1. An 86-year-old patient is being discharged to home on digitalis therapy and has very little information regarding the medication. Which statement best reflects a realistic outcome of patient teaching activities? a. The patient and patient's daughter will state the proper way to take the drug. b. The nurse will provide teaching about the drug's adverse effects. c. The patient will state all the symptoms of digitalis toxicity. d. The patient will call the prescriber if adverse effects occur. 2. A patient has a new prescription for a blood pressure medication that may cause him to feel dizzy during the first few days of therapy. Which is the best nursing diagnosis for this situation? a. Activity intolerance b. Risk for injury c. Disturbed body image d. Self-care deficit 3. A patient's chart includes an order that reads as follows: “Atenolol 25 mg once daily at 0900.” Which action by the nurse is correct? a. The nurse gives the drug via the transdermal route. b. The nurse gives the drug orally. c. The nurse gives the drug intravenously. d. The nurse contacts the prescriber to clarify the dosage route. 4. The nurse is compiling a drug history for a patient. Which question from the nurse will obtain the most information from the patient? a. “Do you depend on sleeping pills to get to sleep?” b. “Do you have a family history of heart disease?” c. “When you have pain, what do you do to relieve it?” d. “What childhood diseases did you have?” 5. A 77-year-old man who has been diagnosed with an upper respiratory tract infection tells the nurse that he is allergic to penicillin. Which is the most appropriate response by the nurse? a. “Many people are allergic to penicillin.” b. “This allergy is not of major concern because the drug is given so often.” c. “What type of reaction did you have when you took penicillin?” d. “Drug allergies don't usually occur in older individuals dueto built-up resistance to allergic reactions.” 6. The nurse is preparing a care plan for a patient who has been newly diagnosed with type 2 diabetes mellitus. Which of these reflect the correct order of the steps of the nursing process? a. Assessment, Planning, Nursing Diagnoses, Implementation, Evaluation b. Evaluation, Assessment, Nursing Diagnoses, Planning, Implementation c. Nursing Diagnoses, Assessment, Planning, Implementation, Evaluation d. Assessment, Nursing Diagnoses, Planning, Implementation, Evaluation 7. The nurse is reviewing new medication orders that have been written for a newly admitted patient. The nurse will need to clarify which orders? (Select all that apply.) a. Metformin (Glucophage) 1000 mg PO twice a day b. Sitagliptin (Januvia) 50 mg daily c. Simvastatin (Zocor) 20 mg PO every evening d. Irbesartan (Avapro) 300 mg PO once a day e. Docusate (Colace) as needed for constipation 8. The nurse is reviewing data collected from a medication history. Which of these data are considered objective data? (Select all that apply.) a. White blood cell count 22,000 mm3 b. Blood pressure 150/94 mm Hg c. Patient rates pain as an “8” on a 10-point scale d. Patient's wife reports that the patient has been very sleepy during the day e. Patient's weight is 68 kg 1. a, 2. b, 3. d, 4. c, 5. c, 6. d, 7. b, e, 8. a, b, e CH2 Pharmacologic principles 1. An elderly woman took a prescription medicine to help her to sleep; however, she felt restless all night and did not sleep at all. The nurse recognizes that this woman has experienced which type of reaction or effect? a. Allergic reaction b. Idiosyncratic reaction c. Mutagenic effect d. Synergistic effect 2. While caring for a patient with cirrhosis or hepatitis, the nurse knows that abnormalities in which phase of pharmacokinetics may occur? a. Absorption b. Distribution c. Metabolism d. Excretion 3. A patient who had a thyroidectomy is now taking levothyroxine, a thyroid hormone, daily. Which term best describes this type of therapy? a. Palliative therapy b. Maintenance therapy c. Supportive therapy d. Supplemental therapy 4. The nurse is giving medications to a patient in heart failure. The intravenous route is chosen instead of the intramuscular route. What patient function does the nurse recognize as the most influential when deciding to use the intravenous route of drug administration? a. Altered biliary function b. Increased glomerular filtration c. Reduced liver metabolism d. Diminished circulation 5. A patient has just received a prescription for an enteric-coated stool softener. When teaching the patient, the nurse should include which statement? a. “Take the tablet with 2 to 3 ounces of orange juice.” b. “Avoid taking all other medications with any entericcoated tablet.” c. “Crush the tablet before swallowing if you have problems with swallowing.” d. “Be sure to swallow the tablet whole without chewing it.” 6. Each statement describes a phase of pharmacokinetics. Put the statements in order, with 1 indicating the phase that occurs first and 4 indicating the phase that occurs last. a. Enzymes in the liver transform the drug into an inactive metabolite. b. Drug metabolites are secreted through passive glomerular filtration into the renal tubules. c. A drug binds to the plasma protein albumin and circulates through the body. d. A drug moves from the intestinal lumen into the mesenteric blood system. 7. A drug that delivers 300 mg has a half-life of 4 hours. How many milligrams of drug will remain in the body after 1 half-life? 8. The nurse is reviewing the various forms of topical medications. Which of these are considered topical medications? (Select all that apply.) a. Rectal ointment for hemorrhoids b. Eye drops for inflammation c. Sublingual tablet for chest pain d. Inhaled medication for asthma e. Intradermal injection for tuberculosis testing 1. b, 2. c, 3. b, 4. d, 5. d, 6. a = 3, b = 4, c = 2, d = 1, 7. 150 mg, 8. a, b, d   CH3 Lifespan consideration 1. The nurse is reviewing factors that influence pharmacokinetics in the neonatal patient. Which factor puts the neonatal patient at risk with regard to drug therapy? a. Immature renal system b. Increased peristalsis in the GI tract c. Irregular temperature regulation d. Smaller circulatory capacity 2. The physiologic differences in the pediatric patient compared with the adult patient affect the amount of drug needed to produce a therapeutic effect. The nurse is aware that one of the main differences is that infants have a. Increased protein in circulation. b. Fat composition lower than 0.001%. c. More muscular body composition. d. Water composition of approximately 75%. 3. While teaching a 76-year-old patient about the adverse effects of his medications, the nurse encourages him to keep a journal of the adverse effects he experiences. This intervention is important for the older adult patient because of which alterations in pharmacokinetics? a. Increased renal excretion of protein-bound drugs b. More alkaline gastric pH, resulting in more adverse effects c. Decreased blood flow to the liver, resulting in altered metabolism d. Less adipose tissue to store fat-soluble drugs 4. When the nurse is reviewing a list of medications taken by an 88-year-old patient, the patient says, “I get dizzy when I stand up.” She also states that she has nearly fainted “a time or two” in the afternoons. Her systolic blood pressure drops 15 points when she stands up. Which type of medication may be responsible for these effects? a. Nonsteroidal antiinflammatory drugs (NSAIDs) b. Cardiac glycosides c. Anticoagulants d. Antihypertensives 5. A pregnant patient who is at 32 weeks' gestation has a cold and calls the office to ask about taking an over-the-counter medication that is rated as pregnancy category A. Which answer by the nurse is correct? a. “This drug causes problems in the human fetus, so you should not take this medication.” b. “This drug may cause problems in the human fetus, but nothing has been proven in clinical trials. It is best not to take this medication.” c. “This drug has not caused problems in animals, but no testing has been done in humans. It is probably safe to take.” d. “Studies indicate that there is no risk to the human fetus, so it is okay to take this medication as directed if you need it.” 6. The nurse is preparing to administer an injection to a preschool-age child. Which approaches are appropriate for this age group? (Select all that apply.) a. Explain to the child in advance about the injection. b. Provide a brief, concrete explanation about the injection. c. Encourage participation in the procedure. d. Make use of magical thinking. e Provide comfort measures after the injection. 7. The nurse is preparing to give an oral dose of acetaminophen (Tylenol) to a child who weighs 12 kg. The dose is 15 mg/kg. How many milligrams will the nurse administer for this dose? 8. An 82 year-old patient is admitted to the hospital after an episode of confusion at home. The nurse is assessing the current medications he is taking at home. Which method is the best way to assess his home medications? a. Ask the patient what medications he takes at home. b. Ask the patient's wife what medications he takes at home. c. Ask the patient's wife to bring his medications to the hospital in their original containers. d. Contact the patient's pharmacy for a list of the patient's current medications. 1. a, 2. d, 3. c, 4. d, 5. d, 6. b, d, e, 7. 180 mg, 8. c   CH4 Cultural, legal, and ethical considerations 1. A patient has been diagnosed with late-stage cancer. After consulting with his family, he tells the nurse, “I would like to try to live long enough to see my granddaughter graduate in 3 months, but after that I don't want any extra treatments.” This patient is demonstrating which of these? a. Veracity b. Beneficence c. Maleficence d. Autonomy 2. When caring for an older adult Chinese patient, the nurse recognizes that which of these cultural issues may influence the care of this patient? a. Chest x-rays are seen as a break in the soul's integrity. b. Hospital diets are interpreted as being healing and healthful. c. The use of heat may be an important practice for this patient. d. Being hospitalized is a source of peace and socialization for this culture. 3. A patient is being counseled for possible participation in a clinical trial for a new medication. After the patient meets with the physician, the nurse is asked to obtain the patient's signature on the consent forms. The nurse knows that this “informed consent” indicates which of the following? a. Once therapy has begun, the patient cannot withdraw from the clinical trial. b. The patient has been informed of all potential hazards and benefits of the therapy. c. The patient has received only the information that will help to make the clinical trial a success. d. No matter what happens, the patient will not be able to sue the researchers for damages. 4. A new drug has been approved for use, and the drug manufacturer has made it available for sale. During the first 6 months, the FDA receives reports of severe adverse effects that were not discovered during the testing and considers withdrawing the drug. This illustrates which phase of investigational drug studies? a. Phase I b. Phase II c. Phase III d. Phase IV 5. A patient of Japanese descent describes a family trait that manifests frequently: She says that members of her family often have “strong reactions” after taking certain medications, but her white friends have no problems with the same dosages of the same drugs. The nurse recognizes that, because of this trait, which statement applies? a. She may need lower dosages of the medications prescribed. b. She may need higher dosages of the medications prescribed. c. She should not receive these medications because of potential problems with metabolism. d. These situations vary greatly, and her accounts may not indicate a valid cause for concern. 6. When evaluating polymorphism and medication administration, the nurse considers which factors? (Select all that apply.) a. Nutritional status b. Drug route c. Genetic factors d. Cultural beliefs e. Patient's age 7. The nurse is reviewing the four clinical phases of investigational drug studies. Place the four phases in the correct order of occurrence. a. Studies that are voluntarily conducted by pharmaceutical companies to obtain more information about the therapeutic and adverse effects of a drug. b. Studies that involve small numbers of volunteers who have the disease or ailment that the drug is designed to diagnose or treat. c. Studies that involve small numbers of healthy subjects who do not have the disease or ailment that the drug is intended to treat. d. Studies that involve large numbers of patients who have the disease that the drug is intended to treat; these studies establish the drug's clinical effectiveness, safety, and dosage range. 8. A patient shows the nurse an article in the newspaper about a new black box warning and states, “I take this drug! Is it safe for me to take now?” What is meant by a black box warning? a. The FDA is asking for a mandatory recall of this drug. b. Serious adverse effects have been reported with this drug, and he will not be able to take it again because the risks outweigh the benefits. c. Even though severe adverse effects have been reported, it can still be prescribed as long as the prescriber and patient are aware of the potential risks. d. Pharmacies will no longer be able to dispense this drug to patients.1. d, 2. c, 3. b, 4. d, 5. a, 6. a, c, d, e, 7. a = 4, b = 2, c = 1, d = 3, 8. C   CH5 Medication errors: preventing and responding 1. The nurse keeps in mind that which measure is used to reduce the risk of medication errors? a. When questioning a drug order, keep in mind that the prescriber is correct. b. Be careful about questioning the drug order a board-certified physician has written for a patient. c. Always double-check the many drugs with sound-alike and look-alike names because of the high risk of error. d. If the drug route has not been specified, use the oral route. 2. During the medication administration process, it is important that the nurse remembers which guideline? a. When in doubt about a drug, ask a colleague about it before giving the drug. b. Ask what the patient knows about the drug before giving it. c. When giving a new drug, be sure to read about it after giving it. d. If a patient expresses a concern about a drug, stop, listen, and investigate the concerns. 3. If a student nurse realizes that he or she has made a drug error, the instructor should remind the student of which concept? a. The student bears no legal responsibility when giving medications. b. The major legal responsibility lies with the health care institution at which the student is placed for clinical experience. c. The major legal responsibility for drug errors lies with the faculty members. d. Once the student has committed a medication error, his or her responsibility is to the patient and to being honest and accountable. 4. The nurse is giving medications to a newly admitted patient who is to receive nothing by mouth (NPO status) and finds an order written as follows: “Digoxin, 250 mcg stat.” Which action is appropriate? a. Give the medication immediately (stat) by mouth because the patient has no intravenous (IV) access at this time. b. Clarify the order with the prescribing physician before giving the drug. c. Ask the charge nurse what route the physician meant to use. d. Start an IV line, then give the medication IV so that it willwork faster, because the patient's status is NPO at this time. 5. The nurse is reviewing medication orders. Which digoxin dose is written correctly? a. digoxin .25 mg b. digoxin .250 mg c. digoxin 0.250 mg d. digoxin 0.25 mg 6. The nurse is administering medications. Examples of high-alert medications include: (Select all that apply.) a. Chemotherapeutic agents b. Antibiotics c. Opiates d. Antithrombotics e. Potassium chloride for injection 7. Convert 250 micrograms to milligrams. Be sure to depict the number correctly according to the guidelines for decimals and zeroes. 8. The nurse is performing medication reconciliation during a patient's admission assessment. Which question by the nurse reflects medication reconciliation? a. “Do you have any medication allergies?” b. “Do you have a list of all the medications, including over the-counter, you are currently taking?” c. “Do you need to take anything to help you to sleep at night?” d. “What pharmacies do you use when you fill your prescriptions?” 1. c, 2. d, 3. d, 4. b, 5. d, 6. a, c, d, e, 7. 0.25 mg, 8. b.   CH6 Patient education and drug therapy 1. A 47-year-old patient with diabetes is being discharged to home and must take insulin injections twice a day. The nurse keeps in mind which concepts when considering patient teaching? a. Teaching needs to begin at the time of diagnosis or admission and is individualized to the patient's reading level. b. The nurse can assume that because the patient is in his forties he will be able to read any written or printed documents provided. c. The majority of teaching can be done with pamphlets that the patient can share with family members. d. A thorough and comprehensive teaching plan designed for an eleventh-grade reading level needs to be developed. 2. The nurse is developing a discharge plan regarding a patient's medication. Which of these statements about the discharge plan is true? a. It will be developed right before the patient leaves the hospital. b. It will be developed only after the patient is comfortable or after pain medications are administered. c. It will include videos, demonstrations, and instructions written at least at the fifth-grade level. d. It will be individualized and based on the patient's level of cognitive development. 3. The nurse is responsible for preoperative teaching for a patient who is mildly anxious about receiving pain medications postoperatively. The nurse recognizes that this level of anxiety may a. Impede learning because anxiety is always a barrier to learning. b. Lead to major emotional unsteadiness. c. Result in learning by increasing the patient's motivation to learn. d. Reorganize the patient's thoughts and lead to inadequate potential for learning. 4. What action by the nurse is the best way to assess a patient's learning needs? a. Quiz the patient daily on all medications. b. Begin with validation of the patient's present level of knowledge. c. Assess family members' knowledge of the prescribed medication even if they are not involved in the patient's care. d. Ask the caregivers what the patient knows about the medications. 5. Which technique would be most appropriate to use when the nurse is teaching a patient with a language barrier? a. Obtain an interpreter who can speak in the patient's native tongue for teaching sessions. b. Use detailed explanations, speaking slowly and clearly. c. Assume that the patient understands the information presented if the patient has no questions. d. Provide only written instructions. 