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202 Cards in this Set

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During theimplementation phase of the nursing process, which action will the nurseperform when administering medications?


A. Switch the route of administrationbased on drug availability.


B. Call the patient by name when enteringthe room to verify the drug is for the right person.


C. Check the patient’s armband beforeadministering the medication.


D. Prepare medications for all patientsfirst, then administer by room to manage time appropriately.

C. Checking the patient’sarmband is the most accurate method of determining identity. All the otheranswers leave room for error.

For which activity isthe nurse responsible during the evaluation phase of drug administration?


A. Preparing and administering prescribedmedications safely


B. Planning measurable outcomes for thepatient related to drug therapy


C. Monitoring the patient continuously fortherapeutic as well as adverse effects


D. Gathering data in a drug and dietaryhistory

C. Ongoing monitoring ofthe patient evaluates the effect of the drug on the patient. All the otheranswers refer to different steps in the nursing process.

The nurse shouldinclude which information when evaluating the outcome after a patient’smedication has been administered?


A. Dose of medication administered


B. Time medication administered


C. Patient allergies to medications


D. Therapeutic effect on patient

D. The therapeutic effect of themedication on the patient is part of the evaluation process after a medicationis administered.

The nursing process isimportant as a well-established, research-supported framework for professionalnursing practice. Which is the correct order for the steps of the nursingprocess?


A. Evaluation, Planning, Diagnoses,Assessment, Implementation


B. Planning, Assessment, Diagnoses,Implementation, Evaluation


C. Diagnoses, Assessment, Planning,Evaluation, Implementation


D. Assessment, Diagnoses, Planning,Implementation, Evaluation

D. The typicalorganization for the nurse process is assessment, nursing diagnoses, planning,implementation, and evaluation. (ADPIE)

What is the study ofthe physiochemical properties of drugs and how they influence the body called?


A. Pharmacokinetics


B. Pharmacotherapeutics


C. Pharmacodynamics


D. Pharmacology

C. In simpler terms,pharmacodynamics is the study of what drugs do to the body.

Pharmacokineticsinvolves the study of


A. physiologic interactions of drugs.


B. distribution rates among various bodycompartments.


C. interactions between various drugs.


D. adverse reactions to medications.

B. Pharmacokineticsinvolves the study of how the drug moves through the body, includingabsorption, distribution, metabolism, and excretion.

A drug given by whichroute is altered by the first-pass effect?


A. Sublingual


B. Subcutaneous


C. Oral


D. Intravenous

C. Medications absorbedin the stomach and small intestine travel through the portal system and aremetabolized by the liver before they reach the general circulation.

The nurse should checka medication how many times before administration of a medication under the“right drug” part of the Six Rights?


A. One time


B. Three times


C. Five times


D. Depends on the drug being administered

B. The nurse should checkthe medication three times and confirm each time that the medication is theright drug before to administration of the medication.

To achieve the mostrapid onset of action, the health care provider will prescribe the medicationto be administered by which route?A. Subcutaneously


B. Intravenously


C. Intramuscularly


D. Intrathecally

B. When a drug isadministered intravenously, it does not need to be absorbed because it isplaced directly into general circulation.

Patients with renalfailure would most likely have problems with drug


A. excretion.


B. absorption.


C. metabolism.


D. distribution.

A. The kidneys areresponsible for the majority of drug excretion.

When a patient asksthe nurse why a lower dose of intravenous pain medication is being given thanthe previous oral dose, what knowledge will the nurse draw on to respond to thepatient?


A. Medications given intravenously are notaffected by the first-pass effect.


B. Medications given orally bypass theportal circulatory system.


C. A large percentage of an intravenouslyadministered drug is metabolized into inactive metabolites in the liver.


D. Drugs administered intravenously enterthe portal system prior to systemic distribution.

A. When drugs with a highfirst-pass effect are administered orally, a large amount of drug may bemetabolized before it reaches the systemic circulation. The same drug givenintravenously will bypass the liver. This prevents the first-pass effect fromtaking place, and therefore more of the drug reaches the circulation.Parenteral doses of drugs with a high first-pass effect are much smaller thanoral doses, yet they produce the same pharmacologic response.

Knowing that thealbumin in neonates and infants has a lower binding capacity for medications,the nurse can expect the prescriber to perform which action to minimize therisk of toxicity?


A. Decrease the amount of drug given


B. Increase the amount of drug given


C. Shorten the time interval between doses D. Administer the medication intravenously

A. A lower bindingcapacity leaves more drug available for action; thus a lower dose would be requiredto prevent toxicity.

The physiologicchanges that normally occur in the older adult have which implication for drugresponse in this patient?


A. Drug metabolism is faster.


B. Drug half-life is lengthened.


C. Drug elimination is faster.


D. Protein binding is more efficient.

B. Drug half-life isextended secondary to diminished liver and renal function in the elderly.

Which actions will thenurse perform to ensure the medication dose for a pediatric patient iscorrect? (Select all that apply.)


A. Use the patient’s weight in pounds.


B. Use a current drug reference to determineusual dosage per 24 hours.


C. Determine the dose parameters by multiplyingthe weight by the minimum and maximum daily doses of the drug (the safe range).


D. Determine the total amount of the drug toadminister per dose and per day.


E. Compare the drug dosage prescribed with thecalculated safe range.


F. If the drug dosage prescribed varies fromrecommended reference range, notify the provider.

B., C., D., E., F. Thepatient’s weight needs to be in kilograms, not pounds. All otherinformation listed is correct and must be followed by the nurse to ensure thecorrect pediatric dosage.

Which statement bestreflects the nurse’s understanding of cultural influences on drug therapy andother health practices?


A. Administration of some drugs may elicitvaried responses in specific racial-ethnic groups. B. Regardless of one’s culturalbackground, it is crucial to always adhere to recommended medical practices.


C. Most cultures are fairly standard inreference to the use of medications during illness.


D. Dietary habits and practices can be oflittle value to the care of an ill adult.

A. Knowledge about drugsthat may elicit varied responses in specific racial or ethnic groups mustremain current. For example, genetic changes in certain CYP enzymes affect therate of drug metabolism and thus affect drug levels and dosage amounts.Cultural practices vary among individuals and should be implemented as an integralpart of holistic nursing care. Dietary habits and practices can affect thepharmacokinetics of medications and are thus an important aspect of thepatient’s history.

The nurse is assessinga patient’s culture and race on admission to the hospital. Which concept is importantfor the nurse to understand regarding drug therapy as it relates to differentraces of individuals?


A. Polypharmacy


B. Polymorphism


C. Pharmacokinetics


D. Pharmacodynamics

B. Drug polymorphismrefers to the effect of a patient’s age, gender, size, body composition, andother characteristics on the pharmacokinetics of specific drugs. The race of anindividual may influence drug therapy decisions for the individual. Polypharmacy is the use of many different drugsconcurrently in treating a patient, who often has several health problems. Pharmacokinetics is the study of what happens to adrug from the time it is put into the body until the parent drug and allmetabolites have left the body. Pharmacodynamics isthe study of what the drug does to the body.

The emergencydepartment nurse is documenting the history of a patient of Asian culture. Thepatient states that she does not take any medications, but the nurse notes abottle of capsules in the patient’s purse. What information will the nurse collectnext?


A. Vital signs


B. Primary care provider name


C. Use of herbs or over-the-countermedications


D. Insurance information

C. The nurse will ask thepatient if she takes any herbs or other non-prescribed medications. The patientis of Asian culture and may use herbal remedies that she does not considermedications.

When planninginterventions aimed at reducing medication errors, the nurse recognizes that


A. only 10% of all preventable adversedrug reactions (ADRs) begin at the medication ordering (prescribing) stage.


B. disciplinary action is necessary toincrease the nurse’s vigilance in preventing medication errors.


C. the majority of medication errorsresult from weaknesses within the system rather than individualshortcomings.


D. the use of trailing zeros (i.e., 1.0mg) and omission of leading zeros (i.e., .25 mg) reduces transcription errors.

C. It is widelyrecognized that the majority of medication errors result from weaknesses withinthe “system” structure of health care organizations, resulting less often fromindividual shortcomings. Vindictive disciplinary action or “finger pointing” isnow generally recognized as being counterproductive in the prevention ofmedication errors. Studies have shown that one half of all preventable ADRsbegin at the medication ordering (prescribing) stage. The use of leading zerosand omission of trailing zeros will help prevent transcription errors.

When admitting an elderlypatient to an acute care setting, which nursing strategy is most appropriate toprevent medication errors?


A. Call the primary care physician toverify current medications.


B. Ask the patient’s family to verifymedications the patient was taking at home.


C. Ask the patient to provide you with awritten list of all medications being taken at home.


D. Ask the patient and/or family to bringin all medications the patient was taking at home.

D. The USP recommends theuse of “brown bagging” sessions of medications to identify drugs that patientsare taking. Patients, family, and/or the primary care physician may not alwaysaccurately report all medications a patient is using. Actual examination of themedications and containers provides the most accurate assessment of currentmedications and allows for appropriate medication reconciliation.

In which step of themedication process can a medication error occur? (Select all that apply.)A. Procurement

B. Prescribing


C. Transcribing


D. Verification


E. Administration

A., B., C., E. Medicationerrors can occur at any point in the medication process: procuring,prescribing, transcribing, dispensing, and administration. Verification is astep in the medication reconciliation process.

The nurse knows thatthe medication reconciliation process involves which three steps? (Select all that apply.)


A. Reporting


B. Reconciliation


C. Verification


D. Administration


E. Clarification

B., C., E. Thethree steps of the medication reconciliation process are verification,clarification, and reconciliation.

When administering a medication subcutaneously, the nurse will


A. use a 1- to 1½-inch, 25-gauge needle.


B. insert the needle at a 45- or 90-degree angle,depending on patient size, to penetrate subcutaneous tissue.


C. aspirate with heparin and insulin injections. D. use the landmark between the greater trochanter andsuperior iliac crest for the vastus lateralis site.

B. The proper technique for subcutaneous injections involves theuse of a 1/2- to 5/8-inch needle, 25-gauge, at a 45- or 90-degree angle ofinsertion dependent on patient size, and aspiration is not done withanticoagulants and insulin. The landmark for the vastus lateralis is onehandbreadth below the greater trochanter and above the knee on the outer aspectof the thigh.

The nurse will use a Z-track technique when giving anintramuscular injection in which situation?


A. When there is insufficient muscle mass in thelandmarked area


B. When massaging the area after medicationadministration is contraindicated


C. With medications that are known to be irritating,painful, and/or staining to tissues


D. With any injection that is given into the ventroglutealmuscle

C. The Z-track method prevents medication from leaking intosubcutaneous tissues where it can be irritating and/or painful. This methodshould be used with medications that are particularly irritating to the tissue.Some institutional policies require the use of the Z-track method with allintramuscular injections.

Which are the appropriate landmarks for an intramuscularinjection into the dorsogluteal region?


A. A “V” formation between the anterior superior iliacspine and the greater trochanter


B. A handbreadth below the greater trochanter and thesacroiliac joint


C. The dorsogluteal region is no longer recommended forinjection; select a different site.


D. Below the iliac spine and between the greatertrochanter and the iliac crest

C. The dorsogluteal injection site is no longer recommended forinjections because of the close proximity to the sciatic nerve and major bloodvessels. Injury to the sciatic nerve from an injection may cause partialparalysis of the leg. The dorsogluteal site is not to be used for intramuscularinjections.

When administering a sublingual medication, which action willthe nurse perform?


A. Ask the patient to chew the medication so that it willabsorb faster.


B. Wear gloves to place the tablet under the patient’stongue.


C. Instruct the patient to drink room temperature waterto enhance dissolution.


D. Have the patient swallow several times while thetablet dissolves.

B. Standard precautions require the wearing of gloves when placing atablet under a patient’s tongue. The patient should not chew a sublingualtablet and should not drink or swallow until the tablet is completely dissolvedand absorbed.

