MULTIPLE CHOICE
- The nurse is providing care for a patient scheduled to take Precose (acarbose) 25 mg three times daily with meals. The patient reports feeling sweaty, weak, and tremulous. Which of the following actions by the nurse is best?
- Reassure the patient that these are common side effects with the medication.
- Call the pharmacy to report an adverse drug reaction.
- Check the patient’s blood glucose level.
- Determine if the patient has a history of anemia.
ANS: C
See Nursing Implications for acarbose: Observe the patient for signs and symptoms of hypoglycemia. Acarbose alone does not cause hypoglycemia; however, other concurrently administered hypoglycemic agents may produce hypoglycemia, requiring treatment. Ignoring these symptoms would be dangerous, but it is not considered an adverse drug reaction requiring an official report. The patient is experiencing symptoms of hypoglycemia not anemia.
KEY: Cognitive Level: Analysis
DIF: Medium
TOP: Therapeutic Classification: Antidiabetics
REF: Drugguide.com
- While responding to a rapid response called on the cardiac step-down unit, the nurse from intensive care observes the unit nurse massaging a patient’s neck and instructing the patient to bear down. Which of the following medications will most likely be used if the patient’s pulse does not return to normal?
- Adenocard (adenosine)
- Adrenaline (epinephrine)
- Tenormin (atenolol)
- Saphris (asenapine)
ANS: A
See adenosine Indications: Adenosine is used for the conversion of paroxysmal supraventricular tachycardia (PVST) to normal sinus rhythm when vagal maneuvers are unsuccessful. Epinephrine is a bronchodilator used in the management of reversible airway disease. Atenolol is a beta blocker used in the management of hypertension. Asenapine is an antipsychotic mood stabilizer used in the acute treatment of schizophrenia or manic/mixed episodes associated with bipolar I disorder.
KEY: Cognitive Level: Application
DIF: Medium
TOP: Therapeutic Classification: Antiarrhythmics
REF: Page 114 | Page 502 | Page 197 | Page 189
- The nurse is instructing the parent of a 6-year-old patient recently started on a ProAir HFA (albuterol) inhaler for exercise-induced asthma. The nurse recognizes that further teaching is necessary by which of the following client statements?
- “He may feel like his heart is racing after he takes his inhaler.”
- “He can use the inhaler as many times during football practice as he needs it.”
- “He should avoid cola and other caffeinated drinks since they may increase his heart rate.”
- “He should take two puffs about 15 minutes before gym class.”
ANS: B
See Contraindications/Precautions, Interactions, and Dosage for albuterol. Excess inhaler use may lead to tolerance and paradoxical bronchospasm. Use with caffeine-containing herbs (cola nut, guarana, tea, coffee) increases stimulant effect. Two inhalations every 4–6 hr or two inhalations 15 min prior to exercise). Tachycardia is an expected side effect with this medication.
KEY: Cognitive Level: Analysis
DIF: Easy
TOP: Therapeutic Classification: Bronchodilators
REF: Page 118
- While providing care for an adolescent patient newly prescribed Elavil (amitriptyline), the nurse should be most concerned by which of the following patient statements?
- “My mouth seems really dry and I’m thirsty all the time.”
- “I take a nap most afternoons now because I feel sleepy sometimes.”
- “I’m not sure why we should even bother anymore; everything seems so pointless.”
- “I drink a cup of coffee most days with breakfast.”
ANS: C
See Contraindications/Precautions for amitriptyline: the use of this medication may increase the risk of suicide attempt/ideation especially during dose early treatment or dose adjustment; risk may be greater in children or adolescents. Sedation is an expected side effect. Dry mouth is an expected side effect. There is no directive to avoid caffeine with this medication.
KEY: Cognitive Level: Analysis
DIF: Medium
TOP: Therapeutic Classification: Antidepressants
REF: Page 145
- The nurse is caring for a patient with otitis media who reports an allergy to penicillin. Orders are received for ampicillin 500 mg every 8 hr. Which of the following actions by the nurse is best?
- Provide the medication as ordered.
- Call the pharmacist to request a substitution.
- Ask the patient if he or she has taken ampicillin in the past.
- Hold the medication.
ANS: D
See contraindications/precautions for ampicillin: Contraindicated in hypersensitivity to penicillin. This medication should be held due to the stated allergy to penicillin.
KEY: Cognitive Level: Application
DIF: Easy
TOP: Therapeutic Classification: Anti-infectives
REF: Page 158
- While caring for a patient in hospice who is actively dying, the nurse notes moderate respiratory distress, copious oral secretion, and a frequent moist cough. Which of the following prn medications would most promote comfort for the patient?
- Morphine (morphine sulfate) 2 mg IV bolus
- Atro-Pen (atropine) 0.4 mg IV bolus
- Ativan (lorazepam) 0.5 mg IV bolus
- Benadryl (diphenhydramine) 25 mg IV bolus
ANS: B
See Action for atropine: Low doses decrease sweating, salivation, and respiratory secretions. Morphine is used for pain control. Lorazepam is used for anxiety. Benadryl is used for itching.
KEY: Cognitive Level: Analysis
DIF: Medium
TOP: Therapeutic Classification: Antiarrhythmics | Therapeutic Classification: Anticholinergics
REF: Page 203
- The nurse is counseling a patient started on Zithromax (azithromycin) for the treatment of an upper respiratory infection. The nurse recognizes that teaching has been effective by which of the following patient statements?