6. A nursing student is identifying situations that involve the psychomotor domain of learning as part of a class project. Which are examples of learning activities that involve the psychomotor domain? (Select all that apply.) a. Teaching a patient how to self-administer eyedrops b. Having a patient list the adverse effects of an antihypertensive drug c. Discussing what foods to avoid while taking antilipemic drugs d. Teaching a patient how to measure the pulse before taking a beta blocker e. Teaching a family member how to give an injection f. Teaching a patient the rationale for checking a drug's blood level 7. The nurse is instructing an older adult patient on how to use his walker. Which education strategies are appropriate? (Select all that apply.) a. Speak slowly and loudly. b. Ensure a quiet environment for learning. c. Repeat information frequently. d. Allow for an increased number of return demonstrations. e. Provide all the information in one teaching session. 8. You are reviewing newly prescribed medications with the wife of a patient who will be discharged today on a liquid diet after jaw surgery. She will be giving the patient his medications. There is a prescription for liquid metoclopramide (Reglan), 10 mg PO before breakfast and dinner. The medication is available in a strength of 5 mg/mL. How many mL will she need to give for each dose? 1. a, 2. d, 3. c, 4. b, 5. a, 6. a, d, e, 7. b, c, d, 8. 2 mL CH7 Over-the-counter drugs and herbal and dietary supplements 1. The nurse is reviewing dietary supplements and recalls that the FDA requires manufacturers of dietary supplements to a. follow FDA standards for quality control. b. Prove efficacy and safety of dietary supplements. c. Identify the active ingredients on the label. d. obtain FDA approval before the products are marketed. 2. When educating patients about the safe use of herbal products, the nurse remembers to include which concept? a. Herbal and over-the-counter products are approved by the FDA and under strict regulation. b. Herbal products are tested for safety by the FDA and the U.S. Pharmacopeia. c. No adverse effects are associated with these products because they are natural and may be purchased without a prescription. d. Take the product with caution because labels may not contain reliable information. 3. When taking a patient's drug history, the nurse asks about use of over-the-counter drugs. The patient responds by saying, “Oh, I frequently take aspirin for my headaches, but I didn't mention it because aspirin is nonprescription.” What is the nurse's best response? a. “That's true; over-the-counter drugs are generally not harmful.” b. “Aspirin is one of the safest drugs out there.” c. “Although aspirin is over the counter, it's still important to know why you take it, how much you take, and how often.” d. “We need you to be honest about the drugs you are taking. Are there any others that you haven't told us about?” 4. When making a home visit to a patient who was recently discharged from the hospital, the nurse notes that she has a small pack over her chest and that the pack has a strong odor. She also is drinking herbal tea. When asked about the pack and the tea, the patient says, “Oh, my grandmother never used medicines from the doctor. She told me that this plaster and tea were all I would need to fix things.” Which response by the nurse is most appropriate? a. “You really should listen to what the doctor told you if you want to get better.” b. “What's in the plaster and the tea? When do you usually use them?” c. “These herbal remedies rarely work, but if you want to use them, then it is your choice.” d. “It's fine if you want to use this home remedy, as long as you use it with your prescription medicines.” 5. A patient tells the nurse that he has been using an herbal supplement that contains kava for several years to help him to relax in the evening. However, the nurse notes that he has a yellow tinge to his skin and sclera, and is concerned about liver toxicity. The nurse advises the patient to stop taking the kava and to see his health care provider for an examination. What else, if anything, should the nurse do at this time? a. Report this incident to MedWatch. b. Notify the state's pharmaceutical board. c. Contact the supplement manufacturer. d. No other action is needed. 6. The nurse is reviewing the drug history of a patient, and during the interview the patient asks, “Why are some drugs over-the-counter and others are not?” The nurse keeps in mind that criteria for over-the-counter status include: (Select all that apply.) a. The condition must be diagnosed by a health care provider. b. The benefits of correct usage of the drug outweigh the risks. c. The drug has limited interaction with other drugs. d. The drug is easy to use. e. The drug company sells OTC drugs at lower prices. 7. A patient comes to the clinic complaining of elbow pain after an injury. He states that he has been taking two pain pills, eight times a day, for the past few days. The medication bottle contains acetaminophen, 325-mg tablets. Calculate how much medication he has been taking per day. Is this a safe dose of this medication? 8. The nurse is reviewing definitions for a pharmacology review class. Which of these products would be categorized as “legend drugs?” (Select all that apply.) a. acetaminophen (Tylenol) b. warfarin (Coumadin) c. Gingko biloba d. Morphine sulfate e. diphenhydramine (Benadryl) 1. c, 2. d, 3. c, 4. b, 5. a, 6. b, c, d, 7. 5200 mg/day, No, 8. b, d   CH8 Gene therapy and pharmacogenomics 1. Which is the most appropriate example of a product formed by an indirect form of gene therapy? a. Stem cells b. Vaccines c. Antigen substitution d. Platelet inhibitors 2. The nurse is explaining the general goal of gene therapy to a patient. With gene therapy, the general goal is to transfer exogenous genes to a patient for which result? a. To change the patient's own genetic functioning to treat a given disease b. To improve drug metabolism c. To prevent genetic disorders in the patient's future children d. To stimulate the growth of stem cells 3. The nurse is reviewing genetic concepts. Which is considered the biologic unit of heredity? a. Gene b. Allele c. Chromosome d. Nucleic acid 4. The presence of certain factors in a person's genetic makeup that increase the likelihood of eventually developing one or more diseases is known as a a. Genetic mutation. b. Genetic polymorphism. c. Genetic predisposition. d. genotype. 5. The nurse is reviewing gene therapy. Which is the primary molecule in the body that serves to transfer genes from parents to offspring? a. RNA b. DNA c. Allele d. Chromosome 6. General responsibilities of the nurse regarding genetics may include which of these activities? (Select all that apply.) a. Assessing the patient's personal and family history b. Referring the patient to a genetic counselor or other genetics specialist c. Communicating the results of genetic tests to the patient and patient's family d. Maintaining privacy and confidentiality during the testing process e. Answering questions about genetic test results 7. The nurse is assessing a patient for a possible increased risk for genetic disorders. Which of these, if present, may indicate an increased risk for a genetic disorder? (Select all that apply.) a. Having a brother who died of a myocardial infarction at age 29 b. Having a family member who has been diagnosed with more than one type of cancer c. Having an uncle who was diagnosed with prostate cancer at age 73 d. A history of allergy to shellfish and iodine e. Having a maternal grandmother, two maternal aunts, and a sister who were diagnosed with colon cancer 8. Liquid potassium chloride is ordered as follows: Give 16 mEq per PEG tube twice a day. The dose on hand contains 20 mEq/15 mL. How much will the nurse give per dose? 1. b, 2. a, 3. a, 4. c, 5. b, 6. a, b, d, 7. a, b, e, 8. 12 mL   CH10 Analgesic drugs 1. For best results when treating severe pain associated with pathologic spinal fractures related to metastatic bone cancer, the nurse should remember that the best type of dosage schedule is to administer the pain medication a. As needed. b. Around the clock. c. On schedule during waking hours only. d. Around the clock, with additional doses as needed for breakthrough pain. 2. A patient is receiving an opioid via a PCA pump as part of his postoperative pain management program. During rounds, the nurse finds him unresponsive, with respirations of 8 breaths/min and blood pressure of 102/58 mm Hg. After stopping the opioid infusion, what should the nurse do next? a. Notify the charge nurse b. Draw arterial blood gases c. Administer an opiate antagonist per standing orders d. Perform a thorough assessment, including mental status examination 3. A patient with bone pain caused by metastatic cancer will be receiving transdermal fentanyl patches. The patient asks the nurse what benefits these patches have. The nurse's best response includes which of these features? a. More constant drug levels for analgesia b. Less constipation and minimal dry mouth c. Less drowsiness than with oral opioids d. Lower dependency potential and no major adverse effects 4. Intravenous morphine is prescribed for a patient who has had surgery. The nurse informs the patient that which common adverse effects can occur with this medication? (Select all that apply.) a. Diarrhea b. Constipation c. Pruritus d. Urinary frequency e. Nausea 5. Several patients have standard orders for acetaminophen as needed for pain. While reviewing their histories and assessments, the nurse discovers that one of the patients has a contraindication to acetaminophen therapy. Which patient should receive an alternate medication? a. A patient with a fever of 103.4° F (39.7° C) b. A patient admitted with deep vein thrombosis c. A patient admitted with severe hepatitis d. A patient who had abdominal surgery 1 week earlier 6. The nurse is administering an intravenous dose of morphine sulfate to a 48-yearold postoperative patient. The dose ordered is 3 mg every 3 hours as needed for pain. The medication is supplied in vials of 4 mg/mL. How much will be drawn into the syringe for this dose? 7. An opioid analgesic is prescribed for a patient. The nurse checks the patient's medical history knowing this medication is contraindicated in which disorder? a. Renal insufficiency b. Severe asthma c. Liver disease d. Diabetes mellitus 8. A patient with renal cancer needs an opiate for pain control. Which opioid medication would be the safest choice for this patient? a. Fentanyl b. hydromorphone (Dilaudid) c. Morphine sulfate d. methadone (Dolophine) 1. d, 2. c, 3. a, 4. b, c, e 5. c, 6. 0.75 mL, 7. b, 8. D CH11 General and local anesthetics 1. The physician has requested “lidocaine with epinephrine.” The nurse recognizes that the most important reason for adding epinephrine is that it a. Helps to calm the patient before the procedure. b. Minimizes the risk for an allergic reaction. c. Enhances the effect of the local lidocaine. d. Reduces bleeding in the surgical area. 2. The surgical nurse is reviewing operative cases scheduled for the day. Which of these patients is more prone to complications from general anesthesia? a. A 79-year-old woman who is about to have hip replacement surgery b. A 49-year-old male athlete who quit heavy smoking 12 years ago c. A 30-year-old woman who is in perfect health but has never had anesthesia d. A 50-year-old woman scheduled for outpatient laser surgery for vision correction 3. Which nursing diagnosis is possible for a patient who is now recovering after having been under general anesthesia for 3 to 4 hours during surgery? a. Impaired urinary elimination related to the use of vasopressors as anesthetics b. Increased cardiac output related to the effects of general anesthesia c. Risk for falls related to decreased sensorium for 2 to 4 days postoperatively d. Impaired gas exchange due to the CNS depressant effect of general anesthesia 4. A patient is recovering from general anesthesia. What is the nurse's main concern during the immediate postoperative period? a. Airway b. Pupillary reflexes c. Return of sensations d. Level of consciousness 5. A patient is about to undergo cardioversion, and the nurse is reviewing the procedure and explaining moderate sedation with propofol. The patient asks, “I am afraid of feeling it when they shock me.” What is the nurse's best response? a. “You won't receive enough of a shock to feel anything.” b. “You will feel the shock but you won't remember any of the pain.” c. “These medications will help ease any pain during the procedure, and many patients often report having no recollection of the procedure.” d. “They will give you enough pain medication to prevent you from feeling it.” 6. The nurse is administering an NMBD to a patient during a surgical procedure. Number the following phases of muscle paralysis in the order in which the patient will experience them. (Number 1 is the first step.) a. Paralysis of intercostals and diaphragm muscles b. Muscle weakness c. Paralysis of muscles of the limbs, neck, and trunk d. Paralysis of small rapidly moving muscles (fingers, eye) 7. During a patient's recovery from a lengthy surgery, the nurse monitors for signs of malignant hyperthermia. In addition to a rapid rise in body temperature, which assessment findings would indicate the possible presence of this condition? (Select all that apply.) a. Respiratory depression b. Tachypnea c. Tachycardia d. Seizure activity e. Muscle rigidity 8. A patient will be receiving diazepam (Valium), 2 mg, IV push as part of preprocedure sedation. The medication is available in an injectable solution of 5 mg/mL. How many milliliters will the nurse give for this dose? 1. d, 2. a, 3. d, 4. a, 5. c, 6. a = 4, b = 1, c = 3, d = 2, 7. b, c, e, 8. 0.4 mL   CH12 Central nervous system depressants and muscle depressants 1. A patient has been admitted to the emergency department because of an overdose of an oral benzodiazepine. He is very drowsy but still responsive. The nurse will prepare for which immediate intervention? a. Hemodialysis to remove the medication b. Administration of flumazenil c. Administration of naloxone d. Intubation and mechanical ventilation 2. An older adult has been given a benzodiazepine for sleep induction, but the night nurse noted that the patient was awake most of the night, watching television and reading in bed. The nurse documents that the patient has had which type of reaction to the medication? a. Allergic b. Teratogenic c. Paradoxical d. Idiopathic 3. The nurse is preparing to administer a medication for sleep. Which intervention applies to the administration of a nonbenzodiazepine, such as zaleplon (Sonata)? a. These drugs need to be taken about 1 hour before bedtime. b. Because of their rapid onset, these drugs need to be taken just before bedtime. c. The patient needs to be cautioned about the high incidence of morning drowsiness that may occur after taking these drugs. d. These drugs are less likely to interact with alcohol. 4. The nurse will monitor the patient who is taking a muscle relaxant for which adverse effect? a. CNS depression b. Hypertension c. Peripheral edema d. Blurred vision 5. A hospitalized patient is complaining of having difficulty sleeping. Which action will the nurse take first to address this problem? a. Administer a sedative-hypnotic drug if ordered. b. Offer tea made with the herbal preparation valerian. c. Encourage the patient to exercise by walking up and down the halls a few times if tolerated. d. Provide an environment that is restful, and reduce loud noises. 6. Which considerations are important for the nurse to remember when administering a benzodiazepine as a sedative-hypnotic drug? (Select all that apply.) a. These drugs are intended for long-term management of insomnia. b. The drugs can be administered safely with other CNS depressants for insomnia. c. The dose needs to be given about 1 hour before the patient's bedtime. d. The drug is used as a first choice for treatment of sleeplessness. e. The patient needs to be evaluated for the drowsiness that may occur the morning after a benzodiazepine is taken. 7. A child is to receive phenobarbital 2 mg/kg IV on call as a preoperative sedative. The child weighs 64 pounds. How many milligrams will the child receive for this dose? (Record your answer using one decimal place.) 8. The nurse is reviewing the prescriptions for a patient who will be discharged to home after being hospitalized for a hysterectomy. The patient asked for a sleeping pill, and the surgeon wrote a prescription for Ambien, 10 mg at bedtime as needed for sleep. What is the nurse's priority action at this time? a. Review the potential adverse effects with the patient. b. Suggest that the patient try drinking a glass of wine at bedtime. c. Contact the prescriber to question the dose of the Ambien. d. Assist the patient to find a pharmacy to fill the prescription on her way home. 1. b, 2. c, 3. b, 4. a, 5. d, 6. c, e, 7. 58.2 mg, 8. c   CH13 Central nervous system depressants and muscle relaxants 1. A patient with narcolepsy will begin treatment with a CNS stimulant. The nurse expects to see which adverse effect? a. Bradycardia b. Nervousness c. Mental clouding d. Drowsiness at night 2. A patient at a weight management clinic who was given a prescription for orlistat (Xenical) calls the clinic hotline complaining of a “terrible side effect.” The nurse suspects that the patient is referring to which problem? a. Nausea b. Sexual dysfunction c. Urinary incontinence d. Fecal incontinence 3. The nurse is developing a plan of care for a patient receiving an anorexiant. Which nursing diagnosis is most appropriate? a. Deficient fluid volume b. Sleep deprivation c. Impaired memory d. Imbalanced nutrition, less than body requirements 4. A patient has a new prescription for sumatriptan (Imitrex). The nurse providing patient teaching on self-administration will include which information? a. Correct technique for intramuscular injections b. Take the medication before the headache worsens. c. Allow at least 30 minutes between injections. d. Take no more than 4 doses in a 24-hour period. 5. The nurse is reviewing the history of a patient who will be starting the triptan sumatriptan (Imitrex) as part of treatment for migraine headaches. Which condition, if present, may be a contraindication to triptan therapy? a. Cardiovascular disease b. Chronic bronchitis c. History of renal calculi d. Diabetes mellitus type 2 6. The nurse is reviewing medication therapy with the parents of an adolescent with ADHD. Which statement is correct? (Select all that apply.) a. “Be sure to have your child blow his nose before administering the nasal spray.” b. “This medication is used only when symptoms of ADHD are severe.” c. “The last dose should be taken 4 to 6 hours before bedtime to avoid interference with sleep.” d. “Be sure to contact the physician right away if you notice expression of suicidal thoughts.” e. “We will need to check your child's height and weight periodically to monitor physical growth.” f. “If adverse effects become severe, stop the medication for 3 to 4 days.” 7. The medication order reads: “Atomoxetine (Strattera) 1.2 mg/kg/day in 2 divided doses.” The child weighs 66 lbs. How much will be given with each dose? 8. A patient with narcolepsy is having problems with excessive daytime sleepiness. The nurse expects which drug to be prescribed to improve the patient's wakefulness? a. phentermine (Ionamin) b. almotriptan (Axert) c. modafinil (Provigil) d. methylphenidate (Ritalin) 1. b, 2. d, 3. d, 4. b, 5. a, 6. c, d, e, 7. 