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 12

1. A patient has been diagnosed with a brain tumor and is dealing with this diagnosis by seeking detailed information about cancer. The nurse would explain to the patient that cancer is essentially a result of the disruption of the
  A) cell cycle.
  B) cell wall.
  C) lymphatic system.
  D) immune system.
  Ans: A
  Malignant cells have lost the normal genetic regulation that controls cell growth, invading normal tissues and taking blood and nutrients away from these tissues. In essence, the cell cycle has been pathologically disrupted.



2. A 49-year-old patient is diagnosed with ovarian cancer. What is a characteristic of malignant cells that differentiates them from normal body cells?
  A) Cancerous cells do not require an energy source in order to proliferate.
  B) Cancerous cells grow in an uncontrollable fashion.
  C) Cancerous cells have a theoretically infinite lifespan.
  D) Cancerous cells are not responsive to the presence of drugs.
  Ans: B
  Malignant cells have lost the normal genetic regulation that controls cell growth, invading normal tissues and taking blood and nutrients away from these tissues. They grow in an uncontrolled fashion without regard to growth regulation signals (e.g., contact with other cells) that stop the growth of normal cells. Cancerous cells, like all cells, have a finite lifespan and need energy. Cancerous cells are responsive to drugs; this is the rationale for treatment with antineoplastics.



3. A patient with a diagnosis of bladder cancer is started on a chemotherapeutic regimen that includes three agents. What is the rationale for using multiple antineoplastic agents?
  A) The use of three agents decreases the development of cell resistance.
  B) The use of three agents increases adherence to treatment.
  C) The use of three agents increases the serum levels of one of the agents.
  D) The use of three agents decreases the total adverse effects.
  Ans: A
  Most chemotherapy regimens involve a combination of drugs with different actions at the cellular level, which destroys a greater number of cancer cells and reduces the risk of the cancer developing drug resistance.



4. A patient has undergone an aggressive chemotherapeutic regimen to treat leukemia. The patient develops gastrointestinal upset, hypertension, and paresthesias. What syndrome is the patient developing?
  A) Fröhlich’s syndrome
  B) Epidermal nevus syndrome
  C) Irritable bowel syndrome
  D) Tumor lysis syndrome
  Ans: D
  With the treatment of leukemias and lymphomas, a serious, life-threatening adverse effect called tumor lysis syndrome may occur. This syndrome occurs when large numbers of cancer cells are killed or damaged, releasing their contents into the blood stream. The patient may have metabolic imbalances, which include gastrointestinal upset, hypertension, and paresthesias. Fröhlich’s syndrome is noted in adolescent boys who have an increase in fat and atrophy of the genitals. Epidermal nevus syndrome is associated with multiple nevi. Irritable bowel syndrome is marked by abdominal pain and disturbances of evacuation.



5. A patient develops tumor lysis syndrome during the administration of chemotherapy agents. Which of the following treatments is implemented to resolve this health problem?
  A) Administration of potassium IV
  B) Administration of anti-inflammatory agents
  C) Limiting of fluid intake and reduction in IV fluid rate
  D) Administration of IV normal saline and sodium bicarbonate
  Ans: D
  The patient experiencing lysis syndrome should receive regular insulin and IV sodium bicarbonate. The patient suffers from hyperkalemia and should not be administered potassium. The patient would not be administered anti-inflammatory agents. The patient should be aggressively hydrated and thus should not have fluids limited or decreased.



6. A patient is being treated with cyclophosphamide (Cytoxan). Which of the following laboratory values should the nurse follow most closely?
  A) D-dimer
  B) Complete blood count
  C) C-reactive protein level
  D) Arterial blood gases
  Ans: B
  The patient’s complete blood count should be assessed frequently because of the adverse effect of bone marrow depression. The other listed lab values may be important to assess at different points but are not normally as critical as the CBC.



7. A patient with colorectal cancer is being treated with oxaliplatin (Eloxatin). Which of the following potential adverse effects should the nurse explain to the patient?
  A) Dysuria
  B) Diarrhea
  C) Insomnia
  D) Cold-induced neuropathy
  Ans: D
  Cold-induced neuropathy is an adverse effect of oxaliplatin. Dysuria, diarrhea, and insomnia are not closely associated with Eloxatin.