Which nursing intervention is most appropriate when crushingoral medications to administer to a patient with dysphagia?


A. Only crush enteric-coated medication.


B. Mix medications together for ease of administration.


C. Crush and administer each medication separately.


D. Open sustained-release capsules prior to crushing.

C. Keeping the drugs separate allowsfor accurate identification if a dose is spilled.

The nurse plans pharmacologic therapy for a patient withpain based on the knowledge that A. narcotic analgesics should not be used for more than 24 hours secondary to the risk of addiction.


B. analgesics should be administered as needed (prn) to minimize side effects.


C. pain relief is best obtained by administering analgesics around the clock.


D. patients should request analgesics when the pain level reaches a “6” on a scale of 1 to 10.

C. When pain is present for morethan 12 hours a day, analgesic dosages are best administered around the clockand not “as needed,” but dosages should always be within the dosage guidelinesfor each drug used. The around-the-clock (or “scheduled”) dosing allows steadystates of the medication and prevents drug dosage “troughs” and escalation ofpain.

Most nonsteroidal antiinflammatory drugs (NSAIDs) work by


A. enhancing pain perception.


B. inhibiting prostaglandin production.


C. increasing blood flow to painful areas.


D. increasing the supply of naturalendorphins

B. Prostaglandins are produced inresponse to activation of the arachidonic pathway. NSAIDs work by blockingcyclooxygenase, the enzyme responsible for conversion of arachidonic acid intoprostaglandins. Decreasing the synthesis of prostaglandins results in decreasedpain and inflammation.

When teaching a patient about potential side effects ofNSAID therapy, the nurse will teach the patient to promptly report whicheffect?


A. Mild indigestion


B. Black tarry stools


C. Nonproductive cough


D. Nausea

B. A major side effect of NSAIDtherapy is gastrointestinal (GI) distress with potential GI bleeding. Blacktarry stools are indicative of a GI bleed.

The advantage of cyclooxygenase-2 (COX-2) inhibitors overother NSAIDs is that they


A. have a longer duration of action.


B. are less likely to cause hepatic toxicity.


C. do not decrease the cytoprotective lining of the stomach.


D. have a more rapid onset of action.

C. By not inhibiting the COX-1enzyme, production of the protective mucus by parietal cells in the GI tract ismaintained, thus decreasing the risks of GI side effects.

The nurse should question an order written to administer acetylsalicylicacid (aspirin) to which patient?


A. 45-year-old man with a history of heart attack B. 28-year-old woman with a history of sports injury


C. 14-year-old boy with a history of flulike symptoms


D. 62-year-old woman with a history of stroke

C. Aspirin should never beadministered to children with flulike symptoms. The use of aspirin in childrenwith flulike symptoms has been associated with Reye’s syndrome.

Which NSAID would the nurse anticipate administeringparenterally for the treatment of acute postoperative pain?


A. allopurinol (Zyloprim)


B. indomethacin (Indocin)


C. ketorolac (Toradol)


D. diclofenac (Cataflam)

C. Ketorolac can be administered byinjection (intramuscularly or intravenously) and is indicated for theshort-term treatment of severe to moderate pain.

The acetic acid derivative indomethacin (Indocin) has whichproperties? (Select all that apply.)

A. Antiinflammatory


B. Antirheumatic


C. Antinausea


D. Antipyretic


E. Anticonvulsant

A., B., D. NSAIDs are known fortheir antiinflammatory effects. Indomethacin, in addition, is also used for itsantirheumatic and antipyretic properties. NSAIDs are often known to have nauseaas a common side effect. Indomethacin is not used as an anticonvulsant.

A patient who is allergic to penicillin is at increased riskfor an allergy to which drug?

A. tetracycline


B. cefazolin sodium (Ancef)


C. gentamicin (Garamycin)


D. erythromycin

B. Patients who are allergic topenicillins have a fourfold to sixfold increased risk of allergy to otherbeta-lactam antibiotics. The incidence of cross-reactivity betweencephalosporins and penicillins is reported to be between 1% and 4%.

The nurse will question the use of a floroquinoloneantibiotic in a patient already prescribed which medication?


A. amiodarone


B. metoprolol


C. furosemide


D. omeprazole

A. Dangerous cardiac dysrhythmiasare more likely to occur when quinolones are taken by patients receiving classIA and class III antiarrhythmic drugs such as disopyramide and amiodarone. Forthis reason, such drug combinations should be avoided.

Quinolones are a class of antibiotics known for severalsignificant complications. Which are possible adverse effects with these drugs?(Selectall that apply.)


A. Abnormal cartilage development in children


B. Prolongation of the QT interval


C. Tendon rupture

A., B., C. Quinolones are notused in prepubescent children due to the risk of cartilage development issues.Quinolones may also cause a cardiac effect that involves prolongation of the QTinterval on the electrocardiogram. The use of these medications can result intendonitis or rupture tendons in adults. Nephrotoxicity and ototoxicity are notassociated with quinolones.

When reviewing a patient’s medication regimen beforedischarge, the patient asks why he is taking pyridoxine when he is alreadytaking isoniazid (INH) to treat tuberculosis. What is the nurse’s bestresponse?


A. “Pyridoxine is another antitubercular drugthat will work synergistically with the isoniazid.”


B. “You really should not be on that drug. Iwill check with the doctor.”


C. “Pyridoxine will help prevent numbness andtingling that can occur secondary to the isoniazid.”


D. “Multidrug therapy is necessary to preventthe occurrence of resistant bacteria.”

C. INH can cause neurotoxicity.Pyridoxine, vitamin B6, is the drug of choice to prevent this adverse reaction.It is not an antiinfective drug and thus will not work to destroy themycobacterium or prevent drug resistance.

What information must be provided to a patient receivingrifampin?


A. A nonharmful side effect of the drug is red-orange discoloration of urine, sweat, and tears.


B. Oral contraception is the preferred method of birth control when using rifampin.


C. Peripheral neuropathy is an expected side effect, and the patient should report any numbness or tingling of the extremities.


D. The patient will only need to take this medication for the prescribed 14-day period.

A. Red-orange discoloration of bodyfluids is a common side effect of rifampin, but it is not harmful. Rifampindoes not cause peripheral neuropathies (INH does), but it does interfere withthe effectiveness of oral contraceptives. All antitubercular drugs need to betaken long term in order to eradicate the slow-growing mycobacterium lying deepwithin the tissues.

Which statement by the patient leads the nurse to believethat the patient has understood the teaching regarding ethambutol (Myambutol)? A. “Dizziness, drowsiness, and decreased urinary output are common with this drug, but they will subside over time.”


B. “Constipation will be a problem, so I will increase the fiber in my diet.”


C. “I will need to have my eyes checked periodically while I am taking this drug.”


D. “This medication may cause my bodily secretions to turn red-orange.”

C. Ethambutol can cause opticneuritis. Ophthalmologic examinations should be performed periodically toassess visual acuity.

The nurse will teach patients taking rifampin and INHprophylactically secondary to tuberculosis exposure that


A. these drugs will only need to be taken for 7 to 10 days.


B. INH may decrease serum glucose in susceptible people.


C. oral contraceptives become ineffective when given with rifampin.


D. tanning beds may be used to counteract the pale skin tone caused by these medications.

C. Women taking oral contraceptiveswho are prescribed rifampin must be switched to another form of birth controlbecause oral contraceptives become ineffective when given with rifampin. Thesemedications must be taken long term because mycobacterium is slow growing. Theycan cause photosensitivity, necessitating the use of sunscreen, not tanningbeds. Finally, INH may increase, not decrease, serum glucose levels.

When assessing for adverse reactions to Rifamate(combination isoniazid and rifampin), the nurse would monitor which laboratoryvalues? (Select all that apply.)


A. Liver function tests


B. CBC


C. Sputum cultures


D. Uric acid levels


E. Cholesterol

A., B. Rifamate can lead toimpairment of liver function as well as hematologic disorders. Assessment ofsputum cultures confirms the diagnosis but is not related to adverse effects.The drug does not affect uric acid levels or cholesterol.

A patient is seen in the clinic for signs and symptoms ofmalaria after a trip to South America. What drug would the nurse expect to beprescribed?


A. chloroquine (Aralen)


B. penicillin


C. metronidazole (Flagyl)


D. pentamidine (Pentam)

A. Chloroquine is a standard drugused for the treatment of malaria in an acute stage.

The nurse would question an order for chloroquine in apatient also prescribed which medication?


A. valproic acid


B. doxycycline (Doryx)


C. clindamycin (Cleocin)


D. diazepam (Valium)

A. Concurrent use of chloroquinewith valproic acid may reduce serum drug levels of valproic acid and thusincrease the risk of seizure activity. Chloroquine may be given concurrentlywith clindamycin or doxycycline for synergistic actions.

The patient’s chart notes the administration of dantrolene(Dantrium) immediately postoperatively. What does the nurse expect the patienthas experienced?


A. Delirium tremens


B. Malignant hyperthermia


C. Tonic-clonic seizure


D. Respiratory arrest

B. Dantrolene is a direct-acting musculoskeletal muscle relaxantand is the drug of choice to treat malignant hyperthermia, a complication ofgeneralized anesthesia.

A patient diagnosed with depression is started on a TCA afterfailure to improve symptoms on an SSRI. The nurse should include which teachingpoint when educating the patient about the new medication?


A. There are no contraindications tothis medication.


B. The medication is safe; it hasbeen used longer than many others.


C. This class of medications has noother use and is only for depression.


D. There is a risk oftoxicity when this medication is taken with alcohol.

D. There is an increased risk of toxicity with TCAs when taken withalcohol and a high rate of morbidity.

Which activity should the patient be cautioned to avoid whiletaking an MAO inhibitor?

Eating aged cheese: Eating foods high in tyramine, including aged cheese, can causea hypertensive crisis in patients taking MAO inhibitors.

A patient diagnosed with an anxiety disorder has been usinglorazepam (Ativan) but finds the side effect of drowsiness to be interferingwith life. Which anxiolytic medications might be a better option for thispatient?


A. alprazolam (Xanax)


B. buspirone (BuSpar)


C. chlordiazepoxide (Librium)


D. hydroxyzine hydrochloride salt(Vistaril)

B. Buspirone (BuSpar) is a third-generation anxiolytic that has theadvantage of being both nonsedating and non–habit-forming. All the otheroptions are sedatives as well as anxiolytics.

While obtaining a medication history for a newly admittedpatient, the nurse notes that the patient is currently prescribed naltrexone(ReVia). The nurse would further question the patient regarding a history of


A. opioid abuse.


B. alcohol abuse.


C. barbiturate abuse.


D. amphetamine abuse.

A. Naltrexone (ReVia), an opioidantagonist, is used to treat opioid abuse or dependence. Naltrexone works byblocking the opioid receptors so that use of opioid drugs does not produceeuphoria. When euphoria is eliminated, the reinforcing effect of the drug islost.

What is the goal of pharmacologic therapy in treatingParkinson’s disease?


A. To increase the amount of acetylcholine at thepresynaptic neurons


B. To decrease the amount of dopamine available in thesubstantia nigra


C. To balance cholinergic and dopaminergic activity inthe brain


D. To block dopamine receptors in both presynaptic andpostsynaptic neurons

C. Parkinson’s disease results froma decrease in dopaminergic (inhibitory) activity, leaving an imbalance with toomuch cholinergic (excitatory) activity. By increasing dopamine, theneurotransmitter activity becomes more balanced and symptoms become controlled.

The mother of a child with attention deficit hyperactivitydisorder (ADHD) who has been prescribed methylphenidate (Ritalin) expressesconcern regarding the use of a controlled substance to treat her child and asksif there are any other options. The nurse’s response is based on the knowledgethat an option for treatment for ADHD might include which non-controlledcentral nervous system (CNS) stimulant?


