Pharmacology Exam Questions and Answers

PHARM QUESTIONS Question 8, Ch 35 Type: MCSA The client has MRSA and receives vancomycin (Vancocin) intravenously (IV). The nurse assesses an upper body rash and decreased urine output. What is the nurse's priority action? 1. Hold the next dose of vancomycin (Vancocin) and notify the physician. 2. Obtain a stat X-ray and notify the physician. 3. Administer an antihistamine and notify the physician. 4. Obtain a sterile urine specimen and notify the physician. Linezolid (Zyvox) is one of two drugs in a class of antibiotics called the oxazolidinones. Linezolid is an alternative to vancomycin for treating MRSA infections. It also is approved to treat VRE infections. The drug is administered IV or PO. Most patients can be converted from IV to PO in about 5 days PG 555 PHARM TXTBK. Question 22, Ch 35 Following surgery, a client is placed on cefotaxime (Claforan). The assessment for possible adverse effects should include observing for 1. diarrhea. 2. headache. 3. constipation. 4. tachycardia. 1/100 Question 17, Ch 35 Type: MCSA Discharge planning for the client prescribed tetracycline will include which instruction? 1. Take the medication with antacids. 2. Take the medication with iron supplements. 3. Do not take the medication with milk. 4. Decrease the amount of vitamins. Question 13, Ch 35 Type: MCSA The physician orders penicillin for a female client who has a sinus infection. What is a priority question to ask the client prior to administering the medication? 1. "Are you pregnant?" 2. "Do you plan to become pregnant?" 3. "Are you breastfeeding?" 4. "Are you taking birth control pills? Question 10, Ch 36 Type: MCSA The female client has a fungal infection and will receive nystatin (Mycostatin). What assessment data is critical for the nurse to review prior to administering this medication? 1. The type of diet the client is eating 2. The amount of fat in the client's diet 3. Whether the patient could be pregnant 4. The client's height and weight Ch 34, Q 30 2/100 Question 30 Type: MCMA A patient has taken two doses of interferon Alfa-2b (Intron-A). He comes to the clinic today with the following complaints. Which symptoms would the nurse identify as common adverse effects of this therapy? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. “I am so dizzy.” 2. “I have an itchy rash on my legs.” 3. “I have no appetite.” 4. “I am so tired.” 5. “My bones ache.” Correct Answer: 1,3,4 Question 7, Ch 36 Type: MCSA The client receives nystatin (Nilstat) for a fungal infection in the mouth. The nurse plans to do medication education prior to discharge. What will the best plan by the nurse include? 1. Dissolve the oral tablet in your mouth and then swallow it. 2. Take the oral suspension with a straw to prevent tooth discoloration. 3. Crush the oral tablet, mix it with orange juice, and then swallow it. 4. Swallow the oral tablet whole without chewing or crushing it. 3/100 Question 23, Ch 36 Type: MCMA An infant is prescribed nystatin (Mycostatin) for treatment of infant oral candidiasis, or thrush. Which information should the nurse provide to the infant’s caregiver in regard to this medication? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Give the medication right before a feeding. 2. Give the infant a small amount of water prior to administering the medication. 3. Use a cotton swab to place medication in several parts of the infant’s mouth. 4. The infant should not breastfeed until this infection is gone. 5. The breastfeeding mother may also require treatment. Question 16, Ch 37 Type: MCSA Which drug is most likely to be ordered for the client with herpes simplex virus? 1. Acyclovir (Zovirax) 2. Zidovudine (Retrovir) 3. Nystatin (Fungizone) 4. Metronidazole (Flagyl) 4/100 Chapter 16 Question 4 Type: MCSA The patient receives imipramine (Tofranil) as treatment for depression. He is admitted to the emergency department following an intentional overdose of this medication. What will the priority assessment by the nurse include? 1. The patient's cardiac status 2. The patient's liver function 3. The patient's renal status 4. The patient's neurological function Correct Answer: 1 Rationale 1: Tricyclic antidepressants are cardiotoxic. An overdose could result in a fatal dysrhythmia. Cardiac status is the primary assessment. Page Number: 189 Question 5 Type: MCSA The patient has been receiving amitriptyline (Elavil) for 2 weeks. He tells the nurse he doesn't think this medicine is working, as he is still depressed. What is the best response by the nurse? 1. "It is working, but it can take several weeks to have an effect." 2. "You might still feel depressed, but you are looking much better." 3. "This may not be the best medicine for you; I'll call your doctor." 4. "It is working, but it can take several months to have an effect." Correct Answer: 1 Rationale 1: The therapeutic effects of tricyclic antidepressants may take 2 to 6 weeks to occur. Page Number: 212 5/100 Question 6 Type: MCSA The physician has prescribed sertraline (Zoloft) for the patient who is anxious and depressed. The patient calls the nurse to report that he has experienced delayed ejaculation since being on this medication. What is the best response by the nurse? 1. "I will let your doctor know, and he will most likely change your medication." 2. "This does happen, but treating your depression is a bigger priority." 3. "I am concerned that you will become suicidal if you stop the medication." 4. "Keep taking the medicine, as this usually goes away after a few months." Correct Answer: 1 Rationale 1: One of the most common side effects of the selective serotonin reuptake inhibitors (SSRIs) relates to sexual dysfunction; up to 70% or men and women can experience this. In men, delayed ejaculation and impotence may occur. Page Number: 203 Question 7 Type: MCSA The patient has been depressed, and the physician plans to begin treatment with an antidepressant medication. In performing the initial assessment, what is the most important question for the nurse to ask? 1. "How much alcohol do you consume during the week?" 2. "Are you allergic to any medications?" 3. "How long have you been depressed?" 4. "Have you had any thoughts about killing yourself?" Correct Answer: 4 Rationale 4: The nurse should always assess for suicidal ideation in any depressed patient who is about to begin antidepressant treatment. The medication takes several weeks before the full benefit is obtained. This is a safety issue. Page Number: 212 6/100 Question 11 Type: MCSA The patient asks the nurse why she needs to continue using table salt because her prescribed lithium (Eskalith) is a salt. What is the best response by the nurse? 1. "You must continue to use salt to avoid lithium (Eskalith) toxicity. If you use sea salt, you don't need as much." 2. "You must use table salt or your kidneys will retain lithium (Eskalith), and you will become toxic." 3. "The amount is not important; just increase your table salt if you notice signs of lithium (Eskalith) toxicity." 4. "Salt is very important to avoid lithium (Eskalith) toxicity, but not as important as drinking 1 to 1.5 L of water per day." Correct Answer: 2 Rationale 2: The kidneys are responsible for maintaining normal sodium levels. If there is sodium depletion, the kidneys will conserve any salt, in this case lithium (Eskalith). This will lead to lithium (Eskalith) toxicity. Page Number: 213 Question 14 Type: MCSA A patient was prescribed sertraline (Zoloft) for the treatment of depression and anxiety. The patient’s spouse calls the clinic and reports the patient is increasingly moody and seems “disconnected with life.” What is the best response by the nurse? 1. "Try giving him some diphenhydramine (Benadryl) to see if that helps him relax." 2. "Bring him to the clinic for assessment today.." 3. "Hold his medication today and see if his mood improves." 4. " “Double the daily dose of sertraline (Zoloft) and call us back in three days.” Correct Answer: 2 Rationale 2: Sertraline (Zoloft) increases the risk of suicidal thinking and behavior. The patient must be assessed. Page Number: 206 7/100 Chapter 17 Question 2 Type: MCSA The patient with schizophrenia is sitting quietly in a chair. The patient does not respond much to what is happening and has a lack of interest in the environment. How does the nurse interpret this assessment? 1. The patient is most likely very depressed. 2. The patient is most likely hearing voices. 3. The patient is experiencing positive symptoms. 4. The patient is experiencing negative symptoms. Correct Answer: 4 Rationale 4: Negative symptoms are those that subtract from normal behavior. These symptoms include a lack of interest, motivation, responsiveness, or pleasure in daily activities. Page Number: 224 Question 3 Type: MCSA The physician has prescribed haloperidol (Haldol) for the patient with schizophrenia. What is the priority patient outcome? 1. The patient will consume adequate fluids and a high-fiber diet. 2. The patient will be compliant with taking the medication as prescribed. 3. The patient will report a decrease in auditory hallucinations. 4. The patient will report symptoms of restlessness. Correct Answer: 2 Rationale 2: Medication compliance is a priority for patients with schizophrenia. Relapse of symptoms will occur without the medications. Page Number: 230 8/100 Question 4 Type: MCSA The nurse is managing the care of a group of patients with schizophrenia. The patients are receiving conventional antipsychotic medications. When assessing for anticholinergic side effects, which would the nurse immediately report to the physician? 1. Acute dystonia 2. Complaint of a severe headache 3. Hypertension 4. Urinary retention Correct Answer: 4 Rationale 4: Urinary retention is an anticholinergic side effect of conventional antipsychotics. This must be reported immediately to the physician. Page Number: 233 Question 8 Type: MCSA The nurse has completed medication education with the patient who is receiving risperidone (Risperdal). The nurse evaluates that the education has been effective when the patient makes which statement? 1. "I must call my doctor if I start to have a lot of nightmares." 2. "I must have my blood work done while taking this medication." 3. "I must call my doctor if I start to lose a lot of weight." 4. "I must call my doctor if I notice any a metallic taste in my mouth." Correct Answer: 2 Rationale 2: Agranulocytosis can be a life-threatening side effect of risperidone (Risperdal), which may also suppress bone marrow and lower infection-fighting ability. It is very important, therefore, that the patient have regular blood work done while on this medication. Page Number: 235 9/100 Question 11 Type: MCSA The patient receives aspirin. The nurse assesses an adverse effect to this drug when the patient makes which response? 1. "My stools have been dark in color." 2. "My nose is stuffed up." 3. "Bright lights give me a headache." 4. "I have to get up a lot at night to urinate." Correct Answer: 1 Rationale 1: Aspirin may result in ulceration and bleeding, which would result in darker than normal stools. Page Number: 251 - Internal bleeding (hematoma, collection of blood in a space, affect on other things (increase in intracranial pressure), upper GI (tarry stools, hematemesis) and lower GI bleeding (melena -blood in stool) hematochezia) Question 24 Type: MCSA Which statement is accurate concerning the use of aspirin (ASA) to treat pain? 1. High doses are necessary (1 gram) to achieve anticoagulant effects. 2. Enteric-coated capsules are available to reduce GI side effects. 3. Increase consumption of herbs such as garlic and ginger to potentiate the anti-inflammatory effects. 4. In low doses (325 mg), it significantly reduces inflammation. Correct Answer: 2 Rationale 2: Enteric-coated capsules can help prevent bleeding. Page Number: 252 10/100 Question 25 Type: MCMA How should the nurse plan to manage caring for patients in pain? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Treat all patients alike. 2. Listen carefully to the patient's comments about pain. 3. Show respect for the patient's preferences. 4. Ask questions about the patient's beliefs and customs regarding pain management. 5. Watch how other nurses provide care to their patients. Correct Answer: 2,3,4 Rationale 2: Careful listening is an important step in providing care. Rationale 3: Showing respect is important in providing care in all areas, including pain management. Rationale 4: The nurse cannot practice what the nurse does not know. Asking questions is the method used to gain information to facilitate sensitive care. Page Number: 240 Chapter 25 Question 7 Type: MCSA The patient has a potassium level of 5.9 mEq/L. The nurse is administering glucose and insulin. The patient's wife says, "He doesn't have diabetes, why is he getting insulin?" What is the best response by the nurse? 1. "Insulin will cause his extra potassium to go into his cells and lower the blood level." 2. "Insulin lowers his blood sugar levels and this is how the extra potassium is excreted." 3. "Insulin is safer than giving laxatives such as Kayexalate." 4. "Insulin will help his kidneys excrete the extra potassium." 11/100 Correct Answer: 1 Rationale 1: Serum potassium levels may be temporarily lowered by administering glucose and insulin, which cause potassium to leave the extracellular fluid and enter cells. Page Number: 365 Question 22 Type: MCSA Potential causes for respiratory alkalosis include 1. hypotension. 2. hypertension. 3. hypoventilation. 4. hyperventilation. Correct Answer: 4 Rationale 4: Hyperventilation occurs with respiratory alkalosis. Page Number: 369 Chapter 46 Question 1 Type: MCMA The nurse teaches a class on pregnancy to clients in their first trimester. The nurse evaluates that learning has occurred when the clients make which statements? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. "Ovulation occurs on approximately Day 21 of the ovarian cycle." 2. "Ovulation is caused by a surge of luteinizing hormone." 3. "Ovulation is caused by a surge of human chorionic gonadotropin." 4. "Follicle-stimulating hormone causes ovarian follicles to develop." 12/100 5. "The pituitary gland secretes gonadotropin-releasing hormone." Correct Answer: 2,4 Rationale 2: Ovulation is caused by a surge of luteinizing hormone. Rationale 4: Follicle-stimulating hormone causes ovarian follicles to develop. Page Number: 787 Question 2 Type: MCSA A client comes to the women's center and tells the nurse she has had unprotected sex. She asks for emergency contraception. What is the best assessment question for the nurse to ask? 1. "How long ago did you have unprotected sex?" 2. "Did you use a condom?" 3. "What kind of birth control have you used in the past?" 4. "Where are you in your monthly cycle?" Correct Answer: 1 Rationale 1: Choice of emergency contraceptive is guided in some ways by the amount of time since unprotected sex. Page Number: 795 Question 3 Type: MCSA The client receives estrogen for prostate cancer. He asks the nurse why he is receiving a female hormone. What is the best response by the nurse? 1. "It shrinks your cancer by making the cells die at a faster rate." 2. "It eliminates the testosterone that feeds your cancer." 3. "It suppresses secretion of the androgens that make your cancer grow." 4. "It keeps nutrients from getting to, and feeding, your cancer." Correct Answer: 3 13/100 Rationale 3: Prostate cancer is usually dependent on androgens for growth; administration of estrogens will suppress androgen secretion. Page Number: 797 Question 5 Type: MCSA The nurse manages care for several clients receiving hormone replacement therapy (HRT). What will the priority assessment by the nurse include as related to side effects? 1. Pain in the calf 2. Decreased libido 3. Low-back pain 4. Chronic fatigue Correct Answer: 1 Rationale 1: Hormone replacement therapy puts the client at risk for thrombophlebitis. The nurse should always assess for calf pain and other symptoms of thrombophlebitis. Page Number: 797 Question 6 Type: MCSA The client is receiving oxytocin (Pitocin) for induction of labor. Which assessment finding will most likely result in the nurse stopping the infusion? 1. Uterine contractions are continuous and sustained. 2. The vaginal exam reveals that the client is entering transition. 3. The client reports that the uterine contractions are strong in intensity. 4. Uterine contractions occur every 2 to 3 minutes and last 40 to 60 seconds. Correct Answer: 1 Rationale 1: Continuous and sustained uterine contractions may lead to uterine rupture.Page Number: 805 14/100 Question 7 Type: MCSA A client calls the clinic and tells the nurse that she has missed taking several of her contraceptive pills during the current cycle. What is the best instruction for the nurse to give the client? 1. "Please come into the clinic immediately to have a pregnancy test done." 2. "You might consider another form of birth control if you keep missing your pills." 3. "If you have missed fewer than three of your pills, you do not need to worry." 4. "You should use an alternative form of birth control for the rest of this cycle." Correct Answer: 4 Rationale 4: If more than one pill is missed, the medication will not be effective and conception could occur, so the client must use an alternative form of birth control for the rest of her current cycle. Page Number: 789 Question 9 Type: MCSA The nurse teaches the postpartum client about oxytocin (Pitocin). The nurse evaluates that learning has occurred when the client makes which statement? 1. "It will increase my uterine contractions." 2. "It will increase my volume of fluid loss." 3. "It will increase my vaginal muscle tone." 4. "It will increase my milk production." Correct Answer: 1 Rationale 1: Oxytocin (Pitocin), administered in the postpartum period, causes the smooth muscle of the uterus to contract. Page Number: 800 15/100 Question 13 Type: MCSA An adolescent client will receive Depo-Provera as a method of birth control. She asks the nurse how long the drug will be effective. What is the best response by the nurse? 1. 2 months 2. 6 months 3. 1 year 4. 3 months Correct Answer: 4 Rationale 4: Depo-Provera is effective for 3 months. Page Number: 790 Question 15 Type: MCSA Estrogens are secreted by the 1. corpus luteum. 2. anterior pituitary. 3. ovarian follicles. 4. endometrium. Correct Answer: 3 Rationale 3: Estrogens are secreted by the ovarian follicles.Page Number: 787 Question 19 Type: MCSA The nurse explains to a client who is taking oral contraceptives that these drugs can increase risk for 1. thrombophlebitis. 2. hypotension. 16/100 3. weight loss. 4. respiratory infection. Correct Answer: 1 Rationale 1: Thrombophlebitis can occur, especially in those who smoke or respiratory infection. Page Number: 792 Question 26 Type: SEQ The nurse educator is reviewing the process of regulation of the female reproductive system. The nurse would arrange these steps in which order beginning with the initial step? 1. A surge of luteinizing hormone (LH) occurs 2. Ovarian follicles mature 3. Secretion of follicle-stimulating hormone (FSH) and luteinizing hormone (LH) 4. Secretion of gonadotropin-releasing hormone (GnRH) 5. The corpus luteum is formed Standard Text: Click and drag the options below to move them up or down. Correct Answer: 4,3,2,1,5 Page Number: 787 Chapter 39 Question 1 Type: MCSA The client tells the nurse that her symptoms have become worse since she has been using oxymetazoline (Afrin) for nasal congestion. What is the best assessment question for the nurse to ask? 1. "How old is the bottle you are using?" 2. "May I take your temperature?" 3. "Are you using any other inhaled medications?" 4. "How long have you been using the medication? 17/100 Question 2 Type: MCSA Which assessment finding, by the nurse, is a priority concern when a client receives pseudoephedrine (Sudafed)? 1. Temperature of 100°F 2. Respiratory rate of 22 3. Heart rate 82 and irregular 4. Complaints of a dry mouth Global Rationale: Pseudoephedrine may cause dysrhythmias. A high temperature, respiratory rate of 22, or a dry mouth is possible with pseudoephedrine but is not the primary concern. Question 4 Type: MCSA The nurse completes medication education for the client receiving antihistamines. The nurse evaluates that learning has occurred when the client makes which statement? 1. "I can still have my after-dinner drink." 