1 The nurse is teaching a patient how a medication works to treat an illness. To do this, the nurse will rely on knowledge of which topic? D 2 What is a desired outcome when a drug is described as easy to administer? C 3 A patient tells the nurse that an analgesic he will begin taking may cause drowsiness and will decrease pain up to 4 hours at a time. Based on this understanding of the drug's effects by the patient, the
nurse will anticipate which outcome? C 4 What are the properties of an ideal drug? (Select all that apply.) B, C, D 5 Before administering a medication, what does the nurse need to know to evaluate how individual patient variability might affect the patient's response to the medication? (Select all that apply.) C, D, E 6 A patient is using a metered-dose inhaler containing albuterol for asthma. The medication label instructs the patient to administer "2 puffs every 4 hours as needed for coughing or wheezing." The patient
reports feeling jittery sometimes when taking the medication, and she doesn't feel that the medication is always effective. Which action is outside the nurse's scope of practice? D 7 A postoperative patient is being discharged home with acetaminophen/hydrocodone [Lortab] for pain. The patient asks the nurse about using Tylenol for fever. Which statement by the nurse is correct? B 8 The nurse is preparing to care for a patient who will be taking an antihypertensive medication. Which action by the nurse is part of the assessment step of the nursing process? C 9 A postoperative patient reports pain, which the patient rates
as an 8 on a scale from 1 to 10 (10 being the most extreme pain). The prescriber has ordered acetaminophen [Tylenol] 650 mg PO every 6 hours PRN pain. What will the nurse do? B 10 A patient newly diagnosed with diabetes is to be discharged from the hospital. The nurse teaching this patient about home management should begin by doing what? A 11 The nurse receives an order to give morphine 5 mg IV every 2 hours PRN pain. Which action is not part of the six rights of drug administration? A 12 A patient tells a nurse that a medication prescribed for recurrent migraine headaches is not working. What will the nurse do? A 13 A nurse is preparing to administer medications. Which patient would the nurse consider to have the greatest predisposition to an adverse reaction? A 14 A nurse consults a drug manual before giving a medication to an 80-year-old patient. The manual states that older-adult patients are at increased risk for hepatic side
effects. Which action by the nurse is correct? A 15 A patient has been receiving intravenous
penicillin for pneumonia for several days and begins to complain of generalized itching. The nurse auscultates bilateral wheezing and notes a temperature of 38.5°C (101°F). Which is the correct action by the nurse? D 16 A postoperative patient has orders for morphine sulfate 1 to 2 mg IV every 1 hour PRN for severe pain and acetaminophen-hydrocodone [Lortab] 7.5 mg PO every 4 to 6 hours PRN for moderate pain. The patient reports pain at a level of 8 on a scale of 1 to 10, with 10 being the worst pain. Which action by the nurse is appropriate? D 17 The nurse is
teaching a patient about home administration of insulin to treat diabetes mellitus. As part of the teaching, the patient and nurse identify goals to maintain specific blood glucose ranges. This represents which aspect of the nursing process? D 18 A nurse is reviewing a patient's medical record before administering a medication. Which factors can alter the patient's physiologic response to the drug? (Select all that
apply.) B, C, D 19 A nurse educator is conducting a continuing education class on pharmacology. To evaluate the learning of the nurses in the class, the nurse educator asks, "Which drug name gives information about the drug's pharmacologic classification?" Which is the correct response? A 20 The FDA Amendments Act (FDAAA) was passed in 2007 to address which aspect of drug safety? B 21 A
nursing student asks a nurse about pharmaceutical research and wants to know the purpose of randomization in drug trials. The nurse explains that randomization is used to do what? A 22 Someone asks a nurse about a new drug that is in preclinical testing and wants to know why it cannot be used to treat a friend's illness. Which statement by the nurse is correct? B 23 A patient asks a nurse why drugs that have been approved by the FDA still have unknown side effects. What will the nurse tell the
patient? D 24 A nurse is teaching nursing students about the use of
nonproprietary names for drugs. The nurse tells them which fact about nonproprietary names? B 25 A patient tells the nurse that the oral drug that has been prescribed has caused a lot of stomach discomfort in the past. What will the nurse ask the prescriber? C 26 A patient claims to get better effects with a tablet of Brand X of a drug than with a tablet of Brand Y of the same drug. Both brands contain the same amount of the active ingredient. What does the nurse know to be most likely? C 27 A patient receives a drug that has a narrow therapeutic range. The nurse administering this medication will expect to do
what? C 28 A patient
is given a prescription for azithromycin [Zithromax] and asks the nurse why the dose on the first day is twice the amount of the dose on the next 4 days. Which reply by the nurse is correct? A 29 A nurse is giving an enteral medication. The patient asks why this method is preferable for this drug. How will the nurse reply? B 30 The nurse is preparing to administer penicillin G intramuscularly to a child. The child's parents ask why the drug cannot be
given in an oral liquid form. What is the nurse's reply? D 31 A provider has written an order for a medication: drug 100 mg PO every 6 hours. The half-life for the drug is approximately 6 hours. The nurse is preparing to administer the first dose at 8:00 AM on Tuesday. On Wednesday, when will the serum drug level reach plateau? B 32 An adult male patient is 1 day postoperative from a total hip replacement. On a pain scale of 0 to 10, with 10 being the greatest pain, the patient reports a pain level of 10. Which medication would be most appropriate for the nurse to administer to this patient? C 33 A nurse is explaining drug metabolism to a nursing student who asks about glucuronidation. The nurse knows that this is a process that allows drugs to be: C 34 A patient is receiving intravenous gentamicin. A serum drug test reveals toxic levels. The dosing is correct, and this medication has been tolerated by this patient in the past. Which could be a probable cause of the test result? C 35 The nurse is caring for a child who has ingested a toxic amount of aspirin. The provider orders an intravenous drug that will increase pH in the blood and urine. The nurse understands that this effect is necessary to: D 36 A patient is taking a drug that does not bind to albumin. Which aspect of renal drug excretion is affected by this characteristic? B 37 When administering medications to infants, it is important to remember which of the following? (Select all that apply.) B, C, D 38 A patient is receiving digoxin twice daily. When assessing the patient before giving a dose, the nurse counts a pulse of 60 beats
per minute and learns that the patient is experiencing nausea. The nurse consults a drug manual and verifies that the ordered dose is correct. What should the nurse do? A 39 A patient reports becoming "immune" to a medication because it no longer works to alleviate symptoms. The nurse recognizes that this decreased effectiveness is likely caused by: C 40 A patient has been receiving an antibiotic with a small
therapeutic index for 10 days. Upon assessment, the nurse notes an increase in the drug's side effects. What would be the nurse's priority action? C 41 A patient who is taking morphine for pain asks the nurse how
a pain medication can also cause constipation. What does the nurse know about morphine? D 42 What occurs when a drug binds to a receptor in the body? B 43 The nurse administers naloxone [Narcan] to a patient who has received a toxic dose of morphine sulfate. The
nurse understands that the naloxone is effective because of which action? C 44 Two nurses are discussing theories of drug-receptor interaction. Which statements are true regarding the affinity of a drug and its receptor? (Select all that apply.) B, C, E 45 Which drugs will not be affected by interpatient variability? (Select all that apply.) A, B, D 46 The nurse is teaching a patient about taking
warfarin and asks if the patient takes aspirin. This assessment by the nurse reflects a knowledge of which type of drug interaction? D 47 A young adult postoperative patient is receiving morphine 2 to 4 mg IV every 2 hours PRN pain. The last dose was 3 mg given 2 hours ago. The patient is asleep, and the nurse notes a heart rate of 86 beats per minute and a respiratory rate of 8 breaths per minute. Which PRN medication will the nurse give this patient? C 48 In a discussion of drug-drug interactions, which would be the best example of a beneficial inhibitory interaction? A 49 A patient is taking drug X and receives a new prescription for drug Y, which is listed as an inducing agent. The nurse caring for this patient understands that this patient may require ____ doses of drug ____. C 50 A patient taking oral contraceptives thinks she may be pregnant. As part of this patient's history, what will the nurse ask the patient? B 51 A child ingests a parent's aspirin tablets, and the prescriber orders sodium bicarbonate to block the toxic effects of the aspirin. The nurse caring for this patient knows that sodium bicarbonate is effective against the aspirin because it: D 52 Which statement about food and drug interactions is true? D 53 A nurse is teaching a patient about a prescription for a monoamine oxidase (MAO) inhibitor for depression. What will the nurse teach the patient to avoid while taking this drug? B 54 A nurse is teaching a patient about a drug that induces P-glycoprotein. The nurse will explain that this drug may cause which effect on
