The APN suspects a patient has digitalis toxicty. The APN would assess for all of the following except?
Polyuria. s&s are confusion, irreg pulse, increased urination, n& v, swelling
Which is not appropriate instruction regarding nitroglycerin usage?
Apply the nitro patch and leave it on for 24 hours. Patch normally left on for 12 hours.
Which lipid medication should be used in a patient with elevated liver enzymes
Bile acid sequestrants bec not absorbed into the blood stream.
Which is true about platelet aggregation inhibitors?
The platelet agregation supression with ASA lasts for 7 days.
Which counts as a risk factor according to NCEP in deciding the proper management for elevated LDL?
HDL of 30.
The advantage of low molecular weight heparin over unfractionated heparin is:
It can be given as a fixed dose schedule. Unfractionated needs close monitoring.
It is important to monitor which electrolyte in patients on digoxin?
potassium bec digoxin can cause diarrhea, hence loss of potassium
You are discussing glucocorticoids with patients at a rheumatoid arthritis support group. When a patient remarks that the drugs must be very safe, which of the following responses by you is the best answer?
Side effects can occur and are dependant on the dose and duration of treatment.
The parent of a child receiving the polio vaccine wants to know why the oral polio vaccine (OPV) is not given. You explain that the oral preparation:
Can cause paralytic poliomyelitis.
True or false? Clemastine (Tavist allergy) is a parental antihistamine the sedative effects of which are classified as low to none.
False: Clemastine (Tavist allergy) is a first generation ethalnolamine H1 antihistamine with mild sedative effects.
A patient with a liver transplant has been receiving cyclosporine (Sandimmune) for six months. When you review this patient's laboratory results, you note a sharp increase in the BUN (blood urea nitrogen) and serum creatinine. Vital signs are normal and the patient reports no discomfort. You suspect?
Nephrotoxicity. Calcineurin inhibitors can cause kidney damage in up to 75% of patients.
A patient comes to the clinical for treatment of asthma exacerbation. The pt uses an inhaled glucocorticoid, montelukast (Singular) and a SABA via MDI. When you assess the patient, you note a RR of 18 BPM, O2 satn of 95%, mild expiratory wheezes, and equal breath sounds bilaterally. Which of the following options is the best thing to do next?
Ask the patient how much albuterol has been used. The patient is likely not using the albuterol inhaler enough but you must assess this before intervening.
A 7YO child with asthma uses a daily inhaled glucocorticoid and an albuterol MDI as needed. You add montelukast (Singular) to the patient's regimen. Which statement by the child's parent indicates understanding of this medication?
I may notice mood changes in my child. Mood changes are a potential side effect of leukotriene receptor antagonist like montelukast.
A parent asks a nurse about given diaphenhydramine (Benadryl) to a child to relieve cold symptoms. Which response is correct?
Because histamine doesn't cause cold symptoms, Benadryl would not be effective.
A patient who takes theophylline (Theochron) twice daily for chronic stable asthma develops an infection and will take ciprofloxacin. The option you will first consider is?
Reducing the theophylline dose. Toxicity of theo is affected by emycin, cimetadine, and fluoroquinolones (such as ciprofloxacin).
The NP is considering ordering propranolol (Inderal) for a patient with a dysrhythmia. Propranolol is useful in treating all of the following dysrythmias except:
Life threatening ventricular dysrhythmias.
Allopurinol and the xanthine-class of anti-gout medications are used primarily for:
preventing gout exacerbations.
Six months ago, a 50yo bread baker was newly diagnosed with moderate to severe RA. She began methotrexate 10 mg once a week. What set of lab values would cause you concern?
WBC 13, platelets 100, AST 35, ALT 50, BG 95, BUN 90, serum creatinine 2.1. (Increased WBC bec of infection).
When recommending OTC acetaminophen, consider all but which of the following?
Children are not at risk for liver toxicity. (Note that children are at risk for liver toxicity from APAP overload!).
