When assessing a patient for adverse effects related to morphine sulfate, which effects would the nurse expect to find? (Select all that apply.) A) Decreased peristalsis B) Diarrhea C) Delayed gastric emptying D) Urinary retention
A, C, D Morphine sulfate causes a decrease in gastrointestinal motility (delayed gastric emptying and decreased peristalsis). This leads to constipation, not diarrhea. Morphine can also cause urinary retention.
A patient needs to switch analgesic drugs secondary to an adverse reaction to the present regimen. The patient is concerned that he will not receive an effective dose of a new drug to control pain. The nurse responds based on knowledge that potencies of analgesics are determined using an equianalgesic table comparing doses with that of A) meperidine. B) fentanyl. C) codeine. D) morphine.
D: The equianalgesic table identifies dosages of various narcotics that are equal to 10 mg of morphine.
A patient is admitted to the psychiatric unit for treatment of narcotic addiction. The nurse would anticipate administration of which medication? A) Morphine B) Methadone C) Meperidine D) Naloxone
B: Methadone is a synthetic opioid analgesic with gentler withdrawal symptoms and is the drug of choice for detoxification treatment.
A patient has been admitted after overdosing on acetaminophen (Tylenol), with a total ingested dose of 14 g over a period of 1 hour. The nurse plans to monitor this patient for development of which of the following signs and symptoms related to the overdose? A) Renal failure B) Kidney stones C) Acute hepatic necrosis D) Metabolic alkalosis
C: Acetaminophen in large doses over a short period is extremely hepatotoxic. The long-term ingestion of large doses of acetaminophen is more likely to result in nephropathy.
While admitting a patient for treatment of an acetaminophen overdose, the nurse prepares to administer which of the following medications to prevent toxicity? A) naloxone (Narcan) B) acetylcysteine (Mucomyst) C) methylprednisolone (Solu-Medrol) D) vitamin K
B: Acetylcysteine is the antidote for acetaminophen overdose. It must be administered as a loading dose followed by subsequent doses every 4 hours for 17 more doses and started as soon as possible after the acetaminophen ingestion (ideally within 12 hours).
Massage therapy is ordered as adjunct treatment for a patient with musculoskeletal pain. The patient asks the nurse how "rubbing my muscles" will help the pain go away. The nurse responds based on the knowledge that A) massaging muscles decreases the inflammatory response that initiates the painful stimuli. B) massaging muscles activates large sensory nerve fibers that send signals to the spinal cord to close the gate, thus blocking painful stimuli from reaching the brain. C) massaging muscles activates small sensory nerve fibers that send signals to the spinal cord to open the gate and allow endorphins to reach the muscles and relieve the pain. D) massaging muscles helps relax the contracted fibers and decrease painful stimuli.
B: The gate theory of pain control identifies large sensory nerves that, when stimulated, send signals to the spinal cord to close the gate, blocking pain stimuli from reaching the brain. Therefore the patient is not having the sensation of pain even if the stimulus is still present.
When assessing for the most serious adverse reaction to a narcotic analgesic, the nurse is careful to monitor the patient's A) respiratory rate. B) heart rate. C) blood pressure. D) mental status.
A: The most serious side effect of narcotic analgesics is respiratory depression.
Which medication is used to treat a patient suffering from severe adverse effects of a narcotic analgesic? A) naloxone (Narcan) B) acetylcysteine (Mucomyst) C) methylprednisolone (Solu-Medrol) D) protamine sulfate
A: Naloxone is the narcotic antagonist that will reverse the effects, both adverse and therapeutic, of opioid narcotic analgesics.
A patient admitted to the hospital with a diagnosis of pneumonia asks the nurse why she is receiving codeine when she does not have any pain. The nurse's response is based on knowledge that codeine also has what effect? A) Stimulation of the immune system B) Cough suppressant C) Expectorant D) Bronchodilation
B: Codeine provides both analgesic and antitussive (cough suppressant) therapeutic effects.
In monitoring a patient for adverse effects related to morphine sulfate, the nurse assesses for stimulation of A) autonomic control over circulation. B) cough reflex center. C) chemoreceptor trigger zone. D) respiratory rate and depth.
C: Morphine sulfate can irritate the gastrointestinal tract, causing stimulation of the chemoreceptor trigger zone in the brain, which in turn causes nausea and vomiting.
The nurse is preparing to administer an injection of morphine to a patient. Assessment notes a respiratory rate of 10 breaths/min. Which action will the nurse perform? A) Administer a smaller dose and record the findings B) Notify the physician and delay drug administration C) Administer the prescribed dose and notify the physician D) Hold the drug, record the assessment, and recheck in 1 hour
B: Respiratory depression is a side effect of narcotic analgesia. Therefore since the patient's respiratory rate is below normal, the nurse should withhold the morphine and notify the physician.
A patient receiving narcotic analgesics for chronic pain can minimize the gastrointestinal (GI) side effects by A) taking Lomotil with each dose. B) eating foods high in lactobacilli. C) taking the medication on an empty stomach. D) increasing fluid and fiber in the diet.
D: Narcotic analgesics decrease intestinal motility, leading to constipation. Increasing fluid and fiber in the diet can prevent this.
The nurse teaches a patient prescribed the fentanyl (Duragesic) transdermal delivery system to change the patch at what interval? A) When pain recurs B) Every 24 hours C) Every 72 hours D) Once a week
C: The fentanyl transdermal delivery system is designed to slowly release analgesic over a 72-hour time frame.
The nurse plans pharmacologic therapy for a patient with pain based on the knowledge that A) narcotic analgesics should not be used for more than 24 hours secondary to the risk of addiction. B) analgesics should be administered as needed (prn) to minimize side effects. C) pain relief is best obtained by administering analgesics around the clock. D) patients should request analgesics when the pain level reaches a "6" on a scale of 1 to 10.
C: When pain is present, analgesic dosages are best administered around the clock and not "as needed," but dosages should always be within the dosage guidelines for each drug used. The around-the-clock (or "scheduled") dosing allows steady states of the medication and prevents drug dosage "troughs" and escalation of pain.
In developing a plan of care for a patient receiving morphine sulfate, which nursing diagnosis is a priority? A) Acute pain B) Risk for injury related to central nervous system side effects C) Impaired gas exchange related to respiratory depression D) Constipation related to gastrointestinal side effects
C: Using Maslow's hierarchy of needs and the ABCs of prioritization, impaired gas exchange is a priority over pain, constipation, and a risk for injury. If a patient cannot oxygenate sufficiently, all of the other problems will not matter because the patient will not live to worry about them.
The nurse notes lithium on a patient's drug history upon admission. Which condition would the nurse suspect that this patient suffers from? A) Obsessive-compulsive disorder B) Absence seizures C) Bipolar disorder D) Paranoid schizophrenia
C: Lithium is an antimanic drug used to treat manic episodes associated with bipolar disorders.
Selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs) both function by which mechanism? A) Blocking the reuptake of neurotransmitters at nerve endings B) Increasing alertness levels in the brain C) Decreasing levels of epinephrine and serotonin at nerve endings D) Increasing the placebo effect
A: SSRIs block the reuptake of serotonin. TCAs block the reuptake of norepinephrine and serotonin.