2. "I need to increase fluids while taking this medication." 3. "This medication is safe because it is sold over-the-counter (OTC)." 4. "This medication could make me very sleepy." Question 5 Type: MCMA The nurse is teaching community education about the major functions of the upper respiratory tract. What will the best plan by the nursing instructor include? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Inward airflow from the trachea branches off to the two bronchi. 18/100 2. The nose warms the air before it reaches the lungs. 3. The nasal mucosa is the first line of immunological defense. 4. Activation of the parasympathetic nervous system constricts arterioles in the nose. 5. Activation of the sympathetic nervous system constricts arterioles in the nose. Question 6 Type: MCMA The client has allergic rhinitis and asks the nurse what causes this. How should the nurse respond? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. "It can occur after exposure to animal dander." 2. "Tobacco smoke causes it in some people." 3. "Exposure to pollens from weeds and grass causes an allergic response in some people." 4. "It is caused by asthma." 5. "You inherited the predisposition for this." Question 7 Type: MCSA The clinic nursing manager reviews histamine receptors with the clinic staff and evaluates that further instruction is needed when a staff member makes which statement? 1. "H1-receptors are found in the stomach." (found in lungs) 2. "H1-receptors are responsible for allergic symptoms." 3. "H2-receptors increase mucus secretion in the stomach." 4. "H2-receptors are responsible for peptic ulcers." Question 8 19/100 Type: MCSA The client receives diphenhydramine (Benadryl) to control allergic symptoms. Which common symptom does the nurse teach the client to report to the physician? 1. Sedation 2. Diarrhea 3. Projectile vomiting 4. Urinary hesitancy Rationale 4: Urinary hesitancy is an anticholinergic effect of diphenhydramine (Benadryl) and should be reported to the physician. Question 9 Type: MCSA The client receives beclomethasone (Beconase) intranasally as treatment for allergic rhinitis. He asks the nurse if this drug is safe because it is a glucocorticoid. What is the best response by the nurse? 1. "Intranasal glucocorticoids produce almost no serious adverse effects." 2. "Intranasal glucocorticoids are safe if you do not swallow any while using them." 3. "Intranasal glucocorticoids are safe if they are not used too long." 4. "Intranasal glucocorticoids are safe only if used once a day." Question 10 Type: MCSA The nurse teaches the client about the difference between oral and nasal decongestants. The nurse evaluates that learning has been effective when the client makes which statement? 1. "Oral decongestants can cause hypertension." 2. "Intranasal decongestants are safe to use for a month, if needed." 3. "Oral and nasal decongestants can cause rebound congestion." 4. "Oral decongestants are the most effective at relieving severe congestion." 20/100 Question 11 Type: MCSA A mother asks the nurse when she should give her child cough medicine. What is the best response by the nurse? 1. "When he is coughing up green secretions." 2. "When he has a temperature over 102°F." 3. "When he has bronchitis." 4. "When he has a dry cough and cannot rest." Question 12 Type: MCSA The physician prescribes fluticasone (Flonase) for the client. The nurse would hold the drug and contact the physician with which assessment finding? 1. The client has diabetes mellitus. 2. The client is pregnant. 3. The client has glaucoma. 4. The client has hypertension. Rationale 2: This is a class C drug so effects on pregnancy are not known; the client should not receive this drug. Question 14 Type: MCSA The client takes diphenhydramine (Benadryl) but forgets to tell the physician about this drug when a monoamine oxidase inhibitor (MAOI) drug is prescribed for depression. What will the best assessment by the nurse reveal? 1. The depression will not subside. 2. The client may develop seizures. 3. The diphenhydramine (Benadryl) will not control allergies. 21/100 4. The client may develop a hypertensive crisis. Question 16 Type: MCSA Antihistamines block the actions of histamine at the 1. H1 receptor site. 2. B1 receptor site. 3. B2 receptor site. 4. C1 receptor site. Question 17 Type: MCSA Oral decongestants differ from intranasal decongestants in that oral decongestants 1. are more effective at relieving severe congestion. 2. have more systemic effects. 3. can cause rebound congestion. 4. have high efficacy. Question 18 Type: MCSA Which over-the-counter (OTC) antihistamine combination contains an analgesic property? 1. Sudafed PE Sinus and Allergy 2. Triaminic Cold/Allergy 3. Tavist Allergy 12-hour 4. Actifed Plus Correct Answer: 4 Rationale 1: Sudafed PE Sinus and Allergy contains chlorpheniramine and phenylephrine. 22/100 Rationale 2: Triaminic Cold/Allergy contains chlorpheniramine and phenylephrine. Rationale 3: Tavist Allergy 12-hour contains clemastine. Rationale 4: Actifed Plus contains acetaminophen. Question 19 Type: MCSA Centrally acting antitussives, such as opioids, are used to 1. decrease nasal congestion. 2. break down mucus. 3. relieve severe cough. 4. relieve mild cough. Question 20 Type: MCSA A patient has been changed from a first generation H1 receptor antagonist to a second generation H1 receptor antagonist. The nurse evaluates that the patient understands the benefit of this change when which statement is made? 1. “I can drink a few beers over the weekend and still take this drug.” 2. “This drug will not dry out my mouth.” 3. “This drug will not affect my ability to urinate.” 4. “This drug will not make me as sleepy.” Question 21- scenario? Type: MCMA 23/100 A client calls the nurse help-line and says, “My friend and I have been swimming and drinking beer all day and he took a couple of swigs of Robitussin DM (dextromethorphan) about 15 minutes ago. Now he is acting funny and seeing things.” What should the nurse consider when formulating a response? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. The patient will need dialysis treatment to reverse overdose. 2. This is an opioid drug. 3. Dextromethorphan is very addicting. 4. Dizziness is one of the adverse effects of this drug. 5. Abuse of this drug can result in coma. Question 23 Type: MCMA A client has been prescribed the opioid combination drug Novahistine DM for control of cough. This drug contains codeine, phenylephrine, and chlorpheniramine. Which instructions should the nurse provide as part of medication education? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. “Drink a full glass of water when taking this medication.” 2. “Keep this medication at your bedside so you can take it as needed.” 3. “Take this drug exactly as indicated.” 4. “If you have head or body aches you may take any over-the-counter analgesic.” 5. “Do not make important decisions or operate machinery while taking this drug.” Correct Answer: 3,4,5 Question 24 Type: MCMA 24/100 The client is prescribed a nasal decongestant spray. What information should the nurse include when educating the client about how to use this medication? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. “Blow your nose immediately before using the medication.” 2. “Drink a full glass of water immediately before using this spray.” 3. “Limit your use of this spray to no more than 5 days.” 4. “Since you are using more than one type of nasal spray, be sure to wait 5–10 minutes between administrations.” 5. “You should spit out any excess spray that drains into your mouth.” Question 25 Type: MCMA A client is prescribed an intranasal corticosteroid. What should the nurse include in client education about this drug? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. “You may feel a burning sensation when using this drug.” 2. “This drug will be most effective if used only when symptoms are present.” 3. “Be careful of how hard you squeeze the container as you can inadvertently give yourself too much medication for one dose.” 4. “This medication may dry out your nasal passages enough to cause nosebleed.” 5. “Do not eat licorice while taking this drug.” Question 26 Type: MCSA 25/100 A patient who reports severe seasonal allergies has been prescribed fluticasone (Flonase). The nurse providing medication information would collaborate with the prescriber if the patient makes which statement? 1. “I don’t like licorice anyway.” 2. “My kids all have that head cold that is going around school.” 3. “Next appointment I want to talk about treatment for my psoriasis.” 4. “I have been eating lots of fresh fruits.” Rationale 2: Corticosteroids should not be used in patients with viral infections. Question 27 Type: MCMA The patient has been prescribed oxymetazoline (Afrin). What medication information should the nurse provide? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. “Be certain to wash your hands after using this spray.” 2. “Do not swallow any medication that drips into your mouth.” 3. “It may take several days before this medication is effective.” 4. “Do not drink grapefruit juice while taking this medication.” 5. “Take this medication exactly as directed as there is no antidote if you overdose.” Question 28 Type: MCMA The patient has been prescribed dextromethorphan (Delsym) What medication information should the nurse provide? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. “Do not smoke while using this drug.” 26/100 2. “Do not drink alcohol while using this drug.” 3. “This drug takes an hour or so to take effect.” 4. “Do not drink grapefruit juice while taking this medication.” 5. “If you notice your speech is slurred, stop taking the medicine and call the clinic.” Question 29 Type: MCMA A patient says, “I have such bad seasonal allergies. Is there anything I can take to keep them from happening?” What information should the nurse provide? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. “Some antihistamines can help prevent onset of allergies.” 2. “Some patients find that intranasal corticosteroids help prevent their allergies.” 3. “Drugs that are mast cell stabilizers may help you avoid your seasonal allergies.” 4. “Oral decongestants can help you prevent allergies.” 5. “Nasal decongestants are very good at preventing allergic response.” Chapter 40 Question 1 Type: MCSA The client receives albuterol (Proventil) via inhaler. He asks the nurse why he can't just take a pill. What is the best response by the nurse? 1. "When you inhale the drug the blood supply in your lungs picks it up rapidly, resulting in quicker effects.” 2. "Because pills cannot help your illness; you must have inhaled medications for relief of symptoms." 3. “Because pills would produce too many side effects; you will have very few side effects with inhaled medications.” 27/100 4. "Because this medication cannot be absorbed from your GI tract; the acid in your stomach would destroy it." Question 2 Type: MCSA The nurse teaches a medication class on bronchodilators for clients with asthma. The nurse evaluates that learning has occurred when the clients make which statement? 1. "The medication widens the airways because it decreases the production of mucus that narrows them." 2. "The medication widens the airways because it decreases the production of histamine that narrows them." 3. "The medication widens the airways because it acts on the parasympathetic nervous system." 4. "The medication widens the airways because it stimulates the fight-or-flight response of the nervous system." Question 5 Type: MCSA A client receives theophylline (Theo-Dur) and calls the clinic to say he has had nausea and vomiting for 2 days. What is the best action by the nurse? 1. Tell the client to come to the clinic for an assessment. 2. Ask the client if he has eaten at any unclean restaurants. 3. Ask the client if he has been exposed to anyone with the flu. 4. Recommend that the client begin a clear liquid diet. Correct Answer: 1 Rationale 1: Nausea and vomiting are symptoms of theophylline toxicity; the client needs to come to the clinic for an assessment. 28/100 Question 8 Type: MCMA The client receives ipratropium (Atrovent) via inhalation for the treatment of chronic asthma. The nurse plans to do medication education with the client. What will the best plan by the nurse include? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Wait 15 minutes before using any other inhaled medications. (wait 2-3 mins) 2. The medication may also be used for acute asthma attacks. (peak @1-2 hrs) 3. Report any increased dyspnea. 4. Report any changes in urinary pattern. 5. Use the medication consistently, not occasionally. Question 10 Type: MCSA The physician has ordered ipratropium (Atrovent) for the client. What is a priority assessment question for the nurse to ask prior to administering this medication? 1. "Are you allergic to soy?" 2. "Do you have diabetes mellitus?" 3. "Do you have seizures?" 4. "Do you have gout?” Correct Answer: 1 Rationale 1: Ipratropium (Atrovent) is contraindicated in patients with hypersensitivity to soy as soya lecithin is used as a propellant in the inhaler. 29/100 Question 13 Type: MCSA The nurse is preparing to administer beclomethasone (Beconase) to several clients. For which client would the nurse hold the drug and contact the physician? 1. The client who has had a myocardial infarction (MI) 2. The client who has methicillin resistant Staphylococcus aureus (MRSA) 3. The client who has diabetes mellitus 4. The client who has terminal cancer Rationale 2: Glucocorticoids can mask the signs of infection and are contraindicated if active infection is present. Question 14 Type: MCSA The client receives ipratropium (Atrovent). She tells the nurse she is going to stop it because of the bitter taste in her mouth after using the medication. What is the best response by the nurse? 1. "That is a good idea; you are experiencing a serious side effect." 2. "That is a common side effect; it will go away in time." 3. "You can decrease that side effect by rinsing your mouth after use." 4. "Are you sure you are using the medication properly?" Question 15 Type: MCSA Bronchoconstriction in the airways is stimulated by 1. perfusion. 2. ventilation. 3. the sympathetic nervous system. (DILATION) 4. parasympathetic nervous system. (constriction) 30/100 Question 17 Type: MCSA Which statement is true regarding dry powder inhalers (DPI)? 1. The medication is delivered by tablet orally. 2. The medication is delivered by fine mist. 3. The device is activated by inhalation. 4. The medication is applied topically. Question 18 Type: MCSA Leukotriene modifiers are primarily used for 1. status asthmaticus. 2. infection. 3. bronchodilation in asthma. 4. prophylaxis of asthma symptoms. Question 21 Type: MCSA Which condition is an adverse effect of a beta-adrenergic agonist? 1. Bradycardia 2. Constipation 3. Tachycardia 4. Runny nose 31/100 Question 23 Type: MCMA A client says, “My doctor told me that I have COPD and might develop emphysema. I always thought I had chronic bronchitis.” How should the nurse respond to this statement? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. “Are you certain he didn’t say you have asthma?” 2. “Chronic bronchitis doesn’t have anything to do with COPD.” 3. “COPD is either asthma, chronic bronchitis, or emphysema, or a combination of those disorders.” 4. “As COPD progresses, it becomes emphysema.” 5. “Both diagnoses are correct.” Question 24 Type: MCMA A client diagnosed with COPD says, “I don’t see why I need to stop smoking. The damage to my lungs is already done.” How should the nurse respond to this statement? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. “If you stop smoking now, your COPD may not get worse as fast.” 2. “If you stop smoking, your lungs will get better pretty quickly.” 3. “Your symptoms might not be as bad if you aren’t smoking.” 4. “You are probably correct, but you should at least try.” 5. “If I were you, I would enjoy what time I have left.” 32/100 Question 26 Type: MCMA An 8-year-old child was just diagnosed with asthma. Which assessment questions should the nurse ask the child and parents? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. “Have you eaten any new foods?” 2. “Are you exposed to anyone who smokes?” 3. “Have you had your carpet cleaned lately?” 4. “Have you grown taller since last year?” 5. “Has there been a change in laundry products recently?” Question 29 Type: MCMA A nurse works in a clinic that sees both children and adults with asthma. Which assessments will the nurse routinely monitor on patients taking corticosteroids? (Select all that apply.) Standard Text: Select all that apply. 1. Height measurement in children 2. Bone density test results in adults 3. IQ measurements in both adults and children 4. Weight measurements in children 5. EKGs on adults Correct Answer: 1,2,4 Rationale 1: Corticosteroids can affect growth in children. Rationale 2: Corticosteroids can affect bone density in adults. Rationale 4: Corticosteroids can affect growth in children. 33/100 Chapter 41 Question 1 Type: MCSA The nursing instructor teaches the student nurses about intrinsic factor. The instructor evaluates that learning has occurred when the students make which response? 1. "Intrinsic factor is secreted by the chief cells of the stomach." 2. "Intrinsic factor is necessary for absorption of vitamin B6." 3. "Intrinsic factor aids in the secretion of mucus to protect the stomach." 4. "Intrinsic factor is necessary for absorption of vitamin B12." Rationale 4: Parietal cells secrete intrinsic factor, which is essential for the absorption of vitamin B12. Question 3 Type: MCSA The physician orders misoprostol (Cytotec) for the female client with peptic ulcer disease (PUD). What is a priority question for the nurse to ask the client prior to administration of this medication? 1. "Do you plan on becoming pregnant?" 2. "Are you sexually active?" 3. "Are you pregnant?" 4. "Are your menstrual cycles irregular?" Question 5 Type: MCSA A client is admitted for treatment of a duodenal ulcer. What will the nurse’s admission assessment likely reveal? 1. Nausea and lower right quadrant abdominal pain 2. Burning pain several hours after eating a meal 34/100 3. Anorexia and weight loss 4. Low back pain radiating down the left leg Question 6 Type: MCSA The nurse has completed education about peptic ulcer disease (PUD) with the client. The nurse evaluates that learning has occurred when the client makes which statement? 1. "I will limit my intake of caffeine products." 2. "I will take ibuprofen (Motrin) for my headaches." 3. "I will drink more milk and limit spicy foods." 4. "I will join a gym and increase my exercise." Question 8 Type: MCSA A client who has gastroesophageal reflux disease (GERD) has been taking proton pump inhibitors (PPIs) for many years. The nurse discusses which potential complication of this longterm therapy? 1. Increased risk of anemia 2. Increased risk of osteopenia 3. Increased risk of hypertension 4. Increased risk of intestinal irritation Rationale 2: Long-term use of PPIs increases risk of osteopenia and osteoporosis. Question 9 Type: MCSA The physician has ordered combination therapy for the client with peptic ulcer disease (PUD) who tested positive for H. pylori. The nurse plans to do medication education. What will the best plan by the nurse include? 1. Combination therapy has the best outcomes when antibiotics are used with antacids. 35/100 2. Combination therapy has the best outcomes when antibiotics are used with proton-pump inhibitors. 3. The use of sucralfate (Carafate) along with antibiotics is the best combination therapy for peptic ulcer disease (PUD). 4. Various antibiotics are used to eradicate the bacteria that are responsible for the development of peptic ulcer disease (PUD). Question 11 Type: MCSA The nurse planning medication administration instruction for a client receiving antacids should consider including which information? 1. Antacids can be safely administered with H2-receptor medications. 2. Antacids can be safely administered with antibiotics. 3. Administer antacids at least 2 hours before other oral medications. 4. Lie down for 30 minutes after taking antacids. Rationale 3: Administering antacids with other oral medications can affect the absorption of the other medications; they should be taken 2 hours before other oral medications. Question 12 Type: MCSA The client receives H2-receptor antagonists for treatment of peptic ulcer disease (PUD). Which assessment finding should be reported immediately to the physician? 