent follow-up with the health care provider |
B Teaching patients to self-manage all aspects of their disease, including treatment modalities and preventing complications, is critical to patient success. Patients must be proficient in the entire therapeutic regimen—diet, activity level, blood or urine testing, medication, self-injection techniques, prevention of complications, and effective management of hypoglycemia or hyperglycemia.
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What laboratory test is the preferred screening test for diabetes in children and nonpregnant adults?
A. FPG B. ECG C. GTT D. A1c |
A The fasting plasma glucose (FPG) is the preferred test used to screen for diabetes in children and nonpregnant adults.
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The patient asks the nurse how sulfonylureas normalize glucose levels. Which response by the nurse is correct?
A. By stimulating pancreatic secretion of insulin B. By inhibiting secretion of insulin by the pancreas C. By increasing glucose production in the liver D. By increasing insulin metabolism in the liver |
A Sulfonylureas stimulate the pancreas to secrete more insulin. They also diminish glucose production and metabolism of insulin by the liver. The net effect is a normalization of insulin and glucose levels.
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The nurse is instructing a patient about insulin administration. Which statement by the patient indicates a need for further teaching?
A. “I may need more insulin if I have surgery.” B. “Once I open my insulin, I will store it in the refrigerator.” C. “I will date the insulin bottle when I open it.” D. “I will keep a spare bottle of insulin on hand.” |
B Once insulin is opened and being used, it can be stored at room temperature for up to 1 month.
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Which instruction by the nurse is accurate to include when providing teaching to a patient recently diagnosed with diabetes who has been prescribed insulin?
A. Beta blockers can mask symptoms of hypoglycemia. B. Lipodystrophy increases the absorption of insulin. C. Infection will decrease the need for insulin. D. Excessive exercise will increase the need for insulin. |
A Beta-adrenergic blocking agents (e.g., propranolol, timolol, nadolol, pindolol) may mask many symptoms of hypoglycemia.
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Which instruction is most important for the nurse to teach a patient with diabetes who is receiving metformin?
A. Take the medication before meals. B. This medication will cause the pancreas to secrete more insulin. C. Stop taking the drug 24 to 48 hours prior to radiopaque dye procedures. D. There may be an increase in the triglyceride level. |
C Radiopaque dyes often induce temporary renal insufficiency, so metformin should be discontinued 24 to 48 hours before procedures in which radiopaque dye will be administered.
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A third subclass of diabetes mellitus includes additional types of diabetes that are part of other diseases having features not generally associated with the diabetic state. Which disorders may have an associated diabetic component? (Select all that apply.)
A. Patients receiving high-dose corticosteroid therapy for disease maintenance B. Cushing’s syndrome C. Alzheimer’s disease D. Acromegaly E. Malnutrition |
ANS: A, B, D, E
Correct Drugs and chemicals that induce hyperglycemia are included in the third subclass of diabetes mellitus. Cushing’s syndrome is included in the third subclass of diabetes mellitus. Acromegaly is included in the third subclass of diabetes mellitus. Malnutrition is included in the third subclass of diabetes mellitus. |
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A 65-year-old man is diagnosed with type 2 diabetes mellitus. Which patient symptoms would indicate type 1 diabetes mellitus, and not type 2? (Select all that apply.)
A. Impotence B. Increased thirst over the past week C. A 10-pound weight loss within the past month D. Polyphagia E. Ketoacidosis |
ANS: B, C, D, E
Diabetes type 2 symptoms are insidious and patients present when symptoms may have been apparent for a prolonged time. Polydipsia is a symptom associated with type 1 diabetes mellitus. Diabetes type 2 symptoms are insidious and patients present when symptoms may have been apparent for a prolonged time. A 10-pound weight loss over this short period (1 month) indicates type 1 diabetes mellitus. Polyphagia is associated with type 1 diabetes. Ketoacidosis is associated with type 1 diabetes. |
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Which dietary control measures are used in the management of diabetes mellitus? (Select all that apply.)
A. Specific daily caloric requirements B. Consistent-carbohydrate diabetes meal plan C. 50% intake of carbohydrates daily D. Adjustments to daily meals according to age, metabolic stress, pregnancy, and advanced age and/or older adults E. 20% intake of proteins daily |
ANS: B, C, D, E
Meal planning systems are used with the diabetic patient. The consistent-carbohydrate diabetes meal plan is used, with an emphasis on consistency of timing of meals and snacks. Daily meals and snacks provide 1500 to 2000 calories, with 50% of the calories from carbohydrates, 20% from protein, and 30% from fat. Individualized adjustments may be required as with children, adolescents, metabolically stressed patients, pregnant women, and geriatric patients. Twenty percent of calories from protein is part of the consistent-carbohydrate diabetes meal plan. |
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Which statements are correct regarding type 2 diabetes mellitus? (Select all that apply.)
