Test Bank For Lehne’s Pharmacology for Nursing Care 9th Edition by Jacqueline Burchum

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Lehne’s Pharmacology for Nursing Care 9th Edition by Jacqueline Burchum

Chapter 01: Orientation to Pharmacology

Test Bank

 

MULTIPLE CHOICE

 

  1. The nurse is teaching a patient how a medication works to treat an illness. To do this, the nurse will rely on knowledge of which topic?
a. Clinical pharmacology
b. Drug efficacy
c. Pharmacokinetics
d. Pharmacotherapeutics

 

 

ANS:  D

Pharmacotherapeutics is the study of the use of drugs to diagnose, treat, and prevent conditions. Clinical pharmacology is concerned with all aspects of drug-human interactions. Drug efficacy measures the extent to which a given drug causes an intended effect. Pharmacokinetics is the study of the impact of the body on a drug.

 

PTS:   1                    DIF:    Cognitive Level: Comprehension   REF:   p. 1

TOP:   Nursing Process: Implementation

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies

 

  1. What is a desired outcome when a drug is described as easy to administer?
a. It can be stored indefinitely without need for refrigeration.
b. It does not interact significantly with other medications.
c. It enhances patient adherence to the drug regimen.
d. It is usually relatively inexpensive to produce.

 

 

ANS:  C

A major benefit of drugs that are easy to administer is that patients taking them are more likely to comply with the drug regimen. Drugs that are easy to give may have the other attributes listed, but those properties are independent of ease of administration.

 

PTS:   1                    DIF:    Cognitive Level: Comprehension   REF:   p. 2

TOP:   Nursing Process: Assessment

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies

 

  1. A patient tells the nurse that an analgesic he will begin taking may cause drowsiness and will decrease pain up to 4 hours at a time. Based on this understanding of the drug’s effects by the patient, the nurse will anticipate which outcome?
a. Decreased chance of having a placebo effect
b. Decreased motivation to take the drug
c. Improved compliance with the drug regimen
d. Increased likelihood of drug overdose

 

 

ANS:  C

A drug is effective if it produces the intended effects, even if it also produces side effects. Patients who understand both the risks and benefits of taking a medication are more likely to comply with the drug regimen.

 

PTS:   1                    DIF:    Cognitive Level: Comprehension   REF:   p. 2

TOP:   Nursing Process: Evaluation

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies

 

MULTIPLE RESPONSE

 

  1. What are the properties of an ideal drug? (Select all that apply.)
a. Irreversible action
b. Predictability
c. Ease of administration
d. Chemical stability
e. A recognizable trade name

 

 

ANS:  B, C, D

In addition to predictability, ease of administration, and chemical stability, other properties include a reversible action so that any harm the drug may cause can be undone and a simple generic name, because generic names are usually complex and difficult to remember and pronounce.

 

PTS:   1                    DIF:    Cognitive Level: Comprehension   REF:   pp. 1-2

TOP:   Nursing Process: Assessment

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies

 

  1. Before administering a medication, what does the nurse need to know to evaluate how individual patient variability might affect the patient’s response to the medication? (Select all that apply.)
a. Chemical stability of the medication
b. Ease of administration
c. Family medical history
d. Patient’s age
e. Patient’s diagnosis

 

 

ANS:  C, D, E

The family medical history can indicate genetic factors that may affect a patient’s response to a medication. Patients of different ages can respond differently to medications. The patient’s illness can affect how drugs are metabolized. The chemical stability of the medication and the ease of administration are properties of drugs.

 

PTS:   1                    DIF:    Cognitive Level: Analysis               REF:   pp. 3-4

TOP:   Nursing Process: Implementation

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential

Chapter 03: Drug Regulation, Development, Names, and Information

Test Bank

 

MULTIPLE CHOICE

 

  1. A nurse educator is conducting a continuing education class on pharmacology. To evaluate the learning of the nurses in the class, the nurse educator asks, “Which drug name gives information about the drug’s pharmacologic classification?” Which is the correct response?
a. Amoxicillin
b. Tylenol
c. Cipro
d. Motrin

 

 

ANS:  A

Amoxicillin is the generic name, and the suffix “-cillin” indicates that it belongs to the penicillin class of antibiotics. Tylenol, Cipro, and Motrin are all trade names without segments that indicate their pharmacologic class.

 

PTS:   1                    DIF:    Cognitive Level: Comprehension   REF:   p. 18

TOP:   Nursing Process: Diagnosis

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies

 

  1. The FDA Amendments Act (FDAAA) was passed in 2007 to address which aspect of drug safety?
a. Allowing pharmaceutical companies to identify off-label uses of medications approved for other uses
b. Evaluating drug safety information that emerges after a drug has been approved and is in use
c. Expediting the approval process of the U.S. Food and Drug Administration (FDA) so that needed drugs can get to market more quickly
d. Requiring manufacturers to notify patients before removing a drug from the market

 

 

ANS:  B

The FDAAA was passed to enable the Food and Drug Administration to continue oversight of a drug after granting it approval so that changes in labeling could be made as necessary and postmarketing risks could be tracked and identified. A provision of the FDA Modernization Act (FDAMA), passed in 1997, allows drug companies to promote their products for off-label uses as long as they promise to conduct studies to support their claims. Regulations to permit accelerated approval of drugs for life-threatening diseases were adopted in 1992 by the FDA. The requirement that drug companies notify patients 6 months before removing a drug from the market is a provision of the FDAMA.

 

PTS:   1                    DIF:    Cognitive Level: Comprehension   REF:   pp. 14-15

TOP:   Nursing Process: Evaluation

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies

 

  1. A nursing student asks a nurse about pharmaceutical research and wants to know the purpose of randomization in drug trials. The nurse explains that randomization is used to do what?
a. To ensure that differences in outcomes are the result of treatment and not differences in subjects
b. To compare the outcome caused by the treatment to the outcome caused by no treatment
c. To make sure that researchers are unaware of which subjects are in which group
d. To prevent subjects from knowing which group they are in and prevent preconception bias

 

 

ANS:  A

Randomization helps prevent allocation bias, which can occur when researchers place subjects with desired characteristics in the study group and other subjects in the control group so that differences in outcome are actually the result of differences in subjects and not treatment. Comparing treatment outcome to no treatment outcome is the definition of a controlled study. The last two options describe the use of blinding in studies; blinding ensures that researchers or subjects (or both) are unaware of which subjects are in which group so that preconceptions about benefits and risks cannot bias the results.

 

PTS:   1                    DIF:    Cognitive Level: Comprehension   REF:   pp. 15-16

TOP:   Nursing Process: Implementation

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies

 

  1. Someone asks a nurse about a new drug that is in preclinical testing and wants to know why it cannot be used to treat a friend’s illness. Which statement by the nurse is correct?
a. “A drug at this stage of development can be used only in patients with serious disease.”
b. “At this stage of drug development, the safety and usefulness of the medication is unknown.”
c. “Clinical trials must be completed to make sure the drug is safe to use in humans.”
d. “Until postmarketing surveillance data are available, the drug cannot be used.”

 

 

ANS:  B

Preclinical testing must be completed before drugs can be tested in humans. In this stage, drugs are evaluated for toxicities, pharmacokinetic properties, and potentially useful effects. Some drugs can be used in patients before completion of Phase III studies, but this is after preclinical testing is complete. Clinical trials proceed in stages, and each stage has guidelines defining how a new drug may be used and which patients may receive it. Postmarketing surveillance takes place after a drug is in general use.

 

PTS:   1                    DIF:    Cognitive Level: Comprehension   REF:   p. 16

TOP:   Nursing Process: Implementation

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential

 

  1. A patient asks a nurse why drugs that have been approved by the FDA still have unknown side effects. What will the nurse tell the patient?
a. Testing for all side effects of a medication would be prohibitively expensive.
b. Patients in drug trials often are biased by their preconceptions of a drug’s benefits.
c. Researchers tend to conduct studies that will prove the benefits of their new drugs.
d. Subjects in drug trials do not always represent the full spectrum of possible patients.

 

 

ANS:  D

All drug trials are limited by a relatively small group of subjects who may not have all the characteristics of people who will be using the drug; therefore, some side effects go undetected until the drug is in use. Although drug trials are very expensive, this is only an indirect reason they do not detect all side effects before approval. In theory, well-designed drug trials, using blinded studies, minimize or eliminate subject bias. Designing studies to prove desired results is unethical.

 

PTS:   1                    DIF:    Cognitive Level: Analysis               REF:   p. 17

TOP:   Nursing Process: Implementation

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies

 

  1. A nurse is teaching nursing students about the use of nonproprietary names for drugs. The nurse tells them which fact about nonproprietary names?
a. They are approved by the FDA and are easy to remember.
b. They are assigned by the U.S. Adopted Names Council.
c. They clearly identify the drug’s pharmacologic classification.
d. They imply the efficacy of the drug and are less complex.

 

 

ANS:  B

Nonproprietary, or generic, names are assigned by the U.S. Adopted Names Council, which ensures that each drug has only one name. Trade names, or brand names, are approved by the FDA and are easier to remember. Some nonproprietary names contain syllables that identify the classification, although not all do. Drug names are not supposed to identify the use for the drug, although some brand names do so.

 

PTS:   1                    DIF:    Cognitive Level: Comprehension   REF:   p. 18

TOP:   Nursing Process: Diagnosis

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential

Chapter 11: Drug Therapy in Geriatric Patients

Test Bank

 

MULTIPLE CHOICE

 

  1. A nurse is concerned about renal function in an 84-year-old patient who is taking several medications. What will the nurse assess?
a. Creatinine clearance
b. Sodium levels
c. Potassium levels
d. Serum creatinine

 

 

ANS:  A

The proper index of renal function in older adults is creatinine clearance, which indicates renal function in older patients whose organs are undergoing age-related deterioration. Sodium and potassium levels are not indicative of renal function. Serum creatinine levels do not reflect kidney function in older adults because lean muscle mass, which is the source of creatinine in serum, declines and may be low even with reduced kidney function.

 

PTS:   1                    DIF:    Cognitive Level: Analysis               REF:   pp. 92-93

TOP:   Nursing Process: Assessment

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential

 

  1. A nurse is preparing to teach a forgetful older adult patient about a multiple drug regimen to follow after discharge from the hospital. To help promote adherence, what will the nurse do?
a. Ask the patient to share the teaching with a neighbor or friend soon after discharge.
b. Give the patient detailed written information about each drug.
c. Cluster medication administration times as much as possible.
d. Make sure the patient understands the actions and side effects of each drug.

 

 

ANS:  C

Unintentional nonadherence often is the result of confusion and forgetfulness. Grouping medications to reduce the number of medication times per day can simplify the regimen and help the patient remember medication times. Enlisting a neighbor, relative, or friend is a good idea, but this person should be included in the teaching. Asking the patient to share what is learned may not be a reasonable expectation of a forgetful patient. Detailed written information may just be more confusing; verbal and written information should be clear and concise. Making sure the patient understands the actions and side effects of medications helps when intentional nonadherence is an issue, but in this case it may just add to the patient’s confusion.

 

PTS:   1                    DIF:    Cognitive Level: Application          REF:   pp. 93-95

TOP:   Nursing Process: Implementation

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential

 

  1. A nurse is reviewing an older adult patient’s chart before giving medications. Which patient information is of most concern?
a. Chronic constipation
b. Increased body fat
c. Low serum albumin
d. Low serum creatinine

 

 

ANS:  C

Low serum albumin reduces protein binding of drugs and can cause levels of free drug to rise, increasing the risk of toxicity. Altered gastrointestinal (GI) absorption is not a major factor in drug sensitivity in the older adult, although delayed gastric emptying can delay drug responses. Increased body fat can alter drug distribution, causing reduced responses in lipid-soluble drugs. Low serum creatinine is a function of decreased lean muscle mass and does not reflect kidney function or drug excretion.

 

PTS:   1                    DIF:    Cognitive Level: Application          REF:   p. 92

TOP:   Nursing Process: Diagnosis

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Physiologic Adaptation

 

  1. Based on changes in hepatic function in older adult patients, which adjustment should the nurse expect for oral medications that undergo extensive first pass metabolism?
a. A higher dose should be used with the same time schedule.
b. The interval between doses should be increased.
c. No change is necessary; metabolism will not be affected.
d. The interval between doses should be reduced.

