Pharmacology A Patient Centered Nursing Process Approach 9th Edition By Linda E-Test Bank

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Pharmacology A Patient Centered Nursing Process Approach 9th Edition By Linda E-Test Bank

Chapter 02: Pharmacokinetics, Pharmacodynamics, and Pharmacogenetics

McCuistion: Pharmacology: A Patient-Centered Nursing Process Approach, 9th Edition

 

MULTIPLE CHOICE

 

  1. Which drug will go through a disintegration process after it is administered?
a. Intramuscular (IM) cephalosporins
b. Intravenous (IV) vasopressors
c. Oral analgesics
d. Subcutaneous antiglycemics

 

 

ANS:   C

When drugs are administered parenterally, there is no disintegration process, which occurs when a drug becomes a solution that can cross the biologic membrane.

 

DIF:    Cognitive Level: Understanding (Comprehension)               REF:    p. 16

TOP:    Nursing Process: Assessment

MSC:   NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. The nurse is preparing to administer an oral medication and wants to ensure a rapid drug action. Which form of the medication will the nurse administer?
a. Capsule
b. Enteric-coated pill
c. Liquid suspension
d. Tablet

 

 

ANS:   C

Liquid drugs are already in solution, which is the form necessary for absorption in the gastrointestinal (GI) tract. The other forms must disintegrate into small particles and then dissolve before being absorbed.

 

DIF:    Cognitive Level: Understanding (Comprehension)               REF:    p. 16

TOP:    Nursing Process: Nursing Intervention

MSC:   NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. The nurse is teaching a patient who will be discharged home with a prescription for an enteric-coated tablet. Which statement by the patient indicates understanding of the teaching?
a. “I may crush the tablet and put it in applesauce to improve absorption.”
b. “I should consume acidic foods to enhance absorption of this medication.”
c. “I should expect a delay in onset of the drug’s effects after taking the tablet.”
d. “I should take this medication with high-fat foods to improve its action.”

 

 

ANS:   C

Enteric-coated tablets resist disintegration in the acidic environment of the stomach and disintegrate when they reach the small intestine. There is usually some delay in onset of actions after taking these medications. Enteric-coated tablets should not be crushed or chewed, which would alter the time and location of absorption. Acidic foods will not enhance the absorption of the medication. The patient should not eat high-fat food before ingesting an enteric-coated tablet because high-fat foods decrease the absorption rate.

 

DIF:    Cognitive Level: Applying (Application)                              REF:    p. 16

TOP:    Nursing Process: Nursing Intervention

MSC:   NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. A patient who is newly diagnosed with type 1 diabetes mellitus asks why insulin must be given by subcutaneous injection instead of by mouth. The nurse will explain that this is because
a. absorption is diminished by the first-pass effects in the liver.
b. absorption is faster when insulin is given subcutaneously.
c. digestive enzymes in the GI tract prevent absorption.
d. the oral form is less predictable with more adverse effects.

 

 

ANS:   C

Insulin, growth hormones, and other protein-based drugs are destroyed in the small intestine by digestive enzymes and must be given parenterally. Because insulin is destroyed by digestive enzymes, it would not make it to the liver for metabolism with a first-pass effect. Subcutaneous tissue has fewer blood vessels, so absorption is slower in such tissue. Insulin is given subcutaneously because it is desirable to have it absorb slowly.

 

DIF:    Cognitive Level: Understanding (Comprehension)               REF:    p. 17

TOP:    Nursing Process: Nursing Intervention: Patient Teaching

MSC:   NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. The nurse is preparing to administer an oral medication that is water soluble. The nurse understands that this drug
a. must be taken on an empty stomach.
b. requires active transport for absorption.
c. should be taken with fatty foods.
d. will readily diffuse into the GI tract.

 

 

ANS:   B

Water-soluble drugs require a carrier enzyme or protein to pass through the GI membrane.

 

DIF:    Cognitive Level: Understanding (Comprehension)               REF:    p. 17

TOP:    Nursing Process: Nursing Intervention

MSC:   NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. A nurse is preparing to administer an oral drug that is best absorbed in an acidic environment. How will the nurse give the drug?
a. On an empty stomach
b. With a full glass of water
c. With food
d. With high-fat food

 

 

ANS:   C

Food can stimulate the production of gastric acid, so medications requiring an acidic environment should be given with a meal. High-fat foods are useful for drugs that are lipid soluble.

 

DIF:    Cognitive Level: Applying (Application)                              REF:    p. 17

TOP:    Nursing Process: Nursing Intervention

MSC:   NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. The nurse is preparing an injectable drug and wants to administer it for rapid absorption. How will the nurse give this medication?
a. IM into the deltoid muscle
b. IM into the gluteal muscle
c. Subcut into abdominal tissue
d. Subcut into the upper arm

 

 

ANS:   A

Drugs given IM are absorbed faster in muscles that have more blood vessels, such as the deltoid, rather than those with fewer blood vessels, such as the gluteals. Subcutaneous routes are used when absorption needs to be slower and more sustained.

 

DIF:    Cognitive Level: Applying (Application)                              REF:    p. 17

TOP:    Nursing Process: Planning

MSC:   NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. The nurse is reviewing medication information with a nursing student prior to administering an oral drug and notes that the drug has extensive first-pass effects. Which statement by the student indicates a need for further teaching about this medication?
a. “The first-pass effect means the drug may be absorbed into systemic circulation from the intestinal lumen.”
b. “The first-pass effect means the drug may be changed to an inactive form and excreted.”
c. “The first-pass effect means the drug may be changed to a metabolite, which may be more active than the original.”
d. “The first-pass effect means the drug may be unchanged as it passes through the liver.”

 

 

ANS:   B

Drugs that undergo first-pass metabolism are absorbed into the portal vein from the intestinal lumen and go through the liver, where they are either unchanged or are metabolized to an inactive or a more active form.

 

DIF:    Cognitive Level: Understanding (Comprehension)               REF:    p. 17

TOP:    Nursing Process: Nursing Intervention

MSC:   NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. The nurse prepares to change a patient’s medication from an IV to an oral form and notes that the oral form is ordered in a higher dose. The nurse understands that this is due to differences in
a. bioavailability.
b. pinocytosis.
c. protein binding.
d. tachyphylaxis.

 

 

ANS:   A

Oral drugs may have less bioavailability because a lower percentage of the drug reaches the systemic circulation. Pinocytosis refers to the process by which cells carry a solute across a membrane. Protein binding can occur with both routes. Tachyphylaxis describes a rapid decrease in response to drugs that occurs when tolerance develops quickly.

 

DIF:    Cognitive Level: Understanding (Comprehension)               REF:    p. 17

TOP:    Nursing Process: Assessment

MSC:   NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. The nurse is preparing to administer a drug and learns that it binds to protein at a rate of 90%. The patient’s serum albumin level is low. The nurse will observe the patient for
a. decreased drug absorption.
b. decreased drug interactions.
c. decreased drug toxicity.
d. increased drug effects.

 

 

ANS:   D

Drugs that are highly protein-bound bind with albumin and other proteins, leaving less free drug in circulation. If a patient has a low albumin, the drug is not bound, and there is more free drug to cause drug effects. There would be increased absorption, increased interactions with other drugs, and increased toxicity.

 

DIF:    Cognitive Level: Applying (Application)                              REF:    p. 18

TOP:    Nursing Process: Evaluation

MSC:   NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. The nurse is administering two drugs to a patient and learns that both drugs are highly protein-bound. The nurse may expect
a. decreased bioavailability of both drugs.
b. decreased drug effects.
c. decreased drug interactions.
d. increased risk of adverse effects.

 

 

ANS:   D

Two drugs that are highly protein-bound will compete for protein-binding sites, leaving more free drug in circulation and an increased risk of adverse effects as well as increased bioavailability, increased drug effects, and increased drug interactions.

 

DIF:    Cognitive Level: Applying (Application)                              REF:    p. 18

TOP:    Nursing Process: Evaluation

MSC:   NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. A patient has been taking a drug that has a protein-binding effect of 75%. The provider adds a new medication that has a protein-binding effect of 90%. The nurse will expect
a. decreased drug effects of the first drug.
b. decreased therapeutic range of the first drug.
c. increased drug effects of the first drug.
d. increased therapeutic range of the first drug.

 

 

ANS:   C

Adding another highly protein-bound drug will displace the first drug from protein-binding sites and release more free drug, increasing the drug’s effects. This does not alter the therapeutic range, which is the serum level between drug effectiveness and toxicity.

 

DIF:    Cognitive Level: Applying (Application)                              REF:    p. 18

TOP:    Nursing Process: Nursing Intervention/Evaluation

MSC:   NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. The nurse gives a medication to a patient with a history of liver disease. The nurse will monitor this patient for
a. decreased drug effects.
b. increased drug effects.
c. decreased therapeutic range.
d. increased therapeutic range.

 

 

ANS:   B

Liver diseases such as cirrhosis and hepatitis alter drug metabolism by inhibiting the drug-metabolizing enzymes in the liver. When the drug metabolism rate is decreased, excess drug accumulation can occur and lead to toxicity.

 

DIF:    Cognitive Level: Applying (Application)                              REF:    p. 19

TOP:    Nursing Process: Assessment/Nursing Intervention

MSC:   NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. The nurse gives 800 mg of a drug that has a half-life of 8 hours. How much drug will be left in the body in 24 hours if no additional drug is given?
a. None
b. 50 mg
c. 100 mg
d. 200 mg

 

 

ANS:   C

Eight hours after the drug is given, there will be 400 mg left. Eight hours after that (16 hours), there will be 200 mg left. At 24 hours, there will be 100 mg left.

 

DIF:    Cognitive Level: Applying (Application)                              REF:    p. 19

TOP:    Nursing Process: Evaluation

MSC:   NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. If a drug has a half-life of 12 hours and is given twice daily starting at 0800 on a Monday, when will a steady state be achieved?
a. 0800 on Tuesday
b. 0800 on Wednesday
c. 0800 on Thursday
d. 0800 on Friday

 

 

ANS:   B

Steady-state levels occur at 3 to 5 half-lives. Wednesday at 0800 is 4 half-lives from the original dose.

 

DIF:    Cognitive Level: Applying (Application)                              REF:    p. 19

TOP:    Nursing Process: Evaluation

MSC:   NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. The nurse is preparing to administer a drug that is ordered to be given twice daily. The nurse reviews the medication information and learns that the drug has a half-life of 24 hours. What will the nurse do next?
a. Administer the medication as ordered
b. Contact the provider to discuss daily dosing
c. Discuss every-other-day dosing with the provider
d. Hold the medication

 

 

ANS:   B

A drug with a longer half-life should be given at longer intervals to avoid drug toxicity.

 

DIF:    Cognitive Level: Applying (Application)                              REF:    p. 19

TOP:    Nursing Process: Planning

MSC:   NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. The nurse is caring for a patient who has taken an overdose of aspirin several hours prior. The provider orders sodium bicarbonate to be given. The nurse understands that this drug is given for which purpose?
a. To counter the toxic effects of the aspirin
b. To decrease the half-life of the aspirin
c. To increase the excretion of the aspirin
d. To neutralize the acid of the aspirin

 

 

ANS:   C

Aspirin is a weak acid and is more readily excreted in alkaline urine. Sodium bicarbonate alkalizes the urine. It does not act as an antidote to aspirin, decrease the half-life, or neutralize its pH.

 

DIF:    Cognitive Level: Applying (Application)                              REF:    p. 19

TOP:    Nursing Process: Planning

MSC:   NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. The nurse is preparing to administer a drug that is eliminated through the kidneys. The nurse reviews the patient’s chart and notes that the patient has increased serum creatinine and blood urea nitrogen (BUN). The nurse will perform which action?
a. Administer the drug as ordered.
b. Anticipate a shorter than usual half-life of the drug.
c. Expect decreased drug effects when the drug is given.
d. Notify the provider and discuss giving a lower dose.

 

 

ANS:   D

Increased creatinine and BUN indicate decreased renal function, so a drug that is eliminated through the kidneys can become toxic. The nurse should discuss a lower dose with the provider. The drug will have a longer half-life and will exhibit increased effects with decreased renal function.

