Nursing Practice and Pharmacological Safety Answer Key Part 3

28. The nurse is teaching the client how to reduce risk for coronary artery disease (CAD). What should the nurse recommend? Select all that apply. ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● A) Lose weight B) Manage hypertension C) Eat a high-protein, low-carbohydrate diet D) Increase intake of food high in antioxidants E) Reduce stress levels whenever possible Ans: A, B, E Feedback: Successful treatment in reducing risk for CAD involves reducing risk factors including decreasing dietary fats (decreasing total fat intake and limiting saturated fats seems to have the most impact on serum lipid levels); losing weight, which helps to decrease insulin resistance and the development of type 2 diabetes; eliminating smoking; increasing exercise levels; decreasing stress; and treating hypertension, diabetes, and gout. Increased protein intake is not recommended; many high-protein foods are also high in fat, and there is no benefit to increased protein. Similarly, foods considered to be high in antioxidants are not of any proven benefit. 28. The client receives a new diagnosis of peripheral artery disease and the nurse anticipates an order for what drug? A) Clopidogrel B) Persantine C) Aspirin D) Warfarin Ans: A Feedback: Clopidogrel is indicated for the treatment of clients who are at risk for ischemic events; clients with a history of myocardial infarction, peripheral artery disease, or ischemic stroke; and clients with acute coronary syndrome. Persantine, aspirin, and warfarin would not be indicated for this client. 28. What drug used to treat anemia might the nurse administer as an antineoplastic drug because it is cytotoxic? A) Epoetin alfa B) Ferrous sulfate C) Hydroxocobalamin D) Hydroxyurea Ans: D Feedback: Hydroxyurea is a cytotoxic antineoplastic drug that is also used to treat leukemia, ovarian cancer, and melanoma. The other options would not serve this purpose. 29. The nurse cares for a 10-year-old child who has been diagnosed with hypercholesterolemia. What is the most common cause of hypercholesterolemia in children? A) Gender B) Diet C) Familial connection D) Sedentary lifestyle Ans: C Feedback: Familial hypercholesterolemia may be seen in children. Because of the importance of lipids in the developing nervous system, treatment is usually restricted to tight dietary restrictions to limit fats and calories. Gender, diet, or exercise- ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● resistant hypercholesterolemia is possible in children, but they are not the most common causes. 29. The nurse is caring for a client diagnosed with a megaloblastic anemia and administers what drug? A) Folic acid B) Hydroxyurea C) Ferrous sulfate D) Epoetin alfa Ans: A Feedback: Folic acid and vitamin B12 are given as replacement therapy for dietary deficiencies, as replacement in high-demand conditions such as pregnancy and lactation, and to treat megaloblastic anemia. Hydroxyurea is used to treat sickle cell anemia. Ferrous sulfate is indicated for the treatment of iron deficiency anemia. Epoetin alfa is administered to treat anemias caused by inadequate erythropoietin production, such as in renal failure. 29. The nurse admits a client in acute respiratory distress secondary to pulmonary emboli. What drug will the nurse administer to lyse the clots? A) Urokinase B) Tenecteplase C) Rivaroxaban D) Fondaparinux Ans: A Feedback: Urokinase is used for lysis of pulmonary emboli and treatment of coronary thrombosis. Reteplase is used to treat coronary artery thrombosis associated with an acute myocardial infarction. Rivaroxaban is used to prevent deep vein thromboses that may lead to pulmonary emboli. Fondaparinux is used to treat and prevent venous thromboembolic events. 30. The nurse is preparing the client prescribed hydroxocobalamin for discharge and teaches the client to be alert for what adverse effects? Select all that apply. A) Itching B) Peripheral edema C) Hypotension D) Heart failure E) Constipation Ans: A, B, D Feedback: Hydroxocobalamin has been associated with itching,rash,andsignsof excessive vitamin B12 levels, which can also include peripheral edema and heart failure. Hypotension and constipation are not adverse effects of hydroxocobalamin therapy. 