A. atomoxetine (Strattera)


B. dextroamphetamine sulfate (Dexedrine) C. methylphenidate (Concerta)


D. amphetamine aspartate (Adderall)

A. Atomoxetine (Strattera) is not a controlled substance as itlacks addictive properties, unlike amphetamines and phenidates.

Which statement correctly identifies the pharmacodynamics of CNSstimulants?


A. CNS stimulants decrease the production of excitatoryneurotransmitters.


B. CNS stimulants increase release of and block reuptakeof neurotransmitters.


C. CNS stimulants block the activity of inhibitoryneurons.


D. CNS stimulants enhance the effects ofphosphodiesterase and subsequent breakdown of cyclic adenosine monophosphate(cAMP).

B. CNS stimulation occurs when theamount of neurotransmitters being released and the duration of action ofexcitatory neurotransmitters are increased.

When assessing a patient for adverse effects related tomorphine sulfate, which effects would the nurse expect to find? (Select allthat apply.)A. Decreased peristalsis


B. Diarrhea


C. Delayed gastric emptying


D. Urinaryretention

A., C., D. Morphine sulfate causes a decrease in gastrointestinal motility (delayed gastric emptying and decreased peristalsis). This leads to constipation, not diarrhea. Morphine can also cause urinary retention.

When assessing for cardiovascular effects of an adrenergic(sympathomimetic) drug, the nurse understands that these drugs produce


A. a positive inotropic, positive chronotropic, and positive dromotropic effect.


B. a positive inotropic, negative chronotropic, and negative dromotropic effect.


C. a negative inotropic, positive chronotropic, and positive dromotropic effect.


D. a negative inotropic, negative chronotropic, and negative dromotropic effect.

A. Adrenergic stimulation of thebeta1-adrenergic receptors on the myocardium and in the conductionsystem of the heart results in an increased heart rate (positive chronotropiceffect), increased contractility (positive inotropic effect), and increasedconductivity (positive dromotropic effect).

When assessing for cardiovascular effects of a beta blocker,the nurse understands that these drugs produce


A. a positive inotropic, positive chronotropic, and positive dromotropic effect.


B. a positive inotropic, negative chronotropic, and negative dromotropic effect.


C. a negative inotropic, positive chronotropic, and positive dromotropic effect.


D. a negative inotropic, negative chronotropic, and negative dromotropic effect.

D. Beta blockers exert asympatholytic effect, blocking the effects of sympathetic nervous systemstimulation, causing a decrease in heart rate (negative chronotropic),conductivity (negative dromotropic), and contractility (negative inotropic).

A hypertensive crisis may occur if adrenergic(sympathomimetic) drugs are given along with A. beta blockers.


B. diuretics.


C. alpha1 blockers.


D. monoamine oxidase (MAO) inhibitors.

D. Adrenergic drugs combined withMAO inhibitors can lead to extreme hypertension. All the other drugs listed areused to treat hypertension.

A patient using Afrin nasal spray complains of worseningcold symptoms and tells the nurse, “I don’t understand why this is not working.I am using it almost every 3 hours!” The nurse’s response is based on knowledgethat


A. Afrin nasal spray is not an effective nasal decongestant.


B. the medication needs to be used every 30 minutes for maximum effectiveness.


C. the patient is suffering from rebound congestion related to excessive use of the Afrin nasal spray.


D. adrenergic decongestants should only be used prophylactically, not to treat acute congestion. Incorrect

C. Afrin nasal spray is asympathomimetic drug with both alpha- and beta-adrenergic effects. Thealpha-adrenergic activity is responsible for causing vasoconstriction in thenasal mucosa. However, excessive use of nasal decongestants can lead to greatercongestion because of a rebound phenomenon that occurs when use of the productis stopped.

Cholinergic (parasympathomimetic) drugs have which therapeutic effect?


A. Urinary retention


B. Increased gastrointestinal motility


C. Mydriasis


D. Vasoconstriction

B. Cholinergic effects mimic theparasympathetic nervous system (rest and digest) as opposed to the sympatheticnervous system (fight or flight). Increasing gastrointestinal (GI) motilityhelps the body digest. Urinary retention, mydriasis, and vasoconstriction aresympathetic nervous system responses.

During postoperative teaching, the nurse explains that thepatient is receiving bethanechol (Urecholine) to treat


A. postoperative hypotension.


B. urinary atony.


C. respiratory atelectasis.


D. postoperative ischemic colitis.

B. Bethanechol is a direct-actingcholinergic agonist that stimulates the cholinergic receptors on the smoothmuscle of the bladder, leading to bladder contraction and emptying.

The nurse administering donepezil (Aricept) to a patientunderstands that the expected therapeutic action of this drug is to


A. relieve anxiety and restless behavior of the patient.


B. increase levels of acetylcholine in the brain by blocking its breakdown.


C. block the effects of acetylcholine at the presynaptic neurons.


D. help control associated urinary incontinence.

B. Donepezil is used to treatAlzheimer’s disease, a disorder of decreased acetylcholine levels in the brain.Donepezil is an indirect-acting anticholinesterase drug.

When providing teaching to a patient diagnosed withmyasthenia gravis, which instruction regarding the administration ofphysostigmine (Antilirium) is most appropriate?


A. Increase fluid and fiber in the diet to prevent constipation. Incorrect


B. Take the medication 30 minutes before meals.


C. If a dose is missed, double the next dose to prevent withdrawal.


D. Common side effects include tachycardia and hypertension.

B. Drugs used for myasthenia gravisshould be given about 30 minutes before meals to allow for onset of action andtherapeutic effects (e.g., decreased dysphagia). Constipation, tachycardia, andhypertension are not effects of cholinergic medications. A missed dose shouldnever be doubled.

The provider has ordered donepezil (Aricept) for thepatient, and the patient states “I have no idea why I take this medication.”What is the most common diagnosis associated with the administration ofdonepezil (Aricept)?


A. Parkinson’s disease


B Bladder retention


C. Alzheimer’s disease


D. Urinary retention

C. Donepezil (Aricept) is acholinesterase inhibitor drug that works centrally in the brain to increaselevels of acetylcholine by inhibiting acetylcholinesterase. It is used in thetreatment of mild to moderate Alzheimer’s disease.

The nurse is providing education to a patient on the primaryuses of cholinergic drugs. Which uses would the nurse include in theteaching? (Select all that apply.)


A. To stimulate peristalsis


B. To elevate heart rate


C. To decrease intraocular pressure


D. To stimulate bladder emptying


E. To dilate pulmonary airways

A., C., D. Cholinergic drugs areused primarily for their effects on the GI tract, bladder, and eye. These drugsstimulate the intestine and bladder, which results in increased gastricsecretions, GI motility, and urinary frequency. They also stimulateconstriction of the pupil, or miosis. This helps decrease intraocular pressure.In addition, cholinergic drugs cause increased salivation and sweating.Cardiovascular effects include reduced heart rate and vasodilation. Pulmonaryeffects include causing the bronchi of the lungs to constrict and the airwaysto narrow.

What would be a priority nursing diagnosis for a patientreceiving anticholinergic (parasympatholytic) drugs?


A. Risk for injury related to excessive central nervous system stimulation


B. Impaired gas exchange related to thickened respiratory secretions


C. Urinary retention related to loss of bladder tone


D. Deficient knowledge related to pharmacologic regimen

B. Although all of these nursingdiagnoses are appropriate, the priority is determined remembering the ABCs.Anticholinergic drugs decrease respiratory secretions, which could lead tomucous plugs and resultant impaired gas exchange.

Side effects to expect from anticholinergic(parasympatholytic) drugs, such as atropine, include (Select all thatapply.)


A. dilated pupils.


B. urinary retention.


C. dry mouth.


D. diarrhea.


E. increased sweating.

A., B., C. Anticholinergic drugsblock the effects of the parasympathetic nervous system, producing sympatheticnervous system effects. These include mydriasis (dilated pupils), decreasedbladder contraction, and decreased oral secretions. The effect on thegastrointestinal system would be to decrease gastrointestinal motility, notcause diarrhea. Sweating would decrease as a result of anticholinergicdrugs.

Nausea and vomiting are frequent adverse effects associated with antineoplastic therapy. Patients who are experiencing this unpleasant effect will be advised


A. to avoid eating any food during chemotherapy.


B. that nothing can be done for this effect and that it will pass with time.


C. to try to maintain hydration and nutrition, which are very important during treatment.


D. to use antacids to relieve the irritation to the stomach, which should stop the nausea.

C. It is very important forpatients undergoing chemotherapy to maintain adequate nutrition and hydration.Several antiemetic drugs are available that are very successful in controllingthis side effect.

When a patient is receiving cyclophosphamide (Cytoxan), heor she should be advised to drink plenty of water/fluids to prevent whichcondition?


A. Renal failure


B. Hemorrhagic cystitis


C. Liver dysfunction


D. Red blood cell count

B. Patients receivingcyclophosphamide should drink at least 2 to 3 L of fluid before, during, andafter administration to prevent hemorrhagic cystitis.

Which are known adverse effects of alkylating agents? (Selectall that apply.)


A. Nephrotoxicity


B. Neurotoxicity


C. Ototoxicity


D. Bone marrow suppression


E. Cardiotoxicity

A., B., C., D. Alkylating drugs arecapable of causing pulmonary fibrosis, nephrotoxicity, neurotoxicity, bonemarrow suppression, peripheral neuropathy, ototoxicity, and hemorrhagiccystitis. The adverse effects of these drugs are important because of theirseverity, but they can often be prevented or minimized by prophylacticmeasures. Cardiotoxicity is not listed as an adverse effect for this class ofdrugs.

What are the major adverse effects specific to the cytotoxicantibiotics? (Select all that apply)


A. Liver toxicity


B. Cardiovascular toxicity


C. Pneumonitis


D. Neurotoxicity


E. Nephrotoxicity

A., B., C., E. As with all of theantineoplastic drugs, cytotoxic antibiotics have the undesirable effects ofhair loss, nausea and vomiting, and myelosuppression. Major adverse effectsspecific to the cytotoxic antibiotics include pulmonary fibrosis, pneumonitis,liver toxicity, heart failure, cardiovascular toxicity, tissue damage in theevent of extravasation, kidney toxicity, and lung toxicity. This class of drugsis not known for neurotoxicity.

When teaching a patient receiving paclitaxel (Taxol), thenurse needs to prepare the patient for which adverse effect?


A. Weight gain


B. Vertigo


C. Arthralgias


D. Hypertension

C. Myalgias and arthralgias are acommon side effect of paclitaxel that the patient should be prepared to expect.

Which are general adverse effects of chemotherapy? (Selectall that apply.)


A. Leukocytosis


B. Thrombocytopenia


C. Alopecia


D. Urinary retention


E. Hypertension

B., C. Bone marrowsuppression (leukopenia, thrombocytopenia, and anemia) and alopecia are commonadverse reactions to antineoplastic drugs. Urinary retention, hypertension, andleukocytosis are not expected side effects.

What is considered a major dose-limiting side effect ofdoxorubicin (Adriamycin)?


A. Hemorrhagic cystitis


B. Cardiomyopathy


C. Hepatoxicity


D. Nephrotoxicity

B. Patients receiving doxorubicin need to be monitored forcardiac toxicity. There is a lifetime limited dose that patients are allowed toreceive to minimize the occurrence of cardiomyopathy.

What are the major adverse effects specific to the cytotoxicantibiotics?


A. Liver toxicity


B. Cardiovascular toxicity


C. Pneumonitis


D. Neurotoxicity


E. Nephrotoxicity

A., B., C., E. As with all of theantineoplastic drugs, cytotoxic antibiotics have the undesirable effects ofhair loss, nausea and vomiting, and myelosuppression. Major adverse effectsspecific to the cytotoxic antibiotics include pulmonary fibrosis, pneumonitis,liver toxicity, heart failure, cardiovascular toxicity, tissue damage in theevent of extravasation, kidney toxicity, and lung toxicity. This class of drugsis not known for neurotoxicity.