 

DIF:    Cognitive Level: Applying (Application)                              REF:    p. 19

TOP:    Nursing Process: Nursing Intervention

MSC:   NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. The nurse understands that the length of time needed for a drug to reach the minimum effective concentration (MEC) is the
a. duration of action.
b. onset of action.
c. peak action time.
d. time response curve.

 

 

ANS:   B

The onset of action is the time it takes to reach the MEC. Duration of action is the length of time a drug has a pharmacologic effect. Peak action time occurs when the drug reaches its highest blood level. The time response curve is an evaluation of the other three measures.

 

DIF:    Cognitive Level: Remembering (Knowledge)                       REF:    p. 20

TOP:    Nursing Process: N/A

MSC:   NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. The nurse administers albuterol to a patient who has asthma. The albuterol acts by stimulating beta2-adrenergic receptors to cause bronchodilation. The nurse understands that albuterol is a beta-adrenergic
a. agonist.
b. antagonist.
c. inhibitor.
d. depressant.

 

 

ANS:   A

An agonist medication is one that stimulates a certain type of cell to produce a response.

 

DIF:    Cognitive Level: Understanding (Comprehension)               REF:    p. 21

TOP:    Nursing Process: N/A

MSC:   NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. The nurse is explaining to the patient why a nonspecific drug has so many side effects. Which statement by the patient indicates a need for further teaching?
a. “Non-specific drugs can affect specific receptor types in different body tissues.”
b. “Non-specific drugs can affect a variety of receptor types in similar body tissues.”
c. “Non-specific drugs can affect hormone secretion as well as cellular functions.”
d. “Non-specific drugs require higher doses than specific drugs to be effective.”

 

 

ANS:   B

Non-specific drugs can act on one type of receptor but in different body tissues, or a variety of receptor types, or act on hormones to produce effects. Non-specific drugs do not require higher doses.

 

DIF:    Cognitive Level: Applying (Application)                              REF:    p. 21

TOP:    Nursing Process: Nursing Intervention: Patient Teaching

MSC:   NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. The nurse is preparing to administer the first dose of digoxin (Lanoxin) to a patient and notes that the dose ordered is much higher than the usual recommended dose. Which action will the nurse perform?
a. Administer the dose as ordered.
b. Give the dose and monitor for toxicity.
c. Hold the dose until reviewing it with the provider.
d. Refuse to give the dose.

 

 

ANS:   A

Digoxin requires a loading dose when first prescribed.

 

DIF:    Cognitive Level: Applying (Application)                              REF:    p. 19

TOP:    Nursing Process: Nursing Intervention

MSC:   NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. The nurse administers a narcotic analgesic to a patient who has been receiving it for 1 day after orthopedic surgery. The patient reports no change in pain 30 minutes after the medication is given. The nurse recognizes that this patient is exhibiting
a. drug-seeking behavior.
b. drug tolerance.
c. the placebo effect.
d. tachyphylaxis.

 

 

ANS:   D

Tachyphylaxis is a rapid decrease in response, or acute tolerance. Tolerance to drug effects can occur with narcotics, requiring increased doses in order to achieve adequate drug effects. Nurses often mistake drug-seeking behavior for drug tolerance. The placebo effect occurs when the patient experiences a response with an inactive drug.

 

DIF:    Cognitive Level: Understanding (Comprehension)               REF:    p. 23

TOP:    Nursing Process: Assessment

MSC:   NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. A patient has been taking a drug for several years and tells the nurse it is no longer working. The nurse learns that the patient has recently begun taking an over-the-counter (OTC) antacid medication. What does the nurse suspect is occurring?
a. An adverse drug reaction
b. A drug interaction
c. Drug incompatibility
d. Drug tolerance

 

 

ANS:   B

Drug interactions are an altered or modified action or effect of a drug as a result of interaction with one or more other drugs. An adverse drug reaction can occur with one or more drugs and has effects ranging from mild to severe toxicity. Drug incompatibility is a chemical reaction of two or more drugs that occurs in vitro. Drug tolerance is the development of reduced response to a medication over time.

 

DIF:    Cognitive Level: Applying (Application)                              REF:    p. 24

TOP:    Nursing Process: Evaluation

MSC:   NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. The nurse is preparing to administer two IV medications that should not be given using the same IV tubing. The nurse understands that this is because of drug
a. adverse reactions.
b. incompatibility.
c. interactions.
d. potentiation.

 

 

ANS:   B

Drugs that are incompatible cannot be mixed together in solution and cannot be mixed in a syringe, IV bag, or other artificial environment. Adverse reactions are symptoms occurring from drug effects. Drug interactions occur in vivo. Potentiation is when one drug causes an enhanced response in another drug.

 

DIF:    Cognitive Level: Applying (Application)                              REF:    p. 24

TOP:    Nursing Process: Nursing Intervention

MSC:   NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. The nurse is teaching a patient who will begin taking ciprofloxacin. What instruction will the nurse include when teaching this patient about this drug?
a. “Do not take this medication with oral contraceptive pills.”
b. “Take at least 1 hour after or 2 hours before taking antacids.”
c. “Take in the morning with your multivitamin tablet.”
d. “Take with milk to reduce gastric upset.”

 

 

ANS:   B

Dairy products, multivitamins, and antacids should be avoided 1 hour after and 2 hours before taking ciprofloxacin because these products contain divalent cations that form a drug complex that prevents absorption of the ciprofloxacin.

 

DIF:    Cognitive Level: Applying (Application)                              REF:    p. 24

TOP:    Nursing Process: Nursing Intervention: Patient Teaching

MSC:   NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. A patient who takes a drug that undergoes gastric absorption will begin taking an opioid analgesic after sustaining an injury in a motor vehicle accident. The nurse will observe the patient closely for which effects?
a. Decreased effects of the first drug
b. Increased effects of the first drug
c. Decreased effects of the narcotic
d. Increased effects of the narcotic

 

 

ANS:   B

Opioids slow gastric emptying, allowing more time for drugs absorbed in the stomach to be absorbed. The nurse should expect increased effects of the first drug.

 

DIF:    Cognitive Level: Applying (Application)                              REF:    p. 24

TOP:    Nursing Process: Evaluation

MSC:   NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. The nurse is preparing to administer furosemide to a patient who takes digoxin. The nurse will plan to monitor the patient for
a. digoxin toxicity.
b. decreased digoxin effects.
c. erythromycin toxicity.
d. decreased erythromycin effects.

 

 

ANS:   A

The renal loss of potassium can result in hypokalemia, which can enhance the action of digoxin and can lead to toxicity.

 

DIF:    Cognitive Level: Applying (Application)                              REF:    p. 25

TOP:    Nursing Process: Evaluation

MSC:   NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. A young adult female patient who takes a combination oral contraceptive (OCP) will begin taking an antibiotic. When teaching the patient about this medication, the nurse will
a. recommend using a backup method of contraception.
b. suggest that she switch to an injectable form of contraception.
c. tell her that the antibiotic is less effective if she is taking OCPs.
d. tell her the antibiotic has a greater risk for toxicity while taking OCPs.

 

 

ANS:   A

Gut bacteria are necessary to hydrolyze estrogen conjugates into free estrogens. Concurrent antibiotic administration can alter these bacteria and prevent the optimal absorption and effectiveness of OCPs. A back-up contraceptive method is recommended.

 

DIF:    Cognitive Level: Applying (Application)                              REF:    p. 24

TOP:    Nursing Process: Nursing Intervention: Patient Teaching

MSC:   NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. A patient has been taking warfarin (Coumadin), which is highly protein-bound. The patient will begin taking gemfibrozil, which is also highly protein-bound. The nurse will observe the patient closely for
a. decreased effects of warfarin.
b. increased effects of warfarin.
c. decreased effects of gemfibrozil.
d. decreased effects of both drugs.

 

 

ANS:   B

The addition of a highly protein-bound drug will compete with warfarin for protein-binding sites, releasing more free warfarin into the system, increasing drug effects, and increasing the chance of toxicity.

 

DIF:    Cognitive Level: Applying (Application)                              REF:    p. 18

TOP:    Nursing Process: Evaluation

MSC:   NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. A patient is taking phenytoin to prevent seizures. The nurse knows that phenytoin is highly protein-bound and has sedative’s side effects. The nurse reviews the patient’s chart and notes a low serum albumin. The nurse will notify the provider and observe the patient for which effects?
a. Decreased sedative effects
b. Increased sedative effects
c. Increased seizures
d. No change in effects

 

 

ANS:   B

Phenytoin is protein-bound. When patients have a low serum albumin, there are fewer protein-binding sites, leaving more free drug in the system. The nurse should expect an increase in the sedative’s side effects.

 

DIF:    Cognitive Level: Applying (Application)                              REF:    p. 18

TOP:    Nursing Process: Evaluation

MSC:   NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. A patient who takes the anticoagulant warfarin will begin taking the anticonvulsant drug carbamazepine. The nurse reviews the drug information for these drugs and learns that carbamazepine is a hepatic enzyme inducer. The nurse anticipates that the provider will make which dosage adjustment?
a. Decrease the dose of carbamazepine
b. Increase the dose of carbamazepine
c. Decrease the dose of warfarin
d. Increase the dose of warfarin

 

 

ANS:   D

Carbamazepine is a hepatic enzyme inducer, which can increase drug metabolism. Patients taking both drugs usually need a larger dose of warfarin.

 

DIF:    Cognitive Level: Applying (Application)                              REF:    p. 24

TOP:    Nursing Process: Planning

MSC:   NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. The nurse is caring for a patient who receives theophylline, which has a narrow therapeutic index. The patient has been receiving cimetidine but will stop taking that drug in 2 days. In 2 days, the nurse will observe the patient closely for
a. decreased effectiveness of theophylline.
b. increased effectiveness of theophylline.
c. decreased toxicity of theophylline.
d. prolonged effectiveness of theophylline.

 

 

ANS:   B

Cimetidine is an enzyme inhibitor that decreases the metabolism of drugs such as theophylline. If the cimetidine is discontinued, the theophylline dose should be decreased to avoid toxicity. The nurse should observe the patient for increased theophylline effects.

 

DIF:    Cognitive Level: Applying (Application)                              REF:    p. 24

TOP:    Nursing Process: Evaluation

MSC:   NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. The nurse is caring for a patient who takes digoxin to treat heart failure. The provider orders furosemide to treat edema. The nurse will monitor the patient for digitalis toxicity because of
a. adverse drug reactions caused by giving these drugs in combination.
b. altered hepatic blood flow caused by the furosemide.
c. changes in reabsorption of water and electrolytes in the kidneys.
d. additive effects of these two drugs given together.

 

 

ANS:   C

Diuretics such as furosemide promote water and sodium excretion from the renal tubules, especially sodium and potassium. Hypokalemia can result, and this will enhance the action of digoxin, and digitalis toxicity can occur.

 

DIF:    Cognitive Level: Applying (Application)                              REF:    p. 25

TOP:    Nursing Process: Evaluation

MSC:   NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. A patient will receive penicillin to treat an infection. The provider orders probenecid (Probalan), a medication to treat gout, even though the patient does not have gout. Which action by the nurse is correct?
a. Administer the drug since the provider ordered it.
b. Recognize that it is being given prophylactically.
c. Refuse to administer the medication since it is not indicated.
d. Verify that it is being given for its secondary action.

 

 

ANS:   D

Two or more drugs with the same route of excretion may compete with each other for elimination. Probenecid is given because it inhibits the excretion of penicillin, which may be desirable when the provider wants to prolong the plasma concentration of penicillin. The nurse should always verify an order that may not be clear.

 

DIF:    Cognitive Level: Applying (Application)                              REF:    p. 25

TOP:    Nursing Process: Nursing Intervention

MSC:   NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. The nurse is preparing to administer meperidine (Demerol), which is an opioid analgesic, and promethazine (Phenergan), which is an antiemetic and antihistamine. The nurse understands that these drugs are given in combination for which reason?
a. They have antagonistic effects to reduce nausea.
b. They have additive effects to enhance analgesia.
c. They have potentiating effects to decrease an allergic response.
d. They have synergistic effects to increase sedation.

 

 

ANS:   D

Meperidine and promethazine have a synergistic effect on each other with a clinical effect that is substantially greater than the combined effect of the two.