8. A patient has been administered methotrexate, which is a purine antagonist used to treat a rapidly growing tumor. The patient develops stomatitis. What is the priority nursing diagnosis for a patient suffering from stomatitis?
  A) Impaired skin integrity
  B) Activity intolerance
  C) Self-care deficit: hygiene
  D) Risk for disuse syndrome
  Ans: A
  Toxic effects of methotrexate include stomatitis, which is an alteration in skin integrity. Disuse syndrome, lack of hygiene, and activity intolerance are less directly related to stomatitis.



9. A patient is administered bevacizumab (Avastin) to treat tumor growth in a breast tumor. What is the action of a monoclonal antibody such as bevacizumab (Avastin)?
  A) It changes the RNA of the tumor cell to a normal form.
  B) It binds to the 30S ribosome.
  C) It prevents the activation of intracellular growth factors.
  D) It blocks the cell wall synthesis.
  Ans: C
  Bevacizumab (Avastin) binds to growth factor receptors found on blood vessels to prevent intracellular growth factors from becoming activated and stimulating cell growth. Bevacizumab does not change the RNA of the tumor cell. Bevacizumab does not bind to the 30S ribosome or block cell wall synthesis.



10. An oncology nurse is preparing to administer cytotoxic chemotherapy medications. Which of the following measures best protects the nurse from harm related to the chemotherapy?
  A) Wearing protective equipment
  B) Performing thorough hand hygiene
  C) Mixing medication in a 1000-mL bag
  D) Administering medication intramuscularly whenever possible
  Ans: A
  Because of the drugs’ toxicity, nurses who administer IV cytotoxic chemotherapy should be specially trained to administer the medications safely and use protective equipment when handling the medication. Hand hygiene is important during care but will only minimally protect from harm. The medication is mixed in a variety of solutions and amounts. The medication is not normally administered intramuscularly.



11. A 32-year-old female patient is being treated with a cytotoxic antineoplastic agent. Which of the following is the most important instruction related to the potential for teratogenicity?
  A) The medication will be completely eliminated 24 hours after the administration.
  B) The patient should protect herself from infections and take Bactrim.
  C) The patient should not become pregnant for several months.
  D) The patient will not get pregnant due to the elimination of ova.
  Ans: C
  Most cytotoxic antineoplastic drugs are potentially teratogenic, and pregnancy should be avoided during and for several months after drug therapy is stopped. The medication is not completely eliminated in 24 hours. The patient should be protected from infection, but this characteristic is not related to pregnancy. The patient can get pregnant after the medication is administered.



12. Fewer adverse effects are associated with monoclonal antibody therapy than those of cytotoxic drugs. However, some of the potential adverse effects of monoclonal antibodies can be life threatening, including which of the following?
  A) Heart failure and bleeding problems
  B) Changes in cognition and personality changes
  C) Ischemic heart disease
  D) Bronchoconstriction and pulmonary edema
  Ans: B
  Although some adverse effects of monoclonal antibodies are rare, they are serious (e.g., heart failure, bleeding problems, electrolyte imbalances) and vary with a particular drug.



13. A patient is undergoing a cytotoxic chemotherapy regimen for the treatment of stage III lung cancer. What effect will this regimen likely have on the patient’s hemostatic function?
  A) The patient’s platelet count will decline.
  B) The patient will be at increased risk of deep vein thrombosis.
  C) The patient will require prophylactic heparin.
  D) The patient will likely experience thrombocytosis.
  Ans: A
  Thrombocytopenia is a common adverse effect of cytotoxic chemotherapy. Heparin is consequently contraindicated, and DVT is not a priority risk.



14. A patient has chosen to receive palliative care after his lung cancer metastasized to his bones and liver. Which of the following is most appropriate during palliative cancer care?
  A) Abrupt cessation of chemotherapy immediately prior to entering palliative care
  B) Aggressive chemotherapy to reduce malignant cell proliferation
  C) The use of chemotherapy to reduce pain
  D) The replacement of chemotherapy with complementary and alternative treatments
  Ans: C
  Palliative chemotherapy is used in advanced cancer to prevent or treat pain and obstruction. Chemotherapy does not need to be stopped abruptly or replaced with CAM. Aggressive chemotherapy would not normally be administered in a palliative context.



