NUR 4739 Pharm Nclex review-questions And Answers,100% CORRECT

NUR 4739 Pharm Nclex review-questions And Answers CH1 The nursing process and drug therapy 1. An 86-year-old patient is being discharged to home on digitalis therapy and has very little information regarding the medication. Which statement best reflects a realistic outcome of patient teaching activities? a. The patient and patient's daughter will state the proper way to take the drug. b. The nurse will provide teaching about the drug's adverse effects. c. The patient will state all the symptoms of digitalis toxicity. d. The patient will call the prescriber if adverse effects occur. 2. A patient has a new prescription for a blood pressure medication that may cause him to feel dizzy during the first few days of therapy. Which is the best nursing diagnosis for this situation? a. Activity intolerance b. Risk for injury c. Disturbed body image d. Self-care deficit 3. A patient's chart includes an order that reads as follows: “Atenolol 25 mg once daily at 0900.” Which action by the nurse is correct? a. The nurse gives the drug via the transdermal route. b. The nurse gives the drug orally. c. The nurse gives the drug intravenously. d. The nurse contacts the prescriber to clarify the dosage route. 4. The nurse is compiling a drug history for a patient. Which question from the nurse will obtain the most information from the patient? a. “Do you depend on sleeping pills to get to sleep?” b. “Do you have a family history of heart disease?” c. “When you have pain, what do you do to relieve it?” d. “What childhood diseases did you have?” 5. A 77-year-old man who has been diagnosed with an upper respiratory tract infection tells the nurse that he is allergic to penicillin. Which is the most appropriate response by the nurse? a. “Many people are allergic to penicillin.” b. “This allergy is not of major concern because the drug is given so often.” c. “What type of reaction did you have when you took penicillin?” d. “Drug allergies don't usually occur in older individuals dueto built-up resistance to allergic reactions.” 6. The nurse is preparing a care plan for a patient who has been newly diagnosed with type 2 diabetes mellitus. Which of these reflect the correct order of the steps of the nursing process? a. Assessment, Planning, Nursing Diagnoses, Implementation, Evaluation b. Evaluation, Assessment, Nursing Diagnoses, Planning, Implementation c. Nursing Diagnoses, Assessment, Planning, Implementation, Evaluation d. Assessment, Nursing Diagnoses, Planning, Implementation, Evaluation 7. The nurse is reviewing new medication orders that have been written for a newly admitted patient. The nurse will need to clarify which orders? (Select all that apply.) a. Metformin (Glucophage) 1000 mg PO twice a day b. Sitagliptin (Januvia) 50 mg daily c. Simvastatin (Zocor) 20 mg PO every evening d. Irbesartan (Avapro) 300 mg PO once a day e. Docusate (Colace) as needed for constipation 8. The nurse is reviewing data collected from a medication history. Which of these data are considered objective data? (Select all that apply.) a. White blood cell count 22,000 mm3 b. Blood pressure 150/94 mm Hg c. Patient rates pain as an “8” on a 10-point scale d. Patient's wife reports that the patient has been very sleepy during the day e. Patient's weight is 68 kg 1. a, 2. b, 3. d, 4. c, 5. c, 6. d, 7. b, e, 8. a, b, e CH2 Pharmacologic principles 1. An elderly woman took a prescription medicine to help her to sleep; however, she felt restless all night and did not sleep at all. The nurse recognizes that this woman has experienced which type of reaction or effect? a. Allergic reaction b. Idiosyncratic reaction c. Mutagenic effect d. Synergistic effect 2. While caring for a patient with cirrhosis or hepatitis, the nurse knows that abnormalities in which phase of pharmacokinetics may occur? a. Absorption b. Distribution c. Metabolism d. Excretion 3. A patient who had a thyroidectomy is now taking levothyroxine, a thyroid hormone, daily. Which term best describes this type of therapy? a. Palliative therapy b. Maintenance therapy c. Supportive therapy d. Supplemental therapy 4. The nurse is giving medications to a patient in heart failure. The intravenous route is chosen instead of the intramuscular route. What patient function does the nurse recognize as the most influential when deciding to use the intravenous route of drug administration? a. Altered biliary function b. Increased glomerular filtration c. Reduced liver metabolism d. Diminished circulation 5. A patient has just received a prescription for an enteric-coated stool softener. When teaching the patient, the nurse should include which statement? a. “Take the tablet with 2 to 3 ounces of orange juice.” b. “Avoid taking all other medications with any entericcoated tablet.” c. “Crush the tablet before swallowing if you have problems with swallowing.” d. “Be sure to swallow the tablet whole without chewing it.” 6. Each statement describes a phase of pharmacokinetics. Put the statements in order, with 1 indicating the phase that occurs first and 4 indicating the phase that occurs last. a. Enzymes in the liver transform the drug into an inactive metabolite. -3 b. Drug metabolites are secreted through passive glomerular filtration into the renal tubules. -4 c. A drug binds to the plasma protein albumin and circulates through the body. -2 d. A drug moves from the intestinal lumen into the mesenteric blood system. -1 7. A drug that delivers 300 mg has a half-life of 4 hours. How many milligrams of drug will remain in the body after 1 half-life? – 150 mg 8. The nurse is reviewing the various forms of topical medications. Which of these are considered topical medications? (Select all that apply.) a. Rectal ointment for hemorrhoids b. Eye drops for inflammation c. Sublingual tablet for chest pain d. Inhaled medication for asthma e. Intradermal injection for tuberculosis testing 1. b, 2. c, 3. b, 4. d, 5. d, 6. a = 3, b = 4, c = 2, d = 1, 7. 150 mg, 8. a, b, d CH3 Lifespan consideration 1. The nurse is reviewing factors that influence pharmacokinetics in the neonatal patient. Which factor puts the neonatal patient at risk with regard to drug therapy? a. Immature renal system b. Increased peristalsis in the GI tract c. Irregular temperature regulation d. Smaller circulatory capacity 2. The physiologic differences in the pediatric patient compared with the adult patient affect the amount of drug needed to produce a therapeutic effect. The nurse is aware that one of the main differences is that infants have a. increased protein in circulation. b. fat composition lower than 0.001%. c. more muscular body composition. d. water composition of approximately 75%. 3. While teaching a 76-year-old patient about the adverse effects of his medications, the nurse encourages him to keep a journal of the adverse effects he experiences. This intervention is important for the older adult patient because of which alterations in pharmacokinetics? a. Increased renal excretion of protein-bound drugs b. More alkaline gastric pH, resulting in more adverse effects c. Decreased blood flow to the liver, resulting in altered metabolism d. Less adipose tissue to store fat-soluble drugs 4. When the nurse is reviewing a list of medications taken by an 88-year-old patient, the patient says, “I get dizzy when I stand up.” She also states that she has nearly fainted “a time or two” in the afternoons. Her systolic blood pressure drops 15 points when she stands up. Which type of medication may be responsible for these effects? a. Nonsteroidal antiinflammatory drugs (NSAIDs) b. Cardiac glycosides c. Anticoagulants d. Antihypertensives 5. A pregnant patient who is at 32 weeks' gestation has a cold and calls the office to ask about taking an over-the-counter medication that is rated as pregnancy category A. Which answer by the nurse is correct? a. “This drug causes problems in the human fetus, so you should not take this medication.” b. “This drug may cause problems in the human fetus, but nothing has been proven in clinical trials. It is best not to take this medication.” c. “This drug has not caused problems in animals, but no testing has been done in humans. It is probably safe to take.” d. “Studies indicate that there is no risk to the human fetus, so it is okay to take this medication as directed if you need it.” 6. The nurse is preparing to administer an injection to a preschool-age child. Which approaches are appropriate for this age group? (Select all that apply.) a. Explain to the child in advance about the injection. b. Provide a brief, concrete explanation about the injection. c. Encourage participation in the procedure. d. Make use of magical thinking. e Provide comfort measures after the injection. 