Rasmussen University: NUR 2474/ NUR2474 Pharmacology for Professional Nursing; Exam 1 (All Chapters) | Questions and Answers.

Pharmacology for Professional Nursing (NUR2474) Exam 1 (2 Versions) Latest Spring26. Exam 1 Pharm 1. Which medication is considered a “rescue inhaler” A. Glucocorticoid such as beclomethasone (Beconase) B. Mucolytic agent such as acetylcysteine (Mucomyst) C. Short-acting beta2 agonist such as albuterol (Proventil) D. Mast cell stabilizer such as cromolyn sodium (Nasalcrom) 2. Which of the following medication is not classified as a topcolytic A. Oxytocin (Pitocin) B. Nifedipine (Procardia) C. Magnesium Sulfate D. Indomethacin (Indocin) 3. A home care nurse is visiting a client with asthma who suddenly experiences an acute asthma attack. Which drug should the nurse prepare to administer A. Mucomyst (Acetylcysteine) B. Spiriva (Tiotropium bromide) C. Singulair (Montelukast) D. Proventil (Albuterol) 4. A woman who has just delivered her infant observes the nurse administering ophthalmic ointment into her infant’s eyes, and she asks why this is done. The nurse will explain that this ointment is given for which purpose? A. To prevent infection B. To prevent chemical conjunctivitis C. To provide moisture D. To treat infection 5. A client will be using an albuterol metered-dose inhaler to treat asthma symptoms. The client asks the nurse about the difference between the effects of inhaled albuterol versus an oral form of albuterol. How should the nurse best explain the difference between inhaled and oral albuterol? A. The inhaled form will not lead to increased doses B. The inhaled form requires an increased dose C. The inhaled form has a more immediate onset of action D. The inhaled form may cause more side effect than the oral form 6. A client with diabetes has been scheduled for a CT scan of the abdomen with oral and IV contrast. Which medication would be of concern? A. Metformin B. Insulin glargine C. Glipizide D. Acarbose 7. The nurse administered 12 units of regular insulin to the client with type 1 diabetes at 0700. Which meal prevents the client from experiencing hypoglycemia from this administration? A. HS snack B. Lunch C. Breakfast D. Supper 8. A client has the feeling of having “chest tightness” while experiencing “cold-like” symptoms. Her cough is nonproductive. Her physician prescribed guaifenesin (Mucinex) to help with secretions. When teaching about this medication, what should the nurse instruct? A. “Take it with an oral antihistamine for better effectiveness “ B. “Monitor urine output closely” C. “Avoid driving or using heavy machinery while on this medication” D. “Drink extra water while taking this medication” 9. The nurse is caring for a client who has experienced head trauma in a motor vehicle accident. The client is having excessive urine output. The nurse should notify the provider and anticipate administering which medication? A. Corticotropin (ACTH or adrenocorticotropic hormone) B. Calciferol (Ergocalciferol) C. Vasopressin (AVP or Argipressin) D. Prednisolone (Prelone) 10. Which medication is prescribed for a client with COPD to treat acute bronchospasm? A. Tiotropium B. Theophylline C. Montelukast D. Epinephrine 11. When are glucocorticoids (steroids) prescribed? A. Severe asthmatic attack B. Asthma that is unresponsive to bronchodilator therapy C. Maintenance therapy of controlled chronic asthma D. Acute allergic reaction 12. What is the rationale for rotating insulin injection sites? A. Decrease potential for insulin shock B. It prevents insulin resistance C. Prevents an allergic raction D. Avoids development of lipodystrophy 13. Which of the following would the nurse have readily available for a client who is receiving magnesium sulfate to treat severe preeclampsia? A. Ferrous sulfate B. Potassium chloride C. Calcium carbonate D. Calcium gluconate 14. What type of insulin should be readily available in client care areas to treat potential emergencies? What type of insulin should be readily available in client care areas to treat potential emergencies? A. Insulin lispro B. NPH insulin C. Regular Insulin D. Insulin glargine 15. A patient is prescribed Glucophage (metformin). Which is a side effect/adverse affect almost occur when clients take metformin? A. Renal failure B. Lactic acidosis or severe increases in lactic acid C. Seizures D. Bitter or metallic taste 16. What is the most common side effect of insulin administration? A. Nausea B. Anaphylaxis C. Hypoglycemia D. Lipodystrophy 17. A nurse gives a patient who is post-op 2 days (Appendectomy) NPH insulin at 8:00am. At 2:00pm the nurse finds the patient guarding his right lower abdomen but extremely lethargic but conscious. The patient is diaphoretic and slightly combative. The patients vital signs are as follows. T=99.1; HR=80; BP=109/62’ RR=18; SPO2=97%; The nurse should first: A. Administer the next dose of insulin STAT B. Call the health care provider an inform him/her that patient is n hypoglycemic shock C. Administer Narcan (Naloxone) STAT D. Administer 2L O2 via nasal canula E. Assess the patients blood sugar using a bedside finger stick blood glucose test 18. Which medication should be used during all steps of management for asthma patients? A. Long acting beta2 agonists B. Inhaled low-dose glucocorticoids C. Combination inhaled glucocorticoids/long-acting beta2 agonists D. Short acting beta2 agonists 19. The nurse receives the following order for insulin: NPH (Humulin NPH) 10 units intravenously daily at 7:00am. The nurse will perform which action? A. Give the drug subcutaneously rather than IV B. Administer the dose but ensure that if mixed with another Humulin-R insulin, to draw the regular insulin up first C. Administer the insulin ordered mixed in 50ML of 0.9%NS IV Piggyback (not to infuse faster than ½ hour or 30 mins) D. Review the insulin order with the prescriber and pharmacy 20. What special administration techniques must the nurse use when administering NPH insulin? A. Roll the vial gently to mix the suspension B. Only administer the insulin at bedtime C. Never mix with another insulin D. When mixing with another insulin, draw the NPH into syringe first 21. Which type of insulin is indicated for sliding scale coverage? A. 70% NPH/30% regular mix B. Insulin glargine C. NPH D. Regular insulin 22. A client with type 1 diabetes mellitus is scheduled for a total hip replacement and will be NPO after midnight. When reviewing the clients orders the evening prior to surgery a nurse notes that the provider did not write an order to change the clients daily insulin dose which is an order for NPH and regular insulin. Which is the best nursing action? A. Do nothing because the provider would want the client to receive the usual insulin dose prior to surgery B. Contact the provider for an order to decrease the morning insulin dose by one- half of the prescribed morning dose C. Hold the morning dose of NPH and regular insulin until after a fasting glucose is done D. Notify the care provider who wrote the insulin order in the clients medical record 23. The nurse is preparing to administer isoproterenol to a client experiencing acute bronchospasm. The nurse understands that because isoproterenol is a non-selective beta-adrenergic agonist, the client will experience which effects? A. Anticholinergic effects B. Cardiac and pulmonary effects C. Alpha and beta adrenergic agonist effects D. A shorter duration of therapeutic effects 24. 