PHARMACOLOGY FINAL TEST BANK

PHARMACOLOGY FINAL TEST BANK 1. A 6-year-old child who has chickenpox also has a fever of 102.9° F (39.4° C). The child's mother asks the nurse if she should use aspirin to reduce the fever. What is the best response by the nurse? a. "It's best to wait to see if the fever gets worse." b. "You can use the aspirin, but watch for worsening symptoms." c. "Acetaminophen (Tylenol) should be used to reduce his fever, not aspirin." d. "You can use aspirin, but be sure to follow the instructions on the bottle."- ANS: C Aspirin is contraindicated in children with flu-like symptoms because the use of this drug has been strongly associated with Reye's syndrome. This is an acute and potentially life-threatening condition involving progressive neurologic deficits that can lead to coma and may also involve liver damage. Acetaminophen is appropriate for this patient. 2. A 10-year-old patient will be started on methylphenidate hydrochloride (Ritalin) therapy. The nurse will perform which essential baseline assessment before this drug is started? a. Eye examination b. Height and weight c. Liver function studies d. Hearing test- ANS: B Assessment of baseline height and weight is important before beginning Ritalin therapy because it may cause a temporary slowing of growth in prepubertal children. The other studies are not as essential at this time. 3. A 38-year-old man has come into the urgent care center with severe hip pain after falling from a ladder at work. He says he has taken several pain pills over the past few hours but cannot remember how many he has taken. He hands the nurse an empty bottle of acetaminophen (Tylenol). The nurse is aware that the most serious toxic effect of acute acetaminophen overdose is which condition? a. Tachycardia b. Central nervous system depression c. Hepatic necrosis d. Nephropathy- ANS: C Hepatic necrosis is the most serious acute toxic effect of an acute overdose of acetaminophen. 4. A 73-year-old male patient is in the clinic for a yearly physical and is asking for a prescription for sildenafil (Viagra). He has listed on his health history that he is taking a nitrate for angina. The nurse is aware that which problem may occur if sildenafil is taken with a nitrate? a. Significant increase in pulse rate b. Significant decrease in blood pressure c. Increased risk of bleeding d. Reduced effectiveness of the sildenafil- ANS: B In patients with pre-existing cardiovascular disease, especially those on nitrates, erectile dysfunction drugs such as sildenafil lower blood pressure substantially, potentially leading to more serious adverse events. 5. A 78-year-old patient is in the recovery room after having a lengthy surgery on his hip. As he is gradually awakening, he requests pain medication. Within 10 minutes after receiving a dose of morphine sulfate, he is very lethargic and his respirations are shallow, with a rate of 7 per minute. The nurse prepares for which priority action at this time? a. Assessment of the patient's pain level b. Immediate intubation and artificial ventilation c. Administration of naloxone (Narcan) d. Close observation of signs of opioid tolerance- ANS: C Naloxone, an opioid-reversal agent, is used to reverse the effects of acute opioid overdose and is the drug of choice for reversal of opioid-induced respiratory depression. This situation is describing an opioid overdose, not opioid tolerance. Intubation and artificial ventilation are not appropriate because the patient is still breathing at 7 breaths/min. It would be inappropriate to assess the patient's level of pain. 6. A cholinergic drug is prescribed for a patient with a new diagnosis of myasthenia gravis, and the nurse provides instructions to the patient about the medication. What is important to include in the teaching? a. Take the medication with meals to avoid gastrointestinal distress. b. Give daytime doses close together for maximal therapeutic effect. c. Take the medication 30 minutes before eating to improve swallowing and chewing. d. Take the medication only if difficulty swallowing occurs during a meal.- ANS: C Taking the medication 30 minutes before meals allows time for the onset of action and therapeutic effects during the meal. The doses should be spaced evenly apart to optimize the effects of the medication. 7. A female patient will be starting therapy with oral isotretinoin (Amnesteem) as part of treatment for severe acne, and the nurse is providing teaching. Which teaching point will the nurse include in her teaching plan about isotretinoin? a. "You will have to use two contraceptive methods while on this drug." b. "You must avoid sexual activity while on this drug." c. "You will have to avoid pregnancy for 2 weeks after taking this drug." d. "If you are taking an oral contraceptive, you may take this drug."- ANS: A It is now required that at least two contraceptive methods be used by sexually active women during and for 1 month after completion of therapy with isotretinoin. 8. A patient about to receive a morning dose of digoxin has an apical pulse of 53 beats/min. What will the nurse do next? a. Administer the dose. b. Administer the dose, and notify the prescriber. c. Check the radial pulse for 1 full minute. d. Withhold the dose, and notify the prescriber.