30. The nurse provides client teaching related to medication and lifestyle changes the client can make to reduce serum lipid levels. One month later, the nurse evaluates the client teaching as having been effective based on what data? Select all that apply. Decreased total cholesterol level B) Decreased high-density lipoprotein (HDL) C) Decreased low-density lipoprotein (LDL) D) Decreased blood pressure E) Weight loss of 8 lb Ans: A, C, D, E ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● Feedback: For most clients, desirable outcomes include increased HDL, decreased LDL, and decreased total cholesterol. Weight loss and blood pressure control are also positive outcomes. 30. The nurse is caring for a postpartum client admitted to the intensive care unit with a diagnosis of disseminated intravascular coagulation (DIC). What is the drug of choice to treat this problem? A) Heparin B) Urokinase C) Aspirin D) Warfarin Ans: A Feedback: The treatment of choice for DIC is heparin, an anticoagulant. It prevents the clotting phase from being completed, thus inhibiting the breakdown of fibrinogen. It may also help avoid hemorrhage by preventing the body from depleting its entire store of coagulation factors. None of the other medications listed in this question are indicated for treatment of DIC and may, in fact, make the condition worse 31. The client has taken epoetin alfa (Epogen) with good results for several months. On this visit, the nurse analyzes the client’s lab results and finds indications of severe anemia and cytopenias. What order will the nurse anticipate receiving? A) Increase the dosage of Epogen. B) Change the client to another erythropoiesis-stimulating agent. C) Discontinue Epogen. D) Begin administering Epogen IV instead of subcutaneously. Ans: C Feedback: In clients treated with Epogen or any drug in this class who develop severe anemia after improvement, the drug should be stopped and should not be changed to another drug in the class because it is likely due to client’s development of neutralizing antibodies. Increasing the dosage will not help, and changing the route of administration will not reverse the process after antibodies have formed. 31. The nurse is caring for a 35-year-old client taking a beta-hydroxy-betamethylglutaryl–coenzyme A (HMG–CoA) reductase inhibitor to lower serum lipid levels. When teaching this client about the medication, what priority teaching point will the nurse include in the teaching plan? A) Need for frequent ophthalmic examinations B) Information about a cholesterol-lowering diet C) Use of barrier contraceptives D) Calling her doctor with any respiratory symptoms Ans: C Feedback: It is important to teach a woman of childbearing age taking HMG–CoA reductase inhibitors to use barrier contraceptives because there is a risk of severe fetal abnormalities associated with these drugs if taken during pregnancy. Both men and women should have routine ophthalmic examinations, but taking this drug does not increase the frequency of examinations needed. Cholesterol-lowering diet should have been initiated before beginning medications to lower lipid levels. There are no associated respiratory risks with these medications, so the client would call the doctor with respiratory symptoms as one normally would. 31. By what route will the nurse administer the antihemophilic agent to the client with hemophilia following a car accident? A) Oral B) Topical C) IV D) Sublingual Ans: C Feedback: All antihemophilic agents are administered IV and are not available for administration by any other route. ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● 32. When providing client teaching to a client beginning therapy with a hydroxymethylglutaryl–coenzyme A (HMG–CoA) reductase inhibitor, the nurse will explain the need for regular monitoring of what laboratory studies? Select all that apply. A) Renal function tests B) Liver function tests C) Lipid panel D) Hemoccult of stool E) Albumin level Ans: A, B, C Feedback: Itisimportanttomonitorrenalandliverfunctiontoidentifyearly signs of toxicity or rhabdomyolysis. Monitoring lipid levels contributes to evaluation of the effectiveness of drug therapy. Hemoccult of stool would be more important with bile acid sequestrants that are associated with GI irritation. Altered albumin levels are not associated with HMG–CoA reductase inhibitors. 32. The nurse administers agents that control bleeding to clients with hemophilia and what other condition? A) Liver disease B) Lyme disease C) Disseminated intravascular coagulation (DIC) D) Pheochromocytoma Ans: A Feedback: Drugs to control bleeding are also given to clients with liver disease because liver disease prohibits clotting factors and proteins needed for clotting from being produced in adequate quantities. Lyme disease, DIC, and pheochromocytoma are not indications for administration of agents to control bleeding. 