 

 

ANS:  B

The interval between doses of the medication should be increased in older adult patients, because drugs that undergo the first pass effect may not be broken down as well as in an individual with full liver function. A higher dose of the medication is not indicated, because toxic effects could occur. A change in administration may be indicated in older adults, because their metabolism is affected. The interval between doses should not be reduced but increased.

 

PTS:   1                    DIF:    Cognitive Level: Application          REF:   pp. 92-93

TOP:   Nursing Process: Planning

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential

 

  1. A nurse is preparing to give medications to four older patients who are all taking multiple medications. Which patient is most likely to have an adverse drug reaction related to increased drug effects?
a. Obese patient
b. Patient with decreased serum creatinine
c. Patient with chronic diarrhea
d. Thin patient with a chronically low appetite

 

 

ANS:  D

The patient who is thin and has a poor appetite has an increased risk of malnutrition, with significant lowering of serum albumin. This can result in increased free drug levels of protein-bound drugs and can lead to drug toxicity. Obesity, which involves increased adipose tissue, would cause lipid-soluble drugs to deposit in adipose tissue, with a resulting reduction of drug effects. Decreased serum creatinine in an older adult patient may just be a function of a decrease in lean body mass and not of renal function. Chronic diarrhea would accelerate the passage of medications through the GI tract and reduce absorption.

 

PTS:   1                    DIF:    Cognitive Level: Analysis               REF:   p. 92

TOP:   Nursing Process: Diagnosis

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Physiologic Adaptation

 

  1. A nurse is caring for an older adult patient during the immediate postoperative period after a total hip replacement. The surgeon has ordered meperidine [Demerol] for severe pain. What will the nurse do?
a. Administer the medication as prescribed and initiate a fall risk protocol.
b. Ask for a PRN order for diphenhydramine [Benadryl] for the expected side effect of itching.
c. Request an order for morphine instead of meperidine [Demerol].
d. Suggest to the surgeon that the patient receive diazepam [Valium] to reduce anxiety and the need for narcotics.

 

 

ANS:  C

In older adults, meperidine is not effective at usual doses and causes more confusion than in younger patients. Morphine is recommended for severe pain. A fall risk protocol is appropriate, but the drug ordered is not. Diphenhydramine is not recommended for older adult patients, because it causes blurred vision. Both diphenhydramine and diazepam have central nervous system (CNS) sedative effects, which will compound the CNS effects of the narcotic. Diazepam also produces prolonged sedation in older adults.

 

PTS:   1                    DIF:    Cognitive Level: Application          REF:   p. 94

TOP:   Nursing Process: Diagnosis

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Physiologic Adaptation

 

  1. An older adult patient is admitted to the hospital for treatment of an exacerbation of a chronic illness. Admission laboratory work reveals an extremely low serum drug level of the drug used to treat this condition. The patient has brought the medication to the hospital, along with other medications taken. The patient’s renal and hepatic function tests are normal. What might the nurse suspect as a likely cause of this finding?
a. Financial concerns
b. Inability to open drug containers
c. Increased tolerance to the drug’s effects
d. Patient’s conviction that the drug is unnecessary

 

 

ANS:  A

Older adult patients who have financial concerns about paying for medications often take less of the drug or take it less often to make the drug last longer. A patient unable to open the drug container would not get any medication and would not have a detectable serum drug level. A patient with increased tolerance to a drug’s effects would require more of the drug to get effects. A patient convinced that the drug is not needed would probably not fill the prescription.

 

PTS:   1                    DIF:    Cognitive Level: Analysis               REF:   pp. 93-95

TOP:   Nursing Process: Evaluation

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential

 

  1. A nurse is teaching a group of nursing students about administering medications to older adult patients. Which statement by a student indicates a need for further teaching?
a. “Alteration in hepatic function requires more frequent drug dosing.”
b. “Changes in GI function in older adult patients lead to lower serum drug levels.”
c. “Most adverse drug reactions in older adult patients are related to altered renal function.”
d. “Most nonadherence among older adult patients is intentional.”

 

 

ANS:  A

Changes in hepatic function in older adult patients lead to decreased metabolism, meaning that drugs metabolized by the liver have prolonged half-lives and should be given less frequently. Altered GI function does not have much effect in this population, but most known effects from this cause are related to poor absorption and less available drug. Alterations in renal function are the cause of most adverse drug effects in the older adult. In most cases, nonadherence to drug regimens is intentional, usually because the patient doesn’t believe that the drug is needed or that the dose prescribed is not necessary.

 

PTS:   1                    DIF:    Cognitive Level: Analysis               REF:   pp. 93-95

TOP:   Nursing Process: Diagnosis

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential

 

  1. A nurse is obtaining a drug history from an older adult patient who is taking multiple medications prescribed by different providers. Which two medications taken together create a reason for concern?
a. Acetaminophen [Tylenol] and oxycodone
b. Amitriptyline [Elavil] and diphenhydramine [Benadryl]
c. Fexofenadine [Allegra] and an over-the-counter laxative
d. Zolpidem [Ambien] and sertraline [Zoloft]

 

 

ANS:  B

Both amitriptyline and diphenhydramine are on the BEERS list, amitriptyline for anticholinergic effects and diphenhydramine because it causes blurred vision. Additionally, they both have CNS effects that can compound each other when the drugs are given together. Acetaminophen and oxycodone are both acceptable and may be given together. Fexofenadine is a second-generation antihistamine with fewer side effects, and it is not contraindicated for use with a laxative. Zolpidem is a sedative that has less risk of physical dependence and less risk of confusion, falls, and cognitive impairment; sertraline is a safer antidepressant, because it has a shorter half-life than others.

 

PTS:   1                    DIF:    Cognitive Level: Application          REF:   p. 94

TOP:   Nursing Process: Diagnosis

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Physiologic Adaptation

 

  1. A nurse is making a home visit to an older adult woman who was recently discharged home from the hospital with a new prescription. The nurse notes that a serum drug level drawn the day before was subtherapeutic. What will the nurse do next?
a. Ask the patient if she has difficulty swallowing pills.
b. Count the pills in the prescription bottle.
c. Notify the provider to request more frequent dosing.
d. Request an order for renal function tests.

 

 

ANS:  B

Intentional nonadherence is common and may occur because older adult patients are not convinced that drugs are needed or that the dose prescribed is correct. Counting the pills would be an appropriate first step as the nurse determines the cause of the low serum drug level, because it provides information about adherence. If the pill count is correct and the patient has taken the drug as prescribed, other causes may have to be investigated. If it is clear that the patient has not been taking enough of the medication, asking about her ability to swallow may be a good follow-up question. The last two options would be steps to discuss with the provider if the patient is taking the medication as prescribed.

 

PTS:   1                    DIF:    Cognitive Level: Application          REF:   p. 94

TOP:   Nursing Process: Evaluation

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential

 

  1. The nurse is teaching a group of nursing students about adherence to medication in older adults. Which statement by the student indicates understanding of the teaching?
a. “An inability to pay for medications contributes to most intentional nonadherence among older adults.”
b. “Most issues associated with nonadherence among older adults would be resolved with simplified drug regimens.”
c. “Most nonadherence in older adults results in drug toxicity and adverse drug effects.”
d. “The majority of older patients who do not adhere to drug regimens do so intentionally.”

 

 

ANS:  D

Intentional nonadherence is common. It accounts for 75% of nonadherence among older adults and may occur because older adult patients are not convinced that drugs are needed or that the dose prescribed is correct. The inability to pay for medications and complicated drug regimens result in nonintentional nonadherence. Although nonadherence may result in therapeutic failure and drug toxicity, subtherapeutic dosing is by far the most common result.

 

PTS:   1                    DIF:    Cognitive Level: Analysis               REF:   pp. 93-95

TOP:   Nursing Process: Evaluation

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential

 

MULTIPLE RESPONSE

 

  1. A thin older adult woman is admitted to the hospital after several days of vomiting, diarrhea, and poor intake of foods and fluids. She has not voided since admission. In preparing to care for this patient, the nurse will look for what laboratory values to help guide medication administration? (Select all that apply.)
a. Creatinine clearance
b. Gastric pH
c. Plasma drug levels
d. Serum albumin
e. Serum creatinine

 

 

ANS:  A, C, D

Creatinine clearance is the best way to evaluate renal function in the older adult. Plasma drug levels are important for determining if the patient has toxic or subtherapeutic drug levels. Serum albumin may be decreased, especially in patients who are thin, are chronically undernourished, or have been vomiting, and the decreased level may result in higher levels of drugs that normally bind to proteins. Gastric pH is not important; most GI changes result in lowered absorption and less free drug. Serum creatinine levels are related to the amount of lean muscle mass, which may be low in older adult patients, and do not reflect renal function.

 

PTS:   1                    DIF:    Cognitive Level: Application          REF:   p. 92

TOP:   Nursing Process: Assessment

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential

Chapter 21: Drugs for Parkinson’s Disease

Test Bank

 

MULTIPLE CHOICE

 

  1. A patient has taken levodopa [Dopar] for Parkinson’s disease for 2 weeks but reports no improvement in the symptoms. Which response by the nurse is correct?
a. “Another agent will be needed to manage your symptoms.”
b. “Double the dose to see whether an effect occurs.”
c. “It may take several months for a response to occur.”
d. “The prescriber may need to change your drug regimen.”

 

 

ANS:  C

A full therapeutic response with levodopa may take several months to develop. Until the true effect of the dose is seen, it is not necessary to change to another drug, increase the dose, or change the drug regimen.

 

PTS:   1                    DIF:    Cognitive Level: Application          REF:   pp. 178-179

TOP:   Nursing Process: Implementation

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies

 

  1. A nurse provides teaching for a patient who is newly diagnosed with Parkinson’s disease. Which statement by the patient indicates understanding of the drug therapy for this disease?
a. “A levodopa/carbidopa combination is used to improve motor function.”
b. “There are several drugs available to treat dyskinesias.”
c. “When ‘off’ times occur, I may need to increase my dose of levodopa.”
d. “With adequate drug therapy, the disease progression may be slowed.”

 

 

ANS:  A

Levodopa combined with carbidopa is the initial drug of choice to treat motor symptoms. Amantadine is the only drug recommended to treat dyskinesias. Entacapone and rasagiline are used to treat abrupt loss of effect, or “off” times. Drug therapy does not slow the progression of the disease.

 

PTS:   1                    DIF:    Cognitive Level: Application          REF:   pp. 177-178

TOP:   Nursing Process: Implementation

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies

 

  1. A patient has been diagnosed with Parkinson’s disease (PD) and begins treatment with levodopa/carbidopa [Sinemet]. After several months of therapy, the patient reports no change in symptoms. The nurse will expect the provider to:
a. add a dopamine agonist.
b. discuss the “on-off” phenomenon.
c. increase the dose of Sinemet.
d. re-evaluate the diagnosis.

 

 

ANS:  D

Patients beginning therapy with levodopa/carbidopa should expect therapeutic effects to occur after several months of treatment. Levodopa is so effective that a diagnosis of PD should be questioned if the patient fails to respond in this time frame. Adding a dopamine agonist is not indicated. The “on-off” phenomenon occurs when therapeutic effects are present. Increasing the dose of levodopa/carbidopa is not indicated.

 

PTS:   1                    DIF:    Cognitive Level: Application          REF:   pp. 178-179

TOP:   Nursing Process: Implementation

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies

 

  1. A patient with Parkinson’s disease is taking levodopa/carbidopa [Sinemet] and reports occasional periods of loss of drug effect lasting from minutes to several hours. The nurse questions the patient further and discovers that these episodes occur at different times related to the medication administration. The nurse will contact the provider to discuss:
a. administering a catechol-O-methyltransferase (COMT) inhibitor, such as entacapone.
b. adding the DA-releasing agent amantadine to the regimen.
c. giving a direct-acting dopamine agonist.
d. shortening the dosing interval of levodopa/carbidopa.

 

 

ANS:  A

This patient is describing abrupt loss of effect, or the “off” phenomenon, which is treated with entacapone or another COMT inhibitor. Amantadine is used to treat dyskinesias. A direct-acting dopamine agonist is useful for gradual loss of effect, which occurs at the end of the dosing interval as the dose is wearing off. Shortening the dosing interval does not help with abrupt loss of effect.