A. Type 2 diabetes is more prevalent in overweight people older than 45 years. B. A genetic predisposition exists for the development of type 2 diabetes mellitus. C. Type 2 diabetes requires lifelong insulin replacement. D. Type 2 diabetes is often diagnosed after complications have resulted. E. Women have a higher incidence of type 2 diabetes. |
ANS: A, B, D, E
Contributing factors to the development of type 2 diabetes mellitus include being older than 45 years and being overweight. Contributing factors to the development of type 2 diabetes mellitus include a family predisposition to the disease. The early symptoms of this type of diabetes are minimal; therefore, many patients do not seek medical assistance until the complications have appeared. Contributing factors to the development of type 2 diabetes mellitus include being female. |
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Which statements are true about gestational diabetes? (Select all that apply.)
A. It is diagnosed in about 2% of all pregnancies in the United States. B. It includes diabetic women who become pregnant. C. Fetal development may be complicated as a result of gestational diabetes. D. The risk of developing diabetes after pregnancy is increased. E. Most women with gestational diabetes have normal glucose tolerance post partum. F. Women need to be reevaluated postpartum to determine their classification with respect to glucose tolerance. |
ANS: C, D, E, F
Gestational diabetic individuals are put into a separate category because of the special clinical features of diabetes that develop during pregnancy and the complications associated with fetal involvement. These women are also at a greater risk of developing diabetes 5 to 10 years after pregnancy. The majority of individuals with gestational diabetes have normal glucose tolerance post partum. Gestational diabetes patients must be reclassified 6 weeks after delivery into one of the following categories—diabetes mellitus, impaired fasting glucose, impaired glucose tolerance, or normoglycemia. |
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Which medication is used to treat hyperthyroidism?
A. Levothyroxine (Synthroid) B. Liotrix (Thyrolar) C. Propylthiouracil (Propacil) D. Liothyronine (Cytomel) |
C Propylthiouracil is an antithyroid agent used in the treatment of hyperthyroidism.
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A patient with a history of heart failure has been diagnosed with hypothyroidism. The drug interaction with glycosides and thyroid replacement therapy will most likely require which change in therapy?
A. Decrease in the daily digoxin dosage B. Gradual increase in the daily glycoside dosage C. Not able to begin thyroid replacement therapy because of the underlying heart condition D. Increased thyroid replacement dosage |
B If thyroid replacement therapy is started while receiving digoxin, a gradual increase in the glycoside will also be necessary to maintain adequate therapeutic activity.
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Which nursing diagnosis may be identified for a patient with hyperthyroidism?
A. Imbalanced Nutrition: More Than Body Requirements B. Constipation C. Disturbed Sleep Pattern D. Ineffective Airway Clearance |
C.Hyperthyroidism is caused by an excess amount of thyroid hormones. Patients typically exhibit the following symptoms: rapid, bounding pulse (even during sleep), cardiac enlargement, palpitations, and dysrhythmias. Patients are nervous and easily agitated. Reflexes are hyperactive and the patient typically experiences insomnia. A nursing diagnosis of Disturbed Sleep Pattern would be a common problem
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The nurse is providing instruction to a patient recently prescribed a radioactive iodine isotope. Which is the correct action of this medication?
A. Stimulates the synthesis of T3 and T4 hormones B. Increases the storage of thyroxine before thyroid surgery C. Destroys hyperactive thyroid tissue D. Replaces deficient thyroid hormone |
C The thyroid gland absorbs high concentrations of radioactive iodine, which destroys the hyperactive thyroid tissue with essentially no damage to other tissues in the body.
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Which patient would be a candidate for radioactive iodine therapy?
A. 17-year-old woman with Graves’ disease B. 64-year-old woman with hypothyroidism C. 46-year-old man with heart disease and thyroid cancer D. 82-year-old man with myxedema crisis |
C Patients typically treated with radioactive iodine therapy are those who are beyond childbearing years, those with severe complicating diseases (e.g., heart disease), those with recurrent hyperthyroidism after previous thyroid surgery, those who are poor surgical risks, and those who have unusually small thyroid glands.
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Which medication is used in the treatment of hypothyroidism?
A. Levothyroxine (Synthroid) B. Radioactive iodine C. Propylthiouracil (Propacil) D. Methimazole (Tapazole) |
A Levothyroxine (T4) is one of the two primary hormones secreted by the thyroid gland. This hormone is partially metabolized to liothyronine (T3), so therapy with levothyroxine replaces both hormones. Levothyroxine (Synthroid) is considered the drug of choice for hormone replacement in hypothyroidism.