 

DIF:    Cognitive Level: Understanding (Comprehension)               REF:    p. 25

TOP:    Nursing Process: Nursing Intervention

MSC:   NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. The provider has ordered amoxicillin with clavulanate (Augmentin) for a child who has otitis media. The child’s parent asks why this drug is necessary when amoxicillin is less expensive. The nurse will explain that clavulanate is added to amoxicillin because it
a. binds with albumin to increase the amount of available amoxicillin.
b. broadens the spectrum of amoxicillin by inhibiting bacterial enzymes.
c. inhibits hepatic blood flow, leading to increased serum drug levels of amoxicillin.
d. inhibits the excretion of amoxicillin by interfering with renal function.

 

 

ANS:   B

Clavulanate is a bacterial enzyme inhibitor, specifically beta-lactamase, which inactivates amoxicillin. When added to amoxicillin, it broadens the antibacterial spectrum.

 

DIF:    Cognitive Level: Applying (Application)                              REF:    p. 26

TOP:    Nursing Process: Nursing Intervention: Patient Teaching

MSC:   NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. The nurse assesses a patient who is receiving morphine sulfate intravenously using a patient-controlled analgesia pump. The nurse notes somnolence and respiratory depression, which are signs of morphine toxicity. The nurse will prepare to administer naloxone (Narcan) because it
a. has synergistic effects with morphine.
b. is a narcotic agonist.
c. is a narcotic antagonist.
d. potentiates narcotic effects.

 

 

ANS:   C

Naloxone is a narcotic antagonist, meaning that it reverses the effects of morphine by blocking morphine receptor sites.

 

DIF:    Cognitive Level: Applying (Application)                              REF:    p. 26

TOP:    Nursing Process: Nursing Intervention

MSC:   NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. The nurse is teaching a patient about a drug that causes photosensitivity. Which statement by the patient indicates a need for further teaching?
a. “I should apply sunscreen with a sun protection factor greater than 15.”
b. “I should avoid sunlight when possible while taking this drug.”
c. “I will wear protective clothing when I am outdoors.”
d. “I will wear sunglasses even while I am indoors.”

 

 

ANS:   D

Drugs that cause photosensitivity make sunburn more likely, so patients should stay out of the sun, wear protective clothing, and use sunscreen with an SPF greater than 15. It is not necessary to wear sunglasses indoors.

 

DIF:    Cognitive Level: Applying (Application)                              REF:    p. 26

TOP:    Nursing Process: Nursing Intervention

MSC:   NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. A patient asks the nurse about using OTC medications. The nurse will tell the patient that OTC medications
a. are not as effective as prescription medications.
b. are not as safe as prescription medications.
c. have fewer side effects and drug interactions than prescription medications.
d. should be included when listing any medications taken by the patient.

 

 

ANS:   D

OTC medications should always be included when listing medications because they can cause drug interactions. OTC medications can be as effective and as safe as prescription medications and have as many side effects and adverse reactions.

 

DIF:    Cognitive Level: Applying (Application)                              REF:    p. 26

TOP:    Nursing Process: Nursing Intervention

MSC:   NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. The nurse is educating the parent of a 20-month-old toddler about OTC products to treat cold symptoms. Which statement by the parent indicates understanding of the teaching?
a. “I should check with the provider for proper dosing instructions.”
b. “OTC medications are less potent and have minimal side effects.”
c. “OTC medications can be given to children younger than 2 years old.”
d. “Using OTC medications may prevent accurate diagnosis of respiratory illness.”

 

 

ANS:   D

OTC cold medications can mask symptoms and prevent accurate diagnosis of potentially serious illnesses. Their use in children is not recommended.

 

DIF:    Cognitive Level: Applying (Application)                              REF:    p. 26

TOP:    Nursing Process: Nursing Intervention

MSC:   NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. A patient calls the clinic and tells the nurse that a newly prescribed medication isn’t working. What is the nurse’s next action?
a. Notify the provider and discuss increasing the dose.
b. Question the patient about compliance with the regimen.
c. Review the drug information with the patient.
d. Suggest the patient discuss changing medications with the provider.

 

 

ANS:   C

It is important for patients to understand the therapeutic effects and expected time frame for effects to occur. The nurse should review this with the patient first to make sure the patient’s expectations are consistent with the drug’s effects. The dose should not be increased or the drug changed until it is determined that the drug is not working as it should. Questioning the patient about compliance first assumes that the patient is doing something wrong. The nurse may question the patient about compliance after reviewing the drug information.

 

DIF:    Cognitive Level: Applying (Application)                              REF:    p. 27

TOP:    Nursing Process: Assessment/Nursing Intervention

MSC:   NCLEX: Health Promotion and Maintenance

 

  1. The community health nurse is teaching a group of elderly residents in an assisted care facility about medication use. The nurse will remind the residents that OTC medications
a. are not as effective as prescription medications.
b. are not recommended for older adults.
c. are safer than prescription medications.
d. should be reviewed with a provider before taking.

 

 

ANS:   D

OTC medications should be reviewed as part of a medication history at every encounter with the provider to prevent food and drug interactions. OTC medications may be just as effective as prescription medications, may be used by older adults, and often have serious side effects.

 

DIF:    Cognitive Level: Applying (Application)                              REF:    p. 28

TOP:    Nursing Process: Nursing Intervention: Patient Teaching

MSC:   NCLEX: Health Promotion and Maintenance

 

  1. The nurse is preparing to teach a patient who will begin taking a monoamine oxidase (MAO) inhibitor. What is most important when teaching patients about MAO inhibitors?
a. Emphasizing the importance of potassium intake
b. Giving detailed drug information
c. Reviewing dietary guidelines
d. Providing a schedule for medication administration

 

 

ANS:   C

MAO inhibitors have many dietary restrictions with potentially serious adverse reactions, so this should be an important part of teaching.

 

DIF:    Cognitive Level: Applying (Application)                              REF:    p. 26

TOP:    Nursing Process: Nursing Intervention: Patient Teaching

MSC:   NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. The nurse is teaching a patient about taking a once-daily medication that has a side effect of drowsiness. The nurse learns that the patient works a 7:00 PM to 7:00 AM shift in a hospital. The nurse will recommend that the patient take this medication at which time of day?
a. 0600
b. 0800
c. 1800
d. 2000

 

 

ANS:   B

The medication should be given when the patient is at home before sleep.

 

DIF:    Cognitive Level: Applying (Application)                              REF:    p. 22

TOP:    Nursing Process: Planning/Nursing Intervention: Patient Teaching

MSC:   NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

MULTIPLE RESPONSE

 

  1. Which patients are at high risk for drug interactions? (Select all that apply.)
a. Patients who are acutely ill
b. Patients who are taking multiple medications
c. Patients who see several specialists
d. Patients who take supplements and OTC medications
e. Patients who use one pharmacy for several medications

 

 

ANS:   B, C, D

Patients who have chronic health conditions, take multiple medications, see more than one provider, and use supplements and OTC medications are at higher risk for drug interactions.

 

DIF:    Cognitive Level: Understanding (Comprehension)               REF:    p. 24

TOP:    Nursing Process: Assessment

MSC:   NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

Chapter 12: Fluid Volume and Electrolytes

McCuistion: Pharmacology: A Patient-Centered Nursing Process Approach, 9th Edition

 

MULTIPLE CHOICE

 

  1. A patient’s serum osmolality is 305 mOsm/kg. Which term describes this patient’s body fluid osmolality?
a. Iso-osmolar
b. Hypo-osmolar
c. Hyper-osmolar
d. Isotonic

 

 

ANS:   C

Normal osmolality is 275 to 295 mOsm/kg. This patient is therefore hyper-osmolar.

 

DIF:    Cognitive Level: Understanding (Comprehension)               REF:    p. 158

TOP:    Nursing Process: Assessment

MSC:   NCLEX: Physiological Integrity: Basic Care and Comfort: Nutrition

 

  1. A patient is admitted after experiencing vomiting and diarrhea for several days. The provider orders intravenous lactated Ringer’s solution. The nurse understands that this fluid is given for which purpose?
a. To increase interstitial and intracellular hydration
b. To maintain plasma volume over time
c. To pull water from the interstitial space into the extracellular fluid
d. To replace water and electrolytes

 

 

ANS:   D

Lactated Ringer’s solution is an isotonic solution and is used to replace water and electrolytes and is often used to replace gastrointestinal losses. Hypotonic fluids increase interstitial and intracellular hydration. Colloidal solutions are used to maintain plasma volume over time. Hypertonic solutions pull water from the interstitial space into the extracellular fluid.

 

DIF:    Cognitive Level: Understanding (Comprehension)               REF:    p. 159

TOP:    Nursing Process: Nursing Intervention

MSC:   NCLEX: Physiological Integrity: Basic Care and Comfort: Nutrition

 

  1. A patient is being treated for shock after a motor vehicle accident. The provider orders 6% dextran 75 to be given intravenously. The nurse should expect which outcome as the result of this infusion?
a. Decreased urine output
b. Improved blood oxygenation
c. Increased interstitial fluid
d. Stabilization of heart rate and blood pressure

 

 

ANS:   D

6% Dextran 75 is a high–molecular-weight colloidal solution and is used to treat shock from hemorrhage, burns, or trauma. Colloids are plasma expanders, and the end result is an improvement in heart rate (decreased) and blood pressure (increased). Plasma expanders will result in an increase in urine output. Blood oxygenation is not affected, and colloids do not increase the amount of interstitial fluid.

 

DIF:    Cognitive Level: Understanding (Comprehension)               REF:    p. 160

TOP:    Nursing Process: Nursing Intervention

MSC:   NCLEX: Physiological Integrity: Basic Care and Comfort: Nutrition

 

  1. The nurse is caring for a patient who weighs 75 kg. The patient has intravenous (IV) fluids infusing at a rate of 50 mL/h and has consumed 100 mL of fluids orally in the past 24 hours. Which action will the nurse take?
a. Contact the provider to ask about increasing the IV rate to 90 mL/h.
b. Discuss with the provider the need to increase the IV rate to 150 mL/h.
c. Encourage the patient to drink more water so the IV can be discontinued.
d. Instruct the patient to drink 250 mL of water every 8 hours.

 

 

ANS:   A

The recommended daily fluid intake for adults is 30 to 40 mL/kg/day. This patient should have a minimum of 2250 mL/day and is currently receiving 1200 mL IV plus 100 mL orally for a total of 1300 mL. Increasing the IV rate to 90 mL/h would give the patient 2160 mL. If the patient continues to take oral fluids, the amount of 2250 mL can be met. A rate of 150 mL/h would give the patient 3600 mL/day, which exceeds the recommended amount. Since this patient is not taking fluids well and is not receiving adequate IV fluids, encouraging an increased fluid intake is not indicated. Even if the patient drank 250 mL of water every 8 hours, the amount would not be sufficient.

 

DIF:    Cognitive Level: Applying (Application)                              REF:    p. 158

TOP:    Nursing Process: Evaluation

MSC:   NCLEX: Physiological Integrity: Basic Care and Comfort: Nutrition

 

  1. The nurse is caring for a patient who has a heart rate of 98 beats per minute and a blood pressure of 82/58 mm Hg. The patient is lethargic, is complaining of muscle weakness, and has had gastroenteritis for several days. Based on this patient’s vital signs, which sodium value would the nurse expect?
a. 126 mEq/L
b. 140 mEq/L
c. 145 mEq/L
d. 158 mEq/L

 

 

ANS:   A

Patients who are hyponatremic will have tachycardia and hypotension along with lethargy and muscle weakness. The normal range for serum sodium is 135 to 145 mEq/L; a serum sodium level of 126 mEq/L would be considered hyponatremic.

 

DIF:    Cognitive Level: Analyzing (Analysis)                                  REF:    p. 168

TOP:    Nursing Process: Assessment

MSC:   NCLEX: Physiological Integrity: Basic Care and Comfort: Nutrition

 

  1. The nurse is caring for a patient who has had severe vomiting. The patient’s serum sodium level is 130 mEq/L. The nurse will expect the patient’s provider to order which treatment?
a. Diuretic therapy
b. Intravenous hypertonic 5% saline
c. Intravenous normal saline 0.9%
d. Oral sodium supplements

 

 

ANS:   C

Patients with hyponatremia may be treated with oral sodium supplements if the patient is able or if the deficit is mild. This patient is vomiting and would not be able to take supplements easily. For a serum level between 125 and 135 mEq/L, normal saline may increase sodium content in vascular fluid. Hypertonic saline is used for severe hyponatremia with a serum sodium <120 mEq/L. Diuretics would further deplete sodium and fluid volume in a patient already likely to be dehydrated from severe vomiting.