 

PTS:   1                    DIF:    Cognitive Level: Application          REF:   pp. 178-179

TOP:   Nursing Process: Assessment

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies

 

  1. A patient newly diagnosed with Parkinson’s disease has been taking levodopa/carbidopa [Sinemet] for several weeks and complains of nausea and vomiting. The nurse tells the patient to discuss what with the provider?
a. Taking a lower dose on an empty stomach
b. Taking an increased dose along with a high-protein snack
c. Taking a lower dose with a low-protein snack
d. Taking dopamine in addition to levodopa/carbidopa

 

 

ANS:  C

Because levodopa activates the chemoreceptive trigger zone (CTZ) of the medulla, causing nausea and vomiting (N/V), the patient may need to take a lower dose temporarily until tolerance develops. A meal helps slow absorption to minimize this side effect. A high protein intake contributes to abrupt loss of effect, so meals should be low in protein. Taking a dose on an empty stomach increases absorption and also N/V. An increased dose with a high-protein snack increases N/V and also abrupt loss of effect. Dopamine increases N/V, because it activates the CTZ of the medulla.

 

PTS:   1                    DIF:    Cognitive Level: Application          REF:   pp. 178-179

TOP:   Nursing Process: Evaluation

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies

 

  1. A nurse is discussing motor symptoms with a patient with Parkinson’s disease who has been taking levodopa/carbidopa [Sinemet] for 9 months and who is now having regular tics. Which statement by the patient indicates understanding of this symptom?
a. “I may need to try a lower dose of Sinemet to reduce my tics.”
b. “My provider may order clozapine to treat these tics.”
c. “These tics are an indication that my dose of Sinemet is too low.”
d. “This means I will have to have surgery to stop the symptoms.”

 

 

ANS:  A

Levodopa can cause movement disorders, generally within the first year of therapy. If they occur, a lower dose of levodopa may be required to alleviate them. Clozapine is an antipsychotic used to treat levodopa-induced psychoses. Movement disorders generally occur as the dose of levodopa increases. Surgery is a last option for treating movement disorders, after amantadine fails.

 

PTS:   1                    DIF:    Cognitive Level: Application          REF:   pp. 178-179

TOP:   Nursing Process: Implementation

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies

 

  1. A patient who has begun taking levodopa/carbidopa [Sinemet] reports feeling lightheaded and dizzy, especially when standing up from a sitting position. What will the nurse recommend?
a. An alpha-adrenergic antagonist medication
b. Discussing amantadine with the prescriber
c. Increasing salt and water intake
d. Taking a drug holiday

 

 

ANS:  C

Postural hypotension is common early in treatment and can be reduced by increasing the intake of salt and water. An alpha-adrenergic agonist, not an antagonist, can help. Amantadine is used to treat levodopa-induced dyskinesias. Drug holidays are used when adverse effects increase with long-term use of levodopa; the drug holiday allows beneficial effects to be achieved with lower doses, which reduces the incidence of side effects.

 

PTS:   1                    DIF:    Cognitive Level: Application          REF:   pp. 179-180

TOP:   Nursing Process: Evaluation

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies

 

  1. A nursing student wants to know why a patient who has been taking levodopa [Dopar] for years will now receive levodopa/carbidopa [Sinemet]. The nurse explains the reasons that levodopa as a single agent is no longer available. Which statement by the student indicates a need for further education?
a. “Carbidopa increases the availability of levodopa in the central nervous system.”
b. “Carbidopa reduces the incidence of nausea and vomiting.”
c. “Combination products reduce peripheral cardiovascular side effects.”
d. “Combination products cause fewer dyskinesias and decreased psychosis.”

 

 

ANS:  D

Adding carbidopa to levodopa does not reduce the incidence of dyskinesias or psychosis. In fact, carbidopa can increase the intensity and the speed of onset of these effects. Carbidopa inhibits decarboxylation of levodopa in the intestine and peripheral tissues, leading to more levodopa in the CNS. Carbidopa cannot cross the blood-brain barrier, so it does not have this action in the CNS. Peripheral side effects are reduced, including nausea, vomiting, and cardiovascular effects.

 

PTS:   1                    DIF:    Cognitive Level: Analysis               REF:   pp. 182-183

TOP:   Nursing Process: Evaluation

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies

 

  1. A nurse is teaching a group of nurses about Parkinson’s medications. The nurse is correct to state that one side effect associated with pramipexole [Mirapex] that is less likely to occur with other dopamine agonists is:
a. sleep attacks.
b. dizziness.
c. hallucinations.
d. dyskinesias.

 

 

ANS:  A

A few patients taking pramipexole have experienced sleep attacks, or an overwhelming and irresistible sleepiness that comes on without warning. Dizziness, hallucinations, and dyskinesias are listed as side effects of pramipexole and other dopamine agonists.

 

PTS:   1                    DIF:    Cognitive Level: Application          REF:   pp. 183-184

TOP:   Nursing Process: Implementation

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies

 

  1. A nursing student wants to know how carbidopa can be effective for treating Parkinson’s disease if it prevents the conversion of levodopa to dopamine. The nurse explains that carbidopa:
a. can be taken with high-protein meals.
b. does not cross the blood-brain barrier.
c. has dopamine-like effects of its own.
d. reduces abrupt loss of effect.

 

 

ANS:  B

Carbidopa inhibits decarboxylation of levodopa in the intestine and peripheral tissues, leading to more levodopa in the CNS. Carbidopa cannot cross the blood-brain barrier, so it does not have this action in the CNS. Carbidopa is not given with high-protein meals. Carbidopa does not have dopamine-like effects. Carbidopa does not affect abrupt loss of effect.

 

PTS:   1                    DIF:    Cognitive Level: Analysis               REF:   pp. 182-183

TOP:   Nursing Process: Evaluation

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies

 

  1. A 25-year-old patient has been newly diagnosed with Parkinson’s disease, and the prescriber is considering using pramipexole [Mirapex]. Before beginning therapy with this drug, the nurse will ask the patient about:
a. any history of alcohol abuse or compulsive behaviors.
b. any previous history of hypertension.
c. difficulty falling asleep or staying asleep.
d. whether any family members have experienced psychoses.

 

 

ANS:  A

Pramipexole has been associated with impulse control disorders, and this risk increases in patients with a history of alcohol abuse or compulsive behaviors. Pramipexole increases the risk of hypotension and sleep attacks, so a history of hypertension or insomnia would not be cautionary. Unlike with levodopa, the risk of psychoses is not increased.

 

PTS:   1                    DIF:    Cognitive Level: Application          REF:   pp. 183-184

TOP:   Nursing Process: Planning

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential

 

  1. A hospitalized patient with Parkinson’s disease who is receiving apomorphine to treat “off” episodes develops nausea and vomiting. The nurse will discuss the use of which medication with the patient’s provider?
a. Levodopa [Dopar]
b. Ondansetron [Zofran]
c. Prochlorperazine [Compazine]
d. Trimethobenzamide [Tigan]

 

 

ANS:  D

Trimethobenzamide can be used as an antiemetic in patients treated with apomorphine. Serotonin receptor agonists (eg, ondansetron) and dopamine receptor antagonists (eg, prochlorperazine) cannot be used, because they increase the risk of serious postural hypotension. Levodopa only increases nausea and vomiting.

 

PTS:   1                    DIF:    Cognitive Level: Application          REF:   pp. 183-184

TOP:   Nursing Process: Planning

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies

 

  1. A patient with Parkinson’s disease is taking levodopa/carbidopa [Sinemet]. The prescriber orders bromocriptine [Parlodel] to treat dyskinesias. The nurse notes that the patient is agitated, and the patient reports having frequent nightmares. The nurse will contact the provider to discuss:
a. adding an antipsychotic medication.
b. changing from bromocriptine to cabergoline [Dostinex].
c. reducing the dose of bromocriptine.
d. reducing the dose of levodopa/carbidopa.

 

 

ANS:  C

Bromocriptine is used to treat levodopa-induced dyskinesias and has dose-dependent psychologic side effects. The nurse should suggest reducing the dose of this drug to minimize these side effects. Adding an antipsychotic medication is not indicated. Cabergoline is not approved for this use. Reducing the dose of levodopa/carbidopa is not indicated.

 

PTS:   1                    DIF:    Cognitive Level: Application          REF:   pp. 184-185

TOP:   Nursing Process: Implementation

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies

 

  1. A patient who is newly diagnosed with Parkinson’s disease is prescribed levodopa [Dopar]. The patient asks the nurse about drugs to prevent disease progression. What will the nurse tell this patient?
a. “Levodopa may prevent disease progression in higher doses and is safe to use for this purpose.”
b. “MAO-B inhibitors and dopamine agonists have both shown neuroprotective effects in human studies.”
c. “Vitamin E has been shown to delay neuron degeneration and may be used as adjunctive therapy.”
d. “While some drugs show promise, there are no studies that have proven a neuroprotective effect.”

 

 

ANS:  D

To date, there is no definitive proof that any drug can protect dopaminergic neurons from progressive degeneration. Levodopa has shown neuroprotective effects, but studies have demonstrated toxic effects in the doses required for this purpose. MAO-B inhibitors have shown benefits, but only in animal studies. Vitamin E was once theorized to offer this protection, but recent studies have provided good evidence that this is not the case.

 

PTS:   1                    DIF:    Cognitive Level: Analysis               REF:   p. 178

TOP:   Nursing Process: Implementation

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies

 

  1. The nurse provides teaching for a patient who will begin taking rotigotine [Neupro] to treat Parkinson’s disease. What will the nurse include in teaching?
a. “If you develop nausea and vomiting, you should stop taking the medication.”
b. “If you need to stop this drug, your provider will order a gradual withdrawal.”
c. “You will start this drug regimen with a higher than usual loading dose.”
d. “You will take this medication by mouth with food.”

 

 

ANS:  B

Rotigotine is a nonergot dopamine agonist, which is given by starting with a 2-mg dose that is increased by 2 mg each week until the lowest effective dose is reached. It should not be stopped abruptly but should be decreased by 2 mg per week until tapered off. It undergoes extensive first-pass metabolism, so it is not given orally and is currently available as a transdermal patch.

 

PTS:   1                    DIF:    Cognitive Level: Application          REF:   p. 184

TOP:   Nursing Process: Implementation

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies

 

  1. A patient with Parkinson’s disease is taking levodopa/carbidopa [Sinemet] along with amantadine [Symmetrel] 400 mg/day to treat dyskinesias. The patient reports having increased dyskinesias several months after beginning the amantadine. The nurse will contact the provider to discuss which action?
a. Increasing the dose of amantadine [Symmetrel]
b. Interrupting treatment with amantadine for several weeks
c. Ordering renal function tests
d. Ordering another anticholinergic medication

 

 

ANS:  B

When amantadine is added to therapy to treat dyskinesias associated with levodopa, it often loses effectiveness after several months. If the effects diminish, they can be restored by either increasing the dosage or by interrupting treatment for several weeks. The maximum dosage of amantadine is 400 mg/day, so it is incorrect to increase the dose. Altered renal function would result in drug toxicity, not ineffectiveness of the drug. It is not necessary to order another drug until determining whether the effectiveness can be restored.

 

PTS:   1                    DIF:    Cognitive Level: Application          REF:   p. 187

TOP:   Nursing Process: Implementation

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies

Chapter 31: Antipsychotic Agents and Their Use in Schizophrenia

Test Bank

 

MULTIPLE CHOICE

 

  1. A patient with schizophrenia has been taking an antipsychotic drug for several days. The nurse enters the patient’s room to administer a dose of haloperidol [Haldol] and finds the patient having facial spasms. The patient’s head is thrust back, and the patient is unable to speak. What will the nurse do?
a. Administer the haloperidol as ordered.
b. Discuss increasing the haloperidol dose with the provider.
c. Request an order to give diphenhydramine.
d. Request an order to give levodopa.

 

 

ANS:  C

An early reaction to antipsychotic drugs is acute dystonia. Initial treatment consists of an anticholinergic medication, such as diphenhydramine. Administering more antipsychotic medication would increase the symptoms and could be life threatening. Levodopa is not given for extrapyramidal symptoms, because it could counteract the beneficial effects of antipsychotic treatment.