- “The med pack will have five pills, one for each of the next 5 days.”
- “If I don’t feel better next week, I can get a refill from the pharmacist.”
- “I only need to take one pill, but my symptoms may not clear for 3 days.”
- “I can take this medication safely even though I’m allergic to erythromycin.”
ANS: A
See Route/Dosage for azithromycin: 500 mg on 1st day, then 250 mg/day for 4 more days. Instruct the patent to notify health-care professional if symptoms do not improve. Teach the patient to take medication as directed and to finish the drug completely. Azithromycin is contraindicated in patients with an allergy to erythromycin.
KEY: Cognitive Level: Analysis
DIF: Easy
TOP: Therapeutic Classification: Anti-infectives
REF: Page 208
- The home-care nurse is preparing to see a patient being treated for diabetic foot ulcerations with Regranex (becaplermin). Which of the following instructions will the nurse include in the patient teaching?
- “Apply the wound gel three times daily to promote healing.”
- “Store the gel in the refrigerator.”
- “Complete healing is expected within 3 days.”
- “After applying the wound gel, cover with a transparent adhesive dressing.”
ANS: B
See Implementation for becaplermin: Calculated amount is applied as a thin layer and covered with a moist saline dressing for 12 hr; dressing is removed, ulcer rinsed, and redressed with moist dressing without becaplermin for rest of day. Process is repeated daily. Store gel in refrigerator; do not freeze. If ulcer does not decrease in size by 30% within 10 wk, continuation of therapy should be reassessed. Cover with a moist saline dressing for 12 hr. Then, remove dressing, rinse ulcer, and redress with moist dressing without becaplermin for rest of day.
KEY: Cognitive Level: Analysis
DIF: Hard
TOP: Therapeutic Classification: Wound/Ulcer/Decubiti healing agents
REF: Page 217
- The nurse is tracking patient symptoms related to acute alcohol intoxication and withdrawal. Which of the following medications would the nurse expect to provide in the management of these symptoms?
- Plavix (clopidogrel)
- Zyban (bupropion)
- Prilosec (omeprazole)
- Tranxene (clorazepate)
ANS: D
See Indications for clorazepate: Clorazepate is used in the management of simple partial seizures, anxiety disorder, symptoms of anxiety, and acute alcohol withdrawal. Clopidogrel is an antiplatelet agent. Bupropion is an antidepressant. Omeprazole is an antiulcer agent.
KEY: Cognitive Level: Application
DIF: Medium
TOP: Therapeutic Classification: Anticonvulsants
REF: Drugguide.com
- The nurse prepares to provide Colcrys (colchicine) to a patient. The nurse should assess which of the following prior to administration of the medication?
- Blood pressure
- Complete blood count
- Triglyceride level
- Oxygen saturation
ANS: B
See Nursing Implications/assessment for colchicine: In patients receiving prolonged therapy, monitor baseline and periodic CBC; may cause decreased platelet count, leukopenia, aplastic anemia, and agranulocytosis. No alteration in the blood pressure, triglyceride, or oxygenation is expected.
KEY: Cognitive Level: Application
DIF: Hard
TOP: Therapeutic Classification: Antigout agents
REF: Page 343
- The nurse is transcribing new orders for a patient with multiple sclerosis. Amrix (cyclobenzaprine) 10 mg orally three times daily has been ordered. Which of the following would require an immediate intervention by the nurse?
- The patient has a noted allergy to acetaminophen.
- The patient has a family history of breast cancer.
- The patient is currently taking Nardil (phenelzine).
- The patient is diabetic.
ANS: C
See Contraindications/Precautions for cyclobenzaprine: Should not be used within 14 days of MAO inhibitor therapy. Phenelzine is an MAO inhibitor. The other factors will not impact the safe provision of cyclobenzaprine.
KEY: Cognitive Level: Analysis
DIF: Hard
TOP: Therapeutic Classification: Skeletal muscle relaxants
REF: Page 375 | drugguide.com
- The nurse is preparing to provide medications for a patient newly admitted with a cerebral vascular accident who reportedly had difficulty swallowing pills during the previous shift. The nurse plans to crush the patient’s medications and provide them in applesauce. Which of the following medications will require an alternative form of administration?
- Aspirin 81 mg daily
- Enablex (darifenacin-XR) 15 mg daily
- Claritin (loratadine) 10 mg daily
- CalCarb (calcium carbonate) 500 mg daily
ANS: B
See Implementation/Nursing Implications for Enablex: Extended-release tablets must be swallowed whole; do not break or crush. Doing so can result in the immediate release of the full dose. Enablex (darifenacin-XR) is a urinary tract antispasmodic.
KEY: Cognitive Level: Application
DIF: Easy
TOP: Therapeutic Classification: Urinary tract antispasmodics
REF: Page 401
- The nurse receives a call from a patient who recently began taking Zyrtec (cetirizine) 5 mg daily. The patient reports that her mouth frequently feels dry. Which of the following responses by the nurse is best?
- “Dry mouth is a common side effect of Zyrtec. Rinse your mouth frequently, and try using sugarless chewing gum or candy for relief.”
- “You may be taking too strong of a dose. You should take half a pill each day to reduce the risk of side effects.”
- “You might be having an allergic reaction to the medication. Are you able to come to the doctor’s office today?”