 

DIF:    Cognitive Level: Applying (Application)                              REF:    p. 168

TOP:    Nursing Process: Planning

MSC:   NCLEX: Physiological Integrity: Basic Care and Comfort: Nutrition

 

  1. The nurse is caring for a newly admitted patient who has severe gastroenteritis. The patient’s electrolytes reveal a serum sodium level of 140 mEq/L and a serum potassium level of 3.5 mEq/L. The nurse receives an order for intravenous 5% dextrose and normal saline with 20 mEq/L potassium chloride to infuse at 125 mL/h. Which action is necessary prior to administering this fluid?
a. Evaluate the patient’s urine output.
b. Contact the provider to order arterial blood gases.
c. Request an order for an initial potassium bolus.
d. Suggest a diet low in sodium and potassium.

 

 

ANS:   A

If the patient is receiving potassium and the urine output is <25 mL/h or <600 mL/d, potassium accumulation may occur. Patients with a low urine output should not receive IV potassium. Arterial blood gases are not necessary prior to IV potassium administration. Potassium should never be given as a bolus. Patients should be put on a potassium-enriched diet when foods are tolerated.

 

DIF:    Cognitive Level: Applying (Application)                              REF:    p. 166

TOP:    Nursing Process: Assessment

MSC:   NCLEX: Physiological Integrity: Basic Care and Comfort: Nutrition

 

  1. A patient who is being treated for dehydration is receiving 5% dextrose and 0.45% normal saline with 20 mEq/L potassium chloride at a rate of 125 mL/h. The nurse assuming care for the patient reviews the patient’s serum electrolytes and notes a serum sodium level of 140 mEq/L and a serum potassium level of 3.6 mEq/L. The patient had a urine output of 250 mL during the last 12-hour shift. Which action will the nurse take?
a. Contact the patient’s provider to discuss increasing the potassium chloride to 40 mEq/L.
b. Continue the intravenous fluids as ordered and reassess the patient frequently.
c. Notify the provider and discuss increasing the rate of fluids to 200 mL/h.
d. Stop the intravenous fluids and notify the provider of the assessment findings.

 

 

ANS:   D

The patient’s potassium level is within normal limits, but the urine output is decreased, so the patient should not be receiving IV potassium. The nurse should stop the IV and report the findings to the provider. The patient does not need an increase in potassium. The patient needs more fluids but not with potassium.

 

DIF:    Cognitive Level: Applying (Application)                              REF:    p. 166

TOP:    Nursing Process: Evaluation

MSC:   NCLEX: Physiological Integrity: Basic Care and Comfort: Nutrition

 

  1. A patient has a serum potassium level of 2.7 mEq/L. The patient’s provider has determined that the patient will need 200 mEq of potassium to replace serum losses. How will the nurse caring for this patient expect to administer the potassium?
a. As a single-dose 200 mEq oral tablet
b. As an intravenous bolus over 15 to 20 minutes
c. In an intravenous solution at a rate of 10 mEq/h
d. In an intravenous solution at a rate of 45 mEq/h

 

 

ANS:   C

Potassium chloride should be given intravenously when hypokalemia is severe, so this patient should receive IV potassium chloride. Potassium should never be given as a bolus and should be administered slowly. The maximum infusion rate for adults with a serum potassium level greater than 2.5 mEq/L is 10 mEq/h or 200 mEq/24 hours.

 

DIF:    Cognitive Level: Applying (Application)                              REF:    p. 166

TOP:    Nursing Process: Nursing Intervention

MSC:   NCLEX: Physiological Integrity: Basic Care and Comfort: Nutrition

 

  1. A patient is taking a thiazide diuretic and reports anorexia and fatigue. The nurse suspects which electrolyte imbalance in this patient?
a. Hypercalcemia
b. Hypocalcemia
c. Hyperkalemia
d. Hypokalemia

 

 

ANS:   D

Thiazide diuretics cause the body to lose potassium. Patients who take thiazide diuretics should be monitored for hypokalemia.

 

DIF:    Cognitive Level: Applying (Application)                              REF:    p. 163

TOP:    Nursing Process: Evaluation

MSC:   NCLEX: Physiological Integrity: Basic Care and Comfort: Nutrition

 

  1. The nurse is caring for a patient whose serum sodium level is 140 mEq/L and serum potassium level is 5.4 mEq/L. The nurse will contact the patient’s provider to discuss an order for
a. a low-potassium diet.
b. intravenous sodium bicarbonate.
c. Kayexalate and sorbitol.
d. salt substitutes.

 

 

ANS:   A

Mild hyperkalemia may be treated with dietary restriction of potassium-rich foods. The patient’s sodium level is normal, so sodium bicarbonate is not indicated. Kayexalate is used for severe hyperkalemia. Salt substitutes contain potassium and would only compound the hyperkalemia.

 

DIF:    Cognitive Level: Applying (Application)                              REF:    p. 163

TOP:    Nursing Process: Nursing Intervention

MSC:   NCLEX: Physiological Integrity: Basic Care and Comfort: Nutrition

 

  1. The provider has ordered Kayexalate and sorbitol to be administered to a patient. The nurse caring for this patient would expect which serum electrolyte values prior to administration of this therapy?
a. Sodium 125 mEq/L and potassium 2.5 mEq/L
b. Sodium 150 mEq/L and potassium 3.6 mEq/L
c. Sodium 135 mEq/L and potassium 6.9 mEq/L
d. Sodium 148 mEq/L and potassium 5.5 mEq/L

 

 

ANS:   C

Severe hyperkalemia, with a potassium level of 6.9 mEq/L, requires aggressive treatment with Kayexalate and sorbitol to increase the body’s excretion of potassium. The normal range for serum potassium is 3.5 to 5.5 mEq/L, so patients with the other potassium levels would not be treated aggressively or would need potassium supplementation.

 

DIF:    Cognitive Level: Applying (Application)                              REF:    p. 167

TOP:    Nursing Process: Nursing Intervention

MSC:   NCLEX: Physiological Integrity: Basic Care and Comfort: Nutrition

 

  1. The nurse is caring for a patient who is receiving oral potassium chloride supplements. The nurse notes that the patient has a heart rate of 120 beats per minute and has had a urine output of 200 mL in the past 12 hours. The patient reports abdominal cramping. Which action will the nurse take?
a. Contact the provider to request an order for serum electrolytes.
b. Encourage the patient to consume less fluids.
c. Report symptoms of hyperchloremia to the provider.
d. Request an order to increase the patient’s potassium dose.

 

 

ANS:   A

Oliguria, tachycardia, and abdominal cramping are signs of hyperkalemia, so the nurse should request an order for serum electrolytes. This patient should increase fluid intake. The patient is not exhibiting signs of hyperchloremia; the patient is showing signs of hyperkalemia, and an increased potassium dose is not indicated.

 

DIF:    Cognitive Level: Applying (Application)                              REF:    pp. 163-164

TOP:    Nursing Process: Evaluation

MSC:   NCLEX: Physiological Integrity: Basic Care and Comfort: Nutrition

 

  1. A patient asks the nurse about taking calcium supplements to avoid hypocalcemia. The nurse will suggest that the patient follow which instruction?
a. Take a calcium and vitamin D combination supplement.
b. Take calcium along with phosphorus to improve absorption.
c. Take calcium with antacids to reduce stomach upset.
d. Use aspirin instead of acetaminophen when taking calcium.

 

 

ANS:   A

Vitamin D enhances the absorption of calcium in the body. Calcium and phosphorus have an inverse relationship—an increased level of one mineral decreases the level of the other. Antacids can contain magnesium, which can promote calcium loss. Aspirin can alter vitamin D levels and interfere with calcium absorption.

 

DIF:    Cognitive Level: Understanding (Comprehension)               REF:    p. 169

TOP:    Nursing Process: Nursing Intervention: Patient Teaching

MSC:   NCLEX: Physiological Integrity: Basic Care and Comfort: Nutrition

 

  1. The nurse is caring for a newly admitted patient who will receive digoxin to treat a cardiac dysrhythmia. The patient takes hydrochlorothiazide (HydroDIURIL) and reports regular use of over-the-counter laxatives. Before administering the first dose of digoxin, the nurse will review the patient’s electrolytes with careful attention to the levels of which electrolytes?
a. Calcium and magnesium
b. Sodium and calcium
c. Potassium and chloride
d. Potassium and magnesium

 

 

ANS:   D

Hypomagnesemia, like hypokalemia, enhances the action of digitalis and causes digitalis toxicity. Laxatives and diuretics can deplete both of these electrolytes.

 

DIF:    Cognitive Level: Applying (Application)                              REF:    p. 172

TOP:    Nursing Process: Assessment

MSC:   NCLEX: Physiological Integrity: Basic Care and Comfort: Nutrition

 

  1. The nurse is administering intravenous fluids to a patient who is dehydrated. On the second day of care, the patient’s weight is increased by 2.25 pounds. The nurse would expect that the patient’s fluid intake has
a. equaled urine output.
b. exceeded urine output by 1 L.
c. exceeded urine output by 2.5 L.
d. exceeded urine output by 3 L.

 

 

ANS:   B

A weight gain of 1 kg, or 2.2 to 2.5 lb, is equivalent to 1 L of fluid.

 

DIF:    Cognitive Level: Applying (Application)                              REF:    p. 162

TOP:    Nursing Process: Evaluation

MSC:   NCLEX: Physiological Integrity: Basic Care and Comfort: Nutrition

 

  1. The nurse is caring for a patient who is receiving isotonic intravenous (IV) fluids at an infusion rate of 125 mL/h. The nurse performs an assessment and notes a heart rate of 102 beats per minute, a blood pressure of 160/85 mm Hg, and crackles auscultated in both lungs. Which action will the nurse take?
a. Decrease the IV fluid rate and notify the provider.
b. Increase the IV fluid rate and notify the provider.
c. Request an order for a colloidal IV solution.
d. Request an order for a hypertonic IV solution.

 

 

ANS:   A

The patient shows signs of fluid volume excess, so the nurse should slow the IV fluid rate and notify the provider. Increasing the rate would compound the problem. Colloidal and hypertonic fluids would pull more fluids into the intravascular space and compound the problem.

 

DIF:    Cognitive Level: Applying (Application)                              REF:    p. 162

TOP:    Nursing Process: Evaluation

MSC:   NCLEX: Physiological Integrity: Basic Care and Comfort: Nutrition

 

  1. The nurse is preparing to administer digoxin to a patient who is newly admitted to the intensive care unit. The nurse reviews the patient’s admission electrolytes and notes a serum potassium level of 2.9 mEq/L. Which action by the nurse is correct?
a. Administer the digoxin and monitor the patient’s electrocardiogram closely.
b. Hold the digoxin dose and notify the provider of the patient’s lab values.
c. Request an order for an intravenous bolus of potassium.
d. Request an order for oral potassium supplements.

 

 

ANS:   B

Hypokalemia can cause digoxin toxicity, so the nurse should hold the dose and notify the provider. Potassium should never be given as an IV bolus. Oral supplements are not used when hypokalemia is severe.

 

DIF:    Cognitive Level: Applying (Application)                              REF:    p. 163

TOP:    Nursing Process: Assessment

MSC:   NCLEX: Physiological Integrity: Basic Care and Comfort: Nutrition

 

  1. The nurse is performing an assessment on a patient brought to the emergency department for treatment for dehydration. The nurse assesses a respiratory rate of 26 breaths/minute, a heart rate of 110 beats/minute, a blood pressure of 86/50 mm Hg, and a temperature of 39.5° C. The patient becomes dizzy when transferred from the wheelchair to a bed. The nurse notes cool, clammy skin. Which diagnosis does the nurse suspect?
a. Fluid volume deficit (FVD)
b. Fluid volume excess (FVE)
c. Mild extracellular fluid (ECF) deficit
d. Renal failure

 

 

ANS:   A

Patients with FVD will exhibit elevated temperature, tachycardia, tachypnea, hypotension, orthostatic hypotension, and cool, clammy skin. Patients with FVE will have bounding pulses, elevated blood pressure, dyspnea, and crackles. Mild ECF deficit causes thirst. Renal failure generally leads to FVE.