A patient with low platelets is prescribed a drug tostimulate platelet production. Which drug would the nurse anticipate beingprescribed? A. oprelvekin (Neumega)


B. epoetin (Epogen)


C. aldesleukin (Proleukin)


D. interferon beta-1a (Avonex)

A. Oprelvekin stimulates theproduction of platelets. Epoetin stimulates the production of red blood cellsin the bone marrow. Interleukins (aldesleukin) and interferons activate theimmune system but do not increase production of white blood cells.

Patients receiving filgrastim (Neupogen) should be taught toexpect which side effect?


A. Hypotension


B. Constipation


C. Bone pain


D. Insomnia

C. Filgrastim increases theproduction of white blood cells in the bone marrow, triggering the common sideeffect of bone pain.

Upon which patient finding would the nurse hold the ordereddose of filgrastim (Neupogen) and notify the provider?


A. Fever of 99.5° F


B. Absolute neutrophil count (ANC) count of 12,000 cells/mm3


C. White blood cell (WBC) count of 4.5/mm3


D. Blood pressure of 142/88 mm Hg

B. Filgrastim (Neupogen) is usually discontinued when apatient’s ANC rises above 10,000 cells/mm3. However, someprescribers will stop it when the ANC is between 1000 and 2000 cells/mm3.

What is the general action of immunosuppressants?


A. They increase antibody response.


B. They increase natural killer (NK) cellular activity.


C. They suppress T-lymphocytes.


D. They suppress hepatic metabolism of steroids.

C. Immunosuppressants inhibitT-lymphocyte synthesis, thus preventing an immune response to organtransplants.

Before administering an immunosuppressant drug, the nurseshould perform which assessments? (Select all that apply.)


A. Blood urea nitrogen and creatinine level


B. Level of consciousness


C. Blood pressure and pulse


D. Hepatic enzymes

A., B., C., D. Adverse reactions toimmunosuppressants include neurotoxicity, renal toxicity, hepatotoxicity, andhypertension.

When educating patients on immunosuprressants, whatinformation would the nurse include in the teaching? (Select all thatapply.)


A. “Never stop taking these medications without being instructed by the prescribing provider.”


B. “Over-the-counter medication are OK to take as needed.”


C. “You must take all medications exactly as prescribed.”


D. “Medications must be taken at the correct time every time to avoid interactions.”

A., C., D. Immunosuppressantsmust be taken exactly as directed and at the exact times and with the exactfoods. Adherence to dosing schedules can be very difficult for patients becausethey are taking multiple medications that must be taken at different times throughoutthe day. Patients should never stop taking their immunosuppressants withoutbeing told to do so by their transplant doctor.

Administration of which of the following provides passiveimmunity?


A. Vaccines


B. Toxoids


C. Antitoxins


D. Immunoglobulins

D. Vaccines, antitoxins, andtoxoids provide active immunity by stimulating the humoral immune system.Immunoglobulins provide passive immunity by giving the patient substances tofight specific antigens.

Which statement most accurately describes thepharmacodynamics of vaccines?


A. Vaccines work by stimulating the humoral immune system.


B. Vaccines provide passive immunity.


C. Vaccines work by suppressing immunoglobulins.


D. Vaccines prevent the formation of antibodies against a specific antigen.

A. Vaccines work by stimulating thehumoral immune system, which synthesizes immunoglobulins. They also stimulatethe formation of antibodies against their specific antigen, providing activeimmunity.

What is the priority nursing assessment to monitor whenadministering vaccinations?


A. Pain at the injection site


B. Signs and symptoms of infection


C. Anaphylaxis


D. Myalgias

C. Anaphylaxis is a potentiallife-threatening adverse reaction to vaccines. Pain and myalgias can occur butare not life threatening.

An allergy to which substance is listed as acontraindication to the administration of an immunizing drug?


A. Soy


B. Corn


C. Wheat


D. Egg

D. Contraindications to theadministration of immunizing drugs include allergy to the immunization itselfor allergy to any of its components, such as eggs or yeast.

The current immunization for tetanus and diphtheria toxoidsand pertussis, Tdap, is administered to people in which age range?


A. Under 6 years of age


B. 11 years of age and older


C. Any age range


D. In the first two years of life

B. Currently DTaP is the preferredpreparation for primary and booster immunization against these diseases inchildren from 6 weeks to 6 years of age, unless use of the pertussis componentis contraindicated. Tdap is the recommended vaccine for adolescents and adults,those over the age of 11.

The nurse will teach patients that antacids are effective intreatment of hyperacidity because they


A. neutralize gastric acid.


B. decrease stomach motility.


C. decrease gastric pH.


D. decrease duodenal pH.

A. Antacids work by neutralizinggastric acid, which would cause an increase in pH. They do not affect gastricmotility.

The nurse will monitor for which adverse reaction toaluminum-containing antacids such as aluminum hydroxide (Amphojel)?


A. Diarrhea


B. Constipation


C. Gastrointestinal upset


D. Fluid retention

B. Aluminum- and calcium-containingantacids cause constipation, magnesium-containing antacids cause diarrhea, andsodium-containing antacids cause sodium and fluid retention.

Which type of antacids will the nurse most likely questionin an order for a patient with chronic renal failure?


A. Aluminum-containing antacids


B. Calcium-containing antacids


C. Magnesium-containing antacids


D. Sodium-containing antacids

C. Magnesium-containing antacidscan cause hypermagnesemia in patients with chronic renal failure.Aluminum-containing antacids may be used as a phosphate binder in patients withchronic renal failure. Sodium- and aluminum-containing antacids are chemicallymore easily excreted in patients with renal compromise. Althoughcalcium-containing antacids may accumulate in the bloodstream of patients withrenal failure, they may also be appropriate because these patients may behypocalcemic.

What condition will the nurse monitor for in a patient usingsodium bicarbonate to treat gastric hyperacidity?


A. Metabolic alkalosis


B. Metabolic acidosis


C. Hyperkalemia


D. Hypercalcemia

A. Solutions containing sodiumbicarbonate (a base) can cause metabolic alkalosis. Serum potassium and serumcalcium would decrease with alkalosis, not increase.

Which nursing diagnosis is appropriate for a patientreceiving famotidine (Pepcid)?


A. Risk for infection related to immunosuppression


B. Risk for injury related to thrombocytopenia


C. Impaired urinary elimination related to retention


D. Ineffective peripheral tissue perfusion related to hypertension

B. A serious side effect offamotidine is thrombocytopenia, which is manifested by a decrease in plateletcount and an increased risk of bleeding. The patient receiving famotidine mayexperience hypotension as an adverse effect, not hypertension. Famotidine doesnot cause immunosuppression or urinary retention.

Which statement demonstrates understanding of patientteaching regarding the use of histamine2-receptor antagonists?


A. “Since I am taking this medication, it is OK for me to eat spicy foods.”


B. “Smoking decreases the effects of this medication, so I should look into cessation programs.”


C. “I should take this medication 1 hour after each meal in order to maximally decrease gastric acidity.”


D. “I should decrease bulk and fluids in my diet to prevent diarrhea.”

B. Patients taking histamine2-receptor–blockingdrugs should avoid spicy foods, extremes in temperatures, alcohol, and smoking.They should also increase bulk and fluids in the diet to prevent constipation.Cimetidine should be taken with meals, while famotidine can be taken withoutregard to meals.

What is the action of histamine2-receptorantagonists?


A. They compete with histamine for binding sites on the parietal cells.


B. They irreversibly bind to H+/K+ ATPase.


C. They cause a decrease in stomach pH.


D. They decrease signs and symptoms of allergies related to histamine release.

A. Histamine receptor–blockingdrugs decrease gastric acid by competing with histamine for binding sites onthe parietal cells.

How will the nurse describe the action of proton pumpinhibitors?


A. They compete with histamine for binding sites on the parietal cells.


B. They irreversibly bind to H+/K+ATPase.


C. They cause a decrease in stomach pH.


D. They cannot be used to treat erosive esophagitis.

B. Proton pump inhibitors work toblock the final step in the acid-secreting mechanisms of the proton pump. Theydo this by irreversibly binding to H+/K+ ATPase, theenzyme for this step.

The nurse would question the prescription for use of bismuthsubsalicylate as an antidiarrheal in a patient on aspirin daily foranticoagulation therapy due to what potential concern?

A. Nausea


B. Increased bleeding


C. Constipation


D. Urinary retention

B. The adsorbent bismuthsubsalicylate is a form of aspirin, or acetylsalicylic acid, and therefore italso has many of the same drug effects as aspirin. Bismuth subsalicylate canlead to increased bleeding times and bruising when administered with warfarinas well as aspirin and other nonsteroidal antiinflammatory drugs.

What is an additional function of lactulose, a hyperosmoticlaxative?


A. Decreasing peripheral edema


B. Correcting sodium imbalances


C. Reducing ammonia levels


D. Alleviating galactose intolerance

C. Lactulose reduces blood ammonialevels by forcing ammonia from the blood into the colon. It is useful intreating patients with hepatic encephalopathy.

A patient is prescribed an over-the-counter laxativemagnesium hydroxide (milk of magnesia). Which disorder in the patient’s historywould alert the nurse that there is a need to discuss this medication with thepatient and the provider?


A. Hypertension


B. Liver dysfunction


C. Renal insufficiency


D. Chronic constipation

C. The magnesium saline laxativesare to be used with caution in patients with renal insufficiency, because theycan be absorbed enough to cause hypermagnesemia. They are most commonly used toevacuate the bowel rapidly in preparation for endoscopic examination and to helpremove unabsorbed poisons from the GI tract.

The nurse will teach patients that antacids are effective intreatment of hyperacidity because they


A. neutralize gastric acid.


B. decrease stomach motility.


C. decrease gastric pH.


D. decrease duodenal pH.

A. Antacids work by neutralizinggastric acid, which would cause an increase in pH. They do not affect gastricmotility.

To avoid fecal impaction, psyllium (Metamucil) should beadministered with at least how many ounces of fluid?


A. 4


B. 6


C. 8


D. 10

C. Bulk-forming laxatives such aspsyllium must be given with at least 8 ounces of liquid plus additional liquideach day to avoid intestinal impaction.

When planning administration of antiemetic medications to apatient, the nurse is aware that combination therapy is preferred because


A. the risk of constipation is decreased.


B. lower doses of medication are cost-effective. C. different vomiting pathways are blocked.


D. increased sedation is achieved by higher doses of medication.

C. Combining antiemetic drugs fromvarious categories allows the blocking of the vomiting center and chemoreceptortrigger zone through different pathways, thus enhancing the antiemetic effect.

A patient receiving an anticholinergic drug to treat nauseaand vomiting should be taught to expect which side effect?


A. Diarrhea


B. Lacrimation


C. Dry mouth


D. Bradycardia

C. Anticholinergic drugs block theparasympathetic nervous system, which causes the body to “rest and digest.”Blocking of these effects leads to constipation, urinary retention, anddecreased secretions (dry mouth).

When planning administration of antiemetic medications to apatient, the nurse is aware that combination therapy is preferred because


A. the risk of constipation is decreased.


B. lower doses of medication are cost-effective. C. different vomiting pathways are blocked.


D. increased sedation is achieved by higher doses of medication.

C. Combining antiemetic drugs fromvarious categories allows the blocking of the vomiting center and chemoreceptortrigger zone through different pathways, thus enhancing the antiemetic effect.

When planning to administer metoclopramide (Reglan), thenurse is aware that this drug must be given


A. with food to decrease gastrointestinal upset. B. every 6 hours around the clock.


C. 30 minutes before meals and at bedtime.


D. with a full glass of water first thing in the morning.

C. Metoclopramide should beadministered 30 minutes before meals and at bedtime. Administering themedication before meals allows time for onset to increase gastrointestinalmotility before food ingestion, thus decreasing stomach distention andresulting nausea and vomiting.

