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The nurse is caring for several clients. With which of the following clients will the nurse most likely anticipate an alteration in drug metabolism?
A) A 3-day-old premature infant
B) A 22-year-old pregnant female
C) A 32-year-old man with kidney stones
D) A 50-year-old executive with hypertension
A nurse is preparing to administer epinephrine to a patient who is having a severe allergic reaction. Which route of administration would provide the fastest and most complete absorption of epinephrine?
Digoxin has a half-life of 36 to 48 hours. Because of the length of the half-life, the nurse expects dosing to be:
A) four times per day.
B) three times per day.
C) two times per day.
D) once a day.
The nurse is caring for a client with renal failure. The nurse would expect the duration of action for most medications to:
C) be unaffected.
The nurse knows that a drug with a high therapeutic index is:
B) often dangerous.
C) frequently risky.
D) most likely effective.
The client is receiving a medication that may cause nephrotoxicity. To prevent this adverse reaction the nurse should encourage the client to:
A) avoid sunbathing and exposure to direct sunlight.
B) increase the intake of potassium-enriched foods.
C) abstain from alcoholic beverages.
D) increase fluid intake to promote adequate hydration.
The thyroid gland is dependent on the hypothalamic-pituitary axis for regulation. Increasing the levels of thyroid hormone (by taking replacement thyroid hormone) would
A) increase hypothalamic release of TRH.
B) increase pituitary release of TSH.
C) suppress hypothalamic release of TRH.
D) stimulate the thyroid gland to produce more T3 and T4.
In the administration of a drug such as levothyroxine (Synthroid), the nurse should teach the client:
A) That therapy typically lasts about 6 months.
B) That weekly laboratory tests for T4 levels will be required.
C) To report weight loss, anxiety, insomnia, and palpitations.
D) That the drug may be taken every other day if diarrhea occurs.
A patient with hyperthyroidism is taking propylthiouracil (PTU). The nurse will monitor the patient for:
A) gingival hyperplasia and lycopenemia.
B) dyspnea and a dry cough.
C) blurred vision and nystagmus.
D) fever and sore throat.
While the client is taking corticosteroids, the nurse will assess for:
A) Irregular heart rate and rhythm.
B) Delayed wound healing.
C) Weight loss of 2 to 3 lb per week.
D) Elevated serum potassium levels
A client with adrenocortical insufficiency has started therapy with fludrocortisone (Florinef). The nurse performs what important intervention during the course of this treatment?
A) Weigh the client daily.
B) Evaluate the pulse oximetry hourly.
C) Measure the respiratory peak flow.
D) Calculate body surface area.
A client with chronic bronchitis is receiving high-dose corticosteroids. The nurse would include in the care plan to monitor which parameter to determine the presence of adverse effects?
A) Breath sounds
B) Blood glucose
C) Bowel sounds
D) Heart rate
A patient with severe asthma has taken high-dose glucocorticoids for 2 months. The symptoms have resolved, and the patient is ready to stop the medication. What patient education would the nurse provide about discontinuing the medication?
A) The dose should be tapered off over 7 to 10 days.
B) The drug can be stopped immediately if it is no longer needed.
C) The drug must be continued for life.
D) An inhaled form of glucocorticoid must be added to the medication regimen.
A health care provider has ordered a corticosteroid for each of these clients. The nurse should question the order for a client with:
A) Allergic disorders
B) Peptic ulcer disease
D) Rheumatoid arthritis
The nurse understands that the four phases of pharmacokinetics that a drug goes through include:
A) Absorption, distribution, ionization, and metabolism.
B) Diffusion, bioavailability, metabolism, and excretion.
C) Active transport, ionization, diffusion, and excretion.
D) Absorption, distribution, metabolism, and excretion.
The nurse is administering an albuterol (Ventolin) inhaler to a client with asthma. The absorption of the medication will occur:
A) Over a 2-3-hour period.
B) Very slowly, since the airways are constricted.
C) Very rapidly
D) In a slow, steady fashion.
The nurse has just administered a client's a.m. dose of medications following a high-fat breakfast. The nurse recognizes that the absorption of the medications will be:
B) Not affected.
The nurse recognizes that when a client is receiving a lipid-soluble medication, higher concentrations will accumulate in which tissues?
A) Skeletal muscle
B) Cardiac muscle
C) Bone marrow
When administering a highly protein-bound drug to a client, the nurse can expect:
A) Duration of action will be prolonged.
B) Onset of drug action will be prolonged.