18 mg per dose, 8. C   CH14 Antiepileptic drugs 1. The nurse is preparing to give medications. Which is the most appropriate nursing action for intravenous (IV) phenytoin (Dilantin)? a. Give IV doses via rapid IV push. b. Administer in normal saline solutions. c. Administer in dextrose solutions. d. Ensure continuous infusion of the drug. 2. The nurse is reviewing the drugs currently taken by a patient who will be starting drug therapy with carbamazepine (Tegretol). Which drug may raise a concern for interactions? a. digoxin (Lanoxin) b. acetaminophen (Tylenol) c. diazepam (Valium) d. warfarin (Coumadin) 3. Which response would the nurse expect to find in a patient with a phenytoin (Dilantin) level of 25 mcg/mL? a. Ataxia b. Hypertensionc. Seizures d. No unusual response; this level is therapeutic. 4. A patient is taking pregabalin (Lyrica) but does not have a history of seizures. The nurse recognizes that this drug is also indicated for a. Postherpetic neuralgia. b. Viral infections. c. Parkinson's disease. d. depression. 5. The nurse is assessing a newly admitted patient who has a history of seizures. During the assessment, the patient has a generalized seizure that does not stop for several minutes. The nurse expects that which drug will be ordered for this condition? a. Valproic acid (Depakote) b. neurontin (Gabapentin) c. carbamazepine (Tegretol) d. diazepam (Valium) 6. The nurse is administering an antiepileptic drug and will follow which guidelines? (Select all that apply.) a. Monitor the patient for drowsiness. b. Medications may be stopped if seizure activity disappears. c. Give the medication at the same time every day. d. Give the medication on an empty stomach. e. Notify the prescriber if the patient is unable to take the medication. 7. The nurse is preparing to administer valproic acid to a child. The order reads: “Give valproic acid, 15 mg/kg/day PO in three divided doses.” The child weighs 33 pounds. How many milligrams will the child receive with each dose? 8. The nurse is providing education for a patient who will be taking an antiepileptic drug for the first time. Which statement by the patient indicates that further teaching is indicated? a. “I will take the medicine at the same time every day.” b. “I will check with my doctor before taking any over-the counter drugs.” c. “I will keep the appointments to check my bloodwork.” d. “I can drive to work again once my drug levels are normal.” 1. b, 2. b, 3. a, 4. a, 5. d, 6. a, c, e, 7. 75 mg per dose, 8. d   CH15 Antiparkinson drugs 1. Which condition will alert the nurse to a potential caution or contraindication regarding the use of a dopaminergic drug for treatment of mild Parkinson's disease? a. Diarrhea b. Tremors c. Angle-closure glaucoma d. Unstable gait 2. A patient is taking entacapone (Comtan) as part of the therapy for Parkinson's disease. Which intervention by the nurse is appropriate at this time? a. Notify the patient that this drug causes discoloration of the urine. b. Limit the patient's intake of tyramine-containing foods. c. Monitor the results of renal studies because this drug can seriously affect renal function. d. Force fluids to prevent dehydration. 3. During a patient teaching session about antiparkinson drugs, the nurse will include which statement? a. “The drug will be stopped when tremors and weakness are relieved.” b. “If a dose is missed, take two doses to avoid significant decreases in blood levels.” c. “Be sure to notify your physician if your urine turns brownish-orange in color.” d. “Take care to change positions slowly to prevent falling due to a drop in blood pressure.” 4. A patient will be taking selegiline (Eldepryl), 10 mg daily, in addition to dopamine replacement therapy for Parkinson's disease. The nurse will implement which precautions regarding selegiline? a. Teach the patient to avoid foods containing tyramine. b. Monitor for dizziness. c. Inform the patient that this drug may cause urine discoloration. d. Monitor for weight gain. 5. A patient with Parkinson's disease will start taking entacapone (Comtan) along with the carbidopa-levodopa (Sinemet) he has been taking for a few years. The nurse recognizes that the advantage of taking entacapone is that a. The entacapone can reduce on-off effects. b. The levodopa may be stopped in a few days. c. There is less GI upset with entacapone. d. It does not cause the cheese effect. 6. The nurse is assessing a patient who has begun therapy with amantadine (Symmetrel) for Parkinson's disease. The nurse will look for which possible adverse effects? (Select all that apply.) a. Nausea b. Palpitations c. Dizziness d. Insomnia e. Fatigue 7. The order reads: bromocriptine (Parlodel) 10 mg per day PO. The medication is available in 2.5-mg tablets. How many tablets will the nurse give per dose? 8. A patient who has been taking carbidopa-levodopa for Parkinson's disease for over 1 year wants to start a low-carbohydrate/high-protein weight-loss diet. The nurse tells the patient that this type of diet may have what effect on his drug therapy? a. There will be no problems with this diet while on this medication. b. The high-protein diet can slow or prevent absorption of this medication. c. The high-protein diet may cause increased blood levels of this medication. d. The high-protein diet will cause no problems as long as the patient also takes pyridoxine (vitamin B6). 1. c, 2. a, 3. d, 4. b, 5. a, 6. a, c, d, 7. 4 tablets, 8. B   CH16 Psychotherapeutic 1. In caring for a patient experiencing ethanol withdrawal, the nurse expects to administer which medication or medication class as treatment for this condition? a. lithium (Eskalith) b. Benzodiazepines c. buspirone (BuSpar) d. Antidepressants 2. Patient teaching for a patient receiving an MAOI would include instructions to avoid which food product? a. Orange juice b. Milk c. Shrimp d. Swiss cheese 3. After a patient has been treated for depression for 4 weeks, the nurse calls the patient to schedule a follow-up visit. What concern will the nurse assess for during the conversation with the patient? a. Weakness b. Hallucinationsc. Suicidal ideation d. Difficulty with urination 4. The nurse is caring for a patient who has been taking clozapine (Clozaril) for 2 months. Which laboratory test(s) should be performed regularly while the patient is taking this medication? a. Platelet count b. WBC count c. Liver function studies d. Renal function studies 5. The nurse is giving medications to a patient. Which drug or drug class, when administered with lithium, increases the risk for lithium toxicity? a. Thiazides b. Levofloxacin c. Calcium citrate d. Beta blockers 6. The nurse is teaching a patient about treatment with an SSRI antidepressant. Which teaching considerations are appropriate? (Select all that apply.) a. The patient should be told which foods contain tyramine and instructed to avoid these foods. b. The patient should be instructed to use caution when standing up from a sitting position. c. The patient should not take any products that contain the herbal product St. John's wort. d. This medication should not be stopped abruptly. e. Drug levels may become toxic if dehydration occurs. f. The patient should be told to check with the prescriber before taking any over-the-counter medications. 7. A patient with a feeding tube will be receiving risperidone (Risperdal) 8 mg in 2 divided doses via the feeding tube. The medication is available in a 1 mg/mL solution. How many milliliters will the nurse administer for each dose? 8. A patient who has been taking lithium for 6 months has had severe vomiting and diarrhea from a gastrointestinal flu. The nurse will assess for which potential problem at this time? a. Anxiety b. Chest pain c. Agitation d. Dehydration 1. b, 2. d, 3. c, 4. b, 5. a, 6. b, c, d, f, 7. 4 mL per dose, 8. D   CH17 Substance abuse 1. A patient is experiencing withdrawal from opioids. The nurse expects to see which assessment finding most commonly associated with acute opioid withdrawal? a. Elevated blood pressure b. Decreased pulse c. Lethargy d. Constipation 2. During treatment for withdrawal from opioids, the nurse expects which medication to be ordered? a. amphetamine (Dexedrine) b. clonidine (Catapres) c. diazepam (Valium) d. disulfiram (Antabuse) 3. The nurse is presenting a seminar on substance abuse. Which drug is the most commonly used illicit drug in the United States? a. Crack cocaine b. Heroin c. Marijuana d. Methamphetamine 4. A patient who is taking disulfiram as part of an alcohol treatment program accidentally takes a dose of cough syrup that contains a small percentage of alcohol. The nurse expects to see which symptom as a result of acetaldehyde syndrome? a. Lethargy b. Copious vomiting c. Hypertension d. No ill effect because of the small amount of alcohol in the cough syrup 5. The nurse is assessing a patient for possible substance abuse. Which assessment finding indicates possible use of amphetamines? a. Lethargy and fatigue b. Cardiovascular depression c. Talkativeness and euphoria d. Difficulty swallowing and constipation 6. A patient experiencing ethanol withdrawal is beginning to show severe manifestations of delirium tremens. The nurse will plan to implement which interventions for this patient? (Select all that apply.) a. Doses of an oral benzodiazepine b. Doses of an intravenous benzodiazepine c. Restraints if the patient becomes confused, agitated, or a threat to himself or others d. Thiamine supplementation e. Oral disulfiram (Antabuse) treatment f. Monitoring in the intensive care unit 7. A patient has been admitted to the emergency department after a suspected overdose of benzodiazepines mixed with alcohol. The patient is lethargic and cannot speak. The nurse expects which immediate measures to be implemented? (Select all that apply.) a. Prepare to administer naloxone (Narcan). b. Prepare to administer flumazenil. c. Monitor the patient for convulsions. d. Prepare for potential respiratory arrest. e. Apply restraints. 8. The nurse is teaching a class about the effects of alcohol. Long-term excessive use of alcohol is associated with which of these problems? (Select all that apply.) a. Coronary artery disease b. Wernicke's encephalopathy c. Polyneuritis d. Seizures e. Cirrhosis of the liver f. Korsakoff's psychosis 1. a, 2. b, 3. c, 4. b, 5. c, 6. b, c, d, f, 7. b, c, d, 8. b, c, e, f CH18 Adrenergic drugs 1. The nurse caring for a patient who is receiving beta1 agonist drug therapy needs to be aware that these drugs cause which effect? a. Increased cardiac contractility b. Decreased heart rate c. Bronchoconstriction d. Increased GI tract motility 2. During a teaching session for a patient who is receiving inhaled salmeterol, the nurse emphasizes that the drug is indicated for which condition? a. Rescue treatment of acute bronchospasms b. Prevention of bronchospasms c. Reduction of airway inflammation d. Long-term treatment of sinus congestion 3. For a patient receiving a vasoactive drug such as intravenous dopamine, which action by the nurse is most appropriate? a. Monitor the gravity drip infusion closely, and adjust as needed. b. Assess the patient's cardiac function by checking the radial pulse. c. Assess the intravenous site hourly for possible infiltration. d. Administer the drug by intravenous boluses according to the patient's blood pressure. 4. A patient is receiving dobutamine for shock and is complaining of feeling more “skipping beats” than yesterday. What will the nurse do next? a. Monitor for other signs of a therapeutic response to the drug. b. Titrate the drug to a higher dose to reduce the palpitations. c. Discontinue the dobutamine immediately. d. Assess the patient's vital signs and cardiac rhythm. 5. When a drug is characterized as having a negative chronotropic effect, the nurse knows to expect which effect? a. Reduced blood pressure b. Decreased heart rate c. Decreased ectopic beats d. Increased force of cardiac contractions 6. The nurse is monitoring a patient who is receiving an infusion of a betaadrenergic agonist. Which adverse effects may occur with this infusion? (Select all that apply.) a. Mild tremors b. Bradycardia c. Tachycardia d. Palpitations e. Drowsiness f. Nervousness 7. The order reads: “Dopamine 3 mcg/kg/min IV.” The solution available is 400 mg in 250 mL D5W, and the patient weighs 176 pounds. The nurse will set the IV infusion pump to run at how many mL/hour? 8. The nurse is reviewing the home medications for a newly admitted patient, and notes that the patient takes Mirabegron (Myrbetriq). The nurse will conclude that the patient has which condition? a. Asthma b. Overactive bladder c. Urinary retention d. Orthostatic hypotension 1. a, 2. b, 3. c, 4. d, 5. b, 6. a, c, d, f, 7. 9 mL/hr, 8. B   CH19 Adrenergic-blocking drugs 1. When a patient has experienced extravasation of a peripheral infusion of dopamine, the nurse will inject the alpha blocker phentolamine (Regitine) into the area of extravasation and expect which effect? a. Vasoconstriction b. Vasodilation c. Analgesia d. Hypotension 2. When administering beta blockers, the nurse will follow which guideline for administration and monitoring? a. The drug may be discontinued at any time. b. Postural hypotension rarely occurs with this drug. c. Tapering off the medication is necessary to prevent rebound hypertension. d. The patient needs to stop taking the medication at once if he or she gains 3 to 4 pounds in a week. 3. The nurse providing teaching for a patient who has a new prescription for beta1 blockers will keep in mind that these drugs may result in which effect? a. Tachycardiab. Tachypnea c. Bradycardia d. Bradypnea 4. A patient who has recently had a myocardial infarction (MI) has started therapy with a beta blocker. The nurse explains that the main purpose of the beta blocker for this patient is to a. Cause vasodilation of the coronary arteries. b. Prevent hypertension. c. Increase conduction through the SA node. d. Protect the heart from circulating catecholamines. 5. Before initiating therapy with a nonselective beta blocker, the nurse will assess the patient for a history of which condition? a. Hypertension b. Liver disease c. Pancreatitis d. Asthma 6. A patient is taking an alpha blocker as treatment for benign prostatic hyperplasia. The nurse will monitor for which potential drug effects? (Select all that apply.) a. Orthostatic hypotension b. Increased blood pressure c. Increased urine flow d. Headaches e. Bradycardia 7. A child in the pediatric ICU has been receiving a dopamine infusion. This morning while on rounds, the nurse noted that the IV has infiltrated. After stopping the infusion, the nurse prepares to administer phentolamine (Regitine). The ordered dose is 0.2 mg/kg, to be injected into the area of extravasation. The child weighs 39 lb. How many milligrams will the nurse administer? (Record your answer using one decimal place.) 8. The nurse is reviewing the mechanism of action of alpha adrenergic drugs. Adrenergic blockade at the alpha receptors leads to which effects? (Select all that apply). a. Miosis b. Vasodilation c. Vasoconstriction d. Bradycardia e. Reduced blood pressure 1. b, 2. c, 3. c, 4. d, 5. d, 6. a, c, d, 7. 3.5 mg, 8. a, b, e.   CH20 Cholinergic drugs 1. The nurse is reviewing the use of bethanechol (Urecholine) in a patient who is experiencing postoperative urinary retention. Which statement best describes the mechanism of action of bethanechol? a. It causes decreased bladder tone and motility. b. It causes increased bladder tone and motility. c. It increases the sensation of a full bladder. d. It causes the sphincters in the bladder to become tighter. 2. The family of a patient who has recently been diagnosed with Alzheimer's disease is asking about the new drug prescribed to treat this disease. The patient's wife says, “I'm so excited that there are drugs that can cure this disease! I can't wait for him to start treatment.” Which reply from the nurse is appropriate? a. “The sooner he starts the medicine, the sooner it can have this effect.” b. “These effects won't be seen for a few months.” c. “These drugs do not cure Alzheimer's disease. Let's talk about what the physician said to expect with this drug therapy.” d. “His response to this drug therapy will depend on how far along he is in the disease process.” 3. The nurse is giving a dose of bethanechol (Urecholine) to a postoperative patient. The nurse is aware that contraindications to bethanechol include: a. Bladder atony. b. Peptic ulcer. c. Urinary retention. d. hypothyroidism. 4. A patient took an accidental overdose of a cholinergic drug while at home. He comes to the emergency department with severe abdominal cramping and bloody diarrhea. The nurse expects that which drug will be used to treat this patient? a. atropine (generic) b. pilocarpine (Salagen) c. bethanechol (Urecholine) d. phentolamine (Regitine) 5. The nurse is reviewing the orders for a newly admitted patient and sees an order for edrophonium (Tensilon). The nurse expects that this drug is ordered for which reason? a. To reduce symptoms and delay the onset of Alzheimer's disease b. To treat the symptoms of myasthenia gravis c. To aid in the diagnosis of myasthenia gravis d. To reverse the effects of non-depolarizing neuromuscular blocking drugs after surgery 6. When giving intravenous cholinergic drugs, the nurse must watch for symptoms of a cholinergic crisis, such as: (Select all that apply.) a. Peripheral tingling. b. hypotension. c. Dry mouth. d. syncope. e. dyspnea. f. tinnitus. 7. A patient who has had an accidental overdose of tricyclic antidepressants is to receive physostigmine (Antilirium), 1.5 mg IM stat. The medication is available in a vial that contains 2 mL, with a concentration of 1 mg/mL. How much medication will the nurse draw up into the syringe for this dose? 8. The nurse is teaching a patient about the possible adverse effects of donepezil (Aricept) for Alzheimer's disease. Which of these are possible adverse effects? (Select all that apply.) a. Constipation b. GI upset c. Drowsinessd. Dizziness e. Blurred vision 1. b, 2. c, 3. b, 4. a, 5. c, 6. b, d, e, 7. 1.5 mL, 8. b, c, d CH21 Cholinergic-blocking drugs 1. The nurse is providing education about cholinergic-blocking drug therapy to an older adult patient. Which is an important point to emphasize for this patient? a. Avoid exposure to high temperatures. b. Limit liquid intake to avoid fluid overload. c. Begin an exercise program to avoid adverse effects. d. Stop the medication if excessive mouth dryness occurs. 