A patient diagnosed with depression is started on a tricyclic antidepressant after failure to improve symptoms on a selective serotonin reuptake inhibitor. The nurse should include which teaching point when educating the patient on the new medication? A) There are no contraindications to this medication B) The medication is safe; it has been used longer than many others C) This class of medications has no other use and is only for depression D) There is a risk of toxicity when this medication is taken with alcohol
D: There is an increased risk of toxicity with TCAs when taken with alcohol and a high rate of morbidity.
A patient currently prescribed duloxetine (Cymbalta) comes to the health clinic complaining of restlessness, agitation, diaphoresis, and tremors. The nurse suspects serotonin syndrome and questions the patient regarding concurrent use of which substance? A) ibuprofen B) St. John's wort C) vitamin E supplements D) glucosamine condroitin
B: Serotonin syndrome may occur with SSRIs when they are combined with herbal products such as ginseng and St. John's wort.
A patient is being switched from amitriptyline (Elavil) to citalopram (Celexa). Which statement made by the patient reflects understanding of patient education? A) "I can just stop taking my Elavil and start taking the Celexa as ordered." B) "I can expect fewer cardiovascular side effects such as orthostatic hypotension with the Celexa." C) "The doctor is switching me to this medication because it is less expensive but just as effective." D) "I will need to limit my intake of cheese when taking Celexa to prevent a rise in my blood pressure."
B: Citalopram, an SSRI, produces minimal anticholinergic and cardiovascular side effects.
Which activity should the patient be cautioned against while taking an MAO inhibitor? A) Participating in a bowling league B) Sunbathing at the pool C) Eating aged cheese D) Smoking a low-nicotine cigarette
C: Eating foods high in tyramine, including aged cheese, can cause a hypertensive crisis in patients taking MAO inhibitors.
Bupropion (Zyban), a second-generation antidepressant, is unique in that it is also used to A) treat orthostatic hypotension. B) aid in smoking cessation. C) increase appetite in patients undergoing chemotherapy. D) treat nocturnal enuresis in children.
B: Zyban is a sustained-released form of bupropion that is useful in helping patients quit smoking.
A patient diagnosed with an anxiety disorder has been utilizing lorazepam (Ativan) but finds the side effect of drowsiness to be interfering with life. Which anxiolytic medications might be a better option for this patient? A) alprazolam (Xanax) B) buspirone (BuSpar) C) chlordiazepoxide (Librium) D) hydroxyzine hydrochloride salt (Atarax)
B: Buspirone (BuSpar) is a third-generation anxiolytic that has the advantage of being both nonsedating and non-habit-forming. All the other options are sedatives as well as anxiolytics.
Which statement made by a patient demonstrates a lack of understanding of patient teaching regarding phenothiazine drug therapy? A) "I need to change positions slowly to prevent dizziness." B) "I will need to wear sunscreen and protective clothing when outdoors." C) "It is okay to take this drug with a small glass of wine to help relax me." D) "I should call my doctor if I notice any uncontrollable movements of my tongue."
C: Drinking alcohol with phenothiazines puts the patient at risk for increased CNS depression.
Which laboratory test should be monitored frequently to assess for a potential life-threatening adverse reaction to clozapine (Clozaril)? A) Renal panel B) Complete blood count C) Liver function tests D) Immunoglobulin levels
B: Patients taking clozapine must be monitored for the life-threatening side effect of agranulocytosis, evidenced by a severe reduction in the number of white blood cells.
The nurse monitors a patient taking an antipsychotic medication for extrapyramidal side effects, including A) dystonia B) orthostatic hypotension C) dry mouth and constipation D) neuroleptic malignant syndrome
A: Dystonia, an impairment of muscle tone, is the only extrapyramidal side effect listed. The other side effects also occur but are not extrapyramidal effects.
An atypical antipsychotic medication useful for treatment of refractory schizophrenia is A) trazodone (Desyrel). B) phenelzine (Nardil). C) amoxapine (Asendin). D) risperidone (Risperdal).
D: Risperidone is effective for refractory schizophrenia, including negative symptoms. The other medications listed are antidepressants.
The patient asks the nurse if switching from citalopram (Celexa) to escitalopram (Lexapro) would be beneficial. The nurse responds based on knowledge that A) citalopram (Celexa) is more expensive than excitalopram (Lexapro). B) both medications have similar therapeutic and side effect profiles. C) escitalopram (Lexapro) has a decreased risk of side effects compared to citalopram (Celexa). D) escitalopram (Lexapro) has a better therapeutic effect if used in combination therapy.
C: Escitalopram is one of the two stereoisomers that make up citalopram. This chemical property gives it greater receptor specificity and therefore reduces the likelihood of side effects.
Epinephrine, as an adrenergic (sympathomimetic) drug, produces which of the following therapeutic effects? A) Urinary retention B) Bronchial constriction C) Increased heart rate and contractility D) Decreased intestinal motility
C: Epinephrine causes sympathomimetic actions, including increased heart rate and contractility. The other effects listed are parasympathomimetic in nature.
The doctor has ordered dopamine to treat your patient's hypovolemic shock due to severe blood loss. For the medication to be effective, the physician must also order A) fluid replacement. B) beta-stimulating drugs. C) antibodies. D) fluid restriction.
A: Dopamine increases blood pressure secondary to vasoconstriction, which has a limited effect if there is not enough volume within the circulatory system.
Your patient is receiving dobutamine as a continuous infusion. Titration of this medication is based upon which factors? (Select all that apply.) A) Heart rate B) Blood pressure C) Urine output D) Liver enzymes
A, B, C: The major therapeutic effect of dobutamine is to increase cardiac output. Cardiac output is reflected in the patient's heart rate, blood pressure, and urine output.
Your patient is to receive dopamine 5 mcg/kg/min. He weighs 176 lb. You have dopamine 400 mg in 500 mL D5W. You will infuse this at A) 20 mL/hr. B) 30 mL/hr. C) 35 mL/hr. D) 50 mL/hr.
B: The patient's weight of 176 lb is converted to kilograms by dividing 176 by 2.2 = 80 kg. 5 mcg/kg/min multiplied by 80 kg = 400 mcg, or 0.4 mg/min. Dividing 0.4 mg/min by 400 mg/500 mL = 0.5 mL/min, which when multiplied by 60 minutes = 30 mL/hour.
When assessing for cardiovascular effects of an adrenergic (sympathomimetic) drug, the nurse understands that these drugs produce A) a positive inotropic, positive chronotropic, and positive dromotropic effect. B) a positive inotropic, negative chronotropic, and negative dromotropic effect. C) a negative inotropic, positive chronotropic, and positive dromotropic effect. D) a negative inotropic, negative chronotropic, and negative dromotropic effect.
A: Adrenergic stimulation of the beta1-adrenergic receptors on the myocardium and in the conduction system of the heart results in an increased heart rate (positive chronotropic effect), increased contractility (positive inotropic effect), and increased conductivity (positive dromotropic effect).
A hypertensive crisis may occur if adrenergic (sympathomimetic) drugs are given along with A) beta-blockers. B) diuretics. C) alpha1-blockers. D) MAO inhibitors.
D: Adrenergic drugs combined with MAO inhibitors can lead to extreme hypertension. All the other drugs listed are used to treat hypertension.