 

PTS:   1                    DIF:    Cognitive Level: Analysis               REF:   pp. 321-322

TOP:   Nursing Process: Implementation

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential

 

  1. A patient who is taking a first-generation antipsychotic (FGA) drug for schizophrenia comes to the clinic for evaluation. The nurse observes that the patient has a shuffling gait and mild tremors. The nurse will ask the patient’s provider about which course of action?
a. Administering a direct dopamine antagonist
b. Giving an anticholinergic medication
c. Increasing the dose of the antipsychotic drug
d. Switching to a second-generation antipsychotic drug

 

 

ANS:  B

The patient is showing signs of parkinsonism, an extrapyramidal effect associated with antipsychotic medications. Anticholinergic medications are indicated. A direct dopamine antagonist would counter the effects of the antipsychotic and remove any beneficial effect it has. Increasing the dose of the antipsychotic medication would only worsen the extrapyramidal symptoms. A second-generation antipsychotic medication may be used if parkinsonism is severe, since the risk of parkinsonism is lower than with the FGAs. This patient is exhibiting mild symptoms, so this is not necessary at this point.

 

PTS:   1                    DIF:    Cognitive Level: Analysis               REF:   pp. 321-322

TOP:   Nursing Process: Implementation

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential

 

  1. A patient taking an FGA medication develops severe parkinsonism and is treated with amantadine [Symmetrel]. The amantadine is withdrawn 2 months later, and the parkinsonism returns. The nurse will expect the provider to:
a. give anticholinergic medications.
b. make a diagnosis of idiopathic parkinsonism.
c. resume the amantadine indefinitely.
d. try a second-generation antipsychotic (SGA).

 

 

ANS:  D

Neuroleptic-induced parkinsonism is treated with some of the same drugs used for idiopathic parkinsonism, such as amantadine. If parkinsonism is severe, switching to an SGA may help, because the risk of parkinsonism is much lower with these drugs. An anticholinergic medication may be used initially. A recurrence of parkinsonism when the drug is withdrawn does not indicate idiopathic parkinsonism. These drugs should not be used indefinitely.

 

PTS:   1                    DIF:    Cognitive Level: Analysis               REF:   pp. 321-322

TOP:   Nursing Process: Evaluation

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies

 

  1. A nurse and a nursing student are discussing the plan of care for a patient with schizophrenia. The patient, who has been taking a high-potency FGA for 2 months, has become restless and constantly needs to be in motion. Which statement by the student indicates a need for further education?
a. “Anticholinergic medications may help control these symptoms.”
b. “Because this may be an exacerbation of psychosis, the provider may increase the dose of the FGA.”
c. “The provider may try a low-potency FGA instead of the high-potency FGA.”
d. “This patient may need to take a benzodiazepine or a beta blocker.”

 

 

ANS:  B

The patient is showing signs of akathisia, which can resemble an exacerbation of psychosis. If the two are confused and the provider orders more of the FGA, the symptoms may actually increase. Anticholinergic medications may be used, a low-potency FGA may be ordered, or a benzodiazepine or beta blocker may be prescribed.

 

PTS:   1                    DIF:    Cognitive Level: Analysis               REF:   p. 322

TOP:   Nursing Process: Evaluation

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies

 

  1. A patient is taking an FGA for schizophrenia. The nurse notes that the patient has trouble speaking and chewing and observes slow, wormlike movements of the patient’s tongue. The nurse recognizes which adverse effect in this patient?
a. Acute dystonia
b. Akathisia
c. Parkinsonism
d. Tardive dyskinesia

 

 

ANS:  D

Tardive dyskinesia can occur in patients during long-term therapy with FGAs. This patient shows signs of this adverse effect. Acute dystonia is characterized by severe spasm of muscles in the face, tongue, neck, or back and by opisthotonus. Akathisia is characterized by constant motion. Parkinsonism is characterized by bradykinesia, drooling, tremor, rigidity, and a shuffling gait.

 

PTS:   1                    DIF:    Cognitive Level: Comprehension   REF:   pp. 321-322

TOP:   Nursing Process: Assessment

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies

 

  1. A nurse provides teaching for a patient about to begin taking an FGA drug for schizophrenia. Which statement by the patient indicates a need for further teaching about side effects of these drugs?
a. “Dry mouth and constipation are uncommon with this medication.”
b. “I may experience gynecomastia and galactorrhea.”
c. “I may feel lightheaded or dizzy and should sit or lie down if this occurs.”
d. “Sedation may occur initially, but will subside in 1 to 2 weeks.”

 

 

ANS:  A

Anticholinergic effects are common with FGAs, so this statement indicates a need for further teaching. Neuroendocrine effects, orthostatic hypertension, and sedation can occur with FGAs.

 

PTS:   1                    DIF:    Cognitive Level: Application          REF:   pp. 322-323

TOP:   Nursing Process: Implementation

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies

 

  1. A patient with schizophrenia shows suicidal behaviors, and the provider orders clozapine [Clozaril]. The nurse teaches the family about the medication and its side effects. Which statement by a family member indicates a need for further teaching about this drug?
a. “Blood counts are necessary for several weeks after discontinuation of the drug.”
b. “Fever, sore throat, and sores in the mouth should be reported immediately.”
c. “If the ANC is less than 3000, the drug will be discontinued permanently.”
d. “Use of this drug requires weekly evaluation of blood work.”

 

 

ANS:  C

Clozapine can cause agranulocytosis. If the absolute neutrophil count (ANC) drops below 1000/mcL, the drug must be discontinued permanently. Blood counts must be evaluated weekly, and this evaluation should be continued for several weeks after withdrawal of the drug. Fever, sore throat, and mouth ulcers are symptoms of agranulocytosis and should be reported immediately.

 

PTS:   1                    DIF:    Cognitive Level: Comprehension   REF:   p. 326

TOP:   Nursing Process: Assessment

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies

 

  1. A patient with schizophrenia receives a dose of risperidone [Risperdal Consta] IM. The nurse teaching this patient about this medication will make which statement?
a. “You will experience therapeutic levels of this drug in 1 to 2 weeks.”
b. “You will need injections of this drug every 6 weeks.”
c. “You will need to take an oral antipsychotic drug for 3 weeks.”
d. “You probably will not have extrapyramidal symptoms with this drug.”

 

 

ANS:  C

Risperidone given intramuscularly is a depot preparation used for long-term therapy. Significant release of the drug does not occur until 2 to 3 weeks after injection; therefore, patients must take an oral antipsychotic medication until drug levels are raised. Therapeutic levels are reached 4 to 6 weeks after injection. Patients need injections every 2 weeks. With IM dosing, the incidence of extrapyramidal symptoms is substantial.

 

PTS:   1                    DIF:    Cognitive Level: Application          REF:   pp. 327-328

TOP:   Nursing Process: Planning

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies

 

  1. A patient with schizophrenia has been taking an oral FGA for 1 week. The patient has been taking the drug daily in two divided doses. The individual complains of daytime drowsiness. The patient’s family reports a decrease in the person’s hostility and anxiety but states that the patient remains antisocial with disordered thinking. What will the nurse tell the patient and the family?
a. An increased dose of the drug may be needed.
b. Intramuscular dosing may be needed.
c. Some symptoms take months to improve.
d. The entire dose may be taken at bedtime.

 

 

ANS:  C

When patients begin therapy with antipsychotic medications, some symptoms resolve sooner than others. During the first week, agitation, hostility, anxiety, and tension may resolve, but other symptoms may take several months to improve. It is not necessary to increase the dose in the first week. IM dosing is indicated for patients with severe, acute schizophrenia and for long-term maintenance. Sedation is normal, and once an effective dose has been determined, the entire dose can be taken at bedtime, but not in the initial days of therapy.

 

PTS:   1                    DIF:    Cognitive Level: Application          REF:   pp. 331-332

TOP:   Nursing Process: Evaluation

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies

 

  1. A patient in whom drug therapy has failed several times in the past is readmitted to a hospital to begin therapy for schizophrenia. What will the nurse do to help improve adherence?
a. Encourage the patient to take responsibility for medication management.
b. Teach the patient about drug side effects and how to manage them.
c. Tell the patient that an abstinence syndrome will occur if the drug is stopped.
d. Tell the patient that the drug may be taken as needed to control symptoms.

 

 

ANS:  B

One way to promote adherence to a medication regimen is to teach patients about drug side effects and how to minimize undesired responses. Family members should be encouraged to oversee medication management for outpatients, because patients themselves may fail to appreciate the need for therapy or may be unwilling to take prescribed medications. It is not true that an abstinence syndrome occurs when these drugs are withdrawn. These drugs are not used PRN; they must be given on a regular basis.

 

PTS:   1                    DIF:    Cognitive Level: Application          REF:   pp. 332-333

TOP:   Nursing Process: Implementation

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies

 

  1. A patient who has diabetes mellitus is diagnosed with schizophrenia and the provider orders thioridazine. The patient asks the nurse why the provider hasn’t ordered olanzapine [Zyprexa], which the patient has seen advertised on television. Which response by the nurse is the most important reason that this patient is not receiving olanzapine?
a. “Olanzapine is more expensive than thioridazine.”
b. “Olanzapine causes more metabolic side effects than thioridazine.”
c. “Thioridazine has fewer side effects than olanzapine.”
d. “Thioridazine has a faster onset of action than olanzapine.”

 

 

ANS:  B

Olanzapine is an SGA and, although it has fewer extrapyramidal side effects than the FGA the provider has ordered, it has an increased risk of metabolic side effects, which is contraindicated in patients with diabetes. It is more expensive, but this is not the most important reason for not prescribing it. Thioridazine has more side effects than olanzapine, but the side effects caused by olanzapine are more critical for this patient. Thioridazine does not have a faster onset of action.

 

PTS:   1                    DIF:    Cognitive Level: Analysis               REF:   p. 331

TOP:   Nursing Process: Implementation

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies

 

MULTIPLE RESPONSE

 

  1. A nurse in a mental health hospital finds a patient with schizophrenia who takes haloperidol [Haldol] lying rigid in bed with a temperature of 41.3°C. A cardiac monitor shows cardiac dysrhythmias. What will be included in the treatment of this patient? (Select all that apply.)
a. Anticholinergic medications
b. Beta blockers
c. Dantrolene
d. Intravenous fluids
e. Withdrawal of haloperidol

 

 

ANS:  C, D, E

Neuroleptic malignant syndrome is characterized by “lead pipe” rigidity, sudden high fever, and autonomic instability. Treatment requires supportive measures, drug therapy, and immediate withdrawal of the antipsychotic medication. Dantrolene is used to relax muscles and reduce heat production. Intravenous fluids are used to maintain hydration. Anticholinergic medications and beta blockers are not helpful.

 

PTS:   1                    DIF:    Cognitive Level: Application          REF:   p. 322

TOP:   Nursing Process: Assessment

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies

 

  1. Which side effects are more common in second-generation antipsychotic medications than in first-generation antipsychotic medications? (Select all that apply.)
a. Agranulocytosis
b. Anticholinergic effects
c. Extrapyramidal symptoms
d. Metabolism by CYP3A4
e. Prolactin elevation

 

 

ANS:  A, B, D

SGAs are more likely than FGAs to cause agranulocytosis and anticholinergic effects and are metabolized by CYP3A4 enzymes. They are not more likely to cause extrapyramidal effects or prolactin elevation.

 

PTS:   1                    DIF:    Cognitive Level: Application          REF:   p. 319

TOP:   Nursing Process: Assessment

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies

 

  1. What are negative symptoms of schizophrenia? (Select all that apply.)
a. Delusions
b. Disordered thinking
c. Poor judgment
d. Poor self-care
e. Poverty of speech

 

 

ANS:  C, D, E

Poor judgment, poor self-care, and poverty of speech are all negative symptoms of schizophrenia. Delusions and disordered thinking are positive symptoms.