- ANS: D Digoxin doses are held and the prescriber notified if the apical pulse is 60 beats/min or lower or is higher than 100 beats/min. 9. A patient arrives in the emergency department with severe chest pain. The patient reports that the pain has been occurring off and on for a week now. Which assessment finding would indicate the need for cautious use of nitrates and nitrites? a. Blood pressure of 88/62 mm Hg b. Apical pulse rate of 110 beats/min c. History of renal disease d. History of a myocardial infarction 2 years ago- ANS: A Hypotension is a possible contraindication to the use of nitrates because the medications may cause the blood pressure to decrease. 10. A patient has a new prescription for tamsulosin (Flomax) as treatment for benign prostatic hyperplasia. The nurse is checking his current medication list and will contact the prescriber regarding a potential interaction if the patient is also taking which drug? a. Levothyroxine (Synthroid) for hypothyroidism b. Sildenafil (Viagra), an erectile dysfunction medication c. Omeprazole (Prilosec), a proton pump inhibitor d. Low-dose aspirin for stroke prevention- ANS: B Drugs that interact with alpha blockers such as tamsulosin include erectile dysfunction drugs; additive hypotensive effects may occur. 11. A patient has an order for the monoclonal antibody adalimumab (Humira). The nurse notes that the patient does not have a history of cancer. What is another possible reason for administering this drug? a. Severe anemia b. Rheumatoid arthritis c. Thrombocytopenia d. Osteoporosis- ANS: B Monoclonal antibodies are used for the treatment of cancer, rheumatoid arthritis and other inflammatory diseases, multiple sclerosis, and organ transplantation. 12. A patient has been diagnosed with angina and will be given a prescription for sublingual nitroglycerin tablets. When teaching the patient how to use sublingual nitroglycerin, the nurse will include which instruction? a. Take up to 5 doses at 15-minute intervals for an angina attack. b. If the tablet does not dissolve quickly, chew the tablet for maximal effect. c. If the chest pain is not relieved after one tablet, call 911 immediately. d. Wait 1 minute between doses of sublingual tablets, up to 3 doses.- ANS: C According to current guidelines, if the chest pain or discomfort is not relieved in 5 minutes, after 1 dose, the patient (or family member) must call 911 immediately. The patient may take one more tablet while awaiting emergency care and may take a third tablet 5 minutes later, but no more than a total of three tablets. The sublingual dose is placed under the tongue, and the patient needs to avoid swallowing until the tablet has dissolved. 13. A patient has been prescribed warfarin (Coumadin) in addition to a heparin infusion. The patient asks the nurse why he has to be on two medications. The nurse's response is based on which rationale? a. The oral and injection forms work synergistically. b. The combination of heparin and an oral anticoagulant results in fewer adverse effects than heparin used alone. c. Oral anticoagulants are used to reach an adequate level of anticoagulation when heparin alone is unable to do so. d. Heparin is used to start anticoagulation so as to allow time for the blood levels of warfarin to reach adequate levels.- ANS: D This overlap therapy is required in patients who have been receiving heparin for anticoagulation and are to be switched to warfarin so that prevention of clotting is continuous. This overlapping is done purposefully to allow time for the blood levels of warfarin to rise, so that when the heparin is eventually discontinued, therapeutic anticoagulation levels of warfarin will have been achieved. Recommendations are to continue overlap therapy of the heparin and warfarin for at least 5 days; the heparin is stopped after day 5 when the international normalized ratio (INR) is above 2. 14. A patient has been taking the monoamine oxidase inhibitor (MAOI) phenelzine (Nardil) for 6 months. The patient wants to go to a party and asks the nurse, "Will just one beer be a problem?" Which advice from the nurse is correct? a. "You can drink beer as long as you have a designated driver." b. "Now that you've had the last dose of that medication, there will be no further dietary restrictions." c. "If you begin to experience a throbbing headache, rapid pulse, or nausea, you'll need to stop drinking." d. "You need to avoid all foods that contain tyramine, including beer, while taking this medication."- ANS: D Foods containing tyramine, such as beer and aged cheeses, should be avoided while a patient is taking an MAOI. Drinking beer while taking an MAOI may precipitate a dangerous hypertensive crisis. 15. A patient has been treated with antiparkinson medications for 3 months. What therapeutic responses should the nurse look for when assessing this patient? a. Decreased appetite b. Gradual development of cogwheel rigidity c. Newly developed dyskinesias d. Improved ability to perform activities of daily living- ANS: D Therapeutic responses to antiparkinson agents include an improved sense of well-being, improved mental status, increased appetite, increased ability to perform activities of daily living and to concentrate and think clearly, and less intense parkinsonian manifestations. 16. A patient in the intensive care unit has a nasogastric tube and is also receiving a proton pump inhibitor (PPI). The nurse recognizes that the purpose of the PPI is which effect? a. Prevent stress ulcers b. Reduce bacteria levels in the stomach c. Reduce gastric gas formation (flatulence) d. Promote gastric motility- ANS: A Stress-related mucosal damage is an important issue for critically ill patients. Stress ulcer prophylaxis (or therapy to prevent severe gastrointestinal [GI] damage) is undertaken in almost every critically ill patient in an intensive care unit and for many patients on general medical surgical units. Procedures performed commonly in critically ill patients, such as passing nasogastric tubes, placing patients on ventilators, and others, predispose patients to bleeding of the GI tract. Guidelines suggest that all such patients receive either a histamine receptor-blocking drug or a proton pump inhibitor. 