The nurse assesses the intravenous infusion site of a patient receiving dopamine and finds it is infiltrated. The nurse will prepare which of the following medications to treat this infiltration? A) lidocaine (Xylocaine) B) phentolamine (Regitine) C) nitroprusside (Nipride) D) naloxone (Narcan)
B: Phentolamine is an alpha-blocker that causes vasodilation, thus counteracting the vasoconstrictive effects of the infiltrated dopamine. The vasodilation will increase blood flow to the site and decrease the risk of tissue necrosis.
A patient using Afrin nasal spray complains of worsening cold symptoms and tells the nurse, "I don't understand why this is not working. I am using it almost every 3 hours!" The nurse's response is based on knowledge that A) Afrin nasal spray is not an effective nasal decongestant. B) the medication needs to be used every 30 minutes for maximum effectiveness. C) the patient is suffering from rebound congestion related to excessive use of the Afrin nasal spray. D) adrenergic decongestants should only be used prophylactically, not to treat acute congestion.
C: Afrin nasal spray is a sympathomimetic drug with both alpha- and alpha-beta-adrenergic effects. The alpha-adrenergic activity is responsible for causing vasoconstriction in the nasal mucosa. However, excessive use of nasal decongestants can lead to greater congestion because of a rebound phenomenon that occurs when use of the product is stopped.
Nonselective beta-blockers may be used to treat
D: Nonselective beta-blockers are used to treat supraventricular arrhythmias secondary to their negative chronotropic effects (decreasing heart rate). They may exacerbate heart failure, COPD, and heart block secondary to their negative inotropic effect (heart failure), blocking of bronchodilation (COPD), and negative chronotropic effects (heart block).
An example of a cardioselective beta-blocker includes A) propranolol (Inderal). B) labetalol (Normodyne). C) atenolol (Tenormin). D) sotalol (Betapace).
C: At therapeutic dosages, atenolol selectively blocks only the beta1 receptors in the heart, not the beta2 receptors located in the lungs.
When teaching a patient about beta-blockers such as atenolol (Tenormin) and metoprolol (Lopressor), it is important to inform the patient that A) these medications may be taken with antacids to minimize gastrointestinal distress. B) hot baths and showers will help enhance the therapeutic effects and are encouraged. C) alcohol intake is encouraged for its vasodilating effects. D) abrupt medication withdrawal may lead to a rebound hypertensive crisis.
D: Abrupt withdrawal of a beta-blocking drug can cause rebound hypertension. These drugs should be gradually decreased.
Propranolol (Inderal) is an effective A) selective alpha-adrenergic antagonist. B) nonselective beta-adrenergic antagonist. C) beta1-adrenergic antagonist. D) beta2-adrenergic antagonist.
B: Propranolol is nonselective; it blocks both beta1 and beta2 receptors at therapeutic doses.
During assessment of a patient diagnosed with pheochromocytoma, the nurse auscultates a blood pressure of 210/110 mm Hg. The nurse would expect to administer which medication? A) nadolol (Corgard) B) phentolamine (Regitine) C) dobutamine (Dobutrex) D) verapamil (Calan)
B: Phentolamine is a potent alpha-blocking drug specifically effective for treatment of hypertension associated with pheochromocytoma.
When assessing for cardiovascular effects of a beta-blocker, the nurse understands that these drugs produce A) a + inotropic, + chronotropic, and + dromotropic effect. B) a + inotropic, - chronotropic, and - dromotropic effect. C) a - inotropic, + chronotropic, and + dromotropic effect. D) a - inotropic, - chronotropic, and - dromotropic effect.
D: Beta-blockers exert a sympatholytic effect, blocking the effects of sympathetic nervous system stimulation, causing a decrease in heart rate (negative chronotropic), conductivity (negative dromotropic), and contractility (negative inotropic).
Beta-blockers are used to treat which disorders? (Select all that apply.) A) Hypertension B) COPD C) Angina pectoris D) Cardiac dysrhythmias
A, C, D: Beta-blockers are effective in treating hypertension (secondary to negative inotropic effects), angina pectoris (decreases cardiac workload when decreasing heart rate and contractility), and cardiac dysrhythmias (decreasing heart rate and conductivity). Beta-blockers can exacerbate COPD as they block beta2 receptors and subsequent bronchodilation.
The priority nursing diagnosis for a patient taking metoprolol (Lopressor) would be A) Ineffective tissue perfusion (cerebral and cardiovascular) related to effects of medication. B) Disturbed sensory perception related to adverse central nervous system effects of the drug. C) Deficient knowledge related to therapeutic regimen. D) Risk for injury related to possible side effects of the adrenergic blockers.
A: Using the ABCs of prioritization, Ineffective tissue perfusion (cerebral and cardiovascular) puts the patient at highest risk. Although the other nursing diagnoses are pertinent, they are not the priority.
Patient teaching for a patient being discharged on a beta-blocker includes which statement? A) "If you take your pulse and it is less than 60, hold your medicine and call your health care provider for instructions." B) "If you become dizzy, do not take your medication for 2 days and then restart on the third day." C) "This medication may make you fatigued; increasing caffeine in your diet may help alleviate this problem." D) "Increase intake of green leafy vegetables to prevent bleeding problems that can be caused by this medication."
A: Beta-blockers have a negative chronotropic effect and could cause symptomatic bradycardia and/or heart block. The physician should be consulted before administering to a patient with bradycardia (heart rate <60 beats/min).
The nurse is admitting a patient with a history of angina and hypertension who is currently experiencing moderate heart failure. The patient's current medication regimen includes digoxin, furosemide, and accupril. Which medication would be most beneficial to add to this patient's treatment plan? A) carvedilol (Coreg) B) propranolol (Inderal) C) esmolol (Brevibloc) D) sotalol (Betapace)
A: Carvedilol (Coreg), a combined alpha1- and beta-blocker, has been shown to slow the progression of heart failure and decrease the frequency of hospitalization in patients with mild to moderate (Class II or III) heart failure. Carvedilol is most commonly added to digoxin, furosemide, and angiotensin-converting enzyme (ACE) inhibitors when used to treat heart failure.
Cholinergic (parasympathomimetic) drugs have which therapeutic effect? A) Urinary retention B) Increased gastrointestinal motility C) Mydriasis D) Vasoconstriction
B: Cholinergic effects mimic the parasympathetic nervous system (rest and digest) as opposed to the sympathetic nervous system (fight or flight). Increasing gastrointestinal motility helps the body digest. Urinary retention, mydriasis, and vasoconstriction are sympathetic nervous system responses.
Cholinergic (parasympathomimetic) drugs are indicated for which situation? A) Treating a postoperative patient who has bradycardia B) Lowering intraocular pressure in patients with glaucoma C) Inhibiting muscular activity in the bladder D) Preventing salivation and sweating
B: Cholinergic drugs stimulate the pupil to constrict (miosis), thus decreasing intraocular pressure.
During postoperative teaching, the nurse explains that the patient is receiving bethanechol (Urecholine) to treat A) postoperative hypotension. B) urinary atony. C) respiratory atelectasis. D) postoperative ischemic colitis.