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A patient with myxedema complains to the nurse that he has a “hangover” the next morning after taking a pain medication at night. Which explanation by the nurse is the most accurate?
A. “You have increased sensitivity to the medicine because of your thyroid condition.” B. “Because you haven’t been sleeping, you have increased fatigue and should increase the analgesic.” C. “You are not taking enough thyroid medication and you should increase the dosage.” D. “The pain medication is incompatible with your thyroid medication and you should find another analgesic to take.” |
A Myxedema patients are sensitive to small doses of sedative-hypnotics, anesthetics, and narcotics.
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Which condition can occur if congenital hypothyroidism is not treated?
A. Diabetes B. Impaired vision C. Periorbital edema D. Cretinism |
D Cretinism is a condition resulting from congenital hypothyroidism.
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What is the mechanism of action of propylthiouracil?
A. Blocks reuptake of thyroid hormone in the liver B. Destroys hormone in the thyroid gland C. Increases synthesis of hormone in the thyroid gland D. Blocks synthesis of hormone in the thyroid gland |
D Propylthiouracil and methimazole are antithyroid agents that act by blocking the synthesis of T3 and T4 in the thyroid gland. They do not destroy any T3 or T4 already produced, so there is usually a latent period of a few days to 3 weeks before symptoms improve once therapy is started.
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A patient recently completed radiation treatment for throat cancer and presents to the health care provider’s office with symptoms indicating possible hypothyroidism. Which symptoms would most likely be exhibited and/or reported? (Select all that apply.)
A. Inability to sleep B. Weight gain C. Lethargy D. Nervousness E. Cold intolerance |
ANS: B, C, E
Correct Symptoms associated with hypothyroidism include weight gain. Symptoms associated with hypothyroidism include lethargy. Symptoms associated with hypothyroidism include cold intolerance. |
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Which is characteristic of antithyroid drugs that act on the thyroid gland? (Select all that apply.)
A. They are a physiologic hormone replacement. B. They block synthesis of T3 and T4 in the thyroid gland. C. They destroy T3 and T4. D. Immediate improvement is observed. E. They may be used before subtotal thyroidectomy. |
ANS: B, E
Correct Antithyroid drugs act by blocking the synthesis of T3 and T4. Antithyroid drugs are prescribed long term for patients with hyperthyroidism and may be used for short-term treatment before subtotal thyroidectomy. |
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A postoperative total thyroidectomy patient is started on levothyroxine (Synthroid) daily. Which information will the nurse include in discharge teaching? (Select all that apply.)
A. “Close follow-up with your health care provider is important.” B. “Notify your health care provider if you experience any palpitations or tachycardia.” C. “A variation in emotions and personality is normal during this adjustment period.” D. “Synthroid may be stopped as soon as the thyroid gland resumes functioning.” E. “When energy levels have returned, Synthroid will be gradually tapered.” |
ANS: A, B, C
Early intervention in correcting complications from the surgery or the hormone replacement therapy is crucial for a timely and positive outcome. Adverse effects such as tachycardia, anxiety, weight loss, abdominal cramping, and diarrhea are common, but should be reported to the health care provider. After surgery, the goal is to return the patient to a euthyroid state with the use of replacement therapy. During this time of adjustment, patients will experience symptoms related to fluctuations in hormonal levels. Variation in emotions and personality may occur |
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Which clinical manifestations would the nurse assess in a patient with hypothyroidism? (Select all that apply.)
A. Cold intolerance, weight gain B. Nervousness, agitation C. Increased susceptibility to infection D. Exophthalmos, fatigue E. Hypoactive reflexes |
ANS: A, C, E
Hypothyroid patients have a lower basal metabolic rate. This may be characterized by intolerance to cold and subnormal body temperature, and weight gain. Patients with hypothyroidism may become susceptible to infection. Hypothyroid patients have a lower basal metabolic rate. This may be characterized by slowness in motion, speech, and mental processes |
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Which clinical symptoms would the nurse observe in a patient with thyrotoxicosis? (Select all that apply.)
A. Decreased metabolic rate B. Decreased heart rate C. Decreased body temperature D. Muscle tremors E. Restlessness F. Anxiety G. Sweating |
ANS: D, E, F, G
Thyrotoxicosis symptoms include muscle weakness and tremors. Thyrotoxicosis symptoms include restlessness and nervousness. Thyrotoxicosis symptoms include anxiety. Thyrotoxicosis symptoms include sweating. |
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A patient has been on high-dose corticosteroid therapy for the treatment of lupus erythematosus. In addition to monitoring electrolyte levels, which laboratory studies will the nurse monitor?
