Abrams’ Clinical Drug Therapy Rationales for Nursing Practice by Geralyn Frandsen -Test Bank




Abrams’ Clinical Drug Therapy Rationales for Nursing Practice by Geralyn Frandsen -Test Bank

chapter 2

1. Which cellular structure stores hormones and other substances and packages these substances into secretory granules?
  A) Golgi apparatus
  B) Endoplasmic reticulum
  C) Mitochondria
  D) Lysosome
  Ans: A
  The golgi apparatus stores hormones and other substances. The endoplasmic reticulum contains ribosomes, which synthesize proteins, including enzymes that synthesize glycogen, triglycerides, and steroids and those that metabolize drugs and other chemicals. The mitochondria generate energy for cellular activities and require oxygen. Lysosomes are membrane-enclosed vesicles that contain enzymes capable of digesting nutrients (proteins, carbohydrates, fats), damaged cellular structures, foreign substances (bacteria), and the cell itself.



2. A patient is suffering from a cough associated with an upper respiratory infection. Which oral medication will likely produce the most therapeutic effect?
  A) A tablet
  B) An expectorant
  C) A topical spray
  D) A timed-release tablet
  Ans: B
  Liquid medications are absorbed faster than tablets or capsules. Expectorants are liquid medications. A tablet is an oral medication that has a slower onset of action than a liquid medication. A topical spray can be sprayed to the back of the throat and provides only a local effect. A timed-release tablet is an oral medication that has a slower onset and longer duration of action.



3. A patient is administered an oral contraceptive. Which of the following is the process that occurs between the time the drug enters the body and the time that it enters the bloodstream?
  A) Absorption
  B) Distribution
  C) Metabolism
  D) Excretion
  Ans: A
  Absorption is the process that occurs from the time the drug enters the body to the time it enters the bloodstream to be circulated. Distribution involves the transport of drug molecules within the body. Metabolism is the method by which drugs are inactivated or biotransformed by the body. Excretion refers to elimination of a drug from the body.



4. Which of the following sites of drug absorption is considered to have an exceptionally large surface area for drug absorption?
  A) Rectum
  B) Fundus of the stomach
  C) Esophagus
  D) Lungs
  Ans: D
  The lungs have a large surface area for absorption of anesthetic gases and a few other drugs. The rectum absorbs the medication through the mucous membranes and has a smaller surface area than the lungs. The fundus and esophagus have comparatively small surface areas.



5. A nurse is aware of the importance of adhering to the intended route of a medication. Which of the following drugs are formulated to be absorbed through the skin?
  A) Amoxicillin, tetracycline, and penicillin
  B) Clonidine, fentanyl, and nitroglycerin
  C) Digoxin, lidocaine, and propranolol
  D) Insulin, heparin, and morphine
  Ans: B
  Some drugs are formulated in adhesive skin patches for absorption through the skin. Clonidine, fentanyl, and nitroglycerin are examples of drugs that are formulated in adhesive skin patch form to be absorbed through the skin. Amoxicillin, tetracycline, and penicillin are administered orally. Digoxin and propranolol are administered orally, and lidocaine can be administered intravenously, subcutaneously, or topically. Insulin and heparin are administered intravenously and subcutaneously. Morphine is administered orally, intramuscularly, and intravenously.



6. An 85-year-old patient has an elevated serum creatinine level, indicating impaired kidney function. When the patient is administered a medication, this patient is at risk for which of the following medication-related effects?
  A) Toxicity
  B) Increased absorption
  C) Delayed gastric emptying
  D) Idiosyncratic effects
  Ans: A
  An elevated creatinine level is indicative of diminished kidney function, which will result in serum drug toxicity. The creatinine level indicates kidney function, does not affect absorption, and has no effect on gastric emptying.



7. Protein binding is an important aspect of pharmacokinetics. Protein binding ultimately has which of the following effects on drug action?
  A) Increases the drug’s speed of action
  B) Decreases the drug’s speed of action
  C) Increases the rate of excretion
  D) Averts adverse effects
  Ans: B
  Protein binding allows part of a drug to be stored and released as needed. Drugs that are highly bound to plasma proteins or stored extensively in other tissues have a long duration of action. Protein binding does not increase the speed of action, increase the excretion rate, or avert adverse effects. Protein binding decreases the speed of action by storing the drug to be released when needed.



8. A patient is taking a medication that is metabolized by the CYP enzymes. Which of the following medications inhibits several of the CYP enzymes?
  A) Cisplatin
  B) Acebutolol hydrochloride
  C) Cimetidine
  D) Dicloxacillin sodium
  Ans: C
  Cimetidine is a gastric acid suppressor that inhibits several CYP enzymes and can greatly decrease drug metabolism. The other listed drugs do not have this specific effect.



9. A nurse is aware that the dosing scheduling of a patient’s new medication takes into account the serum half-life of the drug. What is the serum half-life of a medication?
  A) The time required for IV medications to penetrate the brain tissue
  B) The time needed for the serum level to fall by 50%
  C) The safest margin to prevent toxicity
  D) The dose adjustment that reduces the risk of adverse effects by one half
  Ans: B
  Serum half-life is the time required for the serum concentration of a drug to decrease by 50%. Although many IV medications penetrate the brain tissue, this action does not describe the half-life. The safest margin to prevent toxicity depends on the rate of metabolism and excretion. The half-life of the medication does not relate directly to a specific reduction in adverse effects.



10. A patient has increased intracranial pressure and is ordered to receive a diuretic. Which of the following diuretics does not act on receptor sites to produce diuresis?
  A) Furosemide (Lasix)
  B) Hydrochlorothiazide (HCTZ)
  C) Spironolactone (Aldactone)
  D) Mannitol (Osmitrol)
  Ans: D
  Mannitol (Osmitrol) is an osmotic diuretic that increases the osmolarity of plasma and pulls water out of the tissues into the bloodstream. It does not act on receptor sites. Furosemide (Lasix) is a loop diuretic that inhibits the reabsorption of sodium and chloride in the loop of Henle. Hydrochlorothiazide is associated with drug interference with absorption of sodium ions across the distal renal tubule. Spironolactone acts by competing with aldosterone for cellular receptor sites.



11. A patient older than 65 years is more likely to experience drug reaction than a much younger patient. Which of the following factors accounts for this variation?
  A) Drugs more readily crossing the blood–brain barrier in older people
  B) Age-related physiologic changes
  C) Increased drug-metabolizing enzymes in older people
  D) Diminished immune response
  Ans: B
  In older adults (65 years and older), physiologic changes may alter all pharmacokinetic processes. Although drugs crossing the blood–brain barrier affect drug reaction, this factor is important in all ages. Increased drug-metabolizing enzymes are key in all ages and do not relate to age variations. A diminished immune response is important in all ages and does not affect all medications.



12. A patient who is 6 feet tall and weighs 280 pounds will require which of the following doses?
  A) Higher dose than a patient who weighs 180 pounds
  B) Lower dose than a patient who weighs 180 pounds
  C) Same dose as a patient who weighs 180 pounds
  D) A parenteral rather than oral dose
  Ans: A
  In general, people heavier than average may need larger doses, provided their renal, hepatic, and cardiovascular functions are adequate.