1. The client reports he is constipated. 2. The client reports pain after 24 hours of treatment. 3. The client reports episodes of melena. 4. The client reports he took the antacid Tums with his H2-receptor antagonist. 36/100 Question 15 Type: MCSA The client receives misoprostol (Cytotec) for treatment of peptic ulcer disease (PUD). The client asks the nurse why he is receiving this medication. What is the best response by the nurse? 1. "It dissolves into a gel and sticks to your ulcer." 2. "It increases mucus production in your stomach." 3. "It inhibits bacterial growth." 4. "It neutralizes stomach acid." Question 16 Type: MCSA The pyloric sphincter regulates flow of food into the 1. small intestine. 2. stomach. 3. esophagus. 4. rectum. Question 17 Type: MCSA An erosion of the mucosal layer of the stomach or duodenum describes a 1. diverticulum. 2. Crohn's lesion. 3. hiatal hernia. 4. Peptic ulcer. 37/100 Question 18 Type: MCSA The primary goal in treatment of gastroesophageal reflux disease is to 1. promote ulcer healing. 2. prevent infection. 3. reduce gastric acid secretions. 4. decrease stomach pain. Question 19 Type: MCSA Peptic ulcer disease is treated primarily with 1. pharmacotherapy. 2. exercise. 3. a combination of lifestyle changes and pharmacotherapy. 4. diet. Question 21 Type: MCSA The mechanism of action of proton pump inhibitors is to 1. neutralize acid. 2. reduce acid secretion in the stomach. 3. block H2 receptors in the stomach. 4. decrease infection. 38/100 Question 23 Type: MCMA It is suspected that a client has developed peptic ulcer disease (PUD). Which information should the nurse provide this client regarding projected course of treatment? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. You will be started on an antibiotic. 2. You will be tested for the presence of H. pylori. 3. You may be directed to take Pepto-Bismol along with your other medications. 4. You should plan on taking medication for 4 to 8 weeks. 5. There are some lifestyle changes you can take to make therapy more successful. Question 24 Type: MCMA A client has been prescribed ranitidine (Zantac). The nurse plans to include which information in the teaching plan for this client? Standard Text: Select all that apply. 1. You should experience symptom relief in 10 to 15 minutes after taking this drug. 2. Take this medication after your meal. 3. Take this medication first thing in the morning, before breakfast. 4. This drug will not work as well if you continue smoking. 5. If you experience confusion, discontinue the drug and call for an appointment. 39/100 Question 27 Type: MCMA A patient being treated for GERD has increased risk for development of infection with Clostridium difficile. The nurse would include which information in this patient’s teaching? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Report any episode of diarrhea. 2. Treat diarrhea with over-the-counter antidiarrheal drugs. 3. Increase intake of active culture yogurt. 4. Avoid fatty foods. 5. Increase fluid intake. Question 28 Type: MCMA The patient being treated for GERD says, “I seem to have so many colds and coughs now.” How should the nurse respond to this statement? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. “Be sure to get your flu shot.” 2. “The medicine you are on for GERD changes your gastric pH.” 3. “You need to avoid crowds until your GERD is under control.” 4. “You may be more susceptible to respiratory infection while taking this medication.” 5. “You may be having an allergic reaction to your medicine.” Question 29 40/100 Type: MCMA The nurse is presenting community education regarding self-treatment of heartburn with antacids. As part of this discussion, the nurse advises people with which conditions to avoid antacids? Standard Text: Select all that apply. 1. People with low calcium levels. 2. Those with diminished renal function. 3. Women who are perimenopausal. 4. People who are on sodium-restricted diets. 5. People with coronary artery disease. Question 30 Type: Hot Spot The nurse is using this diagram to teach a patient about GERD. Which spot would the nurse identify as the cardiac sphincter? 1. A 2. B 3. C 4. D Answer: 1 Chapter 38 Question 5 Type: MCSA The client receives tamoxifen (Nolvadex) for treatment of breast cancer. She asks the nurse why the medicine works. What is the best response by the nurse? 1. "Tamoxifen (Nolvadex) works by blocking estrogen receptors on breast tissue." 2. "Tamoxifen (Nolvadex) works by inhibiting the cellular mitosis of breast cancer." 3. "Tamoxifen (Nolvadex) works by inhibiting the metabolism of breast cancer cells." 4. "Tamoxifen (Nolvadex) works by binding to the DNA of breast cancer cells." 41/100 Correct Answer: 1 Rationale 1: Breast cancer is dependent on estrogen for growth. Tamoxifen (Nolvadex) acts by blocking estrogen receptors; the tumor is deprived of estrogen. Question 17 Type: MCSA The client is prescribed tamoxifen for the treatment of breast cancer. The nurse should advise the client to monitor for which adverse effect? 1. Fatigue 2. Cough 3. Vaginal discharge 4. Signs of dehydration Tamoxifen 1. used for 1. breast cancer 2. primary MOA 2. compete with estradiol for binding to estrogen in tissues containing high concentrations of receptors 3. also used for 3. delaying the recurrence of cancer following mastectomy 4. may increase levels of (3) 4. Calcium, cholesterol, and triglycerides 5. assess for s/sx of 5. hypercalcemia: increased urine volume, excessive thirst, N/V, constipation, hypotonicity of muscles, and deep bone and flank pain Ch. 42 Question 1 Type: MCSA The nursing instructor is teaching student nurses about lower gastrointestinal (GI) functioning and the large intestine. The nursing instructor evaluates that learning has occurred when the students make which statement? 1. "The large intestine contains host flora that manufacture vitamin E." 2. "The large intestine absorbs most of the nutrients from food." 3. "The large intestine absorbs water and eliminates stool." 42/100 4. "Food travels through the large intestine for 3 to 6 hours." Global Rationale: Major functions of the large intestine include absorption of water and elimination of stool. The large intestine contains host flora that manufacture B-complex vitamins and vitamin K, not vitamin E. The small intestine, not the large intestine, absorbs most of the nutrients from food. Food travels through the large intestine for 12 to 24 hours, not for 3 to 6 hours. Question 3 Type: MCSA The nurse designs a teaching plan for the client with chronic pancreatitis who receives pancrelipase (Pancreaze). What will the best plan by the nurse include as it relates to the rationale for the client to receive this drug? 1. "These enzymes replace what your ineffective pancreas cannot make." 2. "These enzymes will help promote healing of your pancreas." 3. "These enzymes promote digestion of starches and fats." 4. "These enzymes will help digest all of the food you eat." Question 4 Type: MCMA The nurse is planning care for the client who experiences frequent constipation. What will the best plan by the nurse include? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Increase protein in the diet. 2. Drink a glass of water every hour. 3. Increase dairy products in the diet. 4. Increase dietary fiber in the diet. 5. Increase daily physical exercise. Question 5 43/100 Type: MCMA The client is scheduled for bowel surgery. What medications are appropriate for cleansing the bowel, or “bowel prep,” prior to this procedure? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Docusate sodium (Colace) 2. Bisacodyl (Dulcolax) 3. Methylcellulose (Citrucel) 4. Sodium phosphate (Fleet Phospho-Soda) 5. Mineral oil Question 6 Type: MCSA The client has been vomiting for several days. The nurse would assess the client for which acid– base disturbance? 1. Metabolic acidosis 2. Respiratory alkalosis 3. Metabolic alkalosis 4. Respiratory acidosis Global Rationale: Metabolic alkalosis will result from excessive loss of hydrochloric acid from the stomach brought on by prolonged vomiting. Respiratory alkalosis will not occur as a result of vomiting. Metabolic and respiratory acidosis will not occur as a result of vomiting. Question 9 44/100 Type: MCSA Which client is most at risk to develop constipation? 1. The pediatric client who takes antibiotics for ear infections 2. The elderly client who routinely takes a stimulant laxative twice daily. 3. The young client in the hospital for an appendectomy 4. The middle-aged client who uses an enema when he travels Question 11 Type: MCSA The client receives prochlorperazine (Compazine) for nausea and vomiting. The nurse notices that the client is exhibiting a stiff neck, turned to the side. What is the best action by the nurse? 1. Administer the client’s as needed analgesic immediately. 2. Contact the physician immediately. 3. Hold the next dose and observe the client. 4. Ask the client if she has ever experienced this before. Rationale 2: Prochlorperazine (Compazine) is a phenothiazine drug; the client is experiencing an extrapyramidal side effect known as dystonia. The nurse should immediately alert the physician and prepare to administer an antidote. Question 12 Type: MCSA The primary role of the large intestine is to 1. excrete fecal matter. 2. absorb nutrients. 3. excrete enzymes. 4. control peristalsis. Correct Answer: 1 45/100 Rationale 1: The large intestine is responsible for reabsorption of water and for fecal excretion. Question 18 Type: MCSA A client who was diagnosed with Clostridium difficile calls the clinic and says, “I’m still having diarrhea so I started taking an over-the-counter medication to stop it.” How should the nurse respond? 1. “Which antidiarrheal are you taking?” 2. “How many doses have you taken?” 3. “Stop taking the medicine and come to the clinic.” 4. “Is it stopping your diarrhea?” Rationale 3: Antidiarrheal use is contraindicated in cases of Clostridium difficile. Question 22 Type: MCMA A client calls the clinic and says, “I have been taking Imodium (loperamide) for diarrhea, but it isn’t helping.” How should the nurse respond? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. “Are you taking it after every episode of diarrhea?” 2. “Imodium is not effective against diarrhea.” 3. “This medication may make you sleepy.” 4. “You may have to take the maximum dose for 2 or 3 days before diarrhea slows.” 5. “You should come in for assessment.” Correct Answer: 1,3,5 46/100 Question 24 Type: MCMA A nurse would question a prescription for sulfasalazine (Azulfidine) if the client is also taking which medication? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Insulin 2. Digoxin 3. Warfarin 4. Penicillin 5. Vitamin C Rationale 1: Clients with diabetes may experience hypoglycemia if sulfasalazine is taken concurrently. Rationale 2: Absorption of digoxin may be decreased. Rationale 3: Anticoagulation effects may be increased. Question 27 Type: MCSA A patient who has been taking diphenoxylate with atropine (Lomotil) is very drowsy and has a respiratory rate of 10 bpm. The roommate, who brought the patient to the emergency department, states that the patient took “a whole bottle” of the drug. Which nursing action is indicated? 1. Administer a beta blocker 2. Administer naloxone 3. Administer high volume intravenous fluids 4. Administer activated charcoal Correct Answer: 2 47/100 Ch. 43 Question 4 Type: MCSA The nurse assesses which client as being at greatest risk for developing vitamin deficiencies? 1. The young male client who takes phenytoin (Dilantin) for new-onset epilepsy 2. The young female client who uses oral contraceptives for birth control 3. The young male client who eats a well-balanced diet and does not take vitamins 4. The young pregnant female client who is taking prenatal vitamins Question 5 Type: MCSA The nurse teaches new mothers about the reason their infants receive vitamin K. The nurse evaluates instruction as being effective when the mother makes which statement? 1. "Babies do not need an injection of vitamin K unless bleeding is observed." 2. "Babies will be able to get enough vitamin K through breast milk." 3. "Babies do not have enough intestinal bacteria to synthesize vitamin K." 4. "Babies could receive vitamin K through a liquid or an injection." Question 7 Type: MCSA The client receives topical vitamin A for the treatment of psoriasis. Which laboratory test will the nurse review when assessing for an adverse effect? 1. Serum calcium level 2. Hemoglobin level 3. Thyroid profile 4. Serum potassium level 48/100 I STOPPED HERE!!!! Question 10 Type: MCSA The nurse is planning care for a client who receives total parenteral nutrition. What will the best plan by the nurse include? 1. Check the feeding tube for residual prior to initiating feedings. 2. Remove the solution from the refrigerator 30 minutes prior to hanging. 3. Withhold oral medications while the total parenteral nutrition (TPN) is hanging. 4. Maintain a dedicated percutaneous endoscopic gastrostomy (PEG) tube for the solution. Correct Answer: 2 Rationale 1: Checking the tube for residual is done with enteral feedings, not parenteral feedings. Rationale 2: A cold infusion could cause irritation to the intravenous (IV) site. Rationale 3: The client can continue to receive oral medications while total parenteral nutrition (TPN) is infusing. Rationale 4: Parenteral infusions are done through an intravenous (IV) line, not a percutaneous endoscopic gastrostomy (PEG) tube. Global Rationale: A cold infusion could cause irritation to the intravenous (IV) site. Checking the tube for residual is done with enteral feedings, not parenteral feedings. The client can continue to receive oral medications while total parenteral nutrition (TPN) is infusing. Parenteral infusions are done through an intravenous (IV) line, not a percutaneous endoscopic gastrostomy (PEG) tube. Question 14 Type: MCSA The client is receiving total parenteral nutrition (TPN). What does the best plan by the nurse include to prevent complications from total parenteral nutrition? 1. Assess the client's potassium levels. 49/100 2. Assess the client's blood glucose levels. 3. Assess the client's mental status. 4. Assess the client's blood pressure. Correct Answer: 2 Rationale 1: The client's potassium levels are not as likely to be affected by total parenteral nutrition (TPN). Rationale 2: Hyperglycemia may occur, as total parenteral nutrition (TPN) solutions contain concentrated amounts of glucose. Rationale 3: The client's mental status should not be affected by total parenteral nutrition (TPN). Rationale 4: Blood pressure is not an essential assessment because of total parenteral nutrition (TPN). Global Rationale: Hyperglycemia may occur, as total parenteral nutrition (TPN) solutions contain concentrated amounts of glucose. The client's potassium levels are not as likely to be affected by total parenteral nutrition (TPN). The client's mental status should not be affected by total parenteral nutrition (TPN). Blood pressure is not an essential assessment because of receiving total parenteral nutrition (TPN). Question 19 Type: MCSA Deficiencies in cyanocobalamin (B12) can result in 1. pellagra. 2. pernicious anemia. 3. rickets. 4. scurvy. Correct Answer: 2 Rationale 1: Pellagra is a deficiency of niacin. Rationale 2: Cyanocobalamin (B12) deficiency can result in pernicious or megaloblastic anemia, and can require pharmacotherapy. Rationale 3: Rickets is vitamin D deficiency. 50/100 Rationale 4: Scurvy is a deficiency of vitamin C. Global Rationale: Cyanocobalamin (B12) deficiency can result in pernicious or megaloblastic anemia and can require pharmacotherapy. Pellagra is a deficiency of niacin. Rickets is vitamin D deficiency. Scurvy is a deficiency of vitamin C. Question 20 Type: MCSA The nurse is aware that efficient absorption of calcium is assisted by 1. intrinsic factor. 2. coenzymes. 3. phosphorus. 4. vitamin D. Correct Answer: 4 Rationale 1: Efficient absorption of calcium is not associated with intrinsic factor. Rationale 2: Efficient absorption of calcium is not associated with coenzymes. Rationale 3: Efficient absorption of calcium is not associated with phosphorus. Rationale 4: Efficient absorption of calcium is assisted by vitamin D. Global Rationale: Efficient absorption of calcium is assisted by vitamin D. It is not associated with intrinsic factor, coenzymes, or phosphorus. Question 23 Type: MCMA A client is to receive enteral nutrition. Which information should the nurse provide to the client and family? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. “Nutrition can be given either intermittently or continuously.” 2. “Your nutrition will be administered through your veins.” 51/100 3. “Enteral feedings are chosen when you cannot swallow enough to maintain nutrition.” 4. “Most enteral feeding consists of thinned pureed food.” 5. “Enteral feedings are milk based.” Correct Answer: 1,3 Rationale 1: Enteral products can be given intermittently by bolus or by continuous drip. Rationale 2: Parenteral nutrition is administered through the venous system. Enteral nutrition is delivered into the gastrointestinal tract. Rationale 3: Difficulty swallowing is often the reason enteral feedings are initiated. Rationale 4: Most enteral feeding is formula based. Rationale 5: Formulas consist of various combinations of proteins, carbohydrates, and lipids and are not milk based. Global Rationale: Enteral products can be given intermittently by bolus or by continuous drip. Difficulty swallowing is often the reason enteral feedings are initiated. Parenteral nutrition is administered through the venous system. Enteral nutrition is delivered into the gastrointestinal tract. Most enteral feeding is formula based. Formulas consist of various combinations of proteins, carbohydrates, and lipids and are not milk based. Question 24 Type: MCMA A client is prescribed total parenteral nutrition (TPN). Which education should the nurse provide? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. “You will not be able to return home until the TPN is discontinued.” 2. “Once you go home, you will come in twice a week for TPN.” 3. “Since this is going to be a long-term treatment, your TPN will be given through a central line.” 4. “Your TPN will be infused via an infusion pump.” 5. “All of your nutrition can be supplied by TPN.” 52/100 Correct Answer: 3,4,5 Rationale 1: TPN can be managed at home. Rationale 2: TPN is administered continuously. Rationale 3: Long-term therapy is provided through a central line. Rationale 4: TPN must be monitored closely, so an infusion pump is necessary. Rationale 5: TPN supplies all of a client’s nutrition. Global Rationale: Long-term therapy is provided through a central line. TPN must be monitored closely, so an infusion pump is necessary. TPN supplies all of a client’s nutrition. TPN can be managed at home. TPN is administered continuously. Question 25 Type: MCMA A nurse is providing administration instruction to the wife of a client going home on intermittent enteral nutrition. Which information should the nurse include? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. “Clean the equipment between each feeding administration.” 2. “Once mixed, enteral feeding should hang no more than 8 hours.” 3. “Refrigerate any feeding that is not needed for a feeding.” 4. “You may use plain tap water for scheduled tubing flushes.” 5. “Keep the area around the insertion site clean.” Correct Answer: 1,3,4,5 Rationale 1: The equipment used to provide enteral feedings should be kept clean. Rationale 2: Enteral feedings should hang no more than 4 hours. Rationale 3: Unused feeding should be refrigerated to prevent spoilage. Rationale 4: Plain water is acceptable for tubing flushes. 53/100 Rationale 5: The area around the insertion site should be kept clean. Global Rationale: The equipment used to provide enteral feedings should be kept clean. Enteral feedings should hang no more than 4 hours. Unused feeding should be refrigerated to prevent spoilage. Plain water is acceptable for tubing flushes. The area around the insertion site should be kept clean. Ch. 47 Question 1 Type: MCSA The nursing instructor teaches student nurses about male reproductive function and the role of follicle-stimulating hormone (FSH). The instructor evaluates learning has occurred when the students make which statement? 