A. Complete blood count B. Partial thromboplastin time C. Liver function panel D. Blood glucose levels |
D Corticosteroid therapy may induce hyperglycemia, particularly in prediabetic or diabetic patients. All patients must be monitored for the development of hyperglycemia, particularly during the early weeks of therapy.
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A patient who has been taking glucocorticoids over the past 3 months for Crohn’s disease comes in for a follow-up visit. On assessment, the nurse notes facial edema, thinning extremities, and a fatty deposition (buffalo hump) on the scapular area. The patient reports the symptoms of the Crohn’s disease are “somewhat better.” What will the nurse expect the treatment to be?
A. Decrease the steroid dosage by one half. B. Increase the steroid dosage. C. Maintain the steroid dosage. D. Immediately stop the steroid dosage. |
C Glucocorticoids are primarily used as anti-inflammatory agents. Because the symptoms are improving, the physician will most likely maintain the steroid dosage. Adverse effects are anticipated with corticosteroid therapy.
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What is the rationale for administering glucocorticoid therapy as an adjunct to chemotherapeutic agents?
A. Assists with pain control B. Raises blood sugar to meet the increased metabolic needs C. Produces immunosuppression effects D. Reduces mucositis |
C Glucocorticoids have an anti-inflammatory and antiallergenic action. Suppression of inflammation secondary to cancer enhances the effectiveness of the chemotherapeutic agents.
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A patient with type 1 diabetes was prescribed a glucocorticoid for COPD. Which will the nurse expect in the treatment plan?
A. A decrease in the amount of insulin needed B. No change in the amount of insulin needed C. An increase in the need for carbohydrates D. An increase in the insulin needed |
D Glucocorticoids may elevate blood glucose levels and induce hyperglycemia, particularly in prediabetic or diabetic patients. Insulin needs increase with an increase in blood glucose levels.
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Which condition would require mineralocorticoid replacement?
A. Addison’s disease B. Diabetes insipidus C. Myxedema D. Glomerulonephritis |
A Addison’s disease is a result of failure of the adrenal cortex to produce mineralocorticoids, glucocorticoids, and sex hormones. Replacement therapy of all hormones is essential for the patient to lead a healthy life.
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Which fluid replacement method will the nurse identify for a patient on a fluid restriction?
A. Freely throughout the day and evening shift B. One third of the allowed volume on each shift C. Half the volume with meals and the remainder divided among shifts D. As the patient desires |
C When fluid restrictions are prescribed, one half of fluid volume is generally given with meals. The other half is given on a per-shift basis.
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Which will the nurse include in the teaching plan for a patient asking about the use of salt substitutes while on a sodium-restricted diet?
A. Salt substitutes may be high in potassium and should be used sparingly. B. Salt substitutes are safe for unlimited use. C. The salty flavor is reduced, so additional amounts are needed for desired flavor. D. Salt substitutes may interact with the patient’s medications. |
A Potassium restrictions may be indicated if the patient is taking a potassium-sparing diuretic. Salt substitutes may be high in potassium; therefore, their use must be limited.
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A patient on a high dosage of corticosteroids over a period of time may develop which type of psychiatric complication?
A. Lethargy B. Psychotic behaviors C. Manic phases D. Anxiety attacks |
B A patient receiving a higher dosage of corticosteroids is susceptible to psychotic behavioral changes. The most susceptible patient is one with previous histories of mental dysfunction. Perform a baseline assessment of the patient’s ability to respond rationally to the environment and the diagnosis of the underlying disease.
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What is the rationale for monitoring vital signs of patients receiving corticosteroids?
A. Orthostatic hypotension B. Malignant hyperthermia C. Infection D. Hyperglycemia |
C Patients receiving corticosteroids are more susceptible to infection, and fever is often an early indicator of infection. Glucocorticoids, however, sometimes suppress a febrile response to infection.
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The nurse is assessing a patient for adverse effects of long-term glucocorticoid therapy. Which condition would most likely be present?
A. Dehydration B. Hypotension C. Osteoporosis D. Thrombocytopenia |
C Long-term glucocorticoid therapy may produce osteoporosis.
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The nurse is instructing a patient about adverse effects associated with corticosteroid therapy. Which information would be important to include? (Select all that apply.)