13. A nurse has provided an oral dose of morphine, an opioid agonist, to a woman in early labor. The nurse should be aware of what characteristic of agonists?
  A) Agonists alter the normal processes of distribution and metabolism.
  B) Agonists counteract the action of specific neurotransmitters.
  C) Agonists block the action of specific neurotransmitters.
  D) Agonists bind to receptors and cause a physiological effect.
  Ans: D
  Agonists are drugs that produce effects similar to those produced by naturally occurring hormones, neurotransmitters, and other substances by activating (not blocking or counteracting) a receptor. Classification of a drug as an agonist does not denote a change to metabolism or distribution.



14. A nurse is preparing to simultaneously administer two drugs to a patient. The nurse knows that the drugs have been ordered to be given together because of their synergistic effect. This means that
  A) the adverse effects of one of the drugs are nullified by the other drug.
  B) the combined effects are greater than the effects of either one of the drugs alone.
  C) one of the drugs enhances metabolism, while the other drug enhances either distribution or absorption.
  D) both drugs are toxic in isolation but therapeutic when administered together.
  Ans: B
  Synergism occurs when two drugs with different sites or mechanisms of action produce greater effects when taken together. This does not mean that potential toxicity or adverse effects are “canceled out.” The two drugs would not individually affect different aspects of pharmacokinetics.



15. A patient has been brought to the emergency department by ambulance, and his friend states that he has overdosed on methadone, a long-acting opioid. The care team is preparing to administer the appropriate antidote, naloxone, which has a shorter half-life than methadone. What are the implications of this aspect of pharmacokinetics?
  A) Repeated doses of naloxone will likely be necessary.
  B) A different antidote will be required after the serum level of naloxone decreases.
  C) An increased dose of naloxone will be required.
  D) The antidote is unlikely to have a therapeutic effect on the patient’s symptoms.
  Ans: A
  When an antidote is used, its half-life relative to the toxin’s half-life must be considered. For example, the half-life of naloxone, a narcotic antagonist, is relatively short compared with the half-life of the longer-acting opioids such as methadone, and repeated doses may be needed to prevent recurrence of the toxic state.



16. A patient tells the nurse, “I took my sleeping pill yesterday evening, but it didn’t seem to work for me like it usually does.” The nurse should consider which of the following variables that can affect drug absorption? Select all that apply.
  A) GI function
  B) Blood flow to the site of administration
  C) The presence of other drugs
  D) Route of administration
  E) The presence of receptor agonists
  Ans: A, B, C, D
  Numerous factors affect the rate and extent of drug absorption, including dosage form, route of administration, blood flow to the site of administration, GI function, the presence of food or other drugs, and other variables. Agonist activity is a relevant variable, but this is not an aspect of absorption.



17. A nurse has administered a dose of a drug that is known to be highly protein bound. What are the implications of this characteristic?
  A) The patient must consume adequate protein in order to achieve a therapeutic effect.
  B) The molecules of the drug that are bound to protein are inactive.
  C) Increased levels of serum protein will increase the effect of the drug.
  D) Each molecule of the drug must bind to a protein molecule to become effective.
  Ans: B
  Drug molecules bound to plasma proteins are pharmacologically inactive because the large size of the complex prevents their leaving the bloodstream through the small openings in capillary walls and reaching their sites of action, metabolism, and excretion. Only the free or unbound portion of a drug acts on body cells. The patient’s protein intake or levels of protein are not normally relevant.



18. A patient requires a high dose of his new antihypertensive medication because the new medication has a significant first-pass effect. This means that the drug
  A) must pass through the patient’s bloodstream several times to generate a therapeutic effect.
  B) passes through the renal tubules and is excreted in large amounts.
  C) is extensively metabolized in the patient’s liver.
  D) is ineffective following the first dose and increasingly effective with each subsequent dose.
  Ans: C
  Some drugs are extensively metabolized in the liver, with only part of a drug dose reaching the systemic circulation for distribution to sites of action. This is called the first-pass effect or presystemic metabolism. The first-pass effect is not related to renal function or the need to pass through the bloodstream multiple times.



19. A patient with a diagnosis of bipolar disorder has begun lithium therapy, and the nurse has explained the need for regular monitoring of the patient’s serum drug levels. What is the primary rationale for the nurse’s instruction?
  A) It is necessary to regularly test for blood–drug incompatibilities that may develop during treatment.
  B) It is necessary to ensure that the patient’s drug levels are therapeutic but not toxic.
  C) It is needed to determine if additional medications will be needed to potentiate the effects of lithium.
  D) It is needed in order to confirm the patient’s adherence to the drug regimen.
  Ans: B
  Measuring serum drug levels is useful when drugs with a narrow margin of safety are given, because their therapeutic doses are close to their toxic doses. This is the case during lithium therapy. Serum levels are not commonly taken to monitor adherence to treatment. Blood–drug incompatibilities are not a relevant consideration.



20. A patient in cardiovascular collapse requires pharmacological interventions involving a rapid drug action and response. What route of administration is most likely appropriate?
  A) Intravenous
  B) Oral
  C) Rectal
  D) Topical
  Ans: A
  For rapid drug action and response, the IV route is most effective because the drug is injected directly into the bloodstream.



chapter 16

1. A patient is administered penicillin V orally for a strep throat. What is the mechanism of action of this medication?
  A) It inhibits protein synthesis.
  B) It lowers the pH of cellular contents.
  C) It causes mutations.
  D) It inhibits cell wall synthesis.
  Ans: D
  Beta-lactam antibacterial drugs inhibit synthesis of bacterial cell walls by binding to proteins in bacterial cell membranes. Penicillin V does not inhibit protein synthesis, cause mutations, or lower the pH of a bacterium’s cellular contents.



2. A patient previously experienced an anaphylactic reaction to penicillin G. Which of the following medications should not be administered to this patient due to the potential for cross-sensitivity?
  A) Lactulose (Chronulac)
  B) Ketoconazole (Nizoral)
  C) Kanamycin (Kantrex)
  D) Cefadroxil (Duricef)
  Ans: D
  Cefadroxil (Duricef) is a cephalosporin. Administration of cephalosporins or carbapenems should be avoided if possible in people with life-threatening allergic reactions to penicillin. Lactulose reduces blood ammonia by resident intestinal bacteria. It is not contraindicated in the event of penicillin anaphylaxis. Ketoconazole is an antifungal and does not possess cross-sensitivity to penicillin. Kanamycin is an aminoglycoside and does not possess cross-sensitivity to penicillin.



3. An adult patient has a history of rheumatic fever. Which of the following medications should be administered as prophylaxis for rheumatic fever?
  A) Cyclacillin (Cyclapen)
  B) Amoxicillin (Augmentin)
  C) Dicloxacillin
  D) Penicillin G benzathine (Bicillin LA)
  Ans: D
  Penicillin G benzathine (Bicillin LA) is administered as prophylaxis for rheumatic fever. Cyclacillin, amoxicillin, and dicloxacillin are not routinely administered for prophylaxis of rheumatic fever.



4. A patient has been prescribed an oral penicillin for an infection caused by gram-negative bacilli. When conducting health education for this patient, the nurse should emphasize which of the following?
  A) The need to take the medication on an empty stomach
  B) The fact that a mild rash frequently follows the first few doses
  C) The need to increase fluid intake for the duration of treatment
  D) The fact that the drug should be discontinued once symptoms subside
  Ans: A
  Most penicillins should be best taken on an empty stomach. Increased fluid intake is not normally necessary. A rash is an unexpected finding that should be reported promptly. The patient should take the full course of antibiotics.