15. An adult patient has recently begun cancer treatment with methotrexate (MTX). The nurse is aware of the importance of monitoring the patient closely for adverse effects of treatment. When reviewing this patient’s laboratory work, the nurse should consequently prioritize assessment of which of the following?
  A) Sodium and potassium
  B) BUN and creatinine
  C) Calcium and magnesium
  D) Arterial blood gases
  Ans: B
  The antimetabolites may also be nephrotoxic. MTX use in patients with impaired renal function may lead to accumulation of toxic amounts or additional renal damage. Evaluation of the patient’s renal status should take place before and during MTX therapy. This adverse effect of MTX treatment supersedes the importance of electrolytes and ABGs, though these would also be considered.



16. A patient is being treated on the oncology unit and has developed worsening adverse effects over the past several days of chemotherapy. Administration of filgrastim (Neupogen) may aid in achieving what desired outcome?
  A) Resolution of mucositis
  B) Increased leukocytes
  C) Increased platelet levels
  D) Prevention of hemorrhagic cystitis
  Ans: B
  Severe neutropenia can be prevented or its extent and duration minimized by administering filgrastim or sargramostim to stimulate the bone marrow to produce leukocytes. Filgrastim does not address the patient’s risk for bleeding.



17. A 50-year-old man has just been diagnosed with liver cancer, and the care team is finalizing the chemotherapy regimen that will begin imminently. Administration of chemotherapeutic drugs is best achieved through which of the following?
  A) An intramuscular depot
  B) A peripheral IV in the nondominant forearm
  C) Peripheral intravenous access in the antecubital fossa
  D) A central venous catheter
  Ans: D
  Insertion of an indwelling central venous catheter is often appropriate for patients who have poor peripheral venous access, who require many doses of chemotherapy, or who require continuous infusions. Overall, a CVC is preferable to peripheral access. IM administration is uncommon.



18. A 79-year-old woman has recently moved to a long-term care facility, and the nurse at the facility is conducting a medication reconciliation. The nurse notes that the woman has recently been taking tamoxifen (Nolvadex). The nurse is justified in concluding that the woman has a history of what malignancy?
  A) Ovarian cancer
  B) Breast cancer
  C) Malignant melanoma
  D) Cervical cancer
  Ans: B
  Tamoxifen is an antiestrogen that has been widely used to prevent recurrence of breast cancer after surgical excision in women aged 40 and older and to treat metastatic breast cancer in postmenopausal women with estrogen receptor–positive disease.



19. An oncology nurse is reviewing the medication administration record of a patient being treated for advanced prostate cancer. In addition to two chemotherapeutic agents, the nurse reads that the patient has been ordered a cytoprotective agent. The goal of this agent is to
  A) buffer the cytotoxins that result from the metabolism of chemotherapeutic agents.
  B) protect the patient from pathophysiological effects of his malignancy.
  C) potentiate the beneficial effects of chemotherapy.
  D) reduce the incidence or severity of adverse drug effects.
  Ans: D
  Cytoprotectant agents reduce the adverse effects of cytotoxic drugs, some of which can be severe, debilitating, or life threatening. Cytoprotectant drugs do not potentiate chemotherapy, protect the patient from the effects of cancer, or buffer cytotoxins.



20. A patient’s chemotherapy regimen has been deemed successful, but the patient is experiencing debilitating nausea and vomiting. These adverse effects should signal the nurse to the possibility of what nursing diagnosis?
  A) Acute pain
  B) Adult failure to thrive
  C) Ineffective therapeutic regimen management
  D) Imbalanced nutrition: less than body requirements
  Ans: D
  Nausea and vomiting are major threats to the patient’s nutrition. Failure to thrive is typically a chronic, rather than acute, health problem. Pain does not necessarily accompany nausea, and there is no indication that this patient is not maintaining the necessary regimen.


chapter 24

1. The home care nurse sees a patient for the first time. The patient has crackles in the lower lobes of the lungs, an audible S3, and pitting edema in the feet and ankles. What condition is the patient most likely experiencing?
  A) Pneumonia
  B) Liver disease
  C) Heart failure
  D) Myocardial infarction
  Ans: C
  The cardinal manifestations of heart failure are dyspnea and fatigue, which can lead to exercise intolerance and fluid retention. Fluid retention results in the development of pulmonary congestion and peripheral edema. An audible S3 is often present. The patient is not presenting with myocardial infarction symptoms.