1. "Follicle-stimulating hormone (FSH) regulates sperm production." 2. "Follicle-stimulating hormone (FSH) regulates male androgen production." 3. "Follicle-stimulating hormone (FSH) regulates production of testosterone." 4. "Follicle-stimulating hormone (FSH) regulates male progesterone." Correct Answer: 1 Rationale 1: Follicle-stimulating hormone (FSH) regulates sperm production in men. Rationale 2: Androgens are male sex hormones not regulated by follicle-stimulating hormone (FSH). Rationale 3: Testosterone is regulated by luteinizing hormone (LH), not follicle-stimulating hormone (FSH). Rationale 4: Follicle-stimulating hormone (FSH) does not regulate progesterone in men. Global Rationale: Follicle-stimulating hormone (FSH) regulates sperm production in men. Androgens are male sex hormones not regulated by follicle-stimulating hormone (FSH). Testosterone is regulated by luteinizing hormone (LH), not follicle-stimulating hormone (FSH). Follicle-stimulating hormone (FSH) does not regulate progesterone in men. Question 2 Type: MCSA 54/100 The newly licensed nurse is preparing to administer a high dose of androgen to the female client. The nurse manager asks for the rationale. What is the best response by the new nurse? 1. "My client wants to improve athletic performance." 2. "My client has breast cancer." 3. "My client has brain cancer." 4. "My client is planning on sexual reassignment surgery." Correct Answer: 2 Rationale 1: Androgens will help with athletic performance, but this is not the reason the drug would be administered in a clinical setting. Rationale 2: High doses of androgens are occasionally used as a palliative measure to treat certain types of breast cancer. Rationale 3: Androgens would not have any effect on brain cancer. Rationale 4: Sexual reassignment surgery would not be the reason for the drug to be administered in a clinical setting. Global Rationale: High doses of androgens are occasionally used as a palliative measure to treat certain types of breast cancer. Androgens will help with athletic performance, but this is not the reason the drug would be administered in a clinical setting. Androgens would not have any effect on brain cancer. Sexual reassignment surgery would not be the reason for the drug to be administered in a clinical setting. Question 6 Type: MCSA The nurse plans medication education for a client who receives a prescription for sildenafil (Viagra). What will the best plan by the nurse include? 1. Grapefruit juice will decrease the effects of sildenafil (Viagra). 2. You can take sildenafil (Viagra) anywhere from 1 to 6 hours before sex. 3. Be sure to take only one pill in a 24-hour period. 4. Sildenafil (Viagra) should be taken with food. Correct Answer: 3 55/100 Rationale 1: Grapefruit juice can lead to increased, not decreased, levels of sildenafil (Viagra). Rationale 2: The optimum time for administration is 1 hour before sex, but it can be taken up to 4 hours before sex. Rationale 3: Taking only one pill in a 24-hour period is the recommended dosing for sildenafil (Viagra). Rationale 4: Sildenafil (Viagra) should be taken on an empty stomach, not with food. Global Rationale: Taking only one pill in a 24-hour period is the recommended dosing for sildenafil (Viagra). Grapefruit juice can lead to increased, not decreased, levels of sildenafil (Viagra). The optimum time for administration is 1 hour before sex, but it can be taken up to 4 hours before sex. Sildenafil (Viagra) should be taken on an empty stomach, not with food. Question 7 Type: MCSA A client has benign prostatic hyperplasia (BPH) and hypertension. Which medication could the client safely receive for hypertension? 1. Terazosin (Hytrin) 2. Sildenafil (Viagra) 3. Finasteride (Proscar) 4. Tamsulosin (Flomax) Correct Answer: 1 Rationale 1: Terazosin (Hytrin) is an alpha1-adrenergic blocker that relaxes smooth muscle in the prostate and can also reduce blood pressure. Rationale 2: Sildenafil (Viagra) has no effect on benign prostatic hypertrophy. Rationale 3: Finasteride (Proscar) has no effect on blood pressure. Rationale 4: Tamsulosin (Flomax) can cause severe hypotension but is not used for routine blood pressure management. Global Rationale: Terazosin (Hytrin) is an alpha1-adrenergic blocker that relaxes smooth muscle in the prostate and can also reduce blood pressure. Sildenafil (Viagra) has no effect on benign prostatic hypertrophy. Finasteride (Proscar) has no effect on blood pressure. Tamsulosin (Flomax) can cause severe hypotension but is not used for routine blood pressure management. Question 8 56/100 Type: MCSA The nurse is assessing a client and notes that he is receiving finasteride (Proscar). The client denies having any history of a significant prostate disorder. What is the best assessment question for the nurse to ask at this time? 1. "Do you have male pattern baldness?" 2. "Do you have erectile dysfunction?" 3. "Do you have a stomach ulcer?" 4. "Do you have high blood pressure?" Correct Answer: 1 Rationale 1: Finasteride (Proscar) is also sold as Propecia, which is used to promote hair growth. Rationale 2: Finasteride (Proscar) is not indicated for erectile dysfunction. Rationale 3: Finasteride (Proscar) is not indicated for stomach ulcers. Rationale 4: Finasteride (Proscar) is not indicated for high blood pressure. Global Rationale: Finasteride (Proscar) is also sold as Propecia, which is used to promote hair growth. Finasteride (Proscar) is not indicated for erectile dysfunction, stomach ulcers, or hypertension. Question 9 Type: MCMA The nurse plans to teach a class on anabolic steroids to a group of high school athletes. What will the best plan by the nurse include? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. The use of anabolic steroids can lead to infertility. 2. Your entire body is affected by anabolic steroids, especially your liver. 3. The use of anabolic steroids is the most effective way to increase muscle mass. 4. The use of anabolic steroids should be monitored by your doctor. 57/100 5. The use of anabolic steroids can lead to very aggressive behavior. Correct Answer: 1,2,5 Rationale 1: The use of anabolic steroids can lead to infertility. Rationale 2: The entire body is affected by anabolic steroids, and they can lead to liver damage. Rationale 3: Weight training can effectively build muscle mass. Rationale 4: Anabolic steroid use to enhance athletic performance is illegal, so their use would not be monitored by a physician. Rationale 5: Behavioral changes, including aggression, are associated with anabolic steroids. Global Rationale: The use of anabolic steroids can lead to infertility. The entire body is affected by anabolic steroids, and they can lead to liver damage. Behavioral changes, including aggression, are associated with anabolic steroids. Weight training can effectively build muscle mass. Anabolic steroid use to enhance athletic performance is illegal, so their use would not be monitored by a physician. Question 10 Type: MCMA A male client has erectile dysfunction. Which systems should be assessed that could contribute to the erectile dysfunction? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Cardiovascular 2. Integumentary 3. Endocrine 4. Nervous 5. Renal Correct Answer: 1,3,4,5 Rationale 1: Cardiovascular disorders can contribute to ED. 58/100 Rationale 2: Disorders of the integumentary system are unlikely to contribute to ED. Rationale 3: Endocrine disorders contribute to ED. Rationale 4: Penile erection has both neuromuscular and vascular components. Rationale 5: Kidney disorders may contribute to ED. Global Rationale: Cardiovascular disorders, endocrine disorders, and kidney disorders can contribute to ED. : Penile erection has both neuromuscular and vascular components. Disorders of the integumentary system are unlikely to contribute to ED. Question 13 Type: MCMA An 18-year-old male is being evaluated for hypogonadism. The nurse would evaluate which physical findings as supporting that tentative diagnosis? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Facial hair is minimal, soft, and light in color. 2. Pubic hair is absent. 3. There is decreased subcutaneous fat. 4. Testicles are small. 5. Skin is pale. Correct Answer: 1,2,4 Rationale 1: Lack of secondary sexual characteristics like beard development is associated with hypogonadism. Rationale 2: Lack of secondary sexual characteristics like pubic hair is associated with hypogonadism. Rationale 3: It is more likely that subcutaneous fat will be increased in a patient with hypogonadism. Rationale 4: Lack of secondary sexual characteristics like development of the testes is associated with hypogonadism. Rationale 5: Pale skin is not associated with hypogonadism. 59/100 Global Rationale: Lack of secondary sexual characteristics like beard development, pubic hair, and testicular development is associated with hypogonadism. It is more likely that subcutaneous fat will be increased in a patient with hypogonadism. Pale skin is not associated with hypogonadism. Question 16 Type: MCSA The primary function of luteinizing hormone (LH) in men is to 1. regulate sperm production. 2. regulate secondary sex characteristics. 3. regulate growth of male sex organs. 4. regulate testosterone. Correct Answer: 4 Rationale 1: FSH regulates sperm. Rationale 2: Testosterone regulates secondary sex characteristics. Rationale 3: Androgen regulates growth of male sex organs. Rationale 4: Luteinizing hormone regulates testosterone. Global Rationale: Luteinizing hormone regulates testosterone.FSH regulates sperm. Testosterone regulates secondary sex characteristics. Androgen regulates growth of male sex organs. Question 17 Type: MCSA Androgen is secreted by 1. follicle-stimulating hormone. 2. gonadotropin-releasing hormone. 3. the testes. 4. the pituitary gland. 60/100 Correct Answer: 3 Rationale 1: The pituitary releases follicle-stimulating hormone. Rationale 2: Gonadotropin is released from the hypothalamus. Rationale 3: Androgen is secreted by the testes. Rationale 4: The pituitary releases follicle-stimulating hormone. Global Rationale: Androgen is secreted by the testes. The pituitary releases follicle-stimulating hormone. Gonadotropin is released from the hypothalamus. The pituitary releases folliclestimulating hormone. Question 18 Type: MCSA The goal of androgen therapy in men is to 1. decrease the libido. 2. release follicle-stimulating hormone. 3. increase luteinizing hormone. 4. increase the libido. Correct Answer: 4 Rationale 1: Androgens do not decrease the libido. Rationale 2: Androgens do not release FSH. Rationale 3: Androgens do not increase luteinizing hormone. Rationale 4: Androgen therapy increases the libido and treats erectile dysfunction. Global Rationale: Androgen therapy increases the libido and treats erectile dysfunction. Androgens do not decrease the libido, do not release FSH, and do not increase luteinizing hormone. Question 19 Type: MCSA The drug that will most likely be used for treatment of erectile dysfunction (ED) is 61/100 1. leuprolide (Lupron). 2. finasteride (Proscar). 3. tamsulosin (Flomax). 4. sildenafil (Viagra). Correct Answer: 4 Rationale 1: Leuprolide is an androgen used in high doses for prostate cancer. Rationale 2: Finasteride is used for benign prostatic hypertrophy. Rationale 3: Tamsulosin is used for benign prostatic hypertrophy. Rationale 4: Sildenafil is an agent for ED. Global Rationale: Sildenafil is an agent for ED. Leuprolide is an androgen used in high doses for prostate cancer. Finasteride is used for benign prostatic hypertrophy. Tamsulosin is used for benign prostatic hypertrophy. Question 20 Type: MCSA A client with benign prostatic hyperplasia is to receive finasteride (Proscar). The nurse understands that this drug works by 1. relaxing smooth muscle in the penis. 2. promoting shrinkage of an enlarged prostate gland. 3. increasing testosterone. 4. stimulating RNA synthesis. Correct Answer: 2 Rationale 1: Agents for ED, such as phosphodiesterase-5 inhibitors, relax smooth muscle in the penis. Rationale 2: 5-alpha reductase inhibitors promote shrinkage of the prostate gland. 62/100 Rationale 3: Androgens increase testosterone. Rationale 4: Androgens stimulate RNA synthesis. Global Rationale: 5-alpha reductase inhibitors promote shrinkage of the prostate gland. Agents for ED, such as phosphodiesterase-5 inhibitors, relax smooth muscle in the penis. Androgens increase testosterone. Androgens stimulate RNA synthesis. Question 24 Type: MCMA A client has been prescribed testosterone. Which medication education should the nurse provide? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. “Place the patch on a place that does not have hair.” 2. “Avoid placing the patch on active areas like the thigh or arm.” 3. “The patch should be changed every 7 days.” 4. “Observe for a rash at the patch site.” 5. “Keep these patches away from children.” Correct Answer: 1,4,5 Rationale 1: The patch should be placed on hair-free skin. Rationale 2: As long as the skin is dry and hair-free, the activity of the area is not an issue. Rationale 3: The patch is changed daily. Rationale 4: Skin irritation or rash may occur at the patch site. Rationale 5: Children should not be exposed to these patches or the patch site. Global Rationale: The patch should be placed on hair-free skin. Skin irritation or rash may occur at the patch site. Children should not be exposed to these patches or the patch site. As long as the skin is dry and hair-free, the activity of the area is not an issue. The patch is changed daily. Question 25 Type: MCMA 63/100 A client has been using sildenafil (Viagra) for several months. Which client reports would the nurse interpret as an adverse effect of this medication? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Nasal congestion 2. Earache 3. Blurry vision 4. Priapism 5. Photophobia Correct Answer: 1,3,4,5 Rationale 1: Nasal congestion can occur as an adverse effect of sildenafil. Rationale 2: Earache is not a known adverse effect of sildenafil. Rationale 3: Blurry vision is a known adverse effect of sildenafil. Rationale 4: Sustained erection is a known adverse effect of sildenafil. Rationale 5: Increased sensitivity to light is a known adverse effect of sildenafil. Global Rationale: Nasal congestion, blurry vision, sustained erection, and increased sensitivity to light can occur as an adverse effect of sildenafil. Earache is not a known adverse effect of sildenafil. Question 30 Type: MCMA A male patient has been started on a 5-alpha reductase inhibitor for the treatment of benign prostatic hyperplasia (BPH). Which information should the nurse provide? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. “Use a condom during intercourse.” 2. “Keep this medication in a secure place away from children.” 64/100 3. “Do not give blood while you are taking this medication.” 4. “Do not do heavy exercise while taking this medication.” 5. “Reduce your sodium intake while taking this drug.” Correct Answer: 1,2,3 Rationale 1: The patient should use a condom to prevent exposure of a female partner to semen, which may contain the drug. Rationale 2: This drug is dangerous for children and should be kept in a secure place. Rationale 3: The patient should not give blood during the time this medication is being taken and for up to a month after the drug is stopped. Rationale 4: Heavy exercise is not restricted. Rationale 5: There is no need to decrease sodium. Global Rationale: The patient should use a condom to prevent exposure of a female partner to semen, which may contain the drug. This drug is dangerous for children and should be kept in a secure place. The patient should not give blood during the time this medication is being taken and for up to a month after the drug is stopped. Heavy exercise is not restricted. There is no need to decrease sodium. Chapter 1 2. The student nurse asks the nursing instructor why he needs to take anatomy and physiology, as well as microbiology, when he only wants to learn about pharmacology. What is the best response by the instructor? 1. "Because pharmacology is an outgrowth of those subjects." 2. "You must learn all, since those subjects, as well as pharmacology, are part of the curriculum." 3. "Knowledge of all those subjects will prepare you to provide the best patient care, including the administration of medications." 4. "Because an understanding of those subjects is essential to understanding pharmacology." 3. The nursing instructor is teaching a pharmacology class to student nurses. The current focus is pharmacology and therapeutics. The nursing instructor determines that learning has occurred when the students make which comments? Select all that apply. 1. "Pharmacology is the development of medicines." 2. "Pharmacology is the study of medicines." 65/100 3. "Therapeutics relates to drug use to treat suffering." 4. "Therapeutics is the study of drug interactions." 5. "Pharmacology is the study of drugs to prevent disease." 4. The nurse administers a vaccine to a child. What is the best understanding of the nurse as it relates to the manufacture of this vaccine? 1. The vaccine is produced by natural plant extracts in the laboratory. 2. The vaccine is naturally produced in animal cells or microorganisms. 3. The vaccine is produced by a combination of animal and plant products. 4. The vaccine is most commonly synthesized in a laboratory. 5. The older adult client has gastrointestinal bleeding. The client says to the nurse, "I don't understand this. All I did was take ibuprofen (Advil) for my arthritis." Which plan would be best as it relates to the nurse's education of this client? 1. A plan to teach the client to use drugs that bypass the gastrointestinal system, like topical drugs 2. A plan to teach the client to substitute safer drugs like acetaminophen (Tylenol) 3. A plan to teach the client to obtain physician approval prior to the use of over-thecounter (OTC) medications 4. A plan to teach the advantages and disadvantages of ibuprofen (Advil) 6. The nursing instructor teaches the student nurses about the pharmacological classification of drugs. The instructor evaluates that learning has occurred when the students make which response? 1. "An anti-anginal treats angina." 2. "A calcium channel blocker blocks heart calcium channels." 3. "An antihypertensive lowers blood pressure." 4. "An anticoagulant influences blood clotting." 7. The nurse is providing medication education to a client with hypertension. The nurse teaches the client that the physician ordered a diuretic to decrease the amount of fluid in the client’s body. Which statement best describes the nurse's instruction? 1. The nurse provided appropriate medication education. 2. The nurse explained the drug's mechanism of action. 3. The nurse taught the client about a prototype drug. 4. The nurse explained the consequences of not using the drug. 8. During pharmacology class, the student nurse asks the nursing instructor how students will ever learn about the individual antibiotic drugs since there are so many. What is the best response by the nursing instructor? 1. "You will learn a little trick called mnemonics." 2. "You will learn how to do a flow chart to enhance memory." 3. "You will learn how to categorize the individual drugs." 4. "You will learn a representative drug from each class." 9. The physician ordered a brand name drug for the client, paroxetine (Paxil). After taking this medication for a year, the client tells the nurse that it is no longer working. What is the best assessment of the nurse at this time? 1. "This sounds like your medication needs changing." 66/100 2. "Let's look for interactions with other medications you are taking." 3. "Are you taking Paxil or paroxetine?" 4. "It is time for us to do the Beck Depression assessment again." 10. The student nurse has completed an initial pharmacology course and tells the nursing instructor that it was difficult and she is glad it is over. What is the best response by the nursing instructor? 1. "It may be over, but now you must apply what you have learned to patient care." 2. "Learning is gradual and continuous; we never completely master all areas of pharmacology." 3. "Learning is always painful, but we must continue anyway." 