 

PTS:   1                    DIF:    Cognitive Level: Comprehension   REF:   p. 319

TOP:   Nursing Process: Assessment

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies

 

  1. A parent reports being afraid that a child may have schizophrenia because of disorganized speech and asocial behaviors. The nurse will tell this parent that which of the following must also be present to make a diagnosis? (Select all that apply.)
a. A decrease in self-care, job, or school function
b. A history of substance abuse
c. A 1-month duration of active phase symptoms
d. Continuous signs of disturbance for longer than 6 months
e. The presence of manic episodes

 

 

ANS:  A, C, D

Patients must have at least two symptoms with 1-month duration of active symptoms. One symptom must be delusions, hallucinations, or disordered speech. Patients must have continuous signs of disturbance for longer than 6 months. A history of substance abuse and manic episodes are not associated with schizophrenia.

 

PTS:   1                    DIF:    Cognitive Level: Application          REF:   p. 318

TOP:   Nursing Process: Assessment

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies

Chapter 41: Diuretics

Test Bank

 

MULTIPLE CHOICE

 

  1. A patient is brought to the emergency department with shortness of breath, a respiratory rate of 30 breaths per minute, intercostal retractions, and frothy, pink sputum. The nurse caring for this patient will expect to administer which drug?
a. Furosemide [Lasix]
b. Hydrochlorothiazide [HydroDIURIL]
c. Mannitol [Osmitrol]
d. Spironolactone [Aldactone]

 

 

ANS:  A

Furosemide, a potent diuretic, is used when rapid or massive mobilization of fluids is needed. This patient shows severe signs of congestive heart failure with respiratory distress and pulmonary edema and needs immediate mobilization of fluid. Hydrochlorothiazide and spironolactone are not indicated for pulmonary edema, because their diuretic effects are less rapid. Mannitol is indicated for patients with increased intracranial pressure and must be discontinued immediately if signs of pulmonary congestion or heart failure occur.

 

PTS:   1                    DIF:    Cognitive Level: Application

REF:   pp. 450-452 | pp. 452-453 | pp. 452-454                        TOP:   Nursing Process: Planning

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential

 

  1. A patient who is taking digoxin is admitted to the hospital for treatment of congestive heart failure. The prescriber has ordered furosemide [Lasix]. The nurse notes an irregular heart rate of 86 beats per minute, a respiratory rate of 22 breaths per minute, and a blood pressure of 130/82 mm Hg. The nurse auscultates crackles in both lungs. Which laboratory value causes the nurse the most concern?
a. Blood glucose level of 120 mg/dL
b. Oxygen saturation of 90%
c. Potassium level of 3.5 mEq/L
d. Sodium level of 140 mEq/L

 

 

ANS:  C

This patient has an irregular, rapid heartbeat that might be caused by a dysrhythmia. This patient’s serum potassium level is low, which can trigger fatal dysrhythmias, especially in patients taking digoxin. Furosemide contributes to loss of potassium through its effects on the distal nephron. Potassium-sparing diuretics often are used in conjunction with furosemide to prevent this complication. This patient’s serum glucose and sodium levels are normal and of no concern at this point, although they can be affected by furosemide. The oxygen saturation is somewhat low and needs to be monitored, although it may improve with diuresis.

 

PTS:   1                    DIF:    Cognitive Level: Application          REF:   pp. 450-451

TOP:   Nursing Process: Evaluation

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential

 

  1. A patient has 2+ pitting edema of the lower extremities bilaterally. Auscultation of the lungs reveals crackles bilaterally, and the serum potassium level is 6 mEq/L. Which diuretic agent ordered by the prescriber should the nurse question?
a. Bumetanide [Bumex]
b. Furosemide [Lasix]
c. Spironolactone [Aldactone]
d. Hydrochlorothiazide [HydroDIURIL]

 

 

ANS:  C

Spironolactone is a non–potassium-wasting diuretic; therefore, if the patient has a serum potassium level of 6 mEq/L, indicating hyperkalemia, an order for this drug should be questioned. Bumetanide, furosemide, and hydrochlorothiazide are potassium-wasting diuretics and would be appropriate to administer in a patient with hyperkalemia.

 

PTS:   1                    DIF:    Cognitive Level: Application          REF:   p. 454

TOP:   Nursing Process: Implementation

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential

 

  1. A nurse preparing to administer morning medications notes that a patient with a history of hypertension has been prescribed spironolactone [Aldactone]. The nurse assesses the patient and notes dyspnea, bilateral crackles, and pitting edema in both feet. Which intervention is appropriate?
a. Administer the medications as ordered.
b. Ask the patient about the use of salt substitutes.
c. Contact the provider to request an order for serum electrolytes.
d. Request an order for furosemide [Lasix].

 

 

ANS:  D

Spironolactone takes up to 48 hours for its effects to develop, so it should not be used when the patient needs immediate diuresis. This patient has shortness of breath, crackles, and edema and needs a short-acting diuretic, such as furosemide. Asking the patient about the use of salt substitutes is not indicated. The patient does not need assessment of serum electrolytes.

 

PTS:   1                    DIF:    Cognitive Level: Application          REF:   p. 454

TOP:   Nursing Process: Implementation

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential

 

  1. A patient with hypertension is taking furosemide [Lasix] for congestive heart failure. The prescriber orders digoxin to help increase cardiac output. What other medication will the nurse expect to be ordered for this patient?
a. Bumetanide [Bumex]
b. Chlorothiazide [Diuril]
c. Hydrochlorothiazide [HydroDIURIL]
d. Spironolactone [Aldactone]

 

 

ANS:  D

Spironolactone is used in conjunction with furosemide because of its potassium-sparing effects. Furosemide can contribute to hypokalemia, which can increase the risk of fatal dysrhythmias, especially with digoxin administration. The other diuretics listed are all potassium-wasting diuretics.

 

PTS:   1                    DIF:    Cognitive Level: Application

REF:   pp. 450-452 | pp. 452-453 | pp. 452-454                        TOP:   Nursing Process: Planning

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential

 

  1. A patient who was in a motor vehicle accident sustained a severe head injury and is brought into the emergency department. The provider orders intravenous mannitol [Osmitrol]. The nurse knows that this is given to:
a. reduce intracranial pressure.
b. reduce renal perfusion.
c. reduce peripheral edema.
d. restore extracellular fluid.

 

 

ANS:  A

Mannitol is an osmotic diuretic that is used to reduce intracranial pressure by relieving cerebral edema. The presence of mannitol in blood vessels in the brain creates an osmotic force that draws edematous fluid from the brain into the blood. Mannitol can also be used to increase renal perfusion. It can cause peripheral edema and is not used to restore extracellular fluid.

 

PTS:   1                    DIF:    Cognitive Level: Application          REF:   p. 455

TOP:   Nursing Process: Planning

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential

 

  1. A patient is taking gentamicin [Garamycin] and furosemide [Lasix]. The nurse should counsel this patient to report which symptom?
a. Frequent nocturia
b. Headaches
c. Ringing in the ears
d. Urinary retention

 

 

ANS:  C

Patients taking furosemide should be advised that the risk of furosemide-induced hearing loss can be increased when other ototoxic drugs, such as gentamicin, are also taken. Patients should be told to report tinnitus, dizziness, or hearing loss. Nocturia may be an expected effect of furosemide. Headaches are not likely to occur with concomitant use of gentamicin and furosemide. Urinary retention is not an expected side effect.

 

PTS:   1                    DIF:    Cognitive Level: Application          REF:   pp. 450-451

TOP:   Nursing Process: Implementation

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential

 

  1. An older adult patient with congestive heart failure develops crackles in both lungs and pitting edema of all extremities. The physician orders hydrochlorothiazide [HydroDIURIL]. Before administering this medication, the nurse reviews the patient’s chart. Which laboratory value causes the nurse the most concern?
a. Elevated creatinine clearance
b. Elevated serum potassium level
c. Normal blood glucose level
d. Low levels of low-density lipoprotein (LDL) cholesterol

 

 

ANS:  A

Hydrochlorothiazide should not be given to patients with severe renal impairment; therefore, an elevated creatinine clearance would cause the most concern. Thiazide diuretics are potassium-wasting drugs and thus may actually improve the patient’s potassium level. Thiazides may elevate the serum glucose level in diabetic patients. Thiazides increase LDL cholesterol; however, this patient’s levels are low, so this is not a risk.

 

PTS:   1                    DIF:    Cognitive Level: Application          REF:   pp. 452-453

TOP:   Nursing Process: Assessment

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential

 

  1. A patient with chronic congestive heart failure has repeated hospitalizations in spite of ongoing treatment with hydrochlorothiazide [HydroDIURIL] and digoxin. The prescriber has ordered spironolactone [Aldactone] to be added to this patient’s drug regimen, and the nurse provides education about this medication. Which statement by the patient indicates understanding of the teaching?
a. “I can expect improvement within a few hours after taking this drug.”
b. “I need to stop taking potassium supplements.”
c. “I should use salt substitutes to prevent toxic side effects.”
d. “I should watch closely for dehydration.”

 

 

ANS:  B

Spironolactone is a potassium-sparing diuretic used to counter the potassium-wasting effects of hydrochlorothiazides. Patients taking potassium supplements are at risk for hyperkalemia when taking this medication, so they should be advised to stop the supplements. Spironolactone takes up to 48 hours to have effects. Salt substitutes contain high levels of potassium and are contraindicated. Spironolactone is a weak diuretic, so the risk of dehydration is not increased.

 

PTS:   1                    DIF:    Cognitive Level: Application          REF:   pp. 452-454

TOP:   Nursing Process: Implementation

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential

 

MULTIPLE RESPONSE

 

  1. Besides having diuretic effects for patients with congestive heart failure, thiazides are also used to treat what? (Select all that apply.)
a. Diabetes insipidus
b. Hepatic failure
c. Increased intracranial pressure
d. Intraocular pressure
e. Postmenopausal osteoporosis

 

 

ANS:  A, B, E

Thiazide diuretics have the paradoxical effect of reducing urine output in patients with diabetes insipidus. They can also be used to mobilize edema associated with liver disease. They promote tubular reabsorption of calcium, which may reduce the risk of osteoporosis in postmenopausal women. Mannitol is used to treat edema that causes increased intracranial pressure and intraocular pressure.

 

PTS:   1                    DIF:    Cognitive Level: Analysis               REF:   pp. 452-453 | p. 455

TOP:   Nursing Process: Implementation

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential

Chapter 51: Drugs for Angina Pectoris

Test Bank

 

MULTIPLE CHOICE

 

  1. A nurse is providing teaching for a patient with stable angina who will begin taking nitroglycerin. Which statement by the patient indicates understanding of the teaching?
a. “I should not participate in aerobic exercise while taking this drug.”
b. “I should take aspirin daily to reduce my need for nitroglycerin.”
c. “If I take nitroglycerin before exertion, I can reduce the chance of an anginal attack.”
d. “I take nitroglycerin to increase the amount of oxygen to my heart.”

 

 

ANS:  C

Nitroglycerin can be taken before stressful events or exertion to reduce the chance of an attack of angina. Aerobic exercise is an important part of nondrug therapy to reduce the risk of heart attack. Aspirin therapy is an important adjunct to treatment to prevent coronary thrombus formation, but it does not reduce the need for nitroglycerin. Nitroglycerin reduces cardiac oxygen demand, but it does not increase the amount of oxygen available to the heart.

 

PTS:   1                    DIF:    Cognitive Level: Application          REF:   p. 584 | p. 589

TOP:   Nursing Process: Implementation

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies

 

  1. A nurse is discussing the difference between stable and variant angina with a group of nursing students. Which statement by a student indicates the need for further teaching?
a. “Beta blockers are effective in stable angina but not in variant angina.”
b. “In both types of angina, prophylactic treatment is possible.”
c. “Variant angina is primarily treated with vasodilators to increase oxygen supply.”
d. “Variant angina is the result of increased oxygen demand by the heart.”

 

 

ANS:  D

Variant angina is caused by coronary artery spasm, which reduces the oxygen supply to the heart. Beta blockers are not effective in variant angina but are useful with stable angina. Medications may be given to prevent anginal attacks in both types of angina. Vasodilators are used in variant angina to relieve coronary artery spasm and increase the oxygen supply to the heart.

 

PTS:   1                    DIF:    Cognitive Level: Analysis               REF:   pp. 581-583

TOP:   Nursing Process: Planning

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies

 

  1. A patient with new-onset exertional angina has taken three nitroglycerin sublingual tablets at 5-minute intervals, but the pain has intensified. The nurse notes that the patient has a heart rate of 76 beats per minute and a blood pressure of 120/82 mm Hg. The electrocardiogram is normal. The patient’s lips and nail beds are pink, and there is no respiratory distress. The nurse will anticipate providing:
a. an angiotensin-converting enzyme (ACE) inhibitor.
b. intravenous nitroglycerin and a beta blocker.
c. ranolazine (Ranexa) and quinidine.
d. supplemental oxygen and intravenous morphine.