other drugs? B 55 The nurse is providing
multiple medications to a patient whose spouse brings grapefruit juice every morning. The nurse will be concerned about which classes of drugs? (Select all that apply.) A, B 56 The nurse is administering morning medications. The nurse gives a patient multiple medications, two of which compete for plasma albumin receptor sites. As a result of this concurrent administration, the nurse can anticipate that what might occur? (Select all that apply.) A, B, D 57 A nurse is caring for a patient who is taking multiple medications. To help ensure that adverse drug reactions are prevented or minimized, the nurse will do which of the following? (Select all that apply.) A, B, D 58 The prescriber has ordered an antibiotic for a patient with a bacterial infection. The nurse provides
patient education at discharge and instructs the patient to take the drug on an empty stomach. When should the patient take the drug? (Select all that apply.) A, D 59 A patient is given a new medication and reports nausea within an hour after taking the drug. The nurse consults the drug information manual and learns that nausea is not an expected adverse effect of this drug. When the next dose is due,
what will the nurse do? A 60 A patient is being discharged after surgery. During the admission history, the nurse learned that the patient normally consumes two or three glasses of wine each day. The prescriber has ordered hydrocodone with acetaminophen [Lortab] for pain. What will the nurse do? C 61 A nurse is reviewing a medication administration record before administering medications. Which order will the nurse implement? D 62 A patient is given a drug for the first time and develops shortness of breath. The patient's heart rate is 76 beats per minute, the respiratory rate is 20 breaths
per minute, and the blood pressure is 120/70 mm Hg. The nurse checks a drug administration manual to make sure the correct dose was given and learns that some patients taking the drug experience shortness of breath. The nurse will contact the provider to report what? D 63 A nurse is preparing to give an antibiotic to a patient who reports
being allergic to antibiotics. Before giving the medication, what will the nurse do first? B 64 A nurse provides teaching to a patient who will begin taking a drug with a known risk of hepatotoxicity. Which statement by the patient indicates a need for further teaching? D 65 A patient is taking sertraline [Zoloft] for depression, and the provider orders
azithromycin [Zithromax] to treat an infection. What will the nurse do? A 66 A patient is taking a drug that has known toxic side effects. What will the nurse do? C 67 A nursing student is preparing to give a medication that has a boxed warning. The student asks the nurse what this means. What will the nurse explain about boxed warnings? C 68 Which actions occur in 90% of fatal medication errors? (Select all that apply.) B, C, E 69 Which are effective ways to help prevent medication errors? (Select all that apply.) A, C, E 70 Which patients are at increased risk for adverse drug events? (Select all that apply.) A, C, E 71 A postoperative patient who is worried about pain control will be discharged several days after surgery. The nurse providing discharge teaching tells the
patient that the prescribed Lortab is not as strong as the morphine the patient was given in the immediate postoperative period. Which response is the patient likely to experience? B 72 A nurse administers the same medication in the same preparation in the same dose to several patients and notes that some patients have a better response to the drug than others. What is the most likely
explanation for this phenomenon? C 73 The U.S. Food and Drug Administration (FDA) recommends genetic testing of patients receiving certain medications. Genetic testing helps
prescribers: B 74 A patient asks a nurse why a friend who is taking the same drug responds differently to that drug. The nurse knows that the most common variation in drug response is due to differences in each patient's: C 75 A nurse is preparing to care for a patient who is receiving digoxin. When screening for potential adverse effects from this drug, the nurse will review which of this patient's laboratory results? C 76 A nurse is caring for a woman with breast cancer who is receiving tamoxifen. A review of this patient's chart reveals a deficiency of the CYP2D6 gene. The nurse will contact the provider to suggest: A 77 A nurse is teaching a group of women about medications. The women want to know why so many drugs have unpredictable effects in
women. The nurse will tell them that: B 78 The nurse is assessing a newly admitted older patient who has recently lost 15 pounds. The nurse notes that the patient is taking warfarin (Coumadin). Which laboratory tests will the nurse discuss with this patient's provider? D 79 Which groups of people
are especially sensitive to medication effects? (Select all that apply.) A, C 80 A patient receives morphine and shows signs of toxicity. The prescriber orders naloxone [Narcan] to reverse the effects of the morphine. The nurse understands that the naloxone reverses morphine toxicity by which action on morphine receptor sites? D 81 A nurse is teaching a group of nursing students about neuropharmacology. Which statement by a student about
peripheral nervous system (PNS) drugs indicates a need for further teaching? A 82 A nurse is preparing to administer a medication and learns that it is a nonselective agonist drug. What does the nurse
understand about this drug? A 83 A nurse is administering drug X to a patient. The drug information states that the drug acts by activating receptors in the peripheral nervous system by increasing transmitter synthesis. The nurse understands that the effect of this drug is to: C 84 A nurse learns about a drug that interferes with transmitter storage in the PNS. The transmitter affected by this drug causes an increased heart rate. What response will the nurse expect to see when this drug is administered? A 85 A patient receiving botulinum toxin injections to control muscle spasticity asks how the drug works. The nurse knows that this drug affects the transmitter acetylcholine by: A 86 A patient has allergies and takes an antihistamine. The patient wants to know how the drug works. The nurse understands that antihistamines work because they are what? C 87 A nursing student asks about drugs that interfere with the termination of transmitter action. Which statement by the nurse is correct? D 88 What is the target organ when a beta1 agonist is administered? A 89 A nurse is teaching a patient about a medication that alters sympathetic nervous system functions. To evaluate understanding, the nurse asks the patient to describe which functions the sympathetic nervous system regulates. Which answer indicates the need for further teaching? B 90 A patient is
wheezing and short of breath. The nurse assesses a heart rate of 88 beats per minute, a respiratory rate of 24 breaths per minute, and a blood pressure of 124/78 mm Hg. The prescriber orders a nonspecific beta agonist medication. Besides evaluating the patient for a reduction in respiratory distress, the nurse will monitor for which side effect? B 91 A nurse is teaching a group of nursing students about neurotransmitters. Which statement by a student about acetylcholine indicates a need for further teaching? D 92 A nurse is administering an agonist drug that acts on postganglionic neurons of the sympathetic nervous system. Which response will the nurse expect to see? C 93 Many medications list side effects that include dry mouth, constipation, and urinary
retention. What kinds of effects are these? B 94 A nurse is explaining activation of beta2 receptors to nursing students during a clinical rotation at the hospital. Which statement by a student demonstrates a need for further teaching? B 95 A pregnant patient is in premature labor. Which class of drug will she be given? C 96 A patient is to receive a beta agonist. Before administration of this medication, which assessment finding would most concern the nurse? D 97 A prescriber has ordered pilocarpine [Pilocar]. A nurse understands that the drug stimulates muscarinic receptors and would expect the drug to have which action? B 98 A patient has developed muscarinic antagonist toxicity from ingestion of an unknown chemical. The nurse should prepare to administer which medication? B 99 A prescriber has ordered bethanechol [Urecholine] for a postoperative patient who has urinary retention. The nurse reviews the patient's chart before giving the drug. Which part of the patient's history would be a contraindication to using this drug? A 100 A patient will begin using a transdermal preparation of a muscarinic antagonist for overactive bladder (OAB). The nurse teaches the patient what to do
if side effects occur. Which statement by the patient indicates the need for further teaching? D 101 An older adult