7. The nurse is preparing to give an oral dose of acetaminophen (Tylenol) to a child who weighs 12 kg. The dose is 15 mg/kg. How many milligrams will the nurse administer for this dose? 180 mg 8. An 82 year-old patient is admitted to the hospital after an episode of confusion at home. The nurse is assessing the current medications he is taking at home. Which method is the best way to assess his home medications? a. Ask the patient what medications he takes at home. b. Ask the patient's wife what medications he takes at home. c. Ask the patient's wife to bring his medications to the hospital in their original containers. d. Contact the patient's pharmacy for a list of the patient's current medications. 1. a, 2. d, 3. c, 4. d, 5. d, 6. b, d, e, 7. 180 mg, 8. c CH4 Cultural, legal, and ethical considerations 1. A patient has been diagnosed with late-stage cancer. After consulting with his family, he tells the nurse, “I would like to try to live long enough to see my granddaughter graduate in 3 months, but after that I don't want any extra treatments.” This patient is demonstrating which of these? a. Veracity b. Beneficence c. Maleficence d. Autonomy 2. When caring for an older adult Chinese patient, the nurse recognizes that which of these cultural issues may influence the care of this patient? a. Chest x-rays are seen as a break in the soul's integrity. b. Hospital diets are interpreted as being healing and healthful. c. The use of heat may be an important practice for this patient. d. Being hospitalized is a source of peace and socialization for this culture. 3. A patient is being counseled for possible participation in a clinical trial for a new medication. After the patient meets with the physician, the nurse is asked to obtain the patient's signature on the consent forms. The nurse knows that this “informed consent” indicates which of the following? a. Once therapy has begun, the patient cannot withdraw from the clinical trial. b. The patient has been informed of all potential hazards and benefits of the therapy. c. The patient has received only the information that will help to make the clinical trial a success. d. No matter what happens, the patient will not be able to sue the researchers for damages. 4. A new drug has been approved for use, and the drug manufacturer has made it available for sale. During the first 6 months, the FDA receives reports of severe adverse effects that were not discovered during the testing and considers withdrawing the drug. This illustrates which phase of investigational drug studies? a. Phase I b. Phase II c. Phase III d. Phase IV 5. A patient of Japanese descent describes a family trait that manifests frequently: She says that members of her family often have “strong reactions” after taking certain medications, but her white friends have no problems with the same dosages of the same drugs. The nurse recognizes that, because of this trait, which statement applies? a. She may need lower dosages of the medications prescribed. b. She may need higher dosages of the medications prescribed. c. She should not receive these medications because of potential problems with metabolism. d. These situations vary greatly, and her accounts may not indicate a valid cause for concern. 6. When evaluating polymorphism and medication administration, the nurse considers which factors? (Select all that apply.) a. Nutritional status b. Drug route c. Genetic factors d. Cultural beliefs e. Patient's age 7. The nurse is reviewing the four clinical phases of investigational drug studies. Place the four phases in the correct order of occurrence. a. Studies that are voluntarily conducted by pharmaceutical companies to obtain more information about the therapeutic and adverse effects of a drug. 4 b. Studies that involve small numbers of volunteers who have the disease or ailment that the drug is designed to diagnose or treat. 2 c. Studies that involve small numbers of healthy subjects who do not have the disease or ailment that the drug is intended to treat. 1 d. Studies that involve large numbers of patients who have the disease that the drug is intended to treat; these studies establish the drug's clinical effectiveness, safety, and dosage range. 3 8. A patient shows the nurse an article in the newspaper about a new black box warning and states, “I take this drug! Is it safe for me to take now?” What is meant by a black box warning? a. The FDA is asking for a mandatory recall of this drug. b. Serious adverse effects have been reported with this drug, and he will not be able to take it again because the risks outweigh the benefits. c. Even though severe adverse effects have been reported, it can still be prescribed as long as the prescriber and patient are aware of the potential risks. d. Pharmacies will no longer be able to dispense this drug to patients.1. d, 2. c, 3. b, 4. d, 5. a, 6. a, c, d, e, 7. a = 4, b = 2, c = 1, d = 3, 8. C CH5 Medication errors: preventing and responding 1. The nurse keeps in mind that which measure is used to reduce the risk of medication errors? a. When questioning a drug order, keep in mind that the prescriber is correct. b. Be careful about questioning the drug order a board-certified physician has written for a patient. c. Always double-check the many drugs with sound-alike and look-alike names because of the high risk of error. d. If the drug route has not been specified, use the oral route. 2. During the medication administration process, it is important that the nurse remembers which guideline? a. When in doubt about a drug, ask a colleague about it before giving the drug. b. Ask what the patient knows about the drug before giving it. c. When giving a new drug, be sure to read about it after giving it. d. If a patient expresses a concern about a drug, stop, listen, and investigate the concerns. 3. If a student nurse realizes that he or she has made a drug error, the instructor should remind the student of which concept? a. The student bears no legal responsibility when giving medications. b. The major legal responsibility lies with the health care institution at which the student is placed for clinical experience. c. The major legal responsibility for drug errors lies with the faculty members. d. Once the student has committed a medication error, his or her responsibility is to the patient and to being honest and accountable. 4. The nurse is giving medications to a newly admitted patient who is to receive nothing by mouth (NPO status) and finds an order written as follows: “Digoxin, 250 mcg stat.” Which action is appropriate? a. Give the medication immediately (stat) by mouth because the patient has no IV access at this time. b. Clarify the order with the prescribing physician before giving the drug. c. Ask the charge nurse what route the physician meant to use. d. Start an IV line, then give the medication IV so that it willwork faster, because the patient's status is NPO at this time. 5. The nurse is reviewing medication orders. Which digoxin dose is written correctly? a. digoxin .25 mg b. digoxin .250 mg c. digoxin 0.250 mg d. digoxin 0.25 mg 6. The nurse is administering medications. Examples of high-alert medications include: (Select all that apply.) a. Chemotherapeutic agents b. Antibiotics c. Opiates d. Antithrombotics e. Potassium chloride for injection 7. Convert 250 micrograms to milligrams. Be sure to depict the number correctly according to the guidelines for decimals and zeroes. 