B: Bethanechol is a direct-acting cholinergic agonist that stimulates the cholinergic receptors on the smooth muscle of the bladder, leading to bladder contraction and emptying.
Adverse reactions to bethanechol include A) constipation. B) hypertension. C) tachycardia. D) headache.
D: Side effects of bethanechol include abdominal cramps, diarrhea, hypotension, bradycardia, and headache.
The nurse would question an order for cevimeline (Evoxac) in a patient with a history of A) leg cramps. B) hemorrhoids. C) tachycardia. D) narrow-angle glaucoma.
D: Cevimeline (Evoxac) is a direct-acting cholinergic drug used to stimulate salivation in patients having a disorder known as Sjögren's syndrome, which causes xerostomia (dry mouth). It is contraindicated in any condition in which pupillary miosis might be undesirable, such as narrow-angle glaucoma or iritis, and also in uncontrolled asthma.
The nurse administering donepezil (Aricept) to a patient understands that the expected therapeutic action of this drug is to A) relieve anxiety and restless behavior of the patient. B) increase levels of acetylcholine in the brain by blocking its breakdown. C) block the effects of acetylcholine at the presynaptic neurons. D) help control associated urinary incontinence.
B: Donepezil is used to treat Alzheimer's disease, a disorder of decreased acetylcholine levels in the brain. Donepezil is an indirect-acting anticholinesterase drug.
When providing teaching to a patient diagnosed with myasthenia gravis, which instruction regarding the administration of physostigmine (Antilirium) is most appropriate? A) Increase fluid and fiber in the diet to prevent constipation. B) Take the medication 30 minutes before meals. C) If a dose is missed, double the next dose to prevent withdrawal. D) Common side effects include tachycardia and hypertension.
B: Drugs used for myasthenia gravis should be given about 30 minutes before meals to allow for onset of action and therapeutic effects (e.g., decreased dysphagia). Constipation, tachycardia, and hypertension are not effects of cholinergic medications. A missed dose should never be doubled.
Side effects to expect from anticholinergic (parasympatholytic) drugs, such as atropine, include which effects? (Select all that apply.) A) Dilated pupils (mydriasis) B) Urinary retention C) Dry mouth D) Diarrhea E) Increased sweating
A, B, C: Anticholinergic effects block the effects of the parasympathetic nervous system, producing sympathetic nervous system effects. These include mydriasis, decreased bladder contraction, and decreased oral secretions. The effect on the gastrointestinal system would be to decrease gastrointestinal motility, not cause diarrhea. Sweating would decrease as a result of anticholinergic drugs.
A patient presents with symptomatic bradycardia. The nurse prepares to administer which dose of atropine intravenously? A) 0.3 mg B) 0.5 mg C) 1.25 mg D) 2 mg
B: The recommended dose of atropine to treat symptomatic bradycardia is 0.5 to 1 mg.
A patient presents to the emergency room with insecticide poisoning. The nurse prepares to administer which dose of atropine intravenously? A) 0.3 mg B) 0.5 mg C) 2 mg D) 4 mg
C: Higher doses of atropine (1 to 3 mg) are needed to treat cholinergic overdoses such as insecticide poisoning.
The nurse monitors a patient taking tolterodine (Detrol) for which therapeutic effect? A) Decrease in gastrointestinal motility B) Decrease in urinary frequency C) Increase in heart rate D) Increase in blood pressure
B: Tolterodine (Detrol) blocks the muscarinic receptors in the bladder to decrease urinary frequency and urgency.
The nurse monitors a patient prescribed dicyclomine (Bentyl) for which therapeutic effect? A) Decrease in gastrointestinal motility B) Decrease in urinary frequency C) Increase in heart rate D) Increase in blood pressure
A: Dicyclomine is an antispasmodic cholinergic blocker used to decrease gastrointestinal motility in patients with functional gastrointestinal disorders such as irritable bowel syndrome.
A priority nursing diagnosis for a patient receiving anticholinergic (parasympatholytic) drugs would be A) Risk for injury related to excessive central nervous system stimulation. B) Impaired gas exchange related to thickened respiratory secretions. C) Urinary retention related to loss of bladder tone. D) Deficient knowledge related to pharmacologic regimen.
B: Although all of these nursing diagnoses are appropriate, the priority is determined remembering the ABCs. Anticholinergic drugs decrease respiratory secretions, which could lead to mucous plugs and resultant impaired gas exchange.
Which would be the most appropriate application time for a patient prescribed a scopolamine patch for motion sickness? A) At bedtime B) Every 4 hours as needed C) 4 to 5 hours before travel D) At the first sign of motion sickness
C: For the prevention of motion sickness, scopolamine is available in a convenient transdermal delivery system (a patch) that can be applied just behind the ear 4 to 5 hours before travel. Each patch has a 72-hour duration of action, thus necessitating a change only every 3 days.
Which laboratory value might indicate an adverse response to hydrochlorothiazide (HydroDIURIL)? A) Sodium levels B) Glucose levels C) Calcium levels D) Chloride levels
B: Hydrochlorothiazide can cause hyperglycemia.
When teaching a patient why spironolactone (Aldactone) and furosemide (Lasix) are prescribed together, the nurse's statements are based on knowledge that A) moderate doses of two different types of diuretics are more effective than a large dose of one type. B) this combination promotes diuresis but decreases the risk of hypokalemia. C) this combination prevents dehydration and hypovolemia. D) using two drugs increases osmolality of plasma and the glomerular filtration rate.
B: Spironolactone is a potassium-sparing diuretic; furosemide is a potassium-losing diuretic. Giving these together minimizes electrolyte imbalance.
Which laboratory value depicts a known side effect of furosemide (Lasix)? A) Hyperchloremia B) Hypernatremia C) Hypokalemia D) Hypophosphatemia
C: Furosemide is a potent loop diuretic, resulting in the loss of potassium as well as water, sodium, and chloride.
A patient is admitted to the hospital with pneumonia and has a history of chronic renal insufficiency. The physician orders furosemide (Lasix) 40 mg twice a day because it A) will not cause potassium loss. B) is effective in treating patients with pulmonary congestion. C) is effective in treating patients with renal insufficiency. D) will increase pO2 levels.
C: Furosemide is effective in patients with creatinine clearance as low as 25 L/min (normal is 125 L/min).
A patient taking spironolactone (Aldactone) requests assistance with dietary choices. The nurse would recommend which food choices? (Select all that apply.) A) Lean meat B) Bananas C) Apples D) Squash
A, C, D: Spironolactone is a potassium-sparing diuretic that could potentially cause hyperkalemia. Bananas are high in potassium.
The nurse would question the use of mannitol on which of the following patients? A) A 67-year-old patient who ingested a poisonous substance B) A 21-year-old patient with a head injury C) A 47-year-old patient with anuria D) A 55-year-old patient who receives cisplatin to treat ovarian cancer
C: Mannitol is not metabolized but excreted unchanged by the kidneys. Potential water intoxication could occur if mannitol is given to a patient without urine output and thus renal function.
Acetazolamide (Diamox) is used to treat which disorder? (Select all that apply.) A) Edema associated with heart failure B) Metabolic acidosis C) High-altitude sickness D) Open-angle glaucoma
A, C, D: Acetazolamide causes excretion of bicarbonate, which would worsen metabolic acidosis. It is used to treat high-altitude sickness, edema secondary to heart failure, and open-angle glaucoma and rarely as an antiepileptic drug.