 

DIF:    Cognitive Level: Applying (Application)                              REF:    p. 168

TOP:    Nursing Process: Assessment

MSC:   NCLEX: Physiological Integrity: Basic Care and Comfort: Nutrition

 

  1. The nurse is caring for a patient who will receive 10% calcium gluconate to treat a serum potassium level of 5.9 mEq/L. The nurse performs a drug history prior to beginning the infusion. Which drug taken by the patient would cause concern?
a. Digitalis
b. Hydrochlorothiazide
c. Hydrocortisone
d. Vitamin D

 

 

ANS:   A

Calcium gluconate is given to treat hyperkalemia in order to decrease irritability of the myocardium. When administered to a patient taking digitalis, it can cause digitalis toxicity. The other drugs may affect potassium levels but are not a cause for concern with calcium gluconate.

 

DIF:    Cognitive Level: Applying (Application)                              REF:    p. 170

TOP:    Nursing Process: Assessment

MSC:   NCLEX: Physiological Integrity: Basic Care and Comfort: Nutrition

 

  1. A patient is admitted with orthopnea, cough, pulmonary crackles, and peripheral edema. The patient’s urine specific gravity is 1.002. The nurse will expect this patient’s provider to order which treatment?
a. Diuretics
b. Colloidal IV fluids
c. Hypertonic IV fluids
d. Hypotonic IV fluids

 

 

ANS:   A

This patient has signs of fluid volume excess. Diuretics are prescribed to reduce fluid overload.

 

DIF:    Cognitive Level: Applying (Application)                              REF:    p. 162

TOP:    Nursing Process: Nursing Intervention

MSC:   NCLEX: Physiological Integrity: Basic Care and Comfort: Nutrition

 

  1. The nurse is caring for a patient who is ordered to take nothing by mouth. The patient weighs 65 kg. What volume of intravenous fluid should this patient receive in 24 hours?
a. 2225 mL
b. 2400 mL
c. 2520 mL
d. 2640 mL

 

 

ANS:   C

Fluid maintenance needs for the NPO patient are calculated as 4 mL/kg/h for the first 10 kg of weight, 2 mL/kg/h for the second 10 kg of weight, and 1 mL/kg/h for every kg of weight thereafter. This patient’s fluid needs are (10 kg ´ 4 mL) + (10 kg ´ 2 mL) + (45 kg ´ 1 mL) = 105 mL/h. The 24-hour total is 105 mL/h ´ 24 h = 2,520 mL.

 

DIF:    Cognitive Level: Applying (Application)                              REF:    p. N/A

TOP:    Nursing Process: Planning

MSC:   NCLEX: Physiological Integrity: Basic Care and Comfort: Nutrition

 

MULTIPLE RESPONSE

 

  1. The nurse is caring for a patient who will receive intravenous calcium gluconate. Which nursing actions are appropriate when giving this solution? (Select all that apply.)
a. Administering through a central line
b. Assessing for Trousseau and Chvostek signs
c. Giving as a rapid intravenous bolus
d. Mixing in a solution containing sodium bicarbonate
e. Monitoring the patient’s electrocardiogram (ECG)
f. Reporting a serum calcium level of >2.5 mEq/L

 

 

ANS:   B, E, F

Trousseau and Chvostek signs indicate hypocalcemia, and patients receiving calcium should be monitored closely for signs of calcium imbalance. Hypercalcemia can cause ECG changes. A serum calcium level greater than 2.5 mEq/L indicates hypercalcemia and therefore should be reported. Calcium does not require infusion through a central line and should not be given as a rapid IV bolus. Calcium should not be added to a solution containing bicarbonate, because rapid precipitation occurs.

 

DIF:    Cognitive Level: Applying (Application)                              REF:    p. 171

TOP:    Nursing Process: Nursing Intervention

MSC:   NCLEX: Physiological Integrity: Basic Care and Comfort: Nutrition

 

  1. A patient is suspected of having severe hypocalcemia. While waiting for the patient’s serum electrolyte results, the nurse will assess for which symptoms? (Select all that apply.)
a. Laryngeal spasms
b. Fatigue
c. Muscle weakness
d. Nausea and vomiting
e. Numbness of fingers
f. Twitching of the mouth

 

 

ANS:   A, E, F

Patients who have hypocalcemia will exhibit laryngeal spasms, numbness of fingers, and twitching of the mouth. The other symptoms are not characteristic of hypocalcemia.

 

DIF:    Cognitive Level: Applying (Application)                              REF:    p. 169 | p. 171

TOP:    Nursing Process: Assessment

MSC:   NCLEX: Physiological Integrity: Basic Care and Comfort: Nutrition

 

OTHER

 

  1. A patient with cirrhosis is noted to have low serum albumin levels. The patient is to receive 200 mL of albumin in 30 minutes. The drop factor for the IV set is 15 gtt/mL. The nurse correctly adjusts the IV rate to what rate?

 

ANS:

100 gtt/min

 

(200 mL ´ 15 gtt/mL) ÷ 30 min = 100 gtt/min.

 

DIF:    Cognitive Level: Applying (Application)                              REF:    p. N/A

TOP:    Nursing Process: Nursing Intervention

MSC:   NCLEX: Physiological Integrity: Basic Care and Comfort: Nutrition

Chapter 24: Antiinflammatories

McCuistion: Pharmacology: A Patient-Centered Nursing Process Approach, 9th Edition

 

MULTIPLE CHOICE

 

  1. A nursing student asks the nurse to explain the role of cyclooxygenase-2 (COX-2) and its role in inflammation. The nurse will explain that COX-2
a. converts arachidonic acid into a chemical mediator for inflammation.
b. directly causes vasodilation and increased capillary permeability.
c. irritates the gastric mucosa to cause gastrointestinal upset.
d. releases prostaglandins, which cause inflammation and pain in tissues.

 

 

ANS:   A

COX-2 is an enzyme that converts arachidonic acid into prostaglandins and their products, and this synthesis causes pain and inflammation. They do not act directly to cause inflammation. COX-1 irritates the gastric mucosa. COX-2 synthesizes but does not release prostaglandins.

 

DIF:    Cognitive Level: Understanding (Comprehension)               REF:    p. 308

TOP:    Nursing Process: Nursing Intervention: Patient Teaching

MSC:   NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. A nursing student asks how nonsteroidal antiinflammatory drugs (NSAIDs) work to suppress inflammation and reduce pain. The nurse will explain that NSAIDs
a. exert direct actions to cause relaxation of smooth muscle.
b. inhibit cyclooxygenase that is necessary for prostaglandin synthesis.
c. interfere with neuronal pathways associated with prostaglandin action.
d. suppress prostaglandin activity by blocking tissue receptor sites.

 

 

ANS:   B

NSAIDs act by inhibiting COX-1 and COX-2 to help block prostaglandin synthesis. They do not have direct action on tissues, nor do they interfere with chemical receptor sites or neuronal pathways.

 

DIF:    Cognitive Level: Understanding (Comprehension)               REF:    p. 308

TOP:    Nursing Process: Nursing Intervention: Patient Teaching

MSC:   NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. A patient is taking ibuprofen 400 mg every 4 hours to treat moderate arthritis pain and reports that it is less effective than before. What action will the nurse take?
a. Counsel the patient to discuss a prescription NSAID with the provider.
b. Recommend adding aspirin to increase the antiinflammatory effect.
c. Suggest asking the provider about a short course of corticosteroids.
d. Tell the patient to increase the dose to 800 mg every 4 hours.

 

 

ANS:   A

The patient should discuss another NSAID with the provider if tolerance has developed to the over-the-counter NSAID. Patients should not take aspirin with NSAIDs because of the increased risk of bleeding and gastrointestinal upset. Steroids are not the drugs of choice for arthritis because of their side effects and are not used unless inflammation is severe. A prescription NSAID would be used prior to starting corticosteroids. Increasing the dose will increase side effects but may not increase desired effects. The maximum dose per day is 3200 mg, which would be exceeded when increasing the dose to 800 mg every 4 hours.

 

DIF:    Cognitive Level: Applying (Application)                              REF:    p. 308 | p. 311

TOP:    Nursing Process: Nursing Intervention

MSC:   NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. A patient who is taking aspirin for arthritis pain asks the nurse why it also causes gastrointestinal upset. The nurse understands that this is because aspirin
a. increases gastrointestinal secretions.
b. increases hypersensitivity reactions.
c. inhibits both COX-1 and COX-2.
d. is an acidic compound.

 

 

ANS:   C

Aspirin is a COX-1 and COX-2 inhibitor. COX-1 protects the stomach lining, so when it is inhibited, gastric upset occurs. Aspirin does not increase gastrointestinal secretions or hypersensitivity reactions. It is a weak acid.

 

DIF:    Cognitive Level: Understanding (Comprehension)               REF:    p. 308

TOP:    Nursing Process: N/A

MSC:   NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. A patient is taking aspirin to help prevent myocardial infarction and is experiencing moderate gastrointestinal upset. The nurse will contact the patient’s provider to discuss changing from aspirin to which drug?
a. A COX-2 inhibitor
b. Celecoxib (Celebrex)
c. Enteric-coated aspirin
d. Nabumetone (Relafen)

 

 

ANS:   C

Aspirin is used to inhibit platelet aggregation to prevent cardiovascular accident and myocardial infarction. Patients taking aspirin for this purpose would not benefit from COX-2 inhibitors, since the COX-1 enzyme is responsible for inhibiting platelet aggregation. The patient should take enteric-coated aspirin to lessen the gastrointestinal distress. Celecoxib and nabumetone are both COX-2 inhibitors.

 

DIF:    Cognitive Level: Applying (Application)                              REF:    p. 311

TOP:    Nursing Process: Nursing Intervention

MSC:   NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. A patient who is 7-month pregnant and who has arthritis asks the nurse if she can take aspirin for pain. The nurse will tell her not to take aspirin for which reason?
a. It can result in adverse effects on her fetus.
b. It causes an increased risk of Reye’s syndrome.
c. It increases hemorrhage risk.
d. It will cause increased gastrointestinal distress.

 

 

ANS:   A

Patients should not take aspirin during the third trimester of pregnancy because it can cause premature closure of the ductus arteriosus in the fetus. It does not increase her risk of Reye’s syndrome. Aspirin taken within a week of delivery will increase the risk of bleeding. It can cause gastrointestinal distress, but this is not the reason for caution.

 

DIF:    Cognitive Level: Applying (Application)                              REF:    p. 312

TOP:    Nursing Process: Nursing Intervention: Patient Teaching

MSC:   NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. The nurse is performing a health history on a patient who has arthritis. The patient reports tinnitus. Suspecting a drug adverse effect, the nurse will ask the patient about which medication?
a. Aspirin (Bayer)
b. Acetaminophen (Tylenol)
c. Anakinra (Kineret)
d. Prednisone (Deltasone)

 

 

ANS:   A

Aspirin causes tinnitus at low toxicity levels. The nurse should question the patient about this medication. The other medications do not have this side effect.

 

DIF:    Cognitive Level: Applying (Application)                              REF:    p. 311

TOP:    Nursing Process: Assessment

MSC:   NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. The nurse is teaching a patient about using high-dose aspirin to treat arthritis. What information will the nurse include when teaching this patient?
a. “A normal serum aspirin level is between 30 and 40 mg/dL.”
b. “You may need to stop taking this drug a week prior to surgery.”
c. “You will need to monitor aspirin levels if you are also taking warfarin.”
d. “Your stools may become dark, but this is a harmless side effect.”

 

 

ANS:   B

Aspirin should be discontinued prior to surgery to avoid prolonged bleeding time. A normal serum level is 15 to 30 mg/dL. Patients taking warfarin and aspirin will have increased amounts of warfarin, so the INR will need to be monitored. Tarry stools are a symptom of gastrointestinal bleeding and should be reported.