0.25 mg 8. The nurse is performing medication reconciliation during a patient's admission assessment. Which question by the nurse reflects medication reconciliation? a. “Do you have any medication allergies?” b. “Do you have a list of all the medications, including over the-counter, you are currently taking?” c. “Do you need to take anything to help you to sleep at night?” d. “What pharmacies do you use when you fill your prescriptions?” 1. c, 2. d, 3. d, 4. b, 5. d, 6. a, c, d, e, 7. 0.25 mg, 8. b. CH6 Patient education and drug therapy 1. A 47-year-old patient with diabetes is being discharged to home and must take insulin injections twice a day. The nurse keeps in mind which concepts when considering patient teaching? a. Teaching needs to begin at the time of diagnosis or admission and is individualized to the patient's reading b. The nurse can assume that because the patient is in his forties he will be able to read any written or printed documents provided. c. The majority of teaching can be done with pamphlets that the patient can share with family members. d. A thorough and comprehensive teaching plan designed for an eleventh-grade reading level needs to be developed. 2. The nurse is developing a discharge plan regarding a patient's medication. Which of these statements about the discharge plan is true? a. It will be developed right before the patient leaves the hospital. b. It will be developed only after the patient is comfortable or after pain medications are administered. c. It will include videos, demonstrations, and instructions written at least at the fifth-grade level. d. It will be individualized and based on the patient's level of cognitive development. 3. The nurse is responsible for preoperative teaching for a patient who is mildly anxious about receiving pain medications postoperatively. The nurse recognizes that this level of anxiety may a. impede learning because anxiety is always a barrier to learning. b. lead to major emotional unsteadiness. c. result in learning by increasing the patient's motivation to learn. d. reorganize the patient's thoughts and lead to inadequate potential for learning. 4. What action by the nurse is the best way to assess a patient's learning needs? a. Quiz the patient daily on all medications. b. Begin with validation of the patient's present level of knowledge. c. Assess family members' knowledge of the prescribed medication even if they are not involved in the patient's care. d. Ask the caregivers what the patient knows about the medications. 5. Which technique would be most appropriate to use when the nurse is teaching a patient with a language barrier? a. Obtain an interpreter who can speak in the patient's native tongue for teaching sessions. b. Use detailed explanations, speaking slowly and clearly. c. Assume that the patient understands the information presented if the patient has no questions. d. Provide only written instructions. 6. A nursing student is identifying situations that involve the psychomotor domain of learning as part of a class project. Which are examples of learning activities that involve the psychomotor domain? (Select all that apply.) a. Teaching a patient how to self-administer eyedrops b. Having a patient list the adverse effects of an antihypertensive drug c. Discussing what foods to avoid while taking antilipemic drugs d. Teaching a patient how to measure the pulse before taking a beta blocker e. Teaching a family member how to give an injection f. Teaching a patient the rationale for checking a drug's blood level 7. The nurse is instructing an older adult patient on how to use his walker. Which education strategies are appropriate? (Select all that apply.) a. Speak slowly and loudly. b. Ensure a quiet environment for learning. c. Repeat information frequently. d. Allow for an increased number of return demonstrations. e. Provide all the information in one teaching session. 8. You are reviewing newly prescribed medications with the wife of a patient who will be discharged today on a liquid diet after jaw surgery. She will be giving the patient his medications. There is a prescription for liquid metoclopramide (Reglan), 10 mg PO before breakfast and dinner. The medication is available in a strength of 5 mg/mL. How many mL will she need to give for each dose? Ans.- 2 mL 1. a, 2. d, 3. c, 4. b, 5. a, 6. a, d, e, 7. b, c, d, 8. 2 mL CH7 Over-the-counter drugs and herbal and dietary supplements 1. The nurse is reviewing dietary supplements and recalls that the FDA requires manufacturers of dietary supplements to a. follow FDA standards for quality control. b. prove efficacy and safety of dietary supplements. c. identify the active ingredients on the label. d. obtain FDA approval before the products are marketed. 2. When educating patients about the safe use of herbal products, the nurse remembers to include which concept? a. Herbal and over-the-counter products are approved by the FDA and under strict regulation. b. Herbal products are tested for safety by the FDA and the U.S. Pharmacopeia. c. No adverse effects are associated with these products because they are natural and may be purchased without a prescription. d. Take the product with caution because labels may not contain reliable information. 3. When taking a patient's drug history, the nurse asks about use of over-the-counter drugs. The patient responds by saying, “Oh, I frequently take aspirin for my headaches, but I didn't mention it because aspirin is nonprescription.” What is the nurse's best response? a. “That's true; over-the-counter drugs are generally not harmful.” b. “Aspirin is one of the safest drugs out there.” c. “Although aspirin is over the counter, it's still important to know why you take it, how much you take, and how often.” d. “We need you to be honest about the drugs you are taking. Are there any others that you haven't told us about?” 4. When making a home visit to a patient who was recently discharged from the hospital, the nurse notes that she has a small pack over her chest and that the pack has a strong odor. She also is drinking herbal tea. When asked about the pack and the tea, the patient says, “Oh, my grandmother never used medicines from the doctor. She told me that this plaster and tea were all I would need to fix things.” Which response by the nurse is most appropriate? a. “You really should listen to what the doctor told you if you want to get better.” b. “What's in the plaster and the tea? When do you usually use them?” c. “These herbal remedies rarely work, but if you want to use them, then it is your choice.” d. “It's fine if you want to use this home remedy, as long as you use it with your prescription medicines.” 5. A patient tells the nurse that he has been using an herbal supplement that contains kava for several years to help him to relax in the evening. However, the nurse notes that he has a yellow tinge to his skin and sclera, and is concerned about liver toxicity. The nurse advises the patient to stop taking the kava and to see his health care provider for an examination. What else, if anything, should the nurse do at this time? a. Report this incident to MedWatch. b. Notify the state's pharmaceutical board. c. Contact the supplement manufacturer. d. No other action is needed. 6. The nurse is reviewing the drug history of a patient, and during the interview the patient asks, “Why are some drugs over-the- counter and others are not?” The nurse keeps in mind that criteria for over-the-counter status include: (Select all that apply.) a. The condition must be diagnosed by a health care provider. b. The benefits of correct usage of the drug outweigh the risks. c. The drug has limited interaction with other drugs. d. The drug is easy to use. e. The drug company sells OTC drugs at lower prices. 