A 61yo was involved in an MVA and reports acute pain secondary to lumbosacral strain. His current medication include lisinopril/HCT 20/25 daily. When considering treatment for pain management, you are aware of:
renal toxity. (Low back pain is best treated with NSAIDS, whch can interact with an ACE inhibitor to cause renal toxicity.
To obtain the optimal effect of oral biphosphates (e.g., Fosamax) for the treatment of osteoporosis, which one of the following are of most importance to consider?
Absorption. Biphosphoates must be taken with a full glass of water and pt must sit upright for at least 30 minutes to promote absorption.
Which of the following is a primary advantage of selective Cox-2 inhibitors over nonselective COX inhibitors?
Selective COX-2 inhibitors exert more gastric protection than nonselective COX-2 inhibitors.
A 22 YO sprains her ankle while playing softball. She has tried ice and elevation, but the ankle continues to be painful and mildly swollen. So the most appropriate treatment would be:
Celebrex (celexcob) rather than ibuprofen.
Selective estrogen receptor modulators (e.g., raloxifene/Evista) do all but which one of the following?
Stimulate the endometrium. SERMS do not stimulate the endometrium and might actually protect it.
Jil is a 44yo nonsmoking woman who would like to get back on the pill. The best choice would be to:
put her on a low dose estrogen
A nurse counsels a patient starting on estrogen-progestin hormone therapy. When TP questions the purpose of the progestin component, the nurses best response is:
it prevents uncontrolled endometrial proliferation
An important finding from the women's health initiative was that, for women taking HRT
...risk of mi is increased
For which women would a progestin-only oral contraceptive be perferable over combined oral contraceptives?
...who are breastfeeding
When androgens are given to children, it is important to monitor?
...xrays to evaluate hand and wrist epiphyseal closure
A woman ways to the nurse, "I am going to take some of my husband's Viagra since it helped him so much. I think it would help me too." The nurse's best response would be:
...women are helped more by estrogen ns progrsterone
Which of the following patients should not get a prescription for conjugated esterogens (Premarin)? One who has
a uterus. with uterus must take combined estrogen n progesterone to prevent endometrial hyperplasia
Follicle-stimulating hormone (FSH) and leuteinzing hormone (LH) are produced where?
A 30YO male patient will begin a 3 drug regimen to treat PUD. The regimen will consist of bismuth subsalicylate, tetracycline, and cimetidine (Tagamet). Which of the following is most important to make sure this patient understands about this regimen?
Decreased libido, impotence, and gynecomastia are reversible side effects.
A patient reports taking an oral bisacodyl laxative (Dulcolax) every day for several years. The NP suggests discontinuing the laxative but tp is unsure how to do this. How should this laxative be discontinued for TP?
Stop taking the laxative immediately and expect no stool for several days.
A pregnant patient who is taking odansetron (Zofran) for morning sickiness tells the nurse working at the advanced level that she is experiencing headache and dizziness. What will the nurse tell her?
These are common effects of ondansetron.
A patient will begin taking iron supplements to treat anemia. You recommend that TP take the iron with which food to facilitate absorption?
Which of the following statements is correct about leptin?
Leptin acts to reduce appetite in patients who are known to be leptin deficient.
A young female patient is seen in a rural clinicl after complaining of abdominal pain. The patient is wearing dirty clothing and is barefoot. A review of the complete blood count shows that the patient is anemic. Your index of suspicion is raised that this patient has which of the following infestations?
A clinic leader is teaching a group of hospital executives about the two most common forms of malaria. Plasmodium vivax malaria and plasmodium falciparum malaria. Which statement is incorrect?
Patients with P. vivax malaria experience relapse with increased frequency over time.
A family has just returned from a camping trip and all family members have diarrhea and colicky abdominal pain after eating. The parents report that they drank water from a well while on the camping trip. While awaiting stool cultures, which agent should be order empirically?
Your patient discloses daily use of St. John's Wort in addl to prescription drugs. Which effect of this dietary supplement would be of most concern?
It accelerates the metabolism of some drugs.