 

 

ANS:  B

This patient has unstable angina, and the next step, when pain is unrelieved by sublingual nitroglycerin, is to give intravenous nitroglycerin and a beta blocker. ACE inhibitors should be given to patients with persistent hypertension if they have left ventricular dysfunction or congestive heart failure (CHF). Ranolazine is a first-line angina drug, but it should not be given with quinidine because of the risk of increasing the QT interval. Supplemental oxygen is indicated if cyanosis or respiratory distress is present. IV morphine may be given if the pain is unrelieved by nitroglycerin.

 

PTS:   1                    DIF:    Cognitive Level: Application          REF:   p. 583 | p. 588

TOP:   Nursing Process: Diagnosis

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies

 

  1. A patient asks a nurse how nitroglycerin works to relieve anginal pain. The nurse correctly states, “Nitroglycerin:
a. dilates coronary arteries to increase blood flow to the heart.”
b. increases the oxygen supply to the cardiac muscle.”
c. increases ventricular filling to improve cardiac output.”
d. promotes vasodilation, which reduces preload and oxygen demand.”

 

 

ANS:  D

Nitroglycerin dilates the veins, which reduces venous return to the heart, which in turn decreases ventricular filling. The resulting decrease in preload reduces the oxygen requirements of the heart. Nitroglycerin does not increase the blood flow or oxygen supply to the heart. An increase in ventricular filling would increase oxygen demand and result in increased anginal pain.

 

PTS:   1                    DIF:    Cognitive Level: Analysis               REF:   p. 584

TOP:   Nursing Process: Assessment

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies

 

  1. A hospitalized patient complains of acute chest pain. The nurse administers a 0.3-mg sublingual nitroglycerin tablet, but the patient continues to complain of pain. Vital signs remain stable. What is the nurse’s next step?
a. Apply a nitroglycerin transdermal patch.
b. Continue dosing at 10-minute intervals.
c. Give a second dose of nitroglycerin in 5 minutes.
d. Request an order for intravenous nitroglycerin.

 

 

ANS:  C

An initial dose of sublingual nitroglycerin is taken, and if the chest pain persists, as in this case, the patient should take another dose in 5 minutes. Transdermal delivery systems are not useful for terminating an ongoing attack. Dosing at 10-minute intervals is incorrect. If the patient fails to respond or if the pain intensifies, intravenous nitroglycerin may be indicated.

 

PTS:   1                    DIF:    Cognitive Level: Application          REF:   p. 585

TOP:   Nursing Process: Implementation

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies

 

  1. A patient who has begun using transdermal nitroglycerin for angina reports occasional periods of tachycardia. The nurse will expect the prescriber to order:
a. digoxin [Lanoxin] to slow the heart rate.
b. immediate discontinuation of the nitroglycerin.
c. periods of rest when the heart rate increases.
d. verapamil as an adjunct to nitroglycerin therapy.

 

 

ANS:  D

Nitroglycerin lowers blood pressure by reducing venous return and dilating the arterioles. The lowered blood pressure activates the baroreceptor reflex, causing reflex tachycardia, which can increase cardiac demand and negate the therapeutic effects of nitroglycerin. Treatment with a beta blocker or verapamil suppresses the heart to slow the rate. Digoxin is not recommended. Discontinuation of the nitroglycerin is not indicated. Resting does not slow the heart when the baroreceptor reflex is the cause of the tachycardia.

 

PTS:   1                    DIF:    Cognitive Level: Application          REF:   p. 585

TOP:   Nursing Process: Evaluation

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies

 

  1. A patient with angina who uses sublingual nitroglycerin tells the nurse that the episodes are increasing in frequency and usually occur when the patient walks the dog. The patient reports needing almost daily doses of the nitroglycerin and states that one tablet usually provides complete relief. What will the nurse do?
a. Contact the provider to suggest ordering a transdermal patch for this patient.
b. Question the patient about consumption of grapefruit juice.
c. Suggest that the patient limit walking the dog to shorter distances less frequently.
d. Suggest that the patient take two tablets of nitroglycerin each time, because the symptoms are increasing in frequency.

 

 

ANS:  A

Transdermal patches are good for sustained prophylaxis for anginal attacks and are especially useful when patients have a regular pattern of attacks. Grapefruit juice does not affect the metabolism of nitroglycerin. Patients with angina should be encouraged to increase, not decrease, exercise. Taking two tablets is not recommended when one is effective.

 

PTS:   1                    DIF:    Cognitive Level: Analysis               REF:   pp. 586-587

TOP:   Nursing Process: Evaluation

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies

 

  1. A nursing student asks a nurse how beta blockers increase the oxygen supply to the heart in the treatment of anginal pain. The nurse tells the student that beta blockers:
a. dilate arterioles to improve myocardial circulation.
b. improve cardiac contractility, which makes the heart more efficient.
c. increase arterial pressure to improve cardiac afterload.
d. increase the time the heart is in diastole.

 

 

ANS:  D

Beta blockers increase the time the heart is in diastole, which increases the time during which blood flows through the myocardial vessels, allowing more oxygen to reach the heart. Beta blockers do not dilate arterioles. They do not increase cardiac contractility; they decrease it, which reduces the cardiac oxygen demand. They do not increase arterial pressure, which would increase the cardiac oxygen demand.

 

PTS:   1                    DIF:    Cognitive Level: Comprehension   REF:   p. 587

TOP:   Nursing Process: Planning

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies

 

  1. A patient with stable exertional angina has been receiving a beta blocker. Before giving the drug, the nurse notes a resting heart rate of 55 beats per minute. Which is an appropriate nursing action?
a. Administer the drug as ordered, because this is a desired effect.
b. Withhold the dose and notify the provider of the heart rate.
c. Request an order for a lower dose of the medication.
d. Request an order to change to another antianginal medication.

 

 

ANS:  A

When beta blockers are used for anginal pain, the dosing goal is to reduce the resting heart rate to 50 to 60 beats per minute. Because this heart rate is a desired effect, there is no need to withhold the dose or notify the provider. The dosage does not need to be lowered, because a heart rate of 55 beats per minute is a desired effect. There is no indication of a need to change medications for this patient.

 

PTS:   1                    DIF:    Cognitive Level: Application          REF:   p. 587

TOP:   Nursing Process: Assessment

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies

 

  1. A patient is taking a calcium channel blocker (CCB) for stable angina. The patient’s spouse asks how calcium channel blockers relieve pain. The nurse will explain that CCBs:
a. help relax peripheral arterioles to reduce afterload.
b. improve coronary artery perfusion.
c. increase the heart rate to improve myocardial contractility.
d. increase the QT interval.

 

 

ANS:  A

CCBs promote relaxation of peripheral arterioles, resulting in a decrease in afterload, which reduces the cardiac oxygen demand. CCBs do not improve coronary artery perfusion. CCBs reduce the heart rate and suppress contractility; they do not affect the QT interval.

 

PTS:   1                    DIF:    Cognitive Level: Analysis               REF:   pp. 587-588

TOP:   Nursing Process: Planning

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies

 

  1. A patient with variant angina wants to know why a beta blocker cannot be used to treat the angina. Which response by the nurse is correct?
a. “A beta1-selective beta blocker could be used for variant angina.”
b. “Beta blockers do not help relax coronary artery spasm.”
c. “Beta blockers do not help to improve the cardiac oxygen supply.”
d. “Beta blockers promote constriction of arterial smooth muscle.”

 

 

ANS:  B

Variant angina occurs when coronary arteries go into spasm, thus reducing the circulation and oxygen supply to the heart. CCBs help to reduce coronary artery spasm; beta blockers do not. Beta1-selective beta blockers are used for stable angina for patients who also have asthma, because they do not activate beta2 receptors in the lungs to cause bronchoconstriction. Beta blockers help improve the oxygen supply in stable angina, but they do not relieve coronary artery spasm, so they are not useful in variant angina. Beta blockers do not constrict arterial smooth muscle.

 

PTS:   1                    DIF:    Cognitive Level: Analysis               REF:   pp. 587-588

TOP:   Nursing Process: Planning

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies

 

  1. A nursing student is helping to care for a patient who takes verapamil for stable angina. The nurse asks the student to explain the purpose of verapamil in the treatment of this patient. Which statement by the student indicates a need for further teaching?
a. “It relaxes coronary artery spasms.”
b. “It reduces peripheral resistance to reduce oxygen demands.”
c. “It reduces the heart rate, AV conduction, and contractility.”
d. “It relaxes the peripheral arterioles to reduce afterload.”

 

 

ANS:  A

Verapamil does relax coronary artery spasms, but this is not useful in stable angina. Verapamil is used to relax coronary artery spasms in variant asthma. When used to treat stable angina, verapamil promotes relaxation of peripheral arterioles, which reduces peripheral resistance and decreases afterload. It also reduces the heart rate, AV conduction, and contractility.

 

PTS:   1                    DIF:    Cognitive Level: Application          REF:   p. 588

TOP:   Nursing Process: Planning

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies

 

  1. A patient with angina who is taking ranolazine [Ranexa] has developed a respiratory infection and a dysrhythmia. The provider has ordered azithromycin [Zithromax] for the infection and amlodipine for the dysrhythmia. A nursing student caring for this patient tells the nurse that the patient’s heart rate is 70 beats per minute, and the blood pressure is 128/80 mm Hg. The nurse asks the student to discuss the plan for this patient’s care. Which action is correct?
a. Observe the patient closely for signs of respiratory toxicity.
b. Question the order for azithromycin [Zithromax].
c. Report the patient’s increase in blood pressure to the provider.
d. Request an order for a different calcium channel blocker.

 

 

ANS:  B

Agents that inhibit CYP3A4 can increase levels of ranolazine and also the risk of torsades de pointes. Macrolide antibiotics, such as azithromycin, are CYP3A4 inhibitors. Respiratory toxicity is not an expected effect with this patient. The patient’s blood pressure is not elevated enough to notify the provider. Amlodipine is the only CCB that should be used with ranolazine.

 

PTS:   1                    DIF:    Cognitive Level: Application          REF:   p. 588

TOP:   Nursing Process: Planning

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential

 

  1. A nurse provides teaching to a patient with angina who also has type 2 diabetes mellitus, asthma, and hypertension. Which statement by the patient indicates a need for further teaching?
a. “An ACE inhibitor, in addition to nitroglycerin, will lower my risk of cardiovascular death.”
b. “Beta blockers can help me control hypertension.”
c. “I should begin regular aerobic exercise.”
d. “Long-acting, slow-release calcium channel blockers can help with anginal pain.”

 

 

ANS:  B

Beta blockers can be used for angina in most patients but are contraindicated in patients with asthma, because they cause bronchoconstriction. ACE inhibitors help reduce the risk of death in patients with hypertension. Regular aerobic exercise is recommended to control weight and improve cardiovascular function. Long-acting, slow-release CCBs are recommended for patients who have coexisting type 2 diabetes.

 

PTS:   1                    DIF:    Cognitive Level: Application          REF:   pp. 588-589

TOP:   Nursing Process: Planning

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies

 

  1. A patient who takes nitroglycerine to treat stable angina reports having erectile dysfunction and states that he plans to ask his primary provider for a prescription for tadalafil [Cialis]. What will the nurse tell this patient?
a. “You may take these two drugs together safely as long as you take them as directed.”
b. “You should not take tadalafil and nitroglycerine within 30 to 60 minutes of each other.”
c. “You should discuss another anti-angina medication with your provider.”
d. “You should avoid sexual activity since this increases oxygen demands on the heart.”

 

 

ANS:  C

Use of nitroglycerine with any phosphodiesterase type 5 inhibitor, such as sildenafil or tadalafil is absolutely contraindicated. The patient should be advised to discuss another antianginal agent with the provider. Patients should be taught to increase all activity to maintain as normal a lifestyle as possible.