7. A patient comes to the clinic complaining of elbow pain after an injury. He states that he has been taking two pain pills, eight times a day, for the past few days. The medication bottle contains acetaminophen, 325-mg tablets. Calculate how much medication he has been taking per day. Is this a safe dose of this medication? 5200 mg/day 8. The nurse is reviewing definitions for a pharmacology review class. Which of these products would be categorized as “legend drugs?” (Select all that apply.) a. acetaminophen (Tylenol) b. warfarin (Coumadin) c. gingko biloba d. morphine sulfate e. diphenhydramine (Benadryl) 1. c, 2. d, 3. c, 4. b, 5. a, 6. b, c, d, 7. 5200 mg/day, No, 8. b, d CH8 Gene therapy and pharmacogenomics 1. Which is the most appropriate example of a product formed by an indirect form of gene therapy? a. Stem cells b. Vaccines c. Antigen substitution d. Platelet inhibitors 2. The nurse is explaining the general goal of gene therapy to a patient. With gene therapy, the general goal is to transfer exogenous genes to a patient for which result? a. To change the patient's own genetic functioning to treat a given disease b. To improve drug metabolism c. To prevent genetic disorders in the patient's future children d. To stimulate the growth of stem cells 3. The nurse is reviewing genetic concepts. Which is considered the biologic unit of heredity? a. Gene b. Allele c. Chromosome d. Nucleic acid 4. The presence of certain factors in a person's genetic makeup that increase the likelihood of eventually developing one or more diseases is known as a a. genetic mutation. b. genetic polymorphism. c. genetic predisposition. d. genotype. 5. The nurse is reviewing gene therapy. Which is the primary molecule in the body that serves to transfer genes from parents to offspring? a. RNA b. DNA c. Allele d. Chromosome 6. General responsibilities of the nurse regarding genetics may include which of these activities? (Select all that apply.) a. Assessing the patient's personal and family history b. Referring the patient to a genetic counselor or other genetics specialist c. Communicating the results of genetic tests to the patient and patient's family d. Maintaining privacy and confidentiality during the testing process e. Answering questions about genetic test results 7. The nurse is assessing a patient for a possible increased risk for genetic disorders. Which of these, if present, may indicate an increased risk for a genetic disorder? (Select all that apply.) a. Having a brother who died of a myocardial infarction at age 29 b. Having a family member who has been diagnosed with more than one type of cancer c. Having an uncle who was diagnosed with prostate cancer at age 73 d. A history of allergy to shellfish and iodine e. Having a maternal grandmother, two maternal aunts, and a sister who were diagnosed with colon cancer 8. Liquid potassium chloride is ordered as follows: Give 16 mEq per PEG tube twice a day. The dose on hand contains 20 mEq/15 mL. How much will the nurse give per dose? 12 mL 1. b, 2. a, 3. a, 4. c, 5. b, 6. a, b, d, 7. a, b, e, 8. 12 mL CH10 Analgesic drugs 1. For best results when treating severe pain associated with pathologic spinal fractures related to metastatic bone cancer, the nurse should remember that the best type of dosage schedule is to administer the pain medication a. as needed. b. around the clock. c. on schedule during waking hours only. d. around the clock, with additional doses as needed for breakthrough pain. 2. A patient is receiving an opioid via a PCA pump as part of his postoperative pain management program. During rounds, the nurse finds him unresponsive, with respirations of 8 breaths/min and blood pressure of 102/58 mm Hg. After stopping the opioid infusion, what should the nurse do next? a. Notify the charge nurse b. Draw arterial blood gases c. Administer an opiate antagonist per standing orders d. Perform a thorough assessment, including mental status examination 3. A patient with bone pain caused by metastatic cancer will be receiving transdermal fentanyl patches. The patient asks the nurse what benefits these patches have. The nurse's best response includes which of these features? a. More constant drug levels for analgesia b. Less constipation and minimal dry mouth c. Less drowsiness than with oral opioids d. Lower dependency potential and no major adverse effects 4. Intravenous morphine is prescribed for a patient who has had surgery. The nurse informs the patient that which common adverse effects can occur with this medication? (Select all that apply.) a. Diarrhea b. Constipation c. Pruritus d. Urinary frequency e. Nausea 5. Several patients have standard orders for acetaminophen as needed for pain. While reviewing their histories and assessments, the nurse discovers that one of the patients has a contraindication to acetaminophen therapy. Which patient should receive an alternate medication? a. A patient with a fever of 103.4° F (39.7° C) b. A patient admitted with deep vein thrombosis c. A patient admitted with severe hepatitis d. A patient who had abdominal surgery 1 week earlier 6. The nurse is administering an intravenous dose of morphine sulfate to a 48-yearold postoperative patient. The dose ordered is 3 mg every 3 hours as needed for pain. The medication is supplied in vials of 4 mg/mL. How much will be drawn into the syringe for this dose? 0.75 mL 7. An opioid analgesic is prescribed for a patient. The nurse checks the patient's medical history knowing this medication is contraindicated in which disorder? a. Renal insufficiency b. Severe asthma c. Liver disease d. Diabetes mellitus 8. A patient with renal cancer needs an opiate for pain control. Which opioid medication would be the safest choice for this patient? a. fentanyl b. hydromorphone (Dilaudid) c. morphine sulfate d. methadone (Dolophine) 1. d, 2. c, 3. a, 4. b, c, e 5. c, 6. 0.75 mL, 7. b, 8. D CH11 General and local anesthetics 1. The physician has requested “lidocaine with epinephrine.” The nurse recognizes that the most important reason for adding epinephrine is that it a. helps to calm the patient before the procedure. b. minimizes the risk for an allergic reaction. c. enhances the effect of the local lidocaine. d. reduces bleeding in the surgical area. 2. The surgical nurse is reviewing operative cases scheduled for the day. Which of these patients is more prone to complications from general anesthesia? a. A 79-year-old woman who is about to have hip replacement surgery b. A 49-year-old male athlete who quit heavy smoking 12 years ago c. A 30-year-old woman who is in perfect health but has never had anesthesia d. A 50-year-old woman scheduled for outpatient laser surgery for vision correction 3. Which nursing diagnosis is possible for a patient who is now recovering after having been under general anesthesia for 3 to 4 hours during surgery? a. Impaired urinary elimination related to the use of vasopressors as anesthetics b. Increased cardiac output related to the effects of general anesthesia c. Risk for falls related to decreased sensorium for 2 to 4 days postoperatively d. Impaired gas exchange due to the CNS depressant effect of general anesthesia 4. A patient is recovering from general anesthesia. What is the nurse's main concern during the immediate postoperative period? a. Airway b. Pupillary reflexes c. Return of sensations d. Level of consciousness 5. A patient is about to undergo cardioversion, and the nurse is reviewing the procedure and explaining moderate sedation with propofol. The patient asks, “I am afraid of feeling it when they shock me.” What is the nurse's best response? a. “You won't receive enough of a shock to feel anything.” b. “You will feel the shock but you won't remember any of the pain.” c. “These medications will help ease any pain during the procedure, and many patients often report having no recollection of the procedure.” d. “They will give you enough pain medication to prevent you from feeling it.” 6. The nurse is administering an NMBD to a patient during a surgical procedure. Number the following phases of muscle paralysis in the order in which the patient will experience them. (Number 1 is the first step.) a. Paralysis of intercostals and diaphragm muscles -4 b. Muscle weakness -1 c. Paralysis of muscles of the limbs, neck, and trunk -3 d. Paralysis of small rapidly moving muscles (fingers, eye) -2 7. During a patient's recovery from a lengthy surgery, the nurse monitors for signs of malignant hyperthermia. In addition to a rapid rise in body temperature, which assessment findings would indicate the possible presence of this condition? (Select all that apply.) a. Respiratory depression b. Tachypnea c. Tachycardia d. Seizure activity e. Muscle rigidity 8. A patient will be receiving diazepam (Valium), 2 mg, IV push as part of preprocedure sedation. The medication is available in an injectable solution of 5 mg/mL. How many milliliters will the nurse give for this dose? 0.4 mL 1. d, 2. a, 3. d, 4. a, 5. c, 6. a = 4, b = 1, c = 3, d = 2, 7. b, c, e, 8. 