A. Avoid crowds or people with an infection. B. Monitor and care for your skin daily; change positions frequently. C. Take medication on an empty stomach. D. During periods of physical or psychological stress, higher doses of corticosteroids are necessary. Contact your health care provider. E. Follow a diet low in sodium. |
ANS: A, B, D, E
Corticosteroid therapy patients should avoid large crowds or people with an infection. Patients taking corticosteroid drugs should monitor for signs of edema, skin breakdown, and weight daily. During periods of physical or psychological stress, increased dosing may be necessary. Patients taking corticosteroid drugs should follow a low-sodium diet that is also high in potassium, if not contraindicated |
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Which is a function of glucocorticoids? (Select all that apply.)
A. Maintain fluid and electrolyte balance B. Have anti-inflammatory activities C. Regulate protein, carbohydrate, and fat metabolism D. Provide relief of rheumatoid arthritis E. Include aldosterone |
ANS: B, C, D
Glucocorticoids have anti-inflammatory and antiallergenic activities. Glucocorticoids (cortisone, hydrocortisone, prednisone, and others) regulate carbohydrate, protein, and fat metabolism. Glucocorticoids are effective for immunosuppression in the treatment of certain cancers, organ transplantation, autoimmune diseases (e.g., lupus erythematosus, dermatomyositis, rheumatoid arthritis), relief of allergic manifestations (e.g., serum sickness, severe hay fever, status asthmaticus), and treatment of shock. In addition, they may be used to treat nausea and vomiting secondary to chemotherapy |
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A patient has been diagnosed with rheumatoid arthritis and will begin daily oral corticosteroid treatment. Which baseline assessments are important for a patient receiving corticosteroids? (Select all that apply.)
A. Baseline weight B. Blood pressure C. Complete blood cell count D. Electrolyte studies E. Hydration status |
ANS: A, B, D, E
Baseline assessments for patients receiving corticosteroid therapy include weight. Baseline assessments for patients receiving corticosteroid therapy include blood pressure. Baseline assessments for patients receiving corticosteroid therapy include electrolyte studies and intake and output. Baseline assessments for patients receiving corticosteroid therapy include diet and hydration status. |
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Which are appropriate measures for monitoring hydration and fluid balance in the patient on steroid therapy? (Select all that apply.)
A. Daily weights B. Abdominal girth measurements C. Reports of thirst D. Neurologic assessment E. Assessment for alteration in skin integrity |
ANS: A, B
Perform daily weights using the same scale, in clothing of approximately the same weight, at the same time, usually before breakfast. Record and report significant weight changes. (Weight gains and losses are the best indicators of fluid gain or loss.) As appropriate to the patient’s condition, obtain and record abdominal girth measurements |
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What are the primary therapeutic outcomes expected from fludrocortisone (Florinef) therapy? (Select all that apply.)
A. Reduced inflammation B. Pain relief C. Blood pressure control D. Restored fluid and electrolyte balance |
ANS: C, D
Fludrocortisone is used in combination with glucocorticoids to treat salt-losing adrenogenital syndrome for blood pressure control. Fludrocortisone is used in combination with glucocorticoids to restore fluid and electrolyte balance. |
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A patient with type 2 diabetes is being discharged on glucocorticoid (prednisone) therapy for rheumatoid arthritis. Which information will the nurse include in discharge teaching? (Select all that apply.)
A. “Daily, single-dose therapy should be taken in the morning.” B. “The metabolic needs of your body will be increased.” C. “Steroids should never be abruptly discontinued.” D. “Signs and symptoms of infections may not be evident.” E. “Blood glucose levels will be elevated on corticosteroid therapy.” |
ANS: A, C, D, E
During steroid replacement therapy, the drugs should mimic the body’s circadian rhythm. Steroids ordered once a day are given early in the morning. Steroid replacement therapy is gradually tapered in small increments before discontinuation to ensure that the patient’s adrenal glands are able to start secreting steroids to compensate for the reduced drug dosage. Glucocorticoids have an anti-inflammatory action and therefore suppress the signs and symptoms of an infection. An adverse effect of glucocorticoid therapy is increased blood sugar levels. |
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1.A female patient with a history of endometriosis presents with bilateral lower quadrant pain reportedly at midcycle. Which gonadal drug is indicated for treating symptoms of endometriosis?
A. Estrogen B. Progesterone C. Androgens D. Gonadotropins |
B Progesterones are used to treat secondary amenorrhea, breakthrough uterine bleeding, and endometriosis. They may be combined with estrogens as contraceptives.
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What is the rationale for using an androgen as part of breast cancer treatment?
A. For maintenance of fat stores B. To promote nutrition C. To prevent wasting associated secondary to cancer growth D. For palliative treatment to suppress cancer cell growth |
D When androgens are used for palliation of breast cancer in women, they suppress cancer cell growth.
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The health of a patient receiving androgen therapy for breast cancer declines and she becomes bed bound. Which condition will this patient be at risk of developing?