When preparing to administer furosemide (Lasix) intravenously to a patient with renal dysfunction, the nurse plans implementation based on knowledge that the medication should be administered no faster than which rate? A) 2 mg/min B) 4 mg/min C) 6 mg/min D) 8 mg/min
B: Furosemide infusion rates should not exceed 4 mg/min in patients with renal dysfunction. Otherwise, furosemide may be administered at 20 mg/min, but that is not an option in this question.
Potassium-sparing diuretics may cause which adverse reactions? (Select all that apply.) A) Hyperkalemia B) Dizziness C) Headache D) Hypermagnesemia
A, B, C: Hyperkalemia, dizziness, and headache are common side effects associated with potassium-sparing diuretics.
A patient asks about taking potassium supplements while taking spironolactone (Aldactone). What is the nurse's best response? A) "You are correct about your concern. I will make sure that you get some right away." B) "I will call your doctor and let him know of your concern." C) "Potassium supplements are usually not necessary with this type of diuretic." D) "You are on a diuretic that is potassium-sparing, so there is no need for extra potassium."
D: Spironolactone is a potassium-sparing diuretic and thus the patient does not need potassium supplementation. Although it is true that potassium supplements are not necessary with this type of diuretic, providing the patient with an explanation of why the potassium is not needed is a better response.
The nurse would expect to administer which diuretic to treat a patient diagnosed with primary hyperaldosteronism? A) spironolactone (Aldactone) B) hydrochlorothiazide (HydroDIURIL) C) acetazolamide (Diamox) D) furosemide (Lasix)
A: Spironolactone is the direct antagonist for aldosterone.
The nurse prepares to administer which diuretic to treat a patient suffering from acute pulmonary edema?A) spironolactone (Aldactone) B) amiloride (Midamor) C) triamterene (Dyrenium) D) furosemide (Lasix)
D: Furosemide is a potent, rapid-acting diuretic that would be the drug of choice to treat acute pulmonary edema. The other medications are not potent enough to cause the strong diuresis necessary to treat this acute situation.
When assessing for therapeutic effects of mannitol, the nurse would expect to see A) decreased intracranial pressure. B) decreased excretion of therapeutic medications. C) increased urine osmolality. D) decreased serum osmolality.
A: Mannitol is an osmotic diuretic that pulls fluid from extravascular spaces into the bloodstream to be excreted in urine. This will decrease intracranial pressure, increase excretion of medications, decrease urine osmolality, and increase serum osmolality.
When assessing a patient on triamterene (Dyrenium), the nurse would specifically monitor for which adverse effect? A) Hypokalemia B) Hypoglycemia C) Hyperkalemia D) Hypernatremia
C: Triamterene is a potassium-sparing diuretic.
When teaching a patient about signs and symptoms of hypokalemia, the nurse will instruct the patient to notify the health care provider if which occurs? A) Diaphoresis B) Leg cramps C) Constipation D) Blurred vision
B: Leg cramps are a common clinical manifestation of hypokalemia. The other answers are incorrect.
The nurse would question the health care provider if which type of diuretics is prescribed to a patient with gout? A) Osmotic diuretics B) Thiazide diuretics C) Potassium-sparing diuretics D) Carbonic anhydrase inhibitors
B: Thiazide diuretics can cause hyperuricemia, which would exacerbate gout.
The nurse would assess which laboratory value to determine the effectiveness of intravenous heparin? A) Complete blood count (CBC) B) Activated partial thromboplastin time (aPTT) C) Prothrombin time (PT) D) BUN
B: Heparin dosing is based on aPTT results. The PT is reflective of warfarin's anticoagulant effect.
A patient who has been anticoagulated with warfarin (Coumadin) is admitted with gastrointestinal bleeding. The nurse will anticipate administering which substance? A) vitamin E B) vitamin K C) protamine sulfate D) calcium gluconate
B: Vitamin K is the antagonist for warfarin.
The nurse understands that a patient's international normalized ratio (INR) value of 2.5 means that A) the patient is not receiving enough warfarin for a therapeutic effect. B) the patient's warfarin dose is therapeutic. C) the patient is not receiving enough subcutaneous heparin for a therapeutic effect. D) the patient is receiving a dangerously high amount of heparin.
B: A therapeutic INR is 2 to 3.
Which statement when made by the patient indicates deficient knowledge regarding warfarin? A) "I will avoid contact sports." B) "I will take my medication in the early evening each day." C) "I will increase the dark green leafy vegetables in my diet." D) "I will contact my physician if I develop excessive bruising."
C: Dark green leafy vegetables are rich in vitamin K, which would antagonize the effects of warfarin. Therefore, it is important to maintain a consistent daily intake of vitamin K and avoid eating large amounts of these foods.
Which of the following medications has antiplatelet properties? A) clopidogrel B) enoxaparin C) heparin D) alteplase
A: Clopidogrel (Plavix) is an antiplatelet drug indicated for thrombus prevention associated with strokes and myocardial infarction. Enoxaparin and heparin are anticoagulants. Alteplase is a thrombolytic drug.
While preparing a patient with acute chest pain for an emergency angioplasty, the nurse would anticipate administering which of the following medications to prevent platelet aggregation? A) tirofiban (Aggrastat) B) protamine sulfate C) warfarin (Coumadin) D) aminocaproic acid (Amicar)
A: Tirofiban is a glycoprotein IIbIIIa inhibitor that blocks the enzyme essential for platelet aggregation. This is given to prevent the formation of further clots and is faster acting than warfarin. Protamine sulfate is the antagonist for heparin, not an anticoagulant. Aminocaproic acid is an antifibrinolytic, the opposite of what is needed in this situation.
Enoxaparin sodium (Lovenox) is an anticoagulant used to prevent and treat deep vein thrombosis and pulmonary embolism. This drug is in which drug group? A) Low molecular weight heparin B) Oral anticoagulant C) Glycoprotein IIb/IIIa inhibitor D) Thrombolytic drug
A: Enoxaparin is a low molecular weight heparin. The other answers are incorrect.
The patient asks what the difference is between dalteparin (Fragmin) and heparin. What is the nurse's best response? A) "There is really no difference, but dalteparin is preferred because it is less expensive." B) "Dalteparin is a low molecular weight heparin that has a more predictable anticoagulant effect." C) "I'm not really sure why some physicians choose dalteparin and some heparin, so you should ask your doctor." D) "The only difference is that heparin dosing is based on the patient's weight."
B: A low molecular weight heparin is more predictable in its effect than regular heparin. Dalteparin is more expensive than heparin and is dosed based upon the patient's weight.
Before emergency surgery, the nurse would anticipate administering which medication to a patient receiving heparin? A) vitamin K B) vitamin E C) phenytoin D) protamine sulfate
D: Protamine sulfate binds with heparin in the bloodstream to inactivate it and thus reverse its effect.
Nursing care for a patient receiving alteplase (Activase) would include which action? (Select all that apply.) A) Record vital signs and report changes. B) Observe for signs and symptoms of bleeding. C) Monitor liver enzymes. D) Assess for cardiac dysrhythmias.