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. Schedule an appointment to discuss these effects with the provider B. Drink water or rinse before and after using the inhaler C. Stop taking the medication immediately D. Use the inhaler only as needed for acute bronchospasms 25. The nurse knows that montelukast (Singulair) is given for what purpose? A. Acute bronchospasm B. Seasonal allergy only C. Maintenance and prevention of asthma D. Severe asthmatic attacks 26. The client has been prescribed Synthroid (Levothyroxine) for hypothyroidism. The client asks if he must take this medication with food. What is the nurse’s best response? A. Take this medication on an empty stomach B. Always take this medication with food C. Take this medication with juice and crackers D. Take this medication with a glass of milk 27. The client asks the nurse about storing insulin. Which response by the nurse is correct? A. “Insulin will last longer if kept in the freezer” B. “Opened vials of insulin must be discarded” C. “Vials of insulin must be refrigerated” D. “Insulin pens never have to be refrigerated” 28. A client is ordered to receive Humalog (insulin lispro) at mealtimes. The nurse will instruct the client to administer the medication at which time? A. 15 minutes after eating B. 10 minutes after eating C. 30 minutes before eating D. 5 minutes before eating 29. The prescriber has written a new order for a glucocorticoid inhaler for a client being discharged to home. What information should be included in the teaching plan regarding the use of this medication? A. “This medication may cause you to feel anxious” B. “This medication will cause you to become fatigued” C. “You must gargle and rinse you mouth immediately after each use of this medication” D. “This medication is a leading cause of bronchospasm” 30. A patient is receiving a glucocorticoid medication to treat an exacerbation of COPD and the provider has ordered a slow taper in order to discontinue this medication. The nurse explains to the patient that this done to prevent which condition? A. Thyroid storm B. Adrenocortical insufficiency C. Acromegaly D. Hypertensive crisis 31. The nurse is teaching a patient how to administer insulin. The patient is thin with very little body fat. The nurse will suggest injection inulin. A. By pinching up the skin and injection straight down B. In the abdomen only with the needle at a 90-degree angle C. Using the thigh and buttocks areas exclusively D. Subcutaneously with the needle at a 45 to 60-degree angle 32. The nurse administered NPH insulin at 1700. When would the nurse expect the peak action of this administration? A. Between 1800 and 2100 B. Between 2300 and 0500 C. At 1930 D. There is no peak action with neutral protamine hagedorn insulin 33. A patient admitted to the medical-surgical floor has a history of end-stage COPD. The patient was admitted with the diagnosis of “Exacerbation of COPD”. Which prescription would the RN question as it relates to this patients treatment regimen? A. “O2 @ 2L NC and titrate to keep SPO@ 97% B. “Albuterol nebulizer treatment q 6 hours prn respiratory distress” C. “Prednisone 20 mg PO daily” D. “Cromolyn 20 mg inhaled via nebulization” 34. A client diagnosed with type 2 diabetes will begin taking Glucophage (metformin). The nurse understands that the client is at risk for which serious contion(s) when taking metformin? A. Respiratory distress B. Seizures C. Hyperglycemia D. Lactic acidosis and renal failure 35. A newly diagnosed client with type 1 diabetes was admitted to the ICU with the diagnosis of diabetic ketoacidosis. His status has improved and he has now been downgraded to a medical/surgical unit. After he was transferred to the med/surg unit, he asks if he can receive today’s NPH and regular insulin the same way to avoid being “stuck” since there is still an IV access. What information should be included in the nurse’s response? A. Only regular insulin may be given IV and you will now receive your insulin’s subcutaneously as ordered B. These two insulin’s are not compatible and cannot be mixed together C. NPH insulin can only be given IV in the ICU environment as a insulin drip D. Mixing these two insulin’s may increase their potency and increase the risk of hypoglycemia 36. Mr. Jones a 68-year-old patient with a history of insulin dependent diabetes mellitus (IDDM) was admitted to the hospital with fever and severe dehydration secondary to influenza infection. The patient is in droplet isolation and is receiving 0.9% normal saline at 150 ml/hr via an 18G venous access device in his right anticubital vein. The RN performed a finger stick blood glucose (FSBG or Accucheck) exam on the patient @ 1130 and the patient’s result is 40. The patient’s blood glucose result on this morning’s chemistry profile was 84 g/dl. The patients FSBG from this morning’s check at 0730 was 78. What should the RN’s next immediate course of action be? A. Administer the insulin per the sliding scale B. Administer 4 ounces of orange juice mixed with a packet of sugar STAT C. Assess the patient and recheck the FSBG D. Call for the rapid response teach and notify the physician E. Administer 50 gms Dextrose (1 vial) IV since patient has IV access 37. The nurse is caring for a patient diagnosed with diabetes insipidus who is receiving desmopressin acetate (DDAVP) for the treatment of diabetes insipidus (DI). Which assessments are important while caring for this patient? A. Urine output and serum sodium levels B. Lung sounds and serum glucose levels C. Heart rate and serum finger stick blood glucose (FSGB) checks D. Blood pressure and serum potassium levels 38. The client with type 2 diabetes is taking Glucotrol (glipizide) 10mg PO before meals. The client asks the nurse, “How does this medication help my diabetes?” what is the nurse’s best explanation? A. It increases glucose transport to the muscles B. It promotes the use of glucose by the body cells C. It increases glucose to provide more energy to the body D. It stimulates beta cells in the pancreas to secrete insulin to lower blood glucose 39. The nurse should question a prescription for high dose corticosteroids in a client with which medical condition? A. Chronic asthma B. New diagnosis of lung cancer C. Acute exacerbation of COPD D. Uncontrolled diabetes mellitus 40. Which time frame would be best for administering sliding-scale Humalog (lispro insulin)? A. Within 15 minutes of obtaining blood glucose measurement B. When the breakfast tray is served and ready to eat C. Within 30 minutes of consuming breakfast D. Within 1 hour of obtaining blood glucose measurement 41. The nurse is caring for a patient diagnosed with COPD who has been prescribed Spiriva (tiotropium). Which statement will the nurse include in the education? A. If you experience dry mouth, stop taking the medication immediately B. Remove the capsules from the packaging and place in you 7-day med box C. Tiotropium works by relaxing and dilating the bronchioles D. Use tiotropium as needed for sudden breathing problems 42. Which client statement indicates understanding of the use of an external insulin pump? A. Having an insulin pump with help me lose weight B. I will not need to