patient who lives alone and is somewhat forgetful has an overactive bladder (OAB) and reports occasional constipation. The patient has tried behavioral therapy to treat the OAB without adequate results. Which treatment will the nurse anticipate for this patient? C 102 A patient received atropine intravenously before surgery. The recovery room nurse notes that the patient is delirious upon awakening and has a heart rate of 96 beats per minute, a respiratory rate of 22 breaths per minute, and a blood pressure of 110/78 mm Hg. The nurse notifies the anesthesiologist, who will order: B 103 Bethanechol [Urecholine] is used to treat urinary retention but is being investigated for use in which other condition? B 104 A patient receives topical atropine to facilitate an eye examination. The nurse will tell the patient to remain in a darkened room or to wear sunglasses for several hours until the effects of the medication wear off. This teaching is based
on the nurse's knowledge that muscarinic antagonists cause: C 105 A patient who has esophageal cancer is experiencing dry mouth and the provider orders oral pilocarpine to treat this symptom. What will the nurse expect to teach this patient about this medication? D 106 A nurse is teaching a nursing student about the two classes of adrenergic agonist drugs. Which statement by the nursing student indicates understanding of the teaching? B 107 Dopamine is administered to a patient who has been experiencing hypotensive episodes. Other than an increase in blood pressure, which indicator would the nurse use to evaluate a successful response? B 108 A nursing student asks the nurse about receptor specificity
of adrenergic agonist medications. What will the nurse say? D 109 A patient brought to the emergency department requires sutures. The prescriber orders a local anesthetic with epinephrine. The nurse understands that epinephrine is ordered to: B 110 A nurse is administering intravenous dopamine [Intropin] to a patient in the intensive care unit. Which assessment finding would cause the most concern? C 111 A patient with asthma uses
albuterol [Ventolin] for wheezing. The nurse assesses the patient and notes vital signs of HR, 96 beats per minute; RR, 18 breaths per minute; and BP, 116/78 mm Hg. The patient has clear breath sounds and hand tremors. What will the nurse do?
A 112 A nurse is teaching parents how to use an
Epi-Pen for their child, who has a peanut allergy. Which statement by the parents indicates understanding of the teaching? A 113 Because they cause vasoconstriction, alpha1-adrenergic agonists are especially useful for: A 114 A patient is admitted to the intensive care unit for treatment of shock. The prescriber orders isoproterenol [Isuprel]. The nurse expects this drug to increase tissue perfusion in this patient by activating: C 115 A nursing student asks the nurse why epinephrine, and not other adrenergic agonists, is used to treat anaphylactic shock. What will the nurse tell the
student? B 116 A nursing student asks why albuterol, which is selective for beta2 receptors, causes an increased heart rate in some patients. How should the nurse respond? A 117 A patient is receiving dobutamine
[Dobutrex] as a continuous infusion in the immediate postoperative period. The patient also is receiving a diuretic. What adverse drug reactions are possible in this patient? (Select all that apply.) A, B, E 118 A nurse is teaching nursing students about the use of alpha-adrenergic antagonists. Which statement by a student indicates the need for further teaching? C 119 A patient with pheochromocytoma is admitted for surgery. The surgeon has ordered an alpha-blocking agent to be given preoperatively. What does the nurse understand about this agent? A 120 A patient with type 1 diabetes is taking NPH insulin, 30 units every day. A nurse notes that the patient is also taking metoprolol [Lopressor]. What education should the nurse provide to the patient? C 121 The nurse is discussing home
management with a patient who will begin taking an alpha-adrenergic antagonist for hypertension. Which statement by the patient indicates understanding of the teaching? C 122 A nurse prepares to administer propranolol [Inderal] to a patient recovering from acute myocardial infarction. The patient's heart rate is 52 beats per minute, and the rhythm is regular. What action should the nurse take next? D 123 The nurse assesses a patient who has been given phentolamine [OraVerse] to treat pheochromocytoma. The nurse notes a blood pressure of 76/52 mm Hg and a heart rate of 90 beats per minute. Which action by the nurse is correct? D 124 A nurse is discussing phentolamine [OraVerse] with a nursing student. Which statement by the student indicates the need for further teaching? C 125 A patient taking a beta blocker complains of shortness of breath. The patient has respirations of 28 breaths per minute, a blood pressure of 162/90 mm Hg, and a pulse of 88 beats per minute. The nurse auscultates crackles in all lung fields. The nurse understands that these assessments are consistent with: B 126 A male patient is being treated for benign prostatic hyperplasia and has stopped taking his alpha-adrenergic antagonist medication because of ejaculatory difficulties. Which medication does the nurse expect the provider to prescribe? A 127 A patient is taking a beta-adrenergic antagonist medication for angina pectoris and asks the nurse how the drug works to relieve the discomfort associated with this condition. Which statement by the patient after the nurse's teaching indicates understanding of the drug's effects? B 128 A nurse is caring for a newborn 1 day after delivery. The infant's mother used betaxolol during pregnancy. The nurse will expect to monitor this infant for which condition? C 129 A patient will begin taking propranolol [Inderal] for hypertension. Which statement by the nurse is important when teaching this patient about the medication? A 130 A patient with migraines is started on a beta blocker. The nurse explains the benefits of taking the medication for migraines. Which statement by the patient indicates an understanding of the medication's effects? A 131 Which are adverse effects of alpha blockade? (Select all that apply.) B, C, E 132 Which are conditions that may be treated using beta blockers? (Select all that apply.) A, B, E 133 A prescriber has ordered
clonidine [Catapres] for a patient who has hypertension. The nurse teaches the patient about side effects of this drug. Which statement by the patient indicates understanding of the teaching? A 134 A prescriber has ordered methyldopa for a patient with hypertension. The nurse teaches the patient about drug actions, adverse effects, and the ongoing blood tests necessary with this drug. The nurse is correct to tell the patient what? D 135 A patient complains to the nurse that the
clonidine [Catapres] recently prescribed for hypertension is causing drowsiness. Which response by the nurse to this concern is appropriate? A 136 A nurse is teaching nursing students about the pharmacology of methyldopa. Which statement by a student indicates the need for further teaching? C 137 A nurse is teaching a patient about a new prescription for reserpine [Serpasil] for hypertension. Which statement by the patient indicates the need for further teaching? A 138 A patient who has been taking clonidine [Catapres] for several weeks complains of drowsiness and constipation. What will the nurse do? A 139 A patient with hypertension has a previous history of opioid dependence. Which medication would the nurse question? A 140 A prescriber orders transdermal clonidine [Catapres TTS] for a patient with hypertension. What will the nurse teach this patient? D 141 A prescriber orders clonidine [Kapvay] ER tablets for a 12-year-old child. The nurse understands that
this drug is being given to treat which condition? A 142 A prescriber has ordered methyldopa for a female patient with hypertension. The nurse understands that which laboratory tests are
important before beginning therapy with this drug? (Select all that apply.) A, B, C 143 Clonidine is approved for the treatment of which conditions? (Select all that apply.) A, B,
D 144 A psychiatric nurse is teaching a patient about an antidepressant medication. The nurse tells the patient that therapeutic effects may not occur for several weeks. The nurse understands that this is likely the result of: A 145 A nurse is teaching a group of nursing students how the CNS adapts to psychotherapeutic medications. Which statement by a nursing student indicates a need for further teaching? D 146 A group of nursing students asks a nurse to explain the blood-brain barrier. The nurse would be correct to say that the blood-brain barrier: A 147 A nurse is teaching a group of students about how CNS drugs are developed. Which statement by a student indicates a need for further teaching? D 148 A patient asks a nurse to explain what drug tolerance means. The nurse responds by telling the patient that when tolerance occurs, it means the patient: B 149 An infant who receives a drug that does not produce CNS side effects in adults exhibits drowsiness and sedation. The nurse understands that this is because of differences in which
physiologic system in infants and adults? A 150 Which monoamines act as neurotransmitters in the central nervous system? (Select all that apply.) B, C, D, E 151 Which are medical applications of central nervous system drugs? (Select all that apply.) A, B, E 152 A patient has taken levodopa [Dopar] for Parkinson's disease for 2 weeks but reports no improvement in the symptoms. Which response by the nurse is correct? C 153 A nurse provides
teaching for a patient who is newly diagnosed with Parkinson's disease. Which statement by the patient indicates understanding of the drug therapy for this disease? A 154 A patient has been diagnosed with Parkinson's disease (PD) and begins treatment with levodopa/carbidopa [Sinemet]. After several months of therapy, the patient reports no change in symptoms.