4. "It really isn't over; you should take a graduate course next." 11. The client says to the nurse, "My wife and I take the same drug, but we have different side effects. Are we doing something wrong?" What is the best response by the nurse? 1. "No. Differences such as your sex can result in different side effects." 2. "I'll have to check. What is the name of the drug you were using?" 3. "Possibly. This could happen if one uses generic or brand name drugs." 4. "I'm not sure. Maybe the drug is not the same; you should check it." 12. The client comes to the emergency department with a myocardial infarction. The client's husband tells the nurse that his wife has been taking calcium carbonate (Tums) for years for what she thought was indigestion. What is the best response by the nurse? 1. "Your wife should not have self-diagnosed herself. I hope she will be okay." 2. "Why did you let her do that? She should have seen a doctor." 3. "Well, I am glad she is here, as it certainly wasn't indigestion." 4. "Your wife was self-diagnosing, which is generally not a good idea." 13. The nurse is teaching a class for clients about over-the-counter (OTC) medications. The nurse determines that education has been effective when the clients make which statement? 1. "We should not take any over-the-counter (OTC) medicine without first calling and checking with the doctor's office." 2. "We should always ask the pharmacist about how to take the over-the-counter (OTC) medicine." 3. "We must read all the directions on the label and call the doctor's office if they are not clear." 4. "Medicines that are available over-the-counter (OTC) are really safe, or they would be prescription medicines." 14. The physician has prescribed a brand name drug for the client. The client tells the nurse that the medication is too expensive. What is the best plan by the nurse? 1. Help the client receive free medicine through a "patient assistance" program. 2. Ask the physician if a cheaper brand name drug may be substituted. 3. Ask the physician if a generic drug may be substituted. 4. Maintain the client on samples of the brand name drug from the physician's office. 15. The client is receiving a very expensive medication. The client asks the nurse why the medicine is so expensive. What is the best response by the nurse? 1. "It is expensive, but your insurance covers it and you have a low co-pay." 2. "Drug companies are allowed to advertise medications and this adds to the cost." 67/100 3. "Drug companies must recoup the cost of developing and producing the drug." 4. "I think the drug companies should be more accountable for lowering costs." 16. The application of drugs for the purpose of treating diseases and treatment of suffering is known as 1. biologics. 2. pharmacotherapeutics. 3. alternative therapies. 4. therapeutics. 17. A client with chronic back pain informs the nurse he has been receiving therapeutic touch in addition to his medications. What is the nurse’s best classification of this client’s treatment? 1. pharmacotherapy. 2. drug-absence therapy 3. complementary therapy 4. biologic therapy 18. The client is receiving a brand name drug and wants to change to the generic form because it is cheaper. What is the best outcome for this client? 1. Client will state two ways a brand name drug differs from a generic name drug. 2. Client will take the brand name drug after speaking with the physician. 3. Client will ask the nurse why brand name drugs are better than generic drugs. 4. Client will state two ways to obtain the medication at a reduced cost. 19. The physician orders a brand name drug for the client. The hospital formulary substitutes the generic equivalent of the brand name drug, and the nurse administers the generic drug. Which statement(s) best represent(s) the nurse's action? Select all that apply. 1. The nurse should have contacted the physician prior to administering the drug. 2. The nurse should have called the pharmacist to see if the drugs were bioequivalent. 3. The nurse used good judgment in administering the drug. 4. The nurse was correct; hospital policies allow for this. 5. The nurse should ask the client which brand of drug is used at home. 20. The nurse is categorizing a client’s list of medications completing a health history. Which agents would be categorized as complementary and alternative medicine? Select all that apply. 1. Garlic 2. Vitamin C 3. Zinc 4. Aspirin 5. Benadryl 21. Which type of classification system is being used when drugs are grouped together because they help treat a particular disease or condition? 1. Therapeutic 2. Mechanism of action 3. Chemical 4. Pharmacological 22. An overwhelmed nursing student asks the instructor whether there are any tips that will make learning pharmacology easier. The instructor gives an example of the anticoagulant 68/100 heparin. The instructor indicates that knowing heparin and comparing other drugs to it will facilitate learning the many anticoagulants. Which approach is the instructor using? 1. Mechanism of action approach 2. Generic name approach 3. Trade name approach 4. Prototype drug approach 23. While discussing antihypertensives, the instructor states that a particular agent causes a reduction in blood pressure by blocking receptor sites. The student wishing to understand this statement would research which drug information? 1. Drug–drug interaction 2. Adverse effects 3. Indication 4. Mechanism of action 24. Advil, Motrin, and Nuprin are examples of 1. chemical names. 2. combination names. 3. trade names. 4. generic names. 25. A client says to the admitting nurse, “Why do you need to know the names of all the overthe-counter supplements I take? They aren’t drugs.” Which of the nurse’s responses are appropriate? Select all that apply. 1. “The admitting physician needs to know everything you are taking.” 2. “You’re right. I’m not sure why the admitting paperwork asks for this information. Would you mind listing them anyway?” 3. “The law requires us to keep a list of over-the-counter drugs and supplements that you are taking.” 4. “It is true that supplements are not considered drugs; however, some of these products can cause adverse effects with prescribed drugs.” 5. “We need to know if you are having an allergic reaction to one of them.” 26. A prototype drug is a single drug in a class and can be compared with all other medications in the class. The benefit of studying the prototype drug is that the nurse would be able to predict characteristics of other drugs in the same class, including Select all that apply. 1. which drugs have the most favorable safety profile. 2. their therapeutic indications. 3. their actions. 4. their adverse effects. 5. duration of action of drugs in the group. 27. Chemical names are assigned for each drug. What are the major reasons that nursing usually does not use the chemical name of the drugs? Select all that apply. 1. They are usually not brief or easy to remember. 2. They are often difficult to pronounce. 3. There is no standard for assigning names. 4. They do not explain the nature of the drug. 5. There is only one chemical name for each drug. 69/100 28. A client says, “I don’t understand why so much money is spent on trying to find a cure for cancer. I have epilepsy and wish more money went into epilepsy drugs.” What should the nurse consider prior to responding? Select all that apply. 1. More people are affected by cancer than by epilepsy. 2. Drugs that are effective in treating epilepsy exist. 3. The amounts of money spent on drug development are determined at the federal level. 4. It would be easier to achieve a cure for cancer than to achieve a cure for epilepsy. 5. The client should realize that personal family may develop cancer one day. 29. A client with advanced heart disease says, “I read about a new drug that was just released. Do you think my doctor could get it for me?” What should the nurse include in discussion with the client? Select all that apply. 1. “Since the drug is new it is dangerous to use.” 2. “Decisions on using drugs are based on many different variables.” 3. “We certainly can talk to your physician about the drug.” 4. “When drugs are first developed they are very expensive and their use is limited to those who can afford to purchase them.” 5. “People who are very sick often have unrealistic expectations of what drugs can do.” Chapter 4 1. The nurse is conducting medication education for patients with hypertension. The focus of the education is on enhancing the absorption of their medications. The nurse determines that learning has occurred when the patients make which statement? 1. "We can safely take the drug for at least 6 months beyond the expiration date." 2. "We don't need to worry about storage of the drug, it won't lose potency." 3. "We should not take our medications with milk or dairy products." 4. "We need to be careful about taking the medication with certain foods." 2. The physician ordered a loading dose of medication for the patient; it is to be followed by a lower dose. When the patient receives the lower dose, she says to the nurse, "I think my doctor made a mistake; my medication dose is too low." What is the best response by the nurse? 1. "The initial dose shortened the half-life, so the medication would work more quickly." 2. "We always give medications this way; the doctor did not make a mistake." 3. "You had a larger dose initially so that the medication would work more quickly." 4. "Giving a larger dose initially will reduce the chance of side effects." 3. The patient has meningitis. The physician initially prescribed a water-soluble drug. Another physician changed the order to a lipid-soluble drug. The patient is confused about this. Which plan best resolves the patient's concern? 1. Teach the patient that lipid-soluble drugs are better because of protein binding. 2. Teach the patient that lipid-soluble drugs are more effective in treating his illness. 3. Teach the patient that lipid-soluble drugs are better because they have fewer side effects. 4. Teach the patient that lipid-soluble drugs are more effective because they are excreted at a slower rate. 70/100 4. The patient is malnourished and has a low serum albumin. The physician has ordered aspirin, a highly protein-bound drug, for the patient. Which evaluation by the nurse best describes the effect this will have on the patient? 1. The patient will be at risk to experience a decreased effectiveness of the drug. 2. The patient will be at risk to experience toxic effects of the drug. 3. The patient's kidneys will excrete the drug at a faster rate. 4. The patient's serum globulin is more important than serum albumin. 5. The patient is admitted to the hospital in chronic renal failure and is on several medications. What best describes the nurse's assessment of this patient? 1. The patient's liver may compensate for renal failure; the drugs may be effective. 2. The patient may have drug toxicity from all the drugs. 3. The patient may have drug toxicity only if the drugs are excreted by the kidneys. 4. The patient may have decreased effectiveness of the drugs. 6. The patient comes to the emergency department following an overdose of aspirin, an acidic drug. What will the best plan of the nurse include? 1. Administration of intravenous fluids to flush the kidneys 2. Administration of ammonium chloride to the patient 3. Administration of sodium bicarbonate to the patient 4. Administration of intravenous proteins to bind the aspirin 7. The patient is complaining of a severe headache. The physician orders aspirin. Which action by the nurse will result in the fastest relief of the patient's headache? 1. Administer the aspirin with an alkaline food, like cottage cheese. 2. Administer the aspirin in an enteric-coated formulation. 3. Administer the aspirin with a high-fat food, like peanut butter. 4. Administer the aspirin on an empty stomach. 8. The patient is receiving lithium (Eskalith) and asks the nurse why he has to have blood drawn so often. What is the best response by the nurse? 1. "To detect side effects before they become a problem." 2. "To be sure the medication is working properly." 3. "To determine if your body is responding as it should." 4. "To be sure you have the correct amount of medication in your system." 9. The nursing mother asks the nurse if it is all right to take St. John's wort for mild depression. What is the best response by the nurse? 1. "No, it will probably cause your baby to have more allergies." 2. "No, because it might decrease the amount of milk you produce." 3. "No, it could be excreted in your milk and affect the baby." 4. "No, it will affect the taste of your milk, and your baby might reject nursing." 10. The nursing instructor is teaching pharmacology to student nurses. What will the nursing instructor include as the four major components of pharmacokinetics? Select all that apply. 1. How drugs move from the site of administration to circulating fluids 2. How drugs are converted to a form that is easily removed from the body 3. How drugs change body illnesses and pathogens 71/100 4. How drugs are transported throughout the body 5. How drugs are removed from the body 11. The patient is scheduled to receive a medication that is an enzyme inducer of the P450 system. What best describes the effect of this medication on the patient? 1. In time, the patient will experience no effect from other medications. 2. In time, the patient will experience increased effects from other medications. 3. In time, the patient will experience a reduced effect from this medication. 4. In time, the patient will experience an increased effect from this medication. 12. The patient tells the nurse that he is on many medications and questions how they all get to the right places. What are the best responses by the nurse? Select all that apply. 1. "It depends on how much protein you have in your body." 2. "It depends on the health of your kidneys." 3. "It depends on whether they are fat based or water based." 4. "It depends on the amount of blood flow to your body tissues." 5. "It depends on the health of your liver." 13. The patient receives a drug that is excreted in the bile. What will the best nursing assessment of the effect of this drug on the patient include? 1. The effect of the drug will be a prolonged action. 2. The effect of the drug will be increased side effects. 3. The effect of the drug will be decreased side effects. 4. The effect of the drug will be decreased. 14. The nurse administers medications by various routes of delivery. The nurse recognizes which route of administration as requiring higher dosages of drugs to achieve a therapeutic effect? 1. Intravenous route 2. Oral route 3. Rectal route 4. Sublingual route 15. Enzymatic activity that changes a medication into a less active form is an example of 1. pharmacodynamics. 2. active transport. 3. pharmacokinetics. 4. diffusion. 16. Which of the following are the four categories of pharmacokinetics? 1. Diffusion, active transport, interspersing, and storage 2. Ingestion, metabolism, interspersing, and excretion 3. Absorption, distribution, metabolism, and excretion 4. Ingestion, settling, movement, and storage 17. Following ingestion, a drug crosses a membrane from an area of higher concentration to an area of lower concentration. This is an example of 1. active transport. 2. osmosis. 3. diffusion. 4. metabolism. 72/100 18. Aspirin is ionized as it enters the small intestine. Which statement is accurate regarding the absorption of aspirin in the small intestine? 1. Absorption is decreased. 2. Absorption is increased. 3. Ionization has nothing to do with the absorption rate. 4. Aspirin must travel past the small intestine for absorption to occur. 19. Which statement regarding medication distribution within the body is accurate? 1. The blood–brain barrier inhibits rapid crossing of all medications. 2. Body organs with high levels of blood flow are more difficult organs to which to deliver drugs. 3. Medications that are lipid-soluble are more completely distributed. 4. Drug–protein complexes must form prior to crossing capillary membranes. 20. Which organ is the most responsible for the first-pass effect? 1. Bladder 2. Kidneys 3. Liver 4. Stomach 21. Which substance has the lowest rate of crossing renal tubular membranes and would therefore be excreted in the urine? 1. Lipid-soluble drugs 2. Volatile drugs 3. Ionized drugs 4. Non-ionized drugs 22. Which statement is accurate regarding medications that end up being secreted in bile? 1. All medications secreted in bile are excreted in the feces. 2. Some medications are excreted in the feces while others can be recirculated to the liver many times. 3. Most medications secreted in bile are metabolized in the gallbladder. 4. Generally, medications are not secreted in the bile. 23. Which finding would most accurately indicate that a therapeutic range for a medication had been reached? 1. No serious adverse effects are experienced following administration. 2. The indication for administration was achieved without serious side effects. 3. A pre-specified amount (in milligrams) was administered. 4. The medication was effective, but the patient experienced a lethal dysrhythmia. 24. The nurse is teaching a patient the importance of taking the medication as prescribed. Patient teaching is guided by the nurse's knowledge of which principles of pharmacokinetics? Select all that apply. 1. A medication taken by injection must cross the membranes of the gastrointestinal tract to get to the bloodstream before it can be distributed throughout the body. 2. A drug may be exposed to several physiological processes while en route to target cells. 3. Liver enzymes may chemically change the drug. 73/100 4. Excretion organs such as kidneys and intestines must be healthy enough to eliminate the drug. 5. Many processes to which drugs are exposed are destructive, thereby helping facilitate the drug's movement throughout the body. 25. The nurse is reviewing the role of diffusion in the distribution of medications. Drugs that cannot be distributed by simple diffusion include those with which characteristics? Select all that apply. 1. Large molecules 2. Ionization 3. Water-soluble agents 4. Alcohol 5. Urea 26. A patient who has received an oral medication for treatment of hives says, “How long will it be before my skin clears and quits itching?” Which concepts should the nurse consider when formulating a response? Select all that apply. 1. The amount of time between administration and the drug taking effect is known as onset of action. 2. Peak plasma levels rarely occur with oral medications. 3. Duration of action is the amount of time a drug is effective. 4. Peak plasma level is dependent on the drug’s plasma half-life (t1/2). 5. Drugs with short half-lives are ineffective in treating systemic illnesses. 27. Prior to administering a newly prescribed antibiotic, the nurse asks the patient if any other drugs have been taken today. The patient responds, “Why do you need to know?” Which nursing responses are indicated? Select all that apply. 1. “I need to be certain you are not taking another antibiotic.” 2. “Some drugs block the action of others.” 3. “Some drugs increase the activity of other drugs.” 4. “The antibiotic I am about to give you is a prodrug.” 5. “We don’t want to increase first-pass effect.” 28. The nurse recognizes that medications can be excreted by which routes? Select all that apply. 1. Fecal 2. Gastric 3. Glandular 4. Pulmonary 5. Renal 29. A patient asks the nurse why he experiences a metallic taste after taking certain medications. The nurse explains that some medications are secreted by glandular activity. The nurse would identify which substances as examples of this excretion? Select all that apply. 1. Saliva 2. Sweat 3. Breast milk 4. Urine 5. Feces 74/100 30. Which values must be known in order to determine a drug’s therapeutic range? Select all that apply. 1. Toxic concentration 2. Onset of action 3. Peak plasma level 4. Absorption rate 5. Minimal effective concentration Chapter 5 1. A patient looks up the drug he is taking in a drug guide. The patient asks the nurse why the physician prescribed a medication that has a lethal dose measure. What is the best response by the nurse? 1. "It just refers to what is done in research; it is not used by doctors prescribing drugs." 2. "It is a value determined during research, which helps to determine the safe dose to give." 3. "All that means is that the drug could be lethal, but I will watch you for side effects." 