A, B, D: Alteplase can cause bleeding as well as cardiac dysrhythmias. Vital sign changes can alert the nurse to these complications. Alteplase does not directly affect liver enzymes.
A patient who is taking an anticoagulant requests an aspirin for headache relief. What is the nurse's best action? A) Administer 650 mg of acetylsalicylic acid (ASA), and reassess pain in 30 minutes. B) Take advantage of a teachable moment to inform the patient of potential drug interactions with anticoagulants. C) Explain to the patient that ASA is contraindicated, and administer ibuprofen as ordered. D) Explain that the headache is an expected side effect and will subside shortly.
B: Patients taking an anticoagulant should not use medications that would further increase the risk of bleeding.
A patient is started on oral anticoagulant therapy while still receiving intravenous heparin. The patient is concerned about risk for bleeding. What is the nurse's best response? A) "Your concern is valid in that you are at an increased risk for bleeding, so I will call the doctor to discontinue the heparin." B) "It usually takes 4 to 5 days to achieve a full therapeutic effect for warfarin, so the heparin is continued to help prevent blood clots until the warfarin is working up to speed." C) "Because of your valve replacement, it is especially important for you to be fully anticoagulated, and the heparin and warfarin together are more effective than one alone." D) "Because you are now up and walking, you have a higher risk of blood clots and therefore need to be on both medications."
B: Warfarin works by decreasing the production of clotting factors. However, it takes 4 to 5 days for the body to use up present clotting factors and thus achieve a full therapeutic anticoagulant effect. Because of this, heparin is continued until this is achieved.
The nurse evaluates understanding of discharge instructions regarding warfarin (Coumadin) when the patient states A) "I will double my dose if I forget to take it the day before." B) "I should keep taking ibuprofen for my arthritis." C) "I should decrease the dose if I start bruising easily." D) "I should use a soft toothbrush for dental hygiene."
D: The patient should reduce the risk of bleeding, such as using a soft toothbrush. The other choices are inaccurate.
Before administering alteplase (Activase), it is important for the nurse to perform which action? A) Perform all necessary venipunctures. B) Administer aminocaproic acid (Amicar) to prevent adverse reactions. C) Have the patient void. D) Assess for allergies to iodine.
A: Activase is a thrombolytic drug that can interfere with the body's clotting ability. Therefore all invasive procedures should be completed before administering this drug.
The nurse formulates a plan of care for a patient receiving heparin based upon which nursing diagnosis? A) Excess fluid volume B) Chronic pain C) Risk for injury D) Impaired urinary elimination
C: The patient receiving heparin is at risk for injury secondary to increased risk of bleeding.
The nurse recognizes that patient teaching regarding warfarin (Coumadin) has been successful when the patient acknowledges an increased risk of bleeding with concurrent use of which herbal product? (Select all that apply.) A) Garlic B) Ginkgo C) Ginseng D) Glucosamine
A, B, C: Garlic, ginkgo, and ginseng alter blood coagulation and may increase the risk of bleeding when given concurrently with oral anticoagulants. Glucosamine does not affect coagulation.
While observing a patient self-administer enoxaparin (Lovenox), the nurse identifies the need for further teaching when the patient A) does not aspirate prior to injecting the medication. B) massages the site after administration of the medication. C) administers the medication greater than 2 inches away from the umbilicus. D) injects the medication and then waits 10 seconds before withdrawing the needle.
B: It is not recommended to massage the area of injection of anticoagulants due to the increased risk of hematoma formation.
Which of the following is a rapid-acting insulin with an onset of action of less than 15 minutes? A) insulin glargine (Lantus) B) insulin aspart (Novolog) C) regular insulin (Humulin R) D) insulin detemir (Levemir)
B: Insulin aspart is a rapid-acting insulin. Insulin glargine and insulin detemir are long-acting insulins. Regular insulin is short acting.
Which long-acting insulin mimics natural, basal insulin with no peak action and a duration of 24 hours? A) insulin glargine (Lantus) B) insulin glulisine (Apidra) C) regular insulin (Humulin R) D) NPH insulin (Humulin N)
A: Insulin glargine has a duration of action of 24 hours with no peaks, mimicking the natural, basal insulin secretion of the pancreas.
Which insulin can be administered by continuous intravenous infusion? A) insulin glargine (Lantus) B) insulin aspart (Novolog) C) regular insulin (Humulin R) D) insulin detemir (Levemir)
C: Regular insulin is the only insulin used for intravenous therapy.
For the most complete absorption, the recommended site for insulin injection should be into which area of the body? A) Abdomen B) Arm C) Thigh D) Buttocks
A: Thigh areas and outer areas of the upper arm may be used for insulin injection, but some practitioners recommend only using the abdomen because of more complete absorption.
Assuming the patient eats breakfast at 8:30 AM, lunch at noon, and dinner at 6:00 PM, he or she is at highest risk of hypoglycemia following an 8:00 AM dose of NPH insulin at A) 10:00 AM. B) 2:00 PM. C) 5:00 PM. D) 8:00 PM.
C: Breakfast eaten at 8:30 AM would cover the onset of NPH insulin, and lunch will cover the 2 PM time frame. However, if the patient does not eat a mid-afternoon snack, the NPH insulin may be peaking just before dinner without sufficient glucose on hand to prevent hypoglycemia.
Which information should be included in a teaching plan for patients taking oral hypoglycemic drugs? (Select all that apply.) A) Limit your alcohol consumption. B) Report symptoms of anorexia and fatigue. C) Take your medication only as needed. D) Notify your physician if blood glucose levels rise above the level set for you.
A, B, D: Oral hypoglycemic drugs must be taken on a daily scheduled basis to maintain euglycemia and prevent long-term complications of diabetes. All other options are correct.
The nurse is caring for a patient scheduled to undergo a cardiac catheterization procedure utilizing iodine-based contrast material. The nurse would question an order for which medication to be given to this patient the day before the scheduled procedure? A) acarbose (Precose) B) metformin (Glucophage) C) repaglinide (Prandin) D) rosiglitazone (Avandia)
B: The concurrent use of metformin iodinated (iodine-containing) radiologic contrast media has been associated with both acute renal failure and lactic acidosis. Therefore metformin should be discontinued at least 48 hours prior to any radiologic study requiring such contrast media and should be held for at least 48 hours after the procedure.
Alpha-glucosidase inhibitors differ from the sulfonylureas in that they A) greatly stimulate pancreatic insulin release. B) greatly increase the sensitivity of insulin receptor sites. C) delay the absorption of glucose, leading to lower glucose levels. D) cannot be used in combination with other antidiabetic drugs.
C: Alpha-glucosidase is an enzyme necessary for the absorption of glucose from the gastrointestinal tract. Inhibiting this enzyme inhibits glucose absorption, delaying rises in postprandial serum glucose levels.
Which actions describe the beneficial effects produced by sulfonylurea oral hypoglycemics? (Select all that apply.) A) Stimulate insulin secretion from beta cells B) Increase hepatic glucose production C) Enhance action of insulin in various tissues D) Inhibit breakdown of insulin by liver
A, C, D: The sulfonylureas stimulate insulin secretion from the beta cells of the pancreas; enhance the actions of insulin in muscle, liver, and adipose tissue; and prevent the liver from breaking insulin down as fast as it ordinarily would (reduced hepatic clearance). Increased hepatic glucose production would serve to increase serum glucose levels, the opposite effect of oral hypoglycemic drugs.