The nurse will expect the provider to: D 155 A patient with Parkinson's disease is taking levodopa/carbidopa [Sinemet] and reports occasional periods of loss of drug effect lasting from minutes to several hours. The nurse questions the patient further and discovers that these episodes occur at different times related to the medication administration. The nurse will contact the
provider to discuss: A 156 A patient newly diagnosed with Parkinson's disease has been taking levodopa/carbidopa [Sinemet] for several weeks and complains of nausea and vomiting. The nurse tells the patient to discuss what with the provider? C 157 A nurse is discussing motor symptoms with a patient with Parkinson's disease who has been taking levodopa/carbidopa [Sinemet] for 9 months and who is now having regular tics. Which
statement by the patient indicates understanding of this symptom? A 158 A patient who has begun taking levodopa/carbidopa [Sinemet] reports feeling lightheaded and dizzy, especially when standing up from a sitting position. What will the nurse recommend? C 159 A nursing student wants to know why a patient who has been taking levodopa [Dopar] for years will now receive levodopa/carbidopa [Sinemet]. The nurse explains the reasons that levodopa as a single agent is no longer available. Which statement by the student indicates a need for further education? D 160 A nurse is teaching a group of nurses about Parkinson's medications. The nurse is correct to state that one side effect associated with pramipexole [Mirapex] that is less likely to occur with other dopamine agonists
is: A 161 A nursing student wants to know how carbidopa can be effective for treating Parkinson's disease if
it prevents the conversion of levodopa to dopamine. The nurse explains that carbidopa: B 162 A 25-year-old patient has been newly diagnosed with Parkinson's disease, and the prescriber is considering using pramipexole [Mirapex]. Before beginning therapy with this drug, the nurse will ask the patient about: A 163 A hospitalized patient with Parkinson's disease who is receiving apomorphine to treat "off" episodes develops nausea and vomiting. The nurse will discuss the use of which medication with the patient's provider? D 164 A patient with Parkinson's disease is taking levodopa/carbidopa [Sinemet]. The prescriber orders bromocriptine [Parlodel] to treat dyskinesias. The nurse notes that the patient is agitated, and the patient reports having frequent nightmares. The nurse will
contact the provider to discuss: C 165 A patient who is newly diagnosed with Parkinson's disease is prescribed levodopa [Dopar]. The patient asks the nurse about drugs to prevent disease progression. What will the nurse tell this patient? D 166 The nurse provides teaching for a patient who will begin taking rotigotine [Neupro] to treat Parkinson's disease. What will the nurse include in teaching? B 167 A patient with Parkinson's disease is taking levodopa/carbidopa [Sinemet] along with amantadine [Symmetrel] 400 mg/day to treat dyskinesias. The patient reports having increased dyskinesias several months after beginning the amantadine. The nurse will contact the provider to discuss which action? B 168 A patient asks the nurse what can be given to alleviate severe, chronic pain of several months' duration. The patient has been taking oxycodone [OxyContin] and states that it is no longer effective. The nurse will suggest discussing which
medication with the provider? A 169 A patient who has had abdominal surgery has been receiving morphine sulfate via a patient-controlled analgesia (PCA) pump. The nurse assesses the patient and notes that the patient's pupils are dilated and that the patient is drowsy
and lethargic. The patient's heart rate is 84 beats per minute, the respiratory rate is 10 breaths per minute, and the blood pressure is 90/50 mm Hg. What will the nurse do? D 170 A patient with moderate to severe chronic pain has been taking oxycodone [OxyContin] 60 mg every 6 hours PRN for several months and
tells the nurse that the medication is not as effective as before. The patient asks if something stronger can be taken. The nurse will contact the provider to discuss: B 171 A patient with cancer has been taking an opioid analgesic four times daily for several months and reports needing increased doses for pain. What will the nurse tell the patient? C 172 A woman in labor receives meperidine [Demerol] for pain. The nurse caring for the infant will observe the infant closely for: C 173 A patient who has biliary colic reports a pain level of
8 on a 1 to 10 pain scale with 10 being the most severe pain. The patient has an order for ibuprofen as needed for pain. Which action by the nurse is correct? C 174 A patient is brought to the emergency department by friends, who report finding the patient difficult to awaken.