A. Electrolyte imbalances B. Hypercalcemia C. Hyperglycemia D. Fluid overload |
B Immobilized patients receiving androgens for palliative breast cancer treatment are at risk for hypercalcemia. The nurse should monitor patients for nausea, vomiting, constipation, poor muscle tone, and lethargy.
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Which patient on oral contraceptive therapy will be at greatest risk for heart attack?
A. 34-year-old woman with a history of osteoporosis B. 28-year-old woman with history of eczema C. 36-year-old woman who smokes half a pack per day D. 36-year-old woman who has a history of abnormal Pap smears |
C The incidence of fatal heart attacks is increased for women older than 35 years of age who use gonadal hormones and smoke.
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Which is most important for the nurse to remember when instructing the patient about treatment with gonadal hormones?
A. Dosage, schedule, and adverse effects B. Cost, storage, and route of administration C. Drug interactions and food interactions D. Scheduling follow-up appointments and lab studies |
A Most gonadal hormones are prescribed to patients for prolonged self-administration. Therefore, planning should stress patient education specific to the type of gonadal hormone prescribed and its intended actions, including monitoring of adverse effects to expect and report.
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The nurse is teaching a young woman about birth control pills. For which situation will the patient need to seek immediate follow-up with the health care provider?
A. Breakthrough bleeding B. Nausea C. Missed dose D. Light menstrual flow |
A Breakthrough bleeding is not an expected adverse effect and should be reported to a health care provider immediately to consider alternatives in therapy.
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Which statement is true regarding androgen therapy?
A. Androgen use may cause hyperglycemia. B. Administer with food or milk to avoid gastric irritation. C. Signs of masculinization will appear and are reversible. D. Electrolyte imbalances are extremely rare. |
B Androgens may cause gastric irritation and therefore can be given with food or milk.
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Which is the most potent of the natural estrogenic hormones produced in the ovaries?
A. Estradiol B. Estrone C. Estriol D. Estrogen |
A The natural estrogenic hormone released from the ovaries comprises several closely related chemical compounds: estradiol, estrone, and estriol. The most potent is estradiol.
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Which information will the nurse include when teaching a patient with seizures about estrogen therapy?
A. Phenytoin reduces the effectiveness of estrogen. B. Estrogen reduces the effectiveness of phenytoin. C. Phenytoin may inhibit the metabolism of estrogen. D. Estrogen may inhibit the metabolism of phenytoin. |
D Estrogens may inhibit the metabolism of phenytoin, resulting in phenytoin toxicity.
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What is progestin therapy used for? (Select all that apply.)
A. Contraception B. Endometriosis C. Amenorrhea D. Abnormal uterine bleeding E. Cancer |
ANS: A, B, C, D
Progestin therapy is used in combination with estrogens as a contraceptive. Progestin therapy is used to relieve symptoms of endometriosis. Progestin therapy is used for hormonal balance to relieve amenorrhea. Progestin therapy is used for hormonal balance to relieve abnormal uterine bleeding. |
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The nurse is completing discharge teaching to a new mother who will begin oral contraceptives. Which common adverse effects are expected? (Select all that apply.)
A. Elevated blood pressure B. Breast tenderness C. Weight gain D. Edema E. Increased thirst |
ANS: B, C, D
Correct Breast tenderness is an adverse effect to expect when beginning oral contraceptives. Weight gain is an adverse effect to expect when beginning oral contraceptives. Edema is an adverse effect to expect when beginning oral contraceptives. |
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Why is estrogen therapy used in postmenopausal women? (Select all that apply.)
A. Meet contraceptive needs B. Treat acne C. Prevent osteoporosis D. Treat hot flashes E. Maintain hormonal balance |
ANS: C, E
Estrogen therapy is also used in conjunction with diet, calcium, and physical therapy in the prevention and treatment of osteoporosis and to slow the disease progression in patients with advanced prostate cancer and certain types of breast cancer. Postmenopausal females would take estrogen to maintain hormonal balance. |
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Which condition is of special concern when evaluating a patient for treatment with gonadal hormones? (Select all that apply.)
A. Sexually transmitted disease B. Hypertension C. Liver disease D. Cancer of the reproductive organs E. Smoking |
ANS: B, C, D, E
Hypertension may be a contraindication to treatment with gonadal hormones. Liver disease may be a contraindication to treatment with gonadal hormones. Cancer of the reproductive organs may be a contraindication for treatment with gonadal hormones. Smoking increases the risk of heart attacks, stroke, and embolic disorders in patients taking gonadal hormones. |
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When teaching a patient about estrogen therapy, which drugs will the nurse identify as causing drug interactions? (Select all that apply.)