count carbohydrates anymore C. I will still need to monitor my blood glucose levels D. I will leave this on when bathing or swimming 43. An opioid analgesic is administered to a client in labor. The nurse assigned to care for the client ensures that which medication is readily available if respiratory depression occurs A. Betamethasone (celestone) B. Meperidine hydrochloride (Demerol) C. Naloxone D. Morphine sulfate 44. A young client with cystic fibrosis (CF) is on dornase alfa. What does the nurse teach about the action of this medication A. Decrease thick secretion B. Relieves nasal congestion C. Suppresses cough D. Decrease pain 45. Which statement is accurate regarding theophylline A. Is considered toxic if theophylline levels are between 5-15 mcg/mL B. Has potential to cause central nervous system side effects, especially if levels are elevated C. Has less major side effects than beta-agonists and glucocorticoids D. Is a first line drug currently to treat COPD 46. A client with hyperthyroidism will begin treatment with an antithyroid medication and asks the nurse about dietary requirements. The nurse will counsel the patient to avoid which food? A. Shellfish B. Foods high in purine C. Grapefruit D. Fava beans 47. A patient with type 1 diabetes mellitus is ordered insulin therapy once daily to be administered at bedtime. What is the type of insulin the patient is most likely receiving? A. Humalog (Lispro insulin) B. Humulin R (regular insulin) C. Humulin 70/30 (lente insulin) D. Lantus (insulin glargine) 48. A client has hypocalcaemia caused by a parathyroid hormone deficiency. Which medication should the nurse anticipate giving this client? A. Calcitriol (vitamin d3) B. Calcitonin (calcimar) C. Calcium (PO or via IVPB) D. Vitamin B12 (IM only) 49. Which client statement demonstrates understanding of the nurse’s teaching for levothyroxine? A. It is best to take the medication with food to prevent gastrointestinal upset B. I will take this medication first thing in the morning C. I will double my dose if I gain more than 1 pound per day D. I can expect to see relief of my symptoms within 1 week 50. A client is brought to the emergency room unconscious, with a pulse, and with a blood glucose of 40. The client is wearing a medic alert bracelet indicating that he has type 1 diabetes mellitus. What order should the nurse anticipate? A. Give glucagon B. Give insulin C. Give orange juice D. Perform CPR 51. Which statement by a client taking Glucotrol (glipizide) therapy indicates that more teaching is indicated? A. I will take the medication once a day in the morning B. This medication stimulates my pancreatic cells to make insulin C. I will eat my breakfast very soon after taking my medication D. I will use a new needle every time I take the medication 52. The nurse is teaching a patient about home administration of insulin. The patient’s discharge instructions states to administer (Humulin R) and NPH (Humulin NPH) insulin at 0700 every day. What is important to teach this patient? A. Draw up the regular insulin first B. Inject the insulin into the buttocks only since this is a mixed insulin C. Draw up the NPH insulin first D. Draw up the medications after mixing them in a viral 53. A client is receiving Robitussin (dextromethorphan). The nurse knows the drug is exerting its therapeutic effects with which client report? A. Decreased coughing B. Relief of nasal congestion C. Thinning of secretions D. Bronchodilation 54. 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. My provider will prescribe prophylactic antibiotics B. I will need to take oral prednisone on a daily basis C. My symptoms are reversible with proper medications D. I should use albuterol when my symptoms worsen 55. The nurse administers NPH insulin at 0800. What intervention is essential for the nurse to perform? A. Administer the insulin via IV pump B. Monitor fingerstick at 1400 C. Make sure client eats by 1700 D. Assess the client for hyperglycemia by 1000 56. Before administering Benadryl (diphenhydramine) to a client, it is most important for the nurse to assess for which history? A. Hypotension B. Narrow angle glaucoma C. Diabetes insipidus D. Allergy to penicillin 57. A patient with Graves disease exhibits tachycardia, heat intolerance, and exophthalmos. Prior to surgery, which drug is used to alter thyroid hormone levels? A. Propylthiouracil (PTU) B. Propranolol (Inderal) C. Levothyroxine sodium (Synthroid) D. Liotrix (Thyrolar) 58. The client with seasonal allergies is taking Afrin (oxymetazoline). What should the nurse teach the client about this medication? A. Take this medication at bedtime because it causes drowsiness B. Stop this medication immediately C. Limit the use of this medication to 5 days to prevent rebound nasal congestion D. This medication should only be used for asthma 59. A client prescribed combined oral contraceptives (COC) has presented for a routine visit. Which finding upon assessment should the nurse prioritize? A. Light menstrual flow B. Cramping during menses C. Abdominal pain D. Small amount of breakthrough bleeding 60. A patient who is unconscious and has a pulse is brought to the emergency department. The patient is wearing a medic alert bracelet indicating type 1 diabetes mellitus. The nurse will anticipate an order to administer? A. Cardiopulmonary resuscitation (CPR) B. Orange juice C. Insulin (Hum-R insulin only) Glucagon I’ll Exam 1 Chapter 35: Upper Respiratory Disorders 1. A patient who has narrow-angle glaucoma asks the nurse to recommend a medication to alleviate cold symptoms such as nasal congestion and runny nose. The nurse will suggest the patient talk to the provider about which medication? a. Azelastine (Astelin) b. Cetirizine (Zyrtec) c. Chlorpheniramine maleate (Chlor-Trimeton) d. Diphenhydramine (Benadryl) 2. The nurse is caring for a patient who is receiving diphenhydramine. The nurse notes that the patient has not voided for 12 hours. What action will the nurse take? a. Encourage the patient to drink more fluids. b. Evaluate the bladder to check for distension. c. Request an order for an intravenous fluid bolus. d. Request an order for urinary catheterization. 3. A patient arrives in the emergency department after developing a rash, runny nose, and sneezing after eating strawberries. What action will the nurse expect to take first? a. Administer diphenhydramine. b. Administer epinephrine. c. Assess for urinary retention. d. Assess heart rate, respiratory rate, and lung sounds. 4. A patient who has seasonal allergies with a runny nose during the daytime reports increasing nighttime symptoms of coughing and sneezing that are interfering with sleep. The provider recommends diphenhydramine (Benadryl) at bedtime. What information will the nurse include when teaching the patient about this medication? a. Avoid fluids at bedtime to prevent urinary retention. b. This will help clear your daytime symptoms, too. c. You should be able to sleep better when you take this medication. d. You should take this medication on an empty stomach. 