The friends report removing two fentanyl transdermal patches from the patient's arm. On admission to the emergency department, the patient has pinpoint pupils and a respiratory rate of 6 breaths per minute. A few minutes after administration of naloxone, the respiratory rate is 8 breaths per minute and the patient's pupils are dilated. The nurse recognizes these symptoms as signs of: D 175 A patient with chronic pain has been receiving morphine sulfate but now has decreased pain. The prescriber changes the medication to pentazocine [Talwin]. The nurse will monitor the patient for: D 176 A patient will receive buprenorphine [Butrans] as a transdermal patch for pain. What is important to teach this
patient about the use of this drug? A 177 A nurse is preparing a pediatric patient for surgery and is teaching the patient and the child's parents about the use of the patient-controlled analgesia pump. The parents voice concern about their child receiving an overdose of morphine. What will the nurse do? A 178 A patient has been taking methadone [Dolophine] for 5 months to overcome an opioid addiction. The nurse should monitor the patient for which of the following electrocardiographic changes? A 179 A patient who has developed opioid tolerance will experience which effect? A 180 A nurse is administering morphine sulfate to a postoperative patient. Which are appropriate routine nursing actions when giving this drug? (Select all that apply.) A, B, D 181 Which side effects of opioid analgesics can have therapeutic
benefits? (Select all that apply.) B, C, E 182 A
patient taking fluoxetine [Prozac] complains of decreased sexual interest. A prescriber orders a "drug holiday." What teaching by the nurse would best describe a drug holiday? C 183 A patient whose spouse has died recently reports feeling down most of each day for the past 2 months. On further questioning, the nurse learns that the patient has quit participating in church and social activities, has difficulty falling asleep, and has lost 5 pounds. The patient reports feeling tired and confused all the time but does not have suicidal thoughts. What does the nurse suspect? C 184 A patient is diagnosed with major depression with severe symptoms and begins taking an antidepressant medication. Three weeks after beginning therapy, the patient tells the nurse that the drug is not working. The nurse will counsel this patient to ask the provider about: D 185 A young adult patient has been taking an antidepressant medication for several weeks and reports having increased thoughts of suicide. The nurse questions further and learns that the patient has attempted suicide more than
once in the past. The patient identifies a concrete plan for committing suicide. The nurse will contact the provider to discuss: C 186 A patient has been taking fluoxetine [Prozac] for 2 years and reports feeling cured of depression. The nurse learns that the patient is sleeping well,
participates in usual activities, and feels upbeat and energetic most of the time. The patient's weight has returned to normal. The patient reports last having symptoms of depression at least 9 months ago. What will the nurse tell this patient? B 187 A patient has been taking an SSRI antidepressant for major depression and reports having headaches and jaw pain. What will the nurse tell the patient? C 188 A patient who
has been taking a monoamine oxidase inhibitor (MAOI) for depression for several months tells the provider that the medication has not helped with symptoms. The provider plans to switch the patient to an SSRI. The nurse will teach this patient to: D 189 A neonate is born to a patient who reports taking venlafaxine [Effexor XR]. The nurse caring for the infant will observe the infant
for: A 190 A provider has indicated that a serotonin/norepinephrine reuptake inhibitor (SNRI) will be prescribed for a patient who is experiencing major depression. When conducting a pretreatment health history, the nurse learns that the patient has a recent history of alcohol abuse. Which SNRI would be contraindicated for this patient? B 191 A nurse is teaching a group of nursing students about tricyclic antidepressants (TCAs). Which statement by a student indicates a need for
further teaching? C 192 An older adult patient who is to begin taking imipramine [Tofranil] asks the nurse when the drug should be taken. The nurse will instruct the patient to: A 193 A patient who has
fibromyalgia is diagnosed with major depression. The provider orders a TCA. The nurse will teach this patient to: C 194 A patient taking an MAOI is seen in the clinic with a blood pressure of 170/96 mm Hg. What will the nurse ask this patient? C 195 A patient
who has been taking an SSRI tells the nurse that the drug has caused reduced sexual performance, weight gain, and sedation. The nurse will suggest that the patient ask the provider about using which drug? A 196 A first-time parent of a 6-week-old infant tells the nurse that she feels anxious and sad, cries a lot, and has difficulty sleeping. What will the nurse do? A 197 A woman who is nursing a newborn develops postpartum depression and her provider orders sertraline [Zoloft] to treat her symptoms. The patient is concerned about the safety of this medication for her infant. What will the nurse tell her about this medication? C 198 A patient is brought to the emergency department after taking a handful of TCA pills. The nurse will expect to provide what when caring for this patient? (Select all that apply.) A, B, C 199 Which patients are candidates for MAOIs? (Select all that apply.) A, B, C 200 A nurse is discussing the use of benzodiazepines as sedative-hypnotic agents with a group of nursing students. A student asks about the actions of these drugs in the central nervous system. The nurse makes which correct statement? A 201 A patient who has been using secobarbital for several months to treat insomnia tells the nurse that the prescriber has said the prescription will be changed to temazepam [Restoril] because it is safer. The patient asks why this agent is safer. The nurse is correct in telling
the patient that temazepam: D 202 A hospitalized patient who is given one dose of flurazepam continues to show drowsiness the next day. A nursing student
asks the nurse the reason for this, because the drug's half-life is only 2 to 3 hours. Which response by the nurse is correct? D 203 A patient who is experiencing alcohol withdrawal is given a benzodiazepine. The nurse understands that this drug is effective because: D 204 A patient takes temazepam [Restoril] for insomnia. The patient tells the nurse that a recent telephone bill lists several calls
to friends that the patient does not remember making. What will the nurse do? A 205 A patient has been taking high doses of clorazepate [Tranxene] for several months for an anxiety disorder. The nurse assessing the patient observes that the patient is agitated, euphoric, and anxious. What will the nurse do? C 206 A patient in the emergency department is given intravenous diazepam [Valium] for seizures. When the seizures stop, the nurse notes that the patient is lethargic and confused and has a respiratory rate of 10
breaths per minute. The nurse will expect to administer which of the following? C 207 A patient is brought to the emergency department by friends, who say that they were at a party where alcohol and a mix of barbiturates and benzodiazepines were all available. They tell the nurse
that the patient was among the first to arrive at the party, which started several hours ago. The patient is nonresponsive and has pinpoint pupils and respirations of 6 breaths per minute. After oxygen has been administered, the nurse should prepare the patient for which intervention?
C 208 A patient
who travels frequently for business reports occasional instances of being unable to fall asleep. The patient tells the nurse that job demands require staying up late and then getting up early for meetings. The nurse expects that the provider will prescribe which medication for this patient? C 209 A patient with a new-onset seizure disorder receives a prescription for phenobarbital. The patient reports being concerned about the sedative side
effects of this drug. Which response by the nurse is correct? A 210 A patient with a history of depression and suicidal ideation is taking fluoxetine [Prozac]. The patient reports difficulty maintaining sleep and is prescribed secobarbital [Seconal] as a sedative-hypnotic. The nurse preparing this patient for discharge from
the hospital will: C 211 A nurse is obtaining a health history from an older adult patient in an outpatient clinic. The patient reports chronic
difficulty falling asleep and staying asleep. The nurse knows that the best treatment for this patient will be: B 212 A patient complains of chronic insomnia and reports being tired of being tired all the time. The patient is reluctant to try pharmacologic remedies and asks the nurse what to do. What will the nurse suggest? B 213 A nurse recognizes that the actions of
benzodiazepines include which findings? (Select all that apply.) B, C 214 Which sedative-hypnotics are useful for both difficulty falling asleep and difficulty maintaining sleep? (Select all that apply.) A, B, E 215 A patient is brought to the emergency department with shortness of breath, a respiratory rate of 30 breaths per minute, intercostal retractions, and frothy, pink sputum. The nurse caring for this patient will expect to
administer which drug? A 216 A patient who is taking digoxin is admitted to the hospital for treatment of congestive heart failure. The prescriber has ordered furosemide [Lasix]. The nurse notes an irregular heart rate of 86 beats per minute, a respiratory rate of 22 breaths per