2. A patient is diagnosed with heart failure. She asks the nurse for further details about heart failure. Which of the following statements is most accurate?
  A) “Heart failure can be caused by atherosclerotic plaque due to high-fat diets.”
  B) “Hypothyroidism will result in decreased heart rate and development of heart failure.”
  C) “The administration of diuretics increases blood volume, causing symptoms to abate.”
  D) “The use of digoxin will slow heart rate to make your heart more efficient.”
  Ans: D
  Endothelial dysfunction allows processes that narrow the blood vessel lumen and lead to blood clot formation and vasoconstriction that further narrow the blood vessel lumen. These are major factors in coronary artery disease and hypertension, the most common conditions leading to heart failure. Hyperthyroidism, not hypothyroidism, is a cause of heart failure. The administration of diuretics decreases fluid volume, which prevents the symptoms of heart failure. The use of digoxin increases the force of myocardial contraction and prevents the development of congestive heart failure in patients whose heart cannot pump blood to meet tissue needs. A high-fat diet does not directly cause heart failure.



3. A patient states that he is seeing halos around lights. The patient takes digoxin (Lanoxin) by mouth every day. The physician orders the patient to have serum digoxin level drawn. At what digoxin level would the care team first suspect that the patient is experiencing toxicity?
  A) 0.5 ng/mL
  B) 1.5 ng/mL
  C) 3.0 ng/mL
  D) 6.0 ng/mL
  Ans: C
  The therapeutic serum digoxin level is 0.8 to 2.0 ng/mL.



4. A patient has an elevated BUN and creatinine. The patient has been prescribed digoxin (Lanoxin) for heart failure. What aspect of care is the priority regarding this patient?
  A) The patient should be taught to increase sodium in her diet.
  B) The dose should be increased when her heart rate is below 60.
  C) The dose should be decreased in this patient.
  D) The dosage should be 1.0 mg PO daily.
  Ans: C
  The dose must be reduced in the presence of renal failure because most of the digoxin is excreted unchanged by the kidneys, leading to drug accumulation and toxicity. The patient should be taught to limit sodium intake in the diet. The patient’s heart rate should remain above 60. If the heart rate falls below 60, the digoxin should be held. The dose of 1.0 mg is too large for a patient with altered renal function.



5. A patient with a history of heart failure is being treated with digoxin (Lanoxin). The nurse knows that this medication increases the force of contractions of the heart. What effect improves the contractility of the heart?
  A) Positive chronotropic effect
  B) Positive inotropic effect
  C) Negative inotropic effect
  D) Negative dromotropic effect
  Ans: B
  In heart failure, digoxin exerts cardiotonic or positive inotropic effect that improves the contractility and pumping ability of the heart. A positive chronotropic effect accelerates the rate of the heart, which is not recommended in a patient with heart failure. A negative inotropic effect accelerates the heart, which is not recommended in a patient with heart failure. A negative dromotropic effect changes the conductivity of muscle fiber, increasing heart rate.



6. A patient is admitted to the intensive care unit with an electrolyte imbalance. Which of the following imbalances will contraindicate the administration of digoxin (Lanoxin)?
  A) Hyperkalemia
  B) Hypokalemia
  C) Hypermagnesemia
  D) Hypocalcemia
  Ans: B
  Digoxin is contraindicated in patients with hypokalemia. Digoxin is not contraindicated in patients with hyperkalemia, hypermagnesemia, or hypocalcemia.



7. A patient with heart failure is admitted to the emergency department. The physician orders digoxin (Lanoxin) intravenously. What is the onset of action when digoxin (Lanoxin) is administered intravenously?
  A) 5 minutes
  B) 10 minutes
  C) 45 minutes
  D) 1 hour
  Ans: B
  Digoxin administered intravenously will have an onset of action within 10 to 30 minutes. Five minutes after administration is too soon to provide an onset of action. Forty-five minutes to one hour is after the onset of action.



8. A patient is in the intensive care unit to be digitalized. This patient is to be digitalized rapidly. What is the total dose range of digoxin (Lanoxin) for rapid digitalization?
  A) 0.75 to 1.5 mg
  B) 2.0 to 2.5 mg
  C) 3.75 to 4 mg
  D) 0.125 to 0.05 mg
  Ans: A
  Digitalization may be accomplished rapidly by giving a total dose of 0.75 to 1.5 mg of digoxin in divided doses. A digoxin dose range of 2.0 to 4.0 mg is too large. A digoxin dose range of 0.125 to 0.5 mg is too small.