- “It is important that you take the medication with a full meal and drink at least 12 glasses of water each day.”
ANS: A
See Patient/Family Teaching for cetirizine: Advise patient that good oral hygiene, frequent rinsing of the mouth with water, and sugarless gum or candy may minimize dry mouth. It is outside the nursing scope of practice to alter dosage of a medication. Dry mouth is not a symptom of an allergic reaction and the patient does not need to be seen by a physician—if dry mouth persists beyond 2 wk, the patient should notify a dentist. The medication can be taken without regard to food.
KEY: Cognitive Level: Analysis
DIF: Medium
TOP: Therapeutic Classification: Allergy, cold and cough remedies; Antihistamines
REF: Page 317
- The nurse is caring for a patient who takes Dexedrine (dextroamphetamine). The nurse should be most concerned by which of the following patient statements?
- “I seem to be able to focus better and I’m less distracted now.”
- “I’ve been having some trouble falling asleep at night lately.”
- “I started taking St. John’s wort this week to help with my depression.”
- “I forgot to take my medication in the morning last week so I took it at lunch time.”
ANS: C
See Interactions for dextroamphetamine: St. John’s wort may increase serious side effects; concurrent use is not recommended. Dextroamphetamine is used in the treatment of ADHD, so improved focus is a desired effect. Insomnia is commonly seen and the patient should be instructed to take the medication at least 6 hr prior to bedtime. The medication is generally given 1–2 times each day, and missed doses should be taken as soon as remembered up to 6 hr prior to bedtime.
KEY: Cognitive Level: Analysis
DIF: Medium
TOP: Therapeutic Classification: Central nervous system stimulants
REF: Drugguide.com
- The nurse receives orders to begin Cardura (doxazosin) 1 mg daily with the first dose to start today. Which of the following assessments is the highest priority within the first 2 to 4 hr after provision?
- Urinary output
- Respiratory rate
- Pain relief
- Orthostatic hypotension
ANS: D
See Nursing Implications for doxazosin: Assess for first-dose orthostatic hypotension and syncope. The medication can be used in the treatment of benign prostatic hyperplasia, but orthostatic hypotension is a bigger concern and should be the first concern. No effect on the respiratory rate or pain is anticipated.
KEY: Cognitive Level: Application
DIF: Easy
TOP: Therapeutic Classification: Antihypertensives
REF: Page 461
- The nurse is providing care for a patient who returned from surgery 4 hr earlier. The patient reports adequate pain control with the use of patient-controlled analgesia but states she is having significant nausea. Which of the following medications should the nurse provide?
- Inapsine (droperidol) 2.5 mg IV
- Benadryl (diphenhydramine) 25 mg IV
- Morphine (morphine sulfate) 2 mg IV
- Colace 100 mg po
ANS: A
See Indications for droperidol: Used to produce tranquilization and as an adjunct to general and regional anesthesia; useful in decreasing postoperative or postprocedure nausea and vomiting. Benadryl is an antihistamine used to treat itching. Morphine sulfate is a narcotic used to treat pain. Colace is a stool softener.
KEY: Cognitive Level: Application
DIF: Medium
TOP: Therapeutic Classification: Sedative/hypnotics
REF: Drugguide.com
- The nurse is counseling a patient with diabetes, hypertension, and chronic obstructive pulmonary disease on his medications. To verify patient understanding of his medications, the nurse states, “You are taking Cymbalta (duloxetine) 60 mg once a day; do you know why you take that medication?” The nurse determines the patient has a good understanding of his medications if which of the following responses is given?
- “I take that one to keep my blood sugar under control.”
- “I don’t know honey, is that my little blue pill?”
- “That helps with the pain in my feet.”
- “I think that is to lower my blood pressure.”
ANS: C
See Indications for duloxetine: Duloxetine is used for major depressive disorder, diabetic peripheral neuropathic pain, generalized anxiety disorder and fibromyalgia. Patient education and verification of his or her understanding regarding medication use and purpose is an important component of health care.
KEY: Cognitive Level: Analysis
DIF: Medium
TOP: Therapeutic Classification: Antidepressants
REF: Page 474
- While providing care for patients on a neuroscience unit, which of the following medications should the nurse provide first?
- Dantrium (dantrolene) 1 mg/kg IV to a patient with malignant hyperthermia
- Norpramin (desipramine) 100 mg orally to a patient admitted with syncope
- Enablex (darifenacin) 15 mg orally to a patient admitted for cerebrovascular accident
- Cymbalta (duloxetine) 20 mg to a patient with diabetes
ANS: A
See Indications for dantrolene: Emergency treatment of malignant hyperthermia, which can cause seizures. This is an emergency situation and must be the nurse’s highest priority. Desipramine is an antidepressant. It is not a priority. Darifenacin is used to treat overactive bladder spasms. It is not a priority. Duloxetine is an antidepressant. It is not a priority.
KEY: Cognitive Level: Analysis
DIF: Hard
TOP: Therapeutic Classification: Skeletal muscle relaxants
REF: Page 393 | Page 412 | Page 401 | Page 474
- The nurse is caring for a patient with a history of Parkinson disease who recently started taking Comtan (entacapone). The nurse notes the patient’s urine has a brownish-orange discoloration. Which of the following actions should the nurse take next?
- Notify the physician.
- Determine the patient’s current weight.
- Ask the patient what he or she ate for breakfast.
- Note the assessment finding in the chart.