minute, and a blood pressure of 130/82 mm Hg. The nurse auscultates crackles in both lungs. Which laboratory value causes the nurse the most concern? C 217 A patient has
2+ pitting edema of the lower extremities bilaterally. Auscultation of the lungs reveals crackles bilaterally, and the serum potassium level is 6 mEq/L. Which diuretic agent ordered by the prescriber should the nurse question? C 218 A nurse preparing to administer morning medications notes that a patient with a history of hypertension has been prescribed spironolactone [Aldactone]. The nurse assesses the patient and notes dyspnea, bilateral crackles, and pitting edema in both
feet. Which intervention is appropriate? D 219 A patient who was in a motor vehicle accident sustained a severe head injury and is brought into the emergency department. The provider orders intravenous mannitol [Osmitrol]. The nurse knows that this is given to: A 220 A patient
is taking gentamicin [Garamycin] and furosemide [Lasix]. The nurse should counsel this patient to report which symptom? C 221 An older adult patient with congestive heart failure develops crackles in both lungs and pitting edema of all extremities. The physician orders hydrochlorothiazide [HydroDIURIL]. Before administering this medication, the nurse reviews the patient's chart. Which laboratory value causes the nurse
the most concern? A 222 A patient with chronic congestive heart failure has repeated hospitalizations in spite of ongoing treatment with hydrochlorothiazide [HydroDIURIL] and digoxin. The prescriber has ordered spironolactone [Aldactone] to be added to this patient's drug regimen, and the nurse provides education about this medication. Which
statement by the patient indicates understanding of the teaching? B 223 Besides having diuretic effects for patients with congestive heart failure, thiazides are also used to treat what? (Select all that apply.) A, B, E 224 A patient who is a chronic alcoholic is admitted to the hospital. Admission laboratory work reveals a magnesium level of 1.2 mEq/L. The prescriber orders intravenous magnesium sulfate in a 10% solution at a rate of 10 mL/min. What will the nurse do? C 225 A patient who was injured at home is brought to the emergency department. The nurse caring for this patient notes a respiratory rate of 32 breaths per minute and a heart rate of 90 beats per minute. The injuries are minor, but the patient is inconsolable and hysterical. The
nurse expects that initial management will include: A 226 A child who ingested a handful of aspirin tablets from a medicine cabinet at home is brought to the emergency department. The nurse caring for the child notes a respiratory rate of 48 breaths per minute. The nurse understands that this child's respiratory rate is the result of the body's attempt to compensate for: A 227 A patient with congestive heart failure is admitted to the hospital. During the admission assessment, the nurse learns that the patient is taking a thiazide diuretic. The nurse notes
that the admission electrolyte levels include a sodium level of 142 mEq/L, a chloride level of 95 mEq/L, and a potassium level of 3 mEq/L. The prescriber has ordered digoxin to be given immediately. What will the nurse do initially? B 228 A patient collapses after running a marathon on a hot day and is brought to the emergency department to be treated for dehydration. The nurse will expect to provide which therapy? A patient collapses after running a marathon on a hot day and is brought to the emergency department to be treated for dehydration. The nurse will expect to provide which therapy? 229 A nurse is caring for a child whose
respirations are shallow and marked by a prolonged expiratory phase. The nurse auscultates wheezes and poor air movement bilaterally. The child's respiratory rate is 26 breaths per minute, and the oxygen saturation is 89%. What does the nurse suspect? C 230 A nurse is caring for a postoperative patient who has a nasogastric tube with continuous suction. The nurse notes that the patient has shallow respirations and suspects that this patient has developed: B 231 While performing an admission assessment on a patient, the nurse learns that the patient is taking furosemide [Lasix], digoxin, and spironolactone [Aldactone]. A diet history reveals the use of salt substitutes. The patient is confused and dyspneic and complains of hand and foot tingling. Which is an appropriate nursing action for this patient? A 232 A patient arrives in the emergency department complaining of muscle weakness and drowsiness. The nurse notes a heart rate of 80 beats per minute, a respiratory rate of 18 breaths per minute, and a blood pressure of 90/50 mm Hg. The electrocardiogram reveals an abnormal rhythm. The nurse will question the patient about which over-the-counter medication? A 233 A patient arrives in the emergency department after becoming dehydrated. Based on the patient's history, the provider determines that isotonic
dehydration has occurred. Which solution will the nurse expect to infuse to treat this patient? B 234 A patient is admitted to the hospital after several days of vomiting and diarrhea. After an initial bolus of isotonic (0.9%) sodium chloride solution, the prescriber orders dextrose 5% in normal saline (D5NS) with 20 mEq potassium chloride to infuse at a maintenance rate. What should the nurse review before implementing this order? (Select all that apply.) A, C, E 235 Which order for potassium (KCl) would the nurse question? (Select all that apply.) B, C, E 236 1. A nurse is reviewing the immune system with a group of nursing students. One student asks about the difference between cell-mediated immunity and humoral immunity. What should the nurse reply? a. "Humoral immunity does not
involve helper T cells in the immune response." ANS: D 237 2. A nurse is teaching a nursing student about a specific acquired immunity system. Which statement by the student indicates a need for further teaching? a. "Cell-mediated immunity and humoral immunity are both types of specific acquired immune responses." NS: D 238 3. A nurse is caring for a patient infected with the human immunodeficiency virus (HIV). Which finding would most concern the nurse? a. High level of macrophages ANS: D 239 4. Which statement is true about helper T cells? a. They are useful but are not essential to immune responses. ANS: C 240 5. A nurse is caring for a patient who has undergone organ transplantation. Because the sequence of amino acids in the major histocompatibility complex (MHC) molecules of the donor is different from that of the patient, the nurse will expect to administer which class of drugs? a. Antibiotics ANS: D 241 6. A nurse is teaching a group of nursing students about antibodies. The nurse correctly explains that which type of response is triggered when antigens bind to antibodies on mast cells or basophils? a. Acquired
immune response ANS: C 242 7. A nurse is teaching a group of nursing students about immunoglobulins. Which statement by a student indicates a need for further teaching? a. "IgD provides a first line of defense against microbes entering the body through the lungs." ANS: A 243 8. A patient who breast-feeds her infant asks the nurse about the immunity the infant receives from breast milk. What does the nurse tell the patient about immunity through breast-feeding? a. "The immunity protects the infant from hypersensitivity reactions." ANS: C 244 9. A nurse is discussing the role of antibodies in the complement system with a group of nursing students. Which statement by a student is correct? a. "Antibodies activate the complement cascade by turning on the alternative pathway." ANS: C 245 10. A patient has a Type IV hypersensitivity (delayed-type hypersensitivity) response to an infection. The nurse understands that which two types of cells are necessary for this response? a. Antigen-presenting cells and mast cells ANS: D 246 1. Which immune responses can result in harm to the body? (Select all that apply.) a. Activation of the complement system ANS: B, C, E 247 1. A nurse at an immunization clinic is providing vaccines to children. The parent of a child waiting to receive vaccines tells the nurse that the child has an immune deficiency disorder. The nurse understands that which vaccine should not be administered to this child? a. Diphtheria and tetanus toxoids and acellular pertussis (DTaP) vaccine ANS: D 248 2. A nurse is preparing to administer vaccines to a 1-year-old child. The parents ask the nurse to give the child acetaminophen before administering the vaccine to reduce the pain. Which response by the nurse is correct? a. "Children don't remember pain, so it isn't necessary to give acetaminophen." ANS: D 249 The parents of an infant who will be attending day care tell the nurse that they do not want their child vaccinated against rotavirus because an older cousin developed intussusception after receiving this vaccine. Which response by the nurse is correct? a. "Intussusception is much less serious than getting the disease." ANS: C 250 A -year-old child who has been receiving high-dose systemic glucocorticoids for several months comes to a clinic for school immunizations, which usually include the DTaP vaccine; varicella virus vaccine [Varivax]; the measles, mumps, and rubella virus (MMR) vaccine; and the inactivated poliovirus vaccine (IPV). The clinic nurse will expect to administer which vaccines to this child? a. All four school immunizations ANS: B 251 A 1-year-old child is scheduled to receive the MMR vaccine, pneumococcal vaccine (PCV), Varivax, and hepatitis A vaccine. The child's parents request that the MMR vaccine not be given, saying that, even though there is no demonstrated link with autism, they are still concerned about toxic levels of mercury in the vaccine. Which response by the nurse is correct? a. "Most U.S.-made vaccines have zero to low amounts of mercury." ANS: A 252 The parent of a 2-month-old infant who has just received the first dose of DTaP asks the nurse about expected reactions to the vaccine. The nurse will respond by saying that: a. "Mild reactions, including a low-grade fever, are