0.4 mL CH12 Central nervous system depressants and muscle depressants 1. A patient has been admitted to the emergency department because of an overdose of an oral benzodiazepine. He is very drowsy but still responsive. The nurse will prepare for which immediate intervention? a. Hemodialysis to remove the medication b. Administration of flumazenil c. Administration of naloxone d. Intubation and mechanical ventilation 2. An older adult has been given a benzodiazepine for sleep induction, but the night nurse noted that the patient was awake most of the night, watching television and reading in bed. The nurse documents that the patient has had which type of reaction to the medication? a. Allergic b. Teratogenic c. Paradoxical d. Idiopathic 3. The nurse is preparing to administer a medication for sleep. Which intervention applies to the administration of a nonbenzodiazepine, such as zaleplon (Sonata)? a. These drugs need to be taken about 1 hour before bedtime. b. Because of their rapid onset, these drugs need to be taken just before bedtime. c. The patient needs to be cautioned about the high incidence of morning drowsiness that may occur after taking these drugs. d. These drugs are less likely to interact with alcohol. 4. The nurse will monitor the patient who is taking a muscle relaxant for which adverse effect? a. CNS depression b. Hypertension c. Peripheral edema d. Blurred vision 5. A hospitalized patient is complaining of having difficulty sleeping. Which action will the nurse take first to address this problem? a. Administer a sedative-hypnotic drug if ordered. b. Offer tea made with the herbal preparation valerian. c. Encourage the patient to exercise by walking up and down the halls a few times if tolerated. d. Provide an environment that is restful, and reduce loud noises. 6. Which considerations are important for the nurse to remember when administering a benzodiazepine as a sedative- hypnotic drug? (Select all that apply.) a. These drugs are intended for long-term management of insomnia. b. The drugs can be administered safely with other CNS depressants for insomnia. c. The dose needs to be given about 1 hour before the patient's bedtime. d. The drug is used as a first choice for treatment of sleeplessness. e. The patient needs to be evaluated for the drowsiness that may occur the morning after a benzodiazepine is taken. 7. A child is to receive phenobarbital 2 mg/kg IV on call as a preoperative sedative. The child weighs 64 pounds. How many milligrams will the child receive for this dose? (Record your answer using one decimal place.) 58.2 mg 8. The nurse is reviewing the prescriptions for a patient who will be discharged to home after being hospitalized for a hysterectomy. The patient asked for a sleeping pill, and the surgeon wrote a prescription for Ambien, 10 mg at bedtime as needed for sleep. What is the nurse's priority action at this time? a. Review the potential adverse effects with the patient. b. Suggest that the patient try drinking a glass of wine at bedtime. c. Contact the prescriber to question the dose of the Ambien. d. Assist the patient to find a pharmacy to fill the prescription on her way home. 1. b, 2. c, 3. b, 4. a, 5. d, 6. c, e, 7. 58.2 mg, 8. c CH13 Central nervous system depressants and muscle relaxants 1. A patient with narcolepsy will begin treatment with a CNS stimulant. The nurse expects to see which adverse effect? a. Bradycardia b. Nervousness c. Mental clouding d. Drowsiness at night 2. A patient at a weight management clinic who was given a prescription for orlistat (Xenical) calls the clinic hotline complaining of a “terrible side effect.” The nurse suspects that the patient is referring to which problem? a. Nausea b. Sexual dysfunction c. Urinary incontinence d. Fecal incontinence 3. The nurse is developing a plan of care for a patient receiving an anorexiant. Which nursing diagnosis is most appropriate? a. Deficient fluid volume b. Sleep deprivation c. Impaired memory d. Imbalanced nutrition, less than body requirements 4. A patient has a new prescription for sumatriptan (Imitrex). The nurse providing patient teaching on self-administration will include which information? a. Correct technique for intramuscular injections b. Take the medication before the headache worsens. c. Allow at least 30 minutes between injections. d. Take no more than 4 doses in a 24-hour period. 5. The nurse is reviewing the history of a patient who will be starting the triptan sumatriptan (Imitrex) as part of treatment for migraine headaches. Which condition, if present, may be a contraindication to triptan therapy? a. Cardiovascular disease b. Chronic bronchitis c. History of renal calculi d. Diabetes mellitus type 2 6. The nurse is reviewing medication therapy with the parents of an adolescent with ADHD. Which statement is correct? (Select all that apply.) a. “Be sure to have your child blow his nose before administering the nasal spray.” b. “This medication is used only when symptoms of ADHD are severe.” c. “The last dose should be taken 4 to 6 hours before bedtime to avoid interference with sleep.” d. “Be sure to contact the physician right away if you notice expression of suicidal thoughts.” e. “We will need to check your child's height and weight periodically to monitor physical growth.” f. “If adverse effects become severe, stop the medication for 3 to 4 days.” 7. The medication order reads: “Atomoxetine (Strattera) 1.2 mg/kg/day in 2 divided doses.” The child weighs 66 lbs. How much will be given with each dose? 18 mg per dose 8. A patient with narcolepsy is having problems with excessive daytime sleepiness. The nurse expects which drug to be prescribed to improve the patient's wakefulness? a. phentermine (Ionamin) b. almotriptan (Axert) c. modafinil (Provigil) d. methylphenidate (Ritalin) 1. b, 2. d, 3. d, 4. b, 5. a, 6. c, d, e, 7. 18 mg per dose, 8. C CH14 Antiepileptic drugs 1. The nurse is preparing to give medications. Which is the most appropriate nursing action for intravenous (IV) phenytoin (Dilantin)? a. Give IV doses via rapid IV push. b. Administer in normal saline solutions. c. Administer in dextrose solutions. d. Ensure continuous infusion of the drug. 2. The nurse is reviewing the drugs currently taken by a patient who will be starting drug therapy with carbamazepine (Tegretol). Which drug may raise a concern for interactions? a. digoxin (Lanoxin) b. acetaminophen (Tylenol) c. diazepam (Valium) d. warfarin (Coumadin) 3. Which response would the nurse expect to find in a patient with a phenytoin (Dilantin) level of 25 mcg/mL? a. Ataxia b. Hypertension c. Seizures d. No unusual response; this level is therapeutic. 4. A patient is taking pregabalin (Lyrica) but does not have a history of seizures. The nurse recognizes that this drug is also indicated for a. postherpetic neuralgia. b. viral infections. c. Parkinson's disease. d. depression. 