17. A patient is in an urgent care center with an acute asthma attack. The nurse expects that which medication will be used for initial treatment? a. An anticholinergic such as ipratropium (Atrovent) b. A short-acting beta2 agonist such as albuterol (Proventil) c. A long-acting beta2 agonist such as salmeterol (Serevent) d. A corticosteroid such as fluticasone (Flovent)- ANS: B The short-acting beta2 agonists are commonly used during the acute phase of an asthmatic attack to reduce airway constriction quickly and to restore airflow to normal levels. The other drugs listed are not appropriate for acute asthma attacks. Anticholinergic drugs and long-acting beta2 agonists are used to prevent attacks; corticosteroids are used to reduce airway inflammation. 18. A patient is receiving hydroxychloroquine therapy but tells the nurse that she has never traveled out of her city. The nurse knows that a possible reason for this drug therapy is which condition? a. Lyme disease b. Toxoplasmosis c. Systemic lupus erythematosus d. Intestinal tapeworms- ANS: C Hydroxychloroquine, which is used for malaria, also possesses anti-inflammatory actions and has been used to treat rheumatoid arthritis and systemic lupus erythematosus. 19. A patient is receiving lactulose (Enulose) three times a day. The nurse knows that the patient is not constipated and is receiving this drug for which reason? a. High ammonia levels due to liver failure b. Prevention of constipation c. Chronic renal failure d. Chronic diarrhea- ANS: A Lactulose (Enulose) produces a laxative effect but also works to reduce blood ammonia levels by converting ammonia to ammonium. Ammonium is a water-soluble cation that is trapped in the intestines and cannot be reabsorbed into the systemic circulation. This effect has proved helpful in reducing elevated serum ammonia levels in patients with severe liver disease. 20. A patient is taking digoxin (Lanoxin) and a loop diuretic daily. When the nurse enters the room with the morning medications, the patient states, "I am seeing a funny yellow color around the lights." What is the nurse's next action? a. Assess the patient for symptoms of digoxin toxicity. b. Withhold the next dose of the diuretic. c. Administer the digoxin and diuretic together as ordered. d. Document this finding, and reassess in 1 hour.- ANS: A Seeing colors around lights is one potential indication of developing digoxin toxicity. If a patient complains of this, the nurse needs to assess for other signs and symptoms of digoxin toxicity including bradycardia, headache, dizziness, confusion, nausea, and blurred vision, and then notify the prescriber. 21. A patient is taking gabapentin (Neurontin), and the nurse notes that there is no history of seizures on his medical record. What is the best possible rationale for this medication order? a. The medication is used for the treatment of neuropathic pain. b. The medication is helpful for the treatment of multiple sclerosis. c. The medication is used to reduce the symptoms of Parkinson's disease. d. The medical record is missing the correct information about the patient's history of seizures.- ANS: A Gabapentin (Neurontin) is commonly used to treat neuropathic pain. ALSO PREGABALIN (LYRICA). 22. A patient is taking nystatin (Mycostatin) oral lozenges to treat an oral candidiasis infection resulting from inhaled corticosteroid therapy for asthma. Which instruction by the nurse is appropriate? a. "Chew the lozenges until they are completely dissolved." b. "Let the lozenge dissolve slowly and completely in your mouth without chewing it." c. "Rinse your mouth with water before taking the inhaler." d. "Rinse your mouth with mouthwash after taking the inhaler."- ANS: B Nystatin may be given orally in the form of lozenges, or troches, which need to be slowly and completely dissolved in the mouth for optimal effects; tablets are not to be chewed or swallowed whole. The other options are incorrect. Patients taking an inhaled corticosteroid must rinse their mouths with water thoroughly after taking the inhaler. 23. A patient reports having adverse effects with nicotinic acid (niacin). The nurse can suggest performing which action to minimize these undesirable effects? a. Take the drug on an empty stomach. b. Take the medication every other day until the effects subside. c. Take an aspirin tablet 30 minutes before taking the drug. d. Take the drug with large amounts of fiber.- ANS: C The undesirable effects of nicotinic acid can be minimized by starting with a low initial dose, taking the drug with meals, and taking small doses of aspirin with the drug to minimize cutaneous flushing. Fiber intake has no effect on niacin's adverse effects, and it is not within the nurse's scope of practice to suggest a change of medication dosage. 24. A patient who has been anticoagulated with warfarin (Coumadin) has been admitted for gastrointestinal bleeding. The history and physical examination indicates that the patient may have taken too much warfarin. The nurse anticipates that the patient will receive which antidote? a. Vitamin E b. Vitamin K c. Protamine sulfate d. Potassium chloride- ANS: B Vitamin K is given to reverse the anticoagulation effects of warfarin toxicity. Protamine sulfate is the antidote for heparin overdose. 