2. The nurse is giving a cholinergic-blocking drug and will assess the patient for which contraindications to these drugs? a. Chronic bronchitis b. Peptic ulcer disease c. Irritable bowel syndrome d. Benign prostatic hyperplasia 3. When assessing for adverse effects of cholinergic-blocking drug therapy, the nurse would expect to find that the patient complains of which drug effect? a. Diaphoresis b. Dry mouth c. Diarrhead. Urinary frequency 4. The nurse administering a cholinergic-blocking drug to a patient who is experiencing drug-induced extrapyramidal effects would assess for which therapeutic effect? a. Decreased muscle rigidity and tremors b. Increased heart rate c. Decreased bronchial secretions d. Decreased GI motility and peristalsis 5. During the assessment of a patient about to receive a cholinergic-blocking drug, the nurse will determine whether the patient is taking any drugs that may potentially interact with the anticholinergic, including: a. opioids, such as morphine sulfate. b. antibiotics, such as penicillin. c. Tricyclic antidepressants, such as amitriptyline. d. anticonvulsants, such as phenobarbital. 6. A patient has been given a prescription for transdermal scopolamine patches (Transderm-Scōp) for motion sickness for use during a vacation cruise. The nurse will include which instructions? (Select all that apply.) a. “Apply the patch as soon as you board the ship.” b. “Apply the patch 3 to 4 hours before boarding the ship.” c. “The patch needs to be placed on a nonhairy area on your upper chest or upper arm.” d. “The patch needs to be placed on a nonhairy area just behind your ear.” e. “Change the patch every 3 days.” f. “Rotate the application sites.” 7. The preoperative order for an adult patient reads: “Give scopolamine, 0.7 mg IM on call for surgery.” The medication is available in vials of 0.4 mg/mL. How many milliliters will the nurse administer for this dose? (Record your answer using one decimal place.) 8. The nurse is assessing a patient who has a prescription for dicyclomine (Bentyl). Which condition is considered a contraindication to this medication? a. GI atony b. Irritable bowel syndrome c. Overactive bladder d. Diabetes mellitus 1. a, 2. d, 3. b, 4. a, 5. c, 6. b, d, e, f, 7. 1.8 mL, 8. A   CH22 Antihypertensive 1. The nurse is administering antihypertensive drugs to older adult patients. The nurse knows that which adverse effect is of most concern for these patients? a. Dry mouth b. Hypotension c. Restlessness d. Constipation 2. When giving antihypertensive drugs, the nurse will consider giving the first dose at bedtime for which class of drugs? a. Alpha blockers such as doxazosin (Cardura) b. Diuretics such as furosemide (Lasix) c. ACE inhibitors such as captopril (Capoten) d. Vasodilators such as hydralazine (Apresoline) 3. A 46-year-old man started antihypertensive drug therapy 3 months earlier and is in the office for a follow-up visit. While the nurse is taking his blood pressure, he informs the nurse that he has had some problems with sexual intercourse. Which is the most appropriate response by the nurse? a. “Not to worry. Eventually, tolerance will develop.” b. “The physician can work with you on changing the doseand/or drugs.” c. “Sexual dysfunction happens with this therapy, and you will learn to accept it.” d. “This is an unusual occurrence, but it is important to stay on your medications.” 4. When a patient is being taught about the potential adverse effects of an ACE inhibitor, which of these effects should the nurse mention as possibly occurring when this drug is taken to treat hypertension? a. Diarrhea b. Nausea c. Dry, nonproductive cough d. Sedation 5. A patient has a new prescription for an ACE inhibitor. During a review of the patient's list of current medications, which would cause concern for a possible interaction with this new prescription? (Select all that apply.) a. A benzodiazepine taken as needed for allergies b. A potassium supplement taken daily c. An oral anticoagulant taken daily d. An opioid used for occasional severe pain e. An NSAID taken as needed for headaches 6. The order reads: Give hydralazine (Apresoline) 0.75 mg/kg/day. The child weighs 16 pounds. How much hydralazine will be given? (Record your answer using two decimal places.) 7. The nurse is assessing a patient who will be starting antihypertensive therapy with an ACE inhibitor. Which condition, if present in the patient, would be a reason for cautious use? a. Asthma b. Rheumatoid arthritis c. Hyperthyroidism d. Renal insufficiency 1. b, 2. a, 3. b, 4. c, 5. b, e, 6. 5.45 mg/kg/day, 7. D   CH23 Antianginal drugs 1. A patient has a new prescription for transdermal nitroglycerin patches. The nurse teaches the patient that these patches are most appropriately used for which reason? a. To relieve exertional angina b. To prevent palpitations c. To prevent the occurrence of angina d. To stop an episode of angina 2. A nurse with adequate knowledge about the administration of intravenous nitroglycerin will recognize that which statement is correct? a. The intravenous form is given by IV push injection. b. Because the intravenous forms are short-lived, the dosing must be every 2 hours. c. Intravenous nitroglycerin must be protected from exposure to light through use of special tubing. d. Intravenous nitroglycerin can be given via gravity drip infusions. 3. Which statement by the patient reflects the need for additional patient education about the calcium channel blocker diltiazem (Cardizem)? a. “I can take this drug to stop an attack of angina.” b. “I understand that food and antacids alter the absorption of this oral drug.” c. “When the long-acting forms are taken, the drug cannot be crushed.” d. “This drug may cause my blood pressure to drop, so I need to be careful when getting up.” 4. While assessing a patient with angina who is to start beta blocker therapy, the nurse is aware that the presence of which condition may be a problem if these drugs are used? a. Hypertension b. Essential tremors c. Exertional angina d. Asthma 5. A 68-year-old male patient has been taking the nitrate isosorbide dinitrate (Isordil) for 2 years for angina. He recently has been experiencing erectile dysfunction and wants a prescription for sildenafil (Viagra). Which response would the nurse most likely hear from the prescriber? a. “He will have to be switched to isosorbide mononitrate if he wants to take sildenafil.” b. “Taking sildenafil with the nitrate may result in severe hypotension, so a contraindication exists.” c. “I'll write a prescription, but if he uses it, he needs to stop taking the isosorbide for one dose.” d. “These drugs are compatible with each other, and so I'll write a prescription.” 6. The nurse is reviewing drug interactions with a male patient who has a prescription for isosorbide dinitrate (Isordil) as treatment for angina symptoms. Which substances listed below could potentially result in a drug interaction? (Select all that apply.) a. A glass of wine b. Thyroid replacement hormone c. tadalafil (Cialis), an erectile dysfunction drug d. metformin (Glucophage), an antidiabetic drug e. carvedilol (Coreg), a beta blocker 7. The order reads, “Give metoprolol (Lopressor) 300 mg/day PO in 2 divided doses.” The tablets are available in 50-mg strength. How many tablets will the patient receive per dose? 8. A patient with angina has been given a prescription for a calcium channel blocker. The nurse knows that this class of drugs is used to treat which type of angina? a. Effort b. Unstable c. Crescendo d. Vasospastic 1. c, 2. c, 3. a, 4. d, 5. b, 6. a, c, e, 7. 3 tablets per dose (150 mg per dose), 8. d.   CH24 Heart failure drugs 1. When teaching the patient about the signs and symptoms of cardiac glycoside toxicity, the nurse should alert the patient to watch for a. Visual changes such as photophobia. b. Flickering lights or halos around lights. c. Dizziness when standing up. d. Increased urine output. 2. During assessment of a patient who is receiving digoxin, the nurse monitors for findings that would indicate an increased possibility of toxicity, such as: a. Apical pulse rate of 62 beats/min. b. Digoxin level of 1.5 ng/mL. c. Serum potassium level of 2.0 mEq/L. d. Serum calcium level of 9.9 mEq/L. 3. When monitoring a patient who is receiving an intravenous infusion of nesiritide (Natrecor), the nurse will look for which adverse effect? a. Dysrhythmia b. Proteinuria c. Hyperglycemia d. Hypertension 4. A patient is taking a beta blocker as part of the treatment plan for heart failure. The nurse knows that the purpose of the beta blocker for this patient is to a. Increase urine output. b. Prevent stimulation of the heart by catecholamines. c. Increase the contractility of the heart muscle. d. Cause peripheral vasodilation. 5. The nurse is assessing a patient who is receiving a milrinone infusion and checks the patient's cardiac rhythm on the heart monitor. What adverse cardiac effect is most likely to occur in a patient who is receiving intravenous milrinone? a. Tachycardia b. Bradycardia c. Atrial fibrillation d. Ventricular dysrhythmia 6. The nurse is administering an intravenous infusion of a phosphodiesterase inhibitor to a patient who has heart failure. The nurse will evaluate the patient for which therapeutic effects? (Select all that apply.) a. Positive inotropic effects b. Vasodilation c. Decreased heart rate d. Increased blood pressure e. Positive chronotropic effects 7. The medication order for a 5-year-old patient reads: “Give digoxin elixir, 15 mcg/kg, PO now.” The child weighs 20 kg. How many milligrams will this patient receive? 8. A patient with heart failure will be starting the beta blocker metoprolol (Lopressor). The nurse will monitor for which expected cardiovascular effects? (Select all that apply.) a. Increased heart rate b. Increased myocardial contractility c. Delayed AV node conduction d. Reduced heart rate e. Decreased myocardial automaticity 1. b, 2. c, 3. a, 4. b, 5. d, 6. a, b, e, 7. 0.3 mg, 8. c, d, e.   CH25 Antidysrhythmic drugs 1. A patient with a rapid, irregular heart rhythm is being treated in the emergency department with adenosine. During administration of this drug, the nurse will be prepared to monitor the patient for which effect? a. Nausea and vomiting b. Transitory asystole c. Muscle tetany d. Hypertension 2. When assessing a patient who has been taking amiodarone for 6 months, the nurse monitors for which potential adverse effect? a. Hyperglycemia b. Dysphagia c. Photophobia d. Urticaria 3. The nurse is assessing a patient who has been taking quinidine and asks about adverse effects. An adverse effect associated with the use of this drug includes: a. Muscle pain. b. tinnitus. c. Chest pain. d. Excessive thirst. 4. A patient calls the family practice office to report that he has seen his pills in his stools when he has a bowel movement. How will the nurse respond? a. “The pills are not being digested properly. You need to take them on an empty stomach.” b. “The pills are not being digested properly. You need to take them with food.” c. “What you are seeing is the wax matrix that contained the medication, but the drug has been absorbed.” d. “This indicates that you are not tolerating this medication and will need to switch to a different form.” 5. The nurse is administering lidocaine and considers which condition, if present in the patient, a caution for the use of this drug? a. Tachycardia b. Hypertension c. Ventricular dysrhythmias d. Renal dysfunction 6. When the nurse is teaching a patient about taking an antidysrhythmic drug, which statements by the nurse are correct? (Select all that apply.) a. “Take the medication with an antacid if stomach upset occurs.” b. “Do not chew sustained-release capsules.” c. “If weight gain of 5 pounds within 1 week occurs, notify your physician at the next office visit.” d. “If you experience severe adverse effects, stop the drug and notify your physician.” e. “You may take the medication with food if stomach upset occurs.” 7. A patient is in the emergency department with new-onset rapid-rate atrial fibrillation. The nurse is about to add a continuous infusion of diltiazem (Cardizem) at 5 mg/hr, but must first give a bolus of 0.25 mg/kg over 2 minutes. The patient weighs 220 pounds. The medication comes in a vial of 5 mg/mL. How many milligrams will the patient receive, and how many milliliters will the nurse draw up for this dose? 8. A patient is in the clinic for a follow-up visit. He has been taking amiodarone (Cordarone) for almost 1 year, and today he tells the nurse, “I am noticing some blue color around my face, neck, and upper arms. Is that normal?” Which is the nurse's correct response? a. “This is an expected side effect and should go away soon.” b. “This is a harmless effect. As long as the medication is working, we'll just monitor your skin.” c. “This can happen with amiodarone. I will let your doctor know about it right away.” d. “How much sun exposure have you had recently?” 1. b, 2. c, 3. b, 4. c, 5. d, 6. b, e, 7. 25 mg, 5 mL, 8. c.   CH26 Coagulation modifier drugs 1. The nurse is monitoring a patient who is receiving antithrombolytic therapy in the emergency department because of a possible MI. Which adverse effect would be of the greatest concern at this time? a. Dizziness b. Blood pressure of 130/98 mm Hg c. Slight bloody oozing from the IV insertion site d. Irregular heart rhythm 2. A patient is receiving instructions regarding warfarin therapy and asks the nurse about what medications she can take for headaches. The nurse will tell her to avoid which type of medication? a. Opioids b. acetaminophen (Tylenol) c. NSAIDs d. There are no restrictions while taking warfarin. 3. The nurse is teaching a patient about self-administration of enoxaparin (Lovenox). Which statement will be included in this teaching session? a. “We will need to teach a family member how to give this drug in your arm.” b. “This drug is given in the folds of your abdomen, but at least 2 inches away from your navel.” c. “This drug needs to be taken at the same time every day with a full glass of water.” d. “Be sure to massage the injection site thoroughly after giving the drug.” 4. A patient is receiving dabigatran (Pradaxa), 150 mg twice daily, as part of treatment for atrial fibrillation. Which condition, if present, would be a concern if the patient were to receive this dose? a. Asthma b. Elevated liver enzymes c. Renal impairment d. History of myocardial infarction 5. A patient has received a double dose of heparin during surgery and is bleeding through the incision site. While the surgeons are working to stop the bleeding at the incision site, the nurse will prepare to take what action at this time? a. Give IV vitamin K as an antidote. b. Give IV protamine sulfate as an antidote. c. Call the blood bank for an immediate platelet transfusion. d. Obtain an order for packed red blood cells. 6. A patient is starting warfarin (Coumadin) therapy as part of treatment for atrial fibrillation. The nurse will follow which principles of warfarin therapy? (Select all that apply.) a. Teach proper subcutaneous administration. b. Administer the oral dose at the same time every day. c. Assess carefully for excessive bruising or unusual bleeding. d. Monitor laboratory results for a target INR of 2 to 3. e. Monitor laboratory results for a therapeutic aPTT value of 1.5 to 2.5 times the control value. 7. The order for enoxaparin (Lovenox) reads: Give 1 mg/kg subcut every 12 hours. The patient weighs 242 lb, and the medication is available in an injection form of 120 mg/0.8 mL. How many milligrams will this patient receive? How many milliliters will the nurse draw up for the injection? (Round to hundredths.) 8. The nurse is assessing a patient who has a new prescription for vorapaxar (Zontivity). Which of these conditions are considered contraindications to the use of vorapaxar? (Select all that apply.) a. Impaired renal function b. Impaired liver function c. History of myocardial infarction d. Peripheral artery disease e. History of stroke 1. d, 2. c, 3. b, 4. c, 5. b, 6. b, c, d, 7. 110 mg; 0.73 mL, 8. a, b, e   CH27 Antilipemic drugs 1. A nurse administering niacin would implement which action to help to reduce adverse effects? a. Give the medication with grapefruit juice. b. Administer a small dose of aspirin or an NSAID 30 minutes before the niacin dose. c. Administer the medication on an empty stomach. d. Have the patient increase dietary fiber intake. 2. When administering niacin, the nurse needs to monitor for which adverse effect? a. Cutaneous flushing b. Muscle pain c. Headache d. Constipation 3. Which point will the nurse emphasize to a patient who is taking an antilipemic medication in the “statin” class? a. The drug needs to be taken on an empty stomach before meals. b. A low-fat diet is not necessary while taking these medications. c. It is important to report muscle pain immediately. d. Improved cholesterol levels will be evident within 2 weeks. 4. A patient is being assessed before a newly ordered antilipemic medication is given. Which condition would be a potential contraindication? a. Diabetes insipidus b. Pulmonary fibrosis c. Liver cirrhosis d. Myocardial infarction 5. A patient is currently taking a statin. The nurse considers that the patient may have a higher risk for developing rhabdomyolysis when also taking which product? a. NSAIDs b. A fibric acid derivative c. Orange juice d. Fat-soluble vitamins 6. The nurse is administering cholestyramine (Questran), a bile acid sequestrant. Which nursing intervention(s) is appropriate? (Select all that apply.) a. Administering the drug on an empty stomach b. Administering the drug with meals c. Instructing the patient to follow a low-fiber diet while taking this drug d. Instructing the patient to take a fiber supplement while taking this drug e. Increasing fluid intake f. Not administering this drug at the same time as other drugs 7. The medication order reads: niacin, 500 mg PO, every evening. The medication is available in 250-mg tablets. How many tablets will the patient receive per dose? 8. A patient has been taking simvastatin (Zocor) for 6 months. Today he received a call that he needs to come to the office for a “laboratory check.” The nurse expects which laboratory studies to be ordered at this time? (Select all that apply.) a. PT/INR b. Total cholesterol c. Triglyceride d. Liver function studies e. Complete blood count f. HDL and LDL levels 1. b, 2. a, 3. c, 4. c, 5. b, 6. b, d, e, f, 7. 2 tablets, 8. b, c, d, f   CH28 Diuretic drugs 1. The nurse is reviewing the medications that have been ordered for a patient for whom a loop diuretic has just been prescribed. The loop diuretic may have a possible interaction with which of the following? a. Vitamin D b. Warfarin c. Penicillins d. NSAIDs 2. When monitoring laboratory test results for patients receiving loop and thiazide diuretics, the nurse knows to look for a. Decreased serum levels of potassium. b. Increased serum levels of calcium. c. Decreased serum levels of glucose. d. Increased serum levels of sodium. 3. When the nurse is checking the laboratory data for a patient taking spironolactone (Aldactone), which result would be a potential concern? a. Serum sodium level of 140 mEq/L b. Serum calcium level of 10.2 mg/dL c. Serum potassium level of 5.8 mEq/L d. Serum magnesium level of 2.0 mg/dL 4. Which statement needs to be included when the nurse provides patient education for a patient with heart failure who is taking daily doses of spironolactone (Aldactone)? a. “Be sure to eat foods that are high in potassium.” b. “Avoid foods that are high in potassium.” c. “Avoid grapefruit juice while taking this medication.” d. “A low-fiber diet will help prevent adverse effects of this medication.” 