32. The client on hemodialysis is receiving epoetin alfa (Procrit) and asks the nurse why IV administration is recommended over subcutaneous administration. What is the nurse’s best response? A) “Giving the drug IV reduces risk of a potentially serious response to the drug.” B) “Giving the drug by the IV route makes it begin working sooner.” C) “Only clients with renal disease can receive the drug subcutaneously.” D) “It is all determined by physician preference and this doctor prefers the IV route.” Ans: A Feedback: It is now recommended that clients on hemodialysis receive Procrit and other drugs in this classification intravenously rather than subcutaneously because this reduces the risk of antibody production that can result from severe anemia. This decision is not based on speed of onset, diagnosis, or physician preference. 33. The nurse is administering an erythropoiesis-stimulating agent to a client with renal failure and anemia. What is the maximum hemoglobin level the nurse would want to assess when reviewing this client’s lab results? A) 7 g/dL B) 9 g/dL C) 11 g/dL D) 13 g/dL Ans: C Feedback: In recent years, the Food and Drug Administration alerted providers to the importance of a target hemoglobin of no more than 11 g/dL when using erythropoiesis-stimulating agents. As a result, other options are either too low or too high. ● ● ● ● ● ● ● ● ● ● ● ● ● 33. The nurse is preparing to teach the client about diet therapy when beginning bile sequestrant medication to lower lipid levels. What important point will the nurse include in the teaching plan? A) Increasing carbohydrate intake B) Reducing protein intake C) Increasing fiber intake D) Reducing fluid intake Ans: C Feedback: The nurse would want to teach this client to increase fiber intake to avoid constipation that often occurs with this medication. Protein intake does not need to be reduced, but the client should be taught to avoid fatty protein and instead meet protein needs with vegetable proteins, fish, and lean poultry. Carbohydrate intake should be reduced if weight loss is needed, otherwise no change is needed. Fluid intake should be maintained or increased if there are no diagnoses that would contraindicate fluid intake to help avoid constipation. 33. The nurse is caring for a pediatric client with hemophilia who receives antihemophilic factor several times a year. What should this client be regularly screened for? Select all that apply. A) HIV B) Hepatitis C) Anemia D) Infection E) Cardiomyopathy Ans: A, B, C Feedback: The most common adverse effects associated with antihemophilic agents involve risks associated with the use of blood products (e.g., in a client with hepatitis or AIDS). Clients with hemophilia should also be monitored for anemia secondary to blood loss. There is no associated risk for infection or cardiomyopathy. 34. For what purposes should the nurse administer folic acid to the client? Select all that apply. A) Nutritional deficiency B) Megaloblastic anemia C) Pregnancy or preparation for pregnancy D) Sickle cell anemia E) Renal failure ans: A, B, C Feedback: Folic acid is indicated for the treatment of megaloblastic anemia caused by sprue and to replace a nutritional deficiency. It is also given to women who are, or plan to become, pregnant to reduce the risk of a neural tube disorder in the fetus. It is not indicated for the treatment of sickle cell anemia or renal failure. 1. A client with a history of peptic ulcer disease has responded well to treatment with a histamine-2 antagonist. What effect will this drug have? A) Destroy Helicobacter pylori. B) Coat and protect the stomach lining C) Increase the pH of secreted hydrochloric acid. D) Reduce the quantity of hydrochloric acid secreted. Ans: D Feedback: Histamine-2 antagonists are administered to reduce the amount of hydrochloric acid secreted in the stomach, which helps to prevent peptic ulcer disease. H2 antagonists do not act as an antibiotic to kill bacteria (i.e., H. pylori) ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● coat and protect the stomach lining like sucralfate, or increase the pH of the secreted hydrochloric acid. 1. The nurse is caring for a client who has begun vomiting. The nurse is aware that which part of the client’s brain has been stimulated? A) Chemoreceptor trigger zone (CTZ) B) Limbic system C) Hypothalamus D) Medulla oblongata Ans: A Feedback: The CTZ has to be stimulated in order for vomiting to occur. The limbic system involves emotion, not vomiting or other forms of GI function. The hypothalamus and medulla do not contribute to the vomiting reflex. 