9. A patient has been taking digoxin (Lanoxin) for 5 years for the treatment of heart failure. In the last 3 months, she has noticed she is tired all the time, her heart rate is very slow, and she is always cold. The nurse assessing the patient notes her blood pressure at 88/50 and pulse rate is 44. The nurse instructs the patient not to take her digoxin. What condition may the patient be suffering from that would contraindicate the administration of digoxin?
  A) Hypothyroidism
  B) Myocardial infarction
  C) Cerebrovascular accident
  D) Intermittent claudication
  Ans: A
  Hypothyroidism slows digoxin metabolism and further slows the heart rate. The patient is presenting with signs and symptoms of hypothyroidism. The patient is not experiencing characteristic signs and symptoms of myocardial infarction, cerebrovascular accident, or intermittent claudication.



10. A patient who has been prescribed digoxin (Lanoxin) is also taking furosemide (Lasix) 20 mg daily. Which of the following electrolyte imbalances will precipitate the development of digoxin toxicity?
  A) Hyperkalemia
  B) Hypokalemia
  C) Hypermagnesemia
  D) Hyponatremia
  Ans: B
  Hypokalemia will contribute to the patient developing digoxin toxicity. Hyperkalemia, hypermagnesemia, and hyponatremia will not contribute to the development of digoxin toxicity.



11. A patient is admitted to the emergency department with severe heart failure. Milrinone (Primacor) is administered IV. For what adverse effect should the patient be assessed?
  A) Hypertension
  B) Bradycardia
  C) Atrial dysrhythmias
  D) Lethargy
  Ans: C
  Dose-limiting adverse effects of the drugs include tachycardia, atrial or ventricular dysrhythmias, and hypotension. Hypertension, bradycardia, and lethargy are not adverse effects of milrinone.



12. A patient has been administered nesiritide (Natrecor) to manage symptoms of acute heart failure. How does the drug act?
  A) Nesiritide (Natrecor) exhibits mild inotropic action and decreased platelet aggregation.
  B) Nesiritide (Natrecor) compensates for cardiac deterioration by reducing preload and afterload.
  C) Nesiritide (Natrecor) corrects hyperthyroidism by inhibiting synthesis of the thyroid hormone.
  D) Nesiritide (Natrecor) increases the concentration of acetylcholine to potentiate the action of ACE.
  Ans: B
  Nesiritide (Natrecor) compensates for cardiac deterioration by reducing preload and afterload. Dipyridamole (Persantine) exhibits mild inotropic action and decreased platelet aggregation. It would not be used in acute heart failure. Methimazole (Tapazole) corrects hyperthyroidism by inhibiting synthesis of the thyroid hormone. Physostigmine (Antilirium) increases the concentration of acetylcholine to potentiate the action of ACE on the skeletal muscle.



13. When instructing a patient on a no-added-salt diet, the nurse should instruct the patient on foods with hidden salt. Which of the following foods has hidden salt and should be avoided?
  A) Ice cream
  B) Dehydrated apple chips
  C) Bread
  D) Canned soup
  Ans: D
  Canned soup is very high in sodium and should be avoided. Ice cream contains a small amount of sodium but should be avoided due to the fat content. Dehydrated apple chips are an acceptable food. Bread is an acceptable food.



14. A patient is being treated for heart failure. Which of the following is most indicative of improved health status?
  A) Decreased pedal edema
  B) Increased skin turgor
  C) Heart rate of 52
  D) Improved sensorium
  Ans: A
  Decreased pedal edema improves cardiac output due to the fact that the patient has diminished fluid volume. Increased skin turgor indicates that the patient is well hydrated and does not have fluid volume excess. A heart rate of 52 is too slow to provide good contractility. Improved sensorium indicates adequate perfusion but is not the most indicative of improved heart failure status.



15. A patient is being administered digoxin (Lanoxin) for treatment of heart failure. At what level should the serum potassium level be maintained?
  A) 1.5 to 2.0 mEq/L
  B) 3.5 to 5.0 mEq/L
  C) 6.0 to 8.0 mEq/L
  D) 8.5 to 10 mEq/L
  Ans: B
  Electrolyte imbalance must be monitored during digoxin therapy, and the potassium level should be maintained at 3.5 to 5.0 mEq/L. A potassium level of 1.5 to 2.0 mEq/L is too low. Potassium levels of 6.0 to 8.0 and 8.5 to 10 mEq/L are too high.