5. A patient with diabetes has a new prescription for a thiazide diuretic. Which statement will the nurse include when teaching the patient about the thiazide drug? a. “There is nothing for you to be concerned about when you are taking the thiazide diuretic.” b. “Be sure to avoid foods that are high in potassium.” c. “You need to take the thiazide at night to avoid interactions with the diabetes medicine.” d. “Monitor your blood glucose level closely, because the thiazide diuretic may cause the levels to increase.” 6. An older adult patient has been discharged following treatment for a mild case of heart failure. He will be taking a loop diuretic. Which instruction(s) from the nurse are appropriate? (Select all that apply.) a. “Take the diuretic at the same time each morning.” b. “Take the diuretic only if you notice swelling in your feet.” c. “Be sure to stand up slowly because the medicine may make you feel dizzy if you stand up quickly.” d. “Drink at least 8 glasses of water each day.” e. “Here is a list of foods that are high in potassium; you need to avoid these.” f. “Please call your doctor immediately if you notice muscle weakness or increased dizziness.” 7. The order reads: Give mannitol 0.5 g/kg IV now, over 2 hours. The patient weighs 165 lb, and you have a 100-mL vial of 20% mannitol. How many grams will the patient receive? How many milliliters of mannitol will you prepare for this infusion? 8. A patient is taking an aminoglycoside antibiotic for pneumonia, and will also be taking the loop diuretic furosemide (Lasix) due to fluid overload. The nurse will monitor carefully for which potential effect from the interaction of these two drugs? a. Nephrotoxicity b. Ototoxicity c. Pulmonary fibrosis d. Hepatotoxicity 1. d, 2. a, 3. c, 4. b, 5. d, 6. a, c, f, 7. 37.5 g, 187.5 mL, 8. B   CH29 Fluids and electrolytes 1. Which action by the nurse is most appropriate for the patient receiving an infusion of packed red blood cells? a. Flush the IV line with normal saline before the blood is added to the infusion. b. Flush the IV line with dextrose before the blood is added to the infusion. c. Check the patient's vital signs once the infusion is completed. d. Anticipate that flushed skin and fever are expected reactions to a blood transfusion. 2. When preparing an IV solution that contains potassium, the nurse knows that a contraindication to the potassium infusion would be a. diarrhea. b. Serum sodium level of 145 mEq/L. c. Serum potassium level of 5.6 mEq/L. d. dehydration. 3. When assessing a patient who is about to receive an albumin infusion, the nurse knows that a contraindication for albumin would be a. Acute liver failure. b. Heart failure. c. Severe burns. d. fluid-volume deficit. 4. The nurse is preparing an infusion for a patient who has a deficiency in clotting factors. Which type of infusion is most appropriate? a. Albumin 5% b. Packed RBCs c. Whole blood d. Fresh frozen plasma 5. While monitoring a patient who is receiving an infusion of a crystalloid solution, the nurse will monitor for which potential problem? a. Bradycardia b. Hypotension c. Decreased skin turgor d. Fluid overload 6. The nurse is administering an IV solution that contains potassium chloride to a patient in the critical care unit who has a severely decreased serum potassium level. Which action(s) by the nurse are appropriate? (Select all that apply.) a. Administer the potassium by slow IV bolus. b. Administer the potassium at a rate no faster than 20 mEq/hr. c. Monitor the patient's cardiac rhythm with a heart monitor. d. Use an infusion pump for the administration of IV potassium chloride. e. Administer the potassium IV push. 7. The order reads: “Infuse 1000 mL of normal saline over the next 8 hours.” The IV tubing has a drop factor of 15 gtt/mL. Calculate the mL/hour rate, and calculate the drops/minute setting for the IV tubing with this gravity infusion. 8. A patient is about to receive a dose of the nonprotein plasma expander dextran. The nurse knows that this product is indicated for which type of blood loss? a. Slow loss of 20% or less b. Slow loss of 20% to 50% c. Slow loss of over 50% or acute loss of 20% d. Loss of 80% or more 1. a, 2. c, 3. b, 4. d, 5. d, 6. b, c, d, 7. 125 mL/hr; 31 gtt/min, 8.   CH30 Pituitary drugs 1. A patient is experiencing severe diarrhea, flushing, and life-threatening hypotension associated with carcinoid crisis. The nurse will prepare to administer which drug? a. octreotide (Sandostatin) b. vasopressin (Pitressin) c. somatropin (Humatrope) d. cosyntropin (Cortrosyn) 2. A patient is suspected of having adrenocortical insufficiency. The nurse expects to administer which drug to aid in the diagnosis of this condition? a. octreotide (Sandostatin) b. vasopressin (Pitressin) c. somatropin (Humatrope) d. cosyntropin (Cortrosyn) 3. The nurse is reviewing the medication list for a patient who will be starting therapy with somatropin. Which type of drug would raise a concern that needs to be addressed before the patient starts the somatropin? a. Nonsteroidal antiinflammatory drug for arthritis b. Antidepressant drug c. Penicillin d. Glucocorticoid 4. A patient who is about to be given octreotide is also taking a diuretic, IV heparin, ciprofloxacin (Cipro), and an opioid as needed for pain. The nurse will monitor for what possible interaction? a. Hypokalemia due to an interaction with the diuretic b. Decreased anticoagulation due to an interaction with the heparin c. Prolongation of the QT interval due to an interaction with the ciprofloxacin d. Increased sedation if the opioid is given 5. When monitoring for the therapeutic effects of intranasal desmopressin (DDAVP) in a patient who has diabetes insipidus, which assessment finding will the nurse look for as an indication that the medication therapy is successful? a. Increased insulin levels b. Decreased diarrhea c. Improved nasal patency d. Decreased thirst 6. Which drugs have an action similar to that of the naturally occurring hormone ADH? (Select all that apply.) a. cosyntropin (Cortrosyn) b. desmopressin (DDAVP) c. somatropin (Humatrope) d. vasopressin (Pitressin) e. octreotide (Sandostatin) 7. The order reads: “Give octreotide (Sandostatin) 50 mcg subcut twice a day.” The medication is available in an injectable form of 0.05 mg/mL. How many milliliters will the nurse draw up for the ordered dose? 8. The nurse is preparing to administer somatropin (Humatrope) and will monitor the patient for which adverse effects? (Select all that apply) a. Increased blood pressure b. Headache c. Flulike syndrome d. Nausea e. Hyperglycemia f. Fever 1. a, 2. d, 3. d, 4. c, 5. d, 6. b, d, 7. 1 mL, 8. b, c, e.   CH31 Thyroid and antithyroid drugs 1. When monitoring the laboratory values for a patient who is taking antithyroid drugs, the nurse knows to watch for a. Increased platelet counts. b. Increased white blood cell counts. c. Increased blood urea nitrogen level. d. Increased blood glucose levels. 2. The pharmacy has called a patient to notify her that the current brand of thyroid replacement hormone is on back order. The patient calls the clinic to ask what to do. Which is the best response by the nurse? a. “Go ahead and take the other brand that the pharmacy has available for now.” b. “You can stop the medication until your current brand is available.” c. “You can split the thyroid pills that you have left so that they will last longer.” d. “Let me ask your prescriber what needs to be done; we will need to watch how you do if you switch brands.” 3. The nurse is assessing a 64 year-old patient who will be starting thyroid replacement therapy. Which statement is true regarding the dosage of thyroid replacement hormones for the older adult? a. Thyroid hormone replacement requirements are approximately 25% lower for this age group. b. Older adults require higher dosages of thyroid replacement hormone for therapeutic effects. c. There is no difference in the dosage of thyroid replacement hormone in older adults versus younger adults. d. The dosage of thyroid hormone will depend upon the amount of iodine in the patient's diet. 4. To help with the insomnia associated with thyroid hormone replacement therapy, the nurse will teach the patient to a. Take half the dose at lunchtime and the other half 2 hours later. b. Use a sedative to assist with falling asleep. c. Take the dose upon awakening in the morning. d. Reduce the dosage as needed if sleep is impaired. 5. The nurse is teaching a patient who has a new prescription for the antithyroid drug propylthiouracil (PTU). Which statement by the nurse is correct? a. “There are no food restrictions while on this drug.” b. “You need to avoid foods high in iodine, such as iodized salt, seafood, and soy products.” c. “This drug is given to raise the thyroid hormone levels in your blood.” d. “Take this drug in the morning on an empty stomach.” 6. When teaching a patient who has a new prescription for thyroid hormone, the nurse will instruct the patient to notify the prescriber if which adverse effects are noted? (Select all that apply.) a. Palpitations b. Weight gain c. Angina d. Fatigue e. Cold intolerance 7. The nurse is giving an intravenous dose of levothyroxine (Synthroid). The order reads: “Give 0.1 mg IV push now.” What is the ordered dose in micrograms? 8. The nurse knows that which laboratory tests are used to monitor thyroid hormone replacement therapy? (Select all that apply.) a. Serum TSH b. BUN c. CBC d. Free thyroid hormone levels e. Serum iodine levels 1. c, 2. d, 3. a, 4. c, 5. b, 6. a, c, 7. 100 mcg, 8. a, d   CH32 Antidiabetic drugs 1. Which is the most appropriate timing regarding the nurse's administration of a rapid-acting insulin to a hospitalized patient? a. Give it 15 minutes before the patient begins a meal. b. Give it hour before a meal. c. Give it 1 hour after a meal. d. The timing of the insulin injection does not matter with insulin lispro. 2. Which statement is appropriate for the nurse to include in patient teaching regarding type 2 diabetes? a. “Insulin injections are never used with type 2 diabetes.” b. “You don't need to measure your blood glucose levels because you are not taking insulin injections.” c. “A person with type 2 diabetes still has functioning beta cells in his or her pancreas.” d. “Patients with type 2 diabetes usually have better control over their diabetes than those with type 1 diabetes.” 3. The nurse monitoring a patient for a therapeutic response to oral antidiabetic drugs will look for a. Fewer episodes of diabetic ketoacidosis (DKA). b. Weight loss of 5 pounds. c. hemoglobin A1C levels of less than 7%. d. Glucose levels of 150 mg/dL. 4. A patient with type 2 diabetes is scheduled for magnetic resonance imaging (MRI) with contrast dye. The nurse reviews the orders and notices that the patient is receiving metformin (Glucophage). Which action by the nurse is appropriate? a. Proceed with the MRI as scheduled. b. Notify the radiology department that the patient is receiving metformin. c. Expect to hold the metformin the day of the test and for 48 hours after the test is performed. d. Call the prescriber regarding holding the metformin for 2 days before the MRI is performed. 5. A patient with type 2 diabetes has a new prescription for repaglinide (Prandin). After 1 week, she calls the office to ask what to do, because she keeps missing meals. “I work right through lunch sometimes, and I'm not sure whether I need to take it. What do I need to do?” What is the nurse's best response? a. “You need to try not to skip meals, but if that happens, you will need to skip that dose of Prandin.” b. “We will probably need to change your prescription toinsulin injections because you can't eat meals on a regular basis.” c. “Go ahead and take the pill when you first remember that you missed it.” d. “Take both pills with the next meal, and try to eat a little extra to make up for what you missed at lunchtime.” 6. When checking a patient's fingerstick blood glucose level, the nurse obtains a reading of 42 mg/dL. The patient is awake but states he feels a bit “cloudy-headed.” After double-checking the patient's glucose level and getting the same reading, which action by the nurse is most appropriate? a. Administer two packets of table sugar. b. Administer oral glucose in the form of a semisolid gel. c. Administer 50% dextrose IV push. d. Administer the morning dose of lispro insulin. 7. A patient is taking metformin for new-onset type 2 diabetes mellitus. When reviewing potential adverse effects, the nurse will include information about: (Select all that apply.) a. Abdominal bloating b. Nausea c. Diarrhead. Headache e. Weight gain f. Metallic taste 8. A patient who has a new diagnosis of type 2 diabetes asks the nurse about a new insulin that can be inhaled. “Is there a reason I can't take that drug?” Which condition, if present in the patient, would be a concern? a. Atrial fibrillation b. Chronic lung disease c. Hypothyroidism d. Rheumatoid arthritis 1. a, 2. c, 3. c, 4. c, 5. a, 6. b, 7. a, b, c, f, 8. b. CH33 Adrenal drugs 1. When monitoring for a therapeutic response to prednisone, the nurse will look for which potential outcome? a. Increased lymphocyte levels b. Decreased inflammation c. Increased growth characteristics d. Decrease in Cushing’s syndrome characteristics 2. The nurse has provided teaching about oral corticosteroid therapy to a patient. Which statement by the patient shows a need for more teaching? a. “I will report any fever or sore throat symptoms.” b. “I will stay away from anyone who has a cold or infection.” c. “I can stop this medication if I have severe adverse effects.” d. “I will take this drug with food or milk.” 3. During long-term corticosteroid therapy, the nurse will monitor the patient for Cushing's syndrome, which is manifested by a. Weight loss. b. Moon face. c. hypotension. d. Thickened hair growth. 4. When teaching a patient who has been prescribed a daily dose of prednisone (Deltasone), the nurse knows that the patient will be told to take the medication at which time of day to help reduce adrenal suppression? a. In the morning b. At lunchtime c. At dinnertime d. At bedtime 5. Which teaching is appropriate for a patient who is taking an inhaled glucocorticoid for asthma? a. “Exhale while pushing in on the canister of the inhaler.” b. “Blow your nose after taking the medication.” c. “Rinse your mouth thoroughly after taking the medication.” d. “Do not eat immediately after taking the medication.” 6. During long-term corticosteroid therapy, the nurse will monitor the patient's laboratory results for adverse effects, such as: (Select all that apply.) a. Increased serum potassium levels b. Decreased serum potassium levels c. Increased sodium levels d. Decreased sodium levels e. Hyperglycemia f. Hypoglycemia 7. The order reads: “Give methylprednisolone (Solu-Medrol) 100 mg IV every 6 hours.” The drug is available in vials of 80 mg/mL. How many mL will the nurse draw up for each dose? 8. A patient with acute adrenal insufficiency is to receive 300 mg/day of hydrocortisone (Solu-Cortef), divided into 3 doses every 8 hours. How many milligrams will the patient receive for each dose? 1. b, 2. c, 3. b, 4. a, 5. c, 6. b, c, e, 7. 1.25 mL, 8. 100 mg   CH34 Women’s health drugs 1. The nurse is assessing a patient who is to receive dinoprostone (Prostin E2). Which condition would be a contraindication to the use of this drug? a. Pregnancy at 15 weeks' gestation b. GI upset or ulcer disease c. Ectopic pregnancy d. Incomplete abortion 2. When teaching a patient who is taking oral contraceptive therapy for the first time, the nurse relates that adverse effects may include which of the following? a. Dizziness b. Nausea c. Tingling in the extremities d. Polyuria 3. The nurse is reviewing the use of obstetric drugs. Which situation is an indication for an oxytocin (Pitocin) infusion? a. Termination of a pregnancy at 12 weeks b. Hypertonic uterus c. Cervical stenosis in a patient who is in labor d. Induction of labor at full term 4. The nurse has provided patient education regarding therapy with the SERM raloxifene (Evista). Which statement from the patient reflects a good understanding of the instruction? a. “When I take that long flight to Asia, I will need to stop taking this drug at least 3 days before I travel.” b. “I can continue this drug even when traveling as long as I take it with a full glass of water each time.” c. “After I take this drug, I must sit upright for at least 30 minutes.” d. “One advantage of this drug is that it will reduce my hot flashes.” 5. The nurse is discussing therapy with clomiphene (Clomid) with a husband and wife who are considering trying this drug as part of treatment for infertility. It is important that they be informed of which possible effect of this drug? a. Increased menstrual flow b. Increased menstrual cramping c. Multiple pregnancy (twins or more) d. Sedation 6. A patient calls the clinic because she realized she missed one dose of an oral contraceptive. Which statement from the nurse is appropriate? (Select all thatapply.) a. “Go ahead and take the missed dose now, along with today's dose.” b. “Don't worry, you are still protected from pregnancy.” c. “Please come to the clinic for a reevaluation of your therapy.” d. “Wait 7 days, and then start a new pack of pills.” e. “You will need to use a backup form of contraception concurrently for 7 days.” 7. The order reads: “Give calcitonin (Miacalcin) 50 international units subcut daily.” The medication is available in a vial that contains 200 international units/mL. How many milliliters will the nurse draw up in the syringe for this dose? 8. A woman comes into the emergency department. She says that she is pregnant and that she is having contractions every 3 minutes but she is “not due yet.” She is very upset. While assessing her vital signs and fetal heart tones, what is the most important question the nurse must ask the patient? a. “What were you doing when the contractions started?” b. “Are you preregistered at this hospital to give birth?” c. “How many weeks have you been pregnant?” d. “Have you felt the baby move today?” 1. c, 2. b, 3. d, 4. a, 5. c, 6. a, e, 7. 0.25 mL, 8. c.   CH35 Men’s health drugs 1. A patient has been taking finasteride (Proscar) for almost 1 year. The nurse knows that which is most important to evaluate at this time? a. Complete blood count b. PSA levels c. Blood pressure d. Fluid retention 2. The nurse is performing an assessment of a patient who is asking for a prescription for sildenafil (Viagra). Which finding would be a contraindication to its use? a. 65 years of age b. History of thyroid disease c. Medication list that includes nitrates d. Medication list that includes saw palmetto 3. During a counseling session for a group of teenage athletes, the use of androgenic steroids is discussed. The nurse will explain that which problem is a rare but devastating effect of androgenic steroid use? a. Peliosis of the liver b. Bradycardia c. Kidney failure d. Tachydysrhythmias 4. The nurse is teaching a patient about the possible adverse effect of priapism, which may occur when taking erectile dysfunction drugs. The nurse emphasizes that, if this occurs, the most important action is to a. Stay in bed until the erection ceases. b. Apply an ice pack for 30 minutes. c. Turn toward his left side and rest. d. Seek medical attention immediately. 