Cyanocobalamin (vitamin B12) is indicated for thetreatment of which condition?


A. Acute lymphocytic leukemia


B. Pernicious anemia


C. Bone marrow suppression


D. Optic nerve atrophy

B. Cyanocobalamin is used to treatdeficiency states of vitamin B12. The most common manifestation ofuntreated cyanocobalamin deficiency is pernicious anemia.

A patient prescribed a tube feeding has a history of aseizure disorder. The absorption of which antiepileptic medication is reducedwhen given with tube feedings?


A. phenytoin


B. levetiracetam


C. pregabalin


D. lamotrigine

A. Tube feedings can also reducethe absorption of phenytoin, which may result in seizures. It is recommendedthat tube feedings be held for at least 2 hours before and after theadministration of phenytoin.

Elemental formulations are used for patients with conditionsthat cause limited ability to digest nutrition. Which substances may beincluded in elemental formulations? (Select all that apply.)


A. Amino acids


B. Cow-based proteins


C. Dipeptides


D. Tripeptides


E. Fats

A., C., D. Elementalformulations are enteral supplements that contain dipeptides, tripeptides, orcrystalline amino acids. Minimal digestion is required with elementalformulations. These supplements are indicated for patients with pancreatitis,partial bowel obstruction, irritable bowel disease, radiation enteritis, bowelfistulas, and short bowel syndrome. They are contraindicated in patients whohave had hypersensitivity reactions to them.

Which are nursing responsibilities associated with the careof a patient receiving total parenteral nutrition (TPN)? (Select allthat apply.)


A. Monitoring capillary serum glucose every 6 hours


B. Protecting the solution from exposure to light at all times


C. Maintaining sterile asepsis when handling the site or solution


D. Accelerating the rate of infusion to keep the infusion on time as needed

A., C. Patients receivingTPN are at risk for hyperglycemia and infections secondary to the high glucoseconcentration of the infusion. The nurse would not want to increase the ratejust to catch up the IV because this would increase the risk of hyperglycemiaas well as rebound hypoglycemia when the TPN rate is reduced back tonormal.

The nurse receives labvalues for a patient with a theophylline level of 14 mcg/mL. How does the nurseinterpret this theophylline level?


A. Subtherapeutic


B. Therapeutic


C. Toxic


D. Life-threatening

B. The therapeutictheopylline level is 10 to 20 mcg/mL.

Discharge teaching toa patient receiving a beta-agonist bronchodilator should emphasize reportingwhich side effect?


A. Tachycardia


B. Nonproductive cough


C. Hypoglycemia


D. Sedation

A. A beta-agonistbronchodilator stimulates the beta receptors of the sympathetic nervous system,resulting in tachycardia, bronchodilation, hyperglycemia, and increasedalertness.

The nurse is providingcare to a patient prescribed a nonselective adrenergic agonist bronchodilator.Which medical diagnosis on this patient’s chart would alert the nurse toquestion this order?


A. Coronary artery disease


B. Chronic obstructive pulmonary disease(COPD)


C. Hyperkalemia


D. Premature labor

A. Nonselectiveadrenergic agonist bronchodilators stimulate beta1 receptorsin the heart and beta2 receptors in the lungs.Stimulation of beta1receptors can increase heartrate and contractility, increasing oxygen demand. This increased oxygen demandmay lead to angina or myocardial ischemia in patients with coronary arterydisease.

A nurse is providingeducation to a patient taking two different medications. The nurse identifieswhich characteristic as the advantage of salmeterol (Serevent) over other beta2 agonists such as albuterol (Proventil)?


A. Shorter onset of action


B. Better side effect profile


C. Quicker peak action


D. Longer duration of action

D. Salmeterol has alonger duration of action, requiring the patient to use it only twice a dayinstead of four times a day with albuterol.

Patient teachingregarding the use of antileukotriene drugs such as zafirlukast (Accolate) wouldinclude which statement?


A. “Take the medication as soon as youbegin wheezing.”


B. “It will take about 3 weeks before younotice a therapeutic effect.”


C. “This medication works by preventingthe inflammation that causes your asthma attack.”


D. “Increase fiber and fluid in your dietto prevent the common side effect of constipation.”

C. Antileukotriene drugsblock the inflammatory response of leukotrienes and thus the trigger for asthmaattacks. Response to these drugs is usually noticed within 1 week. They are notused to treat an acute asthma attack. Diarrhea, not constipation, is an adverseeffect of the antileukotriene drugs.

What is the role ofcorticosteroids in the treatment of acute respiratory disorders?


A. They stimulate the immune system.


B. They directly dilate the bronchi.


C. They increase gas exchange in thealveoli. D. They decrease inflammation.

D. Corticosteroidssuppress the immune system. They do not directly affect bronchodilation butrather prevent bronchoconstriction as a response to inflammation.

Which statement by apatient best demonstrates an understanding of the teaching on flunisolide (AeroBid)?


A. “I will take two puffs to treat anacute asthma attack.”


B. “I will rinse my mouth with water aftereach use.”


C. “I will immediately stop taking my oralprednisone as soon as I start using the AeroBid.” D. “I will not use my albuterol inhalerwhile I am taking AeroBid.”

B. Flunisolide is aninhaled corticosteroid. Rinsing the mouth will help prevent oral candidalinfections. It is not used to treat an acute asthma attack and should be takenwith the patient’s bronchodilator medications. If the patient is taking oralprednisone, it needs to be tapered off to prevent acute adrenal crisis sinceflunisolide is minimally absorbed systemically.

Mast cell stabilizersare most effective in treating bronchoconstriction associated with whichcondition?


A. Emphysema


B. Exposure to cold


C. Allergens


D. Infection

C. Mast cell stabilizerswork by preventing the release of chemical mediators that cause bronchospasmand are most effective in preventing asthma caused by extrinsic factors such asallergens or exercise.

1. Which statement wouldbe included when teaching a patient about the proper use of metered-doseinhalers?


A. “After you inhale the medication once, repeatuntil you obtain relief.”


B. “Make sure that you puff out airrepeatedly after you inhale the medication.”


C. “Wait 1 to 2 minutes before you take asecond puff of the same drug.”


D. “Hold the inhaler in your mouth, take adeep breath, and then compress the inhaler.”

C. If a second puff ofthe same drug is ordered, instruct the patient to wait 1 to 2 minutes betweenpuffs. If a second type of inhaled drug is ordered, instruct the patient towait 2 to 5 minutes between the medications or to take as prescribed.

What statement by thepatient, who is using the anticholinergic inhaler ipratropium bromide(Atrovent), indicates to the nurse that teaching has been successful?


A. “I will increase my intake ofcaffeine.”


B. “I may gain weight as a result of takingthis medication.”


C. “Nausea and vomiting are common adverseeffects of this medication, so I will always take it with meals.”


D. “This inhaler is not to be used aloneto treat an acute asthma attack.”

D. Although ipratropiumworks to prevent bronchoconstriction and thus secondarily leads tobronchodilation, a direct-acting bronchodilator is needed to treat an acuteasthma attack.

The physician ordersipratropium bromide (Atrovent), albuterol (Proventil), and beclomethasone(Beclovent) inhalers for your patient. Put the drugs in the correct order inwhich they will be administered, using the choices A through C listed below.


A. "albuterol (Proventil)"


B. "ipratropium bromide (Atrovent)"


C. "beclomethasone (Beclovent)"

A., B., C. Albuterol first, then ipratropium bromide, and then beclomethasone

To prevent oral candidiasis, it is most important for the nurseto teach a patient using a steroid inhaler to perform which action?


A. Rinse the mouth after each use.


B. Minimize use of an inhaler to everyother day.


C. Swish and swallow with mycostatin aftereach use.


D. Report any gingival irritation to thehealth care provider.

A. It is most important to teach patients to rinse their mouth aftereach use of a steroid inhaler to prevent the occurrence of oral candidiasis, afungal infection. Mycostatin is not routinely used to prevent this infectionunless the patient is immunocompromised. Reporting irritation once it hasoccurred does not prevent the infection. Minimizing the use of the inhaler toevery other day negates its therapeutic effect.

What side effect of angiotensin-converting enzyme (ACE)inhibitors most often results in the provider changing the treatment plan to anangiotensin receptor blocker?


A. Orthostatic hypotension


B. Dry, nonproductive cough


C. Fatigue


D. Hypokalemia

B. ACE inhibitors prevent thebreakdown of bradykinin, frequently causing a nonproductive cough. Angiotensinreceptor blockers do not block this breakdown, thus minimizing this annoyingside effect.

Which medication would the nurse question if prescribedconcurrently with ACE inhibitors? A. furosemide (Lasix)


B. morphine


C. Colace


D. potassium

D. ACE inhibitors block theconversion of angiotensin I to angiotensin II, thus also blocking the stimulusfor aldosterone production. Aldosterone is responsible for potassiumexcretion—decreased aldosterone can result in increased serum potassium.

The nurse would plan to administer which calcium channelblocker to a patient with cerebral artery spasms following a subarachnoidhemorrhage?


A. amlodipine (Norvasc)


B. diltiazem (Cardizem)


C. nimodipine (Nimotop)


D. verapamil (Calan)

C. Nimodipine crosses theblood-brain barrier and has a greater effect on the cerebral arteries than onother arteries in the body; thus, it is indicated for the treatment of cerebralartery spasm following subarachnoid hemorrhage.

The nurse is conducting a community education program. Whenexplaining different medication regimens to treat hypertension, it would beaccurate to state that African Americans probably respond best to whichcombination of medications?


A. ACE inhibitors and diuretics


B. Diuretics and calcium channel blockers


C. Diuretics and beta blockers


D. ACE inhibitors and beta blockers

B. Research has demonstrated thatAfrican Americans do not typically respond therapeutically to beta blockers orACE inhibitors. They respond better to diuretics and calcium channel blockers.

ACE inhibitors and angiotensin receptor blockers both workto decrease blood pressure by


A. preventing the formation of angiotensin II.


B. enhancing sodium and water resorption.


C. increasing the breakdown of bradykinin.


D. preventing aldosterone secretion.

D. ACE inhibitors block theformation of angiotensin II, whereas angiotensin receptor blockers allow theformation of angiotensin II but block its effect at the receptors. Without thereceptors stimulated (because of either drug), aldosterone is not produced,diminishing the reabsorption of sodium and water.

Which is a priority nursing diagnosis for a patient takingan antihypertensive medication?


A. Ineffective cerebral tissue perfusion related to disease process and/or medication


B. Deficient knowledge related to medication regimen


C. Fatigue related to side effects of medication D. Risk for injury to mucous membranes related to medication side effects

A. Ineffective cerebral tissueperfusion is always a priority over fatigue, risk for injury, and/or knowledgedeficit. Patients taking antihypertensive medication are also at risk forineffective renal and cardiac perfusion.

When teaching a patient about carvedilol (Coreg), the nurseexplains that this medication reduces blood pressure by which actions? (Selectall that apply.)


A. Reducing heart rate


B. VasodilationCorrect


C. Decreasing stress


D. Increasing urine output

A. Carvedilol (Coreg)has the dual antihypertensive effects of reducing heart rate(beta1 receptor blockade) and also vasodilation


Which instruction should be included in the dischargeteaching for a patient with a transdermal nitroglycerin patch?


A. “Apply the patch to a nonhairy, nonirritated area of the upper torso or arms.”


B. “Apply the patch to the same site each day to maintain consistent drug absorption.”


C. “If you get a headache, remove the patch for 4 hours and then reapply.”


D. “If you get chest pain, apply a second patch right next to the first patch.”

A. A nitroglycerin patch should beapplied to a nonhairy, nonirritated area for the best and most consistentabsorption rates. Sites should be rotated to prevent skin irritation, and thedrug should be continued if headache occurs because tolerance will develop.Sublingual nitroglycerin should be used to treat chest pain.

Which statement by the patient demonstrates a need forfurther education regarding nitroglycerin?