 

DIF:    Cognitive Level: Applying (Application)                              REF:    p. 312

TOP:    Nursing Process: Nursing Intervention: Patient Teaching

MSC:   NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. A patient who takes high-dose aspirin to treat rheumatoid arthritis has a serum salicylate level of 35 mg/dL. The nurse will perform which action?
a. Assess the patient for tinnitus.
b. Monitor the patient for signs of Reye’s syndrome.
c. Notify the provider of severe aspirin toxicity.
d. Request an order for an increased aspirin dose.

 

 

ANS:   A

Mild toxicity occurs at levels above 30 mg/dL, so the nurse should assess for signs of toxicity, such as tinnitus. This level will not increase the risk for Reye’s syndrome. Severe toxicity occurs at levels greater than 50 mg/dL. The dose should not be increased.

 

DIF:    Cognitive Level: Applying (Application)                              REF:    p. 312

TOP:    Nursing Process: Nursing Intervention

MSC:   NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. The nurse provides teaching for a patient who will begin taking indomethacin (Inderal) to treat rheumatoid arthritis. Which statement by the patient indicates a need for further teaching?
a. “I should limit sodium intake while taking this drug.”
b. “I should take indomethacin on an empty stomach.”
c. “I will need to check my blood pressure frequently.”
d. “I will take the medication twice daily.”

 

 

ANS:   B

Indomethacin is very irritating to the stomach and should be taken with food. It can cause sodium retention and elevated blood pressure, so patients should limit sodium intake. The medication is taken twice daily.

 

DIF:    Cognitive Level: Applying (Application)                              REF:    p. 313

TOP:    Nursing Process: Nursing Intervention: Patient Teaching

MSC:   NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. The nurse is caring for a postpartum woman who is refusing opioid analgesics but is rating her pain as a 7 or 8 on a 10-point pain scale. The nurse will contact the provider to request an order for which analgesic medication?
a. Diclofenac sodium (Voltaren)
b. Ketoprofen (Orudis)
c. Ketorolac (Toradol)
d. Naproxen (Naprosyn)

 

 

ANS:   C

Ketorolac is the first injectable NSAID and has shown analgesic efficacy equal or superior to that of opioid analgesics. The other NSAIDs listed are not used for postoperative pain.

 

DIF:    Cognitive Level: Applying (Application)                              REF:    p. 313

TOP:    Nursing Process: Intervention

MSC:   NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. A patient who has osteoarthritis with mild to moderate pain asks the nurse about taking over-the-counter ibuprofen (Motrin). What will the nurse tell this patient?
a. “It may take several weeks to achieve therapeutic effects.”
b. “Unlike aspirin, there is no increased risk of bleeding with ibuprofen.”
c. “Take ibuprofen twice daily for maximum analgesic benefit.”
d. “Combine ibuprofen with acetaminophen for best effect.”

 

 

ANS:   A

OTC NSAIDs can be effective for mild to moderate arthritis pain, but the effects may not appear for several weeks. NSAIDs carry a risk for bleeding. Ibuprofen is taken TID or QID. Ibuprofen should not be combined with aspirin or acetaminophen.

 

DIF:    Cognitive Level: Applying (Application)                              REF:    p. 314

TOP:    Nursing Process: Nursing Intervention: Patient Teaching

MSC:   NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. The nurse is caring for a patient who has been taking an NSAID for 4 weeks for osteoarthritis. The patient reports decreased pain, but the nurse notes continued swelling of the affected joints. The nurse will perform which action?
a. Assess the patient for drug-seeking behaviors.
b. Notify the provider that the drug is not effective.
c. Reassure the patient that swelling will decrease eventually.
d. Remind the patient that this drug is given for pain only.

 

 

ANS:   B

This medication is effective for both pain and swelling. After 4 weeks, there should be some decrease in swelling, so the nurse should report that this medication is ineffective. There is no indication that this patient is seeking an opioid analgesic. The drug should be effective within several weeks. NSAIDs are given for pain and swelling.

 

DIF:    Cognitive Level: Applying (Application)                              REF:    p. 308

TOP:    Nursing Process: Evaluation

MSC:   NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. The nurse is caring for a patient who has rheumatoid arthritis and who is receiving infliximab (Remicade) IV every 8 weeks. Which laboratory test will the nurse anticipate that this patient will need?
a. Calcium level
b. Complete blood count
c. Electrolytes
d. Potassium

 

 

ANS:   B

Infliximab is an immunomodulator and can cause agranulocytosis, so patients should have regular CBC evaluation.

 

DIF:    Cognitive Level: Applying (Application)                              REF:    p. 316

TOP:    Nursing Process: Planning

MSC:   NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. The nurse is teaching a patient about taking colchicine to treat gout. What information will the nurse include when teaching this patient about this drug?
a. Avoid all alcohol except beer.
b. Include salmon in the diet.
c. Increase fluid intake.
d. Take on an empty stomach.

 

 

ANS:   C

The patient who is taking colchicine should increase fluid intake to promote uric acid excretion and prevent renal calculi. Foods rich in purine should be avoided, including beer, and some sea foods, such as salmon. Gastric irritation is a common problem, so colchicine should be taken with food.

 

DIF:    Cognitive Level: Applying (Application)                              REF:    p. 318

TOP:    Nursing Process: Planning/Nursing Intervention: Patient Teaching

MSC:   NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. Which antigout medication is used to treat chronic tophaceous gout?
a. Allopurinol (Zyloprim)
b. Colchicine
c. Probenecid (Benemid)
d. Sulfinpyrazone (Anturane)

 

 

ANS:   A

Allopurinol inhibits the biosynthesis of uric acid and is used long-term to manage chronic gout. Colchicine does not inhibit uric acid synthesis or promote uric acid secretion and is not used for chronic gout. Probenecid can be used for chronic gout but is not the first choice. Sulfinpyrazone has many serious side effects.

 

DIF:    Cognitive Level: Remembering (Knowledge)                       REF:    p. 318

TOP:    Nursing Process: Nursing Intervention

MSC:   NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. The nurse is assessing a patient who has gout who will begin taking allopurinol (Zyloprim). The nurse reviews the patient’s medical record and will be concerned about which laboratory result?
a. Elevated BUN and creatinine
b. Increased serum uric acid
c. Slight increase in the white blood count
d. Increased serum glucose

 

 

ANS:   A

Antigout drugs are excreted via the kidneys, so patients should have adequate renal function.

 

DIF:    Cognitive Level: Applying (Application)                              REF:    p. 319

TOP:    Nursing Process: Nursing Intervention

MSC:   NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. The nurse provides teaching for a patient who will begin taking allopurinol. Which statement by the patient indicates understanding of the teaching?
a. “I should increase my vitamin C intake.”
b. “I will get yearly eye exams.”
c. “I will increase my protein intake.”
d. “I will limit fluids to prevent edema.”

 

 

ANS:   B

Patients taking allopurinol can have visual changes with prolonged use and should have yearly eye exams. It is not necessary to increase vitamin C. Protein can increase purine intake, which is not recommended. Patients should consume extra fluids.

 

DIF:    Cognitive Level: Applying (Application)                              REF:    p. 320

TOP:    Nursing Process: Nursing Intervention

MSC:   NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

MULTIPLE RESPONSE

 

  1. Which are characteristic signs of inflammation? (Select all that apply.)
a. Edema
b. Erythema
c. Heat
d. Numbness
e. Pallor
f. Paresthesia

 

 

ANS:   A, B, C

Edema, erythema, and heat are signs of inflammation. The other three are signs of neurocirculatory compromise.

 

DIF:    Cognitive Level: Remembering (Knowledge)                       REF:    p. 307

TOP:    Nursing Process: Assessment

MSC:   NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

Chapter 36: Lower Respiratory Disorders

McCuistion: Pharmacology: A Patient-Centered Nursing Process Approach, 9th Edition

 

MULTIPLE CHOICE

 

  1. The nurse is caring for a patient recently diagnosed with mild emphysema and provides teaching about the disease and medications for treatment. Which statement by the patient indicates understanding of the medication regimen?
a. “I should use albuterol when my symptoms worsen.”
b. “I will need to take oral prednisone on a daily basis.”
c. “My provider will prescribe prophylactic antibiotics.”
d. “My symptoms are reversible with proper medications.”

 

 

ANS:   A

Albuterol is used to treat bronchospasm during symptom flares. Oral prednisone is given for acute flares but not generally on a daily basis until symptoms are chronic and severe because of the risk of adrenal suppression. Prophylactic antibiotics are not given regularly because of the risk of antibiotic resistance. Symptoms of emphysema are not reversible.

 

DIF:    Cognitive Level: Applying (Application)                              REF:    p. 520

TOP:    Nursing Process: Nursing Intervention: Patient Teaching

MSC:   NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. The nurse is preparing to administer epinephrine to a patient who is experiencing an acute bronchospasm. The nurse understands that because epinephrine is a nonselective alpha- and beta-adrenergic agonist, the patient will experience which effects?
a. Decreased blood pressure
b. Anticholinergic effects
c. A shorter duration of therapeutic effects
d. Cardiac and pulmonary effects

 

 

ANS:   D

Nonselective sympathomimetic epinephrine is an alpha1, beta1, and beta2 agonist that is given to promote bronchodilation and elevate blood pressure. It does not have anticholinergic effects.

 

DIF:    Cognitive Level: Understanding (Comprehension)               REF:    p. 519

TOP:    Nursing Process: Nursing Intervention

MSC:   NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. A patient will be discharged home with albuterol (Proventil) to use for asthma symptoms. What information will the nurse include when teaching this patient about this medication?
a. Failure to respond to the medication indicates a need for a higher dose.
b. Monitor for hypoglycemia symptoms when using this medication.
c. Palpitations are common with this drug even at normal, therapeutic doses.
d. Overuse of this medication can result in airway narrowing and bronchospasm.

 

 

ANS:   D

Excessive use of an aerosol drug can occasionally cause severe paradoxical airway resistance, so patients should be cautioned against overuse. Excessive use can also lead to tolerance and loss of drug effectiveness, but patients should not increase the dose because of the risk of bronchospasm and the increased incidence of adverse effects such as tremors and tachycardia. Hyperglycemia can occur. Palpitations are common with increased doses but not at therapeutic doses.

 

DIF:    Cognitive Level: Applying (Application)                              REF:    p. 520

TOP:    Nursing Process: Nursing Intervention: Patient Teaching

MSC:   NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. A patient will begin using ipratropium bromide (Atrovent), albuterol (Proventil), and an inhaled glucocorticoid medication (steroid) to treat chronic bronchitis. When teaching this patient about disease and medication management, the nurse will instruct the patient to administer these medications in which order?
a. Albuterol, ipratropium bromide, steroid
b. Albuterol, steroid, ipratropium bromide
c. Ipratropium bromide, albuterol, steroid
d. Steroid, ipratropium bromide, albuterol

 

 

ANS:   A

Patients who use a beta agonist should be taught to use it 5 minutes before administering ipratropium bromide, and ipratropium bromide should be given 5 minutes prior to an inhaled glucocorticoid. This helps the bronchioles to dilate so the subsequent medication can be deposited in the bronchioles for improved effect.

 

DIF:    Cognitive Level: Applying (Application)                              REF:    p. 7

TOP:    Nursing Process: Nursing Intervention: Patient Teaching

MSC:   NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. A provider has prescribed ipratropium bromide/albuterol sulfate (Combivent) for a patient who has chronic obstructive pulmonary disease (COPD). The nurse explains that this combination product is prescribed primarily for which reason?
a. To be more convenient for patients who require both medications
b. To improve compliance in patients who may forget to take both drugs
c. To increase forced expiratory volume, an indicator of symptom improvement
d. To minimize the side effects that would occur if the drugs are given separately

 

 

ANS:   C

Combivent is more effective and has a longer duration of action than if either agent is used alone, and the two agents combined increase the forced expiratory volume in 1 second (FEV1). While it is more convenient and may improve compliance, this is not the primary reason for using it. The combination does not alter the drug’s side effects.