common." ANS: A 253 A 1-year-old child receives the MMR vaccine. The next day the child's parent calls the nurse to report that the child has a temperature of 103°F. What will the nurse do? a. File an adverse event report with the Vaccine Adverse Event Reporting System (VAERS). ANS: C 254 The parent of a child who attends day care questions the need for Varivax. What will the nurse tell the parent? a. "Chickenpox is not as contagious as other communicable diseases." ANS: D 255 A clinic nurse receives a phone call from a parent who states that a 2-month-old infant has a severe cough, a low-grade fever, and a runny nose that have lasted over a week. What will the nurse ask the parent? a. Whether the infant has had the first set of vaccines ANS: A 256 The nurse at a public health infant immunization clinic is acting as a preceptor for a nursing student. To assess the student's understanding of vaccinations, the nurse asks the student where the hepatitis B vaccine (HepB) should be administered. The student would be correct to respond that the hepatitis B vaccine should be administered in the: a. dorsogluteal muscle in an adult. ANS: B 257 An 11-year-old boy received all childhood immunizations before attending school as a kindergartner. Which vaccines are recommended for this child at his current age? a. DTaP, MCV4, Varivax ANS: C 258 An immigrant child is in the clinic for MMR vaccination. The nurse learns that the child has recently received an immune globulin injection for a viral infection, currently has an upper respiratory infection with a temperature of 100°F, and has a recent history of thrombocytopenia, which has resolved. What does the nurse tell the child's parents? a. "The vaccine is contraindicated in this child because of the history of thrombocytopenia." ANS: D 259 An otherwise healthy child receives a varicella virus vaccine. Three weeks later the parent calls to report that the child has a mild case of chickenpox and wonders how this could happen after the vaccination. What will the nurse tell the parent? a. "A varicella-like rash can occur after the vaccine is given." ANS: A 260 A 3-year-old child who has asthma is in the clinic for a well-child checkup. The nurse notes that the child is up-to-date for the DTaP, Hepatitis A, Hepatitis B, and the MMR vaccines but has only had one each of the Hib, the Rotavirus, and the PCV13 vaccines. Which vaccine(s) will the nurse anticipate administering to this child? a. Hib and Rotavirus vaccines ANS: B 261 The public health nurse is teaching a group of parents about immunizations. The nurse tells the parents that after receiving the varicella virus vaccine, children should temporarily avoid close contact with whom? (Select all that apply.) ANS: A, D, E 262 Which are recommended measures to help minimize pain associated with vaccine administration? (Select all that apply.) a. Administer acetaminophen or
ibuprofen before the vaccine is given. ANS: B, C, E 263 A patient has undergone liver transplantation. The provider orders cyclosporine [Sandimmune], prednisone, and sirolimus [Rapamune]. What will the nurse do? a. Question the order for sirolimus. A 264 A patient with a liver transplant has been receiving cyclosporine [Sandimmune] for 6 months. The nurse reviews this patient's laboratory results and notes a sharp increase in the blood urea nitrogen (BUN) and serum creatinine. Vital signs are normal, and the patient reports no discomfort. What does the nurse suspect? a. Hepatotoxicity D 265 A nurse provides teaching to a patient who has undergone kidney transplantation and will begin taking cyclosporine [Sandimmune], a glucocorticoid, and sirolimus [Rapamune]. Which statement by the patient indicates understanding of the teaching? a. "I should take sirolimus at the same time as the cyclosporine." C 266 A patient with a history of lung transplantation is admitted for treatment for a respiratory infection. The patient has been taking cyclosporine [Sandimmune], prednisone, and azathioprine [Imuran] for 8 months. The provider has ordered azithromycin [Zithromax] to treat the infection and acetaminophen [Tylenol] as needed for fever. The nurse will contact the provider to: a. ask whether a different antibiotic can be used. A 267 A patient is taking cyclosporine [Sandimmune] and prednisone to prevent organ rejection after right renal transplantation. The patient is febrile and complains of right-sided flank pain. The nurse reviews the patient's chart and finds that the patient's BUN and serum creatinine are elevated. The cyclosporine trough is 150 ng/mL. What will the nurse do? a. Be concerned that the left kidney is failing. B 268 A patient is started on immunosuppressant drugs after kidney transplantation and will be taking azathioprine [Imuran] as part of the drug regimen. The patient asks the nurse why it is necessary to have a specimen for a complete blood count drawn at the beginning of therapy and then periodically thereafter. The nurse explains that azathioprine can alter blood cells and tells the patient to report: a. alopecia. B 269 A nurse is teaching a patient who is about to undergo allograft transplantation of the liver. Which statement by the patient indicates understanding of the post-transplant medications? a. "Immunosuppressants help
reduce the risk of postoperative infection." B 270 The nurse knows that which immunosuppressants are among the most effective? a. Azathioprine [Imuran] and everolimus [Zortress] B 271 A nursing student asks the nurse how antibodies provide immune suppression. The nurse responds by telling the student that antibodies: a. block T-cell function. A 272 10. The nurse is preparing to administer basiliximab [Simulect] to a patient to prevent acute rejection. By which route will the nurse administer the drug? a. Oral
C 273 The nurse is caring for a patient after recent renal transplantation. The patient is taking sirolimus [Rapamune] to prevent transplant rejection. What other medications would the nurse expect the patient to be taking? a. Rifampin and ketoconazole C 274 The nurse is administering medications to a patient who is receiving cyclosporine [Sandimmune]. Which medication, when administered concurrently with cyclosporine, would warrant a reduction in the dosage of cyclosporine? a. Phenytoin [Dilantin]
C 275 The nurse is caring for a 15-year-old patient who has undergone a liver transplant. Which provider order will the nurse question? a. Cyclosporine [Sandimmune] and ketoconazole [Nizoral] B 276 A patient who is taking azathioprine [Imuran] to prevent rejection of a renal transplant develops gout and the provider orders allopurinol. The nurse will contact the provider to discuss: a. decreasing the allopurinol dose. B 277 A pregnant patient asks the nurse if she can take antihistamines for seasonal allergies during her pregnancy. What will the nurse tell the patient? a. Antihistamines should be avoided unless absolutely necessary. A 278 A family is preparing for travel and the parents report that their 5-year-old child has frequent motion sickness. The nurse will tell the parents to ask the provider about which antihistamine to help prevent symptoms? a. Desloratadine [Clarinex] B 279 A nurse is teaching a group of nursing students about antihistamines. Which statement by a student indicates an understanding of the mechanism of action of the antihistamines? a. "Antihistamines block H1 receptors to prevent actions of histamine at these sites." A 280 A patient who has chronic allergies takes loratadine [Claritin] and develops a severe reaction to bee stings. The patient asks the nurse why the antihistamine did not prevent the reaction. What will the nurse say? a. "Allergy symptoms that are severe are caused by mediators other than histamine." A 281 A patient tells a nurse that antihistamines help relieve cold symptoms and wants to know why they are not recommended or prescribed for this purpose. The nurse tells the patient that antihistamines provide only mild relief from some cold symptoms by: a. anticholinergic properties that decrease rhinorrhea. B 282 A patient will begin taking fexofenadine [Allegra] for hay fever. The nurse teaching this patient will tell the patient that: a. fexofenadine should be taken with food to prevent gastrointestinal (GI) symptoms. B 283 An 18-month-old child develops an urticarial reaction after a transfusion. The prescriber orders intravenous promethazine [Phenergan]. What will the nurse do? a. Give the medication as ordered. C 284 A 5-year-old child is brought to the emergency department after ingesting diphenhydramine [Benadryl]. The child is uncoordinated and agitated. The nurse observes that the child's face is flushed, the temperature is 37.1oC, and the heart rate is 110 beats per minute. The nurse will expect to: a. administer atropine to reverse the adverse effects. C 285 A provider has ordered intravenous promethazine [Phenergan] for an adult patient postoperatively to prevent nausea and vomiting (N/V). What will the nurse do? a. Administer the drug at a rate of 25 mg/min or more to achieve maximum effects. C 286 A prescriber orders