5. A patient is asking about the use of saw palmetto for prostate health. The nurse tells him that drugs that interact with saw palmetto include: a. acetaminophen (Tylenol). b. nitrates. c. Nonsteroidal antiinflammatory drugs. d. Antihypertensive drugs. 6. When the Testoderm form of testosterone is ordered to treat hypogonadism in a teenage boy, which instructions by the nurse are correct? (Select all that apply.) a. Place the patch on clean, dry skin on the back, upper arms, abdomen, or thighs. b. Place the patch on clean, dry scrotal skin that has been shaved. c. Place the patch on clean, dry scrotal skin, but do not shave the skin first. d. Place the patch on any clean, dry, nonhairy area of the body. e. Remove the old patch before applying a new patch. 7. A 16-year-old male is to receive testosterone cypionate (Depo-Testosterone), 50 mg IM every 2 weeks. The medication is available in 100-mg/mL containers. How many mL will the nurse draw up in the syringe to administer for each dose? 8. The nurse is reviewing the medication list for a patient and notes that finasteride (Propecia) 1 mg daily is on the list. This drug is for which of these problems? a. Benign prostatic hypertrophy (BPH) b. Erectile dysfunction c. Alopecia in male patients d. Alopecia in male and female patients. 1. b, 2. c, 3. a, 4. d, 5. c, 6. b, e, 7. 0.5 mL per dose, 8. c   CH36 Antihistamines, decongestants, antitussives, and expectorants 1. When assessing a patient who is to receive a decongestant, the nurse will recognize that a potential contraindication to this drug would be which condition? a. Glaucoma b. Fever c. Peptic ulcer disease d. Allergic rhinitis 2. When giving decongestants, the nurse must remember that these drugs have alpha-adrenergic–stimulating effects that may result in which effect? a. Fever b. Bradycardia c. Hypertension d. CNS depression 3. The nurse is reviewing a patient's medication orders for prn (as necessary) medications that can be given to a patient who has bronchitis with a productive cough. Which drug will the nurse choose? a. An antitussive b. An expectorant c. An antihistamine d. A decongestant 4. The nurse knows that an antitussive cough medication would be the best choice for which patient? a. A patient with a productive cough b. A patient with chronic paranasal sinusitis c. A patient who has had recent abdominal surgery d. A patient who has influenza 5. A patient is taking a decongestant to help reduce symptoms of a cold. The nurse will instruct the patient to observe for which possible symptom, which may indicate an adverse effect of this drug? a. Increased cough b. Dry mouth c. Slower heart rate d. Heart palpitations 6. The nurse is giving an antihistamine and will observe the patient for which side effects? (Select all that apply.) a. Hypertension b. Dizziness c. “Hangover” effect d. Drowsiness e. Tachycardia f. Dry mouth 7. The order for a 4-year-old patient reads: “Give guaifenesin, 80 mg PO, every 4 hours as needed for cough. Maximum of 600 mg/24 hours.” The medication comes in a bottle that has 100 mg/5 mL. How many milliliters will the nurse give per dose? 8. The nurse notes in a patient's medication history that the patient is taking benzonatate (Tessalon Perles) as needed. Based on this finding, the nurse interprets that the patient has which problem? a. Cough b. Seasonal allergies c. Chronic rhinitis d. Motion sickness 1. a, 2. c, 3. b, 4. c, 5. d, 6. b, c, d, f, 7. 4 mL, 8. a   CH37 Respiratory drugs 1. A patient who has a history of asthma is experiencing an acute episode of shortness of breath and needs to take a medication for immediate relief. The nurse will choose which medication that is appropriate for this situation? a. A beta agonist, such as albuterol b. A leukotriene receptor antagonist, such as montelukast c. A corticosteroid, such as fluticasone d. An anticholinergic, such as ipratropium 2. After a nebulizer treatment with the beta agonist albuterol, the patient complains of feeling a little “shaky,” with slight tremors of the hands. The patient's heart rate is 98 beats/min, increased from the pretreatment rate of 88 beats/min. The nurse knows that this reaction is an a. Expected adverse effect of the medication. b. Allergic reaction to the medication. c. Indication that he has received an overdose of the medication. d. Idiosyncratic reaction to the medication. 3. A patient has been receiving an aminophylline (xanthine derivative) infusion for 24 hours. The nurse will assess for which adverse effect when assessing the patient during the infusion? a. CNS depression b. Sinus tachycardia c. Increased appetite d. Temporary urinary retention 4. During a teaching session for a patient who will be receiving a new prescription for the LTRA montelukast (Singulair), the nurse will tell the patient that the drug has which therapeutic effect? a. Improves the respiratory drive b. Loosens and removes thickened secretions c. Reduces inflammation in the airway d. Stimulates immediate bronchodilation 5. After the patient takes a dose of an inhaled corticosteroid, such as fluticasone (Flovent), what is the most important action the patient needs to do next? a. Hold the breath for 60 seconds. b. Rinse out the mouth with water. c. Follow the corticosteroid with a bronchodilator inhaler, if ordered. d. Repeat the dose in 15 minutes if the patient feels short of breath. 6. The nurse is teaching a patient about the inhaler Advair (salmeterol/fluticasone).Which statements by the patient indicate a correct understanding of this medication? (Select all that apply.) a. “I will rinse my mouth with water after each dose.” b. “I need to use this inhaler whenever I feel short of breath, but not less than 4 hours between doses.” c. “This medication is taken twice a day, every 12 hours.” d. “I can take this inhaler if I get short of breath while exercising.” e. “I will call my doctor if I notice white patches inside my mouth.” 7. A patient who is taking a xanthine derivative for chronic bronchitis asks the nurse, “I miss my morning coffee. I can't wait to go home and have some.” What is the nurse's best response? a. “I know how you feel. I'd miss my coffee too.” b. “I can get some coffee for you. I'll be right back.” c. “It's important not to take coffee or other caffeinated products with this medicine as it may cause an increased heart rate as well as other problems.” d. “You've been on this medicine for a few days. I can call your prescriber to ask whether you can have some coffee.” 8. The nurse is preparing to administer the elixir form of theophylline to a patient who has a PEG tube. The dose is 240 mg daily, and the medication is available in a concentration of 80 mg/15 mL. How many milliliters of medication will the nurse give per dose? 1. a, 2. a, 3. b, 4. c, 5. b, 6. a, c, e, 7. c, 8. 45 mL.   CH38 Antibiotics part 1 1. A patient is scheduled for colorectal surgery tomorrow. He does not have sepsis, his WBC count is normal, he has no fever, and he is otherwise in good health. However, there is an order to administer an antibiotic on call before he goes to surgery. The nurse knows that the rationale for this antibiotic order is to a. Provide empiric therapy. b. Provide prophylactic therapy. c. Treat for a superinfection. d. Reduce the number of resistant organisms. 2. A teenage patient is taking a tetracycline drug as part of treatment for severe acne. When the nurse teaches this patient about drug-related precautions, which is the most important information to convey? a. When the acne clears up, the medication may be discontinued. b. This medication needs to be taken with antacids to reduce GI upset. c. The patient needs to use sunscreen or avoid exposure to sunlight, because this drug may cause photosensitivity. d. The teeth should be observed closely for signs of mottling or other color changes. 3. A newly admitted patient reports a penicillin allergy. The prescriber has ordered a second-generation cephalosporin as part of the therapy. Which nursing action is appropriate? a. Call the prescriber to clarify the order because of the patient's allergy. b. Give the medication, and monitor for adverse effects. c. Ask the pharmacy to change the order to a first-generation cephalosporin. d. Administer the drug with a nonsteroidal anti-inflammatory drug to reduce adverse effects. 4. During patient education regarding an oral macrolide such as erythromycin, the nurse will include which information? a. If GI upset occurs, the drug will have to be stopped. b. The drug needs to be taken with an antacid to avoid GI problems. c. The patient needs to take each dose with a sip of water. d. The patient may take the drug with a small snack to reduce GI irritation. 5. A woman who has been taking an antibiotic for a UTI calls the nurse practitioner to complain of severe vaginal itching. She has also noticed a thick, whitish vaginal discharge. The nurse practitioner suspects that a. This is an expected response to antibiotic therapy. b. the UTI has become worse instead of better. c. A superinfection has developed. d. the UTI is resistant to the antibiotic. 6. The nurse is reviewing the orders for wound care, which include use of an antiseptic. Which statements best describe the use of antiseptics? (Select all that apply.) a. Antiseptics are appropriate for use on living tissue. b. Antiseptics work by sterilizing the surface of the wound. c. Antiseptics are applied to nonliving objects to kill microorganisms. d. The patient's allergies must be assessed before using the antiseptic. e. Antiseptics are used to inhibit the growth of microorganisms on the wound surface. 7. The order for a child reads: “Give cefoxitin (Mefoxin) 160 mg/kg/day, IVPB, divided into doses given every 6 hours.” The child weighs 55 lb. How much will the patient receive each day? For each dose? 8. The nurse is reviewing the orders for a patient who has been admitted for treatment of pneumonia. The antibiotic orders include an order for doxycycline. However, when the patient is asked about his allergies, he lists “doxycycline” as one of his allergies. What is the nurse's priority action at this time? a. Call the prescriber to clarify the order because of the patient's allergy. b. Ask the patient to explain what happened when he had the allergic reaction. c. Ask the pharmacy to order a different antibiotic. d. Administer the drug with an antihistamine to reduce adverse effects. 1. b, 2. c, 3. a, 4. d, 5. c, 6. a, d, e, 7. 4000 mg/day; 1000 mg/dose, 8. b   CH39 Antibiotics part 2 1. While assessing a woman who is receiving quinolone therapy for pneumonia, the nurse notices that the patient has a history of heart problems. The nurse will monitor for which potential cardiac effect of quinolone therapy? a. Bradycardia b. Dysrhythmias c. Tachycardia d. Prolonged QT interval 2. A patient has been admitted for treatment of an infected leg ulcer and will be started on intravenous linezolid. The nurse is reviewing the list of the patient's current medications. Which type of medication, if listed, would be of most concern if taken with the linezolid? a. Beta blocker b. Oral anticoagulant c. Selective serotonin reuptake inhibitor antidepressant d. Thyroid replacement hormone 3. When administering vancomycin, the nurse knows that which of these is most important to assess before giving the medication? a. Renal function b. WBC count c. Liver function d. Platelet count 4. During therapy with an intravenous aminoglycoside, the patient calls the nurse and says, “I'm hearing some odd sounds, like ringing, in my ears.” What is the nurse's priority action at this time? a. Reassure the patient that these are expected adverse effects. b. Reduce the rate of the intravenous infusion. c. Increase the rate of the intravenous infusion. d. Stop the infusion immediately. 5. When giving intravenous quinolones, the nurse needs to keep in mind that these drugs may have serious interactions with which drugs? a. Selective serotonin reuptake inhibitor antidepressants b. Nonsteroidal antiinflammatory drugs c. Oral anticoagulants d. Antihypertensives 6. The nurse is administering an intravenous aminoglycoside to a patient who has had gastrointestinal surgery. Which nursing measures are appropriate? (Select all that apply.) a. Report a trough drug level of 0.8 mcg/mL, and hold the drug. b. Enforce strict fluid restriction. c. Monitor serum creatinine levels. d. Instruct the patient to report dizziness or a feeling of fullness in the ears. e. Warn the patient that the urine may turn darker in color. 7. The order reads: “Give vancomycin, 1250 mg in 250 mL NS, IVPB, every 12 hours. Infuse over 90 minutes.” The nurse will set the infusion pump to what setting for mL/hour? 8. A patient has been receiving therapy with the aminoglycoside tobramycin, and the nurse notes that the patient's latest trough drug level is 3 mcg/mL. This drug is given daily, and the next dose is to be administered now. Based on this trough drug level, what is the nurse's priority action? a. Administer the drug as ordered. b. Hold the drug, and notify the prescriber. c. Call the laboratory to have the test repeated and verified. d. Hold this dose, but administer the next dose as scheduled. 1. d, 2. c, 3. a, 4. d, 5. c, 6. c, d, 7. 167 mL/hour,   CH40 Antiviral drugs 1. During treatment with zidovudine, the nurse needs to monitor for which potential adverse effect? a. Retinitis b. Deep vein thromboses c. Kaposi's sarcoma d. Bone marrow suppression 2. After giving an injection to a patient with HIV infection, the nurse accidentally receives a needle stick from a too-full needle disposal box. Recommendations for occupational HIV exposure may include the use of which drug(s)? a. Didanosine b. Lamivudine and enfuvirtide c. Emtricitabine and tenofovir d. acyclovir 3. When the nurse is teaching a patient who is taking acyclovir for genital herpes, which statement by the nurse is accurate? a. “This drug will help the lesions to dry and crust over.” b. “Acyclovir will eradicate the herpes virus.” c. “This drug will prevent the spread of this virus to others.” d. “Be sure to give this drug to your partner, too.” 4. A patient who has been newly diagnosed with HIV has many questions about the effectiveness of drug therapy. After a teaching session, which statement by the patient reflects a need for more education? a. “I will be monitored for side effects and improvements while I'm taking this medicine.” b. “These drugs do not eliminate the HIV, but hopefully the amount of virus in my body will be reduced.” c. “There is no cure for HIV.” d. “These drugs will eventually eliminate the virus from my body.” 5. After surgery for organ transplantation, a patient is receiving ganciclovir, even though he does not have a viral infection. Which statement best explains the rationale for this medication therapy? a. Ganciclovir is used to prevent potential exposure to the HIV virus. b. This medication is given prophylactically to prevent influenza A infection. c. Ganciclovir is given to prevent CMV infection. d. The drug works synergistically with antibiotics to prevent superinfections. 6. The nurse is reviewing the use of multidrug therapy for HIV with a patient. Which statements are correct regarding the reason for using multiple drugs to treat HIV? (Select all that apply.) a. The combination of drugs has fewer associated toxicities. b. The use of multiple drugs is more effective against resistant strains of HIV. c. Effective treatment results in reduced T-cell counts. d. The goal of this treatment is to reduce the viral load. e. This type of therapy reduces the incidence of opportunistic infections. 7. The order for a patient who has a severe case of shingles is for acyclovir (Zovirax) 10 mg/kg IV every 8 hours for 7 days. The patient weighs 165 pounds. How much is each dose? 8. The nurse notes in the patient's medication history that the patient is taking sofosbuvir (Solvald) with ribavirin. Based on this finding, the nurse interprets that the patient has which disorder? a. Cytomegalovirus b. Genital herpes c. Chronic hepatitis C d. Respiratory syncytial virus infection 1. d, 2. c, 3. a, 4. d, 5. c, 6. b, d, e, 7. 750 mg per dose, 8. c   CH41 Antitubercular drugs 1. The nurse is teaching a patient who is starting antitubercular therapy with rifampin. Which adverse effects would the nurse expect to see? a. Headache and neck pain b. Gynecomastia c. Reddish brown urine d. Numbness or tingling of extremities 2. During antitubercular therapy with isoniazid, a patient received another prescription for pyridoxine. Which statement by the nurse best explains the rationale for this second medication? a. “This vitamin will help to improve your energy levels.” b. “This vitamin helps to prevent neurologic adverse effects.” c. “This vitamin works to protect your heart from toxic effects.” d. “This vitamin helps to reduce gastrointestinal adverse effects.” 3. The nurse is counseling a woman who is beginning antitubercular therapy with rifampin. The patient also takes an oral contraceptive. Which statement by the nurse is most accurate regarding potential drug interactions? a. “You will need to switch to another form of birth controlwhile you are taking the rifampin.” b. “Your birth control pills will remain effective while you are taking the rifampin.” c. “You will need to take a stronger dose of birth control pills while you are on the rifampin.” d. “You will need to abstain from sexual intercourse while on the rifampin to avoid pregnancy.” 4. When counseling a patient who has been newly diagnosed with TB, the nurse will make sure that the patient realizes that he or she is contagious a. During all phases of the illness. b. Any time up to 18 months after therapy begins. c. During the postictal phase of TB. d. During the initial period of the illness and its diagnosis. 5. While monitoring a patient, the nurse knows that a therapeutic response to antitubercular drugs would be: a. The patient states that he or she is feeling much better. b. The patient's laboratory test results show a lower white blood cell count. c. The patient reports a decrease in cough and night sweats. d. There is a decrease in symptoms, along with improved chest x-ray and sputum culture results. 6. The nurse is monitoring for liver toxicity in a patient who has been receiving long-term isoniazid therapy. Manifestations of liver toxicity include: (Select all that apply.) a. Orange discoloration of sweat and tears b. Darkened urine c. Dizziness d. Fatigue e. Visual disturbances f. Jaundice 7. The order for isoniazid (INH) reads: “Give 5 mg/kg PO daily.” The patient weighs 275 pounds. What is the amount per dose? Is this a safe dose? 8. Bedaquiline (Sirturo) is prescribed for a patient, and the nurse is providing instructions to the patient about the medication. Which statement by the patient indicates a correct understanding of the instructions? a. “I will take this with food.” b. “I need to take this 1 hour before breakfast.” c. “I can stop this drug if the side effects bother me.” d. “It's okay to have a glass of wine while taking this drug.” 1. c, 2. b, 3. a, 4. d, 5. d, 6. b, d, f, 7. 