 

DIF:    Cognitive Level: Applying (Application)                              REF:    p. 522

TOP:    Nursing Process: Nursing Intervention: Patient Teaching

MSC:   NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. The nurse is teaching a patient who will begin taking oral theophylline (Theo-Dur) when discharged home from the hospital. What information will the nurse include when teaching the patient about this drug?
a. An extra dose should be taken when symptoms worsen.
b. Anorexia and gastrointestinal upset are unexpected side effects.
c. Avoid caffeine while taking this medication.
d. Food will decrease the amount of drug absorbed.

 

 

ANS:   C

Caffeine and theophylline are both xanthine derivatives and should not be taken together because of the increased risk of toxicity and severe adverse effects. Theophylline has a narrow therapeutic range and must be dosed carefully; patients should never increase or decrease the dose without consulting their provider. Gastrointestinal symptoms are common side effects. Food slows absorption but does not prevent the full dose from being absorbed.

 

DIF:    Cognitive Level: Applying (Application)                              REF:    p. 523

TOP:    Nursing Process: Nursing Intervention: Patient Teaching

MSC:   NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. The nurse is caring for a patient who is receiving intravenous theophylline. The patient complains of headache and nausea. The nurse will contact the provider to
a. change the medication to an oral theophylline.
b. obtain an order for a serum theophylline level.
c. request an order for an analgesic medication.
d. suggest an alternative methylxanthine medication.

 

 

ANS:   B

Theophylline has a narrow therapeutic index and a risk for severe symptoms with toxic levels. When patients report symptoms of theophylline adverse effects, a serum drug level should be obtained. Giving an oral theophylline would only compound the problem if the patient has a toxic drug level. Analgesics may be used, but only after toxicity is ruled out. Adding a different methylxanthine will compound the symptoms and will likely result in drug interaction or unwanted synergism.

 

DIF:    Cognitive Level: Applying (Application)                              REF:    p. 523

TOP:    Nursing Process: Evaluation/Nursing Intervention

MSC:   NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. The nurse is caring for a patient who will begin taking theophylline at home. During the assessment, the nurse learns that the patient smokes. The nurse reports this to the provider and will expect the provider to
a. decrease the dose of theophylline.
b. increase the dose of theophylline.
c. keep the theophylline dose as ordered.
d. discontinue the theophylline.

 

 

ANS:   B

Tobacco smoking increases the metabolism of theophylline, so the dose should be increased. Decreasing the dose will lead to subtherapeutic effects.

 

DIF:    Cognitive Level: Applying (Application)                              REF:    p. 523

TOP:    Nursing Process: Assessment/Planning

MSC:   NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. A patient who has been taking theophylline at home reports having palpitations and jitteriness. What action will the nurse take?
a. Ask the patient if herbal medications are used.
b. Notify the provider to report theophylline toxicity.
c. Recommend that the patient increase fluid intake.
d. Request an order for renal function studies.

 

 

ANS:   A

Ephedra is a stimulant that potentiates theophylline and may increase side effects. Patients should be questioned about use of herbal medications. To determine toxicity, serum drug levels must be drawn; at this point, the patient reports symptoms of theophylline side effects. Increasing fluid intake will not alleviate symptoms. Renal function studies are not indicated.

 

DIF:    Cognitive Level: Applying (Application)                              REF:    p. 526

TOP:    Nursing Process: Assessment/Evaluation

MSC:   NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. The nurse provides teaching for patient who will begin taking montelukast sodium (Singulair). The patient reports sensitivity to aspirin. Which statement by the patient indicates a need for further teaching?
a. “I will need to have periodic laboratory tests while taking this medication.”
b. “I will not take ibuprofen for pain or fever while taking this drug.”
c. “I will take one tablet daily at bedtime.”
d. “I will use this as needed for acute symptoms.”

 

 

ANS:   D

Montelukast and other leukotriene receptor antagonists are not used to treat acute symptoms. Because they can affect liver enzymes, periodic liver function tests should be performed. Patients taking this drug should not use ibuprofen or aspirin for pain or fever if they have aspirin sensitivity. Patients will achieve maximum effectiveness if the drug is taken in the evening.

 

DIF:    Cognitive Level: Applying (Application)                              REF:    p. 527

TOP:    Nursing Process: Nursing Intervention: Patient Teaching

MSC:   NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. A patient who uses an inhaled glucocorticoid medication reports having a sore tongue. The nurse notes white spots on the patient’s tongue and oral mucous membranes. After notifying the provider, the nurse will remind the patient to perform which action?
a. Avoid using a spacer with the inhaled glucocorticoid medication.
b. Clean the inhaler with hot, soapy water after each use.
c. Consume yogurt daily while using this medication.
d. Rinse the mouth thoroughly with water after each use.

 

 

ANS:   D

When using inhaled glucocorticoid medications, Candida albicans oropharyngeal infections may be prevented by rinsing the mouth and throat with water after each dose. Patients should also use a spacer to reduce deposits of the drug in the oral cavity. The inhaler should be washed with warm water daily, but not after each use. There is no indication that yogurt is effective.

 

DIF:    Cognitive Level: Applying (Application)                              REF:    p. 528

TOP:    Nursing Process: Evaluation

MSC:   NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. A patient will begin using an albuterol metered-dose inhaler to treat asthma symptoms. The patient asks the nurse about the difference between using an oral form of albuterol and the inhaled form. The nurse will explain that the inhaled form of albuterol
a. has a more immediate onset than the oral form.
b. may cause more side effects than the oral preparation.
c. requires an increased dose in order to have therapeutic effects.
d. will not lead to tolerance with increased doses.

 

 

ANS:   A

Inhaled medications have more immediate effects than oral preparations. As long as they are used correctly, systemic side effects are less common. Less drug is needed for therapeutic effects since the drug is delivered directly to target tissues. Increased doses will lead to drug tolerance.

 

DIF:    Cognitive Level: Applying (Application)                              REF:    p. 520

TOP:    Nursing Process: Nursing Intervention: Patient Teaching

MSC:   NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. The nurse is performing a medication history on a patient who reports long-term use of montelukast (Singulair) and an albuterol metered-dose inhaler (Proventil). The nurse will contact the provider to discuss an order for which laboratory tests?
a. Cardiac enzymes and serum calcium
b. Electrolytes and a complete blood count
c. Liver function tests and serum glucose
d. Urinalysis and serum magnesium

 

 

ANS:   C

The beta2 agonists can increase serum glucose levels and montelukast can elevate liver enzymes, so these should be monitored in patients taking these medications.

 

DIF:    Cognitive Level: Applying (Application)                              REF:    p. 521 | p. 526

TOP:    Nursing Process: Planning

MSC:   NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. The nurse is caring for a patient diagnosed with COPD who has been prescribed tiotropium. Which statement will the nurse include in the education?
a. Remove the capsules from the packaging and place in your 7-day med box.
b. If you experience dry mouth, stop taking the medication immediately.
c. Use tiotropium as needed for sudden breathing problems.
d. Tiotropium works by relaxing and dilating the bronchioles.

 

 

ANS:   D

Tiotropium is an anticholinergic drug used for maintenance treatment of bronchospasms associated with COPD. It inhibits M3 receptor response to acetylcholine, thereby relaxing smooth muscle of bronchi; it dilates the bronchi. Patients should discard any capsules that are opened and not used immediately. Dry mouth is a common side effect. It is not to be used as a rescue inhaler.

 

DIF:    Cognitive Level: Understanding (Comprehension)               REF:    p. 522

TOP:    Nursing Process: Nursing Intervention

MSC:   NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. A patient who is using inhaled cromolyn sodium (Intal) daily calls the clinic to report experiencing cough and a bad taste. The nurse will instruct the patient to perform which action?
a. Drink water before and after using the inhaler.
b. Schedule an appointment to discuss these effects with the provider.
c. Stop taking the medication immediately.
d. Use the inhaler only as needed for acute bronchospasms.

 

 

ANS:   A

Cough and a bad taste are the most common side effects associated with cromolyn sodium, and these effects can be decreased by drinking water before and after using the drug. The effects are not serious and do not warrant discussion with the provider. Stopping the medication abruptly can cause a rebound bronchospasm. This medication is not useful in acute bronchospasm.

 

DIF:    Cognitive Level: Applying (Application)                              REF:    p. 528

TOP:    Nursing Process: Evaluation

MSC:   NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

Chapter 48: Urinary Disorders

McCuistion: Pharmacology: A Patient-Centered Nursing Process Approach, 9th Edition

 

MULTIPLE CHOICE

 

  1. A 25-year-old female patient reports urinary frequency with pain on urination, flank pain, fever, and chills. The nurse recognizes these symptoms as characteristic of which condition?
a. Cystitis
b. Dysuria
c. Pyelonephritis
d. Urethritis

 

 

ANS:   C

These are symptoms of pyelonephritis, characterized by fever, dysuria, flank pain, and urinary frequency.

 

DIF:    Cognitive Level: Understanding (Comprehension)               REF:    p. 702

TOP:    Nursing Process: Assessment

MSC:   NCLEX: Physiological Integrity: Pathophysiology

 

  1. A male patient reports urinary urgency and pain with burning on urination. The nurse understands that this patient will be treated for which condition?
a. Cystitis
b. Prostatitis
c. Pyelonephritis
d. Urethritis

 

 

ANS:   B

In a male patient, a lower urinary tract infection is most likely prostatitis with symptoms similar to cystitis.

 

DIF:    Cognitive Level: Understanding (Comprehension)               REF:    p. 702

TOP:    Nursing Process: Assessment

MSC:   NCLEX: Physiological Integrity: Pathophysiology

 

  1. The nurse is caring for a patient who is diagnosed with a urinary tract infection. The patient reports always having difficulty remembering to take medications. Which drug will the nurse expect the provider to select when treating this patient?
a. Fosfomycin tromethamine (Monurol)
b. Ciprofloxacin (Cipro)
c. Nitrofurantoin (Macrodantin)
d. Trimethoprim-sulfamethoxazole (Bactrim)

 

 

ANS:   A

Fosfomycin is given as a one-time, single dose. Ciprofloxacin is given daily or twice a day. Nitrofurantoin is given four times daily. Trimethoprim-sulfamethoxazole is given twice daily.

 

DIF:    Cognitive Level: Applying (Application)                              REF:    p. 703

TOP:    Nursing Process: Planning

MSC:   NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. The nurse is caring for a hospitalized patient who has symptoms characteristic of pyelonephritis. Before administering the first dose of the intravenous antibiotic, the nurse will ensure that which action is performed?
a. An antipyretic is administered.
b. A dose of oral antibiotic is given.
c. A urinary analgesic is given.
d. A urine culture is obtained.

 

 

ANS:   D

A urinalysis, as well as a culture and sensitivity, is usually performed before initiating drug therapy. An antipyretic is indicated for fever but does not need to be timed before the antibiotic. An oral antibiotic is not indicated. A urinary analgesic is given as needed.

 

DIF:    Cognitive Level: Applying (Application)                              REF:    p. 703

TOP:    Nursing Process: Nursing Intervention

MSC:   NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. The nurse provides teaching for a patient who will begin taking nitrofurantoin (Macrodantin) to treat a urinary tract infection. Which statement by the patient indicates understanding of the teaching?
a. “If I experience gastrointestinal upset, I may take an antacid.”
b. “I should notify my provider immediately if my urine is brown.”
c. “I should take the drug with food and increase my fluid intake.”
d. “Tingling of my fingers is a harmless side effect of this drug.”

 

 

ANS:   C

Patients taking nitrofurantoin should take the drug with foods and increase fluid intake. The drug should not be taken with antacids. Brown urine is a harmless side effect. Tingling of extremities can indicate neuropathy.

 

DIF:    Cognitive Level: Applying (Application)                              REF:    p. 703

TOP:    Nursing Process: Nursing Intervention: Patient Teaching

MSC:   NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. The nurse is preparing to administer methenamine (Hiprex) to a patient who is diagnosed with a urinary tract infection. The nurse reviews the patient’s chart and notes a urinary pH of 6.0. Which action will the nurse take?
a. Administer the drug as ordered.
b. Obtain an order for 8 ounces of cranberry juice three times daily.
c. Request an order for an increased dose.
d. Restrict fluids to concentrate the patient’s urine.

 

 

ANS:   B

Methenamine produces a bactericidal effect when the urine pH is less than 5.5. Cranberry juice will help to acidify the urine.