A. “If I get a headache, I should keep taking my nitroglycerin and use Tylenol for pain relief.”


B. “I should keep my nitroglycerin in a cool, dry place.”


C. “I should change positions slowly to avoid getting dizzy from the nitroglycerin’s effect on my blood pressure.”


D. “I can take up to four tablets at 5-minute intervals for chest pain.”

D. Patients are taught to take upto three tablets 5 minutes apart. According to current guidelines, if the chestpain or discomfort is not relieved in 5 minutes, after one dose, the patient(or family member) must call 911 immediately.

In order to prevent the development of tolerance, the nurseinstructs the patient to perform which action?


A. Apply the nitroglycerin patch every other day. B. Switch to sublingual nitroglycerin when the patient’s systolic blood pressure elevates to >140 mm Hg.


C. Apply the nitroglycerin patch for 16 hours each and remove for 8 hours at night.


D. Use the nitroglycerin patch for acute episodes of angina only.

C. Tolerance can be prevented bymaintaining an 8-hour nitrate-free period each day

The patient asks how nitroglycerin should be stored whiletraveling. What is the nurse’s best response?


A. “You can protect it from heat by placing the bottle in an ice chest.”


B. “It’s best to keep it in its original container away from heat and light.”


C. “You can put a few tablets in a resealable bag and carry in your pocket.”


D. “It’s best to lock them in the glove compartment of your car to keep them away from heat and light.”

B. Although nitroglycerin needs to be kept in a cool, dryplace, it should not be placed in an ice chest where it could freeze. It shouldalso not be locked up and needs to be kept away from light, not in a clearplastic bag.

Patient teaching regarding sublingual nitroglycerin shouldinclude which statement?


A. “You can take up to five doses every 3 minutes for chest pain.”


B. “Chew the tablet for the quickest effect.”


C. “Keep the tablets locked in a safe place until you need them.”


D. “Sit or lie down after you take a nitroglycerin tablet to prevent dizziness.”

D. Nitroglycerin is a vasodilatorand can cause orthostatic hypotension, resulting in dizziness. It should bekept in a readily accessible location for immediate use should chest painoccur. Three tablets may be taken 5 minutes apart. It should be placed underthe tongue and allowed to dissolve.

Which statement indicates that the patient understandsdischarge teaching about nitroglycerin?


A. “I will need to refill my prescription once a year in order to maintain potency.”


B. “I will need to keep the nitroglycerin stored in the bottle it comes in.”


C. “I will take a nitroglycerin tablet every 15 minutes until my chest pain is gone.”


D. “I should take a nitroglycerin tablet 2 hours before I want to engage in activity that will cause chest pain.”

B. Nitroglycerin needsto be stored away from heat, humidity, and light, all of which can decrease itspotency. Keeping it in the brown light-resistant bottle helps achieve this. Itshould be replaced every 3 to 6 months in order to maintain potency.Nitroglycerin is used every 5 minutes for pain relief or just before engagingin activity that is known to cause chest pain.

A patient who is taking sublingual nitroglycerin iscomplaining of flushing and headaches. What is the nurse’s best response?


A. “This is a normal response to your chest pain.” B. “Stop taking the nitroglycerin because you are probably allergic to it.”


C. “These are the most common side effects of nitroglycerin. They should subside with continued use of nitroglycerin.”


D. “These symptoms are not related to your sublingual nitroglycerin. You should notify your doctor for diagnostic testing.”

C. Headache and flushing are themost common side effects of nitroglycerin and will subside with continued use.

It is most important to instruct a patient prescribednitroglycerin to avoid which substance(s)?


A. Antacids


B. Grapefruit juice


C. Thiazide diuretics


D. Erectile dysfunction medications

D. Concurrent administration oferectile dysfunction medications such as sildenafil citrate (Viagra) can causean acute exacerbation of nitrate-related hypotension.

When caring for a patient with angina, the nurse wouldquestion an order for a noncardioselective beta blocker in a patient with whatcoexisting medical diagnosis?


A. Hypertension


B. Atrial fibrillation


C. Bronchial asthma


D. Myocardial infarction

C. Noncardioselective beta blockersshould be used with caution in patients with bronchial asthma since any levelof blockade of beta2-receptors can promote bronchoconstrictionthrough unopposed parasympathetic (vagal) tone.

Which are common side effects of nitroglycerin? (Selectall that apply.)


A. Blurred vision


B. Flushing


C. Headache


D. Hypotension

B., C., D. Common side effectsof nitroglycerin include flushing, headache, and hypotension.

Which is an expected outcome associated with the administration of digoxin?


A. Increased heart rate


B. Decreased heart rate


C. Decreased urinary output


D. Increased blood pressure

B. Digoxin has a negativechronotropic effect (decreased heart rate).

The patient has a serum digoxin level drawn and it comesback 0.4 ng/mL. How does the nurse interpret this lab value result?


A. Below the therapeutic level


B. A therapeutic level


C. Above the therapeutic level


D. A toxic level

A. Therapeutic serum digoxin levelsare 0.5 to 2 ng/mL.

A patient is taking digoxin (Lanoxin) 0.25 mg and furosemide(Lasix) 40 mg. When the nurse enters the room, the patient states, “I think Ineed to take a nap. Everything is starting to look a little yellow.” Whichaction will the nurse take? A. Evaluate the patient for other symptoms of digoxin toxicity.


B. Withhold the furosemide.


C. Administer the medication as ordered.


D. Document the findings and reassess in 1 hour.

A. Yellow or green halos aroundobjects is a red flag symptom of digoxin toxicity.

Which are therapeutic effects of digoxin?


A. Positive inotropic, negative chronotropic, and negative dromotropic


B. Positive inotropic, positive chronotropic, and negative dromotropic


C. Negative inotropic, negative chronotropic, and negative dromotropic


D. Positive inotropic, negative chronotropic, and positive dromotropic

A. Digoxin increases cardiaccontractility (positive inotropic effect), decreases heart rate (negativechronotropic effect), and decreases conductivity (negative dromotropic effect).

The nurse reviews a patient’s laboratory values and finds adigoxin level of 10 ng/mL and a serum potassium level of 6.2 mEq/L. The nursewould notify the health care provider and anticipate administering


A. sodium polystyrene sulfonate.


B. atropine.


C. epinephrine.


D. digoxin immune Fab.

D. Digoxin immune Fab is indicatedfor severe digoxin toxicity as evidenced in this question by a digoxin level of10 ng/mL and hyperkalemia.

When teaching a patient regarding the administration ofdigoxin, the nurse instructs the patient not to take this medication with whichfood?


A. Bananas


B. Wheat bran


C. French toast


D. Scrambled eggs

B. Large amounts of bran taken withdigoxin will decrease and negatively impact the drug’s absorption.

Assessment of a patient receiving a positive inotropic drugwould include reviewing which values? (Select all that apply.)


A. Lung sounds


B. Daily weights


C. Apical pulse


D. Serum electrolytes


E. Complete blood count

A., B., C., D. All of theseassessments are appropriate for patients receiving an inotropic drug. Lungsounds and daily weights are appropriate assessments related to the treatmentof heart failure with inotropic drugs. The apical pulse and serum electrolytesare important assessments related to potential adverse reactions (bradycardia,toxicity with hypokalemia).

The nurse would assess which laboratory value to determinethe effectiveness of intravenous heparin?


A. Complete blood count (CBC)


B. Activated partial thromboplastin time (aPTT)


C. Prothrombin time (PT)


D. Blood urea nitrogen (BUN)

B. Heparin dosing is based on aPTTresults. The PT is reflective of warfarin’s anticoagulant effect.

A patient who has been anticoagulated with warfarin(Coumadin) is admitted with gastrointestinal bleeding. The nurse willanticipate administering which substance?


A. vitamin E


B. vitamin K


C. protamine sulfate


D. calcium gluconate

B. Vitamin K is the antagonist forwarfarin.

The nurse interprets a patient’s international normalizedratio (INR) value of 2.5. What is the meaning of this reported value?


A. The patient is not receiving enough warfarin for a therapeutic effect.


B. The patient’s warfarin dose is therapeutic.


C. The patient is not receiving enough subcutaneous heparin for a therapeutic effect. D. The patient is receiving a dangerously high amount of heparin.

B. INR determination is a routinetest to evaluate coagulation while patients are taking warfarin, not heparin. Atherapeutic INR is 2 to 3.

Which statement when made by the patient indicates deficientknowledge regarding warfarin?


A. “I will avoid contact sports.”


B. “I will take my medication in the early evening each day.”


C. “I will increase the dark green leafy vegetables in my diet.”


D. “I will contact my physician if I develop excessive bruising.”

C. Dark green leafy vegetables arerich in vitamin K, which would antagonize the effects of warfarin. Therefore,it is important to maintain a consistent daily intake of vitamin K and avoideating large amounts of these foods.

Enoxaparin sodium (Lovenox) is an anticoagulant used to prevent and treat deep vein thrombosis and pulmonary embolism. This drug is in which drug group?


A. Low–molecular-weight heparin


B. Oral anticoagulant


C. Glycoprotein IIb/IIIa inhibitor


D. Thrombolytic drug

A. Enoxaparin is alow–molecular-weight heparin.

The patient asks what the difference is between dalteparin(Fragmin) and heparin. What is the nurse’s best response?


A. “There is really no difference, but dalteparin is preferred because it is less expensive.”


B. “Dalteparin is a low–molecular-weight heparin that has a more predictable anticoagulant effect.”


C. “I’m not really sure why some physicians choose dalteparin and some heparin, so you should ask your doctor.”


D. “The only difference is that heparin dosing is based on the patient’s weight.”

B. A low–molecular-weight heparinis more predictable in its effect than regular heparin. Dalteparin is moreexpensive than heparin and is dosed based upon the patient’s weight.

Before emergency surgery, the nurse would anticipateadministering which medication to a patient receiving heparin?


A. vitamin K


B. vitamin E


C. phenytoin


D. protamine sulfate

D. Protamine sulfatebinds with heparin in the bloodstream to inactivate it and thus reverse itseffect

A patient who is taking an anticoagulant requests an aspirinfor headache relief. What is the nurse’s best action?


A. Administer 650 mg of acetylsalicylic acid (ASA), and reassess pain in 30 minutes.


B. Take advantage of a teachable moment to inform the patient of potential drug interactions with anticoagulants.


C. Explain to the patient that ASA is contraindicated, and administer ibuprofen as ordered.


D. Explain that the headache is an expected side effect and will subside shortly.

B. Patients taking an anticoagulantshould not use medications that would further increase the risk of bleeding.

A patient is started on oral anticoagulant therapy whilestill receiving intravenous heparin. The patient is concerned about risk forbleeding. What is the nurse’s best response?


A. “Your concern is valid in that you are at an increased risk for bleeding, so I will call the doctor to discontinue the heparin.”


B. “It usually takes 4 to 5 days to achieve a full therapeutic effect for warfarin, so the heparin is continued to help prevent blood clots until the warfarin is working up to speed.”


C. “Because of your valve replacement, it is especially important for you to be fully anticoagulated, and the heparin and warfarin together are more effective than one alone.”


D. “Because you are now up and walking, you have a higher risk of blood clots and therefore need to be on both medications.”

B. Warfarin works by decreasing theproduction of clotting factors. However, it takes 4 to 5 days for the body touse up present clotting factors and thus achieve a full therapeuticanticoagulant effect. Because of this, heparin is continued until this isachieved.

The nurse evaluates and determines the patient has a goodunderstanding of the discharge instructions regarding warfarin (Coumadin) whenthe patient responds with which statement?


A. “I will double my dose if I forget to take it the day before.”


B. “I should keep taking ibuprofen for my arthritis.”


C. “I should decrease the dose if I start bruising easily.”


D. “I should use a soft toothbrush for dental hygiene.”

D. The patient should reduce therisk of bleeding, such as using a soft toothbrush. The other choices areinaccurate.

While observing a patient self-administer enoxaparin(Lovenox), the nurse identifies the need for further teaching when the patientcompletes which action?