C) Metabolism of the drug will be delayed.
D) Drug excretion will be accelerated.
The nurse checks a newly ordered medication and finds it to be 92% protein-bound. The nurse understands that the amount of drug which will be readily available to the client is:
The nurse anticipates that the medications ordered for a client with cirrhosis will:
A) Be administered by the parenteral route.
B) Need to be given with an antacid.
C) Need to be divided evenly throughout the day.
D) Be in lower doses than normal.
The nurse is administering a drug with a half-life of 6 hours. The nurse understands the client will eliminate most of the drug in how many hours?
The nurse is teaching the client about a newly prescribed medication. Which of the following statements made by the client would indicate the need for further medication education?
A) "The liquid form of the drug will be absorbed faster than the tablets."
B) "The higher the dose of the drug, the greater the response."
C) "Taking this drug with food will increase the absorption rate."
D) "I can consult my health care provider if I experience unexpected adverse effects."
An Alzheimer's patient has been taking a cholinesterase inhibitor for a week. What anticipated side effects (signs and symptoms) related to the medication would the nurse anticipate in the patient?
A) Numbness and tingling in the extremities
C) Nausea, vomiting, and diarrhea
D) Tinnitus and hearing loss
A nurse plans to administer atropine (Sal-Tropine) to a patient on multiple concurrent medications. The nurse feels confident that which class of drugs would be safe to administer with atropine?
B) Phenothiazine antipsychotics
C) Tricyclic antidepressants
D) Narcotic analgesics
A prescriber has ordered pilocarpine (Pilocar). A nurse understands that the drug stimulates muscarinic receptors. The nurse would anticipate the drug to have which action?
A) Reduce excessive secretions and mucus in a postoperative patient
B) Lower intraocular pressure in patients with glaucoma
C) Inhibit muscular activity in the bladder
D) Prevent hypertensive crisis
Which drug is commonly used to treat muscarinic poisoning?
A) Bethanechol (Urecholine)
B) Pilocarpine (Pilocar)
C) Acetylcholine (Miochol)
D) Atropine (Sal-Tropine)
A patient is brought to the emergency department by paramedics. The patient is a farmer who was exposed to large quantities of organophosphate insecticides. Which assessment finding would the nurse anticipate to see in this patient?
A) Urinary retention
B) Increased gastrointestinal motility
A patient receives succinylcholine (Anectine) for paralysis during endoscopy. During the procedure, the patient's muscles become rigid and the skin feels hot to the touch. The major concern for this patient would be the potential development of what complication?
A) Esophageal obstruction
B) Malignant hyperthermia
D) Thyroid storm
A patient is brought into the emergency department by ambulance. Based on the patient's signs and symptoms, the physician suspects an overdose of an irreversible cholinesterase inhibitor. The nurse would prepare for which primary intervention to treat the resultant respiratory depression?
A) Physostigmine (Antilirium)
B) Succinylcholine (Anectine)
C) Atropine (Sal-Tropine)
D) Intubation and mechanical ventilation
A nurse is caring for a patient being treated for newly diagnosed irritable bowel syndrome. The nurse should anticipate the administration of which muscarinic antagonist?
A) Bethanechol (Urecholine)
B) Pirenzepine and telenzepine
D) Dicyclomine (Bentyl)
A patient is going on a cruise and asks the nurse practitioner for a medication for motion sickness. The nurse practitioner should anticipate providing education on which medication that would be ordered?
A) Ipratropium (Atrovent)
B) Atropine (Sal-Tropine)
C) Acetylcholine (Miochol)
A patient is prescribed bethanechol for urinary retention. If the patient exhibits signs of an overdose (increased salivation and sweating, bradycardia, and hypotension), the nurse will administer:
C) cholinesterase inhibitor.
A nurse is taking care of a patient who is having vision difficulty. The ophthalmologist comes to examine the patient and administers eye drops to dilate the patient's pupils. The nurse is aware that the eye drops would be considered what class of medication?
A) Parasympathomimetic agent
B) Sympathetic agonist
C) Sympathetic antagonist
D) Parasympathetic agonist
A patient with myasthenia gravis is prescribed neostigmine (Prostigmin). Which of the following will the nurse include in patient teaching?
A) The medication is an irreversible cholinesterase inhibitor that may cause a cholinergic crisis
B) It is possible to adjust the doseage based on the patient's activity level.
C) The patient should restrict physical activity so the lowest dose of the drug can be taken.
D) The condition is curable, and the medication will be taken for 2 to 3 months.