ANS: D
See Adverse Reactions/Side Effects GU for entacapone: This is a normal finding for patients taking entacapone. There is no need to take a specific action, and the assessments listed will not help determine the presence of other side effects or concerns.
KEY: Cognitive Level: Analysis
DIF: Hard
TOP: Therapeutic Classification: Antiparkinson agents
REF: Page 498
- A young woman reports to the emergency department with frank vaginal bleeding and a stated history of being 10 wk pregnant. Ultrasound confirms an incomplete miscarriage, and the woman is scheduled for a dilatation and curettage. Which of the following medications should the nurse anticipate being provided after the surgical procedure?
- Rheumatrex (methotrexate)
- Methergine (methylergonovine)
- Magnesium sulfate
- Terbutaline
ANS: B
See indications for methylergonovine: Prevention and treatment of postpartum or postabortion hemorrhage caused by uterine atony or involution. Methotrexate is a neoplastic agent that has been used to induce chemical abortion. Magnesium sulfate is given in the treatment of preeclampsia. Terbutaline is used off label to reduce uterine contraction in the prevention of preterm labor.
KEY: Cognitive Level: Application
DIF: Medium
TOP: Therapeutic Classification: Oxytocics
REF: Pages 837
- The nurse is assisting in the discharge of a patient with a peripherally inserted central catheter (PICC) who will receive antibiotic therapy with Invanz (ertapenem) at home under the direction of a home health-care agency. The nurse recognizes that teaching has been effective by which of the following client statements?
- “The nurses will come out every 6 hours to provide the IV antibiotic.”
- “If the dressing over the PICC line pulls back, the nurse will change it the next day.”
- “I will have to get the antibiotic once a day, usually for 2 weeks.”
- “Since I’m not allergic to penicillin, I won’t be allergic to this medication.”
ANS: C
See Route/Dosage and Nursing Implications for ertapenem: Ertapenem dosage is 1 g daily for up to 14 days (IV). The dressing on a PICC line must remain occlusive to prevent infection—if the dressing should pull back, the home care nurse should be notified immediately. Ertapenem is given once daily. Persons with a negative history of penicillin sensitivity may still have an allergic response.
KEY: Cognitive Level: Analysis
DIF: Medium
TOP: Therapeutic Classification: Anti-infectives
REF: Page 516
- A nursing faculty is observing a student nurse prepare and provide morning medications including delayed-released Nexium (esomeprazole) capsules to a patient with a nasogastric (NG) tube. The nurse should intervene if which of the following is noted?
- The student asks the patient to state his name and birth date prior to preparing the medication.
- The student opens the capsule and mixes the granules with 50 mL of water.
- The student uses a 60 mL cath-tipped syringe to instill the medication into the NG tube.
- The student waited for the granules to dissolve to prevent clogging of the NG tube.
ANS: D
See Nursing Implications/Implementation for esomeprazole: The NG must be flushed after medication provision, and tube feeding should be held for at least 1 hr. Verifying patient identity with two unique identifiers is the correct way to ensure safe medication administration. For patients with an NG tube, delayed-release capsules can be opened and intact granules emptied into a 60 mL syringe and mixed with 50 mL of water. Replace plunger and shake vigorously for 15 sec. Hold syringe with tip up and check for granules in tip. Attach syringe to NG tube and administer solution. After administering, flush syringe with additional water. Do not administer if granules have dissolved or disintegrated. Administer immediately after mixing. Provide at least 1 hr before meals. The NG tube must be flushed after medication provision, and tube feeding should be held for at least 1 hr.
KEY: Cognitive Level: Analysis
DIF: Medium
TOP: Therapeutic Classification: Anti-ulcer agents
REF: Pages 525-526
- The nurse caring for patients on a gynecological surgery unit would monitor which of the following women most closely for evidence of a deep vein thrombosis?
- A 64-year-old patient taking Apriso (mesalamine) who has a history of ulcerative colitis.
- A 47-year-old patient admitted for lumpectomy with a family history of breast cancer.
- A 58-year-old patient taking Estrace (estradiol) with a 42-pack-per-year history of smoking.
- A 61-year-old patient who had a bladder-sling procedure whose platelet count is 167,000 cells/mm3.
ANS: C
See Adverse Reactions/Side effects for estradiol: CV risk for MI and thromboembolism; smoking increases risk of adverse CV reactions. Mesalamine is a GI anti-inflammatory agent used in the treatment of ulcerative colitis and does not increase risk of thromboembolism. The platelet count is normal and although all surgical patients have an increased risk for thromboembolism, the patient taking estradiol is at higher risk.
KEY: Cognitive Level: Analysis
DIF: Medium
TOP: Therapeutic Classification: Hormones
REF: Page 527
- A student nurse is taking care of patients on a medical unit and receives new orders for Lunesta (eszopiclone) 2 mg orally each evening. In transcribing this order, the student should take which of the following actions?
- Schedule the medication routinely at 6 p.m.
- Schedule the medication 1 hr prior to the evening meal.
- Call the pharmacy to ask what time the medication should be given.
- Schedule the medication at bedtime.
ANS: D
See Route/Dosage for eszopiclone: 2 mg immediately before bedtime.
KEY: Cognitive Level: Application
DIF: Easy
TOP: Therapeutic Classification: Sedative/hypnotics
REF: Page 532
MULTIPLE CHOICE
- The nurse is providing care for an 82-year-old client with glaucoma. Diamox (acetazolamide) 250 mg orally twice daily has been ordered as a new medication. The nurse would be most concerned by which of the following?