5. The parents of a 3-year-old child tell the nurse that they are planning to give their child diphenhydramine (Benadryl) on a flight to visit the childs grandparents to help the child sleep during the flight. What will the nurse tell the parents about giving this drug? a. Administer 25 mg of diphenhydramine when using to induce sleep. b. Diphenhydramine may have the opposite effect and could cause agitation. c. Give the diphenhydramine about 5 minutes prior to takeoff. d. Loratadine should be used instead of diphenhydramine to minimize side effects. 6. The nurse is caring for a patient who is hospitalized for an asthma exacerbation. The patient reports taking diphenhydramine at home at night to help with symptoms of allergic rhinitis and cough. The nurse will contact the patients provider to request an order for which medication? a. Benzonatate (Tessalon Perles) b. Cetirizine (Zyrtec) c. Dextromethorphan hydrobromide (Benylin DM) d. Diphenhydramine (Benadryl) 7. A patient is admitted to the hospital after developing pneumonia. During the admission assessment, the patient reports having used a nasal decongestant spray for the past few weeks but thinks the nasal congestion is getting worse. The nurse will a. request an order for a systemic decongestant medication. b. request an order so the patient can continue to use the decongestant spray. c. tell the patient the congestion will clear up after stopping the spray. d. tell the patient to increase oral fluid intake. 8. The patient who has nasal congestion asks the nurse to recommend a decongestant medication. The nurse performs a medication history and learns that the patient takes a beta blocker to treat hypertension. Which over-the-counter product will the nurse recommend? a. Diphenhydramine (Benadryl) b. Ephedrine HCl (Pretz-D) c. Phenylephrine nasal (NeoSynephrine Nasal) d. Loratadine (Claritin) 9. The nurse is providing teaching for a patient who will use intranasal dexamethasone (Decadron) after discharge home from the hospital. What information is important to include when teaching this patient about this drug? a. Dexamethasone may be used for year-round symptoms. b. Dexamethasone should be discontinued after 30 days. c. Dexamethasone should not be taken with antihistamines. d. Dexamethasone should not cause systemic steroid side effects. 10. A patient asks the nurse about using dextromethorphan for cough. What information will the nurse include when teaching this patient about this drug? a. It does not cause sedation except at high doses. b. It may be used to treat cough for up to 2 weeks. c. It is non-narcotic, and it is OK to consume alcohol while taking this drug. d. It should not be taken by patients who have chronic obstructive pulmonary disease (COPD). 11. A patient with chronic obstructive pulmonary disease (COPD) who has a persistent nonproductive cough asks about a medication that will not cause sedation. The nurse will encourage the patient to discuss which medication with the provider? a. Benzonatate HCl (Tessalon Perles) b. Dextromethorphan hydrobromide (Benylin DM) c. Guaifenesin and codeine d. Promethazine with dextromethorphan 12. A patient who has a nonproductive cough will begin taking guaifenesin to help with secretions. When teaching this patient about the medication, the nurse will provide which instruction? a. Avoid driving or using heavy machinery. b. Drink extra water while taking the medication. c. Monitor urine output closely. d. Take with an oral antihistamine for better effects. Chapter 36: Lower Respiratory Disorders 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. 2. The nurse is preparing to administer isoproterenol (Isuprel) to a patient who is experiencing an acute bronchospasm. The nurse understands that, because isoproterenol is a nonselective beta-adrenergic agonist, the patient will experience which effects? a. Alpha- and beta-adrenergic agonist effects b. Anticholinergic effects c. A shorter duration of therapeutic effects d. Cardiac and pulmonary effects 3. 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. 4. 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 5. 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 6. 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. 7. 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. 8. 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. 9. 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. 10. 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. 11. A patient who uses an inhaled glucocorticoid medication reports having a sore tongue. The nurse notes white spots on the patients 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. 12. 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. 13. 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 14. A patient is brought to the emergency department and reports having taken a lot of acetaminophen extra- strength tablets 16 hours prior. The nurse will expect the provider to order a. acetylcysteine (Mucomyst). b. dornase alfa (Pulmozyme). c. gastric lavage. d. renal enzyme tests. 15. 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. Chapter 42: Gastrointestinal Tract Disorders 1. A patient who experiences motion sickness when flying asks the nurse the best time to take the medication prescribed to prevent motion sickness for a 0900 flight. The nurse will instruct the patient to take the medication at which time? a. As needed, at the first sign of nausea b. At 0700, before leaving for the airport c. At 0830, just prior to boarding the plane d. When seated, just prior to takeoff 2. The nurse is caring for a patient who has unexplained, recurrent vomiting and who is unable to keep anything down. Until the cause of the vomiting is determined, the nurse will anticipate administering which medications? a. Antibiotics and antiemetics b. Intravenous fluids and electrolytes c. Non-prescription antiemetics d. Prescription antiemetics 3. The parent of an 18-month-old toddler calls the clinic to report that the child has vomited 5 times that day. The nurse determines that the child has had three wet diapers in the past 6 hours. What will the nurse recommend for this child? a. Administering an OTC antiemetic medication such as diphenhydramine b. Giving frequent, small amounts of Pedialyte c. Keeping the child NPO until vomiting subsides d. Taking the child to the emergency department for IV fluids 4. The nurse is teaching a patient who is about to take a long car trip about using dimenhydrinate (Dramamine) to prevent motion sickness. What information is important to include when teaching this patient? a. Do not drive while taking this medication. b. Dry mouth is a sign of toxicity with this mediation. c. Take the medication 1 to 2 hours prior to beginning the trip. d. Take 100 mg up to 6 times daily for best effect. 5. The nurse is caring for a patient who has postoperative nausea and vomiting. The surgeon has ordered promethazine HCl (Phenergan). Which aspect of this patients health history would be of concern? a. Asthma b. Diabetes c. GERD d. Glaucoma 6. The nurse is teaching a group of nursing students about the use of antipsychotic drugs for antiemetic purposes. The nurse will explain that, when given as antiemetics, these drugs are given a. in smaller doses. b. less frequently. c. with anticholinergics. d. with antihistamines. 