hydroxyzine [Vistaril] for a patient with acute urticaria. The nurse will include which information when teaching the patient about this drug? a. The drug will reduce redness and itching but not edema. C 287 A patient has seasonal allergies and needs an antihistamine to control symptoms. The patient likes to have wine with dinner occasionally and wants to know which antihistamine will be the safest to take. The nurse will tell the patient to discuss which medication with the provider? a. Cetirizine [Zyrtec] B 288 A 5-year-old child with seasonal allergies has been taking 2.5 mL of cetirizine [Zyrtec] syrup once daily. The parents tell the nurse that the child does not like the syrup, and they do not think that the drug is effective. The nurse will suggest they discuss which drug with their child's healthcare provider? a. Cetirizine [Zyrtec] 5-mg chewable tablet once daily A 289 A patient is brought to the emergency department after ingesting a handful of diphenhydramine [Benadryl] tablets. The patient has dilated pupils, a flushed face, and tremors. The patient is agitated and has a heart rate of 110 beats per minute. The nurse may anticipate administering which agents? (Select all that apply.) a. Activated charcoal A, B, D 290 Which parenteral antihistamines have sedative effects that are classified as low to none? (Select all that apply.) a. Cetirizine [Zyrtec] C, D, E 291 A nurse is teaching a group of nursing students about cyclooxygenase (COX) inhibitors. A student asks the nurse about characteristics of COX-1 inhibitors. Which statement by the nurse is true? a. "COX-1 inhibitors protect
against colorectal cancer." B 292 A patient who takes daily doses of aspirin is scheduled for surgery next week. The nurse should advise the patient to: a. continue to use aspirin as scheduled. C 293 A patient who is taking acetaminophen for pain wants to know why it does not cause gastrointestinal upset, as do other over-the-counter pain medications. The nurse will explain that this is most likely because of which property of acetaminophen? a. It does not inhibit
cyclooxygenase. B 294 A patient tells the nurse that she takes aspirin for menstrual cramps, but she does not feel that it works well. What will the nurse suggest? a. The patient should avoid any type of COX inhibitor because of the risk of Reye's syndrome. C 295 A patient who takes aspirin for rheumatoid arthritis is admitted to the hospital complaining of headache and ringing in the ears. The plasma salicylate level is 300 mcg/mL, and the urine pH is 6.0. What will the nurse do? a. Increase the
aspirin dose to treat the patient's headache. D 296 An adolescent is brought to the emergency department by a parent who reports that the patient took a whole bottle of extended-release acetaminophen tablets somewhere between 8 and 10 hours ago. The nurse will anticipate administering which of the following? a. Acetylcysteine [Mucomyst] A 297 An older male patient with an increased risk of MI is taking furosemide [Lasix] and low-dose aspirin. The patient is admitted to the hospital, and the nurse notes an initial blood pressure of 140/80 mm Hg. The patient has had a 10-pound weight gain since a previous admission 3 months earlier. The patient has voided only a small amount of concentrated urine. The serum creatinine and blood urea nitrogen (BUN) levels are elevated. The nurse will contact the provider to discuss: a. adding an antihypertensive medication. D 298 A pregnant patient in her third trimester asks the nurse whether she can take aspirin for headaches. Which response by the nurse is correct? a. "Aspirin is safe during the second and third trimesters of pregnancy." B 299 A nurse is caring for a patient who has been taking low-dose aspirin for several days. The nurse notes that the patient has copious amounts of watery nasal secretions and an urticarial rash. The nurse will contact the provider to discuss: a. administering epinephrine. A 300 A nurse is teaching a nursing student who wants to know how aspirin and nonaspirin first-generation NSAIDs differ. Which statement by the student indicates a need for further teaching? a. "Unlike aspirin, first-generation NSAIDs cause reversible inhibition of cyclooxygenase." C 301 A nurse is providing teaching for an adult patient with arthritis who has been instructed to take ibuprofen [Motrin] for discomfort. Which statement by the patient indicates a need for further teaching? a. "I may experience
tinnitus with higher doses of this medication." A 302 A woman who has arthritis is breast-feeding her infant and asks the nurse if it is safe to take NSAIDs while nursing. What will the nurse tell this patient? a. NSAIDs are safe to take while breast-feeding. A 303 A nurse is providing medication teaching for a patient who will begin taking diclofenac [Voltaren] gel for osteoarthritis in both knees and elbows. Which statement by the patient indicates understanding of the teaching? a.
"Because this is a topical drug, liver toxicity will not occur." B 304 A patient has been receiving intravenous ketorolac 30 mg every 6 hours for postoperative pain for 4 days. The patient will begin taking oral ketorolac 10 mg every 4 to 6 hours to prepare for discharge in 1 or 2 days. The patient asks the nurse whether this drug will be prescribed for management of pain after discharge. The nurse will respond by telling the patient that the provider will prescribe a(n): a. different nonsteroidal anti-inflammatory drug for home management of pain. A 305 A patient who reports regular consumption of two or three alcoholic beverages per day asks about taking acetaminophen when needed for occasional recurrent pain. What will the nurse tell the patient? a. "Do not take more than 2 gm of acetaminophen a day." A 306 A nurse is discussing glucocorticoids with a group of nursing students. Which statement by a student indicates understanding of the teaching? A 307 A nurse tells a nursing student that the glucocorticoids given for rheumatoid arthritis are nearly identical to substances produced naturally by the body. The student remarks that the drug must be very safe. Which response by the nurse is correct? a. "As long as the drug is taken as prescribed, side effects usually do not occur." C 308 A clinic patient who has been taking a glucocorticoid for arthritis for several months remarks to the nurse, "It's a good thing my symptoms are better, because my mother has been quite ill, and I have to take care of her." The patient's blood pressure is 100/60 mm Hg. The nurse will report this to the provider and ask about: a. reducing the patient's dose. C 309 A nurse is teaching a group of nursing students why glucocorticoids are preferred over nonsteroidal anti-inflammatory drugs in the treatment of inflammation. Which statement by a student indicates a need for further teaching? a. "Glucocorticoids act by multiple mechanisms and have more anti-inflammatory effects than NSAIDs." B 310 A patient who is a long-distance runner has been diagnosed with rheumatoid arthritis in both knees and will begin glucocorticoid therapy. When teaching the patient about the medication, the nurse will include what information? a. "By reducing inflammation, this drug will slow the progression of your disease." B
311 The prescriber orders 20 mg of hydrocortisone orally once each day. The nurse will make sure the drug is scheduled to be administered at what time? a. 8:00 AM A 312 A patient is about to receive prednisone for tendonitis. The nurse reviewing the chart would be concerned about which of the following in the patient's medical history? a. Asthma and allergic rhinitis D 313 A 60-year-old female patient is about to begin long-term therapy with a glucocorticoid. Which of the following will be important for minimizing the risk of osteoporosis? a. Baseline vitamin D level B 314 A patient taking high doses of a glucocorticoid develops weakness in the muscles of the upper arms and in the legs. What will the nurse do? a. Contact the provider to ask about reducing the dose. A 315 A patient taking a glucocorticoid for arthritis reports feeling bloated. The nurse notes edema of the patient's hands and feet. Which action by the nurse is correct? a. Ask the patient about sodium intake. A 316 A child is to begin long-term glucocorticoid therapy. The parents ask the nurse about the effects of this drug on the child's growth. Which response by the nurse is correct? a. "A smaller dose may be indicated for your child." B 317 A patient who has been taking a glucocorticoid for several months arrives in the clinic. The nurse notes that the patient's cheeks appear full and that a prominent hump of fat is present on the upper back. The nurse will ask the provider to order which test(s)? a. Liver function tests B 318 A nurse is teaching a patient who has taken glucocorticoids for over a year about glucocorticoid withdrawal. Which statement by the patient indicates a need for further teaching? a. "I should reduce the dose by half each day until I stop taking the drug." A 319 A patient who has arthritis has been taking ibuprofen [Motrin] and a glucocorticoid medication. The patient reports having tarry stools but denies gastric pain. Which action by the nurse is correct? a. Contact the provider to discuss ordering an antiulcer medication. A 320 A woman who is breastfeeding is prescribed a low pharmacologic dose of a glucocorticoid and asks the nurse about potential effects on her infant. What will the nurse tell her about this medication? a. "At this dose, the concentration in your breast milk is safe." A 321 Which disorders may be treated with glucocorticoids? (Select all that apply.) a. Allergic rhinitis A, D, E |