A patient with type 1 diabetes reports mixing NPH and regular insulin to allow for one injection. How does the APN respond?
This is an acceptable practice.
You are serving as a preceptor for a student nurse on a medical-surgical unit. The nurse, who is discussing the mechanisms of actions of antibiotics is currently talking about the mechanism of action of PCN. Which statement by the student nurse best demonstrates understanding?
PCN works by weaking the bacterial wall, which then ruptures and dies.
The APN is working at an STD clinic. A pt has been diagnosed with an STD and will be treated with PCN G. The nurse understands that PCN G is the drug of choice for the treatment of?
All of the statements about the differences between 1st and 4th generation cephalosporins are correct except?
1st generation agents have increased resistance to beta lactamases.
The incident of nosocomial infections be reduced by all of the following statements except?
Antimicrobial therapy should include broad-spectrum antibiotics for colonization.
The nurse, who is teaching a pharmacology refresher course to a group of nurses, is discussing selective toxicity, which refers to the drugs ability to
kill or injure a target organism w/o injuring the host.
The nurse is caring for a patient on a medical-surgical unit who has been experiencing fever of unknown origin. The prescriber has ordered a broad spectum-antibiotic. Which intervention is the priority?
Obtain all cultures before antibiotic is administered.
A pregnant adolescent asks the nurse whether it would be all right to continue to take her RX for tetracycline (Sumycin) to clear up her acne. What response by the nurse provides the best information?
A tetracycline drug could be harmful to the baby's teeth and should be avoided.
A patient who recently was discharged from the hospital and prescribed ciprofloxacin (Cipro) phones the prescriber's office complaining of pain above the heel while walking or stretching. The nurse expects the patient to be instructed to
discontinue the medication and avoid weight-bearing on the ankle.
In which of the following scenarios should the nurse not consider prophylactic antibiotic therapy?
A patient with a fever of unknown origin.
The APN has been caring for a patient who has been taking antibiotics for 2 weeks. Upon assessing the patient, the nurse notices that the individual has developed oral thrush. Which of the following describes the etiology of thrush?
The nurse would correctly describe the method of action of cell cycle-specific anticancer agents as only toxic to cells
that are passing through a particular phase of the cell cycle.
What statement made by the nurse best demonstrates understanding of the difference between a disseminating cancer and a solid tumor?
A solid tumor usually has lower growth fractions versus a disseminating cancer.
The nurse wants to evaluate a nursing student's understanding of chemotherapy. The nurse asks, "Which of the following factors would be a major obstacle to successful chemotherapy?
The toxicity of cancer drugs to normal tissue.
A nurse is providing patient education to a pregnant woman regarding chronic asthma bec tp has just been diagnosed with the disease. Which statement made by the nurse best demonstrates the nurse's understanding of the use of asthma medications during pregnancy?
Untreated asthma may be more detrimental to the developing fetus than the drugs used to treat it.
A nurse understands the pharmacokinetics assocd with medications in the elderly. Which laboratory finding would the nurse associate with the greatest risk of increased drug effects in the geriatric patient who is taking a drug that is highly protein bound?
Low serum albumin level.
Concerned parents of a child admitted with pneumonia ask many questions of the nurse. They ask the nurse what makes children so sensitive to medications. The nurse's best response would be that drug sensitivity in children is a result of?
Organ system immaturity.
The nurse is providing education to a group of geriatric nurses regarding drug therapy in the elderly. Which response by a member of the group demonstrates a need for further teaching?
Elderly persons have a greater tolerance to medications than younger adults. NOT TRUE
A nurse is teaching a class to a group of pregnant women. The nurse correctly teaches that the period during which the highest risk of teratogen-induced gross malformations exists is:
during the first trimester.
A breastfeeding patient has been given a RX medication. The prescriber assures her that the drug is safe for both her and her baby. The mother is concerned but wants to continue to breastfeed. What clarification should the nurse provide for the patient?
Take the medication immediately after breastfeeding.