5. Unasyn is being administered to a patient with an infection caused by Staphylococcus aureus. What type of anti-infective is Unasyn?
  A) Extended-spectrum antipseudomonal penicillin
  B) Penicillin–beta-lactamase inhibitor combination
  C) Cephalosporin
  D) Aminopenicillin
  Ans: B
  Unasyn is a penicillin–beta-lactamase inhibitor combination. It is ampicillin and sulbactam. Unasyn is not classified as an extended-spectrum antipseudomonal penicillin, cephalosporin, or aminopenicillin.



6. A patient is administered Augmentin (amoxicillin and clavulanate potassium) to treat otitis media. How does a beta-lactamase inhibitor agent achieve a therapeutic effect?
  A) It extends the spectrum of antibacterial activity of penicillin.
  B) It extends the spectrum of the beta-lactamase inhibitor.
  C) It decreases the side effects of high-dose penicillin.
  D) It increases the absorption of the penicillin.
  Ans: A
  When combined with a penicillin, the beta-lactamase inhibitor protects the penicillin from destruction by the enzymes and extends the penicillin’s spectrum of antimicrobial activity. Augmentin does not extend the spectrum of beta-lactamase inhibitor. Augmentin does not decrease the side effects of high-dose penicillin. Augmentin does not increase the absorption of penicillin.



7. A patient is administered a third-generation cephalosporin. Which of the following microorganisms are cephalosporins most effective in treating?
  A) Gram-positive
  B) Gram-negative
  C) Fungi
  D) Virus
  Ans: B
  Cephalosporins are broad-spectrum agents with activity against both gram-positive and gram-negative bacteria. Compared with penicillins, they are, in general, less active against gram-positive organisms but more active against gram-negative ones. Cephalosporins are not effective against fungi or viruses.



8. A patient is diagnosed with infective endocarditis. Which of the following medications is most effective in treating this patient?
  A) Dicloxacillin
  B) Ampicillin
  C) Nafcillin
  D) Oxacillin
  Ans: B
  Health care providers use ampicillin in the treatment or prophylaxis of infective endocarditis. Dicloxacillin, nafcillin, and oxacillin are typically used to treat methicillin-resistant Staphylococcus aureus.



9. A patient with septicemia is administered cefotaxime sodium (Claforan), a second-generation cephalosporin. How is this medication excreted?
  A) It is excreted by the lungs.
  B) It is excreted by the liver.
  C) It is excreted by the kidneys.
  D) It is excreted through the GI tract.
  Ans: C
  Cefotaxime sodium, like all cephalosporins, is excreted by the kidneys. Cefotaxime is not excreted by the lungs, liver, or GI tract.



10. A patient is scheduled for a vaginal hysterectomy. Which of the following medications is the drug of choice for surgical prophylaxis?
  A) Cefadroxil (Duricef)
  B) Cefazolin sodium (Ancef)
  C) Cephalexin (Keflex)
  D) Cephradine (Velosef)
  Ans: B
  Cefazolin sodium (Ancef) is the drug of choice for surgical prophylaxis in most surgical procedures. Cefadroxil, cephalexin, and cephradine are all first-generation cephalosporins, but they are not utilized as the drug of choice for surgical prophylaxis.



11. A patient is diagnosed with B. fragilis, an anaerobic organism resistant to most drugs. What is the drug of choice to treat this microorganism?
  A) Cefaclor (Ceclor)
  B) Cefamandole nafate (Mandol)
  C) Cefoxitin (Mefoxin)
  D) Cefuroxime sodium (Zinacef)
  Ans: C
  Cefoxitin (Mefoxin) is active against B. fragilis, an anaerobic organism resistant to most drugs. Cefaclor, cefamandole nafate, and cefuroxime sodium are all second-generation cephalosporins but not the drug of choice for B. fragilis.



12. A patient is to receive imipenem–cilastatin (Primaxin) IM to treat P. aeruginosa. What should imipenem–cilastatin be mixed with prior to administering intramuscularly?
  A) Meropenem (Merrem)
  B) Gentamicin (Garamycin)
  C) Lidocaine
  D) Epinephrine
  Ans: C
  When preparing imipenem–cilastatin for IM injection, lidocaine is added to decrease pain. Meropenem, gentamicin, and epinephrine are not added to imipenem–cilastatin.



13. A patient is administered imipenem–cilastatin for the treatment of an E. coli infection. The nurse should be aware that cilastatin is combined with the imipenem for what purpose?
  A) To eliminate adverse effects of imipenem administration
  B) To inhibit the destruction of imipenem
  C) To potentiate the therapeutic effects of imipenem
  D) To allow imipenem to cross the blood–brain barrier
  Ans: B
  Cilastatin inhibits the destruction of imipenem, increasing the urinary concentration of imipenem and reducing its potential renal toxicity. It does not allow the drug to cross the blood–brain barrier, and cilastatin does not eliminate all adverse effects.



14. A patient is administered aztreonam (Azactam). What is the major advantage of this monobactam over the aminoglycosides in treating P. aeruginosa?
  A) It is a lower-cost medication.
  B) It is administered orally.
  C) It causes less GI distress.
  D) It has lower risk for hearing loss.
  Ans: D
  Aztreonam is effective against gram-negative bacteria similar to aminoglycosides, but the drug does not cause kidney damage or hearing loss. Aztreonam is not a lower-cost medication. Aztreonam is not administered orally. Aztreonam does not cause less GI upset.



15. A 71-year-old man with a history of osteoarthritis is scheduled for hip replacement surgery, and the surgeon has ordered a first-generation cephalosporin to be administered before and after surgery as prophylaxis. Which of the following drugs is a first-generation cephalosporin?
  A) Cefotetan (Cefotan)
  B) Cefoxitin (Mefoxin)
  C) Ceftriaxone (Rocephin)
  D) Cefazolin (Ancef)
  Ans: D
  Cefazolin (Ancef) is a first-generation cephalosporin. Cefotetan (Cefotan) and cefoxitin (Mefoxin) belong to the second generation, and ceftriaxone (Rocephin) is a third-generation cephalosporin.



16. Oral ampicillin has been ordered for a female patient whose urinary tract infection will be treated in a home setting. When teaching this patient about her antibiotic, the nurse should instruct the patient to do which of the following?
  A) Take the first dose together with diphenhydramine to reduce the chance of an allergic reaction.
  B) Take the drug immediately before a meal, unless the meal will contain large amounts of fat.
  C) Drink a full glass of water when taking a dose of the drug.
  D) Taper off the drug rather than abruptly stopping it.
  Ans: C
  Patients taking penicillins should take oral doses with a full glass of water. The drugs should otherwise be taken on an empty stomach. Tapering is unnecessary, and it is not advised to take the drug with diphenhydramine in an effort to reduce the allergy risk.



17. An older adult patient has just been diagnosed with community-acquired pneumonia and aztreonam (Azactam) has been ordered. What action should the nurse perform before administering the first dose?
  A) Administer a 500 mL bolus of normal saline.
  B) Confirm the patient’s allergy status.
  C) Swab the patient’s nares for the presence of MRSA.
  D) Teach the patient to expect discolored urine during treatment.
  Ans: B
  As with all antibiotics, it is important to assess the patient’s allergy status prior to drug administration. This is especially important before the initial dose. An IV bolus is unnecessary, and discoloration of urine is not expected. MRSA testing is not relevant to aztreonam administration.