16. A patient is experiencing nausea and visual disturbances when taking digoxin (Lanoxin). Which of the following medications will be administered?
  A) Acetylsalicylic acid (aspirin)
  B) Nesiritide (Natrecor)
  C) Felbamate (Felbatol)
  D) Digoxin immune fab (Digibind)
  Ans: D
  A patient who has nausea and visual changes while taking digoxin will most likely be administered digoxin immune fab (Digibind). Acetylsalicylic acid is not administered for digoxin toxicity. Nesiritide is not administered when the patient is experiencing digoxin toxicity. Felbamate is administered for the treatment of seizures.



17. A 77-year-old patient was diagnosed with heart failure 3 years ago, and he had achieved reasonable symptom control with digoxin. In the last several months, his cardiac function has decreased significantly and his cardiologist has prescribed nesiritide during his current admission. What aspect of this patient’s health status would potentially contraindicate the administration of nesiritide?
  A) Blood pressure of 88/50 mm Hg
  B) Jaundice
  C) Presence of +2 peripheral edema
  D) Irregular apical heart rate
  Ans: A
  Nesiritide should not be administered if the systolic blood pressure is less than 90 mm Hg. The presence of jaundice, edema, or an irregular heart rate does not necessarily contraindicate the use of this drug.



18. An older adult patient has been receiving treatment for heart failure and has been experiencing frequent episodes of peripheral edema. As a result, her care provider has added furosemide (Lasix) to her medication regimen. What assessment should the nurse perform on a daily basis for the duration of treatment?
  A) Body weights
  B) Arterial blood gases
  C) Magnesium level
  D) Pupillary response
  Ans: A
  When a patient is being treated with furosemide, the nurse weighs the patient daily and reports any increase in weight of greater than 2 pounds in 24 hours to the health care provider. Electrolyte levels must be assessed, but sodium and potassium levels are the priority. There is no particular need to assess ABGs or pupillary response.



19. A nurse has poured a hospital patient’s scheduled dose of hydrochlorothiazide (HCTZ). The nurse should know that this drug reduces preload by which of the following means?
  A) Exerting a direct relaxant effect on the vascular smooth muscle
  B) Increasing renal excretion of sodium and water
  C) Increasing the contractility of myocardial fibers
  D) Stimulating the SA node to fire more frequently
  Ans: B
  Hydrochlorothiazide inhibits the reabsorption of sodium and chloride in the distal renal tubule, increasing the excretion of sodium and water by the kidneys. Thiazide diuretics do not relax smooth muscle, increase contractility, or stimulate the SA node.



20. A gerontological nurse is aware that increased aldosterone is a major factor in the pathophysiology of heart failure. Which of the following medications reduces aldosterone-induced retention of sodium and water?
  A) Hydrochlorothiazide
  B) Enalapril maleate
  C) Spironolactone
  D) Losartan potassium
  Ans: C
  Spironolactone (Aldactone) is an aldosterone antagonist that reduces aldosterone-induced retention of sodium and water and impaired vascular function. Thiazide diuretics, ACE inhibitors, and angiotensin II–receptor blockers do not have this mechanism of action.


chapter 36

1. A patient is experiencing nausea and vomiting as a response to radiation therapy. Which of the following antiemetic agents is a phenothiazine administered to control nausea and vomiting?
  A) Prochlorperazine (Compazine)
  B) Metoclopramide (Reglan)
  C) Mesna (Mesnex)
  D) Dexamethasone
  Ans: A
  Prochlorperazine (Compazine) is a commonly used phenothiazine administered for nausea and vomiting related to radiation therapy. Metoclopramide is a prokinetic agent that increases GI motility and the rate of gastric emptying by increasing the release of acetylcholine from nerve endings in the GI tract. Mesna is used for thrombocytopenia. Dexamethasone is a corticosteroid.



2. A pregnant woman suffers from morning sickness. Which of the following should be considered a first-line treatment?
  A) Vitamin B6
  B) Promethazine (Phenergan)
  C) Vitamin E
  D) Diphenhydramine (Benadryl)
  Ans: A
  For pregnant women, taking pyridoxine (vitamin B6) 30 to 75 mg daily in three divided doses with or without the antihistamine doxylamine 12.5 mg every 8 hours as needed is considered a first-line treatment option that is safe and effective. Phenergan is not a first-line treatment for morning sickness. Benadryl and vitamin E are not used to treat nausea.