5. The nurse is assessing a newly admitted patient who has a history of seizures. During the assessment, the patient has a generalized seizure that does not stop for several minutes. The nurse expects that which drug will be ordered for this condition? a. valproic acid (Depakote) b. neurontin (Gabapentin) c. carbamazepine (Tegretol) d. diazepam (Valium) 6. The nurse is administering an antiepileptic drug and will follow which guidelines? (Select all that apply.) a. Monitor the patient for drowsiness. b. Medications may be stopped if seizure activity disappears. c. Give the medication at the same time every day. d. Give the medication on an empty stomach. e. Notify the prescriber if the patient is unable to take the medication. 7. The nurse is preparing to administer valproic acid to a child. The order reads: “Give valproic acid, 15 mg/kg/day PO in three divided doses.” The child weighs 33 pounds. How many milligrams will the child receive with each dose? 75 mg/dose 8. The nurse is providing education for a patient who will be taking an antiepileptic drug for the first time. Which statement by the patient indicates that further teaching is indicated? a. “I will take the medicine at the same time every day.” b. “I will check with my doctor before taking any over-the counter drugs.” c. “I will keep the appointments to check my bloodwork.” d. “I can drive to work again once my drug levels are normal.” 1. b, 2. b, 3. a, 4. a, 5. d, 6. a, c, e, 7. 75 mg per dose, 8. d CH15 Antiparkinson drugs 1. Which condition will alert the nurse to a potential caution or contraindication regarding the use of a dopaminergic drug for treatment of mild Parkinson's disease? a. Diarrhea b. Tremors c. Angle-closure glaucoma d. Unstable gait 2. A patient is taking entacapone (Comtan) as part of the therapy for Parkinson's disease. Which intervention by the nurse is appropriate at this time? a. Notify the patient that this drug causes discoloration of the urine. b. Limit the patient's intake of tyramine-containing foods. c. Monitor the results of renal studies because this drug can seriously affect renal function. d. Force fluids to prevent dehydration. 3. During a patient teaching session about antiparkinson drugs, the nurse will include which statement? a. “The drug will be stopped when tremors and weakness are relieved.” b. “If a dose is missed, take two doses to avoid significant decreases in blood levels.” c. “Be sure to notify your physician if your urine turns brownish-orange in color.” d. “Take care to change positions slowly to prevent falling due to a drop in blood pressure.” 4. A patient will be taking selegiline (Eldepryl), 10 mg daily, in addition to dopamine replacement therapy for Parkinson's disease. The nurse will implement which precautions regarding selegiline? a. Teach the patient to avoid foods containing tyramine. b. Monitor for dizziness. c. Inform the patient that this drug may cause urine discoloration. d. Monitor for weight gain. 5. A patient with Parkinson's disease will start taking entacapone (Comtan) along with the carbidopa-levodopa (Sinemet) he has been taking for a few years. The nurse recognizes that the advantage of taking entacapone is that a. the entacapone can reduce on-off effects. b. the levodopa may be stopped in a few days. c. there is less GI upset with entacapone. d. it does not cause the cheese effect. 6. The nurse is assessing a patient who has begun therapy with amantadine (Symmetrel) for Parkinson's disease. The nurse will look for which possible adverse effects? (Select all that apply.) a. Nausea b. Palpitations c. Dizziness d. Insomnia e. Fatigue 7. The order reads: bromocriptine (Parlodel) 10 mg per day PO. The medication is available in 2.5-mg tablets. How many tablets will the nurse give per dose? 4 tablets 8. A patient who has been taking carbidopa-levodopa for Parkinson's disease for over 1 year wants to start a low- carbohydrate/high-protein weight-loss diet. The nurse tells the patient that this type of diet may have what effect on his drug therapy? a. There will be no problems with this diet while on this medication. b. The high-protein diet can slow or prevent absorption of this medication. c. The high-protein diet may cause increased blood levels of this medication. d. The high-protein diet will cause no problems as long as the patient also takes pyridoxine (vitamin B6). 1. c, 2. a, 3. d, 4. b, 5. a, 6. a, c, d, 7. 4 tablets, 8. B CH16 Psychotherapeutic 1. In caring for a patient experiencing ethanol withdrawal, the nurse expects to administer which medication or medication class as treatment for this condition? a. lithium (Eskalith) b. Benzodiazepines c. buspirone (BuSpar) d. Antidepressants 2. Patient teaching for a patient receiving an MAOI would include instructions to avoid which food product? a. Orange juice b. Milk c. Shrimp d. Swiss cheese 3. After a patient has been treated for depression for 4 weeks, the nurse calls the patient to schedule a follow-up visit. What concern will the nurse assess for during the conversation with the patient? a. Weakness b. Hallucinations c. Suicidal ideation d. Difficulty with urination 4. The nurse is caring for a patient who has been taking clozapine (Clozaril) for 2 months. Which laboratory test(s) should be performed regularly while the patient is taking this medication? a. Platelet count b. WBC count c. Liver function studies d. Renal function studies 5. The nurse is giving medications to a patient. Which drug or drug class, when administered with lithium, increases the risk for lithium toxicity? a. Thiazides b. levofloxacin c. calcium citrate d. Beta blockers 6. The nurse is teaching a patient about treatment with an SSRI antidepressant. Which teaching considerations are appropriate? (Select all that apply.) a. The patient should be told which foods contain tyramine and instructed to avoid these foods. b. The patient should be instructed to use caution when standing up from a sitting position. c. The patient should not take any products that contain the herbal product St. John's wort. d. This medication should not be stopped abruptly. e. Drug levels may become toxic if dehydration occurs. f. The patient should be told to check with the prescriber before taking any over-the-counter medications. 7. A patient with a feeding tube will be receiving risperidone (Risperdal) 8 mg in 2 divided doses via the feeding tube. The medication is available in a 1 mg/mL solution. How many milliliters will the nurse administer for each dose? 4 mL per dose 8. A patient who has been taking lithium for 6 months has had severe vomiting and diarrhea from a gastrointestinal flu. The nurse will assess for which potential problem at this time? a. Anxiety b. Chest pain c. Agitation d. Dehydration 1. b, 2. d, 3. c, 4. b, 5. a, 6. b, c, d, f, 7. 4 mL per dose, 8. D CH17 Substance abuse 1. A patient is experiencing withdrawal from opioids. The nurse expects to see which assessment finding most commonly associated with acute opioid withdrawal? a. Elevated blood pressure b. Decreased pulse c. Lethargy d. Constipation 2. During treatment for withdrawal from opioids, the nurse expects which medication to be ordered? a. amphetamine (Dexedrine) b. clonidine (Catapres) c. diazepam (Valium) d. disulfiram (Antabuse) 3. The nurse is presenting a seminar on substance abuse. Which drug is the most commonly used illicit drug in the United States? a. Crack cocaine b. Heroin c. Marijuana d. Methamphetamine 4. A patient who is taking disulfiram as part of an alcohol treatment program accidentally takes a dose of cough syrup that contains a small percentage of alcohol. The nurse expects to see which symptom as a result of acetaldehyde syndrome? a. Lethargy b. Copious vomiting c. Hypertension d. No ill effect because of the small amount of alcohol in the cough syrup 5. The nurse is assessing a patient for possible substance abuse. Which assessment finding indicates possible use of amphetamines? a. Lethargy and fatigue b. Cardiovascular depression c. Talkativeness and euphoria d. Difficulty swallowing and constipation 6. A patient experiencing ethanol withdrawal is beginning to show severe manifestations of delirium tremens. The nurse will plan to implement which interventions for this patient? (Select all that apply.) a. Doses of an oral benzodiazepine b. Doses of an intravenous benzodiazepine c. Restraints if the patient becomes confused, agitated, or a threat to himself or others d. Thiamine supplementation e. Oral disulfiram (Antabuse) treatment f. Monitoring in the intensive care unit 7. A patient has been admitted to the emergency department after a suspected overdose of benzodiazepines mixed with alcohol. The patient is lethargic and cannot speak. The nurse expects which immediate measures to be implemented? (Select all that apply.) a. Prepare to administer naloxone (Narcan). b. Prepare to administer flumazenil. c. Monitor the patient for convulsions. d. Prepare for potential respiratory arrest. e. Apply restraints. 