A. The client has a listed allergy to sulfonamides.
B. The client has a history of rheumatoid arthritis.
C. The client takes Cogentin (benztropine) daily.
D. The client’s potassium is 3.6 mEq/dL.
ANS: A
See Contraindications/Precautions for acetazolamide. Hypersensitivity or cross-sensitivity with sulfonamides may occur.
KEY: Cognitive Level: Application
DIF: Medium
TOP: Therapeutic Classification: Anticonvulsants, Antiglaucoma agents
REF: Drugguide.com
- A 21-year-old client is brought to the emergency room with suspected overdose with Tylenol (acetaminophen). Which of the following medications would the nurse expect to be ordered?
A. Protamine sulfate
B. Primaxin (imipenem)
C. Acetadote (acetylcysteine)
D. Diabeta (glyburide)
ANS: C
See Toxicity and overdose for acetaminophen and Indications for acetylcysteine: Acetylcysteine is the antidote for the management of potentially hepatotoxic overdose of acetaminophen.
KEY: Cognitive Level: Application
DIF: Medium
TOP: Therapeutic Classification: Antidotes, mucolytic
REF: Pages 102 and 104
- The nurse is providing care for a 64-year-old client on the telemetry unit whose heart rate suddenly jumps to 144 bpm. Telemetry shows supraventricular tachycardia and the client reports feeling a bit lightheaded and dizzy. The nurse attempts vagal stimulation without success and prepares to administer Adenocard (adenosine) 6 mg IV push. The nurse would expect which of the following to occur?
A. A gradual slowing of the heart rate over the next 30 min with an end result of normal sinus rhythm and improved symptoms.
B. Slowing of the tachycardia with an end rate between 100–120 bpm and improved dizziness within 5 min.
C. Loss of consciousness for the client in preparation for electric shock/cardioversion. - A short period of heart block or asystole immediately after injection followed by conversion to normal sinus rhythm.
ANS: D
See Nursing Implications adenosine: Monitor heart rate frequently (every 15–30 sec) and ECG continuously during therapy. Short transient periods of 1st, 2nd, or 3rd degree heart block or asystole may occur following injection; usually resolves quickly due to short duration of adenosine. Once conversion to normal sinus rhythm is achieved, transient arrhythmias may occur but generally last a few seconds.
KEY: Cognitive Level: Application
DIF: Hard
TOP: Therapeutic Classification: Antiarrythmics
REF: Page 113
- The nurse is caring for a 34-year-old patient with a large hilar mass due to lymphoma. Chemotherapy is being provided and the client also has orders for Zyloprim (allopurinol) 300 mg orally twice daily. When providing this medication, the nurse would include which of the following statements in the client teaching?
A. “This medication will help prevent gout, which occurs when clients are given radiation therapy.”
B. “Allopurinol binds to the uric acid being released by the destroyed cancer cells and prevents it from damaging your kidneys.”
C. “Chemotherapy agents can reduce the number of white blood cells, red blood cells, and platelets in your body; this medication helps protect those cells.”
D. “This is part of the chemotherapy regimen since some chemo agents are given in your IV and others are given by mouth.”
ANS: B
See Indications for allopurinol: Treatment of secondary hyperuricemia, which may occur during treatment of tumors or leukemias.
KEY: Cognitive Level: Analysis
DIF: Hard
TOP: Therapeutic Classification: Antigout, antihyperuremics
REF: Page 125
- The nurse is providing Ethyol (amifostine) to a 51-year-old woman with ovarian cancer who is also receiving Cisplatin. Which of the following nursing assessments during the infusion is of the highest priority?
A. Monitor client blood sugar every hr.
B. Monitor client’s respiratory rate every 30 min.
C. Monitor client’s blood pressure every 5 min.
D. Monitor client’s urine output every 4 hr.
ANS: C
See Nursing Implications Assessment for amifostine. Monitor BP before and every 5 min during infusion. Discontinue antihypertensives 24 hr prior to the treatment. If significant hypotension requiring interruption of therapy occurs, place client in Trendelenburg position and administer an infusion of 0.9% NaCl using separate IV line.
KEY: Cognitive Level: Analysis
DIF: Hard
TOP: Therapeutic Classification: Cytoprotective agents
REF: Page 133
- While preparing to give Fungizone (amphotericin B) to a client who is also receiving Dexasone (dexamethasone), the nurse recognizes the client is at increased risk for which of the following?
A. Hypoglycemia
B. Hyponatremia
C. Hypocalcemia
D. Hypokalemia
ANS: D
See Interactions for amphotericin B with corticosteroids. Concurrent use with corticosteroids increases risk of hypokalemia.
KEY: Cognitive Level: Knowledge
DIF: Hard
TOP: Therapeutic Classification: Antifungals
REF: Page 154
- A client with breast cancer is taking Arimidex (anastrozole). The nurse recognizes that teaching has been effective by which of the following client statements?
A. “If I miss a dose, I should take a double dose the next day.”
B. “I must take this medication on an empty stomach before going to bed each night.”
C. “Oral chemotherapy generally has fewer side effects and is much safer.”
D. “There is a risk of allergic reaction for this medication so I need to notify the doctor right away if I have any swelling in my face, difficulty swallowing, or rashes.”