25. A patient who has been on antibiotic therapy for 2 weeks has developed persistent diarrhea. The nurse expects which medication class to be ordered to treat this diarrhea? a. Lubricants b. Adsorbents c. Anticholinergics d. Probiotics- ANS: D Probiotics work by replenishing bacteria that may have been destroyed by antibiotic therapy, thus restoring the balance of normal flora and suppressing the growth of diarrhea-causing bacteria. 26. A patient who has been taking antihypertensive drugs for a few months complains of having a persistent dry cough. The nurse knows that this cough is an adverse effect of which class of antihypertensive drugs? a. Beta blockers b. Angiotensin-converting enzyme (ACE) inhibitors c. Angiotensin II receptor blockers (ARBs) d. Calcium channel blockers- ANS: B ACE inhibitors cause a characteristic dry, nonproductive cough that reverses when therapy is stopped. 27. A patient who has received chemotherapy has a critically low platelet count. The nurse expects which drug or drug class to be used to stimulate platelet cell production? a. Filgrastim (Neupogen) b. Interferons c. Oprelvekin (Neumega) d. Epoetin alfa (Epogen)- ANS: C Oprelvekin (Neumega) stimulates bone marrow cells, specifically megakaryocytes, which eventually form platelets. 28. A patient with elevated lipid levels has a new prescription for nicotinic acid (niacin). The nurse informs the patient that which adverse effects may occur with this medication? a. Pruritus, cutaneous flushing b. Tinnitus, urine with a burnt odor c. Myalgia, fatigue d. Blurred vision, headaches- ANS: A Possible adverse effects of nicotinic acid include pruritus, cutaneous flushing, and gastrointestinal distress. Tinnitus, urine with a burnt odor, and headaches are possible adverse effects of bile acid sequestrants. Headaches are also possible adverse effects of HMG-CoA reductase inhibitors, as are myalgia and fatigue. 29. A patient with end-stage renal failure has been admitted to the hospital for severe anemia. She is refusing blood transfusions. The nurse anticipates drug therapy with which drug to stimulate the production of red blood cells? a. Folic acid b. Cyanocobalamin (vitamin B12) c. Epoetin alfa (Epogen) d. Filgrastim (Neupogen)- ANS: C Epoetin alfa is a colony-stimulating factor that is responsible for erythropoiesis, or formation of red blood cells. 30. A patient with gout has been treated with allopurinol (Zyloprim) for 2 months. The nurse will monitor laboratory results for which therapeutic effect? a. Decreased uric acid levels b. Decreased prothrombin time c. Decreased white blood cell count d. Increased hemoglobin and hematocrit levels- ANS: A Treatment of gout with allopurinol should result in decreased uric acid levels. 31. A patient, newly diagnosed with hypothyroidism, has received a prescription for thyroid replacement therapy. The nurse will instruct the patient to take this medication at which time of day? a. In the morning b. With the noon meal c. With the evening meal d. At bedtime- ANS: A If possible, it is best to administer thyroid drugs taken once daily in the morning so as to decrease the likelihood of insomnia that may result from evening dosing. 32. A woman is traveling to a country where she will be at high risk for malarial infection. What will the nurse teach her regarding prophylactic therapy with hydroxychloroquine (Plaquenil)? a. Hydroxychloroquine is better absorbed and has fewer adverse effects if taken on an empty stomach. b. The drug is started 3 weeks before exposure but can be discontinued once she leaves the area. c. The medication is taken only when she observes mosquito bites because it can have toxic effects if taken unnecessarily. d. The drug is usually started 1 to 2 weeks before traveling to endemic areas and is continued for 4 weeks after leaving the area.- ANS: D Prophylaxis of malaria with hydroxychloroquine is usually started 1 to 2 weeks before exposure and continued for 4 weeks after the person has left the area. The medication should be taken with food to decrease gastrointestinal upset. 33. A young adult calls the clinic to ask for a prescription for "that new flu drug." He says he has had the flu for almost 4 days and just heard about a drug that can reduce the symptoms. What is the nurse's best response to his request? a. "Now that you've had the flu, you will need a booster vaccination, not the antiviral drug." b. "We will need to do a blood test to verify that you actually have the flu." c. "Drug therapy should be started within 2 days of symptom onset, not 4 days." d. "We'll get you a prescription. As long as you start treatment within the next 24 hours, the drug should be effective."- ANS: C These drugs need to be started within 2 days of influenza symptom onset; they can be used for prophylaxis and treatment of influenza. ACE Inhibitors Adverse Effects- Dry, non-productive cough Hyperkalemia Hypotension Rash Angioedema 34. After starting treatment for type 2 diabetes mellitus 6 months earlier, a patient is in the office for a follow-up examination. The nurse will monitor which laboratory test to evaluate the patient's adherence to the antidiabetic therapy over the past few months? a. Hemoglobin levels b. Hemoglobin A1C level c. Fingerstick fasting blood glucose level d. Serum insulin levels- ANS: B The hemoglobin A1C level reflects the patient's adherence to the therapy regimen for several months previously, thus evaluating how well the patient has been doing with diet and drug therapy. 