625 mg/dose; no, maximum dose is 300 mg, 8. a   CH42 Antifungal drugs 1. The nurse is assessing a patient who is about to receive antifungal drug therapy. Which problem would be of most concern? a. Endocrine disease b. Hepatic disease c. Cardiac disease d. Pulmonary disease 2. While monitoring a patient who is receiving intravenous amphotericin B, the nurse expects to see which adverse effect(s)? a. Hypertension b. Bradycardia c. Fever and chills d. Diarrhea and stomach cramps 3. When administering antifungal drug therapy, the nurse knows that an issue that contributes to many of the drug interactions with antifungals is the patient's a. History of cardiac disease. b. History of gallbladder surgery. c. Ethnic background. d. cytochrome P-450 enzyme system. 4. During an infusion of amphotericin B, the nurse knows that which administration technique may be used to minimize infusion-related adverse effects? a. Forcing of fluids during the infusion b. Infusing the medication quickly c. Infusing the medication over a longer period of time d. Stopping the infusion for 2 hours after half of the bag has infused, and then resuming 1 hour later 5. When teaching a patient who is taking nystatin lozenges for oral candidiasis, which instruction by the nurse is correct? a. “Chew the lozenge carefully before swallowing.” b. “Dissolve the lozenge slowly and completely in your mouth.” c. “Dissolve the lozenge until it is half the original size, and then swallow it.” d. “These lozenges need to be swallowed whole with a glass of water.” 6. When monitoring a patient who is receiving caspofungin, the nurse will look for which serious adverse effects? (Select all that apply.) a. Blood dyscrasias b. Hypotension c. Pulmonary infiltrates d. Tinnitus e. Hepatotoxicity 7. The order reads, “Give nystatin (Mycostatin) suspension, 500,000 units by mouth (swish and swallow) 4 times a day for 1 week.” The medication is available in a suspension of 100,000 units per mL. How many milliliters will the nurse give per dose? 8. The nurse notes in a patient's medication history that the patient is taking terbinafine (Lamisil). Based on this finding, the nurse interprets that the patient has which disorder? a. Vaginal candidiasis b. Cryptococcal meningitis c. Invasive aspergillosis d. Onychomycosis 1. b, 2. c, 3. d, 4. c, 5. b, 6. a, b, e, 7. 5 mL, 8. d   CH43 Antimalarial, antiprotozoal, and anthelmintic drugs 1. The nurse is reviewing the medication history of a patient who is taking hydroxychloroquine. However, the patient's chart does not reveal a history of malaria or travel out of the country. The patient is most likely taking this medication for a. Plasmodium. b. Thyroid disorders. c. roundworms. d. Rheumatoid arthritis. 2. Which teaching point would be appropriate to include when the nurse is informing a patient about the adverse effects of antimalarials? a. The skin may turn blotchy while these medications are taken. b. These medications may cause anorexia and abdominal distress. c. These medications may cause increased urinary output. d. The patient may experience periods of diaphoresis and chills. 3. When teaching a patient about the potential drug interactions with antiprotozoal drugs, the nurse will include information about a. acetaminophen. b. warfarin. c. decongestants. d. antibiotics. 4. Before administering antiprotozoal drugs, the nurse will review which baseline assessment? a. Complete blood count b. Serum magnesium level c. Creatinine clearance d. Arterial blood gas concentrations 5. The nurse knows that antimalarial drugs are used to treat patients with infections caused by which microorganism? a. Plasmodium spp. b. Candida albicans c. Pneumocystis jirovecii d. Mycobacterium 6. When giving metronidazole, the nurse implements appropriate administration techniques, including which of these? (Select all that apply.) a. Giving oral forms with food b. Giving oral forms on an empty stomach with a full glass of water c. Infusing intravenous doses over 30 to 60 minutes d. Administering intravenous doses by bolus over 5 minutes e. Obtaining ordered specimens before starting the medication 7. A 5-year-old patient has been diagnosed with malaria after returning from an overseas trip. The patient is to receive one dose of mefloquine (Lariam), 25 mg/kg PO. The child weighs 44 lb. How much mefloquine will this child receive? 8. Praziquantel (Biltricide) is prescribed for a patient with a tapeworm infection. The nurse prepares to administer the medication via which route? a. Rectal b. Oral c. Intravenous d. Inhalation 1. d, 2. b, 3. b, 4. a, 5. a, 6. a, c, e, 7. 500 mg, 8. b   CH44 Antiinflammatory and antigout drugs 1. When a patient is receiving long-term NSAID therapy, which drug may be given to prevent the serious gastrointestinal adverse effects of NSAIDs? a. misoprostol (Cytotec) b. metoprolol (Lopressor) c. metoclopramide (Reglan) d. Magnesium sulfate 2. The nurse recognizes that manifestations of NSAID toxicity include a. constipation. b. Nausea and vomiting. c. tremors. d. Urinary retention. 3. During a teaching session about antigout drugs, the nurse tells the patient that antigout drugs work by which mechanism? a. Increasing blood oxygen levels b. Decreasing leukocytes and platelets c. Increasing protein and rheumatoid factors d. Decreasing serum uric acid levels 4. When the nurse is teaching about antigout drugs, which statement by the nurse is accurate? a. “Drink only limited amounts of fluids with the drug.” b. “This drug may cause limited movements of your joints.” c. “There are very few drug interactions with these medications.” d. “Colchicine is best taken on an empty stomach.” 5. A mother calls the clinic to ask what medication to give her 5-year-old child for a fever during a bout of chickenpox. The nurse's best response would be: a. “Your child is 5 years old, so it would be okay to use children's aspirin to treat his fever.” b. “Start with acetaminophen or ibuprofen, but if these do not work, then you can try aspirin.” c. “You can use children's dosages of acetaminophen or ibuprofen, but aspirin is not recommended.” d. “It is best to wait to let the fever break on its own without medication.” 6. A 49-year-old patient has been admitted with possible chronic salicylate intoxication after self-treatment for arthritis pain. The nurse will assess for which symptoms of salicylate intoxication? (Select all that apply). a. Tinnitus b. Headache c. Constipation d. Nausea e. Bradycardia 7. An order for a child reads: “Give ibuprofen suspension 30 mg/kg/day, divided into four doses, for pain.” The child weighs 33 pounds. How many milligrams will this child receive per dose? 8. The nurse is reviewing a patient's medication list during a preoperative visit. The patient is scheduled for diagnostic laparoscopy in 2 weeks. He asks the nurse, “I hope I can continue the Motrin, because I really ache if I don't take it. It's just minor surgery, right?” What is the nurse's best response? a. “You can continue to take it as the laparoscopy is considered minor surgery.” b. “You will need to take a lower dosage during the preoperative period. c. “I'll check with your prescriber, but this drug is usually stopped a week before the surgery because it can cause increased bleeding tendencies.” d. “You can switch to aspirin before the surgery; both aspirin and Motrin are over-the-counter pain relievers.” 1. a, 2. b, 3. d, 4. d, 5. c, 6. a, b, d, 7. 112.5 mg per dose, 8. c.   CH45 Antineoplastic drugs part 1: cancer overview and cell cycle-specific drugs 1. A patient is experiencing stomatitis after a round of chemotherapy. Which intervention by the nurse is correct? a. Clean the mouth with a soft-bristle toothbrush and warm saline solution. b. Rinse the mouth with commercial mouthwash twice a day. c. Use lemon-glycerin swabs to keep the mouth moist. d. Keep dentures in the mouth between meals. 2. The nurse is caring for a patient who becomes severely nauseated during chemotherapy. Which intervention is most appropriate? a. Encourage light activity during chemotherapy as a distraction. b. Provide antiemetic medications 30 to 60 minutes before chemotherapy begins. c. Provide antiemetic medications only upon the request of the patient. d. Hold fluids during chemotherapy to avoid vomiting. 3. The nurse monitors a patient who is experiencing thrombocytopenia from severe bone marrow suppression by looking for a. Severe weakness and fatigue. b. Elevated body temperature. c. Decreased skin turgor. d. Excessive bleeding and bruising. 4. A patient receiving chemotherapy is experiencing severe bone marrow suppression. Which nursing diagnosis is most appropriate at this time? a. Activity intolerance b. Risk for infection c. Disturbed body image d. Impaired physical mobility 5. If extravasation of an antineoplastic medication occurs, which intervention will the nurse perform first? a. Apply cold compresses to the site while elevating the arm. b. Inject subcutaneous doses of epinephrine around the IV site every 2 hours. c. Stop the infusion immediately while leaving the catheter in place. d. Inject the appropriate antidote through the IV catheter. 6. The nurse is assessing a patient who has experienced severe neutropenia after chemotherapy and will monitor for which possible signs of infection? (Select all that apply.) a. Elevated WBC count b. Fever c. Nausea d. Sore throat e. Chills 7. The order for chemotherapy reads: “Give asparaginase (Elspar) IV 200 units/kg/day.” The patient weighs 297 lb. The pharmacy department will prepare the medication for intravenous infusion. How much drug will be given per dose? 8. The nurse is assessing a patient who has developed anemia after two rounds of chemotherapy. Which of these may be indications of anemia? (Select all that apply.) a. Hypoxia b. Fever c. Infection d. Bleeding e. Fatigue 1. a, 2. b, 3. d, 4. b, 5. c, 6. b, d, e, 7. 27,000 units, 8. a, e   CH46 Antineoplastic drugs part 2: cell-cycle-nonspecific and miscellaneous drugs 1. A patient who is receiving chemotherapy with cisplatin (Platinol) has developed pneumonia. The nurse would be concerned about nephrotoxicity if which type of antibiotic was ordered as treatment for the pneumonia at this time? a. Penicillin b. Sulfa drug c. Fluoroquinolone d. Aminoglycoside 2. During treatment with doxorubicin (Adriamycin), the nurse must monitor closely for which potentially life-threatening adverse effect? a. Nephrotoxicity b. Peripheral neuritis c. Cardiomyopathy d. Ototoxicity 3. While teaching a patient who is about to receive cyclophosphamide (Cytoxan) chemotherapy, the nurse will instruct the patient to watch for potential adverse effects, such as a. Cholinergic diarrhea. b. Hemorrhagic cystitis. c. Peripheral neuropathy. d. ototoxicity. 4. When chemotherapy with alkylating drugs is planned, the nurse expects to implement which intervention to prevent nephrotoxicity? a. Hydrating the patient with intravenous fluids before chemotherapy b. Limiting fluids before chemotherapy c. Monitoring drug levels during chemotherapy d. Assessing creatinine clearance during chemotherapy 5. During therapy with the cytotoxic antibiotic bleomycin, the nurse will assess for a potentially serious adverse effect by monitoring a. Blood urea nitrogen and creatinine levels. b. Cardiac ejection fraction. c. Respiratory function. d. Cranial nerve function. 6. While administering bevacizumab (Avastin), what will the nurse assess to look for drug-related toxicities? (Select all that apply.) a. Blood pressure b. Color of the skin and sclera of the eye (for jaundice) c. Blood glucose level d. Urine protein level e. Hearing f. Weight 7. The nurse is preparing to add a dose of bevacizumab (Avastin) to a patient's intravenous infusion. The infusion bag prepared by the pharmacy has 70 mg of bevacizumab in 100 mL of normal saline, and it is to infuse over 90 minutes. The nurse will set the infusion pump to what rate for this dose? 8. The day before a third round of chemotherapy, the nurse reads that a patient's neutrophil count is 1650 cells/mm3. The nurse expects that the oncologist will follow which course of treatment? a. The chemotherapy will be started as scheduled. b. The chemotherapy will be given at a lower dosage. c. The oncologist will order a neutrophil transfusion to be given first. d. The chemotherapy will not be given today. 1. d, 2. c, 3. b, 4. a, 5. c, 6. a, d, f. 7. 67 mL/hour (66.66 rounds to 67), 8. a.   CH50 Acid-controlling drugs 1. A 30-year-old patient is taking simethicone for excessive flatus associated with diverticulitis. During a patient teaching session, the nurse explains the mechanism of action of simethicone by saying: a. “It neutralizes gastric pH, thereby preventing gas.” b. “It buffers the effects of pepsin on the gastric wall.” c. “It decreases gastric acid secretion and thereby minimizes flatus.” d. “It causes mucus-coated gas bubbles to break into smaller ones.” 2. When evaluating the medication list of a patient who will be starting therapy with an H2 receptor antagonist, the nurse is aware that which drug may interact with it? a. Codeine b. Penicillin c. Phenytoin d. acetaminophen 3. Which is the correct action when the nurse is administering sucralfate? a. Giving the drug with meals b. Giving the drug on an empty stomach c. Instructing the patient to restrict fluids d. Waiting 30 minutes before administering other drugs 4. A patient with a history of renal problems is asking for advice about which antacid he should use. The nurse will make which recommendation? a. “Patients with renal problems cannot use antacids.” b. “Aluminum-based antacids are the best choice for you.” c. “Calcium-based antacids are the best choice for you.” d. “Magnesium-based antacids are the best choice for you.” 5. A patient who is taking oral tetracycline complains of heartburn and requests an antacid. Which action by the nurse is correct? a. Give the tetracycline, but delay the antacid for 1 to 2 hours. b. Give the antacid, but delay the tetracycline for at least 4 hours. c. Administer both medications together. d. Explain that the antacid cannot be given while the patient is taking the tetracycline. 6. When the nurse is administering a proton pump inhibitor (PPI), which actions by the nurse are correct? (Select all that apply.) a. Giving the PPI on an empty stomach b. Giving the PPI with meals c. Making sure the patient does not crush or chew the capsules d. Instructing the patient to open the capsule and chew the contents for best absorption e. Administering the PPI only when the patient complains of heartburn 7. The order reads: “Give cimetidine (Tagamet) 300 mg in 100 mL normal saline IVPB tid and at bedtime. Infuse over 30 minutes.” The infusion pump can only be programmed to deliver over 60 minutes (mL per hour). The nurse will set the pump to deliver how many mL/hour for each IVPB dose? 8. The nurse is preparing to administer the first dose of misoprostol (Cytotec) for a patient who has been diagnosed with a gastric ulcer. What condition would be a contraindication to this medication? a. Hypothyroidism b. Type 2 diabetes mellitus c. Pregnancy d. Hypertension 1. d, 2. c, 3. b, 4. b, 5. a, 6. a, c, 7. 200 mL/hour, 8. c.   CH51 Bowel disorder drugs 1. A patient is being prepared for a colonoscopy. The nurse expects which laxative to be used as preparation for this procedure? a. Methylcellulose b. Docusate sodium c. PEG-3350 d. glycerin 2. The nurse is administering oral methylcellulose (Citrucel) and keeps in mind that a major potential concern with this drug is a. dehydration. b. Tarry stools. c. Renal calculi. d. Esophageal obstruction. 3. A 45-year-old woman has been diagnosed with irritable bowel syndrome (IBS) and will be taking linaclotide (Linzess). The nurse assesses for conditions that may be contraindications to this drug, such as a. constipation. b. Bowel obstruction. c. Renal calculi. d. anemia. 4. When the nurse teaches a patient about taking bisacodyl tablets, which instruction is correct? a. “Take this medication on an empty stomach.” b. “Chew the tablet for quicker onset of action.” c. “Take this medication with juice or milk.” d. “Take this medication with an antacid if it upsets your stomach.” 5. A patient has been receiving long-term antibiotic therapy as part of treatment for an infected leg wound. He tells the nurse that he has had “spells of diarrhea” for the last week. Which medication is most appropriate for him at this time? a. Bismuth subsalicylate b. L. Acidophilus c. Diphenoxylate with atropine d. codeine 6. A parent calls to ask about giving a medication for diarrhea to his child, 15 years of age, who is recovering from the flu. The nurse expects the prescriber to recommend which medication? a. Bismuth subsalicylate (Pepto-Bismol) b. Lactobacillus GG (Culturelle) c. Belladonna alkaloid/phenobarbital combination (Donnatal Elixir) d. loperamide (Imodium A-D) 7. A patient has been instructed to use an over-the-counter (OTC) form of the bulkforming laxative methylcellulose (Citrucel) to prevent constipation. The nurse will advise the patient of potential adverse effects, including (Select all that apply) a. Electrolyte imbalances. b. Decreased absorption of vitamins. c. Gas formation. d. Darkened stools. e. Discolored urine. 8. A patient has been given a new prescription for alosetron (Lotronex), and the nurse is providing education about this medication. Which statement by the patient indicates a need for further education? a. “I will not take a double dose in the afternoon if I forget my morning dose.” b. “I should be seeing improvement within a few days.” c. “I will call my doctor if I experience severe constipation or bloody diarrhea.” d. “This drug will improve symptoms but won't cure my IBS.” 1. c, 2. d, 3. b, 4. a, 5. b, 6. d, 7. a, c, 8. b.   CH52 Antiemetic and antinausea drugs 1. The nurse is providing patient teaching regarding scopolamine transdermal patches (Transderm-Scōp) to a patient who is planning an ocean cruise. Which instruction is most appropriate? a. “Apply the patch the day before traveling.” b. “Apply the patch at least 4 hours before traveling.” c. “Apply the patch to the shoulder area.” d. “Apply the patch to the temple just above the ear.” 2. A middle-aged woman is experiencing severe vertigo. The nurse expects this patient will receive which drug, which is considered the most appropriate drug treatment for vertigo? a. meclizine (Antivert) b. prochlorperazine (Compazine) c. metoclopramide (Reglan) d. dronabinol (Marinol) 3. A 33-year-old patient is in the outpatient cancer center for his first round of chemotherapy. The nurse knows that which schedule is the most appropriate timing for the intravenous antiemetic drug? a. Four hours before the chemotherapy beginsb. Thirty to sixty minutes before the chemotherapy begins c. At the same time as the chemotherapy drugs are given d. At the first sign of nausea 4. When reviewing the various types of antinausea medications, the nurse recognizes that prokinetic drugs are also used for a. Motion sickness. b. vertigo. c. Delayed gastric emptying. d. GI obstruction. 