3. A patient with Parkinson’s disease develops nausea and vomiting. Promethazine may be contraindicated because it depletes levels of what neurotransmitter?
  A) Acetylcholine
  B) Serotonin
  C) Dopamine
  D) Adenosine
  Ans: C
  Promethazine and other phenothiazines have widespread effects on the body. The therapeutic effects in nausea and vomiting are attributed to their ability to block dopamine from receptor sites in the brain and CTZ. This blockage of dopamine has the potential to exacerbate parkinsonian effects.



4. What is a nonpharmacological measure that is effective in treating nausea and vomiting in pregnant women?
  A) Ginkgo biloba
  B) Ginger
  C) Garlic
  D) Ginseng
  Ans: B
  Clinical trials indicate that ginger can effectively reduce nausea and vomiting associated with motion sickness, pregnancy, and surgery.



5. A patient is administered promethazine (Phenergan) for nausea and vomiting. Which of the following is an adverse effect of promethazine (Phenergan)?
  A) Urinary incontinence
  B) Tachycardia
  C) Taste alteration
  D) Extrapyramidal symptoms
  Ans: D
  Extrapyramidal symptoms are adverse effects of promethazine. Urinary retention is an adverse effect, not urinary incontinence. Tachycardia is not an adverse effect of promethazine. Taste alteration is not an adverse effect of promethazine.



6. A patient is administered an antihistamine for nausea. Which of the following is an adverse effect of this classification of medication?
  A) Diarrhea
  B) Prolonged QRS complex
  C) Urinary retention
  D) Inverted T wave
  Ans: C
  Adverse anticholinergic effects of antihistamines are dizziness, confusion, dry mouth, and urinary retention. Diarrhea, prolonged QRS complex, and inverted T wave are not adverse effects of antihistamines.



7. A patient is administered a phenothiazine for nausea and vomiting. What is the action of phenothiazine?
  A) Increases gastric motility
  B) Antagonizes dopamine receptors
  C) Blocks histamine receptors
  D) Antagonizes serotonin receptors
  Ans: B
  Phenothiazines act on the CTZ and vomiting center by blocking dopamine. They do not increase gastric motility. Phenothiazines do not block histamine receptors. Phenothiazines do not antagonize serotonin receptors.



8. A patient has been administered hydroxyzine for the treatment of nausea. Which of the following statements indicates that she has understood the teaching provided by the nurse?
  A) “I will take repeated doses of this medication until my nausea resolves.”
  B) “I may experience drowsiness with this medication.”
  C) “I should eat before I take this medication.”
  D) “I will need to take potassium with this medication.”
  Ans: B
  Hydroxyzine will produce drowsiness in the patient. Repeated doses are unsafe. The patient should not eat with nausea. The patient does not need to take potassium with hydroxyzine.



9. A pediatric patient is receiving chemotherapy. What is the recommended treatment of nausea and vomiting with pediatric chemotherapy agents?
  A) Corticosteroids and 5-HT3 receptor antagonists
  B) Phenothiazines and benzodiazepines
  C) Proton pump inhibitors and antacids
  D) Prokinetic agents and antihistamines
  Ans: A
  5-HT3 receptor antagonists and corticosteroids are used to treat nausea and vomiting in pediatric oncology patients.



10. A 1-year-old postoperative patient has been experiencing repeated vomiting. What antiemetic drug has a black box warning against use in a patient of this age?
  A) Promethazine (Phenergan)
  B) Benzquinamide (Emete-Con)
  C) Buclizine (Bucladin-S)
  D) Cyclizine (Marezine)
  Ans: A
  A black box warning alerts nurses that promethazine is contraindicated in children younger than 2 years of age because of the risk of potentially fatal respiratory depression. Benzquinamide, buclizine, and cyclizine do not have such warnings.



11. An adult patient is administered hydroxyzine for nausea. What adverse effect is most likely with this medication?
  A) Thrombocytopenia
  B) Palpitations
  C) Hypertonic muscle tone
  D) Dry mouth
  Ans: D
  Anticholinergic effects, including dry mouth, can result from the use of hydroxyzine. This drug is not associated with thrombocytopenia, palpitations, or hypertonicity.



12. An 85-year-old patient is administered dimenhydrinate (Dramamine). Which of the following is the priority nursing intervention?
  A) Encourage fluids with this patient.
  B) Have the patient void after administration.
  C) Maintain IV access.
  D) Protect from injury.
  Ans: D
  Dimenhydrinate (Dramamine) causes drowsiness, especially in older adults, and therefore should be used cautiously. The nurse should protect the patient from injury. The nurse should not force fluids. The patient will not require IV access unless fluid replacement is ordered.