 

DIF:    Cognitive Level: Applying (Application)                              REF:    p. 704

TOP:    Nursing Process: Nursing Intervention

MSC:   NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. Which side effects are common to most urinary antiseptics?
a. Dyspnea and chest pain
b. Nausea and vomiting
c. Peripheral neuritis
d. Visual disturbances

 

 

ANS:   B

Nausea and vomiting are common side effects with most urinary antiseptics.

 

DIF:    Cognitive Level: Remembering (Knowledge)                       REF:    p. 704

TOP:    Nursing Process: Evaluation

MSC:   NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. The nurse is preparing to administer a phenazopyridine HCl (Pyridium) dose to a patient who has diabetes. The nurse notes that the patient has a positive Clinitest. What will the nurse do next?
a. Encourage the patient to increase oral fluid intake.
b. Hold the dose until the patient’s Clinitest is negative.
c. Notify the provider of the patient’s hyperglycemia.
d. Request an order for serum blood glucose.

 

 

ANS:   D

Phenazopyridine can alter the glucose urine test (Clinitest), so a blood test should be done to monitor glucose levels.

 

DIF:    Cognitive Level: Applying (Application)                              REF:    p. 706

TOP:    Nursing Process: Nursing Intervention

MSC:   NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. A patient who has pain with urination associated with cystitis will be discharged home with a prescription for phenazopyridine (Pyridium). What instruction will the nurse include when teaching the patient about this drug?
a. “Do not take this drug concurrently with an antibiotic.”
b. “Report reddish-brown urine to the provider immediately.”
c. “This drug has antiseptic and analgesic properties.”
d. “The drug provides symptomatic relief of pain.”

 

 

ANS:   D

Phenazopyridine is used to provide symptomatic pain relief. It may be taken with antibiotics. Reddish-brown urine is a harmless side effect. It does not have antiseptic properties.

 

DIF:    Cognitive Level: Applying (Application)                              REF:    p. 706

TOP:    Nursing Process: Nursing Intervention: Patient Teaching

MSC:   NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. The nurse is preparing to administer bethanechol chloride (Urecholine) to a patient. The nurse understands that this drug acts to
a. block parasympathetic nerve impulses.
b. increase the tone of the urinary detrusor muscle.
c. relax smooth muscles in the urinary tract.
d. relieve urinary pain and burning.

 

 

ANS:   B

Bethanechol is used to increase the tone of the detrusor muscle and increase the bladder tone to stimulate urination. It stimulates the parasympathetic nerves. It tones the smooth muscles of the urinary tract. It does not alleviate dysuria.

 

DIF:    Cognitive Level: Understanding (Comprehension)               REF:    p. 706

TOP:    Nursing Process: Nursing Intervention

MSC:   NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. An older woman has urgent urinary incontinence related to an overactive bladder. Which medication does the nurse expect the provider to order?
a. Dimethylsulfoxide (DMSO)
b. Flavoxate (Urispas)
c. Phenazopyridine HCl (Pyridium)
d. Tolterodine tartrate (Detrol)

 

 

ANS:   D

Detrol is used to treat an overactive bladder. Dimethylsulfoxide (DMSO) and flavoxate (Urispas) are used to relax uterine smooth muscle. Phenazopyridine HCl (Pyridium) is used to alleviate the pain and burning sensation during urination that is experienced with chronic cystitis.

 

DIF:    Cognitive Level: Understanding (Comprehension)               REF:    p. 706

TOP:    Nursing Process: Nursing Intervention

MSC:   NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. The nurse assumes care for a patient who is experiencing urinary tract spasms and is ordered to receive flavoxate HCl (Urispas). When reviewing this patient’s history, which condition would cause the nurse to notify the provider?
a. Chronic obstructive pulmonary disorder
b. Diabetes
c. Glaucoma
d. Hypotension

 

 

ANS:   C

Urispas should not be used for patient who has gastrointestinal or urinary tract obstruction or if the patient has glaucoma.

 

DIF:    Cognitive Level: Applying (Application)                              REF:    p. 706

TOP:    Nursing Process: Nursing Intervention

MSC:   NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. The nurse is preparing to administer methenamine (Hiprex) to a patient who has pyelonephritis. Which action will the nurse perform?
a. Increase fluid intake to 2000 mL/day.
b. Monitor the patient’s urine for dark brown color.
c. Order alkaline foods three times daily.
d. Request an order for a sulfonamide antibiotic.

 

 

ANS:   A

Patients who take methenamine can develop crystalluria and should increase fluid intake to prevent this effect. A reddish-brown color is a harmless side effect. Patients should have acidic urine, not alkaline urine. Methenamine taken with sulfonamides increases the risk of crystalluria.

 

DIF:    Cognitive Level: Applying (Application)                              REF:    p. 704

TOP:    Nursing Process: Nursing Intervention

MSC:   NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. The nurse is teaching a parent about administering nitrofurantoin suspension to a 5-year-old child. Which instruction will the nurse include in the patient teaching?
a. “Give the medication on an empty stomach.”
b. “Have the child rinse the mouth after taking the drug.”
c. “Limit the child’s fluid intake to concentrate the urine.”
d. “Report brownish-colored urine to the child’s provider.”

 

 

ANS:   B

Nitrofurantoin suspension can stain the teeth, so patients should rinse the mouth after taking it. Nitrofurantoin should be taken with food, and patients should increase fluids. A reddish-brown color is a harmless side effect.

 

DIF:    Cognitive Level: Applying (Application)                              REF:    p. 703

TOP:    Nursing Process: Nursing Intervention: Patient Teaching

MSC:   NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. A patient will begin taking a urinary antimuscarinic medication. Which symptom should the patient report immediately?
a. Dry mouth
b. Fatigue
c. Increased heart rate
d. Urinary retention

 

 

ANS:   D

Urinary retention should be reported to the provider. Dry mouth, fatigue, and increased heart rate are side effects, but they do not necessarily warrant reporting immediately. Urinary retention is more serious.

 

DIF:    Cognitive Level: Applying (Application)                              REF:    p. 706

TOP:    Nursing Process: Evaluation

MSC:   NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

Chapter 54: Sexually Transmitted Infections

McCuistion: Pharmacology: A Patient-Centered Nursing Process Approach, 9th Edition

 

MULTIPLE CHOICE

 

  1. A woman is diagnosed with bacterial vaginosis and will begin taking metronidazole (Flagyl). What will the nurse teach the patient about this medication?
a. “Abstain from sexual intercourse while taking this medication.”
b. “Do not consume alcohol while taking this drug and for 48 hours after finishing the prescription.”
c. “Take this medication on an empty stomach to increase absorption.”
d. “Topical preparations are ineffective for treating bacterial vaginosis.”

 

 

ANS:   B

Metronidazole can cause a disulfiram-like reaction when taken with alcohol, so patients should be cautioned against using foods or drug products that contain alcohol. There is no need to abstain from sexual intercourse. Metronidazole should be taken with food. The topical preparation is effective against bacterial vaginosis.

 

DIF:    Cognitive Level: Applying (Application)                              REF:    p. 804

TOP:    Nursing Process: Nursing Intervention: Patient Teaching

MSC:   NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. The nurse is teaching the parent of an 11-year-old girl about the Gardasil vaccine. What will the nurse include in teaching?
a. “Gardasil is given to females and not to males.”
b. “Gardasil protects against cervical dysplasia.”
c. “Gardasil reduces the need for routine Pap smears.”
d. “Gardasil will be given as a single injection.”

 

 

ANS:   B

Gardasil protects against human papillomavirus, which is a cause of cervical dysplasia and cancer. It is offered to both females and males. The vaccine does not decrease the need for regular cervical cancer screening. It is given in a 3-vaccine series, with the second dose in 2 months and the third dose in 6 months.

 

DIF:    Cognitive Level: Applying (Application)                              REF:    p. 7

TOP:    Nursing Process: Nursing Intervention: Patient Teaching

MSC:   NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. A patient is taking azithromycin to treat a chancroid infection. What nonpharmacologic measures will the nurse recommend as adjunct therapy to treat this infection?
a. Apply a bacteriostatic ointment to the lesions twice daily.
b. Avoid washing the lesions to prevent spread of the infection.
c. Cover the lesions with gauze at all times to minimize discomfort.
d. Use compresses to remove necrotic material and clean the lesions three times daily.

 

 

ANS:   D

Patients should be counseled to cleanse the lesions three times daily and to use compresses to remove necrotic material. It is not necessary to apply bacteriostatic ointment or to cover the lesions with gauze. Washing the lesions is recommended.

 

DIF:    Cognitive Level: Applying (Application)                              REF:    p. 803

TOP:    Nursing Process: Nursing Intervention: Patient Teaching

MSC:   NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. A woman is diagnosed with gonorrhea and asks the nurse about treatment. Which statement will the nurse include in teaching?
a. “Ceftriaxone IM is prescribed.”
b. “Erythromycin ointment is prescribed.”
c. “IM ceftriaxone and oral azithromycin are prescribed.”
d. “Oral doxycycline is prescribed.”

 

 

ANS:   C

A single dose of IM ceftriaxone and a single dose of azithromycin are prescribed for gonorrhea. The use of two drugs improves treatment efficacy and slows the development of drug resistance. Erythromycin ophthalmic ointment is used on the neonate.

 

DIF:    Cognitive Level: Understanding (Comprehension)               REF:    p. 805

TOP:    Nursing Process: Nursing Intervention: Patient Teaching

MSC:   NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. A woman is diagnosed with gonorrhea and receives ceftriaxone intramuscularly in clinic and a prescription for doxycycline to be taken twice daily for 7 days. She asks the nurse why she needs to take medicine since she has had a shot. How will the nurse respond?
a. “Both medications are required to fully treat the gonorrheal infection.”
b. “Doxycycline helps prevent spread of gonorrhea to your sexual partners.”
c. “Patients with gonorrhea are always treated for chlamydia as well.”
d. “The second medication decreases your chances of disease recurrence.”

 

 

ANS:   C

Patients with gonorrhea should be treated for chlamydia empirically. Doxycycline is used to treat chlamydia. Ceftriaxone does not prevent spread of gonorrhea to sexual partners or decrease the risk of relapse.

 

DIF:    Cognitive Level: Applying (Application)                              REF:    p. 805

TOP:    Nursing Process: Nursing Intervention: Patient Teaching

MSC:   NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. A woman is diagnosed with herpes simplex virus (genital herpes). Which statement by the patient indicates understanding of the medication regime?
a. “Antiviral drugs, it taken long enough, can cure the virus.”
b. “I can take a drug that reduces the frequency of outbreaks.”
c. “If I am taking antiviral medication, I cannot pass the virus on to my partner.”
d. “I can use the medications once a month to treat symptoms.”

 

 

ANS:   C

Suppressive therapy reduces the frequency of genital herpes recurrences by 70% in those who have frequent recurrences. Systemic antiviral drugs can control some of the signs and symptoms of genital herpes, but these do not cure herpes. Outbreaks occur even while on antiviral medication, and transmission can occur when patients are asymptomatic. Episodic treatment, to be effective, should begin within 1 day of lesion onset or during the prodrome period, not a given week each month.

 

DIF:    Cognitive Level: Understanding (Comprehension)               REF:    p. 806

TOP:    Nursing Process: Nursing Intervention: Patient Teaching

MSC:   NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. A woman with complaints of abnormal vaginal discharge, vaginal soreness, pruritus, and dysuria is diagnosed with vulvovaginal candidiasis (VVC). Which statement will the nurse include in teaching?
a. “Treatment with prescription medication is lifelong.”
b. “Alcohol should be avoided during treatment.”
c. Candida albicans can be readily passed between sex partners.”
d. “Over the counter cream is used to treat the condition.”

 

 

ANS:   D

Over the counter or prescribed medications can be used to treat the condition; treatment is episodic. The medications do not interact with alcohol. Uncomplicated VVC is not usually acquired through sexual intercourse; thus treatment of sexual partners is not necessary.

 

DIF:    Cognitive Level: Understanding (Comprehension)               REF:    p. 808

TOP:    Nursing Process: Nursing Intervention: Patient Teaching

MSC:   NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

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