18. An intensive care unit (ICU) nurse is preparing to administer an intravenous dose of imipenem–cilastatin to a patient who is being treated for sepsis. What aspect of this patient’s history would contraindicate the use of this drug?
  A) The patient has a history of type 1 diabetes mellitus.
  B) The patient is showing signs and symptoms of fluid volume excess.
  C) The patient’s most recent creatinine level was 140 mmol/L (high).
  D) The patient has a documented allergy to penicillin.
  Ans: D
  It is important to avoid administering imipenem–cilastatin and the other carbapenems to people with life-threatening allergic reactions to penicillin. Diabetes, slightly increased creatinine levels, and fluid overload do not necessarily contraindicate the use of imipenem–cilastatin.



19. A nurse has established intravenous access in a patient whose infection necessitates treatment with IV cefazolin. What potential adverse reaction is most likely during this patient’s course of treat?
  A) Gastrointestinal upset
  B) Dry skin and pruritus
  C) Drowsiness
  D) Orthostatic hypotension
  Ans: A
  Adverse effects to cefazolin and the other cephalosporins are similar to those of most other antibiotics: abdominal pain, diarrhea, gastritis, nausea, and vomiting. Integumentary, neurological, and blood pressure changes are atypical.



20. A 69-year-old female responded well to inpatient treatment with a third-generation cephalosporin. After being largely symptom free for 48 hours, the woman has developed a fever of 38.6°C and an elevated white cell count. What phenomenon may account for this patient’s current clinical presentation?
  A) The patient may be infected with microorganisms that were resistant to the cephalosporin.
  B) The patient may be experiencing a delayed (type IV) hypersensitivity reaction to the cephalosporin.
  C) The patient may be developing glomerulonephritis secondary to the nephrotoxic cephalosporin.
  D) The cephalosporin may have initially caused leukopenia and made the patient susceptible to secondary infection.
  Ans: A
  Patients treated with cephalosporins may be vulnerable to superinfections (infection after a previous infection, typically caused by microorganisms that are resistant to the antibiotics used earlier). Delayed hypersensitivity and renal involvement are highly unlikely. Antibiotics do not cause leukopenia.



chapter 32

1. The physician has ordered the patient hydrochlorothiazide. What assessment should the nurse make before administering the first dose of hydrochlorothiazide?
  A) Pulse rate
  B) Hemoglobin level
  C) Sulfonamide allergy
  D) Neutrophil level
  Ans: C
  Thiazide diuretics must be used cautiously in patients allergic to sulfonamide drugs because there is a known cross-sensitivity of some sulfonamide-allergic patients to sulfonamide nonantibiotic. It is not imperative to assess pulse, hemoglobin, or neutrophil levels.



2. A patient has edema of the lower extremities and abdomen. What is the reason for administering a stronger diuretic than a thiazide diuretic to this patient?
  A) A thiazide diuretic will reabsorb potassium in the distal tubule.
  B) A thiazide diuretic will be ineffective for immediate diuresis.
  C) A thiazide diuretic will provide peak effects in 2 hours.
  D) A thiazide diuretic will be excreted in more than 72 hours.
  Ans: B
  Thiazide diuretics are ineffective when immediate diuresis is required. A thiazide diuretic acts to reabsorb sodium, not potassium, in the distal convoluted tubule. A thiazide diuretic reaches its peak in 4 to 6 hours. A thiazide diuretic is excreted in 72 hours maximum.



3. A patient is admitted to the hospital with a diagnosis of heart failure. The patient is ordered to receive furosemide (Lasix) 40 mg IV. How soon after administration should the nurse expect to see evidence of diuretic effects?
  A) 1 minute
  B) 5 minutes
  C) 30 minutes
  D) 2 hours
  Ans: B
  After IV administration, diuretic effects occur within 5 minutes. The diuretic effect is not seen in 1 minute. The peak of the action occurs in 30 minutes, not the onset of action. The duration of action is 2 hours, not the onset of action.



4. A patient is administered furosemide (Lasix) 20 mg PO every morning. What effect will a diet high in sodium have on the patient?
  A) Decreased blood pressure
  B) Decreased diuresis
  C) Hyperkalemia
  D) Hyperglycemia
  Ans: B
  A high dietary intake of sodium can cause sodium retention and reduce or cancel the diuretic-induced sodium loss. A high dietary intake of sodium will not increase diuresis. A high dietary intake of sodium will not cause hyperkalemia. A high dietary intake of sodium will not cause hyperglycemia.



5. A patient is switched from furosemide (Lasix) to spironolactone (Aldactone). The patient asks the nurse why she has been switched to a new medicine. What is the nurse’s best response?
  A) “You will lose less potassium with spironolactone than with furosemide.”
  B) “You will have greater potassium losses with spironolactone than with furosemide.”
  C) “You will have greater water losses with spironolactone than with furosemide.”
  D) “You will have greater sodium losses with spironolactone than with furosemide.”
  Ans: A
  Spironolactone promotes retention of sodium and water and excretion of potassium by stimulating the sodium–potassium exchange mechanism in the distal tubule. The patient will not have greater potassium losses, water losses, or sodium losses with spironolactone rather than furosemide.



6. A patient is taking spironolactone (Aldactone). When providing patient teaching about this medication, what foods should the patient be instructed to avoid?
  A) Fish
  B) Apples
  C) Crackers
  D) Bananas
  Ans: D
  Bananas are high in potassium and should be avoided with potassium-sparing diuretics. It is acceptable for the patient to eat fish, apples, and crackers.



7. A patient is admitted to the emergency department and is unconscious as a result of a head injury. The patient’s intracranial pressure is increased. What type of diuretic will the nurse most likely administer to the patient?
  A) Loop diuretic
  B) Potassium-sparing diuretic
  C) Thiazide diuretic
  D) Osmotic diuretic
  Ans: D
  An osmotic diuretic is used to reduce intracranial pressure related to a head injury. Loop diuretics, potassium-sparing diuretics, and thiazide diuretics do not reduce intracranial pressure.



8. A patient with hypertension has been prescribed a combination diuretic. What is the major purpose in administering a combination diuretic agent?
  A) It prevents sodium imbalance.
  B) It is less expensive than two medications.
  C) It prevents potassium imbalance.
  D) It prevents allergic reactions.
  Ans: C
  The major purpose of the diuretic combinations is to prevent potassium imbalances. The combination products do not prevent sodium imbalance. The combination products are not less expensive than taking two medications. The combination products do not prevent allergic reactions.



9. A patient asks the nurse why she has to take two diuretics when her friend only takes one with a combination medication. The patient takes hydrochlorothiazide 75 mg every day with a potassium-sparing diuretic. What is the nurse’s best response?
  A) “Maybe you should speak with your doctor about the combination.”
  B) “I do not know why your doctor prefers that you take two medications.”
  C) “It could be that you need a larger dose than is available in the combination medications.”
  D) “The combination medications are not as effective as two medications.”
  Ans: C
  The fixed-dose combination of hydrochlorothiazide and a potassium-sparing diuretic contains 50 mg of hydrochlorothiazide, and this patient requires 75 mg of hydrochlorothiazide. The statement “It could be that you need a larger dose than is available in the combination medications” is the best answer. The statement “Maybe you should speak with your doctor about the combination” does not provide adequate teaching. The statement “I do not know why your doctor prefers that you take two medications” does not provide adequate patient education. The combination medications are very effective, and the statement that they are not as effective is inaccurate.