35. An 8-year-old child has been diagnosed with true pituitary dwarfism and is being treated with somatropin. In follow-up visits, the nurse will monitor for which expected outcome? a. Increased growth b. Decreased urinary output c. Increased muscle strength d. Increased height when the child reaches puberty- ANS: A In patients for whom somatropin is indicated, increased growth is expected. An 83 year old male come in suffering from confusion. He states he suffers from GERD. What is a possible reason for confusion?- H2 receptor antagonists can cause confusion, dementia, and disorientation. Asses for it's administration before jumping to Parkinson's or Alzheimer's. 36. An infant has been hospitalized with a severe lung infection caused by the respiratory syncytial virus (RSV) and will be receiving medication via the inhalation route. The nurse expects which drug to be used? a. Acyclovir (Zovirax) b. Ganciclovir (Cytovene) c. Amantadine (Symmetrel) d. Ribavirin (Virazole)- ANS: D The inhalational form of ribavirin (Virazole) is used primarily in the treatment of hospitalized infants with severe lower respiratory tract infections caused by RSV. 37. Antilipemic drug therapy is prescribed for a patient, and the nurse is providing instructions to the patient about the medication. Which instructions will the nurse include? (Select all that apply.) a. Limit fluid intake to prevent fluid overload. b. Eat extra servings of raw vegetables and fruit. c. Report abnormal or unusual bleeding or yellow discoloration of the skin. d. Report the occurrence of muscle pain immediately. e. Drug interactions are rare with antilipemics. f. Take the drug 1 hour before or 2 hours after meals to maximize absorption.- ANS: B, C, D Instructions need to include preventing constipation by encouraging a diet that is plentiful in raw vegetables, fruit, and bran. Forcing fluids (up to 3000 mL/day unless contraindicated)may also help to prevent constipation. Notify the prescriber if there are any new or troublesome symptoms, abnormal or unusual bleeding, yellow discoloration of the skin, or muscle pain. These drugs are highly protein-bound; therefore, they interact with many drugs. Taking these drugs with food may help to reduce gastrointestinal distress. 38. During a blood transfusion, the patient begins to have chills and back pain. What is the nurse's priority action? a. Observe for other symptoms. b. Slow the infusion rate of the blood. c. Discontinue the infusion immediately, and notify the prescriber. d. Tell the patient that these symptoms are a normal reaction to the blood product.- ANS: C Because of the possibility of a transfusion reaction, the infusion should be discontinued immediately and the prescriber notified. The intravenous line should be kept patent with isotonic normal saline solution infusing at a slow rate, and the health care institution's protocol for transfusion reactions should always be followed. 39. During a follow-up visit, a patient who has been on estrogen therapy admits that she has continued to smoke cigarettes. The nurse will remind the patient that smoking while on estrogen may lead to increased: a. incidence of nausea. b. risk for thrombosis. c. levels of triglycerides. d. tendency to bleed during menstruation.- ANS: B Smoking should be avoided during estrogen therapy because it adds to the risk for thrombosis formation. 40. During a routine checkup, a patient states that she is unable to take the prescribed antihistamine because of one of its most common adverse effects. The nurse suspects that which adverse effect has been bothering this patient? a. Constipation b. Abdominal cramps c. Drowsiness d. Decreased libido- ANS: C Drowsiness is usually the chief complaint of people who take antihistamines. 41. During a teaching session for a patient on antithyroid drugs, the nurse will discuss which dietary instructions? a. Using iodized salt when cooking b. Avoiding foods containing iodine c. Restricting fluid intake to 2500 mL/day d. Increasing intake of sodium- and potassium-containing foods- ANS: B Patients on antithyroid therapy need to avoid iodine-containing foods. These foods may interfere with the effectiveness of the antithyroid drug. 42. During interleukin drug therapy, a patient is showing signs of severe fluid retention, with increasing dyspnea and severe peripheral edema. The next dose of the interleukin is due now. Which action will the nurse take next? a. Hold the drug, and notify the prescriber. b. Give the drug, and notify the prescriber. c. Give the drug along with acetaminophen and diphenhydramine (Benadryl). d. Monitor the patient for 2 hours, and then give the drug if the patient's condition improves.- ANS: A The fluid retention that may occur with interleukin therapy is reversible; if therapy is stopped, the prescriber must be notified Epidural opioids side effects- Urinary retention and spinal headache Exentide (Byetta) Indication- Type 2 diabetes H2 receptor antagonists- Cimetidine, Famotidine, Ranitidine "-idine" Hematopoietic Stimulating Factors- Filgrastim (wbc) Sargramostim (wbc) Oprekleukin (platelets) Epoetin alpha (rbc) How can bone marrow suppression present itself?- Decreased red blood cells, white blood cells, and platelets How should the administration of steroids be stopped to avoid withdrawal syndrome?