ANS: D
See Patient/Family Teaching for anastrozole. Inform client of potential for adverse reactions and advise client to notify health care professional immediately if allergic reactions or chest pain occurs.
KEY: Cognitive Level: Analysis
DIF: Easy
TOP: Therapeutic Classification: Antineoplastics
REF: Page 163
- A nurse is receiving shift-to-shift report for a client in the intensive care unit with multiple medical problems. The client is receiving Argatroban infusion. The nurse recognizes this medication is ordered to address which of the following health-care problems for the client?
A. Ventilator-associated pneumonia
B. Deep vein thrombosis
C. Hypotension
D. Urosepsis
ANS: B
See Indications for Argatroban. Prophylaxis or treatment of thrombosis in client with heparin-induced thrombocytopenia.
KEY: Cognitive Level: Application
DIF: Easy
TOP: Therapeutic Classification: Anticoagulations
REF: Page 182
- The nurse is caring for a 6-month-old patient receiving oral Moxatag (amoxicillin) 25 mg/kg/day divided into two doses and distributed as 50 mg/mL oral suspension. The child weighs 33 pounds. How much medication (in mL) will this nurse pour/provide each dose?
ANS: 3.75 mL = 3.8 mL
See Availability for amoxicillin and perform drug calculation. 2.2 pounds = 1 kg so weight conversion is 33 pounds divided by 2.2 = 15 kg. Calculate daily drug dose by multiplying 25 mg/kg and 15 = 375 mg. Divide by 2 for single dose = 187.5. Since medication comes 50 mg/mL, divide by 50 to calculate oral amount in each dose = 3.75 mL
KEY: Cognitive Level: Analysis
DIF: Hard
TOP: Therapeutic Classification: Anti-infectives, Anti-ulcer agents
REF: Page 148
- While providing care for a client who is to receive Abilify (aripiprazole), the nurse recognizes that the client understands this medication by which of the following statements?
A. “This medication may cause me to have a dry mouth or lower my saliva production.”
B. “This medication will reduce my nicotine cravings and help me quit smoking.”
C. “I need to let the doctor know right away if I have any thoughts of suicide or worsening depression.”
D. “I need to be sure and drink at least 4 quarts of water each day while I’m taking this medication.”
ANS: C
See Patient Family Teaching for aripiprazole. Advise patient and family to notify health care professional if thoughts about suicide or dying, attempts to commit suicide, new or worse depression, or new or worse anxiety occur. The medication can cause tardive dyskinesia or neuroleptic malignant syndrome but does not typically cause a dry mouth nor are increased fluids required.
KEY: Cognitive level: Application
DIF: Medium
TOP: Therapeutic Classification: Antipsychotics, Mood stabilizers
REF: Pages 187-188
- In reviewing new orders, the nurse notes Azactam (aztreonam) 1 gram IV every 8 hr has been ordered. Before initiating therapy, the nurse should assess for an allergy history to which of the following? Select all that apply.
A. Penicillins
B. MAO inhibitors
C. Antifungals
D. Cephalosporins
E. Non-steroidal anti-inflammatory agents
ANS: A, D
See Nursing Implications Assessment for aztreonam. Obtain a history before initiating therapy to determine previous use of and reaction to penicillins and cephalosporins.
KEY: Cognitive Level: Knowledge
DIF: Medium
TOP: Therapeutic Classification: Anti-infectives
REF: Pages 212-213
- While caring for a client with Parkinson disease who has recently started taking Cogentin (benztropine), the client reports, “My mouth seems so dry all the time.” Which of the following statements by the nurse is best?
A. “Dry mouth is common with your new medications. You should rinse frequently and consider using hard sugarless candies or gum to help with the symptom.”
B. “I wonder if your dose is too high; try taking half the pill twice a day instead of all at once and see if that helps.”
C. “You should call your doctor and let them know about that—it could be a serious side effect of the new medication.”
D. “Have you noticed any fever or night sweats lately?”
ANS: A
See Patient/Family Teaching for benztropine. Instruct patient that frequent rinsing of mouth and good oral hygiene, and sugarless gum or candy may decrease dry mouth.
KEY: Cognitive Level: Analysis
DIF: Medium
TOP: Therapeutic Classification: Antiparkinson agents
REF: Page 223
- The nurse is providing instructions to a client who has started therapy with Buprenex (buprenorphine) to assist with opioid withdrawal. The nurse instructs the client to avoid which of the following natural substances/herbs? Select all that apply.
- Kava-kava
B. Valerian
C. Garlic
D. Ginger
E. Chamomile
F. Hops
ANS: A, B, E, F
See Drug-Natural Products under Interactions for buprenorphine. Concomitant use of kava-kava, valerian, chamomile, or hops can increase CNS depression.
KEY: Cognitive Level: Knowledge
DIF: Hard
TOP: Therapeutic Classification: Opioid analgesics
REF: Page 248
- While providing care for an 84-year-old patient with Parkinson disease who is taking Sinemet (carbidopa/levodopa), the nurse notes abnormalities in the client’s lab values. Which of the following could be attributed to the medication?