10. A patient has edema of the lower extremities with crackles in the lung bases. What diuretic is the nurse most likely to administer?
  A) Hydrochlorothiazide
  B) Furosemide
  C) Spironolactone
  D) Mannitol
  Ans: B
  Acute pulmonary edema is an indication for the use of Lasix. HCTZ, spironolactone, and mannitol are not used for this purpose, largely due to their slower onset of action.



11. A patient has been prescribed digoxin (Lanoxin) and furosemide (Lasix) for treatment of congestive heart failure. What is the patient at risk for developing with this combination of medications?
  A) Hyperkalemia
  B) Hyperglycemia
  C) Tachycardia
  D) Digoxin toxicity
  Ans: D
  When digoxin and diuretics are used concomitantly, the risk of digoxin toxicity is increased. The patient is at risk for hypokalemia, not hyperkalemia. The patient is not at a particular risk for hyperglycemia or tachycardia.



12. A patient is receiving furosemide (Lasix) and a potassium supplement. When monitoring daily laboratory values, what should the potassium level be for this patient?
  A) 1.5 to 3.0 mEq/L
  B) 3.5 to 5.0 mEq/L
  C) 5.0 to 7.5 mEq/L
  D) 6.0 to 6.5 mEq/L
  Ans: B
  The normal serum potassium level is 3.5 to 5.0 mEq/L. A serum potassium level of 1.5 to 3.0 mEq/L is too low. A serum potassium level of 5.0 to 7.5 mEq/L is indicative of hyperkalemia. A serum potassium level of 6.0 to 6.5 mEq/L is indicative of hyperkalemia.



13. An elderly patient with a history of heart failure has presented to the emergency department in respiratory distress. Assessment reveals the presence of pulmonary edema, and an infusion of IV furosemide (Lasix) has been ordered. For the duration of treatment, the nurse should prioritize assessments related to what nursing diagnosis?
  A) Risk for deficient fluid volume related to diuretic administration
  B) Risk for decreased cardiac output related to adverse effects of furosemide
  C) Ineffective health maintenance related to pulmonary edema
  D) Functional urinary incontinence related to diuretic administration
  Ans: A
  Increased diuresis creates a risk of deficient fluid volume. Impaired health maintenance and urinary incontinence are not priorities at this time. Lasix will not reduce cardiac output.



14. A hospital patient with a diagnosis of liver failure has been prescribed a low dose of spironolactone in order to treat ascites. The nurse who is providing this patient’s care should prioritize assessments for the signs and symptoms of what health problem?
  A) Peritonitis
  B) Liver cancer
  C) Cirrhosis
  D) Hepatic encephalopathy
  Ans: D
  Spironolactone is used in the treatment of ascites. However, it should be used cautiously and carefully monitored in patients with significant hepatic impairment because a rapid change in fluid and electrolyte balance may lead to hepatic coma. It is important to monitor susceptible patients carefully for signs and symptoms of hepatic encephalopathy. There is no risk for liver cancer, cirrhosis, or peritonitis that results directly from the use of spironolactone.



15. A clinical nurse educator on a nephrology and dialysis unit is reviewing renal physiology with a nursing student who is completing a preceptorship on the unit. The student should be aware that a majority of reabsorption takes place in what anatomical location?
  A) Ureters
  B) Proximal tubule
  C) Efferent arteriole
  D) Afferent arteriole
  Ans: B
  Most reabsorption occurs in the proximal tubule. Almost all glucose and amino acids are reabsorbed; about 80% of water, sodium, potassium, chloride, and most other substances is reabsorbed. Arterial blood enters the glomerulus by the afferent arteriole, and blood that does not become part of the glomerular filtrate leaves the glomerulus through the efferent arteriole. The ureters connect the kidneys to the bladder.



16. A hospital patient with peripheral edema has been prescribed furosemide (Lasix). How should the nurse best determine the extent of the patient’s desired fluid loss?
  A) Assess the patient’s skin turgor on a daily basis.
  B) Test the osmolarity of the patient’s urine regularly.
  C) Weigh the patient daily.
  D) Auscultate the patient’s chest each morning.
  Ans: C
  The nurse should measure and record weights to assist in determining the amount of mobilization of excess fluid. This is a more accurate gauge of changes in fluid status than skin turgor, urine osmolarity, or chest auscultation.



17. An adult patient with a diagnosis of hypertension has had oral Lasix added to his medication regimen by his primary care provider. The nurse is planning a brief health education session with the patient in light of this change in his treatment plan. What goal should the nurse specify when planning this teaching session?
  A) The patient will identify strategies for limiting his sodium intake.
  B) The patient will describe the rationale for increasing his fluid intake.
  C) The patient will be able to demonstrate correct technique for blood glucose monitoring.
  D) The patient will accurately describe the basic structure and functions of the kidneys.
  Ans: A
  The reason for furosemide use should guide patient teaching. In most instances, it is necessary to initiate measures to limit sodium intake. Key considerations should include not adding salt to food during preparation or at the dinner table, reading food labels carefully to be aware of hidden sources of sodium, and avoiding processed or high-sodium foods. Blood glucose monitoring is not indicated, and there is no need for increased fluid intake. Renal anatomy and physiology are not priority teaching points.



18. An older adult patient has a complex medical history that includes heart failure, type 1 diabetes, and diabetic nephropathy. The nurse has questioned a care provider’s order for oral spironolactone because the patient’s health problems would contribute to a high risk of
  A) metabolic acidosis.
  B) hypocalcemia.
  C) hemolytic anemia.
  D) hyperkalemia.
  Ans: D
  The presence of renal insufficiency is also a contraindication to the use of spironolactone because use of spironolactone may cause hyperkalemia through the inhibition of aldosterone and the subsequent retention of potassium. This patient does not face a greatly increased risk of anemia, hypocalcemia, or acidosis.



19. A nurse is reviewing a newly admitted patient’s medication administration record and notes that the patient takes a loop diuretic as well as a thiazide diuretic. The nurse understands what primary rationale for the concurrent use of these two drugs?
  A) Increased diuretic effect
  B) Reduced risk of potassium imbalances
  C) Decreased blood pressure without a risk of bradycardia
  D) Increased adherence to treatment
  Ans: A
  When an inadequate diuretic response occurs with one drug, people sometimes take two potassium-losing diuretics concurrently. The combination of a loop and a thiazide diuretic has synergistic effects because the drugs act in different segments of the renal tubule. Thus, the rationale for this particular combination is not rooted in prevention of potassium imbalances, increased adherence, or maintenance of a normal heart rate.