1. The nurse teaches the client to best promote optimal GI function by including what in the daily routine? A) Exercise, adequate sleep, and avoiding caffeine B) Nutritious diet, adequate fluid intake, and exercise C) Nutritious diet, avoiding alcohol, and cautious use of laxatives D) Avoiding prescription medications, increased fluid intake, and vigorous exercise Ans: B Feedback: The best way to maintain gastrointestinal(GI) function is through proper diet including optimizing fiber intake, adequate fluid intake, and exercise, which will stimulate GI activity. Drugs should only be used when normal function cannot be maintained. Caffeine does not harm GI function. Some, but not all, prescription medications affect GI function. 2. A client with peptic ulcer disease is experiencing fewer symptoms because of suppression of hydrochloric acid secretion into the lumen of the stomach. What category of medication is this client most likely receiving? A) Antipeptic agent B) Histamine-2 antagonist C) Proton pump inhibitor D) Prostaglandin Ans: C Feedback: Proton pump inhibitors suppress the secretion of hydrochloric acid into the lumen of the stomach. Antipeptic agents coat any injured area in the stomach to prevent further injury. H2 antagonists block the release of hydrochloric acid in response to gastrin. Prostaglandins inhibit secretion of gastrin and increase secretion of the mucous lining of the stomach. 2. The nurse admits to the clinic a 7-month-old infant whose parents report that the baby has not had a bowel movement in 4 days. What is the nurse’s best action? A) Encourage watchful waiting for 24 hours. B) Administer magnesium hydroxide as prescribed. C) Encourage feeding supplementation with free water. D) Administer a glycerin suppository as prescribed. Ans: D Feedback: Glycerin suppositories are the best choice for infants and young children when constipation is a problem. Magnesium hydroxide is not recommended for infants or children. Free water would not likely be beneficial, and it would be unsafe to not provide any interventions after 4 days with no bowel movement. 2. A 25-lb (11.3-kg) child is in the clinic because of frequent vomiting the last 24 hours. The nurse is to administer trimethobenzamide. What dose should the nurse administer, and by what route? ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● A) 0.25 mg IV B) 1.1 mg/kg IM C) 100 mg rectally D) 200 mg orally Ans: C Feedback: The nurse will administer 100 mg rectally. The other doses are inappropriate. A usual dose of palonosetron for an adult is 0.25 mg IV. A usual dose of hydroxyzine for a child is 1.1 mg/kg IM, and a usual dose of trimethobenzamide for a child weighing more than 30 lbs is 200 mg orally. The client’s vomiting likely precludes oral administration. 3. The nurse is caring for a client requiring digestive enzyme replacement therapy. What is the appropriate nursing diagnosis for this client? A) Acute pain B) Risk for constipation C) Risk for imbalanced nutrition D) Bowel incontinence Ans: C Feedback: The nurse would be concerned about the client’s nutritional status because lack of digestive enzymes results in malnutrition. Replacement digestive enzymes help the client improve digestion and absorption of essential nutrients. Effectiveness of the therapy is determined by the client’s ability to maintain balanced nutrition. The other three options are not applicable to the use of replacement digestive enzymes. 3. The nurse provides drug teaching to the client who will begin taking polycarbophil. What is the nurses priority teaching point? A) Do not eat or drink anything for 2 hours after taking the medication. B) Drink lots of water when taking the drug. C) Take at night before bedtime. D) The drug can be taken up to six times per day. Ans: B Feedback: Clients must take plenty of water with polycarbophil. If only a little water is consumed, the medication may absorb enough fluid in the esophagus to swell the food into a gelatin-like mass that can cause obstruction and other severe problems. The drug should be taken no more than four times a day and should not be taken at night. 