A. Diazepam (Valium) B. Warfarin (Coumadin) C. Thyroid hormones D. Phenytoin (Dilantin) E. Acetaminophen (Tylenol) |
ANS: B, C, D
Correct Estrogen may diminish the anticoagulant effects of warfarin. Monitor the prothrombin time and increase the dosage of warfarin, if necessary. Patients who have no thyroid function and who start estrogen therapy may require an increase in thyroid hormone dosage. Estrogens increase thyroid-binding globulin levels, which reduce the level of circulating free T4. The total level of T4 is either normal or increased. Do not adjust the thyroid dosage until the patient shows clinical signs of hypothyroidism. Estrogens may inhibit the metabolism of phenytoin, resulting in phenytoin toxicity. Monitor patients with concurrent therapy for signs of phenytoin toxicity (e.g., nystagmus, sedation, lethargy). Serum levels may be ordered, and a reduced dosage of phenytoin may be required. |
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The nurse is preparing a patient for an ophthalmic examination. Which action occurs when the nurse instills eye drops to produce mydriasis?
a. Drying of tears in the eyes b. Extreme dilation of the pupil c. Opening of the canal of Schlemm d. Paralysis of the ciliary muscle |
B Dilating the eye before eye examinations allows for better visualization of the interior of the globe.
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Which type of medication would be used to dilate the pupils before an eye examination?
a. Osmotics b. Adrenergic agent c. Beta-adrenergic agent d. Corticosteroid |
B Adrenergic agents are sympathomimetic. They cause pupil dilation, increased outflow of aqueous humor, vasoconstriction, relaxation of ciliary muscle, and a decrease in the formation of aqueous humor. Adrenergic agents are used to lower intraocular pressure (IOP) in open-angle glaucoma, relieve congestion and hyperemia, and produce mydriasis for ocular examinations.
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Which medication is used to produce miosis following a diagnostic procedure?
a. Pilocarpine (Pilocar) b. Mannitol (Osmitrol) c. Atropine (Isopto-Atropine) d. Epinephrine (EpiPen) |
A Pilocarpine is a direct-acting cholinergic agent that is used to counter the effects of mydriatic and cycloplegic agents after surgery or eye ophthalmoscopic examinations. Cholinergic agents also reduce IOP in glaucoma patients by widening the filtration angle that permits outflow of aqueous humor.
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Which discharge instruction will the nurse include for a patient sent home from the clinic who is taking an adrenergic ophthalmic solution for an acute inflammation?
a. Headaches and eye pain are adverse effects to be reported to the health care provider immediately. b. Mouth dryness should be reported immediately. c. Avoid driving or operating machinery until blurring subsides. d. “Halos” or yellow rings around objects will be seen while taking this medication. |
C Adrenergic agents cause the smooth muscle of the ciliary body and iris to relax, producing mydriasis. Blurred vision will temporarily occur until the patient can adjust to the increased light coming into the eyes. Activities such as driving or operating machinery should be avoided until vision stabilizes. Sunglasses help reduce the brightness.
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What is the action of timolol maleate (Timoptic), a beta-adrenergic blocking agent?
a. Draws aqueous humor from the eye into the circulatory network b. Increases the production of aqueous humor c. Increases the outflow of aqueous humor d. Decreases the production of aqueous humor |
D Timolol maleate is a beta-adrenergic blocking agent used to reduce increased intraocular pressure. The exact mechanism of action of these medications is unknown, but they are believed to reduce the production of aqueous humor.
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What is the mechanism of action of osmotic agents when used to decrease IOP?
a. Promoting outflow of the aqueous humor into the tear ducts b. Increasing plasma osmolarity and drawing extracellular fluid into the blood c. Blocking production of aqueous humor d. Decreasing viscosity of the tears and allowing fluid to drain away from the eye |
B Osmotic agents elevate the osmotic pressure of the plasma, causing fluid from the extravascular spaces to be drawn into the blood. The effect on the eye is reduction of volume of intraocular fluid, which produces a decrease in IOP.
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Which is a potential serious adverse effect associated with mannitol (Osmitrol)?
a. Bradycardia b. Fluid overload c. Anaphylaxis d. Fever |
B Mannitol, an osmotic agent, acts on blood volume by pulling fluid from the tissue spaces into the general circulation (blood). Patients should be assessed at regularly scheduled intervals for signs and symptoms of fluid overload, pulmonary edema, or heart failure.