 

PTS:   1                    DIF:    Cognitive Level: Application          REF:   p. 585

TOP:   Nursing Process: Planning

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential

 

  1. A patient who has renal impairment will begin taking ranolazine [Ranexa] as an adjunct to nitroglycerine to treat angina. What will the nurse include when teaching this patient?
a. “You will need to monitor your blood pressure closely while taking this drug.”
b. “You should take this drug 1 hour before or 2 hours after a meal.”
c. “You may experience rapid heart rate while taking this medication.”
d. “You do not need to worry about drug interactions with this medication.”

 

 

ANS:  A

Ranolazine can elevate blood pressure in patients with renal impairment, so patients taking this drug will need to monitor blood pressure. The drug can be taken without regard to food. It does not cause reflex tachycardia. It has many significant drug interactions.

 

PTS:   1                    DIF:    Cognitive Level: Application          REF:   p. 588

TOP:   Nursing Process: Planning

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies

 

MULTIPLE RESPONSE

 

  1. A patient with asthma and depression develops stable angina. In addition to organic nitrites, which other medications will be used to treat this condition? (Select all that apply.)
a. ACE inhibitors
b. Antiplatelet drugs
c. Beta blockers
d. Calcium channel blockers
e. Cholesterol-lowering drugs

 

 

ANS:  A, B, D, E

ACE inhibitors have shown benefit in reducing the incidence of adverse outcomes in patients with coronary artery disease (CAD) and are recommended as part of therapy. Antiplatelet drugs are recommended to reduce the risk of thrombus formation. CCBs are used as adjuncts to nitroglycerin and are safe in patients with asthma and depression. Cholesterol-lowering drugs are recommended to help slow the progression of CAD. Beta blockers are not recommended in patients with asthma or depression.

 

PTS:   1                    DIF:    Cognitive Level: Analysis               REF:   pp. 588-589

TOP:   Nursing Process: Assessment

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential

Chapter 61: Estrogens and Progestins: Basic Pharmacology and Noncontraceptive Applications

Test Bank

 

MULTIPLE CHOICE

 

  1. A 50-year-old postmenopausal patient who has had a hysterectomy has moderate to severe vasomotor symptoms and is discussing estrogen therapy (ET) with the nurse. The patient is concerned about adverse effects of ET. The nurse will tell her that:
a. an estrogen-progesterone product will reduce side effects.
b. an intravaginal preparation may be best for her.
c. side effects of ET are uncommon among women her age.
d. transdermal preparations have fewer side effects.

 

 

ANS:  D

Transdermal preparations of estrogen have fewer adverse effects, use lower doses of estrogen, and have less fluctuation of estrogen levels than do oral preparations. Progesterone is contraindicated in women who have undergone hysterectomy. Intravaginal preparations are most useful for treating local estrogen deficiency such as vaginal and vulvar atrophy. Side effects of ET are the same at the patient’s age as for other women using ET.

 

PTS:   1                    DIF:    Cognitive Level: Application          REF:   p. 736

TOP:   Nursing Process: Planning

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies

 

  1. A patient who is at risk for osteoporosis will begin taking the selective estrogen receptor modulator raloxifene [Evista]. Which statement will the nurse include when teaching this patient about the medication?
a. Raloxifene reduces the risk of thromboembolism.
b. The drug is associated with an increased risk of breast cancer.
c. Use of this drug increases the risk of endometrial carcinoma.
d. Vasomotor symptoms are a common side effect of this drug.

 

 

ANS:  D

Raloxifene can induce hot flashes in patients taking the drug. It increases the risk for thromboembolism. It protects against breast cancer and does not pose a risk of uterine cancer.

 

PTS:   1                    DIF:    Cognitive Level: Application          REF:   pp. 736-737

TOP:   Nursing Process: Implementation

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies

 

  1. A nurse provides teaching to a patient who has had a hysterectomy and is about to begin hormone therapy to manage menopausal symptoms. Which statement by the patient indicates understanding of the teaching?
a. “Because I am not at risk for uterine cancer, I can take hormones indefinitely.”
b. “I can take estrogen to reduce my risk of cardiovascular disease.”
c. “I should take the lowest effective dose for the shortest time needed.”
d. “I will need a progestin/estrogen combination since I have had a hysterectomy.”

 

 

ANS:  C

For patients who have undergone hysterectomy, progestin is unnecessary; estrogen-only preparations still carry increased risk of breast cancer and should be taken in the lowest effective dose for the shortest time possible. Even though uterine cancer is no longer a possibility, breast cancer is still a risk. Studies have shown no protection against coronary heart disease but increased risk of stroke and breast cancer with estrogens.

 

PTS:   1                    DIF:    Cognitive Level: Application          REF:   p. 741

TOP:   Nursing Process: Implementation

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies

 

  1. A nurse provides teaching to a group of nursing students about the risks and benefits of hormone therapy (HT), including estrogen therapy (ET) and combination estrogen/progestin therapy (EPT). Which statement by a student indicates understanding of the teaching?
a. “ET can provide protection against coronary heart disease and reverse osteoporosis.”
b. “EPT is generally safer than ET, especially in women who have undergone hysterectomies.”
c. “In women with established coronary heart disease, EPT can protect against myocardial infarction.”
d. “Principle benefits of ET are suppression of menopausal symptoms and prevention of bone loss.”

 

 

ANS:  D

ET can be used to suppress menopausal symptoms and to prevent osteoporosis, but it carries risks of breast cancer and stroke, while conferring no preventive benefit for coronary heart disease. ET does not reverse osteoporosis but may help prevent it. EPT is not safer than ET; progestins appear to increase the risk of breast cancer. EPT does not prevent myocardial infarction in patients with coronary heart disease.

 

PTS:   1                    DIF:    Cognitive Level: Application          REF:   p. 741

TOP:   Nursing Process: Implementation

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies

 

  1. A postmenopausal patient who has had a hysterectomy and who has a family history of coronary heart disease reports experiencing vaginal dryness and pain with intercourse but tells the nurse that she doesn’t want to take hormones because she is afraid of adverse effects. The nurse will suggest that the woman ask her provider about:
a. Depo Provera.
b. Estraderm.
c. low-dose estrogens.
d. Premarin vaginal.

 

 

ANS:  D

Estrogens for intravaginal administration are used for local effects, primarily to treat vulval and vaginal atrophy. Because these preparations bypass the liver, the total dose is reduced and there is a lower risk of systemic effects. Depo Provera is a progesterone and is not indicated. Transdermal estrogen is used to treat hot flushes. Low-dose estrogens still have systemic effects.

 

PTS:   1                    DIF:    Cognitive Level: Application          REF:   p. 736

TOP:   Nursing Process: Implementation

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential

 

  1. A patient with osteopenia asks a nurse about the benefits of hormone therapy in preventing osteoporosis. Which statement by the nurse is correct?
a. “Estrogen can help reverse bone loss.”
b. “Hormone therapy increases bone resorption.”
c. “Hormone therapy does not decrease fracture risk.”
d. “When hormone therapy is discontinued, bone mass is quickly lost.”

 

 

ANS:  D

Benefits of HT for patients with osteopenia are not permanent; bone loss resumes when HT is discontinued. HT does not reverse bone loss that has already occurred. HT reduces bone resorption. HT can decrease fracture risk by a small amount.

 

PTS:   1                    DIF:    Cognitive Level: Application          REF:   p. 742

TOP:   Nursing Process: Implementation

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies

 

  1. A patient who will begin combination estrogen/progestin therapy (EPT) for menopause asks the nurse why she can’t take an estrogen-only preparation. The patient has not had a hysterectomy, has a slightly increased risk of cardiovascular disease, and has mild osteopenia. The nurse will tell her that the progestin is necessary to:
a. decrease her risk of endometrial cancer.
b. increase bone resorption to prevent fractures.
c. lower her risk of myocardial infarction (MI).
d. prevent deep vein thrombosis (DVT).

 

 

ANS:  A

In patients who still have a uterus, progestin is necessary to reduce the risk of endometrial carcinoma. Progestins do not have effects on bone density and do not decrease risk of MI or DVT.

 

PTS:   1                    DIF:    Cognitive Level: Application          REF:   pp. 742-743

TOP:   Nursing Process: Implementation

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies

 

  1. The nurse is providing patient education about the application of transdermal estrogen spray. Which statement made by the patient best demonstrates understanding of the application of this medication? “I should apply this medication to my:
a. waistline and shoulders.”
b. abdomen and arms.”
c. breasts and abdomen.”
d. thighs and calves.”

 

 

ANS:  D

The top of the thighs and the back of the calves are the preferred sites for application of the transdermal spray. The waistline and abdomen are used for the patches. The gel is applied to arms. Breasts are never used for application of transdermal estrogen.

 

PTS:   1                    DIF:    Cognitive Level: Application          REF:   p. 736

TOP:   Nursing Process: Implementation

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies

 

MULTIPLE RESPONSE

 

  1. According to studies of estrogen/progestin therapy (EPT), what are its known benefits? (Select all that apply.)
a. Cardiovascular protection in older patients
b. Decreased osteoporosis risk
c. Glycemic control
d. Improved wound healing
e. Prevention of colorectal cancer

 

 

ANS:  B, C, D

EPT can lower osteoporosis risk, improve glycemic control, and aid in wound healing. Preparations with estrogen alone can provide cardiovascular protection or help prevent colorectal cancer, but not preparations containing progestin.

 

PTS:   1                    DIF:    Cognitive Level: Analysis               REF:   pp. 741-742

TOP:   Nursing Process: Implementation

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies

 

  1. The nurse is providing patient education for a postmenopausal patient who is considering EPT. Which risks associated with EPT should the nurse discuss with the patient? (Select all that apply.)
a. Increased colon cancer
b. Stroke
c. Deep vein thrombosis
d. Ovarian cancer
e. Decreased bone density

 

 

ANS:  B, C, D

Risk factors for EPT include stroke, deep vein thrombosis, and ovarian cancer. A decreased risk of colon cancer is associated with EPT. EPT preserves bone mineral density.

 

PTS:   1                    DIF:    Cognitive Level: Application          REF:   pp. 742-743

TOP:   Nursing Process: Implementation

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential

Chapter 71: Cyclooxygenase Inhibitors: Nonsteroidal Anti-inflammatory Drugs and Acetaminophen

Test Bank

 

MULTIPLE CHOICE

 

  1. A nurse is teaching a group of nursing students about cyclooxygenase (COX) inhibitors. A student asks the nurse about characteristics of COX-1 inhibitors. Which statement by the nurse is true?
a. “COX-1 inhibitors protect against colorectal cancer.”
b. “COX-1 inhibitors protect against myocardial infarction and stroke.”
c. “COX-1 inhibitors reduce fever.”
d. “COX-1 inhibitors suppress inflammation.”

 

 

ANS:  B

COX-1 inhibitors have beneficial effects of reducing platelet aggregation and thus reducing the risk of myocardial infarction and stroke. COX-2 inhibitors protect against colorectal cancer, reduce inflammation, and reduce fever.

 

PTS:   1                    DIF:    Cognitive Level: Analysis               REF:   p. 849

TOP:   Nursing Process: Evaluation

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies

 

  1. A patient who takes daily doses of aspirin is scheduled for surgery next week. The nurse should advise the patient to:
a. continue to use aspirin as scheduled.
b. reduce the aspirin dosage by half until after surgery.
c. stop using aspirin immediately.
d. stop using aspirin 3 days before surgery.

 

 

ANS:  C

Aspirin must be withdrawn at least 1 week before surgery. Aspirin cannot be continued as scheduled, because the risk for bleeding is too great. An interval of 3 days is not long enough for the bleeding effects of aspirin to be reversed. Cutting the dose in half would not reduce the effects of bleeding associated with aspirin use.

 

PTS:   1                    DIF:    Cognitive Level: Application          REF:   p. 853

TOP:   Nursing Process: Implementation

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies

 

  1. A patient who is taking acetaminophen for pain wants to know why it does not cause gastrointestinal upset, as do other over-the-counter pain medications. The nurse will explain that this is most likely because of which property of acetaminophen?
a. It does not inhibit cyclooxygenase.
b. It has minimal effects at peripheral sites.
c. It is more similar to opioids than to nonsteroidal anti-inflammatory drugs (NSAIDs).
d. It is selective for cyclooxygenase-2.