4. "Don't worry about that, I'll have your doctor explain it to you." 2. Prior to administering medications, the student nurse reviews the therapeutic index. Which statement best describes the student's understanding of therapeutic index? 1. The student is able to determine if the physician prescribed the best drug for the patient. 2. The student is able to determine if the patients are receiving safe doses of the medications. 3. The student is able to identify interactions among the drugs each patient is receiving. 4. The student is able to identify the patients who will need to have serum blood levels monitored. 3. The nursing instructor prepares to teach student nurses about how mean effective doses of medications are related to clinical practice. As a result of the instruction, what is the best understanding of the student nurses? 1. About 50% of patients will experience severe side effects from the drug. 2. Some patients will respond differently depending on their ethnic background. 3. About 50% of patients will not experience any effect from the drug. 4. Some patients will require more or less than the average dose of the drug. 4. The patient receives antibiotics for a serious infection. The patient asks the nurse, "Why don't you just give me more of that drug to cure this infection faster?" What is the best response by the nurse? 1. "I will check with the doctor to see if it is time to increase the medication." 2. "You are at a maximum dose; taking more will cause interactions with other medications." 3. "You must stay on this drug for 2 more weeks before it can be increased." 75/100 4. "You are at a maximum dose; taking more will not help." 5. The nurse administers narcotics to surgical patients. Which statement represents the nurse's best understanding as it relates to the potency of different narcotics? 1. Codeine is less potent than morphine; it will not produce an allergic reaction. 2. Morphine is more potent than codeine; a lesser dose will be required. 3. Morphine is more potent than codeine; it will produce more adverse effects. 4. Codeine is less potent than morphine; it will not relieve pain as well. 6. The nurse is conducting medication education about the difference between potency and efficacy to a group of patients. The nurse correctly determines that learning has occurred when the patients makes which response? 1. "The best drug for us is the one with the highest potency." 2. "The best drug for us is the one with the greatest efficacy." 3. "Drugs with the greatest efficacy will produce the least side effects." 4. "Low-potency drugs have efficacy and do not produce side effects." 7. The patient has had hypertension for many years. The physician orders an antihypertensive drug that has just come on the market. The nurse teaches the patient that this drug works more effectively than his prior drug and has fewer side effects. The patient asks how this can be. What is the best response by the nurse? Select all that apply. 1. "Newer drugs are altered to affect your cells' receptors in a different way." 2. "Receptors tend to ‘burn-out,’ so newer drugs are required." 3. "Research into receptors helps ‘fine-tune’ drugs to be more effective." 4. "Changing the response of the drug to protein receptor-complexes produces fewer side effects." 5. "It is a process of trial and error with receptors until the new drug proves effective." 8. Type: Hot Spot Indicate the spot of the median effective dose on the frequency distribution curve. Figure: Use Figure 5.1 of the text. Delete the ED50 designation. Hot spot A should be at the beginning of the curve, Hot spot B should be at the middle of the ascending leg of the curve. Hot spot C should be at the point currently marked ED50, and Hot Spot D should be halfway down the descending leg of the curve. 1. A 2. B 3. C 4. D 9. The patient and his wife receive the same medication for hypertension. The patient's wife asks the nurse why she is receiving a higher amount of the medication. What is the best response by the nurse? 1. "Females have a higher metabolism, so you need more medication." 76/100 2. "Everyone is unique and responds differently to medications." 3. "Your hormones are different from your husband's, so you need more medication." 4. "You have a greater percentage of body fat, so more medication is needed." 10. The student nurse has been reading about the Human Genome Project and asks the nursing instructor how this will impact future pharmacological therapies. What is the best response by the instructor? 1. "We will be able to alter genes so we will not need drugs." 2. "We will be able to standardize drug doses to make prescribing easier." 3. "It will help prevent disease through gene manipulation but will not impact drugs." 4. "It will help to individualize drug therapy for people in a more effective way." 11. The home health nurse notes that the elderly patient doubled up on his pain medication, even though the prescribed dose was at a therapeutic level. The patient says, "If one pill is good, two pills are better." Which statement best describes the result of the patient's action? 1. The patient develops tolerance and does not experience any difference. 2. The patient experiences more pain relief from the additional dose. 3. The patient develops tolerance and will need increased doses of the drug. 4. The patient is more likely to exhibit side effects from the additional dose. 12. The patient was receiving haloperidol (Haldol), a dopamine antagonist. The psychiatrist changed the order to aripiprazole (Abilify), a partial dopamine antagonist. Which statement best describes the effect of the change of medication on the patient? 1. The patient is more compliant in taking his medication. 2. The patient experiences greater efficacy. 3. The patient experiences a greater reduction in symptoms. 4. The patient experiences fewer side effects. 13. The student nurse asks the nursing instructor why drug plateaus occur with medications. What are the best responses by the nursing instructor? Select all that apply. 1. "It could be that all of the receptors for the drug are occupied." 2. "It may mean that the drug has brought 100% relief to the patient." 3. "It means that the patient has developed resistance and needs another drug." 4. "It probably means that the drug is losing efficacy." 5. "It means that the patient needs a higher dose of the drug." 14. When administering a standard or median effective dose to a patient, the nurse explains that this amount of drug will have which effect? 1. It will produce an effect without the presence of adverse effects. 2. It will be metabolized within 24 hours. 3. It will be effective in half of the population. 4. It will be effective in the majority of patients. 15. Drug X has a median lethal dose of 30 mg and a median effective dose of 10. Drug Y has a therapeutic index of 4, while drug Z has a therapeutic index of 3. Which statement is accurate based on this information? 1. Drugs X and Y are safer than drug Z. 2. The therapeutic index of drug X is 20. 3. Drug Y is the safest of the three. 4. Drug Z is the safest of the three. 77/100 16. When reading about a drug, the nurse learns it has a median toxic dose of 50 mg. The patient has been receiving 60 mg of the drug. What analysis does the nurse make? 1. It is likely the drug will not produce the desired effect. 2. The efficacy and potency of this drug have not been well defined. 3. The patient will be at greater risk of adverse effects. 4. This amount of drug would have been lethal to half the population. 17. Graded dose-response curves are most useful for determining 1. response intensity within an individual. 2. response intensity within a large group of people with different characteristics. 3. response intensity within a large group of people with similar characteristics. 4. response intensity within a small group of people with similar characteristics. 18. At a dose of 10 mg, drug X lowers total cholesterol by 50 mg/dL, while a maximum drop in cholesterol of 65 mg/dL is achieved at 40 mg. At a dose of 5 mg, drug Y lowers cholesterol by 50 mg/dL, while a maximum drop in cholesterol of 55 mg/dL is achieved at 10 mg. What can be concluded about the efficacy and potency of these two drugs? 1. Drug X is more potent, and drug Y has a higher efficacy. 2. Drug X is more potent and has higher efficacy. 3. Drug Y is more potent and has higher efficacy. 4. Drug Y is more potent, and drug X has a higher efficacy. 19. A drug has been prescribed to decrease the effects of an endogenous chemical. The nurse would place this drug in which category? 1. An agonist 2. A partial agonist 3. An antagonist 4. An agonist-antagonist 20. Pharmacogenetics is a relatively new area within pharmacology. Which statement best describes the potential of this new area? 1. To customize drugs and prevent idiosyncratic responses 2. To reduce the overall number of drugs and their associated adverse effects 3. To reduce medication errors and provide optimal drug choices 4. To provide cost-effective pharmacotherapy and higher drug efficacy 21. From a transcription error, a patient received an overdose of a prescribed medication. If the therapeutic index of the medication is 10 and the median effective dose is 2, the nurse would calculate as the median lethal dose for the medication as _____. Correct Answer: 20 22. The nurse is participating in the clinical trial of a new medication for the treatment of hypertension. To assess the effectiveness of the medication, which interventions would the nurse perform to help determine whether the average dose is effective for the patient? Select all that apply. 1. Monitoring blood pressure 2. Monitoring heart rate 3. Interpreting laboratory values 4. Monitoring diet 5. Monitoring sleep habits 78/100 23. The nurse explains to a student nurse that the median lethal dose of drugs is often determined in laboratory preclinical trials because - Select all that apply. 1. it would be unethical to determine these values in human subjects. 2. the safety of the medication must be determined prior to clinical trials. 3. it is difficult to obtain sufficient participants for clinical trials. 4. clinical trials determine only the effective dose of a drug. 5. it is too costly to conduct the studies during clinical trials. 24. The nurse is preparing to administer a medication to a patient on a medical-surgical unit. The median lethal dose of the drug is 40 mg, and the median effective dose is 10 mg. The nurse calculates the therapeutic index to be _____. Correct Answer: 4 25. A patient with hypertension is taking a potent antihypertensive without results. The patient is concerned when the health care provider orders a new drug. The nurse explains, - Select all that apply. 1. "The drug you took is very potent, and a higher dose is needed." 2. "The new drug has greater efficacy, so it will help reduce your blood pressure." 3. "The prescriber must have made an error in the orders." 4. "Efficacy in treating your hypertension is more important than potency." 5. "You are correct. I think the prescriber meant to order both drugs." 26. The nurse is reviewing the medication administration record for a group of patients and recognizes that which agents have nonspecific cellular responses? Select all that apply. 1. Ethyl alcohol 2. General anesthetics 3. Osmotic diuretics 4. Calcium channel blockers 5. Alpha-adrenergic antihypertensives 27. Type: Hot Spot Mark the location of the beginning of the plateau phase on this dose-response relationship curve. Figure: Use Figure 5.3 from the text. Delete the three phase labels. Hot spot A should be at the beginning of the curve, hot spot B should be at the area where the curve moves upward, hot spot C should be half way up the upstroke of the curve (about where phase 2 is currently), and hot spot D should be the horizontal area at the top of the curve (currently marked phase 3). 1. A 2. B 3. C 4. D 28. Literature review reveals that a new drug has a median lethal dose of 10 and a median effective dose of 5. The nurse determines that an error in which _____ times the correct dose is given could be lethal. Correct Answer: 2 79/100 29. During assessment, the patient mentions that he recently “sent off to a company for pharmacogenomic testing.” What nursing responses are indicated? Select all that apply. 1. “Have you changed your medications any?” 2. “Have you talked with your physician about the results?” 3. “Why did you do that?” 4. “Was that test expensive?” 5. “Who told you about the testing?” 30. The nurse reads that a newly discovered drug is a functional antagonist for some commonly administered medications. The nurse interprets this information as indicating the new drug could have which actions? Select all that apply. 1. Blocks alpha receptors 2. Enhances drug excretion 3. Blocks beta receptors 4. Speeds drug metabolism 5. Inhibits protein synthesis Chapter 8 1. The nurse teaches a class about medication used during pregnancy to pregnant women. The nurse determines that additional instruction is required when a class participant makes which response? 1. "The baby can only be harmed by medications during the first trimester." 2. "It is important to not take over-the-counter (OTC) drugs during my pregnancy." 3. "Exposure to teratogens can result in my baby's death or in malformations." 4. "If I breastfeed my baby, drugs can come through my breast milk." 2. The pregnant patient plans to breastfeed her baby. She asks the nurse about the use of herbal products during breastfeeding. What is the best response by the nurse? 1. "Be sure to check the label to see if the herbal product could be used during breastfeeding." 2. "Most drugs can be transferred to the infant during breastfeeding, so this is not recommended." 3. "Herbal products are considered natural, so it should be fine to use them during breastfeeding." 4. "This should be fine, as long as there is at least 12 hours between the time you use the product and when you breastfeed." 3. The nurse plans to teach a safety class to parents of toddlers about household exposure to medications. What will the best plan of the nurse include? Select all that apply. 1. Keep the toddler awake and observe for side effects of the medication. 2. Keep all medications locked up and stored out of reach of the toddler. 3. Use syrup of ipecac immediately if the toddler has ingested medication. 4. Call the Poison Control Center for guidance with any medication ingested. 5. Teach the toddler that medications are for adult use only. 4. The nursing instructor teaches student nurses about the Food and Drug Administration (FDA) Pregnancy Categories. What is the best information to include? Select all that apply. 80/100 1. Food and Drug Administration (FDA) Pregnancy Category C is safe to use during pregnancy. 2. Food and Drug Administration (FDA) Pregnancy categories provide a framework for safe use of drugs in pregnant women. 3. Food and Drug Administration (FDA) Pregnancy categories for individual drugs seldom change once they are established. 4. Food and Drug Administration (FDA) Pregnancy categories are based on studies using clinical human research trials. 5. Food and Drug Administration (FDA) Pregnancy Category X has been associated with teratogenic effects. 5. The nurse plans to administer medication to the preschool child. Which approach indicates the nurse has an understanding of growth and development? 1. The child is often more cooperative if the parent is not in the room. 2. The child does better with verbal instruction than with play instruction. 3. There should be no need to restrain a child of this age. 4. Use a brief rationale, followed by quick administration of the medication. 6. The nurse will administer medication to a school-age child. What is the preferred action by the nurse? 1. Teach the child the action and expected side effects of the medication. 2. Tell the child he will not be allowed to go to recess if the medication is not taken. 3. Offer the child a choice of beverage with which to take the medication. 4. Offer to play with the child prior to medication administration. 7. An adolescent patient comes to the school nurse with complaints of vague abdominal pain. What assessment data would help to confirm the nurse's suspicion that the adolescent has body image concerns? 1. The adolescent says, "Everyone makes a big deal about what I eat, so don't ask." 2. The adolescent tells the nurse, "I have been sexually active with my boyfriend." 3. The adolescent reports, "My periods are irregular. Should I see a doctor?" 4. The adolescent tells the nurse, "I just can't seem to get along with my parents." 8. The nurse provides care for elders in an assisted living facility. What does the nurse assess as a primary contributing factor for drug toxicity in the elderly? 1. Older adults often abuse alcohol. 2. Older adults are frequently dehydrated. 3. Older adults are frequently constipated. 4. Older adults have increased stomach acid. 9. The pregnant patient tells the nurse that her prescribed medication is not as effective as it was before her pregnancy. What is the best response by the nurse? 1. "This is because your blood volume has increased." 2. "Tell me how you have been taking your medication." 3. "This is because your baby is receiving part of the medication." 4. "Maybe the medication has expired; check the label." 10. The toddler refuses to take his oral medication. What is the best suggestion to the mother from the nurse for ensuring the toddler receives his medication? 1. "Tell him you will buy him a toy if he takes the medication." 81/100 2. "Crush the tablet and mix it with a small amount of jam." 3. "Crush the tablet and mix it with milk." 4. "Tell him he will be punished if he does not take the medicine." 11. The adolescent is supposed to go to the school nurse at 12:00 to receive his medication for attention-deficit hyperactivity disorder (ADHD). He often does not go for the medication. What best describes the nurse's understanding of this situation? 1. The adolescent is embarrassed in front of his peers. 2. The adolescent does not understand the need for the medication. 3. The adolescent forgets that he is supposed to take the medication. 4. The adolescent has made a conscious decision not to take the medication. 12. The nurse is teaching a caregivers' support group for caretakers of older adult patients. The focus is medication compliance. The nurse determines that learning has occurred when the caregivers make which response? 1. "We should crush their medicine and put it in applesauce so they will swallow it." 2. "We should use a medication management box so they won't forget to take it." 3. "We should ask the doctor if all the medication is really necessary." 4. "We should give them more education about the medicine so they will take it." 13. A nurse working in an obstetric practice should consider which fact when discussing medication use with pregnant patients? 1. Inhaled drugs may be absorbed to a greater extent. 2. Drug excretion rates are lowered. 3. Oral drug absorption rate is lowered. 4. Drugs should not be used during pregnancy. 14. Which classification of drugs would the nurse refuse to administer to a pregnant patient? 1. category A 2. category B 3. cautionary 4. teratogenic 15. The nurse teaching a pre-conception class would tell participants that they should be most careful about exposure to drugs during which stage of pregnancy? 1. Each stage is equal in risk. 2. Pre-implantation period 3. Third trimester 4. Embryonic 16. A drug for which research has shown an adverse effect in animals but not in pregnant women would be categorized as Category 1. A. 2. B. 3. D. 4. C. 17. A woman who wishes to become pregnant is concerned about the drugs she must take in order to treat a serious medical condition. The nurse reviewing the drug list would be most concerned about which kind of drug? 1. A drug with a long half-life 82/100 2. A drug with no active metabolites 3. A drug with high protein-binding ability 4. A drug taken only when needed 18. Which method would the nurse use to administer medications to school-age children? 1. Allow the child to make decisions regarding how medications are taken 2. Provide a brief explanation 3. Administer drugs while holding the child down 4. Provide a lengthy explanation followed by quick drug administration 19. Which statement is accurate regarding pharmacotherapy in the older adult? 