8. The nurse is teaching a class about the effects of alcohol. Long-term excessive use of alcohol is associated with which of these problems? (Select all that apply.) a. Coronary artery disease b. Wernicke's encephalopathy c. Polyneuritis d. Seizures e. Cirrhosis of the liver f. Korsakoff's psychosis 1. a, 2. b, 3. c, 4. b, 5. c, 6. b, c, d, f, 7. b, c, d, 8. b, c, e, f CH18 Adrenergic drugs 1. The nurse caring for a patient who is receiving beta1 agonist drug therapy needs to be aware that these drugs cause which effect? a. Increased cardiac contractility b. Decreased heart rate c. Bronchoconstriction d. Increased GI tract motility 2. During a teaching session for a patient who is receiving inhaled salmeterol, the nurse emphasizes that the drug is indicated for which condition? a. Rescue treatment of acute bronchospasms b. Prevention of bronchospasms c. Reduction of airway inflammation d. Long-term treatment of sinus congestion 3. For a patient receiving a vasoactive drug such as intravenous dopamine, which action by the nurse is most appropriate? a. Monitor the gravity drip infusion closely, and adjust as needed. b. Assess the patient's cardiac function by checking the radial pulse. c. Assess the intravenous site hourly for possible infiltration. d. Administer the drug by intravenous boluses according to the patient's blood pressure. 4. A patient is receiving dobutamine for shock and is complaining of feeling more “skipping beats” than yesterday. What will the nurse do next? a. Monitor for other signs of a therapeutic response to the drug. b. Titrate the drug to a higher dose to reduce the palpitations. c. Discontinue the dobutamine immediately. d. Assess the patient's vital signs and cardiac rhythm. 5. When a drug is characterized as having a negative chronotropic effect, the nurse knows to expect which effect? a. Reduced blood pressure b. Decreased heart rate c. Decreased ectopic beats d. Increased force of cardiac contractions 6. The nurse is monitoring a patient who is receiving an infusion of a betaadrenergic agonist. Which adverse effects may occur with this infusion? (Select all that apply.) a. Mild tremors b. Bradycardia c. Tachycardia d. Palpitations e. Drowsiness f. Nervousness 7. The order reads: “Dopamine 3 mcg/kg/min IV.” The solution available is 400 mg in 250 mL D5W, and the patient weighs 176 pounds. The nurse will set the IV infusion pump to run at how many mL/hour? 9 mL/hr 8. The nurse is reviewing the home medications for a newly admitted patient, and notes that the patient takes Mirabegron (Myrbetriq). The nurse will conclude that the patient has which condition? a. Asthma b. Overactive bladder c. Urinary retention d. Orthostatic hypotension 1. a, 2. b, 3. c, 4. d, 5. b, 6. a, c, d, f, 7. 9 mL/hr, 8. B CH19 Adrenergic-blocking drugs 1. When a patient has experienced extravasation of a peripheral infusion of dopamine, the nurse will inject the alpha blocker phentolamine (Regitine) into the area of extravasation and expect which effect? a. Vasoconstriction b. Vasodilation c. Analgesia d. Hypotension 2. When administering beta blockers, the nurse will follow which guideline for administration and monitoring? a. The drug may be discontinued at any time. b. Postural hypotension rarely occurs with this drug. c. Tapering off the medication is necessary to prevent rebound hypertension. d. The patient needs to stop taking the medication at once if he or she gains 3 to 4 pounds in a week. 3. The nurse providing teaching for a patient who has a new prescription for beta1 blockers will keep in mind that these drugs may result in which effect? a. Tachycardia b. Tachypnea c. Bradycardia d. Bradypnea 4. A patient who has recently had a myocardial infarction (MI) has started therapy with a beta blocker. The nurse explains that the main purpose of the beta blocker for this patient is to a. cause vasodilation of the coronary arteries. b. prevent hypertension. c. increase conduction through the SA node. d. protect the heart from circulating catecholamines. 5. Before initiating therapy with a nonselective beta blocker, the nurse will assess the patient for a history of which condition? a. Hypertension b. Liver disease c. Pancreatitis d. Asthma 6. A patient is taking an alpha blocker as treatment for benign prostatic hyperplasia. The nurse will monitor for which potential drug effects? (Select all that apply.) a. Orthostatic hypotension b. Increased blood pressure c. Increased urine flow d. Headaches e. Bradycardia 7. A child in the pediatric ICU has been receiving a dopamine infusion. This morning while on rounds, the nurse noted that the IV has infiltrated. After stopping the infusion, the nurse prepares to administer phentolamine (Regitine). The ordered dose is 0.2 mg/kg, to be injected into the area of extravasation. The child weighs 39 lb. How many milligrams will the nurse administer? (Record your answer using one decimal place.) 3.5 mg 8. The nurse is reviewing the mechanism of action of alpha adrenergic drugs. Adrenergic blockade at the alpha receptors leads to which effects? (Select all that apply). a. Miosis b. Vasodilation c. Vasoconstriction d. Bradycardia e. Reduced blood pressure 1. b, 2. c, 3. c, 4. d, 5. d, 6. a, c, d, 7. 3.5 mg, 8. a, b, e. CH20 Cholinergic drugs 1. The nurse is reviewing the use of bethanechol (Urecholine) in a patient who is experiencing postoperative urinary retention. Which statement best describes the mechanism of action of bethanechol? a. It causes decreased bladder tone and motility. b. It causes increased bladder tone and motility. c. It increases the sensation of a full bladder. d. It causes the sphincters in the bladder to become tighter. 2. The family of a patient who has recently been diagnosed with Alzheimer's disease is asking about the new drug prescribed to treat this disease. The patient's wife says, “I'm so excited that there are drugs that can cure this disease! I can't wait for him to start treatment.” Which reply from the nurse is appropriate? a. “The sooner he starts the medicine, the sooner it can have this effect.” b. “These effects won't be seen for a few months.” c. “These drugs do not cure Alzheimer's disease. Let's talk about what the physician said to expect with this drug therapy.” d. “His response to this drug therapy will depend on how far along he is in the disease process.” 3. The nurse is giving a dose of bethanechol (Urecholine) to a postoperative patient. The nurse is aware that contraindications to bethanechol include: a. bladder atony. b. peptic ulcer. c. urinary retention. d. hypothyroidism. 