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Which statement is true about aqueous humor? (Select all that apply.)
a. Bathes and feeds the lens, posterior surface of the cornea, and iris b. Maintains the iris color c. Drains out of the eye through drainage channels located near the junction of the cornea and sclera d. Manufactures fluid for tear production e. Flows out of the canal of Schlemm into the venous system of the eye |
ANS: A, C, E
Aqueous humor bathes and feeds the lens, posterior surface of the cornea, and iris. After it is formed, the fluid flows forward between the lens and the iris into the anterior chamber. Aqueous humor drains out of the eye through drainage channels located near the junction of the cornea and sclera. Aqueous humor drains into a meshwork leading into the canal of Schlemm and into the venous system of the eye. |
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A factory worker had a chemical inadvertently splashed into his right eye. An eyewash was used at the work site. Which nursing assessments are important to include? (Select all that apply.)
a. Visual acuity b. Presence of pain, blurred or halo vision, or lack of vision c. Type of chemical d. Presence of nystagmus e. Presence of contacts or use of eyeglasses |
ANS: A, B, C, E
Important nursing assessments would include visual acuity and baseline vital signs. Important nursing assessments would include subjective data such as pain, clarity, and acuity of vision, observation of any physical abnormalities of the eye or lid, pupil characteristics, drainage or excessive tearing, edema or redness, and interventions completed before arrival. Important nursing assessments would include the type and cause of injury. Important nursing assessments would include whether contacts or eyeglasses are worn |
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Which information will the nurse include when instructing a patient on the correct method of instilling eye drops? (Select all that apply.)
a. With an infection, prevent cross-contamination and use a separate source of medication and droppers for each eye. b. Wash hands before and after administration. c. Place lid on surface area as instructed to avoid contamination. d. Never touch the tip of the dropper or opening of the ointment container. e. Wipe eye from the outer to inner canthus. |
ANS: A, B, C, D
Separate medication sources should be used when an eye infection is present to avoid cross-contamination. Washing of hands before and after instillation will prevent infection. The medication lid should not lie with the opening down on any surface. Any medications instilled into the eye should be sterile. The medication tip should not touch anything, including the eye, face, or fingers. |
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A patient recently diagnosed with glaucoma is to begin drug therapy with carbonic anhydrase inhibitors. About which assessment would the nurse need to contact the health care provider? (Select all that apply.)
a. Electrolyte levels b. Any signs of gastric symptoms before initiating drug therapy c. Allergy to sulfonamides d. Patient history of menopause e. Elevated intraocular pressure levels |
ANS: A, C
Correct Baseline electrolyte studies, weight, hydration data, vital signs, and mental status should be obtained before beginning drug therapy. Carbonic anhydrase inhibitors should be held and the health care provider notified if the patient is pregnant or allergic to sulfonamides. |
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What is the purpose of administering a cycloplegic agent? (Select all that apply.)
a. Facilitate examination of the eye b. Facilitate surgery on the eye c. Cause pupillary dilation d. Paralyze the ciliary muscle e. Decrease the production of aqueous humor |
ANS: A, B, D
The eye is easier to examine in some cases if the ciliary muscle is paralyzed. Surgery on the eye is easier when the ciliary muscle is paralyzed. Cycloplegic agents are used to paralyze the ciliary muscle in preparation for examination or surgery |
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Which are important teaching points for the nurse to review with a patient recently diagnosed with open-angle glaucoma? (Select all that apply.)
a. The disease will cause damage to the optic disc if left untreated. b. Symptoms are sudden and painful when the disease begins. c. Loss of peripheral vision is a common trigger for diagnosis. d. Total blindness may result if the glaucoma is not treated. e. Glaucoma is not a serious disease and will cause only mild inconvenience to the patient. f. Treatment is only necessary when symptoms are bothersome. |
ANS: A, C, D
IOP builds up and, if not treated, will damage the optic disc. Initially, the patient has no symptoms, but over the years, peripheral vision is gradually lost. If glaucoma is left untreated, total blindness may result. |
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Which information will the nurse include when teaching the patient and family about postoperative care for a trabeculectomy? (Select all that apply.)
a. Use aseptic technique for all dressing changes and medication administration. b. Place the patient on the operated side. c. Avoid heavy lifting. d. Redness in the eye, pain, and swelling are common occurrences after surgery. e. Avoid straining on defecation. |
ANS: A, C, D, E
Teach the patient and family proper hygiene and eye care techniques to ensure that medications, dressings, and/or surgical wounds are not contaminated during necessary eye care. Explain and enforce activity and exercise restrictions. To prevent an increase in IOP, instruct the patient to avoid heavy lifting, straining on defecation, coughing, or bending and placing the head in a dependent position. Teach the patient and family about signs and symptoms of infections and when and how to report them to allow early recognition and treatment of possible infection. Straining increases IOP and should be avoided. |