Which oral hypoglycemic drug has a quick onset and short duration of action, enabling the patient to take the medication 30 minutes before eating and skip the dose if he or she does not eat? A) acarbose (Precose) B) metformin (Glucophage) C) repaglinide (Prandin) D) rosiglitazone (Avandia)
C: Repaglinide is known as the "Humalog of oral hypoglycemic drugs." The drug's very fast onset of action allows patients to take the drug with meals and skip a dose when they skip a meal.
Pramlintide (Symlin) is added to the treatment plan for a patient with type 1 diabetes. When teaching the patient about this medication, the nurse recognizes that A) pramlintide slows gastric emptying.B) pramlintide increases glucagon excretion. C) pramlintide works to prevent side effects of insulin. D) pramlintide is an oral drug administered 15 minutes before meals.
A: Pramlintide is a synthetic form of the naturally occurring hormone amylin. It works by slowing gastric emptying, suppressing glucagon secretion, and centrally modulating appetite and satiety. It is only administered subcutaneously.
When administering 30 units regular insulin and 70 units NPH insulin, the nurse will perform which action? A) Draw up the regular insulin into the syringe first, followed by the cloudy NPH insulin. B) Inform the patient that mixing insulins will help increase insulin production. C) Rotate sites at least once weekly and label the sites used on a diagram. D) Use a 23- to 25-gauge syringe with a 1-inch needle for maximum absorption.
A: Drawing up the regular insulin into the syringe first prevents accidental mixture of NPH insulin into the vial of regular insulin, which could cause an alteration in the onset of action of the regular insulin.
The nurse would include which statement when teaching a patient about insulin glargine? A) "You should inject this insulin just before meals because it is very fast acting." B) "The duration of action for this insulin is approximately 8 to10 hours, so you will need to take it twice a day." C) "You can mix this insulin with NPH insulin to enhance its effects." D) "You cannot mix this insulin with regular insulin and thus will have to take two injections."
D: Insulin glargine is a long-acting insulin with duration of action up to 24 hours. It should not be mixed with any other insulins.
To achieve the most beneficial effect, the nurse plans to administer glipizide (Glucotrol) A) with food. B) 30 minutes before a meal. C) 15 minutes postprandial. D) at bedtime.
B: Glipizide works best if given 30 minutes before meals. This allows the timing of the insulin secretion induced by the glipizide to correspond to the elevation in the blood glucose level induced by the meal.
Diabetic teaching includes treatment of hypoglycemia with which drug? A) propranolol (Inderal) B) glucagon C) acarbose (Precose) D) bumetanide (Bumex)
B: Glucagon stimulates glycogenolysis, raising serum glucose levels.
When caring for a patient newly diagnosed with gestational diabetes, the nurse would question an order for which drug? A) insulin glargine (Lantus) B) glipizide (Glucotrol) C) insulin glulisine (Apidra) D) NPH insulin (Humulin N)
B: All currently available oral antidiabetic drugs are contraindicated for pregnant patients.
When monitoring for the most common side effect of traditional antihistamines, the nurse will assess the patient's A) cardiac status. B) neurologic status. C) respiratory status. D) gastrointestinal status.
B: The most common side effect of antihistamines is sedation.
Loratadine (Claritin) has an advantage over traditional antihistamines such as diphenhydramine (Benadryl) in that loratadine has A) less risk of cardiac arrhythmias. B) less sedative effect. C) increased bronchodilating effects. D) less gastrointestinal upset.
B: Loratadine does not affect the central nervous system and therefore is nonsedating.
A patient complains of worsening nasal congestion despite the use of oxymetazoline (Afrin) nasal spray for several days. The nurse's response is based on knowledge that A) oxymetazoline is not an effective nasal decongestant. B) sustained use of nasal decongestants over several days may result in rebound congestion. C) oxymetazoline should be administered in an hourly regimen for severe congestion. D) the patient is probably displaying an idiosyncratic reaction to oxymetazoline.
B: Oxymetazoline is an effective nasal decongestant, but overuse results in worsening or "rebound" congestion. It should not be used more than every 4 hours.
Which statement by the patient demonstrates understanding of beclomethasone diproprionate (Beconase)? A) "I will need to taper off the medication to prevent acute adrenal crisis." B) "This medication will help prevent the inflammatory response of my allergies." C) "I will need to monitor my blood sugar more closely because it may increase secondary to Beconase." D) "I only need to take this medication when my symptoms get bad."
B: Diproprionate is a steroid spray administered nasally. It is used to prevent allergy symptoms. Its effect is localized, and therefore the patient does not have systemic side effects with normal use and does not have to worry about weaning down the medication as with oral corticosteroids.
Which is a common side effect of antitussive medications? A) Drowsiness and dizziness B) Diarrhea and abdominal cramping C) Tremors and anxiety D) Bradycardia and increased lacrimation
A: Antitussive medications also affect the central nervous system, thus causing drowsiness and dizziness.
Patient teaching regarding expectorants should instruct the patient to perform which action? A) Restrict fluids in order to decrease mucus production. B) Take the medication once a day only, usually at bedtime. C) Increase fluid intake in order to decrease viscosity of secretions. D) Increase fiber and fluid intake to prevent constipation.
C: Expectorant drugs are used to decrease viscosity of secretions and allow them to be more easily expectorated. Increasing fluid intake helps this action.
The nurse would question an order for pseudoephedrine in a patient with a history of which condition? A) Pneumonia B) Osteoporosis C) Atrial fibrillation D) Peptic ulcer disease
C: Adrenergic drugs are usually contraindicated in patients with diabetes, hypertension, cardiac disease, thyroid dysfunction, prostatitis, or a known hypersensitivity to such drugs.
When providing general education on use of over-the-counter medications for allergies, which is the highest priority for the nurse to include? A) Discontinue use 4 days prior to allergy testing. B) Do not use in patients less than 6 years of age, unless prescribed. C) It may cause dry mouth. D) The medication treats the symptoms but is not a cure.
B: The FDA recommends not using over-the-counter medications for allergies in children under the age of 6. A health care provider may prescribe the medications for this age group.
Immunosuppressants, in general, work by A) increasing antibody response. B) increasing natural killer (NK) cellular activity. C) suppressing T-lymphocytes. D) suppressing hepatic metabolism of steroids.
C: Immunosuppressants inhibit T-lymphocyte synthesis, thus preventing an immune response to organ transplants.
Which condition is not an anticipated side effect of azathioprine (Imuran)? A) Leukopenia B) Thrombocytopenia C) Alopecia D) Hepatotoxicity
C: Common side effects of azathioprine include leukopenia, thrombocytopenia, and hepatotoxicity. Alopecia (hair loss) is not an expected side effect.
The nurse would anticipate administering which medication to a patient demonstrating acute organ rejection? A) azathioprine (Imuran) B) basiliximab (Simulect) C) muromonab-CD3 (Orthoclone-OKT3) D) sirolimus (Rapamune)
C: Only muromonab-CD3 (Orthoclone-OKT3) is used to treat acute organ rejection. The other immunosuppressants are used to prevent organ rejection.