4. A patient took an accidental overdose of a cholinergic drug while at home. He comes to the emergency department with severe abdominal cramping and bloody diarrhea. The nurse expects that which drug will be used to treat this patient? a. atropine (generic) b. pilocarpine (Salagen) c. bethanechol (Urecholine) d. phentolamine (Regitine) 5. The nurse is reviewing the orders for a newly admitted patient and sees an order for edrophonium (Tensilon). The nurse expects that this drug is ordered for which reason? a. To reduce symptoms and delay the onset of Alzheimer's disease b. To treat the symptoms of myasthenia gravis c. To aid in the diagnosis of myasthenia gravis d. To reverse the effects of non-depolarizing neuromuscular blocking drugs after surgery 6. When giving intravenous cholinergic drugs, the nurse must watch for symptoms of a cholinergic crisis, such as: (Select all that apply.) a. peripheral tingling. b. hypotension. c. dry mouth. d. syncope. e. dyspnea. f. tinnitus. 7. A patient who has had an accidental overdose of tricyclic antidepressants is to receive physostigmine (Antilirium), 1.5 mg IM stat. The medication is available in a vial that contains 2 mL, with a concentration of 1 mg/mL. How much medication will the nurse draw up into the syringe for this dose? 1.5 mL 8. The nurse is teaching a patient about the possible adverse effects of donepezil (Aricept) for Alzheimer's disease. Which of these are possible adverse effects? (Select all that apply.) a. Constipation b. GI upset c. Drowsiness d. Dizziness e. Blurred vision 1. b, 2. c, 3. b, 4. a, 5. c, 6. b, d, e, 7. 1.5 mL, 8. b, c, d CH21 Cholinergic-blocking drugs 1. The nurse is providing education about cholinergic-blocking drug therapy to an older adult patient. Which is an important point to emphasize for this patient? a. Avoid exposure to high temperatures. b. Limit liquid intake to avoid fluid overload. c. Begin an exercise program to avoid adverse effects. d. Stop the medication if excessive mouth dryness occurs. 2. The nurse is giving a cholinergic-blocking drug and will assess the patient for which contraindications to these drugs? a. Chronic bronchitis b. Peptic ulcer disease c. Irritable bowel syndrome d. Benign prostatic hyperplasia 3. When assessing for adverse effects of cholinergic-blocking drug therapy, the nurse would expect to find that the patient complains of which drug effect? a. Diaphoresis b. Dry mouth c. Diarrhea d. Urinary frequency 4. The nurse administering a cholinergic-blocking drug to a patient who is experiencing drug-induced extrapyramidal effects would assess for which therapeutic effect? a. Decreased muscle rigidity and tremors b. Increased heart rate c. Decreased bronchial secretions d. Decreased GI motility and peristalsis 5. During the assessment of a patient about to receive a cholinergic-blocking drug, the nurse will determine whether the patient is taking any drugs that may potentially interact with the anticholinergic, including: a. opioids, such as morphine sulfate. b. antibiotics, such as penicillin. c. tricyclic antidepressants, such as amitriptyline. d. anticonvulsants, such as phenobarbital. 6. A patient has been given a prescription for transdermal scopolamine patches (Transderm-Scōp) for motion sickness for use during a vacation cruise. The nurse will include which instructions? (Select all that apply.) a. “Apply the patch as soon as you board the ship.” b. “Apply the patch 3 to 4 hours before boarding the ship.” c. “The patch needs to be placed on a nonhairy area on your upper chest or upper arm.” d. “The patch needs to be placed on a nonhairy area just behind your ear.” e. “Change the patch every 3 days.” f. “Rotate the application sites.” 7. The preoperative order for an adult patient reads: “Give scopolamine, 0.7 mg IM on call for surgery.” The medication is available in vials of 0.4 mg/mL. How many milliliters will the nurse administer for this dose? (Record your answer using one decimal place.) 1.8 mL 8. The nurse is assessing a patient who has a prescription for dicyclomine (Bentyl). Which condition is considered a contraindication to this medication? a. GI atony b. Irritable bowel syndrome c. Overactive bladder d. Diabetes mellitus 1. a, 2. d, 3. b, 4. a, 5. c, 6. b, d, e, f, 7. 1.8 mL, 8. A CH22 Antihypertensive 1. The nurse is administering antihypertensive drugs to older adult patients. The nurse knows that which adverse effect is of most concern for these patients? a. Dry mouth b. Hypotension c. Restlessness d. Constipation 2. When giving antihypertensive drugs, the nurse will consider giving the first dose at bedtime for which class of drugs? a. Alpha blockers such as doxazosin (Cardura) b. Diuretics such as furosemide (Lasix) c. ACE inhibitors such as captopril (Capoten) d. Vasodilators such as hydralazine (Apresoline) 3. A 46-year-old man started antihypertensive drug therapy 3 months earlier and is in the office for a follow-up visit. While the nurse is taking his blood pressure, he informs the nurse that he has had some problems with sexual intercourse. Which is the most appropriate response by the nurse? a. “Not to worry. Eventually, tolerance will develop.” b. “The physician can work with you on changing the dose and/or drugs.” c. “Sexual dysfunction happens with this therapy, and you will learn to accept it.” d. “This is an unusual occurrence, but it is important to stay on your medications.” 4. When a patient is being taught about the potential adverse effects of an ACE inhibitor, which of these effects should the nurse mention as possibly occurring when this drug is taken to treat hypertension? a. Diarrhea b. Nausea c. Dry, nonproductive cough d. Sedation 5. A patient has a new prescription for an ACE inhibitor. During a review of the patient's list of current medications, which would cause concern for a possible interaction with this new prescription? (Select all that apply.) a. A benzodiazepine taken as needed for allergies b. A potassium supplement taken daily c. An oral anticoagulant taken daily d. An opioid used for occasional severe pain e. An NSAID taken as needed for headaches 6. The order reads: Give hydralazine (Apresoline) 0.75 mg/kg/day. The child weighs 16 pounds. How much hydralazine will be given? (Record your answer using two decimal places.) 5.45 mg/kg/day 7. The nurse is assessing a patient who will be starting antihypertensive therapy with an ACE inhibitor. Which condition, if present in the patient, would be a reason for cautious use? a. Asthma b. Rheumatoid arthritis c. Hyperthyroidism d. Renal insufficiency 1. b, 2. a, 3. b, 4. c, 5. b, e, 6. 5.45 mg/kg/day, 7. D CH23 Antianginal drugs 1. A patient has a new prescription for transdermal nitroglycerin patches. The nurse teaches the patient that these patches are most appropriately used for which reason? a. To relieve exertional angina b. To prevent palpitations c. To prevent the occurrence of angina d. To stop an episode of angina 2. A nurse with adequate knowledge about the administration of intravenous nitroglycerin will recognize that which statement is correct? a. The intravenous form is given by IV push injection. b. Because the intravenous forms are short-lived, the dosing must be every 2 hours. c. Intravenous nitroglycerin must be protected from exposure to light through use of special tubing. d. Intravenous nitroglycerin can be given via gravity drip infusions. 3. Which statement by the patient reflects the need for additional patient education about the calcium channel blocker diltiazem (Cardizem)? a. “I can take this drug to stop an attack of angina.” b. “I understand that food and antacids alter the absorption of this oral drug.” c. “When the long-acting forms are taken, the drug cannot be crushed.” d. “This drug may cause my blood pressure to drop, so I need to be careful when getting up.” 4. While assessing a patient with angina who is to start beta blocker therapy, the nurse is aware that the presence of which condition may be a problem if these drugs are used? a. Hypertension b. Essential tremors c. Exertional angina d. Asthma 5. A 68-year-old male patient has been taking the nitrate isosorbide dinitrate (Isordil) for 2 years for angina. He recently has been experiencing erectile dysfunction and wants a prescription for sildenafil (Viagra). Which response would the nurse most likely hear from t