20. A patient has been taking an ACE inhibitor and a beta-blocker for the treatment of hypertension but has been consistently obtaining blood pressure readings in the vicinity of 145/90 mm Hg. As a result, the patient’s primary care provider has prescribed furosemide (Lasix). What order would be most consistent with this patient’s health needs?
  A) Lasix 125 mg PO OD
  B) Lasix 40 mg IV TID
  C) Lasix 20 mg IV OD
  D) Lasix 40 mg PO BID
  Ans: D
  For hypertension, Lasix is commonly given as 40 mg PO twice daily and gradually increased if necessary.



chapter 48

1. A surgical patient has highly elevated AST and ALT levels. Standard orders specify that she is to receive morphine sulfate 10 mg postoperatively. What action should the nurse take prior to administering the medication?
  A) Draw up half of the medication for administration.
  B) Notify the physician for a reduced dosage.
  C) Assess the patient’s respiratory status.
  D) Assess the patient’s pain tolerance.
  Ans: B
  Morphine and meperidine form pharmacologically active metabolites. Thus, liver impairment can interfere with metabolism, and kidney impairment can interfere with excretion. Drug accumulation and increased adverse effects may occur if dosage is not reduced. The nurse cannot administer half of the medication without a physician’s order. It is important to assess the patient’s respiratory status before administration, but this action is not the primary intervention in this case. Narcotics prior to surgery are administered to increase pain tolerance during the surgical procedure, not during the preoperative phase.



2. An outpatient has been prescribed hydrocodone for back pain related to a compression fracture. Which of the following interventions should the patient be taught regarding the medication administration?
  A) Consume a diet high in fiber.
  B) Decrease activity due to pain.
  C) Elevate the lower extremities.
  D) Take aspirin with the medication.
  Ans: A
  Hydrocodone is an opioid, which, in the gastrointestinal tract, slows motility. To prevent constipation, the patient should consume a diet high in fiber. A decrease in activity due to pain will increase constipation. Elevating the lower extremities will not increase or decrease pain. Hydrocodone should not be routinely combined with aspirin unless prescribed by the physician.



3. A hospice patient has been ordered morphine (Roxanol) 5 mg sub-Q every 2 hours. Roxanol contains 10 mg/mL. How many milliliters will be administered?
  A) 0.25 mL
  B) 0.5 mL
  C) 1 mL
  D) 2 mL
  Ans: B
  5 mg/X = 10 mg/mL. The calculation results in 0.5 mL. The administration of 0.25, 1, or 2 mL is incorrect.



4. A patient who suffers from cancer pain is receiving morphine every 2 hours. For which of the following should the family be taught to assess while the patient is on morphine?
  A) Diarrhea
  B) Respiratory depression
  C) Lung sounds
  D) Urinary incontinence
  Ans: B
  The administration of morphine can result in respiratory depression. The family should be taught to assess the patient for respiratory depression. Morphine sulfate can be administered to treat severe diarrhea. The patient’s lung sounds are important to assess, but only after the nurse assesses for respiratory depression. Morphine does not cause urinary incontinence.



5. A patient is admitted to the surgical division after a mastectomy. The patient has a PCA pump and states to you that she is fearful she will overdose on morphine. Which of the following interventions is most appropriate to teach the patient?
  A) “The pump will administer all of the doses, so you don’t have to worry.”
  B) “If you follow the instructions, that won’t happen to you.”
  C) “The device is preset, so you cannot receive more than you need.”
  D) “The device will give you a placebo when you press it often.”
  Ans: C
  PCA pumps deliver a basic amount of analgesic by continuous infusion, with the patient injecting additional doses when needed. The amount of the drug is preset and limited. The pump will administer a basal rate, but the patient can administer the medication at preset intervals. Telling the patient not to worry is not effective teaching or use of therapeutic communication. Telling the patient to follow the instructions is not effective teaching or use of therapeutic communication. Instructing the patient on a placebo is not effective teaching or use of therapeutic communication.



6. A patient has been given MS Contin. You enter the room and the patient is unresponsive. His respirations are 6 breaths per minute. What medication will be ordered for the patient?
  A) Naloxone (Narcan)
  B) Capsaicin (Zostrix)
  C) Butorphanol (Stadol)
  D) Nalbuphine (Nubain)
  Ans: A
  Naloxone (Narcan) has long been the drug of choice to treat respiratory depression caused by an opioid. Capsaicin is made from cayenne pepper and applied topically for pain relief. Butorphanol (Stadol) is a synthetic, Schedule IV agonist similar to morphine in analgesic effects and ability to cause respiratory depression. Nalbuphine (Nubain) is a synthetic analgesic used for moderate to severe pain.



7. A patient has been administered an opioid. For which of the following effects should the patient be assessed?
  A) Oliguria
  B) Decreased level of consciousness
  C) Edema
  D) Tachycardia
  Ans: B
  Opioids will produce decreased LOC. Oliguria is not a result of the administration of an opioid. Edema is not a result of the administration of an opioid. Tachycardia is not a result of the administration of an opioid.



8. A nurse is teaching a patient about her prescription for Tylenol #3 that she will take at home. This medication consists of acetaminophen and what other drug?
  A) Codeine
  B) Acetylsalicylic acid (aspirin)
  C) Methadone (Dolophine)
  D) Tramadol (Ultram)
  Ans: A
  Tylenol #3 is acetaminophen (Tylenol) and codeine. Acetylsalicylic acid (aspirin) is not combined with acetaminophen (Tylenol). Methadone (Dolophine) is not combined with Tylenol. Tramadol (Ultram) is not combined with Tylenol.



9. A patient is near the end of life and has developed increased respiratory secretions and labored breathing. The physician is likely to order which of the following medications to decrease these symptoms?
  A) Meclizine (Antivert)
  B) Ampicillin
  C) Naloxone (Narcan)
  D) Morphine sulfate
  Ans: D
  Morphine is used for the treatment of acute pulmonary edema. Meclizine (Antivert) is given for dizziness. Ampicillin is used to treat infection. Naloxone (Narcan) is the opioid antidote.



10. A patient has been receiving morphine sulfate 5 mg IV every 4 hours for the past several days. She states that the pain is not being relieved as well as it was in the past. What is the reason for this development?
  A) She has developed a dependency on the morphine.
  B) She has metastatic cancer and is dying.
  C) She has greater pain with inactivity.
  D) She has developed tolerance to morphine.
  Ans: D
  Larger-than-usual doses of morphine are required to treat pain in opiate-tolerant people. The patient has not developed a dependence on morphine. A patient with metastatic cancer will require increasing pain management, but this feature is not the rationale for the patient’s statement. The increased pain is not related to inactivity.



11. In which of the following patients should the nurse question the physician’s order for IV morphine?
  A) An 88-year-old female with failure to thrive
  B) A 45-year-old female, 1-day postoperative mastectomy
  C) An 8-year-old male with a fractured femur
  D) A 17-year-old female, 1-day postoperative appendectomy
  Ans: A
  Opioid analgesics should be used cautiously in older adults, especially if they are debilitated. Treatment with morphine 1 day after mastectomy is appropriate for pain management. The treatment of pain with morphine is appropriate for a patient with a fractured femur. The treatment of pain with morphine is appropriate for a patient who is 1-day postoperative for an appendectomy.



12. A 30-year-old male patient has been ordered Demerol 75 mg IM every 4 hours after a fractured femur. What action should the nurse take?
  A) Give the medication as ordered.
  B) Administer half the dose.
  C) Call the physician for a smaller dose.
  D) Give the dose by mouth.
  Ans: A
  The patient should be administered the full dose of medication, which is within dosing recommendations. A male patient with a fractured femur who has adequate hepatic and renal function should not receive a lower dose of Demerol and should not receive the medication by mouth.



13. A nurse is instructing a patient on the administration of an opioid medication. What medication effect will most likely develop?
  A) Lower extremity paresthesia
  B) Drowsiness
  C) Occipital headache
  D) Polyuria
  Ans: B
  Drowsiness and sedation are results of central nervous system depression. The patient will not develop lower extremity paresthesia, occipital headache, or polyuria. If these effects develop, they are not related to the opioid medication.