A. Platelet count—440,000 c/mm3
B. Hemoglobin—10.4 g/dL
C. Albumin—3.2 g/dL
D. B-type natriuretic peptide (BNP)—449 pg/mL
ANS: B
See Nursing Implications for carbidopa/levodopa. May cause decreased hemoglobin/hematocrit, agranulocytosis, hemolytic and non-hemolytic anemia, thrombocytopenia, leucopenia, and increased WBC. The listed platelet count is high, which is not expected with the drug, the hemoglobin is low and could be attributed to the drug, the protein value is low with no correlation to the drug, and the BNP is high with no correlation to the drug.
KEY: Cognitive Level: Analysis
DIF: Hard
TOP: Therapeutic Classification: Anti-Parkinson Agents
REF: Page 279
- While caring for a client taking Clozaril (clozapine), the nurse determines the medication is effective by which of the following findings?
A. Decreased swelling noted at the site of cellulitis in the left hand.
B. Apical heart rate is regular at 72 bpm.
C. Client is cooperative; oriented to person, place, and time; and has no hallucinations or delusions.
D. Breath sounds are clear throughout anterior, lateral, and posterior aspects.
ANS: C
See Indications and Evaluation/Desired Outcomes for clozapine. Used in the treatment of schizophrenia. The medication will have no impact on infection, heart rate, or breath sounds but will help reduce psychotic behaviors.
KEY: Cognitive Level: Analysis
DIF: Medium
TOP: Therapeutic Classification: Antipsychotics
REF: Pages 336-339
- While caring for a client who is taking Sandimmune (cyclosporine) after a cardiac transplant, the nurse is aware that it is most important to monitor for which of the following?
A. Hypokalemia
B. Hypotension
C. Anorexia
D. Nephrotoxicity
ANS: D
See Adverse Reactions/Side Effects for cyclosporine: Can cause hyperkalemia and hypertension (not hypokalemia or hypotension) as well as anorexia and nephrotoxicity—the highest priority of those listed (anorexia and nephrotoxicity) is nephrotoxicity.
KEY: Cognitive Level: Application
DIF: Hard
TOP: Therapeutic Classification: Immunosuppressants
REF: Page 378
- A client admitted with atrial fibrillation would most likely be started on which of the following medications to reduce the risk of embolization?
A. Pradaxa (dabigatran)
B. DDAVP (desmopressin)
C. Effexor (venlafaxine)
D. Flomax (tamsulosin)
ANS: A
See Indications for dabigatran: to reduce the risk of stroke/systemic embolization associated with non-valvular atrial fibrillation. DDAVP is used in the treatment of diabetes insipidus. Venlafexine is an antidepressant and tamsulosin is an anti-adrenergic agent used for prostatic hyperplasia.
KEY: Cognitive Level: Knowledge
DIF: Hard
TOP: Therapeutic Classification: Anticoagulants
REF: Page 385
18. While caring for a client who is receiving Desferal (deferoxamine), the nurse notes the client’s urine is reddish colored. Which of the following conclusions should the nurse draw?
MULTIPLE CHOICE
- The nurse works in a pediatric psychiatry unit. Ritalin (methylphenidate) 5 mg three times daily is commonly prescribed for many of the clients. The nurse recognizes this drug needs to be used cautiously in which of the following children?
A. An 8-year-old patient with a history of cardiovascular disease
B. A 12-year-old patient with a history of scoliosis
C. A 6-year-old patient who takes Singulair (montelukast) daily
D. A 7-year-old patient with a history of sickle cell anemia
ANS: A
See Contraindications/Precautions for methylphenidate: Sudden death has occurred in children with structural cardiac abnormalities or other cardiovascular disease.
KEY: Cognitive Level: Application
DIF: Medium
TOP: Therapeutic Classification: Central nervous system stimulants
REF: Pages 840-841
- A 71-year-old client was newly prescribed Zaroxolyn (metolazone). The nurse recognizes the drug has been effective by which of the following assessments?
A. White blood cell count = 5,500 cells/mm3
B. Client reports sleeping 8 hr per night
C. BP = 132/74
D. Client denies hallucinations
ANS: C
See Evaluation for metolazone: Decrease in BP and edema, increase in urine output.
KEY: Cognitive Level: Application
DIF: Medium
TOP: Therapeutic Classification: Antihypertensives, Diuretics
REF: Page 847
- The nurse is providing care for a 64-year-old client being prepped for a colonoscopy who is given midazolam. The nurse would expect to see which of the following responses?
A. Decrease in oral secretions
B. Increased heart rate
C. Decrease in abdominal cramping
D. Increased drowsiness
ANS: D
See Nursing Implications for midazolam: Pre-procedural sedation.
KEY: Cognitive Level: Application
DIF: Medium
TOP: Therapeutic Classification: Anti-anxiety agents; sedative/hypnotics
REF: Pages 855-856
- The nurse is providing milrinone to a 71-year-old woman with heart failure. Which of the following nursing assessments during the infusion is of the highest priority?
A. Monitor client’s blood sugar every 4 hr.
B. Monitor client’s sedation level hourly.
C. Monitor client’s telemetry continuously.
D. Monitor client’s urine output every 4 hr.
ANS: C
See Nursing Implications Assessment for milrinone: Monitor ECG continuously during infusion. Arrhythmias are common and may be life threatening.
KEY: Cognitive Level: Analysis
DIF: Hard
TOP: Therapeutic Classification: Inotropics
REF: Page 863
- While preparing to give morning medications, Remeron (mirtazapine) was newly ordered for the patient to begin this morning. The nurse would immediately call the physician to question this order if which of the following medications was included in the patient’s list of home medications?