- Taper steroids. Do not stop abruptly because the body will be unable to produce the appropriate level of hormones requires leading to withdrawal. Hyperkalemia signs- Bradycardia Hypotension Diarrhea Nausea Vomiting Hypersensitivity Reaction- anaphylaxis- respiratory distress/closure, dyspnea, cardiovascular collapse (hypotension) Important assessment if patient is on antidepressant medication- Ask if they are thinking of killing themselves and then ask if they have a plan. If the answer is yes, it is required that you call the police and Baker Act them. Antidepressant have a Black Box warning for suicidal ideation Important monitoring for Clonazepam- Respiratory rate since Clonazepam is a CNS depressant Kayexalate (sodium polystyrene sulfonate) indication & contraindication- Indication: Hyperkalemia Contraindication: Hypokalemia Lantus effect on the body lasts how long?- 24 hours with no peak and a steady effect Normal levels of Digitalis (digoxin)- 0.5-2 ng/ml Normal potassium levels- 3.5-5 Patient advice for Miacalcin spray- Alternate nostrils each day. Do not re-administer even if the spray isn't felt because it could lead to dry mucous membranes Pilocarpine indication- Glaucoma due to pupillary constriction effects Pyridium most common side effect- Urine discoloration. Urine might turn orange, advice the patient to continue use even if this occurs. Severe side effects of Exenatide- hypoglycemia Signs of decreased platelets- petechiae (tiny patches of bleeding under skin), bruises, and increased bleeding Signs of decreased red blood cells- Fatigue, pallor Signs of decreased white blood cells- fever, infection Sumatriptan Side Effects- Vomiting and Nausea 43. The nurse has given medication instructions to a patient receiving phenytoin (Dilantin). Which statement by the patient indicates that the patient has an adequate understanding of the instructions? a. "I will need to take extra care of my teeth and gums while on this medication." b. "I can go out for a beer while on this medication." c. "I can skip doses if the side effects bother me." d. "I will be able to stop taking this drug once the seizures stop."- ANS: A Scrupulous dental care is necessary to prevent gingival hypertrophy during therapy with phenytoin. Alcohol and other central nervous system depressants may cause severe sedation. Consistent dosing is important to maintain therapeutic drug levels. Therapy with AEDs usually must continue for life and must not be stopped once seizures stop. 44. The nurse is about to administer a stat dose of intravenous atropine sulfate to a patient who is experiencing a symptomatic cardiac dysrhythmia. During administration of this drug, the nurse will monitor the patient closely for which adverse effect? a. Tachycardia b. Bradycardia c. Ectopic beats d. Cardiac standstill- ANS: A Cardiovascular effects of cholinergic blockers include increased heart rate and dysrhythmias. One indication for use is the treatment of sinus bradycardia accompanied by hemodynamic compromise. 45. The nurse is administering a stat dose of epinephrine. Epinephrine is appropriate for which situation? a. Severe hypertension b. Angina c. Cardiac arrest d. Tachycardia- ANS: C Treatment of cardiac arrest is an indication for the use of epinephrine. 46. The nurse is administering a vancomycin (Vancocin) infusion. Which measure is appropriate for the nurse to implement in order to reduce complications that may occur with this drug's administration? a. Monitoring blood pressure for hypertension during the infusion b. Discontinuing the drug immediately if red man syndrome occurs c. Restricting fluids during vancomycin therapy d. Infusing the drug over at least 1 hour- ANS: D Infuse the medication over at least 1 hour to reduce the occurrence of red man syndrome. Adequate hydration (at least 2 L of fluid in 24 hours) during vancomycin therapy is important for the prevention of nephrotoxicity. Hypotension may occur during the infusion, especially if it is given too rapidly. 47. The nurse is assessing a patient for contraindications to drug therapy with acetaminophen (Tylenol). Which patient should not receive acetaminophen? a. A patient with a fever of 101° F (38.3° C) b. A patient who is complaining of a mild headache c. A patient with a history of liver disease d. A patient with a history of peptic ulcer disease- ANS: C Liver disease is a contraindication to the use of acetaminophen. Fever and mild headache are both possible indications for the medication. Having a history of peptic ulcer disease is not a contraindication. 48. The nurse is assessing a patient who has been admitted to the emergency department for a possible opioid overdose. Which assessment finding is characteristic of an opioid drug overdose? a. Dilated pupils b. Restlessness c. Respiration rate of 6 breaths/min d. Heart rate of 55 beats/min- ANS: C The most serious adverse effect of opioid use is CNS depression, which may lead to respiratory depression. Pinpoint pupils, not dilated pupils, are seen. Restlessness and a heart rate of 55 beats/min are not indications of an opioid overdose. 49. The nurse is counseling a woman who will be starting rifampin (Rifadin) as part of antitubercular therapy. The patient is currently taking oral contraceptives. Which statement is true regarding rifampin therapy for this patient? a. Women have a high risk for thrombophlebitis while on this drug. b. A higher dose of rifampin will be necessary because of the contraceptive. c. Oral contraceptives are less effective while the patient is taking rifampin. d. The incidence of adverse effects is greater if the two drugs are taken together.