5. A patient who has been receiving chemotherapy tells the nurse that he has been searching the Internet for antinausea remedies and that he found a reference to a product called Emetrol (phosphorated carbohydrate solution). He wants to know if this drug would help him. What is the nurse's best answer? a. “This may be a good remedy for you. Let's talk to your prescriber.” b. “This drug is used only after other drugs have not worked.” c. “This drug is used only to treat severe nausea and vomiting caused by chemotherapy.” d. “This drug may not help the more severe nausea symptoms associated with chemotherapy.” 6. The nurse is preparing to administer dronabinol (Marinol) to a patient. Which statements about dronabinol therapy are true? (Select all that apply.) a. It is approved for nausea and vomiting related to cancer chemotherapy. b. It is approved for use with hyperemesis gravidarum (nausea and vomiting associated with pregnancy). c. It is approved to help stimulate the appetite in patients with nutritional wasting due to cancer or AIDS. d. It may cause extrapyramidal symptoms. e. It may cause drowsiness or euphoria. 7. The order reads: “Give promethazine (Phenergan) 12.5 mg IM q4h prn nausea/vomiting.” The medication is available in 25-mg/mL vials. How many milliliters will the nurse draw up for this dose? 8. The nurse is reviewing the current medications for a patient who has a new prescription for aprepitant (Emend). Which of these medications may have an interaction with aprepitant? (Select all that apply.) a. Digoxin b. Warfarin c. Oral contraceptives d. Nonsteroidal antiinflammatory drugs e. corticosteroids 1. b, 2. a, 3. b, 4. c, 5. d, 6. a, c, e, 7. 0.5 mL, 8. b, c, e.   CH53 Vitamins and minerals 1. When giving calcium intravenously, the nurse needs to administer it slowly, keeping in mind that rapid intravenous administration of calcium may cause which problem? a. Ototoxicity b. Renal damage c. Tetany d. Cardiac dysrhythmias 2. The nurse will assess which laboratory test results before administration of vitamin K? a. Prothrombin time and international normalized ratio b. Red blood cell and white blood cell counts c. Phosphorous and calcium levels d. Total protein and albumin levels 3. A patient has GI malabsorption due to severe intestinal damage from a gastrointestinal infection. The nurse will need to assess for signs of a deficiency of which vitamin? a. Vitamin A (retinol) b. Vitamin B12 (cyanocobalamin) c. Vitamin B6 (pyridoxine) d. Vitamin E (tocopherols) 4. The nurse is providing wound care for a patient with a stage IV pressure ulcer and expects that the patient will receive which supplements to assist in wound healing? (Select all that apply.) a. Vitamin K b. Vitamin B1 c. Zinc d. Calcium e. Vitamin C 5. While caring for a newly admitted patient who has a long history of alcoholism, the nurse anticipates that part of the patient's medication regimen will include which vitamin? a. Vitamin B1 (thiamine) b. Vitamin B6 (pyridoxine) c. Vitamin C (ascorbic acid) d. Vitamin A (retinol) 6. When administering vitamin and mineral supplements, the nurse implements which appropriate interventions? (Select all that apply.) a. Not administering oral calcium tablets along with oral tetracyclines b. Administering intravenous calcium via a rapid intravenous push infusion c. Monitoring the heart rhythm (ECG) of a patient receiving an intravenous magnesium infusion d. Giving oral niacin with milk or food to decrease gastrointestinal upset e. Monitoring for the formation of renal stones in patients taking large doses of vitamin C 7. The order reads: “Give vitamin K (AquaMEPHYTON) 0.5 mg IM within 1 hour of birth.” The medication is available in a vial that contains 1 mg/0.5 mL. How many milliliters will the nurse draw up for the injection? 8. The nurse is assessing a patient who has been recently admitted to the hospital after living on the streets for over 1 year. The nurse notes that the patient has severely chapped and fissured lips. This could be a sign of which vitamin deficiency? a. Vitamin B2 (riboflavin) b. Vitamin B6 (pyridoxine) c. Vitamin C (ascorbic acid) d. Vitamin E (tocopherols) 1. d, 2. a, 3. b, 4. c, e, 5. a, 6. a, c, d, e, 7. 0.25 mL, 8. a.   CH54 Anemia drugs 1. When administering oral iron tablets, the nurse should keep in mind that the most appropriate substance, other than water, to give with these tablets is a. pudding. b. An antacid. c. milk. d. Orange juice. 2. The nurse is teaching a patient about oral iron supplements. Which statement is correct? a. “You need to take this medication on an empty stomach or else it won't be absorbed.” b. “It is better absorbed on an empty stomach, but if that causes your stomach to be upset, you can take it with food.” c. “Take this medication with a sip of water, and then lie down to avoid problems with low blood pressure.” d. “If you have trouble swallowing the tablet, you may crush it.” 3. The nurse is administering an intravenous dose of iron dextran. For which potential adverse effect is it most important for the nurse to monitor at this time? a. Anaphylaxis b. Gastrointestinal distress c. Black, tarry stools d. Bradycardia 4. The nurse is assessing a patient who is to receive folic acid supplements. It is important to rule out which condition before giving the folic acid? a. Malabsorption syndromes b. Pernicious anemia c. Tropical sprue d. Pregnancy 5. A patient with renal failure has severe anemia, and there is an order for darbepoetin (Aranesp). As the nurse assesses the patient, which condition listed will the nurse consider a contraindication to use of this medication? a. Uncontrolled hypertension b. Diabetes mellitus c. Hypothyroidism d. Angina 6. When iron sucrose is administered, which nursing interventions are correct? (Select all that apply.) a. Administer a test dose before giving the full dose. b. Give via deep intramuscular injection into a large muscle mass using the Z-track method. c. Administer large doses over 2.5 to 3.5 hours, intravenously. d. Monitor the patient for hypertension. e. Monitor the patient for hypotension. 7. The order reads: “Give epoetin alfa (Epogen), 3500 units subcut, three times a week.” The medication is available in a vial that contains 4000 units/mL. How many milliliters will the nurse draw up for the ordered dose? (Record your answer using two decimal places.) 8. A woman who is planning to become pregnant asks the nurse when she should start to take folic acid supplements. What is the nurse's best response? a. “There is no evidence to support the use of folic acid during pregnancy.” b. “You should start taking it at least 1 month before you become pregnant and continue it throughout early pregnancy.” c. “You need to start it as soon as you discover you are pregnant.” d. “You should only take it during the last trimester of your pregnancy, and not any earlier.” 1. d, 2. b, 3. a, 4. b, 5. a, 6. c, e, 7. 0.88 mL (rounded from 0.875), 8. b.   CH55 Nutritional supplements 1. The nurse is assessing an enteral feeding that is infusing via a nasogastric feeding tube. Which statement about this tube is accurate? a. It is surgically inserted into the stomach. b. It is inserted through the nose into the jejunum. c. It is surgically inserted directly into the jejunum. d. It is inserted through the nose into the stomach. 2. When administering total parenteral nutrition (TPN), the nurse is aware that one purpose of intravenous fat (lipid) emulsions is to provide which nutrient? a. Calories b. Amino acids c. Minerals d. Immunoglobulins 3. The nurse is monitoring a patient who is receiving a total parenteral nutrition (TPN) infusion and notes that the patient has cold clammy skin, shows tachycardia, and is complaining of feeling dizzy. What is the nurse's immediate action at this time? a. Stop the TPN infusion. b. Check the patient's blood glucose level. c. Order a stat (immediate) electrocardiogram. d. Obtain an order for blood cultures. 4. A patient has new orders for administration of peripheral parenteral nutrition (PPN). The nurse knows that PPN is most appropriate in which situation? a. Therapy is expected to last longer than 2 weeks. b. Therapy is expected to last fewer than 14 days. c. A dextrose concentration of 20% is needed. d. Nutritional needs are 3000 kcal/day. 5. During the night shift, a patient's total parenteral nutrition (TPN) infusion runs out, the pharmacy is closed, and a new TPN bag will not be available for about 6 hours. What is the nurse's most appropriate action at this time? a. Hang a bottle of lipid solution. b. Hang a bag of normal saline. c. Hang a bag of 10% dextrose. d. Call the prescriber for stat TPN orders. 6. The nurse is assessing a patient who is receiving an enteral tube feeding. Which are possible adverse effects associated with enteral feedings? (Select all that apply.) a. Hypoglycemia b. Air embolism c. Aspiration d. Diarrhea e. Infection 7. A patient is receiving a tube feeding of Glucerna via percutaneous enteral gastrostomy (PEG) tube at 50 mL/hr. The orders also read to check the residual and flush the tubing every 4 hours with 30 mL of water. Calculate the total intake of fluid at the end of a 12-hour shift. 8. The nurse is assessing a newly admitted patient who had been living his car for several months. Which of these are clinical signs of essential fatty acid deficiency? (Select all that apply.) a. Hair loss b. Wounds with delayed healing c. Increased platelet levels d. Scaly dermatitis e. Excessive bruising 1. d, 2. a, 3. b, 4. b, 5. c, 6. c, d, 7. 690 mL, 8. A, b, d   CH56 Dermatologic drugs 1. The nurse is assessing the skin of a teenage patient who has been using a benzoyl peroxide product for 2 weeks as part of treatment for acne. Which assessment findings indicate that the patient is having an allergic reaction and will need to stop treatment? a. Reddened skin over the treatment area b. Blistering skin over the treatment area c. Peeling skin over the treatment area d. Sensation of warmth when the product is applied 2. When considering the variety of OTC topical corticosteroid products, the nurse is aware that which type of preparation is generally most penetrating and effective? a. Gel b. Lotion c. Spray d. Ointment 3. The nurse is monitoring for an allergic reaction to topical bacitracin, which would be evident by presence of a. petechia. b. Thickened skin. c. Itching and burning. d. Purulent drainage. 4. When the nurse is teaching a patient about the mechanism of action of tretinoin, which statement by the nurse is correct? a. “This medication acts by killing the bacteria that cause acne.” b. “This medication actually causes skin peeling.” c. “This medication acts by protecting your skin from UV sunlight.” d. “This medication has antiinflammatory actions.” 5. When the nurse is providing wound care with Dakin's solution for a patient who has a stage III pressure ulcer, the patient exclaims, “I smell bleach! Why are you putting bleach on me?” What is the nurse's best explanation? a. “This is a very dilute solution and acts to reduce the bacteria in the wound so that it can heal.” b. “This solution is used instead of medication to promote wound healing.” c. “This solution is used to dissolve the dead tissue in your wound.” d. “Don't worry; we would never use bleach on a patient!” 6. The nurse is instructing a parent on the use of lindane (Kwell) shampoo for treatment of a child's head lice. Which statement by the parent indicates a need for further education? a. “I will wash his hair, and then rinse out the shampoo immediately.” b. “I will leave the shampoo on his hair for 4 minutes before rinsing.” c. “After shampooing, I will rinse and dry his hair.” d. “When the hair is dry, I will comb the hair to remove the nits.” 7. The nurse is performing wound care on a burned area using silver sulfadiazine cream in a patient with an arm wound. Which actions by the nurse are correct? (Select all that apply.) a. Applying the cream over the previous layer to avoid disturbing the wound bed b. Gently cleansing the wound to remove the previous layer of cream and wound debris c. Using clean gloves to apply the ointment d. Using sterile gloves to apply the ointment e. Always covering the wound with a dressing after applying the cream f. Washing hands before and after the procedure 8. The nurse is reviewing the use of topical anesthetic drugs. Which of these is an appropriate use for the lidocaine/prilocaine combination cream known as EMLA? a. To reduce the discomfort of insect bites b. To reduce the pain of sunburn c. To relieve the itching associated with poison ivy d. To reduce pain before a needle insertion 1. b, 2. d, 3. c, 4. b, 5. a, 6. a, 7. b, d, f, 8. d. CH57 Ophthalmic drugs 1. The ophthalmologist has given a patient a dose of ocular atropine drops before an eye examination. Which statement by the nurse accurately explains to the patient the reason for these drops? a. “These drops will cause the surface of your eye to become numb so that the doctor can do the examination.” b. “These drops are used to check for any possible foreign bodies or corneal defects that may be in your eye.” c. “These drops will reduce your tear production for the eye examination.” d. “These drops will cause your pupils to dilate, which makes the eye examination easier.” 2. When assessing a patient who is receiving a direct-acting cholinergic eyedrop as part of treatment for glaucoma, the nurse anticipates that the drug affects the pupil in which way? a. It causes mydriasis, or pupil dilation. b. It causes miosis, or pupil constriction. c. It changes the color of the pupil. d. It causes no change in pupil size. 3. During patient teaching regarding self-administration of ophthalmic drops, which statement by the nurse is correct? a. “Hold the eyedrops over the cornea, and squeeze out the drop.” b. “Apply pressure to the lacrimal duct area for 5 minutes after administration.” c. “Be sure to place the drop in the conjunctival sac of the lower eyelid.” d. “Squeeze your eyelid closed tightly after placing the drop into your eye.” 4. When the nurse is providing teaching about eye medications for glaucoma, the nurse tells the patient that miotics help glaucoma by which mechanism of action? a. Decreasing intracranial pressure b. Decreasing intraocular pressure c. Increasing tear production d. Causing pupillary dilation 5. During the assessment of a glaucoma patient who has newly prescribed carbonic anhydrase inhibitor eyedrops, the nurse would report a history of which condition? a. Allergy to sulfa drugs b. Decreased renal function c. Diabetes mellitus d. Hypertension 6. The nurse is preparing to administer ketorolac (Acular) eyedrops. The patient asks, “Why am I getting these eyedrops?” What is the nurse's correct response? a. “These drops will reduce the pressure inside your eye as part of treatment for glaucoma.” b. “These drops are for a bacterial eye infection.” c. “These drops will relieve your dry eyes.” d. “These drops work to reduce the inflammation in your eyes.” 7. A patient has undergone an eye procedure during which ophthalmic mydriatics and anesthetic drops were used. The nurse gives which instructions to the patient prior to discharge? (Select all that apply.) a. “Do not rub or touch the numb eye.” b. “You may reinsert your contact lenses before you leave.” c. “Be sure to wear sunglasses when you go outside.” d. “Your pupils will appear very tiny until the medication wears off.” e. “Report any increase in eye pain or drainage to the ophthalmologist immediately.” 8. The nurse is administering sympathomimetic ophthalmic drops. Which therapeutic drug effect will these drops have on the patient's eyes? a. Miosis b. Reduced intraocular pressure c. Reduced inflammation d. Increased lubrication. 1. d, 2. b, 3. c, 4. b, 5. a, 6. d, 7. a, c, e, 8. b.   CH58 Otic drugs 1. While teaching a patient about treatment of otitis media, the nurse should mention that untreated otitis media may lead to a. mastoiditis. b. Throat infections. c. Fungal ear infection. d. Decreased cerumen production. 2. During a teaching session about eardrops, the patient tells the nurse, “I know why an antibiotic is in this medicine, but why is hydrocortisone in these eardrops?” What is the nurse's best response? a. “The hydrocortisone will help to soften the cerumen.” b. “The hydrocortisone reduces itching and inflammation.” c. “The hydrocortisone also has antifungal effects.” d. “This medication helps to anesthetize the area to decrease pain.” 3. The nurse is preparing to administer eardrops. Which technique for administering eardrops is correct? a. Warm the solution to 100° F (37.7° C) before using. b. Position the patient so that the unaffected ear is accessible. c. Massage the tragus before administering the eardrops. d. Gently insert a cotton ball into the outer ear canal after the drops are given. 4. The nurse is discussing treatment of earwax buildup with a patient. Which statement about earwax emulsifiers is correct? a. These drugs are useful for treatment of ear infections. b. They loosen impacted cerumen so that it may be removed by irrigation. c. They are used to rinse out excessive earwax. d. They enhance the secretion of earwax. 5. During an examination, the nurse notes that a patient has a perforated tympanic membrane. There is an order for eardrops. Which is the nurse's most appropriate action at this time? a. Give the medication as ordered. b. Check the patient's hearing, and then give the drops. c. Hold the medication, and check with the prescriber. d. Administer the drops with a cotton wick. 6. The nurse is preparing to administer eardrops and finds that the bottle has been stored in the medication room refrigerator. Which is the nurse's best action at this time? a. Remove the bottle from the refrigerator, and administer the drops. b. Heat the bottle for 5 seconds in the microwave oven before administering the drops. c. Let the bottle sit in a cup of hot water for 15 minutes before administering the drops. d. Remove the bottle from the refrigerator 1 hour before the drops are due to be given. 7. The nurse is preparing to administer carbamide peroxide (Debrox) to an adult patient with impacted cerumen. Which actions by the nurse are correct? (Select all that apply.) a. Have the patient lie on his or her side with the affected ear up. b. Chill the medication before administering it. c. Pull the pinna of the ear down and back. d. Pull the pinna of the ear up and back. e. Gently irrigate the ear with warm water to remove the softened earwax. 8. A child is in the clinic with a severe case of otitis media. The prescriber has decided to treat it with an antibiotic, and the nurse anticipates that which antibiotic will be prescribed as a first-line drug for this condition? a. Tetracycline b. Penicillin c. Amoxicillin d. ciprofloxacin 1. a, 2. b, 3. d, 4. b, 5. c, 6. d, 7. a, d, e, 8. c.