7. A patient who is receiving chemotherapy will be given dronabinol (Marinol) to prevent nausea and vomiting. The nurse will tell the patient that this drug will be given at which time? a. Before and after the chemotherapy b. During chemotherapy c. Immediately prior to chemotherapy d. 24 hours prior to chemotherapy 8. A woman who is 2 months pregnant reports having morning sickness every day and asks if she can take any medications to treat this problem. The nurse will recommend that the patient take which action first? a. Contact the provider to discuss a possible need for intravenous fluids. b. Contact the provider to discuss a prescription antiemetic. c. Use nonpharmacologic measures such as saltines. d. Take over-the-counter antiemetics such as diphenhydramine. 9. The parent of a child who is receiving chemotherapy asks the nurse why metoclopramide (Reglan) is not being used to suppress vomiting. The nurse will explain that, in children, this drug is more likely to cause which effect? a. Excess sedation b. Extrapyramidal symptoms c. Paralytic ileus d. Vertigo 10. The child who is a candidate for treatment with syrup of ipecac after ingestion of a toxic substance or overdose is the child who has ingested which substance? a. Acetaminophen elixir b. Chlorine bleach c. Kerosene d. Toilet cleanser 11. The nurse is teaching a group of parents about the use of syrup of ipecac. Which instruction will the nurse provide? a. Do not administer ipecac without consulting a poison control center. b. Expect the onset of emesis to be immediate. c. Give ipecac with a glass of milk to increase its emetic effect. d. Use ipecac fluid extract and not ipecac syrup. 12. A patient asks the nurse about using loperamide (Imodium) to treat infectious diarrhea. Which response will the nurse give? a. Loperamide results in many central nervous system (CNS) side effects. b. Loperamide has no effect on infectious diarrhea. c. Loperamide is taken once daily. d. Loperamide may prolong the symptoms. 13. A child is brought to the emergency department after ingestion of a toxic substance. The child is alert and conscious and is reported to have ingested kerosene 20 minutes prior. The nurse will anticipate administering a. activated charcoal. b. an anticholinergic antiemetic. c. gastric lavage. d. syrup of ipecac. 14. A patient who is taking diphenoxylate with atropine (Lomotil) to treat diarrhea asks the nurse why it contains atropine. The nurse will explain that atropine is added to a. decrease abdominal cramping. b. increase intestinal motility. c. minimize nausea and vomiting. d. provide analgesia. 15. The nurse is caring for an older adult who is receiving diphenoxylate with atropine (Lomotil) to treat severe diarrhea. The nurse will monitor this patient closely for which effect? a. Bradycardia b. Fluid retention c. Nervousness and tremors d. Respiratory depression 16. A patient asks the nurse the best way to prevent travelers diarrhea. The nurse will provide which recommendation to the patient? a. Ask your provider for prophylactic antibiotics. b. Drink bottled water and eat only well-cooked meats. c. Eat fresh, raw fruits and vegetables. d. Take loperamide (Imodium) every day. 17. An appropriate goal when teaching a patient who has diarrhea is that the patient a. will have less frequent, more formed stools. b. will not have a stool for 1 to 2 days. c. will receive adequate intravenous fluids. d. will receive appropriate antibiotic therapy. 18. A patient reports having three to four stools, which are sometimes hard, per week. The nurse will perform which action? a. Recommend increased fluids and dietary fiber. b. Request an order for a laxative as needed. c. Request an order for a stool softener. d. Suggest discussing chronic constipation with the provider. 19. The nurse is instructing a patient who will take psyllium (Metamucil) to treat constipation. What information will the nurse include when teaching this patient? a. The importance of consuming adequate amounts of water b. The need to monitor for systemic side effects c. The onset of action of 30 to 60 minutes after administration d. The need to use the dry form of Metamucil to prevent cramping Chapter 43: Antiulcer Drugs 1. A patient who has been instructed to use a liquid antacid medication to treat gastrointestinal upset asks the nurse about how to take this medication. What information will the nurse include when teaching this patient? a. Take a laxative if constipation occurs. b. Take 60 minutes after meals and at bedtime. c. Take with at least 8 ounces of water to improve absorption. d. Take with milk to improve effectiveness. 2. A patient who has symptoms of peptic ulcer disease will undergo a test that requires drinking a liquid containing 13C urea and breathing into a container. The nurse will explain to the patient that this test is performed to a. assess the level of hydrochloric acid. b. detect H. pylori antibodies. c. measure the pH of gastric secretions. d. test for the presence of 13CO2. 3. A patient is taking esomeprazole (Nexium) 15 mg per day to treat a duodenal ulcer. After 10 days of treatment, the patient reports that the pain has subsided. The nurse will counsel the patient to a. continue the medication for 4 more weeks. b. reduce the medication dose by half. c. stop taking the medication. d. take the medication every other day. 4. A patient with a peptic ulcer has been diagnosed with H. pylori. The provider has ordered lansoprazole (Prevacid), clarithromycin (Biaxin), and metronidazole (Flagyl). The patient asks the nurse why two antibiotics are needed. The nurse will explain that two antibiotics a. allow for less toxic dosing. b. combat bacterial resistance. c. have synergistic effects. d. improve acid suppression. 5. A patient who takes propantheline bromine (Pro-Banthine) and omeprazole (Prilosec) for an ulcer will begin taking an antacid. The nurse will give which instruction to the patient regarding how to take the antacid? a. Take the antacid 2 hours after taking the propantheline. b. Take the antacid along with a meal. c. Take the antacid with milk. d. Take the antacid with the propantheline bromine. 6. Which antacid is likely to cause acid rebound? a. Aluminum hydroxide b. Calcium carbonate c. Magnesium hydroxide d. Magnesium trisilicate 7. Patients provider to request an order for which laboratory tests? a. Liver enzymes and serum calcium b. Liver enzymes and serum magnesium c. Renal function tests and serum calcium d. Renal function tests and serum magnesium 8. The nurse is caring for a patient who has Zollinger-Ellison syndrome. Which medication order would the nurse question for this patient? a. Cimetadine (Tagamet) b. Pantoprazole (Protonix) c. Rabeprazole (Aciphex) d. Ranitidine (Zantac) 9. A patient who is diagnosed with peptic ulcer disease has been started on a regimen that includes ranitidine (Zantac) 300 mg daily at bedtime. The patient calls the clinic 1 week later to report no relief from discomfort. What action will the nurse take? a. Contact the provider to discuss changing to cimetidine (Tagamet). b. Notify the provider to discuss increasing the dose. c. Reassure the patient that the drug may take 1 to 2 weeks to be effective. d. Suggest that the patient split the medication into twice daily dosing. 10. A male patient who has been taking a histamine2 blocker for several months reports decreased libido and breast swelling. What will the nurse do? a. Contact the provider to report possible drug toxicity. b. Reassure the patient that these symptoms will stop when the drug is discontinued. c. Request an order for serum hormone levels. d. Suggest that the patient see an endocrinologist. 