A patient asks the nurse the indications for a newly prescribed medication, echothiophate (Phospholine Iodide). The nurse tells the patient the medication will treat:
A) muscle weakness and fatigue.
B) dementia from Alzheimer's disease.
C) neuromuscular blockade toxicity.
D) increased intraocular pressure.
A nurse has arrived at work late and missed report. While reviewing the patient's medications, the nurse notes that the patient is on an irreversible cholinesterase inhibitor. The nurse understands that the only indication for an irreversible cholinesterase inhibitor would be
B) muscular dystrophy.
C) myasthenia gravis.
A nurse is preparing a neuromuscular blocking agent to be used for endotracheal intubation. The drug most often used is:
A) Doxacurium (Nuromax)
C) Succinylcholine (Anectine).
D) Atropine (Sal-Tropine)
Stimulating these receptors in the bronchi causes dilatation which allows easier breathing during a fight-or-flight response
Stimulating these receptors cause blood pressure to rise and more blood to flow to peripheral muscles
Stimulating these receptors in the heart cause the heart to beat faster and to provide more blood to the body's tissues
A client diagnosed with asthma asks the nurse why an albuterol (Proventil) inhaler is better than isoproterenol (Isuprel). The nurse's response should be based on the physiologic concept that isoproterenol affects:
A) Alpha-1 receptors
B) Beta-2 receptors
C) Beta-1 and beta-2 receptors
D) All of the receptors
A client receives epinephrine for anaphylactic shock. The nurse should be aware of which one of the following mechanisms by which epinephrine acts?
A) Indirectly, by promoting release of norepinephrine
B) Directly, by stimulating adrenergic receptors
C) Inhibiting reuptake of norepinephrine from the synaptic cleft
D) Inhibiting destruction of norepinephrine by enzyme MAO
After 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?
A) Decrease in pulse
B) Increase in urine output
C) Weight gain
D) Improved gastric motility
A client is prescribed tetrahydrozoline (Tyzine) for redness of the eye. The nurse knows that this medication is indicated because it causes:
A) Relaxation of the radial muscles of the iris.
B) Constriction of the pupil.
C) Vasoconstriction of the arterioles in the eye.
D) Absorption of fluid in the conjunctival sac.
Which symptom is the client on alpha-1 antagonist therapy likely to complain of within the first 24 hours?
A) Blurring of vision
B) Dizziness and faintness
C) Difficulty swallowing
D) Decreased urinary frequency
A client is given tamsulosin (Flomax) for benign prostatic hyperplasia (BPH). The nurse knows that the action of this drug is due to selective blockade of which one of the following receptors?
A client diagnosed with hypertension is prescribed atenolol (Tenormin). The nurse knows that atenolol (Tenormin) is a selective beta-1 blocker, and can be safely used for clients with which of the following diagnoses?
B) Heart failure
D) Hepatic disease
A type I diabetic patient comes to the clinic for a follow-up appointment. The patient 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?
A) "You need to increase your insulin to allow for the agonist effects of metoprolol."
B) "Metoprolol may potentiate the effects of the insulin, so the dose should be reduced."
C) "Metoprolol has no effects on diabetes mellitus or on your insulin requirements."
D) "Metoprolol may mask signs of hypoglycemia, so you need to monitor your blood glucose closely."
A client prescribed propranolol (Inderal) for angina asks the nurse why this drug should not be abruptly discontinued. The nurse would be correct in telling the client that abrupt withdrawal could lead to:
A) Extreme weight loss
B) Rebound chest pain or heart attack
C) Increase in blood glucose levels
Clonidine (Catapres) is prescribed for a hypertensive patient. Which instruction should the nurse include in the patient education?
A) "You may have difficulty falling asleep while taking this drug."
B) "If you have problems tolerating the drug, you may stop taking it."
C) "Many patients taking this drug experience excessive salivation."
D) "Take frequent sips of water to relieve dryness in your mouth."
While the nurse is performing a physical assessment, the patient begins to cry and states, "I just can't seem to be happy. I thought the reserpine I was prescribed would help my chronic depression and my high blood pressure." Which of the following is the best nursing response to the patient?
A) Explain to the patient that the medication is not indicated for depression; depression is actually a side effect of the medication. The patient should speak to the prescriber about alternative medications.
B) Reassure the patient that the medication takes about 3 weeks for full effectiveness to treat both hypertension and depression.
C) Explain to the patient that the depression will last only a few days.
D) Have a psychiatric consult ordered.
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