1. Increased body water can lead to a higher risk of drug toxicity. 2. Plasma levels are increased, leading to a heightened drug response. 3. Generally, drug doses should be increased due to prolonged drug metabolism. 4. Drug absorption is slower due to increased gastric pH. 20. A patient presents with hypotension and bradycardia. The patient indicates that one of her physicians recently prescribed three new medications to her current list of 10 medications per day. Based on this information, which statement would be the most accurate? 1. The patient is having an allergic reaction to one of the new medications. 2. The patient is experiencing adverse reactions as a result of polypharmacy. 3. The patient is not in compliance with her prescribed medications. 4. The patient is experiencing an adverse effect that will go away in time. 21. When possible, drug therapy is postponed until after pregnancy and lactation. However, certain acute and chronic conditions must be managed during pregnancy, including Select all that apply. 1. epilepsy. 2. serious cystic acne. 3. sexually transmitted infections. 4. gestational diabetes. 5. hypertension. 22. The nurse preparing a teaching plan for an adolescent postpartum mother includes which topics? Select all that apply. 1. Most medications are secreted into breast milk. 2. Dietary supplements should be avoided. 3. Over-the-counter (OTC) herbal products are secreted into breast milk and have the potential to cause harm to the infant. 4. All tobacco products should be avoided. 5. Most drugs are safe to take right after breastfeeding because they will clear the bloodstream prior to the next feeding. 23. The nurse is planning care for a pregnant patient prone to substance abuse. When the patient states, "My baby isn't getting my drugs, I am," how does the nurse respond? Select all that apply. 1. "Most illicit drugs will cross the placenta and hurt the baby." 2. "Drugs may work longer in your baby." 3. "Some drugs result in your baby not growing enough." 83/100 4. "You are correct. You are far enough along in your pregnancy that drugs will not harm your baby." 5. "If you continue to take drugs, it will make you have a very irritable infant." 24. A pregnant patient suspected of drug abuse is admitted to the emergency department. The nurse plans to teach the patient about which complications associated with drug use during pregnancy? Select all that apply. 1. Preterm birth 2. Low birth weight 3. Birth defects 4. Allergies to narcotics 5. Increased labor 25. For which patient would the nurse expect the health care provider to continue prescribed medications during pregnancy? Select all that apply. 1. The patient recently diagnosed with gonorrhea 2. The patient with a history of frequent asthma attacks 3. The patient with hypertension 4. The patient with frequent insomnia 5. The patient with a family history of stroke 26. The clinic nurse will immediately alert the health care provider when which category X drugs are identified on the medication record of a recently diagnosed pregnant patient? Select all that apply. 1. Tetracycline 2. ACE inhibitor antihypertensive medication 3. Methotrexate 4. Isotretinoin (Accutane) 5. Oral contraceptives 27. The nurse preparing to transfer to a pediatric hospital would expect to administer medications to children from birth to age _____ years. Correct Answer: 16 28. A nurse has provided discharge medication instructions to the parents of a child being released from the emergency department. The nurse evaluates that learning has occurred when the parents make which statements? Select all that apply. 1. “I should give this antibiotic as prescribed until the bottle is empty.” 2. “I should use a spoon to give this medication.” 3. “I will keep this medication in the refrigerator as the label directs.” 4. “If my child develops any adverse effects, I will discard the rest of the medicine.” 5. “This antibiotic should help my child’s infection clear.” 29. A nurse is reviewing medication records of older adults living in extended care. Which concepts about the pharmacotherapy of older adults should be considered? Select all that apply. 1. Plasma-binding of drugs is greater in those over age 65. 2. Drug distribution is slowed in the older adult. 3. The half-life of many drugs is lessened in older adults. 4. First-pass metabolism is reduced in the older adult. 84/100 5. Changes in the kidney may result in decreased drug excretion. 30. A nurse is providing care to a patient who wears bilateral hearing aids. Which nursing interventions are indicated? Select all that apply. 1. Speak a bit slower than normal. 2. Speak more loudly than normal. 3. Ensure that verbal and nonverbal communication is congruent. 4. Allow extra time for communication. 5. Use bright lighting in the room. Chapter 14 1. The patient tells the nurse he worries about everything all day, feels confused, restless, and just can't stop worrying. What is the best response by the nurse? 1. "You have generalized anxiety; I will teach you some relaxation techniques." 2. "This sounds like social anxiety. You need to calm down and you'll be fine." 3. "You have posttraumatic stress disorder (PTSD), and it is time for your therapy session." 4. "This is called panic disorder; I'll get your medication for you." 2. The nurse has completed group education for patients with anxiety disorders. The education is evaluated as successful when the patients make which statements? Select all that apply. 1. "Relaxation techniques will often decrease anxiety." 2. "Antianxiety medicine should be used until anxiety is gone." 3. "Antianxiety medicine should not be used indefinitely." 4. "Therapy may help identify where this anxiety comes from." 5. "Different medications are required for treating anxiety than for treating difficulty sleeping." 3. The patient tells the nurse that she is interested in the human brain and questions which parts of the brain control anxiety and insomnia. What is the best reply by the nurse? 1. "The limbic system and reticular activating system control anxiety and insomnia." 2. "The frontal lobes and limbic system control anxiety and insomnia." 3. "The thalamus and reticular activating system control anxiety and insomnia." 4. "The limbic system and hypothalamus control anxiety and insomnia." 4. The patient tells the nurse, "I am really confused after talking to my doctor. He said I would be taking different kinds of medications for my anxiety and insomnia. Will you please explain it?" What is the best response by the nurse? Select all that apply. 1. "You will be taking medications known as sedative-hypnotics." 2. "You will be taking medications known as antidepressants." 3. "You will be taking a medication known as paraldehyde." 4. "You will be taking medications known as barbiturates." 5. "You will be taking medications known as benzodiazepines." 5. The patient has generalized anxiety disorder. He asks the nurse, "Will I need medication for this? My neighbor is very nervous and he takes medication." What is the best response by the nurse? 1. "Medications are a way of life for patients with anxiety disorders." 85/100 2. "Medication is necessary initially; later we will try therapy." 3. "Probably not, but you shouldn't compare yourself to your neighbor." 4. "Medication is necessary when anxiety interferes with your quality of life." 6. The patient has been treated by the same physician for 2 years and has had insomnia the entire time. Many different medications have been tried with limited success. What should be the nurse's primary assessment at this time? 1. Assess for a primary sleep disorder such as sleep apnea. 2. Assess if the patient has been selling his medications to addicts. 3. Assess if the patient has an addictive personality disorder. 4. Assess the patient for a primary personality disorder. 7. The patient is scheduled to have an EEG to confirm the presence of a sleep disorder. The patient asks the nurse to describe NREM stage 3 sleep. What is the best response by the nurse? 1. "This is the lightest stage of sleep and is profoundly affected by anxiety." 2. "Dreaming occurs here; without dreams you will be irritable and paranoid." 3. "This is the deepest stage of sleep; without it you will be tired and depressed." 4. "This is the also called paradoxical sleep." 8. The patient has been taking lorazepam (Ativan) for 2 years. The patient stopped this medication after a neighbor said the drug manufacturer's plant was contaminated with rat droppings. What best describes the nurse's assessment of the patient when seen 3 days after stopping his medication? 1. Increased heart rate, fever, and muscle cramps 2. Nothing different; it is safe to abruptly stop lorazepam (Ativan) 3. Pinpoint pupils, constipation, and urinary retention 4. A sense of calmness and lack of anxiety 9. The patient comes to the emergency department after an overdose of lorazepam (Ativan). The nurse will plan to administer which medication? 1. Pralidoxime (Protopam) 2. Naloxone (Narcan) 3. Flumazenil (Romazicon) 4. Nalmefene (Revex) 10. The nurse works with a physician who frequently prescribes benzodiazepines. The use of benzodiazepines in which patient would cause the nurse the most concern? 1. An 87-year-old patient who uses a cane for ambulation 2. A 9-year-old child with panic attacks 3. A 42-year-old businessman who travels internationally 4. A 32-year-old mother of two preschool children 11. The nurse has completed medication education for the anxious patient who is receiving buspirone (BuSpar). The nurse determines that the patient needs additional instruction when the patient makes which statement? 1. "Side effects I might experience include dizziness, headache, and drowsiness." 2. "I can take this medication when I feel anxious and it will relax me." 3. "I have to take this medicine on a regular basis for it to help me." 4. "I don't need to worry about becoming dependent on this medication." 86/100 12. The patient is receiving zolpidem (Ambien) for treatment of short-term insomnia. What is the primary safety concern of the nurse when the patient takes this medication? 1. Dizziness and daytime sedation 2. Nausea 3. Diarrhea 4. Sleepwalking 13. The patient is receiving escitalopram (Lexapro) for treatment of generalized anxiety disorder. The patient asks the nurse, "I am just nervous, not depressed. Why am I taking an antidepressant medicine?" What is the best response by the nurse? 1. "The same brain chemicals are involved with anxiety as well as depression.” 2. "You are really depressed; it is just manifested as anxiety. These medications are safer than benzodiazepines." 3. "Your doctor thinks that this is the best treatment for your anxiety, and these medications are safer than benzodiazepines." 4. "The two disorders go together, and if you treat depression, the anxiety goes away." 14. The patient has been receiving escitalopram (Lexapro) for treatment of obsessivecompulsive disorder. Unknown to the nurse, the patient has also been self-medicating with St. John's wort. The patient comes to the office with symptoms of hyperthermia and diaphoresis. Which statement best describes the result of the nurse's assessment? 1. The patient is experiencing symptoms of St. John's wort toxicity, as the medication was most likely outdated. 2. The patient has contracted a viral infection. Escitalopram (Lexapro) and St. John's wort are safe to take together. 3. The patient has not been taking escitalopram (Lexapro) and is experiencing withdrawal. 4. The patient has combined two antidepressant medications and is experiencing serotonin syndrome. 15. The patient is receiving the benzodiazepine clonazepam (Klonopin) for the treatment of panic attacks. What is an important medication outcome for this patient as it relates to safety? 1. The patient will verbalize the signs of developing Stevens-Johnson rash. 2. The patient will verbalize the importance of diet restrictions related to this drug. 3. The patient will verbalize the importance of having routine blood work done. 4. The patient will verbalize the consequences of stopping the drug abruptly. 16. An individual who has difficulty sleeping due to two final examinations scheduled for the same day later in the week most likely would be suffering from 1. situational anxiety. 2. social anxiety. 3. obsessive-compulsive disorder. 4. performance anxiety. 17. The most productive way of managing stress would be to 1. use a combined approach (drug use and nonpharmacological strategies). 2. use anxiolytics. 3. practice meditation. 4. determine the cause and address it accordingly. 87/100 18. Which area of the brain is primarily responsible for maintaining sleep and wakefulness? 1. Reticular activating system 2. Cerebral cortex 3. Limbic system 4. Cerebellum 19. Which drug category can be used for treating anxiety? 1. Antitussives 2. Anticoagulants 3. Seizure drugs 4. Antibiotics 20. Benzodiazepines are often the drug of choice for managing anxiety and insomnia. Which statement best explains why? 1. Benzodiazepines are the most effective. 2. Benzodiazepines have the lowest risk of dependency and tolerance. 3. Benzodiazepines are most likely to be covered under insurance premiums. 4. Benzodiazepines are the most affordable. 21. Which common adverse effects of selective serotonin reuptake inhibitors (SSRIs) would be stressed by the nurse during patient discharge? 1. Drowsiness and coma 2. Weight gain and sexual dysfunction 3. Headache and nausea 4. Dry mouth and urine retention 22. A patient taking which of the following medications should avoid foods high in tyramine? 1. MAOIs 2. SSRIs 3. Beta blockers 4. Benzodiazepines 23. Which statement regarding the use of zolpidem (Ambien) for insomnia is accurate? 1. Patients using Ambien should avoid foods that contain tyramine. 2. Ambien will take longer to produce an effect when taken with food. 3. Ambien is contraindicated during pregnancy but can be taken by breastfeeding mothers. 4. Ambien is classified as a benzodiazepine. 24. Which explanation best indicates why barbiturates are rarely used to treat anxiety and insomnia? 1. They have a greater associated cost. 2. They have a high risk of producing an allergic response. 3. They are seldom effective. 4. They produce many serious adverse effects. 25. It is important for the nurse to obtain a thorough history from a patient who is experiencing anxiety. This history will help to distinguish Select all that apply. 1. the best method of pharmacotherapy. 2. whether the patient might benefit from individual or group therapy. 3. the category of anxiety disorder. 88/100 4. the region of the brain that is causing the anxiety disorder. 5. substances that might worsen anxiety. 26. The patient is diagnosed with post-traumatic stress disorder. What will the nurse assess in this patient? Select all that apply. 1. Tachycardia 2. Extreme nervousness or panic attacks 3. Inability to focus 4. A fear of exposure to germs 5. Hallucinations, nightmares, or flashbacks 27. A patient has been in the intensive care unit for a week receiving various procedures throughout the day and night. Currently the patient, though physiologically stable, is irritable and paranoid and complains of vivid dreams when dozing off to sleep. What are the best actions for the nurse to take at this time? Select all that apply. 1. Check the patient's oxygen status. 2. Request an order for sleep medication. 3. Assess the patient's vital signs. 4. Turn down the lights at night and reduce noise to a minimum. 5. Schedule all tests and procedures before 9 p.m. or after 7 a.m. 28. A patient whose spouse recently died is having difficulty falling asleep and does not want to take any prescription medications to induce sleep. How should the nurse respond? Select all that apply. 1. "Make certain your bedroom is nice and warm." 2. "There are alternative methods to treat insomnia, such as yoga, meditation, and massage therapy." 3. "Eating a large meal at bedtime will help induce sleep." 4. "Avoid caffeinated beverages, nicotine, and alcohol immediately prior to bedtime." 5. "Count sheep after lying down in order to enhance sleep." 29. A patient who has recently experienced the loss of a spouse asks the nurse if there are any over-the-counter herbs or nonprescription medications that can be used to improve insomnia. How should the nurse respond to this patient? Select all that apply. 1. "Ginger root is commonly taken to improve sleep." 2. "Ginkgo is an herb commonly taken to improve sleep." 3. "Diphenhydramine (Benadryl) and doxylamine are over-the-counter meds sometimes taken to produce drowsiness." 4. "Valerian and melatonin are herbs commonly taken to improve sleep." 5. "Kava is an herb taken to improve sleep." 30. A patient who is complaining of anxiety and difficulty sleeping has asked what prescription medications would assist in getting to sleep. What would be appropriate responses? Select all that apply. 1. Diphenhydramine (Benadryl) 2. Valerian root 3. Ramelteon (Rozerem) 4. Flurazepam (Dalmane) 5. Zolpidem (Ambien) 89/100 Chapter 16 1. The patient tells the nurse, "I thought I was just depressed, but my doctor says I have bipolar disorder. What is that?" What is the best response by the nurse? a. "Bipolar disorder is just another type of depression, except your depression occurs in cycles." b. "Bipolar disorder is a type of depression that includes attention deficit disorder symptoms." c. "Bipolar disorder just means that your mood alternates with the seasons, and it becomes worse in the winter." d. "Bipolar disorder means you have cycles of depression as well as hyperactivity, or mania." 2. The mother of a 7-year-old child says to the nurse, "My child is distractible in school, cannot complete assignments on time, and interrupts other children while they are speaking. What do you think?" What is the best response by the nurse? a. "This sounds like your child is depressed; depression looks different in children and is very serious." b. "This sounds like bipolar disorder; you might want to have your child tested by a child psychiatrist." c. "This could be attention-deficit hyperactivity disorder (ADHD); you might want to have your child tested." d. "This sounds like typical 7-year-old behaviors to me; if they do not resolve, have your child tested." 3. The nurse is conducting a group education session for patients who have been diagnosed with depression. The nurse evaluates the education as effective when a patient makes which comments about the cause of depression? Select all that apply. a. 1. "Depression has many causes; they could include environmental as well as brainbased disorders." b. 2. "Depression includes impaired relationships and is also an inherited illness." c. 3. "We really don't know what causes depression; it has not been studied very much." d. 4. "Depression results from unresolved conflicts in your childhood." e. 5. "Depression results from parents who are cold and distant and don't really care about their children." 4. The patient receives imipramine (Tofranil) as treatment for depression. He is admitted to the emergency department following an intentional overdose of this medication. What will the priority assessment by the nurse include? a. 1. The patient's cardiac status b. 2. The patient's liver function c. 3. The patient's renal status d. 4. The patient's neurological function 5. The patient has been receiving amitriptyline (Elavil) for 2 weeks. He tells the nurse he doesn't think this medicine is working, as he is still depressed. What is the best response by the nurse? a. 1. "It is working, but it can take several weeks to have an effect." b. 2. "You might still feel depressed, but you are looking much better." c. 3. "This may not be the best medicine for you; I'll call your doctor." d. 4. "It is working, but it can take several months to have an effect." 90/100 6. The physician has prescribed sertraline (Zoloft) for the patient who is anxious and depressed. The patient calls the nurse to report that he has experienced delayed ejaculation since being on this medication. What is the best response by the nurse? a. 1. "I will let your doctor know, and he will most likely change your medication." b. 2. "This does happen, but treating your depression is a bigger priority." c. 3. "I am concerned that you will become suicidal if you stop the medication." d. 4. "Keep taking the medicine, as this usually goes away after a few months." 