3. The clinic nurse is caring for a 55-year-old farmer who has been prescribed an antiemetic for an inner ear problem. The client states “I need to get back to work.” With this client especially, what will the nurse caution him about? A) Weight gain B) Suicidal ideation C) Diarrhea D) Photosensitivity Ans: D Feedback: Photosensitivity is a common adverse reaction with many antiemetics. The nurse should advise the client to use sunscreen and wear protective garments if exposure cannot be avoided, which is unlikely considering the client’s occupation. Weight gain, suicidal ideation, and diarrhea have not been identified as adverse effects of antiemetics. 4. The nurse is caring for a client who is receiving antacids to relieve GI discomfort. What nursing action is most appropriate? A) Administer this drug with other drugs or food to prolong therapeutic effects. ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● B) Administer the antacid one hour before or two hours after other oral medications. C) Limit fluid intake to decrease dilution of the medication in the stomach. D) Have the client swallow the antacid whole and do not crush or chew the tablet. Ans: B Feedback: A client taking antacids should be advised to take the antacid 1 hour before or 2 hours after other oral medications. These tablets are often chewed to increase effectiveness. Limiting fluid intake can result in rebound fluid retention so that clients should be encouraged to maintain hydration. It is not necessary to take an antacid with other drugs nor with food. 4. A new mother required an episiotomy during the birth of her baby. Two days after delivery, the client is in need of a laxative. What will be the most effective drug for the nurse to administer? A) Bisacodyl B) Castor oil C) Magnesium sulfate D) Docusate Ans: D Feedback: Docusate is a stool softener that will make expulsion of stool easier in a traumatized body area following an episiotomy. Care must be taken to choose a mild laxative that will not enter breast milk and not affect the newborn if the mother is nursing. Docusate is the drug of choice from this list because it is mild and will produce a soft stool and decrease the need to strain. The other options would not be appropriate because they do not soften the stool and are harsher laxatives that can enter breast milk. 4. A college student with migraine headaches that cause nausea and vomiting has been prescribed trimethobenzamide. The nurse should caution the student to avoid using which substance? A) St. Johns wort B) Calcium channel blockers C) Selective serotonin reuptake inhibitors (SSRIs) D) Alcohol Ans: D Feedback: Locally acting antiemetics depress areas of the CNS. If combined with other CNS depressants, such as alcohol, clients could experience increasing CNS depression including dizziness and somnolence. St. John’s wort, calcium channel blockers, and SSRIs are not CNS depressants and are not otherwise contraindicated. 5. The nurse is reviewing medication prescriptions. Which is an appropriate dosage and frequency of cimetidine? A) 20 mg PO b.i.d. B) 150 mg PO b.i.d. C) 300 mg PO at bedtime D) 800 mg PO at bedtime Ans: D Feedback: An appropriate dosage and frequency for cimetidine is 800 mg PO at bedtime. Alternatively, 300 mg can be taken q.i.d. at meals and at bedtime. Ranitidine is taken 150 mg daily or b.i.d. Famotidine is taken 20 mg PO b.i.d. Nizatidine can be taken 150 to 300 mg PO at bedtime. 5. The nurse is teaching a client who is to be discharged with an order to use chemical stimulant laxatives PRN. The nurse should caution the client about what potential adverse effect? A) Abdominal cramping B) Rectal bleeding ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● C) Confusion D) Gastroesophageal reflux Ans: A Feedback: Common adverse effects of laxatives are diarrhea, abdominal cramping, and nausea. Central nervous system (CNS) adverse effects such as dizziness, headache, and weakness can occur. Rectal bleeding and confusion are not associated with appropriate use of laxatives but may occur when laxatives are abused. Reflux is not expected. 