- ANS: C Women taking oral contraceptives and rifampin need to be counseled about other forms of birth control because of the impaired effectiveness of the oral contraceptives during concurrent use of rifampin. 50. The nurse is monitoring for therapeutic results of antibiotic therapy in a patient with an infection. Which laboratory value would indicate therapeutic effectiveness of this therapy? a. Increased red blood cell count b. Increased hemoglobin level c. Decreased white blood cell count d. Decreased platelet count- ANS: C Decreased white blood cell counts are an indication of reduction of infection and are a therapeutic effect of antibiotic therapy. 51. The nurse is preparing to administer adenosine (Adenocard) to a patient who is experiencing an acute episode of paroxysmal supraventricular tachycardia. When giving this medication, which is important to remember? a. The onset of action occurs in 5 minutes. b. The medication must be given as a slow intravenous (IV) push. c. Asystole may occur for a few seconds after administration. d. The medication has a long half-life, and therefore duration of action is very long.- ANS: C Adenosine has an extremely short half-life of less than 10 seconds; its onset occurs within 1 minute; and it must be given as a fast IV push injection. In addition, a very brief episode of asystole may occur after administration. 52. The nurse is preparing to administer dopamine. Which is the correct technique for administering dopamine? a. Orally b. Intravenous (IV) push injection c. Intermittent IV infusions (IV piggyback) d. Continuous IV infusion with an infusion pump- ANS: D Dopamine is available only as an IV injectable drug and is given by continuous infusion, using an infusion pump. 53. The nurse is presenting information to a class of students about adrenergic drugs. Which are the effects of drugs that stimulate the sympathetic nervous system? (Select all that apply.) a. Dilation of bronchioles b. Constriction of bronchioles c. Decreased heart rate d. Increased heart rate e. Dilated pupils f. Constricted pupils g. Glycogenolysis- ANS: A, D, E, G Stimulation of the sympathetic nervous system causes bronchodilation, increased heart rate, pupil dilation, and glycogenolysis as well as many other effects (see Table 18-1). The other responses are effects that occur as a result of the stimulation of the parasympathetic nervous System. 54. The nurse is providing counseling to a woman who is HIV positive and has just discovered that she is pregnant. Which anti-HIV drug is given to HIV-infected pregnant women to prevent transmission of the virus to the infant? a. Acyclovir (Zovirax) b. Zidovudine (Retrovir) c. Ribavirin (Virazole) d. Foscarnet (Foscavir)- ANS: B Zidovudine, along with various other antiretroviral drugs, is given to HIV-infected pregnant women and even to newborn babies to prevent maternal transmission of the virus to the infant. 55. The nurse is providing teaching regarding drug therapy to the husband of a woman with Alzheimer's disease. She was diagnosed 3 months ago, has mild memory loss, and will be receiving donepezil (Aricept). What is the drug's expected action? a. Prevents memory loss in later stages b. Reverses the course of Alzheimer's disease c. Provides sedation to prevent agitation and restlessness d. May help to improve the mood and decrease confusion- ANS: D Donepezil is used to treat mild-to-moderate dementia occurring in Alzheimer's disease and may improve the symptoms of the disease. 56. The nurse is providing teaching to a patient taking an oral tetracycline antibiotic. Which statement by the nurse is correct? a. "Avoid direct sunlight and tanning beds while on this medication." b. "Milk and cheese products result in increased levels of tetracycline." c. "Antacids taken with the medication help to reduce gastrointestinal distress." d. "Take the medication until you are feeling better."- ANS: A Drug-related photosensitivity occurs when patients take tetracyclines, and it may continue for several days after therapy. Milk and cheese products result in decreased levels of tetracycline when the two are taken together. Antacids also interfere with absorption and should not be taken with tetracycline. Counsel patients to take the entire course of prescribed antibiotic drugs, even if they feel that they are no longer ill. 57. The nurse is reviewing vitamin therapy in preparation for a nutrition class. Which statements are accurate regarding vitamin C (ascorbic acid)? (Select all that apply.) a. Vitamin C is important in the maintenance of bone, teeth, and capillaries. b. Vitamin C is essential for night vision. c. Vitamin C is important for tissue repair. d. Vitamin C is found in animal sources such as dairy products and meat. e. Vitamin C is found in tomatoes, strawberries, and broccoli. f. Vitamin C is also known as the "sunshine vitamin." g. Vitamin C deficiency is known as scurvy.- ANS: A, C, E, G These statements are true of vitamin C. Vitamin A is essential for night vision, and vitamin D is known as the sunshine vitamin. With the exception of liver, meat and dairy products are not sources of vitamin C. 58. The nurse will assess the patient for which potential contraindication to antitubercular therapy? a. Glaucoma b. Anemia c. Heart failure d. Hepatic impairment- ANS: D Results of liver function studies (e.g., bilirubin level, liver enzyme levels) need to be assessed because isoniazid and rifampin may cause hepatic impairment; severe liver dysfunction is a contraindication to these drugs. In addition, the patient's history of alcohol use needs to be assessed. 