14. A patient has been ordered a fentanyl patch known as Duragesic for chronic pain. What patient teaching should be provided to the patient and family?
  A) Remove the patch every 3 days.
  B) Apply it to the chest only.
  C) Apply it for breakthrough pain.
  D) Remove it daily and clean skin.
  Ans: A
  Duragesic has a slow onset of action, but lasts about 72 hours. Duragesic can be applied to other areas of the skin, not solely on the chest. Duragesic is not applied for breakthrough pain. Duragesic is not removed daily.



15. What is the most effective way to evaluate the patient’s pain response after administering an opioid analgesic?
  A) Observe the patient when he/she is not aware you are assessing him/her.
  B) Ask another nurse to assess the patient’s response to the medication.
  C) Using a pain scale, ask the patient to describe the pain.
  D) Ask the family to determine the patient’s response to the pain.
  Ans: C
  Asking the patient to describe the pain using a pain scale is the most effective assessment of pain response. Observing the patient when he/she is unaware is an objective assessment and does not represent a true pain experience. Asking another nurse to assess the patient’s response will not provide accurate data. Asking the family to determine the patient’s response will not provide accurate data.



16. Nonopioid analgesics may sometimes be added to a narcotic analgesic. What action will result?
  A) Antagonism
  B) Additive effect
  C) Interference
  D) Increased excretion
  Ans: B
  Aspirin and Tylenol are added to narcotic analgesics for additive effects of pain relief without the addition of narcotic adverse effects. Aspirin and Tylenol do not provide an antagonistic effect. Aspirin and Tylenol do not cause an interference of action. Aspirin and Tylenol will not increase excretion.



17. A 16-year-old has been brought to the emergency department by his football coach after twisting his ankle during a practice drill. Diagnostic testing reveals a fracture. This patient is experiencing what type of pain?
  A) Acute somatic pain
  B) Acute cutaneous pain
  C) Visceral pain
  D) Neuropathic pain
  Ans: A
  Sprains and other traumatic injuries are examples of acute somatic pain. Somatic pain results from stimulation of nociceptors in skin, bone, muscle, and soft tissue. Visceral pain, which is diffuse and not well localized, results when nociceptors are stimulated in abdominal or thoracic organs and their surrounding tissues. Neuropathic pain is caused by lesions or physiologic changes that injure peripheral pain receptors, nerves, or the central nervous system. Cutaneous pain is not a recognized category.



18. A patient with traumatic injuries describes his current pain as being “unbearable.” The pathophysiology of pain begins with a signal from
  A) myelin sheaths.
  B) nociceptors.
  C) baroceptors.
  D) synapses.
  Ans: B
  For a person to feel pain, the signal from nociceptors in peripheral tissues must be transmitted to the spinal cord, then to the hypothalamus and cerebral cortex in the brain. Myelin sheaths, synapses, and baroceptors are not directly involved in pain transmission.



19. A 54-year-old woman is being admitted to the postsurgical unit following a transverse rectus abdominis myocutaneous (TRAM) flap. The patient’s care plan specifies the use of preemptive analgesia. This approach to pain control will involve
  A) frequent administration of high-dose opioids.
  B) simultaneous use of analgesics from different drug classes.
  C) alternating administration of opioid antagonists with opioid agonists.
  D) patient-controlled analgesia.
  Ans: B
  Preemptive analgesia is used to reduce postsurgical pain by simultaneously administering medications from different drug classes to suppress pain by blocking multiple pain pathways. It is not synonymous with PCA and does not require alternation between opioid agonists and antagonists.



20. Following the administration of pentazocine (Talwin) to a patient with moderate pain, the nurse should assess for what change in the patient’s vital signs?
  A) Increased blood pressure
  B) Decreased oxygen saturation
  C) Increased temperature
  D) Increased respiratory rate
  Ans: A
  Talwin may cause increased blood pressure. It does not typically cause deoxygenation, fever, or tachypnea.



chapter 60

1. A teenager is using a tanning bed two times per week. Which cells within the skin change color in response to the tanning bed’s lights?
  A) Melanocytes
  B) Stratum corneum
  C) Merkel cells
  D) Dermis
  Ans: A
  Melanocytes are pigment-producing cells located at the junction of the epidermis and the dermis. The stratum corneum, Merkel cells, and dermis do not perform this role.



2. A teenager is being treated for acne vulgaris. Which oral antibiotics may be prescribed to treat acne?
  A) Neomycin and vancomycin
  B) Gentamicin and Rocephin
  C) Tetracycline and erythromycin
  D) Bacitracin and polymyxin B
  Ans: C
  Commonly used oral antibiotics for acne treatment include tetracycline, doxycycline, minocycline, and erythromycin. Neomycin and vancomycin are not used to treat acne. Gentamicin and Rocephin are not used to treat acne. Bacitracin and polymyxin B are not used to treat acne.



3. A young mother is seen in the clinic with her young children. It is May, and the family is planning to go to the beach for vacation. Which of the following aspects of patient teaching is most important?
  A) “Try to stay indoors as much as possible.”
  B) “Apply SPF 30 sunscreen to the children before sun exposure.”
  C) “Be sure that each child wears a hat at the beach.”
  D) “Apply Neosporin to any skin abrasions your children get.”
  Ans: B
  Dermatologists recommend sunscreen preparations that block both UVA and UVB and have a sun protective factor of SPF value 30 or higher. It is unnecessary to avoid all outdoor locations. The mother should apply a hat, but this advice is not the most important health promotion intervention; this does not prevent sun damage to most skin surfaces. The mother should be cautious with the application of Neosporin.



4. A 17-year-old woman is prescribed isotretinoin (Accutane) for severe acne vulgaris. Which of the following is the most important intervention related to the administration of this medication?
  A) Effective contraception must accompany this medication.
  B) Administer the medication on an empty stomach to decrease discomfort.
  C) The tablets should be crushed if they are too large to swallow.
  D) Administer a vitamin A supplement daily to enhance effectiveness.
  Ans: A
  The administration of retinoids requires adequate contraceptive practices in women. Retinoids should be given with food, not on an empty stomach. The tablets should not be crushed. The patient should not take vitamin A or a multivitamin because of the retinoid toxicity.



5. A college sophomore has sought care because of her worsening acne. Before beginning a medical regime that includes a retinoid, which of the following laboratory tests must be negative?
  A) Throat culture
  B) Skin culture
  C) Stool for occult blood
  D) Pregnancy test
  Ans: D
  The female patient should have a negative pregnancy test before beginning retinoid therapy. It is not necessary to have a negative throat culture or skin culture. If the patient has a positive stool for occult blood, the cause should be determined but is not affected by retinoid therapy.



6. A teenage male patient is administered isotretinoin (Accutane) for severe acne. When teaching the teen and his parents about the medication, which of the following assessments should be routinely made?
  A) Assess blood pressure.
  B) Assess blood lipid levels.
  C) Assess for euphoria.
  D) Assess for increased weight.
  Ans: B
  The administration of isotretinoin is linked with increased blood lipid levels. The parents and teen should be taught that lipid levels should be periodically assessed. The assessment of blood pressure is not imperative. The patient should be assessed for depression, not euphoria. The patient will not need his weight assessed.