7. The patient has been depressed, and the physician plans to begin treatment with an antidepressant medication. In performing the initial assessment, what is the most important question for the nurse to ask? a. 1. "How much alcohol do you consume during the week?" b. 2. "Are you allergic to any medications?" c. 3. "How long have you been depressed?" d. 4. "Have you had any thoughts about killing yourself?" 8. The nurse has completed medication education for a patient prior to the patient receiving phenelzine (Nardil). The nurse evaluates the education as effective when the patient makes which statements? Select all that apply. a. 1. "I am really going to miss my morning coffee and sweet roll." b. 2. "I'll have to give up my beer at the football games." c. 3. "I can't eat fried chicken and gravy." d. 4. "I am not supposed to have processed meats or cheese." e. 5. "I really shouldn't eat at a restaurant; too many foods are on my restricted list." 9. The patient has bipolar disorder and is in a manic phase. The physician prescribes lithium (Eskalith). The patient's current lithium level is 0.4. What will the nurse expect to assess in this patient? a. 1. A return to baseline behavior, calm and rational b. 2. Hyperactivity and pressured speech c. 3. Signs and symptoms of depression d. 4. A decrease in manic behavior 10. The nurse has completed medication education with the patient who is receiving lithium (Eskalith). What is the priority patient outcome? a. 1. The patient will be able to work a normal work schedule and will receive adequate sleep. b. 2. The patient will identify signs of lithium (Eskalith) toxicity and verbalize measures to avoid it. c. 3. The patient will engage in activities of daily living and report enjoyment with them. d. 4. The patient will report stabilization of mood, including absence of mania or depression. 11. The patient asks the nurse why she needs to continue using table salt because her prescribed lithium (Eskalith) is a salt. What is the best response by the nurse? a. 1. "You must continue to use salt to avoid lithium (Eskalith) toxicity. If you use sea salt, you don't need as much." b. 2. "You must use table salt or your kidneys will retain lithium (Eskalith), and you will become toxic." c. 3. "The amount is not important; just increase your table salt if you notice signs of lithium (Eskalith) toxicity." d. 4. "Salt is very important to avoid lithium (Eskalith) toxicity, but not as important as drinking 1 to 1.5 L of water per day." 91/100 12. What is the priority outcome for a 6-year-old patient who had been started on methylphenidate (Ritalin)? a. 1. The patient will avoid altercations with peers. b. 2. The patient will be able to complete age-appropriate chores at home. c. 3. The patient will use age-appropriate play with peers. d. 4. The patient will maintain weight within norms for this age group. 13. The 8-year-old patient is receiving methylphenidate (Ritalin). The patient's mother tells the nurse that he won't eat while on his medication. What is the best response by the nurse? a. 1. "It sounds like he is becoming depressed. I will speak to the doctor about starting an antidepressant medication." b. 2. "Give the medication after meals and encourage him to have supplements between meals." c. 3. "You are right to be concerned. I will speak to the doctor about starting an appetite stimulant medication." d. 4. "This is a very serious concern; it would be best for him to see a nutritionist for counseling." 14. A patient was prescribed sertraline (Zoloft) for the treatment of depression and anxiety. The patient’s spouse calls the clinic and reports the patient is increasingly moody and seems “disconnected with life.” What is the best response by the nurse? a. 1. "Try giving him some diphenhydramine (Benadryl) to see if that helps him relax." b. 2. "Bring him to the clinic for assessment today.." c. 3. "Hold his medication today and see if his mood improves." d. 4. " “Double the daily dose of sertraline (Zoloft) and call us back in three days.” 15. Which symptoms experienced over 1 month would be most helpful to diagnose bipolar disorder? a. 1. Difficulty sleeping, obsession with death, hallucinations b. 2. Delusions, unkempt appearance, fatigue c. 3. Abnormal eating patterns, feelings of despair, flight of ideas d. 4. Increased goal-directed behavior and talkativeness, distractibility 16. Which statement is accurate regarding attention-deficit hyperactivity disorder (ADHD)? a. 1. ADHD is characterized by periods of mania and periods of depression. b. 2. Anxiety and social withdrawal are more frequently seen in girls than in boys. c. 3. Diagnosis is higher in girls than in boys. d. 4. ADHD is generally diagnosed later in life. 17. Depression that occurs during cold winter months would be classified as a. 1. baby blues. b. 2. bipolar disorder. c. 3. seasonal affective disorder. d. 4. obsessive-compulsive disorder. 18. Which drug type used to treat depression works by preventing enzymatic destruction of the neurotransmitter norepinephrine? a. 1. Serotonin-norepinephrine reuptake inhibitors (SNRIs) b. 2. Selective serotonin reuptake inhibitors (SSRIs) c. 3. Tricyclic antidepressants (TCAs) d. 4. Monoamine oxidase inhibitors (MAOIs) 19. Which drug type is often used as a first-line treatment for depression due to its side effect profile? a. 1. Monoamine oxidase inhibitors (MAOIs) 92/100 20. 21. 22. 23. 24. 25. 26. b. 2. Beta-adrenergic blockers c. 3. Tricyclic antidepressants (TCAs) d. 4. Selective serotonin reuptake inhibitors (SSRIs) Which food items should the nurse advise a patient taking a monoamine oxidase inhibitor (MAOI) to avoid? a. 1. Orange juice, cottage cheese, and turkey b. 2. Spring water, ice cream, and salmon c. 3. Chocolate, wine, and fava beans d. 4. Spinach, rice, and venison The traditionally prescribed drug types used to treat attention-deficit hyperactivity disorder (ADHD) include a. 1. CNS depressants. b. 2. parasympathomimetics. c. 3. CNS stimulants. d. 4. sympathomimetics. Which statement best explains drugs like methylphenidate help a patient with attention-deficit hyperactivity disorder (ADHD)? a. 1. Neurotransmitters are blocked, limiting the effects they can produce within the PNS. b. 2. Activation of certain areas of the brain causes increased attention and ability to focus. c. 3. Neurotransmitter levels are reduced, which produces a calming effect within the CNS. d. 4. Certain areas of the brain are deactivated, resulting in a calming effect. A 40-year-old patient experiencing periods of mania and periods of depression would most likely benefit from which of the following? a. 1. Atomoxetine (Strattera) b. 2. Amitriptyline (Elavil) c. 3. Methylphenidate (Ritalin) d. 4. Carbamazepine (Tegretol) The nurse is concerned that a patient is moving into the manic phase of bipolar disorder when what is assessed? Select all that apply. a. 1. Not sleeping b. 2. Losing weight c. 3. Sluggish activity d. 4. Complaints of muscle pain e. 5. Constant talking The nurse is instructing a patient on the cause of bipolar disorder. What neurotransmitters will the nurse describe as contributing to the manic phase of this disorder? Select all that apply. a. 1. Excessive glutamate b. 2. Excessive norepinephrine c. 3. Deficiency of gamma-aminobutyric acid d. 4. Deficiency of dopamine e. 5. Excessive serotonin During a health history, the nurse wants to include an assessment of depression with an older patient. What statements will the nurse use to make this assessment? Select all that apply. a. 1. "How often do you go out to socialize with friends?" b. 2. "Explain your self-care activities." c. 3. "How much alcohol do you consume every day?" d. 4. "How is living with your oldest daughter and her family working out for you?" e. 5. "Are you feeling depressed?" 93/100 27. During a health history, the nurse is concerned that a patient with depression is at risk for suicide when the patient Select all that apply. a. 1. states that "suicide is always an option." b. 2. describes a previous unsuccessful attempt at suicide by aspirin overdose. c. 3. states that the prescribed medication is not working and that feelings of depression are worse. d. 4. requests prescriptions for pain medication and a sleeping aid. e. 5. expresses interest in meeting with friends more often. 28. A patient who has been taking antidepressant medication for several months and is demonstrating an improvement in symptoms tells the nurse that counseling sessions might be helpful. Which types of therapies will the nurse review with the patient? Select all that apply. a. 1. Behavioral therapy b. 2. Interpersonal therapy c. 3. Cognitive-behavioral therapy d. 4. Psychodynamic therapy e. 5. Crisis therapy 29. A patient with depression does not want to take prescribed medication because of the side effects. What can the nurse suggest to help with medication adherence? Select all that apply. a. 1. Use ice chips to help alleviate dry mouth. b. 2. Chew gum or use hard candy to help alleviate dry mouth. c. 3. Avoid alcohol-based mouthwash to help alleviate dry mouth. d. 4. Use "dry eye" drops to help with eye dryness. e. 5. Ask the pharmacist to fill the prescription with the same drug from a different manufacturer. 30. The parent of a child being treated for ADHD says a neighbor child with the same diagnosis is on a “drug holiday.” How should the nurse explain this treatment option? Select all that apply. a. 1. “Drug holidays may be used to reduce dependence on medications or to assess symptoms.” b. 2. “If you feel like the medication is sedating your child too much, you can hold doses for 3 or 4 days which is known as a drug holiday.” c. 3. “Drug holidays are times when dosage is increased to assess the patient’s tolerance to medications.” d. 4. “You should not consider using a drug holiday until you have discussed that option with your provider.” e. 5. “Drug holidays require careful scheduling.” Chapter 48 1. A child has rickets and is being treated at the clinic. In addition to taking vitamin D as prescribed, what is the best information the nurse can provide? 94/100 1. Avoid dairy products while taking vitamin D. 2. Be sure to take brand name, not generic, vitamin D. 3. Spend at least 20 minutes/day in the sunlight. 4. Take your vitamin D on an empty stomach. 2. The client receives alendronate (Fosamax) as treatment for osteoporosis. The nurse has completed medication education and evaluates learning has occurred when the client makes which statements? Select all that apply. 1. "I cannot lie down for at least 30 minutes after taking the medication." 2. "Milk will help with the absorption of this medication." 3. "I should call my doctor if I experience heartburn." 4. "I must take this with a full glass of water." 5. "The medication can be taken with or without food." 3. The client has osteomalacia, and the physician has ordered a treatment to restore calcium balance. What will the nurse plan to administer to the client? 1. Calcium supplements and dark green, leafy vegetables 2. Calcium supplements and milk products 3. Calcium supplements and potassium 4. Calcium supplements and vitamin D 4. The nurse is teaching about the need for vitamin D in the body. The nurse would put these steps of vitamin D activation and action in which order? 1. Calcium absorption is increased in the small intestine 2. Calcifediol is formed 3. Dietary products are consumed 4. Calcitriol is formed 5. Cholecalciferol is synthesized Correct Answer: 3,5,2,4,1 5. The client receives hydroxychloroquine sulfate (Plaquenil). Which test does the nurse tell the client should be done on a regular basis? 1. Serum potassium 2. Eye exams 3. Serum glucose 4. Blood pressure 6. The client has gout and receives allopurinol (Zyloprim). The nurse has completed medication education and evaluates that learning has occurred when the client makes which statements? Select all that apply. 1. “It may take a few days or weeks for me to get the full effect of this medication.” 2. “I should not drink alcohol while taking this drug.” 3. “If I develop a skin rash, I should contact the prescriber.” 4. “I should not crush this medication.” 5. “I should take this medication with food.” 7. The client takes calcium supplements. What is the best instruction by the nurse? 1. "This drug may cause insomnia." 2. "Take your calcium with a meal." 3. "It does not matter if vitamin D is added." 95/100 4. "Take them on an empty stomach." 8. The nurse assesses the client might be experiencing toxicity from colchicine. Which statement by the client would most likely confirm the nurse's suspicion? 1. "My joints hurt more." 2. "I have nausea, vomiting, and abdominal pain every day." 3. "I don't see as well as I used to, and my taste has changed." 4. "I wake up at night with muscle cramps." 9. The client takes a bisphosphonate for osteoporosis. Which assessment is best in determining the effectiveness of the medication? 1. Normal serum calcium levels 2. Absence of fractures 3. Bone density scan 4. Absence of bone pain 10. The nurse has taught the client with osteoporosis about how to manage the illness. Which statement by the client indicates that additional teaching is necessary? 1. "I will avoid drinking alcohol." 2. "I will walk for 30 minutes every day." 3. "I will take my calcium at bedtime." 4. "I will drink milk regularly." 11. The client has arthritis and has just learned that she is pregnant. What is the best instruction by the nurse? 1. Avoid using heat on the joint. 2. Hydroxychloroquine (Plaquenil) is the best medication for you. 3. You could try splinting for discomfort. 4. Glucocorticoids are considered safe during pregnancy. 12. The nurse teaches a class for college students about osteoporosis. What is the best information to include? 1. Prevention of osteoporosis begins in early adulthood. 2. Medication is the primary treatment to prevent and halt bone loss. 3. Osteoporosis is an inevitable part of aging. 4. Men do not need to be concerned about osteoporosis. 13. The client's calcium level is low. What will be the nurse's primary concern? 1. Seizures 2. Bone fractures 3. Hypoglycemia 4. Depression 14. The nurse administers calcium intravenously (IV) to the client. What will a key assessment by the nurse include? 1. Assess the serum glucose levels. 2. Assess the intravenous (IV) site. 3. Assess the serum potassium levels. 4. Assess for peripheral edema. 96/100 15. The client receives alendronate (Fosamax) as treatment for osteoporosis. Which symptoms, caused by an adverse effect of the medication, does the nurse teach should be reported to the physician? 1. Ringing of the ears 2. Hot and dry skin 3. Vision changes and photophobia 4. Muscle spasms and facial twitching 16. An important function of calcium is to 1. regulate acid–base balance. 2. improve glucose absorption. 3. increase energy. 4. regulate nerve transmission. 17. Which sign is common with hypocalcemia? 1. Bruising 2. Hypertension 3. Muscle wasting 4. Muscle spasms 18. The symptoms of gout are due to 1. an increase in the excretion of uric acid. 2. buildup of uric acid in the blood. 3. cartilage loss in the joints. 4. a decrease in uric acid in the blood. 19. A client takes calcium three times a day in the form of supplements. The nurse will advise the client to take the drug 1. with tea or coffee. 2. on an empty stomach. 3. with zinc supplements. 4. with food. 20. The mechanism of action of selective estrogen receptor modulators (SERMs), such as raloxifene (Evista), is to 1. increase calcium levels in the bone. 2. slow bone resorption. 3. inhibit synthesis of microtubules. 4. increase bone mass and density. 21. During a medication history, the client states, “I take the calcium supplement called calcitriol.” How should the nurse respond to this statement? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. “Calcitriol is a vitamin D supplement.” 2. “What other medications do you take?” 3. “You don’t understand the medications you are taking.” 4. “Do you also take a vitamin D supplement?” 5. “Do you take the prescription strength or over-the-counter?” Correct Answer: 1,2 97/100 22. A client who has osteoporosis says, “I am exercising more. I go to the gym once a week.” How should the nurse respond? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. “What kind of exercises are you doing?” 2. “You should try to exercise three to five times a week.” 3. “That is not enough.” 4. “Is there somewhere that you can walk on the days you don’t go to the gym?” 5. “Exercise will not improve your osteoporosis.” Correct Answer: 1,2,4 23. A client states, “I stopped taking my medications for osteoporosis. I couldn’t see how they were helping me any.” How should the nurse respond? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. “The results from these medications are hard for you to see.” 2. “It takes about 6 months to see any results.” 3. “When did you stop taking the medications?” 4. “Were there any other reasons that you decided to discontinue the medications?” 5. “You are not helping us help you when you don’t follow directions.” Correct Answer: 1,3,4 24. A client has been prescribed denosumab (Prolia). What medication education should the nurse provide? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. “I will give your medication in the form of an injection.” 2. “You may feel more fatigued than usual when taking this drug.” 3. “Be certain to keep your appointments for follow-up.” 4. “Do not take any kind of calcium supplement or vitamin D supplement while taking this drug.” 5. “We must monitor your cholesterol while you are taking this drug.” Correct Answer: 1,2,3,5 25. A client is receiving therapy for gout. Which information should the nurse provide? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. “You should not drink alcohol.” 2. “You should increase intake of fatty fish like salmon and sardines.” 3. “Take a vitamin C supplement while on your medication for gout.” 4. “Increase your fluid intake to 2 to 4 liters each day.” 5. “If your joint pain does not improve, let us know.” Correct Answer: 1,4,5 26. A patient has been prescribed a bisphosphonate for treatment of osteoporosis. The nurse evaluates that additional teaching is required if the patient makes which statement? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 98/100 1. “It will take at least 5 years for the maximum effect of this drug to happen.” 2. “If I stop taking this drug, all of the bone density improvement will rapidly disappear.” 3. “I still need to eat foods high in calcium.” 4. “I should spend 15 to 20 minutes in the sun on most days.” 5. “The medication I took to correct my vitamin D deficiency was in preparation for this new treatment.” Correct Answer: 1,2 27. A nurse is presenting community education for a group of patients with osteoarthritis. The nurse gives which information regarding the goals of pharmacotherapy for osteoarthritis? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. “Medications for osteoarthritis help to prevent development of rheumatoid arthritis.” 2. “Medications are given to help reduce the pain of osteoarthritis.” 3. “Some of the medications for osteoarthritis focus on reducing inflammation.” 4. “We can give medications to prevent the development of osteoarthritis.” 5. “Antibiotics are given to treat common infections caused by osteoarthritis.” Correct Answer: 2,3 28. A patient has been prescribed a bisphosphonate for treatment of osteoporosis. The nurse prioritizes teaching about immediately reporting which finding? 1. New onset thigh pain 2. Nausea 3. Headache 4. Dry, itchy skin Correct Answer: 1 29. A patient reports having “arthritis.” The nurse would determine that the patient’s arthritis is rheumatoid arthritis if which findings are reported by history? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Joint pain 2. Frequent fever 3. Pulmonary disease 4. Pericarditis 5. Inflammation in joints Correct Answer: 2,3,4 30. A patient calls the clinic to report severe exacerbation of gout. The patient says, “My probenecid (Probalan) is not helping.” The nurse would consider which information before responding? 1. The patient is confused on the drug name as probenecid (Probalan) is administered intravenously. 2. The patient will not have relief of pain until probenecid (Probalan) levels are increased, which takes at least 48 hours. 3. Probenecid (Probalan) is not used to treat acute attacks of gout. 99/100 100/100