5. A client with cancer has arrived to receive chemotherapy. The nurse administers prochlorperazine prophylactically before the infusion. What will the nurse’s teaching for this client include? A) Transfer or change positions slowly in case of dizziness. B) Temporarily avoid foods that are high in potassium. C) Monitor urine output for 24 hours after being administered the drug. D) Check blood pressure at home on a regular basis. Ans: A Feedback: Prochlorperazine is an antiemetic that can cause dizziness and drowsiness. There is no need to limit potassium intake, and the drug is unlikely to affect urine output. This drug should not affect blood pressure, so there is no need to test for it. 6. The nurse develops a discharge teaching plan for a client who has been prescribed pancreatic enzyme replacement. What education should the nurse provide? A) Take the enzymes on an empty stomach. B) Crush the capsules and take with food. C) Avoid spilling the powder on the skin. D) Pancreatin and pancrelipase are interchangeable. Ans: C Feedback: Clients receiving pancreatic enzymes should be taught to avoid spilling the powder on the skin because it can be very irritating. The enzymes should be taken with food and are often in a powder form. Pancreatin and pancrelipase are not interchangeable. 6. A client taking a chemical stimulant laxative and medications for heart failure and osteoarthritis calls the clinic and reports, “I’m just not feeling right.” What is the priority question the nurse should ask this client? A) Previous effectiveness of laxatives B) Timing of medication administration C) The amount of fiber intake D) Amount of fluid intake Ans: B Feedback: Because laxatives increase the motility of the gastrointestinal (GI) tract and some laxatives interfere with the timing or process of absorption, it is not advisable to take laxatives with other prescribed medications. The administration of laxatives and other medications should be separated by at least 30 minutes, so the nurse should question when the client is taking the laxatives and other medication. Other options may be questions the nurse would eventually ask, but the priority is timing of medication administration. 6. What is an appropriate nursing action for a hospitalized client receiving aprepitant? A) Elevate the head of the bed. B) Encourage fluids as tolerated. C) Monitor the clients temperature closely. D) Place an NPO sign above the client’s bed. Ans: B Feedback: Because dehydration is an adverse effect of aprepitant, the nurse will want to encourage the client to drink as much liquid as possible. Elevating the head of the bed would be unnecessary; the client’s temperature would not be affected by aprepitant; we are encouraging fluids, so placing an NPO sign on the door would not be appropriate for this client. ● ● ● ● ● ● ● ● ● ● ● ● 7. A client comes to the clinic reporting weakness and myalgia and describes a long history of acid indigestion. The client is tired of using over-the-counter (OTC) antacids “almost every hour, it seems.” The nurse should assess for signs and symptoms of what health problem? A) Alkalosis B) Hypocalcemia C) Appendicitis D) Diverticulosis Ans: A Feedback: Prolonged or excessive use of OTC antacids can lead to the development of metabolic alkalosis. Many antacids contain calcium so that low calcium levels would be unlikely. Appendicitis and diverticulosis are not typically linked to excessive use of antacids. 7. A client who is taking metoclopramide has present to the clinic for a follow- up visit. The nurse will be most concerned about a drug–drug interaction when learning the client is taking what other medication? A) Albuterol B) Digoxin C) Furosemide D) Acetylsalicylic acid Ans: B Feedback: Metoclopramide has been associated with decreased absorption of digoxin from the gastrointestinal (GI) tract. The nurse should monitor clients taking this combination carefully. The other options do not pose a concern about drug– drug interactions. 7. An 8-year-old client who weighs 61 lbs is undergoing chemotherapy and has been prescribed dolasetron 1.8 mg/kg PO before chemotherapy. How many 50-mg tablets should the nurse administer? Ans: 1 tablet Feedback: The client’s weight must first be converted to kilograms: 61 ÷ 2.2 = 27.7 kg. The prescribed dose is 1.8 mg/kg, and 1.8 × 27.7 = 49.86 mg. This would be rounded to 50 mg for oral administration, so the nurse should administer one 50-mg tablet. 8. A client with a duodenal ulcer is receiving sucralfate for short-term treatment. What should the nurse advise the client to avoid? A) Milk of Magnesia B) Calcium carbonate C) Aluminum salts D) Proton pump inhibitors Ans: C Feedback: If aluminum salts are taken concurrently with sucralfate, a risk of high aluminum levels and related aluminum toxicity exists. The combination of sucralfate and aluminum salts should be avoided or used with extreme caution. Adverse reactions with sucralfate are not associated with milk of magnesia, calcium carbonate, or proton pump inhibitors.