11. A patient who has been taking ranitidine (Zantac) continues to have pain associated with peptic ulcer. A noninvasive breath test is negative. Which treatment does the nurse expect the provider to order for this patient? a. Adding an over-the-counter antacid to the patients drug regimen b. A dual drug therapy regimen c. Amoxicillin (Amoxil), clarithromycin (Biaxin), and omeprazole (Prilosec) d. Lansoprazole (Prevacid) instead of ranitidine 12. A patient has been taking famotidine (Pepcid) 20 mg bid to treat an ulcer but continues to have pain. The provider has ordered lansoprazole (Prevacid) 15 mg per day. The patient asks why the new drug is necessary, since it is more expensive. The nurse will explain that lansoprazole a. can be used for long-term therapy. b. does not interact with other drugs. c. has fewer medication side effects. d. is more potent than famotidine. 13. The nurse is caring for a patient who will begin taking omeprazole (Prevacid) 20 mg per day for 4 to 8 weeks to treat gastroesophageal reflux disease esophagitis. The nurse learns that the patient takes digoxin. The nurse will contact the provider for orders to a. decrease the dose of omeprazole. b. increase the dose of digoxin. c. increase the omeprazole to 60 mg per day. d. monitor for digoxin toxicity. 14. A patient reports experiencing flatulence and abdominal distension to the nurse. Which over-the-counter medication will the nurse recommend? a. Alka-Seltzer b. Maalox c. Mylicon d. Tums 1. A patient who recently began having mild symptoms of GERD is reluctant to take medication. What measures will the nurse recommend to minimize this patients symptoms? (Select all that apply.) a. Avoiding hot, spicy foods b. Avoiding tobacco products c. Drinking a glass of red wine with dinner d. Eating a snack before bedtime e. Taking ibuprofen with food f. Using a small pillow for sleeping g. Wearing well-fitted clothing , B, E Chapter 46: Pituitary, Thyroid, Parathyroid, and Adrenal Disorders 1. The parents of an 11-year-old boy ask about growth hormone therapy for their child who is shorter than his 10-year-old sister. The nurse will tell the parents that growth hormone a. does not affect other hormones when given. b. is available as an oral tablet to be taken once daily. c. is given after tests prove that it is necessary. d. may be given until the childs desired height is reached. 2. The nurse is caring for a patient who is receiving growth hormone. Which assessment will the nurse monitor daily? a. Complete blood count b. Height and weight c. Renal function d. Serum glucose 3. The parents of a 16-year-old boy who plays football want their child to receive growth hormone to improve muscle strength. What will the nurse tell the parents? a. Growth hormone may be used to improve strength in young athletes. b. If the epiphyses are not fused, growth hormone may be an option. c. Small doses of growth hormone may be used indefinitely for this purpose. d. Using growth hormone to build muscle mass is not recommended. 4. Which would be a contraindication for hormone therapy with somatropin (Genotropin) in a school-age child? a. Asthma b. Dwarfism c. Enuresis d. Prader-Willi syndrome 5. A child exhibits acromegaly caused by a tumor that cannot be destroyed with radiation. Which medication will most likely be used to treat this child? a. Bromocriptine mesylate (Parlodel) b. Octreotide acetate (Sandostatin) c. Somatrem (Protropin) d. Somatropin (Genotropin) 6. The nurse is caring for a patient who has hypothyroidism. To assist in differentiating between primary and secondary hypothyroidism, the nurse will expect the provider to order which drug? a. Liothyronine sodium (Cytomel) b. Liotrix (Thyrolar) c. Methimazole (Tapazole) d. Thyrotropin (Thytropar) 7. The nurse administers intravenous corticotropin (Acthar) to a patient. A serum cortisol level drawn 60 minutes later shows no change in serum cortisol levels from prior to the dose. What is the nurses first action? a. Notify the provider to discuss a possible non-functioning adrenal gland. b. Recognize the need for an increased dose to treat pituitary insufficiency. c. Request an order for a second dose of corticotropin to treat cortisone deficiency. d. Request an order to repeat the serum cortisol level in 1 to 2 hours. 8. The nurse provides teaching for a patient receiving corticotropin. The nurse will instruct the patient to contact the provider if which condition occurs? a. Bruising b. Constipation c. Myalgia d. Nausea 9. The nurse is caring for a patient who has experienced head trauma in a motor vehicle accident. The patient is having excessive output of dilute urine. The nurse will notify the provider and will anticipate administering which medication? a. Calcifediol (Calderol) b. Corticotropin (Acthar) c. Prednisolone (AK-Pred) d. Vasopressin (Pitressin) 10. The nurse is preparing to administer piperacillin to a patient to treat an infection caused by pseudomonas. The nurse learns that the patient receives corticotropin to treat multiple sclerosis. The nurse will request an order for a. a different antibiotic. b. blood glucose monitoring. c. cardiac monitoring. d. serum electrolytes. 11. The nurse is caring for a patient who is receiving desmopressin acetate (DDAVP). Which assessments are important while caring for this patient? a. Blood pressure and serum potassium b. Heart rate and serum calcium c. Lung sounds and serum magnesium d. Urine output and serum sodium 12. A 35-year-old woman reports lethargy, difficulty remembering things, facial edema, dry skin, and cessation of menses. The nurse notes a heart rate of 60 beats per minute and a weight increase of 5 pounds from a previous visit. The nurse will notify the provider of which possible condition? a. Cretinism b. Early menopause c. Hyperthyroidism d. Myxedema 13. A patient is admitted to the hospital to treat hypothyroidism. For rapid improvement in symptoms, the nurse will expect to administer which medication? a. Levothyroxine sodium (Synthroid) b. Liothyronine (Cytomel) c. Liotrix (Thyrolar) d. Thyroid desiccated (Armour Thyroid) 14. A patient who takes warfarin (Coumadin) and digoxin (Lanoxin) develops hypothyroidism and will begin taking levothyroxine (Synthroid). The nurse anticipates which potential adjustments in dosing for this patient? a. Decreased digoxin and decreased warfarin b. Decreased digoxin and increased warfarin c. Increased digoxin and decreased warfarin d. Increased digoxin and increased warfarin 15. A patient who takes the oral antidiabetic agent metformin (Glucophage) will begin taking levothyroxine (Synthroid). The nurse will teach this patient to monitor for a. hyperglycemia. b. hypoglycemia. c. hyperkalemia. d. hypokalemia. 16. A patient who has hyperthyroidism will begin treatment with an antithyroid medication. The patient asks the nurse about dietary requirements. The nurse will counsel the patient to avoid which food(s)? a. Fava beans b. Foods high in purine c. Grapefruit d. Shellfish 17. The nurse is caring for a patient who is being treated for hypothyroidism. The patient reports insomnia, nervousness, and flushing of the skin. Before notifying the provider, the nurse will perform which action? a. Assess serum glucose to evaluate possible hypoglycemia. b. Check the patients heart rate to assess for tachycardia. c. Perform an assessment of hydration status. d. Take the patients temperature to evaluate for infection. 