A. Enteric coated aspirin
B. Lasix (furosemide)
C. Digoxin (lanoxin)
D. Nardil (phenelzine)
ANS: D
See Interactions for mirtazapine: Concurrent use with MAO inhibitors can cause hypertension, seizures, and death.
KEY: Cognitive Level: Analysis
DIF: Hard
TOP: Therapeutic Classification: Antidepressants
REF: Page 865
- A nurse is receiving a shift-to-shift report for a client with multiple medical problems. The client is receiving nabumetone. The nurse recognizes this medication is ordered to address which of the following health-care problems for the client?
A. Benign prostatic hypertrophy
B. Rheumatoid arthritis
C. Venous-thrombosis embolic prophylaxis
D. Urinary tract infection
ANS: B
See Indications for nabumetone: Symptomatic management of rheumatoid arthritis.
KEY: Cognitive Level: Application
DIF: Medium
TOP: Therapeutic Classification: Antirheumatics, Nonsteroidal anti-inflammatory agents
REF: Drugguide.com
- While providing care for a client who is to receive Amerge (naratriptan), the nurse recognizes that the client understands this medication by which of the following statements?
A. “If my migraine headache doesn’t go away, I can repeat the dose within 30 minutes.”
B. “This medication will typically make me very sleepy after I take it.”
C. “I need to let the doctor know right away if I have any chest pain or tightness after taking this medication.”
D. “I need to be sure and take a laxative when I take this medication.”
ANS: C
See Patient Family Teaching for naratriptan: Advise patient and family to notify health-care professional prior to next dose of naratriptan if pain or tightness in the chest occurs during use. Dose may be repeated in 4 hr if response is inadequate. Medication does not cause sedation or constipation.
KEY: Cognitive level: Analysis
DIF: Medium
TOP: Therapeutic Classification: Vascular headache suppressants
REF: Pages 896
- In reviewing new orders, the nurse notes Starlix (nateglinide) 120 mg three times daily before meals has been ordered. Before initiating therapy, the nurse should assess for which of the following?
- Blood sugar
B. Respiratory rate
C. Level of consciousness
D. Creatinine clearance
ANS: A
See Nursing Implications Assessment for nateglinide: Monitor serum glucose.
KEY: Cognitive Level: Application
DIF: Medium
TOP: Therapeutic Classification: Antidiabetics
REF: Drugguide.com
- While caring for a client with hypertension who has recently started taking Bystolic (nebivolol), the client reports, “This medication seems to give me a headache.” Which of the following statements by the nurse is best?
A. “Headaches are common with your new medications. You should continue to take the medication to help control your blood pressure.”
B. “That’s too bad. You could try taking half a pill twice a day.”
C. “You should call your doctor and let them know about that—it could be a serious side effect of the new medication.”
D. “Have you noticed any muscle twitching or facial numbness?”
ANS: A
See Adverse Reactions/Side Effects for nebivolol: Can cause dizziness, fatigue, and headache.
KEY: Cognitive Level: Analysis
DIF: Medium
TOP: Therapeutic Classification: Antihypertensives
REF: Page 897
- The nurse is providing instructions to a client who has started therapy withnicardipine. The nurse instructs the client to avoid which of the following foods?
A. Kiwi
B. Grapefruit juice
C. Garlic
D. Ginger
ANS: B
See Drug-food under Interactions for nicardipine: Grapefruit and grapefruit juice increases serum levels and effect.
KEY: Cognitive Level: Knowledge
DIF: Easy
TOP: Therapeutic Classification: Antianginals, Antihypertensives
REF: Page 903
- While providing care for a client in the intensive care unit, the nurse is preparing to initiate therapy with Nitropress (nitroprusside). Orders are to start the infusion at 0.3 mcg/kg/min. The client weighs 154 pounds. The IV fluid has been sent with 50 mg in 250 mL D5W. Calculate the rate of medication in mL/hr. ______________ mL/hr
ANS: 6.3
Drug calculation: Multiple 50 mg by 1,000 mcg/mg and divide by 250 mL = 200 mcg/ml to determine solution concentration. Divide 154 lbs by 2.2 = 70 kg to determine client weight. Multiply 0.3 mcg by 70 kg = 21 mcg/min to determine dose. Multiply 21 mcg/min x 60 min/hr x 1 mL/200 mcg = 6.3 mL/hr.
KEY: Cognitive Level: Application
DIF: Hard
TOP: Therapeutic Classification: Antihypertensives
REF: Page 918
- While caring for a client who is taking Dipentum (olsalazine) for ulcerative colitis, the nurse is aware that it is most important to determine if the patient has an allergy to which of the following?
A. Penicillins or cephalosporins
B. NSAIDs or opioids
C. Beta blockers or nitrosoureas
D. Sulfonamides or salicylates
ANS: D
See Nursing Implications/Assessment for olsalazine: Assess patient for allergy to sulfonamides and salicylates. Patients allergic to sulfasalazine may take mesalamine or olsalazine without difficulty, but therapy should be discontinued if rash or fever occurs.
KEY: Cognitive Level: Application
DIF: Hard
TOP: Therapeutic Classification: Gastrointestinal anti-inflammatories
REF: Page 939
13. A client admitted with neutropenia would most likely be started on which of the following medications to promote neutrophil differentiation?
A. Epogen (epoetin)
B. Neulasta (pegfilgrastim)