13. A patient is administered promethazine. The patient has an elevated creatinine level. Which of the following is important when administering promethazine to this patient?
  A) Administer the routine dose.
  B) Administer a lower dose.
  C) Administer a higher dose.
  D) Hold the medication.
  Ans: B
  A dose reduction may be necessary in patients with renal impairment to avoid the possibility of adverse effects, toxicity, or increased sensitivity to phenothiazines.



14. A patient who is scheduled to begin chemotherapy for the treatment of breast cancer is anxious about the possibility of experiencing nausea and has asked the nurse multiple questions about the physiology of the phenomenon. When explaining the physiology of nausea and vomiting, the nurse should include which of the following statements?
  A) The vomiting center is a cluster of cells in the cerebellum.
  B) The vomiting center sends afferent signals to the chemoreceptor trigger zone (CTZ).
  C) The chemoreceptor trigger zone CTZ is composed of neurons in the fourth ventricle.
  D) The CTZ is located partly within the central nervous system and partly in the peripheral nervous system.
  Ans: C
  The CTZ is composed of neurons in the fourth ventricle. The vomiting center is a nucleus of cells in the medulla oblongata. Stimuli are relayed to the vomiting center by afferent signals from the chemoreceptor trigger zone (CTZ).



15. An adult hospital patient has been experiencing intractable nausea and vomiting for several hours, so the nurse has obtained an order for an antiemetic from the primary care provider. The order reads: “Promethazine 25 mg sub-Q every 6 hours PRN.” The nurse should contact the care provider to question what aspect of this order?
  A) The drug
  B) The dose
  C) The route
  D) The frequency
  Ans: C
  A black box warning alerts nurses that promethazine is contraindicated for subcutaneous administration. The other parameters of the order are within recommendations.



16. An older adult’s physician has recommended the occasional use of hydroxyzine for relief of nausea. Following administration, the nurse should assess the patient for
  A) pruritus.
  B) drowsiness.
  C) urinary frequency.
  D) bradycardia.
  Ans: B
  The use of hydroxyzine is associated with drowsiness. Antihistamines do not typically cause pruritus, frequency, or bradycardia.



17. A patient has been admitted to the postsurgical unit from postanesthetic recovery following a transurethral prostatic resection. The patient is experiencing nausea subsequent to anesthesia. What antiemetic is the most common first-line drug for the treatment of postoperative nausea and vomiting?
  A) Ondansetron (Zofran)
  B) Dronabinol (Marinol)
  C) Dimenhydrinate (Dramamine)
  D) Hydroxyzine (Vistaril, Atarax)
  Ans: A
  The 5-HT3 receptor antagonists are usually considered drugs of first choice for postoperative nausea and vomiting. Ondansetron (Zofran) is the prototype of the 5-HT3 receptor antagonists.



18. A patient is undergoing a course of radiotherapy for the treatment of leukemia. Treatments in the past have caused the patient severe nausea and vomiting. The oncology nurse should normally administer antiemetics on what schedule?
  A) Simultaneous with radiation treatment
  B) The night before a scheduled radiation treatment
  C) 30 to 60 minutes before the treatment
  D) 10 to 15 minutes before the treatment
  Ans: C
  The nurse should normally administer antiemetic drugs 30 to 60 minutes before a nausea-producing event, when possible.



19. When reviewing a newly admitted patient’s previous medication record, the nurse notes that the patient has previously been treated with aprepitant (Emend). The nurse is justified is suspecting that this patient’s medical history includes which of the following?
  A) Placement of a nasogastric tube
  B) Chemotherapy
  C) Endoscopy
  D) Radiation therapy
  Ans: B
  Prescribers often order aprepitant as part of combination therapy along with a 5-HT3 receptor antagonist and corticosteroids to treat both acute and delayed nausea and vomiting associated with chemotherapy. NG tube insertion, radiation therapy, and endoscopy are not typical indications for the use of aprepitant.



20. A hospital patient has a standing order for aprepitant on an as-needed basis. The patient should be encouraged to request a dose of the drug
  A) when she anticipates that she will become nauseous.
  B) at the same time each day.
  C) as soon as she senses the onset of nausea.
  D) when her nausea results in vomiting.
  Ans: A
  The nurse instructs patients to take aprepitant as prescribed before the onset of nausea and vomiting. It does not need to be taken on a regular schedule and should not be withheld until the onset or peak of symptoms.


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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