A. Does not aspirate prior to injecting the medication


B. Massages the site after administration of the medication


C. Administers the medication greater than 2 inches away from the umbilicus


D. Injects the medication and then waits 10 seconds before withdrawing the needle

B. It is not recommended to massagethe area of injection of anticoagulants due to the increased risk of hematomaformation.

The nurse recognizes that patient teaching regardingwarfarin (Coumadin) has been successful when the patient acknowledges anincreased risk of bleeding with concurrent use of which herbal product? (Selectall that apply.)


A. Garlic


B. Ginkgo


C. Dong quai


D. Glucosamine


E. St. John’s wort

A., B., C., E. Garlic, ginkgo, dongquai, and St. John’s wort alter blood coagulation and may increasethe risk of bleeding when given concurrently with oral anticoagulants.Glucosamine does not affect coagulation.

Which statement will indicate to the nurse that the patientunderstands the discharge instructions regarding cholestyramine (Questran)?


A. “I will take Questran 1 hour before my other medications.”


B. “I will increase fiber in my diet.”


C. “I will weigh myself weekly.”


D. “I will have my blood pressure checked weekly.”

B. Cholestyramine can causeconstipation; thus increasing fiber in diet is appropriate. All other drugsshould be taken 1 hour before or 4 hours after cholestyramine to facilitateproper absorption.

The nurse plans which intervention to decrease the flushingreaction of niacin?


A. Administer niacin with an antacid.


B. Administer aspirin 30 minutes before nicotinic acid.


C. Administer diphenhydramine hydrochloride (Benadryl) with the niacin.


D. Apply cold compresses to the head and neck.

B. Administration of an antiinflammatorydrug such as aspirin has been shown to decrease the flushing reactionassociated with niacin.

What education and discharge information for a patientreceiving an antilipemic medication would the nurse include for the patient?


A. “This medication will take over for other interventions you have been trying to decrease your cholesterol.”


B. “It is important for you to double your dose if you miss one in order to maintain therapeutic blood levels.”


C. “Stop taking the medication if it causes nausea and vomiting.”


D. “Continue your exercise program, and maintain a diet high in omega-3 fatty acids.”

D. Antilipemic medications are anaddition to, not a replacement of, the therapeutic regimen used to decreaseserum cholesterol.

Which statement, made by the patient, demonstrates aknowledge deficit regarding colestipol (Colestid)?


A. “The medication may cause constipation, so I will increase fluid and fiber in my diet.”


B. “I should take this medication 1 hour after or 4 hours before my other medications.”


C. “I might need to take fat-soluble vitamins to supplement my diet.”


D. “I should mix and stir the powder in as small an amount of fluid as possible in order to maintain potency of the medication.”

D. Colestipol is available as apowder that must be well diluted in fluids before administration to avoidesophageal irritation or obstruction and intestinal obstruction. The powdershould not be stirred because it may clump—it should be left to dissolve slowlyfor at least 1 minute.

Which test will the nurse use to assess for adversereactions to HMG-CoA reductase inhibitors?


A. Serum cholesterol levels


B. Liver function tests


C. Serum electrolytes


D. Complete blood count

B. HMG-CoA reductase inhibitors cancause hepatic toxicity; thus it is necessary to monitor liver function testsevery 3 months for the first year of treatment.

Discharge teaching for a patient receiving simvastatin(Zocor) would include the importance of reporting which symptoms that mightindicate a serious adverse reaction to the medication?


A. Muscle pain


B. Headache


C. Weight loss


D. Fatigue

A. Muscle pain must be reportedbecause it could signify an uncommon but serious side effect of rhabdomyolysisassociated with statin drugs.

The nurse would question an order for simvastatin (Zocor) ina patient with which condition?


A. Leukemia


B. Diabetes


C. Hepatic disease


D. Chronic obstructive pulmonary disease (COPD)

C. Simvastatin (Zocor) can cause anincrease in liver enzymes and thus should not be used in patients withpreexisting liver disease.

The nurse will assess a patient receiving gemfibrozil(Lopid) and warfarin (Coumadin) for which adverse effect?


A. Increased risk of clotting


B. Increased risk of vitamin K toxicity


C. Increased risk of bleeding


D. Deep vein thrombosis

C. Gemfibrozil can bind withvitamin K in the intestinal tract, reducing vitamin K absorption. Since vitaminK is the antidote for warfarin, a lack of vitamin K increases the anticoagulanteffect of warfarin and thus the risk of bleeding.

Which are common side effects of fenofibrate (Tricor), afibric acid derivative? (Select all that apply.)


A. Nausea, vomiting, and abdominal pain


B. Increase in gallstone formation


C. Impotence


D. Constipation


E. Rash

A., B., C., E. Diarrhea, notconstipation, is a common side effect of fibric acid derivatives. All of theother side effects listed can occur with fenofibrate.

A patient receiving a unit of red blood cells suddenlydevelops shortness of breath, chills, and fever. Following patient assessment,what is the nurse’s initial action?


A. Reassure the patient that this is an expected reaction.


B. Notify the physician while a peer monitors the blood transfusion.


C. Discontinue the infusion of packed cells.


D. Decrease the infusion rate, and reassess the patient in 15 minutes.

C. These are signs and symptoms ofa blood transfusion reaction that could escalate to anaphylaxis. Therefore itis a priority to immediately stop the blood transfusion.

The nurse is caring for a patient with an acute renal insufficiency and thrombocytopenia. Along with platelet transfusions, the nurse would expect to administer which substance to increase deficient clotting factors in this patient? A. Fresh frozen plasma


B. Albumin


C. Plasma protein factors


D. Whole blood

A. Fresh frozen plasma is indicatedto increase clotting factors in patients with a known deficiency. Albumin andplasma protein factors do not contain clotting factors. Although whole blooddoes contain the same ingredients as fresh frozen plasma, the amount of volumethat must be administered to give the patient the necessary clotting factorsmay be prohibitive in a patient with renal insufficiency.

A patient receiving a unit of red blood cells suddenly develops shortness of breath, chills, and fever. Following patient assessment, what is the nurse’s initial action?


A. Reassure the patient that this is an expected reaction.


B. Notify the physician while a peer monitors the blood transfusion.


C. Discontinue the infusion of packed cells.


D. Decrease the infusion rate, and reassess the patient in 15 minutes.

C. These are signs and symptoms ofa blood transfusion reaction that could escalate to anaphylaxis. Therefore itis a priority to immediately stop the blood transfusion.

Which laboratory value might indicate an adverse response tohydrochlorothiazide (HydroDIURIL)?


A. Sodium levels


B. Glucose levels


C. Calcium levels


D. Chloride levels

B. Hydrochlorothiazide can causehyperglycemia; therefore, glucose levels can indicate this adverse response.

The nurse is providing education to a patient on whyspironolactone (Aldactone) and furosemide (Lasix) are prescribed together. Whatinformation does the nurse provide to the patient?


A. Moderate doses of two different types of diuretics are more effective than a large dose of one type.


B. This combination promotes diuresis but decreases the risk of hypokalemia.


C. This combination prevents dehydration and hypovolemia.


D. Using two drugs increases osmolality of plasma and the glomerular filtration rate.

B. Spironolactone is apotassium-sparing diuretic; furosemide is a potassium-losing diuretic. Givingthese together minimizes electrolyte imbalance.

Which laboratory value depicts a known side effect offurosemide (Lasix)?


A. Hyperchloremia


B. Hypernatremia


C. Hypokalemia


D. Hypophosphatemia

C. Furosemide is a potent loopdiuretic, resulting in the loss of potassium as well as water, sodium, andchloride.

A patient is admitted to the hospital with pneumonia and hasa history of chronic renal insufficiency. Why does the physician orderfurosemide (Lasix) 40 mg twice a day?


A. Furosemide will not cause potassium loss.


B. Furosemide is effective in treating patients with pulmonary congestion.


C. Furosemide is effective in treating patients with renal insufficiency.


D. Furosemide will increase PO2 levels.

C. Furosemide is effective inpatients with creatinine clearance as low as 25 L/min (normal is 125 L/min).

The nurse would question the use of mannitol for whichpatient?


A. A 67-year-old patient who ingested a poisonous substance


B. A 21-year-old patient with a head injury


C. A 47-year-old patient with anuria


D. A 55-year-old patient who receives cisplatin to treat ovarian cancer

C. Mannitolis not metabolized but excreted unchanged by the kidneys. Potential waterintoxication could occur if mannitol is given to a patient without urine outputand thus renal function.

A patient asks about taking potassium supplements whiletaking spironolactone (Aldactone). What is the nurse’s best response? A. “You are correctabout your concern. I will make sure that you get some right away.”


B. “I will call yourdoctor and let him know of your concern.”


C. “Potassiumsupplements are usually not necessary with this type of diuretic.”


D. “You are on adiuretic that is potassium-sparing, so there is no need for extra potassium.”

D. Spironolactone is apotassium-sparing diuretic and thus the patient does not need potassiumsupplementation. Although it is true that potassium supplements are notnecessary with this type of diuretic, providing the patient with an explanationof why the potassium is not needed is a better response.

The nurse prepares to administer which diuretic to treat apatient with acute pulmonary edema? A. spironolactone (Aldactone)


B. amiloride (Midamor)


C. triamterene (Dyrenium)


D. furosemide (Lasix)

D. Furosemide is a potent,rapid-acting diuretic that would be the drug of choice to treat acute pulmonaryedema. The other medications are not potent enough to cause the strong diuresisnecessary to treat this acute situation.

When teaching a patient about signs and symptoms of hypokalemia, the nurse will instruct the patient to notify the health care provider if which occurs?


A. Diaphoresis


B. Leg cramps


C. Constipation


D. Blurred vision

B. Leg cramps are a common clinicalmanifestation of hypokalemia. The other answers are incorrect.

A patient taking spironolactone (Aldactone) requests assistance with dietary choices. The nurse would recommend which food choices? (Select all that apply.)


A. Lean meat


B. Bananas


C. Apples


D. Squash

A., C., D. Spironolactone is apotassium-sparing diuretic that could potentially cause hyperkalemia. Bananasare high in potassium and should be avoided in patients takingspironolactone.

Potassium-sparing diuretics may cause which adverse reactions? (Select all that apply.)


A. Hyperkalemia


B. Dizziness


C. Headache


D. Hypermagnesemia


E. Muscle cramps

A., B., C. Hyperkalemia,dizziness, and headache are common side effects associated withpotassium-sparing diuretics.

Isotretinoin (Amnesteem) and tretinoin (Retin-A) are commondermatologic drugs used to treatA. acne.


B. male pattern baldness.


C. keloid scarring.


D. fungal infections

A. Isotretinoin and tretinoin are effective topical treatments foracne vulgaris. Isotretinoin inhibits sebaceous gland activity, and tretinoinstimulates the turnover of epidermal cells, resulting in skin peeling.

The nurse will anticipate application of which medication totreat a patient diagnosed with impetigo?


A. mupirocin (Bactroban)


B. benzoyl peroxide


C. isotretinoin (Amnesteem)


D. retinoic acid (Renova)

A. Impetigo is a skin disorder caused by bacteria and is treatedwith a topical antibacterial agent, mupirocin.

A teenage female patient is going to be prescribed isotretinoin(Amnesteem) for acne. Which information is most important for the nurse toinclude in the education of the patient?A. The drug is supplied in oral form.


B. The patient must use at least two formsof contraception while taking this medication.


C. The drug is used in treatment of severeacne.


D. Providers who prescribe this medicationmust be registered with the FDA.

B. The most important and mandatory teaching by the Food and DrugAdministration is the requirement to use two different forms of contraceptionif the patient is female and of childbearing age.

A patient who is prescribed the drug miconazole (Monistat), atopical antifungal, has most likely been diagnosed with which condition?