7. The physician orders tretinoin (Retin-A) for the treatment of acne. Which of the following instructions should be provided?
  A) “You will see positive results in 1 week”
  B) “Apply the medication two to three times a day.”
  C) “Apply the topical medication one time per day.”
  D) “Apply the medication for 1 hour and remove it.”
  Ans: C
  Tretinoin is applied one time per day. Positive results from the medication will be noted in 12 weeks, not 1 week. The medication should not be applied two to three times per day. The medication should not be applied for 1 hour and then removed.



8. A teenager has acne that requires treatment. The physician does not want to use retinoids because of the adverse effects. Which of the following medication regimens will likely be most effective?
  A) Topical azelaic acid
  B) Topical benzoyl peroxide
  C) Topical clindamycin
  D) Topical clindamycin with benzoyl peroxide
  Ans: D
  Combination products of topical clindamycin or erythromycin and benzoyl peroxide are more effective than antibiotics alone. Azelaic acid and benzoyl peroxide are effective but not as effective as combination medications. Topical clindamycin is effective, but combination medications may be more effective.



9. A patient has a severe reaction to poison ivy. Which of the following medications will be most effective?
  A) Topical antihistamines
  B) Corticosteroids
  C) Emollients
  D) Analgesics
  Ans: B
  Corticosteroids are used to treat the inflammation present in many dermatologic conditions. They are most often applied topically but also may be given orally or parenterally. Emollients and analgesics would be ineffective. Antihistamines are not administered topically.



10. A patient has psoriasis and has been prescribed coal tar (Balnetar). How will this prescription be administered?
  A) Topically
  B) Orally in divided daily doses
  C) Orally in the morning
  D) Parenterally at bedtime
  Ans: A
  Coal tar is administered topically.



11. A child who has not received the chickenpox vaccine has developed the chickenpox virus. The child has itching related to the chickenpox pustules. Which of the following herbal preparations would be helpful to decrease itching?
  A) Coal tar (Balnetar)
  B) Colloidal oatmeal (Aveeno)
  C) Clindamycin
  D) Bacitracin (Bacillin)
  Ans: B
  Oat preparations, such as Aveeno, are used topically to treat minor skin irritation. Coal tar is not used for this child; it is primarily administered for psoriasis and dermatitis. Clindamycin is not administered to treat minor skin irritation. Bacitracin is not administered to relieve itching related to chickenpox.



12. A patient has rosacea. Which of the following medications is most effective in treating rosacea?
  A) Topical metronidazole (Flagyl)
  B) Oral nystatin (Mycostatin)
  C) Oral prednisone
  D) Topical hydrocortisone
  Ans: A
  Topical metronidazole is commonly used for rosacea. Oral Mycostatin is not used for rosacea. Oral prednisone is not used for rosacea. Topical hydrocortisone is not used for rosacea.



13. A patient has a bacterial skin infection. Which medication can be applied to the lesion?
  A) Bacitracin
  B) Benzoyl peroxide
  C) Butenafine (Mentax)
  D) Clotrimazole (Lotrimin)
  Ans: A
  Bacitracin is used to treat a bacterial skin infection. Butenafine is an antifungal agent. Clotrimazole is used to treat tinea infections. Benzoyl peroxide is used to treat acne.



14. A patient has developed urticaria following the administration of an oral antibiotic. What substance most commonly mediates the formation of the wheals that characterize urticaria?
  A) Cytokines
  B) CD4+ lymphocytes
  C) Histamine
  D) Interleukin
  Ans: C
  Histamine is the most common mediator of urticaria; it causes vasodilation, increased vascular permeability, and pruritus. Cytokines, including interleukin, and CD4+ lymphocytes do not usually mediate the development of urticaria.



15. An older adult who resides in a long-term care facility has been diagnosed with oral candidiasis (thrush). When considering factors that may have contributed to this health problem, the nurse should prioritize which of the following?
  A) The resident recently completed a course of broad-spectrum antibiotics.
  B) The resident takes metformin for the treatment of type 2 diabetes.
  C) The resident has been using OTC skin emollients several times a day.
  D) The resident was immunized against the influenza virus 1 week ago.
  Ans: A
  Oral candidiasis (thrush) involves mucous membranes of the mouth. It often occurs as a superinfection after the use of broad-spectrum systemic antibiotics. Oral antihyperglycemics, skin emollients, and vaccinations do not contribute to thrush.



16. A topical corticosteroid has been prescribed for short-term use on an infant’s skin. When planning the use of a topical medication for an infant, what principle should guide the nurse’s actions?
  A) Topical medications on infants’ skin must be covered with an impermeable barrier.
  B) Infants’ skin is more permeable to medication than older patients’.
  C) Infants have more subcutaneous fat than older patients, so higher concentrations of topical medications are often necessary.
  D) Systemic drugs are preferable to topical medications in the care of infants.
  Ans: B
  With topical medications, cautious use is recommended with infants and young children due to the fact they have more permeable skin and are more likely to absorb the topical drugs. Infants have significant subcutaneous fat, but this does not necessitate higher concentrations of drugs. Topical drugs do not necessarily have to be covered with a barrier following administration.



17. A patient has been diagnosed with severe atopic dermatitis and treatment with tacrolimus (Protopic) ointment has been deemed necessary. When planning this patient’s care, the nurse should ensure that the patient has been informed of what risk?
  A) Risk of chemical burn injury
  B) Increased risk of developing psoriasis or type IV hypersensitivity
  C) Risk of opportunistic fungal infection that may become systemic
  D) Increased risks of skin cancer and lymphoma
  Ans: D
  Tacrolimus has a black box warning about a possible increased risk of skin cancer and lymphoma. It is not noted to cause fungal infections, psoriasis, or chemical burn injuries.



18. A 15-year-old boy has begun acne treatment using a combination ointment of clindamycin and benzoyl peroxide. The nurse should teach the boy to expect maximum results in how long?
  A) 5 to 7 days
  B) 1 to 2 weeks
  C) 3 to 5 weeks
  D) 8 to 12 weeks
  Ans: D
  Best results of combination acne treatments require 8 to 12 weeks of therapy, and maintenance therapy is usually required.



19. A young adult began acne treatment several weeks ago using a combination ointment and has presented for a follow-up appointment at the clinic. When assessing the patient for adverse effects of treatment, what question should the nurse prioritize?
  A) “Have you found that the ointment makes your skin a lighter color?”
  B) “Do you find that the ointment makes your pimples bleed more easily?”
  C) “Do your eyes burn when you apply the ointment to your face?”
  D) “Is the skin on your face uncomfortably dry since you began using the ointment?”
  Ans: D
  Adverse effects of topical antibiotics include erythema, peeling, dryness, and burning as well as development of resistant strains of P. acnes. Such ointments are not expected to produce eye irritation, bleeding, or changes in skin tone.



20. A nurse practitioner has discussed the possible risks and benefits of isotretinoin treatment with a patient who has acne vulgaris. The nurse should be aware that this medication achieves a reduction in the signs and symptoms of acne by what method?
  A) Stimulating phagocytosis in the epidermis and dermis
  B) Suppressing the production of sebum
  C) Enhancing humoral immunity
  D) Inhibiting the function of sudoriferous glands
  Ans: B
  The antiacne effects of isotretinoin include suppression of sebum production, inhibition of comedone formation, and inhibition of inflammation. The drug does not stimulate immune function or reduce the function of sweat glands.







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