 

 

ANS:  B

The differences between the effects of acetaminophen and aspirin are thought to result from selective inhibition of cyclooxygenase; acetaminophen has only minimal effects on cyclooxygenase at peripheral sites, which may explain why acetaminophen does not have adverse GI, renal, and antiplatelet effects. Acetaminophen is a selective COX inhibitor. It is not more similar to opioids than NSAIDs. It is not selective for COX-2.

 

PTS:   1                    DIF:    Cognitive Level: Application          REF:   p. 861

TOP:   Nursing Process: Evaluation

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies

 

  1. A patient tells the nurse that she takes aspirin for menstrual cramps, but she does not feel that it works well. What will the nurse suggest?
a. The patient should avoid any type of COX inhibitor because of the risk of Reye’s syndrome.
b. The patient should increase the dose to a level that suppresses inflammation.
c. The patient should use a first-generation nonsteroidal anti-inflammatory medication instead.
d. The patient should use acetaminophen because of its selective effects on uterine smooth muscle.

 

 

ANS:  C

Aspirin (ASA) has analgesic effects for joint pain, muscle pain, and headache, but it is relatively ineffective against visceral pain, including uterine smooth muscle pain, for which NSAIDs are indicated. The risk of Reye’s syndrome is associated with the use of ASA in children to treat fever. Increasing the ASA dose to anti-inflammatory levels is useful for rheumatic fever, tendonitis, and bursitis. Acetaminophen is not effective for dysmenorrhea.

 

PTS:   1                    DIF:    Cognitive Level: Application          REF:   p. 850 | pp. 851-852

TOP:   Nursing Process: Implementation

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies

 

  1. A patient who takes aspirin for rheumatoid arthritis is admitted to the hospital complaining of headache and ringing in the ears. The plasma salicylate level is 300 mcg/mL, and the urine pH is 6.0. What will the nurse do?
a. Increase the aspirin dose to treat the patient’s headache.
b. Notify the provider of possible renal toxicity.
c. Prepare to provide respiratory support, because the patient shows signs of overdose.
d. Withhold the aspirin until the patient’s symptoms have subsided.

 

 

ANS:  D

This patient shows signs of salicylism, which occurs when ASA levels climb just slightly above the therapeutic level. Salicylism is characterized by tinnitus, sweating, headache, and dizziness. Tinnitus is an indication that the maximum acceptable dose has been achieved. Toxicity occurs at a salicylate level of 400 mcg/mL or higher. ASA should be withheld until the symptoms subside and then should be resumed at a lower dose. Increasing the dose would only increase the risk of toxicity. Signs of renal impairment include oliguria and weight gain, which are not present in this patient. This patient has salicylism, not salicylate toxicity, so respiratory support measures are not indicated.

 

PTS:   1                    DIF:    Cognitive Level: Application          REF:   pp. 853-854

TOP:   Nursing Process: Evaluation

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies

 

  1. An adolescent is brought to the emergency department by a parent who reports that the patient took a whole bottle of extended-release acetaminophen tablets somewhere between 8 and 10 hours ago. The nurse will anticipate administering which of the following?
a. Acetylcysteine [Mucomyst]
b. Activated charcoal
c. Hemodialysis
d. Respiratory support

 

 

ANS:  A

The nurse should anticipate giving acetylcysteine, because it is the specific antidote for acetaminophen overdose. It is 100% effective when given within 8 to 10 hours after ingestion and may still have some benefit after this interval. Activated charcoal is effective only if given before the medication is absorbed, so it must be given much sooner. Hemodialysis is not indicated. Respiratory support is used for ASA overdose.

 

PTS:   1                    DIF:    Cognitive Level: Application          REF:   p. 863

TOP:   Nursing Process: Implementation

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential

 

  1. An older male patient with an increased risk of MI is taking furosemide [Lasix] and low-dose aspirin. The patient is admitted to the hospital, and the nurse notes an initial blood pressure of 140/80 mm Hg. The patient has had a 10-pound weight gain since a previous admission 3 months earlier. The patient has voided only a small amount of concentrated urine. The serum creatinine and blood urea nitrogen (BUN) levels are elevated. The nurse will contact the provider to discuss:
a. adding an antihypertensive medication.
b. obtaining serum electrolytes.
c. ordering a potassium-sparing diuretic.
d. withdrawing the aspirin.

 

 

ANS:  D

This patient shows signs of renal impairment, as evidenced by weight gain despite the use of diuretics, decreased urine output, hypertension, and elevated serum creatinine and BUN. ASA can cause acute, reversible renal impairment and should be withdrawn. Hypertensive medications do not treat the underlying cause. Serum electrolytes are not indicated. Addition of a potassium-sparing diuretic is not indicated.

 

PTS:   1                    DIF:    Cognitive Level: Application          REF:   p. 853

TOP:   Nursing Process: Assessment

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies

 

  1. A pregnant patient in her third trimester asks the nurse whether she can take aspirin for headaches. Which response by the nurse is correct?
a. “Aspirin is safe during the second and third trimesters of pregnancy.”
b. “Aspirin may cause premature closure of the ductus arteriosus in your baby.”
c. “Aspirin may induce premature labor and should be avoided in the third trimester.”
d. “You should use a first-generation nonsteroidal anti-inflammatory medication.”

 

 

ANS:  B

Aspirin poses risks to the pregnant patient and her fetus, including premature closure of the ductus arteriosus. ASA is not safe, especially in the third trimester, because it can cause anemia and can contribute to postpartum hemorrhage. ASA does not induce labor but can prolong labor by inhibiting prostaglandin synthesis. NSAIDs have similar effects and also should be avoided.

 

PTS:   1                    DIF:    Cognitive Level: Application          REF:   p. 855

TOP:   Nursing Process: Implementation

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies

 

  1. A nurse is caring for a patient who has been taking low-dose aspirin for several days. The nurse notes that the patient has copious amounts of watery nasal secretions and an urticarial rash. The nurse will contact the provider to discuss:
a. administering epinephrine.
b. changing to a first-generation NSAID.
c. reducing the dose of aspirin.
d. giving an antihistamine.

 

 

ANS:  A

Aspirin can cause a hypersensitivity reaction in some patients. This may start with profuse watery rhinorrhea and progress to generalized urticaria, bronchospasm, laryngeal edema, and shock. It is not a true anaphylactic reaction, because it is not mediated by the immune system. Epinephrine is the treatment of choice. Patients with sensitivity to ASA often also have sensitivity to NSAIDs; the first indication with this patient is to treat the potential life-threatening effect, not to change the medication. Reduction of the dose of ASA is not indicated, because this reaction is not dose dependent. Antihistamines are not effective, because this is not an allergic reaction.

 

PTS:   1                    DIF:    Cognitive Level: Application          REF:   p. 854

TOP:   Nursing Process: Implementation

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential

 

  1. A nurse is teaching a nursing student who wants to know how aspirin and nonaspirin first-generation NSAIDs differ. Which statement by the student indicates a need for further teaching?
a. “Unlike aspirin, first-generation NSAIDs cause reversible inhibition of cyclooxygenase.”
b. “NSAIDs do not increase the risk of myocardial infarction and stroke; however, unlike ASA, they do not provide protective benefits against those conditions.”
c. “Unlike aspirin, first-generation NSAIDs do not carry a risk of hypersensitivity reactions.”
d. “Unlike aspirin, first-generation NSAIDs cause little or no suppression of platelet aggregation.”

 

 

ANS:  C

Nonaspirin first-generation NSAIDs carry a risk of hypersensitivity reactions similar to the risk posed by ASA. These agents cause reversible COX inhibition, whereas ASA causes irreversible COX inhibition. NSAIDs do not provide protective benefits for myocardial infarction or stroke, as does ASA. Nonaspirin first-generation NSAIDs do cause suppression of platelet aggregation, but the suppression is reversible.

 

PTS:   1                    DIF:    Cognitive Level: Application          REF:   p. 850

TOP:   Nursing Process: Implementation

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies

 

  1. A nurse is providing teaching for an adult patient with arthritis who has been instructed to take ibuprofen [Motrin] for discomfort. Which statement by the patient indicates a need for further teaching?
a. “I may experience tinnitus with higher doses of this medication.”
b. “I may take up to 800 mg 4 times daily for pain.”
c. “I should limit alcohol intake to fewer than three drinks a day.”
d. “I will take this medication with meals to help prevent stomach upset.”

 

 

ANS:  A

NSAIDs do not cause salicylism and therefore do not cause tinnitus with higher doses. The maximum dose for adults is 3200 mg/day, or 800 mg 4 times/day. Patients taking NSAIDs should be cautioned to limit alcohol intake. Taking NSAIDs with meals helps prevent GI upset.

 

PTS:   1                    DIF:    Cognitive Level: Application          REF:   pp. 856-857

TOP:   Nursing Process: Implementation

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies

 

  1. A woman who has arthritis is breast-feeding her infant and asks the nurse if it is safe to take NSAIDs while nursing. What will the nurse tell this patient?
a. NSAIDs are safe to take while breast-feeding.
b. NSAIDs are not safe, even in small amounts.
c. She should take only COX-2 inhibitors while breast-feeding.
d. She should request a prescription for narcotic analgesics.

 

 

ANS:  A

NSAIDs are safe and may be taken while breast-feeding. It is not necessary to use a COX-2 inhibitor while breast-feeding. Narcotics cross breast milk and should be used cautiously while breast-feeding.

 

PTS:   1                    DIF:    Cognitive Level: Application          REF:   p. 855

TOP:   Nursing Process: Implementation

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies

 

  1. A nurse is providing medication teaching for a patient who will begin taking diclofenac [Voltaren] gel for osteoarthritis in both knees and elbows. Which statement by the patient indicates understanding of the teaching?
a. “Because this is a topical drug, liver toxicity will not occur.”
b. “I should cover areas where the gel is applied to protect them from sunlight.”
c. “I will apply equal amounts of gel to all affected areas.”
d. “The topical formulation has the same toxicity as the oral formulation.”

 

 

ANS:  B

Diclofenac is available in topical and oral preparations. Patients should be warned to protect treated areas from sunlight. Side effects occur, such as liver toxicity, even with topical dosing. Patients should apply smaller amounts to the upper extremities. Systemic toxicity is lower with topical formulations.

 

PTS:   1                    DIF:    Cognitive Level: Application          REF:   p. 858

TOP:   Nursing Process: Implementation

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies

 

  1. A patient has been receiving intravenous ketorolac 30 mg every 6 hours for postoperative pain for 4 days. The patient will begin taking oral ketorolac 10 mg every 4 to 6 hours to prepare for discharge in 1 or 2 days. The patient asks the nurse whether this drug will be prescribed for management of pain after discharge. The nurse will respond by telling the patient that the provider will prescribe a(n):
a. different nonsteroidal anti-inflammatory drug for home management of pain.
b. fixed-dose opioid analgesic/nonsteroidal anti-inflammatory medication.
c. lower dose of the oral ketorolac for long-term pain management.
d. intranasal preparation of ketorolac for pain management at home.

 

 

ANS:  A

Ketorolac is not indicated for chronic or minor pain and should not be used longer than 5 days. Patients discharged home will be instructed to use other NSAIDs for pain. A fixed-dose opioid/NSAID is not indicated. Low-dose ketorolac would not be used, because 5 days would have passed. The intranasal therapy would not be indicated after 5 days.

 

PTS:   1                    DIF:    Cognitive Level: Application          REF:   p. 859

TOP:   Nursing Process: Implementation

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies

 

  1. A patient who reports regular consumption of two or three alcoholic beverages per day asks about taking acetaminophen when needed for occasional recurrent pain. What will the nurse tell the patient?
a. “Do not take more than 2 gm of acetaminophen a day.”
b. “Do not take more than 3 gm of acetaminophen a day.”
c. “Do not take more than 4 gm of acetaminophen a day.”
d. “Do not take a fixed-dose preparation with opioid analgesics.”

 

 

ANS:  A

Acetaminophen poses a risk of liver toxicity when taken chronically or in larger doses, especially when combined with alcohol. Patients who drink regularly should be advised to take acetaminophen in low doses and not to exceed 2 gm per day.

 

PTS:   1                    DIF:    Cognitive Level: Application          REF:   p. 862

TOP:   Nursing Process: Implementation

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies

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