A. Candidiasis


B. Pruritus


C. Eczema


D. Folliculitis

A. Miconazole is used in the treatment of candidiasis, which iscommonly known as a yeast infection.

A patient is prescribed bacitracin topical ointment. What doesthe nurse suspect as the possible diagnosis based on the medication prescribed?


A. Fungal infection


B. Bacterial infection


C. Parasitic infection


D. Viral infection

B. Bacitracin is a polypeptide antibiotic that is applied topicallyfor the treatment or prevention of local skin infections caused by susceptibleaerobic and anaerobic gram-positive organisms such as staphylococci,streptococci, anaerobic cocci, corynebacteria, and clostridia.

A male patient has been ordered clotrimazole (Lotrimin,Mycelex-G) after a diagnosis of jock itch. What is the technical name the nursewould use to document the diagnosis on the chart and the reason the patient hasbeen prescribed this medication?


A. Tinea corporis


B. Tinea capitis


C. Tinea pedis


D. Tinea cruris

D. Infections caused by dermatophytes are called tinea, or ringworm, infections. Tinea infections areidentified by the body location where they occur: tinea pedis (foot), tineacruris (groin), tinea corporis (body), and tinea capitis (scalp). Tineainfections of the foot are also known as athlete’s foot andthose of the groin as jock itch

Parasympathomimetic ophthalmic drugs such as pilocarpine(Pilocar) reduce intraocular pressure in the treatment of glaucoma by whichmechanism of action?


A. Mydriasis


B. Miosis


C. Decrease in drainage of aqueous humor


D. Pupillary dilatation

B. Pilocarpine is a direct-acting parasympathomimetic drug that isused as a miotic in the treatment of open-angle glaucoma. Miosis causespupillary constriction, increasing the outflow of aqueous humor.

Which statement, made by a patient, indicates the need for further patient teaching regarding proper administration of eyedrops?


A. “I will put pressure on the inside corner of my eye after I administer the drops.”


B. “I will be careful not to touch my eye with the dropper.”


C. “I will rinse the eyedropper with tap water after each use.”


D. “I will turn my head slightly toward the outside of the eye I am putting the drops in.”

C. It is important to maintain sterility of the eyedrop container,and therefore it should not be rinsed; the cap should be put immediately backon the container.

The nurse is providing education to a patient who was diagnosed with bilateral conjunctivitis (pink eye). The patient is prescribed sulfacetamide (Bleph-10) for the diagnosis. What information in the patient history has the highest priority and should be reported immediately to the health care provider?


A. Patient is allergic to sulfa drugs.


B. Patient does not like eyedrops.


C. Patient reports never having pink eye before.


D. Patient wears contacts.

A. The other data are important for education and teaching;however, a patient allergic to sulfa drugs should not be prescribed a sulfadrug for treatment. The health care provider would need to be alertedimmediately.

The nurse is educating a patient who was administered atropine sulfate solution for an eye exam. The nurse includes which information in the education?


A. The patient will have to wait 72 hours to wear contacts.


B. Use of sunglasses is encouraged to decrease sunlight sensitivity.


C. The patient may have small pupils for 12 hours after administration.


D. A common side effect is dry eyes.

B. The medication is a mydriatic and is used to dilate the pupilsfor an eye exam. The patient may have increased sunlight sensitivity and shouldwear sunglasses until the pupils return to normal size.

The nurse bases the plan of care regarding administration ofeardrops on knowledge that


A. proper administration includes holdingthe pinna up and out in an infant.


B. warming the eardrops to roomtemperature before administration helps reduce a vestibular-typereaction.


C. the pinna of an adult should be helddown and back.


D. eardrops may be warmed in the microwavebefore administration.

B. Eardrops that are administered too cold may cause vomiting anddizziness by stimulating a vestibular-type reaction. Neither should theeardrops be warmed in the microwave because too high a temperature can destroythe effectiveness of the medication. Room air temperature is sufficient.Eardrops in adults should be administered by holding the pinna up and out; inchildren under 3 years of age, the pinna is held down and back.

The nurse is teaching the mother of a 1-year-old patient how toinstill ear drops for OE. What instructions on instillation does the nurseprovide to the mother?


A. “Hold the pinna down and back.”


B. “Just put in as many drops as you canget into the ear.”


C. “Put a cotton ball in to keep themedication in the ear.”


D. “Keep the ear drops in cold place sothey work better.”

A. When administering eardrops to adults, hold the pinna up and back. In children younger than 3 years ofage, hold the pinna down and back.Allow a period of time for adequate coverage of the ear by the medication.Store eardrops, solutions, and ointments at room temperature beforeinstillation. Administration of solutions that are too cold may cause avestibular type of reaction with vomiting and dizziness.

What would the nurse assess when monitoring for the therapeuticeffectiveness of vasopressin?


A. Fluid balance


B. Patient’s pain scale


C. Serum albumin levels Incorrect


D. Adrenocorticotropic hormone (ACTH)levels

A. Vasopressin causes decreased water excretion in the renaltubule, thus decreasing urine output. It is used to treat diabetes insipidus,which presents with polyuria and dehydration.

The nurse is providing care to a patient following anon-accidental traumatic brain injury. The patient has developed diabetesinsipidus due to the injury. What medication is most often used in themanagement of diabetes insipidus?


A. desmopressin (DDAVP)


B. corticotrophin (Acthar)


C. octreotide (Sandostatin)


D. somatropin (Humatrope)

A. Vasopressin (Pitressin) and desmopressin (DDAVP) are used toprevent or control polydipsia (excessive thirst), polyuria, and dehydration inpatients with diabetes insipidus caused by a deficiency of endogenousantidiuretic hormone

Which statement by the patient demonstrates an understanding ofdischarge instructions on the use of levothyroxine (Synthroid)?


A. “I will take this medication in themorning so as not to interfere with sleep.”


B. “I will double my dose if I gain morethan 1 pound per day.”


C. “I will stop the medication immediatelyif I lose more than 2 pounds in a week.”


D. “I can expect to see relief of mysymptoms within 1 week.”

A. Levothyroxine increases basal metabolism and thus wakefulness.Patients should not double the dose or stop taking the medication abruptly. Itmay take up to 4 weeks for a therapeutic response to occur.

The nurse would suspect excessive thyroid replacement in apatient taking levothyroxine (Synthroid) when the patient is exhibiting whichadverse effect?


A. Depression


B. Intolerance to cold


C. Weight gain


D. Irritability

D. Irritability is a symptom of hyperthyroidism. The other choicesare signs of hypothyroidism.

Patients taking levothyroxine (Synthroid) and warfarin(Coumadin) concurrently would be monitored for which adverse effect?


A. Cardiac arrhythmias


B. Increased risk of bleeding


C. Excessive weight loss


D. Increased risk of deep vein thrombosis

B. Levothyroxine can compete with protein-binding sites ofwarfarin, allowing more warfarin to be unbound or free, thus increasing effectsof warfarin and risk of bleeding.

Which is a rapid-acting insulin with an onset of action of lessthan 15 minutes?


A. insulin glargine (Lantus)


B. insulin aspart (NovoLog)


C. regular insulin (Humulin R)


D. insulin detemir (Levemir)

B. Insulin aspart is a rapid-acting insulin. Insulin glargine andinsulin detemir are long-acting insulins. Regular insulin is short acting.

Which long-acting insulin mimics natural, basal insulin with nopeak action and a duration of 24 hours?


A. insulin glargine (Lantus)


B. insulin glulisine (Apidra)


C. regular insulin (Humulin R)


D. NPH insulin

A. Insulin glargine has a duration of action of 24 hours with nopeaks, mimicking the natural, basal insulin secretion of the pancreas.

Which insulin can be administered by continuous intravenousinfusion?


A. insulin glargine (Lantus)


B. insulin aspart (Novolog)


C. regular insulin (Humulin R)


D. insulin detemir (Levemir)

C. Regular insulin is the only insulin used for intravenoustherapy.

Assuming the patient eats breakfast at 8:30 AM, lunch at noon,and dinner at 6:00 PM, he or she is at highest risk of hypoglycemia followingan 8:00 AM dose of NPH insulin at what time?


A. 10:00 AM


B. 2:00 PM


C. 5:00 PM


D. 8:00 PM

C. Breakfast eaten at 8:30 AM would cover the onset of NPH insulin,and lunch will cover the 2 PM time frame. However, if the patient does not eata mid-afternoon snack, the NPH insulin may be peaking just before dinnerwithout sufficient glucose on hand to prevent hypoglycemia.

The nurse is caring for a patient scheduled to undergo a cardiaccatheterization procedure utilizing iodine-based contrast material. The nursewould question an order for which medication to be given to this patient theday before the scheduled procedure?


A. acarbose (Precose)


B. metformin (Glucophage)


C. repaglinide (Prandin)


D. pioglitazone (Actos)

B. The concurrent use of metformin and iodinated(iodine-containing) radiologic contrast media has been associated with bothacute renal failure and lactic acidosis. Therefore metformin should bediscontinued at least 48 hours prior to any radiologic study requiring suchcontrast media and should be held for at least 48 hours after the procedure.

Which oral hypoglycemic drug has a quick onset and shortduration of action, enabling the patient to take the medication 30 minutesbefore eating and skip the dose if he or she does not eat?


A. acarbose (Precose)


B. metformin (Glucophage)


C. repaglinide (Prandin)


D. pioglitazone (Actos)

C. Repaglinide is known as the “Humalog of oral hypoglycemicdrugs.” The drug’s very fast onset of action allows patients to take the drugwith meals and skip a dose when they skip a meal.

The nurse would include which statement when teaching a patientabout insulin glargine?


A. “You should inject this insulin justbefore meals because it is very fast acting.”


B. “The duration of action for thisinsulin is approximately 8 to10 hours, so you will need to take it twice aday.”


C. “You can mix this insulin with NPHinsulin to enhance its effects.”


D. “You cannot mix this insulin withregular insulin and thus will have to take two injections.”

D. Insulin glargine is a long-acting insulin with duration ofaction up to 24 hours. It should not be mixed with any other insulins.

The nurse is providing education to a patient about the time totake glipizide (Glucotrol). For maximum benefit, the nurse will tell the patientto administer glipizide at which time?


A. In the morning


B. 30 minutes before a meal


C. 15 minutes postprandial


D. At bedtime

B. Glipizide works best if given 30 minutes before meals. Thisallows the timing of the insulin secretion induced by the glipizide tocorrespond to the elevation in the blood glucose level induced by the meal.

When caring for a patient newly diagnosed with gestationaldiabetes, the nurse would question an order for which drug?


A. insulin glargine (Lantus)


B. glipizide (Glucotrol)


C. insulin glulisine (Apidra)


D. NPH insulin

B. Oral antidiabetic drugs are generally not recommended forpregnant patients.

Which information should be included in a teaching plan forpatients taking oral hypoglycemic drugs? (Select all that apply.)


A. Limit your alcohol consumption.


B. Report symptoms of anorexia and fatigue.


C. Take your medication only as needed


D. Notify your physician if blood glucose levelsrise above the level set for you.

A., B., D. Oral hypoglycemic drugs must be taken on a daily scheduled basis tomaintain euglycemia and prevent long-term complications of diabetes. All otheroptions are correct.

Which statement, made by the patient, indicates an understandingof discharge teaching regarding alendronate (Fosamax)?


A. “I need to decrease my intake of dairyproducts so as to prevent hypercalcemia.”


B. “I need to take this medication withfood to prevent damage to my esophagus.”


C. “I will take the medication first thingin the morning with 8 ounces of water and remain upright for 30 minutes.”


D. “This medication will help relieve thebone pain I have from my osteoporosis.”

C. Alendronate can cause erosive esophagitis. To prevent this sideeffect, it is important to take the medication first thing in the morning on anempty stomach without any other medications and maintain an upright positionfor 30 minutes. These actions facilitate rapid absorption and prevent refluxinto the esophagus.