Before administering an immunosuppressant drug, the nurse should perform which assessments? (Select all that apply.) A) BUN and creatinine levels B) Level of consciousness C) Blood pressure and pulse D) Hepatic enzymes
ALL: Adverse reactions to immunosuppressants include neurotoxicity, renal toxicity, hepatotoxicity, and hypertension.
Before administering intravenous basiliximab (Simulect), the nurse would anticipate giving which medication? A) methylprednisolone sodium (Solu-Medrol) B) diphenhydramine (Benadryl) C) acetaminophen (Tylenol) D) meperidine (Demerol)
A: Methylprednisolone sodium is administered 30 minutes before basiliximab injection to prevent or minimize acute allergic-type reactions associated with this medication.
The nurse would teach a patient prescribed cyclosporine to avoid which substance? A) Sunscreen B) Chocolate milk C) Grapefruit juice D) Acetaminophen
C: Patients should avoid consuming grapefruit or grapefruit juice because they will increase the blood concentrations of cyclosporine. Sunscreen should be used to avoid photosensitivity, and the medication should be taken with food or chocolate milk to prevent gastrointestinal upset.
Which statement most accurately describes the pharmacodynamics of vaccines? A) Vaccines work by stimulating the humoral immune system. B) Vaccines provide passive immunity. C) Vaccines work by suppressing immunoglobulins. D) Vaccines prevent the formation of antibodies against a specific antigen.
A: Vaccines work by stimulating the humoral immune system, which synthesizes immunoglobulins. They also stimulate the formation of antibodies against their specific antigen, providing active immunity.
When administering vaccinations, the nurse's priority assessment would be monitoring for A) pain at the injection site. B) signs and symptoms of infection. C) anaphylaxis. D) myalgias.
C: Anaphylaxis is a potential life-threatening adverse reaction to vaccines. Pain and myalgias can occur but are not life threatening.
Passive immunity can be obtained via the administration of A) vaccines. B) toxoids. C) antitoxins. D) immune globulins.
D: Vaccines, antitoxins, and toxoids provide active immunity by stimulating the humoral immune system. Immunoglobulins provide passive immunity by giving the patient substances to fight specific antigens.
Patients receiving tetanus toxoid should be instructed A) to increase fluid and fiber in the diet to prevent constipation. B) that soreness at the injection site is a common reaction. C) that they will have lifetime immunity from this injection. D) that this medication must be repeated weekly for four weeks.
B: Myalgia at the injection site is a common side effect of tetanus toxoid.
The anthrax vaccine is recommended for which groups of people? (Select all that apply.) A) Military personnel B) Veterinarians C) Workers who process imported animal hair D) Emergency room health care providers
A, B, C: People at risk for exposure to the anthrax bacterium include military personnel, veterinarians, and workers who process imported animal hair.
When administering ferrous sulfate (iron) to a patient, the nurse plans to give this medication with which fluid to increase absorption of the iron? A) 8 ounces of water B) 4 ounces of milk C) Hot tea D) Orange juice
D: The absorption of iron can be enhanced when it is given with ascorbic acid (vitamin C), which is present in orange juice.
The nurse will plan to inject iron dextran by which of the following techniques? A) Subcutaneous injection with a ½-inch, 25-gauge needle B) Intramuscular injection using the Z-track method C) Intradermal injection with a sunburst technique of administration D) Intramuscular injection with a ½-inch, 18-gauge needle
B: Iron dextran should be administered deep in a large muscle mass using the Z-track method and a 23-gauge, 1½-inch needle to prevent skin irritation and potential necrosis.
The nurse is educating a patient on diet. Which food will the nurse encourage the patient to include in a diet as a source of folate? A) Cheese B) Dried beans C) Steak D) Apples
B: Dried beans, green vegetables, and oranges are some of the common folate-containing foods.
The nurse knows a common expected adverse effect of iron supplementation is which effect?A) Fatigue B) Constipation C) Heartburn D) Flatus
B: Constipation and change in the color of stool to darker or green are the most common complaints with iron supplementation and are expected.
If you were bitten by a Black widow spider or an animal with rabies, what kind of medicine would restore you to health? a. antibiotic b. anti-toxoid c. antivenom d. morphine
This drug interferes with the activation of fibrin and fibrinogen from thrombin that keeps clots from forming. a. warfarin b. heparin c. aspirin d. plavix
What lab value do we monitoring during heparin administration? a. weight b. Hbg/Hct c. PTT d. PO2
c. PTT (1.5-2 times normal range)
What drug is used to prevent DVT, pulmonary embolism & emboli in a-fib? a. heparin b. coumadin c. plavix d. aspirin
Side fx of heparin include all BUT the following: a. thrombycytopenia b. confusion c. renal disfunction d. muscous membrane spontaneous bleeding
The antidote to heparin is a. aspirin b. vitamin K c. warfarin d. protamine sulfate
d. protamine sulfate
_______________ is used to prevent clot formation with DVT, PE, A-Fib, TIA & coronary occlusive problems. a. heparin b. coumadin c. plavix d. aspirin.
A(n) ___________ of coumadin can cause hemorrhage, headache, bruising, back pain, tachycardia & hypotension. a. early dose b. underdose c. therapeutic dose d. overdose
Vitamin K is the _____________ coumadin. a. antidote to b. prodrug of c. same as d. synthetic
a. antidote to
How do we monitor the effectiveness of coumadin? a. monitor vital signs b. PT/INR c. weight d. ask the pt how they feel.
Which benzodiazepine is used for status epilipticus? a. valium b. ativan c. librium d. xanax
What do we need to monitor for pts taking benzodiazepines? a. HR b. BP c. CBG's d. Respiratory rate
d. Respiratory rate
Adverse fx for benzodiazepines are ________________ of their therapeutic fx. a. opposite b. minor expressions c. overexpressions d. inverse expressions
All of the following are main emotional and mental disorders EXCEPT: a. anxiety b. affective disorders c. psychoses d. COPD
This is a severe emotional disorder that impairs the mental function of an individual to the point that the individual can't participate in ADL's. a. anxiety b. affective disorder c. psychosis d. being in nursing school
Abnormal levels of catchecolamines (dopamine, norepinephrine) and indolamines (seratonin & histamine) can lead to mental illness. This is the premise of the ___________ theory a. stress based b. genetic c. biochemical imbalance d. environmental
c. biochemical imbalance
How do benzodiazapines work? a. stimulate CNS b. promote neurotransmitter synthesis c. depress brainstem & limbic system d. good question!
c. depress brainstem & limbic system
This benzodiazapine reduces anxiety and pts memory of painful procedures that don't require general anesthesia. a. xanax b. ativan c. valium d. versed
Which of these drugs is reverses the fx of benzodiazapines? a. risperdal b. flumazenil c. probenicid d. sotalol
This drug of choice for treatment of mania is thought to be potentiate serotogenic neurotransmission. a. lithium b. amitriptyline c. trazodone d. ativan
Affective disorders are caused by decreased levels of ... a. catchecolamines b. seratonin c. endorphins d. stress
Mania results from decreased seratonin and __________ catchecolemines. a. increased b. decreased c. inconsistant d. absent