18. A patient with Graves disease exhibits tachycardia, heat intolerance, and exophthalmos. Prior to surgery, which drug is used to alter thyroid hormone levels? a. Liotrix (Thyrolar) b. Propranolol (Inderal) c. Propylthiouracil (PTU) d. Thyroid (Thyrotab) 19. A patient has hypocalcemia caused by parathyroid hormone deficiency. Which medication will the nurse anticipate giving to this patient? a. Calcitonin b. Calcitriol c. Calcium d. Vitamin D 20. A patient is receiving a glucocorticoid medication to treat an inflammatory condition, and the provider has ordered a slow taper in order to discontinue this medication. The nurse explains to the patient that this is done to prevent which condition? a. Acromegaly b. Adrenocortical insufficiency c. Hypertensive crisis d. Thyroid storm 21. A patient is taking prednisolone and fludrocortisone (Florinef). When teaching this patient about dietary intake, the nurse will instruct the patient to consume a diet a. high in carbohydrates. b. high in fat. c. high in protein. d. low in potassium. 22. A patient who takes high-dose aspirin to treat arthritis will need to take prednisone to treat an acute flare of symptoms. What action will the nurse perform? a. Observe the patient for hypoglycemia. b. Monitor closely for increased urine output. c. Observe the patient for hypotension. d. Request an order for enteric-coated aspirin. Chapter 47: Antidiabetics 1. The nurse is teaching a group of nursing students about diabetes. The nurse explains that which type of diabetes is the most common? a. Type 1 diabetes mellitus b. Type 2 diabetes mellitus c. Diabetes insipidus d. Secondary diabetes 2. A patient develops type 2 diabetes mellitus. The nurse will explain that this type of diabetes a. is generally triggered by medications. b. is not as common as type 1 diabetes. c. is often related to heredity and obesity. d. will not require insulin therapy. 3. A patient who is overweight is being evaluated for diabetes. The patient has a blood glucose level of 160 mg/dL and a hemoglobin A1c of 5.8%. The nurse understands that this patient has which condition? a. Diabetes mellitus b. Hypoglycemia c. Normal blood levels d. Prediabetes 4. The nurse is teaching a patient who is newly diagnosed with type 1 diabetes mellitus about insulin administration. Which statement by the patient indicates a need for further teaching? a. I may use a chosen site daily for up to a week. b. I should give each injection a knuckle length away from a previous injection. c. I will not be concerned about a raised knot under my skin from injecting insulin. d. Insulin is absorbed better from subcutaneous sites on my abdomen. 5. The nurse is teaching a patient how to administer insulin. The patient is thin with very little body fat. The nurse will suggest injecting insulin a. by pinching up the skin and injecting straight down. b. in the abdomen only with the needle at a 90-degree angle. c. subcutaneously with the needle at a 45- to 60-degree angle. d. using the thigh and buttocks areas exclusively. 6. The nurse receives the following order for insulin: IV NPH (Humulin NPH) 10 units. The nurse will perform which action? a. Administer the dose as ordered. b. Clarify the insulin type and route. c. Give the drug subcutaneously. d. Question the insulin dose. 7. The nurse will administer parenteral insulin to a patient who will receive a mixture of NPH (Humulin NPH) and regular (Humulin R). The nurse will give this medication via which route? a. Intradermal b. Intramuscular c. Intravenous d. Subcutaneous 8. The nurse is teaching a patient about home administration of insulin. The patient will receive regular (Humulin R) and NPH (Humulin NPH) insulin at 0700 every day. What is important to teach this patient? a. Draw up the medications in separate syringes. b. Draw up the NPH insulin first. c. Draw up the regular insulin first. d. Draw up the medications after mixing them in a vial. 9. A patient is ordered to receive insulin lispro at mealtimes. The nurse will instruct this patient to administer the medication at which time? a. 5 minutes before eating b. 15 minutes after eating c. 30 minutes before eating d. 10 minutes after eating 10. The parent of a junior high-school child who has type 1 diabetes asks the nurse if the child can participate in sports. The nurse will tell the parent a. that strenuous exercise is not recommended for children with diabetes. b. that the child must be monitored for hyperglycemia while exercising. c. to administer an extra dose of regular insulin prior to exercise. d. to send a snack with the child to eat just prior to exercise. 11. A patient has administered regular insulin 30 minutes prior but has not received a breakfast tray. The patient is experiencing nervousness and tremors. What is the nurses first action? a. Administer glucagon. b. Give the patient orange juice. c. Notify the kitchen to deliver the tray. d. Perform bedside glucose testing. 12. A patient who has type 1 diabetes mellitus asks the nurse about using a combination insulin product such as Humalog 75/25. The nurse will tell the patient that use of this product a. depends on individual insulin needs. b. is useful for patient with insulin resistance. c. means less rotation of injection sites. d. requires refrigeration at all times. 13. The patient asks the nurse about storing insulin. Which response by the nurse is correct? a. All insulin vials must be refrigerated. b. Insulin will last longer if kept in the freezer. c. Opened vials of insulin must be discarded. d. Some combination pens do not require refrigeration. 14. A patient who has insulin-dependent diabetes mellitus must take a glucocorticoid medication for osteoarthritis. When teaching this patient, the nurse will explain that there may be a need to a. decrease the glucocorticoid dose. b. decrease the insulin dose. c. increase the glucocorticoid dose. d. increase the insulin dose. 15. Which statement by a patient who will begin using an external insulin pump indicates understanding of this device? a. I will have an increased risk for hypoglycemia. b. I will leave this on when bathing or swimming. c. I will not need to count carbohydrates anymore. d. I will still need to monitor serum glucose. 16. A patient who is unconscious and has a pulse is brought to the emergency department. The patient is wearing a Medic-Alert bracelet indicating type 1 diabetes mellitus. The nurse will anticipate an order to administer a. cardiopulmonary resuscitation (CPR). b. glucagon. c. insulin. d. orange juice. 17. A patient who has type 2 diabetes mellitus asks the nurse why the provider has changed the oral antidiabetic agent from tolbutamide (Orinase) to glipizide (Glucotrol). The nurse will explain that glipizide a. has a longer duration of action. b. has fewer gastrointestinal side effects. c. may be taken on an as-needed basis. d. results in less hypoglycemic potential. 