59. The nurse will monitor a patient for signs and symptoms of hyperkalemia if the patient is taking which of these diuretics? a. Hydrochlorothiazide (HydroDIURIL) b. Furosemide (Lasix) c. Acetazolamide (Diamox) d. Spironolactone (Aldactone)- ANS: D Spironolactone (Aldactone) is a potassium-sparing diuretic, and patients taking this drug must be monitored for signs of hyperkalemia. 60. The prescriber has changed the patient's medication regimen to include the leukotriene receptor antagonist (LTRA) montelukast (Singulair) to treat asthma. The nurse will emphasize which point about this medication? a. The proper technique for inhalation must be followed. b. The patient needs to keep it close by at all times to treat acute asthma attacks. c. It needs to be taken every day on a continuous schedule, even if symptoms improve. d. When the asthma symptoms improve, the dosage schedule can be tapered and eventually discontinued.- ANS: C These drugs are indicated for chronic, not acute, asthma and are to be taken every day on a continuous schedule, even if symptoms improve. 61. The teaching for a patient who is taking tamsulosin (Flomax) to reduce urinary obstruction due to benign prostatic hyperplasia will include which of these? a. Fluids need to be restricted while on this medication. b. Take the medication with breakfast to promote the maximum effects of the drug. c. Get up slowly from a sitting or lying position. d. Blood pressure must be monitored because the medication may cause hypertension.- ANS: C This medication is used to relieve impaired urinary flow in men with benign prostatic hyperplasia, but it also can cause orthostatic hypotension when changing positions from sitting or lying positions. Because of these effects, the blood pressure may become dramatically lowered, and lightheadedness may occur, increasing the risk of falling. Urinary retention assessment includes- palpating for bladder distention 62. Vicodin (acetaminophen/hydrocodone) 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. Lightheadedness d. Nervousness e. Urinary retention f. Itching- ANS: B, C, E, F Constipation (not diarrhea), lightheadedness (not nervousness), urinary retention, and itching are some of the common adverse effects that the patient may experience while taking Vicodin. What drugs can cause hyperkalemia?- Ace Inhibitors Spironolactone Angiotensin II Blockers What is vital for pregnant women to do before taking any drugs?- Consult HCP before starting any medication What occurs as a result to use of antineoplastics or chemotherapy?- Bone marrow suppression What time should Ranitidine (H2 receptor antagonist) be administered?- Give at bedtime 63. When a patient is receiving vasopressin (Pitressin), the nurse will monitor for which therapeutic response? a. Improved appetite b. Increased serum albumin levels c. Increased serum potassium levels d. Decreased urinary output- ANS: D Decreased severe thirst and decreased urinary output are the therapeutic responses expected with vasopressin. 64. When a patient is taking an adrenergic drug, the nurse expects to observe which effect? a. Increased heart rate b. Bronchial constriction c. Constricted pupils d. Increased intestinal peristalsis- ANS: A Increased heart rate is one of the effects of adrenergic drugs. Sympathetic nervous system stimulation also results in bronchodilation, dilated pupils, and decreased gastrointestinal mobility, depending upon which receptors are stimulated. 65. When assessing a patient who is receiving a loop diuretic, the nurse looks for the manifestations of potassium deficiency, which would include what symptoms? (Select all that apply.) a. Dyspnea b. Constipation c. Tinnitus d. Muscle weakness e. Anorexia f. Lethargy- ANS: D, E, F Symptoms of hypokalemia include anorexia, nausea, lethargy, muscle weakness, mental confusion, and hypotension. 66. When monitoring patients on antitubercular drug therapy, the nurse knows that which drug may cause a decrease in visual acuity? a. Rifampin (Rifadin) b. Isoniazid (INH) c. Ethambutol (Myambutol) d. Streptomycin- ANS: C Ethambutol may cause a decrease in visual acuity or even blindness resulting from retrobulbar neuritis. 67. When reviewing the allergy history of a patient, the nurse notes that the patient is allergic to penicillin. Based on this finding, the nurse would question an order for which class of antibiotics? a. Tetracyclines b. Sulfonamides c. Cephalosporins d. Quinolones- ANS: C Allergy to penicillin may also result in hypersensitivity to cephalosporins. 68. When reviewing the laboratory values of a patient who is taking antithyroid drugs, the nurse will monitor for which adverse effect? a. Decreased glucose levels b. Decreased white blood cell count c. Increased red blood cell count d. Increased platelet count- ANS: B Antithyroid drugs may cause bone marrow suppression, resulting in agranulocytosis, leukopenia, thrombocytopenia, and other problems. Where are injections administered on infants?- Vastus lateralis up until walking 69. While monitoring a patient who had surgery under general anesthesia 2 hours ago, the nurse notes a sudden elevation in body temperature. This finding may be an indication of which problem? a. Tachyphylaxis b. Postoperative infection c. Malignant hypertension d. Malignant hyperthermia- ANS: D A sudden elevation in body temperature during the postoperative period may indicate the occurrence of malignant hyperthermia, a life-threatening emergency.