18. A patient who has been taking a sulfonylurea antidiabetic medication will begin taking metformin (Glucophage). The nurse understands that this patient is at increased risk for which condition? a. Hypoglycemia b. Hyperglycemia c. Renal failure d. Respiratory distress 19. A 45-year-old patient who is overweight has had a diagnosis of type 2 diabetes for 2 years. The patient uses 20 units of insulin per day. The patients fasting blood glucose (FBG) is 190 mg/dL. The patient asks the nurse about using an oral antidiabetic agent. The nurse understands that oral antidiabetic agents a. cannot be used if the patient is overweight. b. cannot be used once a patient requires insulin. c. may be used since this patient meets criteria. d. may not be used since this patients fasting blood glucose is too high. Chapter 49: Pregnancy and Preterm Labor 1. A pregnant woman asks the nurse about whether a medication is safe to take during pregnancy. The nurse notes that the drug has a low molecular weight. Based on this drug characteristic, the nurse understands that this drug a. can cause greater gastrointestinal distress and hyperemesis. b. has reduced renal elimination resulting in toxicity. c. is more sensitive to metabolism by circulating maternal hormones. d. will be more likely to cross the placenta and affect the fetus. 2. A woman who is 4 weeks pregnant is worried that a medication she took until 3 weeks ago may cause birth defects. The nurse will tell her that a. drugs taken in the first week of pregnancy can cause CNS defects. b. medications have increased teratogenicity during the first week of pregnancy. c. she should have an ultrasound immediately. d. teratogenic effects are rare in the first 2 weeks of pregnancy. 3. Which statement by the nurse is accurate regarding iron supplementation during pregnancy? a. All women should take iron supplements throughout their pregnancy. b. Iron supplements are given to supply the fetus. c. Iron supplements usually are not necessary until the second trimester. d. The greatest iron demand is in the first trimester of pregnancy. 4. A patient who has just delivered her baby asks the nurse if she needs to continue taking her iron supplement. What instruction will the nurse provide to the patient? a. Continue taking iron for 6 more weeks. b. Stop taking the iron supplement now. c. Take the iron supplement while nursing. d. Take the iron only if your hemoglobin is low. 5. The nurse is teaching a woman who is pregnant about iron supplementation. Which statement by the woman indicates understanding of the teaching? a. I may take the iron with an antacid to reduce gastrointestinal upset. b. I should drink a glass of milk with iron to increase absorption. c. I should take the iron supplement with a glass of orange juice. d. I will stop taking the iron if my stools turn black and tarry. 6. A young woman who is contemplating pregnancy asks the nurse what she can do to get healthy in preparation for pregnancy. The nurse will recommend which dietary supplement? a. 60 mg of elemental iron per day b. 400 mg of folic acid per day c. 400 IU of vitamin D per day d. 1200 mg of calcium per day 7. A pregnant woman who has morning sickness asks the nurse what she can do to decrease her symptoms. The nurse will counsel her to take which action? a. Avoid fatty foods. b. Drink fluids with meals. c. Eat a large lunch and dinner. d. Take an iron supplement in the morning. 8. A pregnant woman asks the nurse if she must give up caffeinated coffee while pregnant. How will the nurse advise the patient? a. Two cups of coffee can increase your risk of spontaneous abortion. b. Drinking fewer than 6 cups of coffee per day is not harmful. c. You may consume coffee freely during your third trimester. d. There is evidence that caffeine is teratogenic. 9. The nurse is caring for a patient who is 6 to 7 weeks pregnant and has moderate to severe vomiting. The provider has ordered doxylamine (Unisom) and intravenous fluids. The patient reports a history of asthma and type 2 diabetes mellitus. The nurse will hold the drug and contact the provider because doxylamine should not be given to patients who a. are pregnant. b. are in their first trimester. c. have asthma. d. have diabetes. 10. A woman who is pregnant tells the nurse she has frequent heartburn in spite of eating small meals slowly; avoiding greasy, gas-forming foods, and remaining upright for 30 minutes after eating. The nurse will recommend which over-the-counter product? a. Alka-Seltzer b. Magaldrate c. Pepcid d. TUMS 11. A pregnant woman reports having constipation and has tried dietary changes without success. What will the nurse recommend? a. Bisacodyl (Dulcolax) b. Mineral oil c. Psyllium (Metamucil) d. Senna (Senokot) 12. A woman who is in her third trimester of pregnancy asks the nurse why she cannot take ibuprofen instead of acetaminophen for headaches. The nurse will explain that NSAIDs a. will affect her fetus. b. have renal toxicity. c. induce premature labor. d. prolong labor. 13. A woman who is experiencing premature labor is being given betamethasone (Celestone). She asks the nurse why this drug is being given. The nurse will explain that betamethasone is given for which reason? a. It lowers her blood pressure and prevents seizures. b. It prevents closure of the ductus arteriosus. c. It prevents respiratory distress in her infant. d. It stops her contractions. 14. The nurse is caring for a woman who is experiencing premature labor. The provider has ordered intravenous terbutaline (Brethine) to be given. The nurse will explain that this medication will have which action? a. It will decrease uterine contractions. b. It will enhance fetal lung development. c. It will increase fetal blood supply. d. It will lower her blood pressure. 15. The nurse is caring for a woman who is in labor and has a blood pressure of 180/98 mm Hg with proteinuria of 400 mg/24 hours. The woman is receiving magnesium sulfate. The woman becomes lethargic with slurring of her speech and decreased muscle tone. Her serum magnesium sulfate level is 11 mEq/L. The nurse recognizes which condition in this patient? a. Abruptio placenta b. Hypertensive crisis c. Impending eclampsia d. Magnesium toxicity 1. Which are physiologic changes during pregnancy that affect drug absorption, metabolism, distribution, and excretion? (Select all that apply.) a. Circulating steroid hormones b. Decreased gastrointestinal motility c. Decreased renal perfusion d. Increased maternal circulatory blood volume e. Poor sleep and fatigue f. Rapid respiratory rate , B, D Chapter 50: Labor, Delivery, and Postpartum 1. The nurse is caring for a woman who is in early labor. The woman wants to avoid pain medications as long as possible. What will the nurse tell her? a. I can give you a sedative-hypnotic now to help you relax. b. I can teach you some simple breathing exercises to help lessen discomfort. c. If you take fentanyl (Sublimaze) now, it will be more effective than if you wait. d. You may take ibuprofen, which wont cause drowsiness. 2. The nurse administers meperidine (Demerol) to a woman who is in early labor. Immediately after the drug is given, the womans labor progresses quickly, and she delivers her infant. The nurse will monitor the infant closely for which condition? a. Opioid withdrawal syndrome b. Orthostatic hypotension c. Respiratory depression d. Tachycardia and poor perfusion 3. The nurse is caring for an infant who is 2 days postpartum and notes that the infant has a poor sucking response. The nurse reviews the delivery record and will likely note that wh