DAVIS’S DRUG GUIDE FOR NURSES 15th Edition - Test Bank

Drug Guide Test Bank MULTIPLE CHOICE 1. The nurse is providing care for a patient scheduled to take Precose (acarbose) 25 mg three times daily with meals. The patient reports feeling sweaty, weak, and tremulous. Which of the following actions by the nurse is best? A. Reassure the patient that these are common side effects with the medication. B. Call the pharmacy to report an adverse drug reaction. C. Check the patient’s blood glucose level. D. Determine if the patient has a history of anemia. ANS: C See Nursing Implications for acarbose: Observe the patient for signs and symptoms of hypoglycemia. Acarbose alone does not cause hypoglycemia; however, other concurrently administered hypoglycemic agents may produce hypoglycemia, requiring treatment. Ignoring these symptoms would be dangerous, but it is not considered an adverse drug reaction requiring an official report. The patient is experiencing symptoms of hypoglycemia not anemia. KEY: Cognitive Level: Analysis DIF: Medium TOP: Therapeutic Classification: Antidiabetics REF: D 2. While responding to a rapid response called on the cardiac step-down unit, the nurse from intensive care observes the unit nurse massaging a patient’s neck and instructing the patient to bear down. Which of the following medications will most likely be used if the patient’s pulse does not return to normal? A. Adenocard (adenosine) B. Adrenaline (epinephrine) C. Tenormin (atenolol) D. Saphris (asenapine) ANS: A See adenosine Indications: Adenosine is used for the conversion of paroxysmal supraventricular tachycardia (PVST) to normal sinus rhythm when vagal maneuvers are unsuccessful. Epinephrine is a bronchodilator used in the management of reversible airway disease. Atenolol is a beta blocker used in the management of hypertension. Asenapine is an antipsychotic mood stabilizer used in the acute treatment of schizophrenia or manic/mixed episodes associated with bipolar I disorder. KEY: Cognitive Level: Application DIF: Medium TOP: Therapeutic Classification: Antiarrhythmics REF: Page 114 | Page 502 | Page 197 | Page 189 3. The nurse is instructing the parent of a 6-year-old patient recently started on a ProAir HFA (albuterol) inhaler for exercise-induced asthma. The nurse recognizes that further teaching is necessary by which of the following client statements? A. “He may feel like his heart is racing after he takes his inhaler.” B. “He can use the inhaler as many times during football practice as he needs it.” C. “He should avoid cola and other caffeinated drinks since they may increase his heart rate.” D. “He should take two puffs about 15 minutes before gym class.” ANS: B See Contraindications/Precautions, Interactions, and Dosage for albuterol. Excess inhaler use may lead to tolerance and paradoxical bronchospasm. Use with caffeine-containing herbs (cola nut, guarana, tea, coffee) increases stimulant effect. Two inhalations every 4–6 hr or two inhalations 15 min prior to exercise). Tachycardia is an expected side effect with this medication. KEY: Cognitive Level: Analysis DIF: Easy TOP: Therapeutic Classification: Bronchodilators REF: Page 118 4. While providing care for an adolescent patient newly prescribed Elavil (amitriptyline), the nurse should be most concerned by which of the following patient statements? A. “My mouth seems really dry and I’m thirsty all the time.” B. “I take a nap most afternoons now because I feel sleepy sometimes.” C. “I’m not sure why we should even bother anymore; everything seems so pointless.” D. “I drink a cup of coffee most days with breakfast.” ANS: C See Contraindications/Precautions for amitriptyline: the use of this medication may increase the risk of suicide attempt/ideation especially during dose early treatment or dose adjustment; risk may be greater in children or adolescents. Sedation is an expected side effect. Dry mouth is an expected side effect. There is no directive to avoid caffeine with this medication. KEY: Cognitive Level: Analysis DIF: Medium TOP: Therapeutic Classification: Antidepressants REF: Page 145 5. The nurse is caring for a patient with otitis media who reports an allergy to penicillin. Orders are received for ampicillin 500 mg every 8 hr. Which of the following actions by the nurse is best? A. Provide the medication as ordered. B. Call the pharmacist to request a substitution. C. Ask the patient if he or she has taken ampicillin in the past. D. Hold the medication. ANS: D See contraindications/precautions for ampicillin: Contraindicated in hypersensitivity to penicillin. This medication should be held due to the stated allergy to penicillin. KEY: Cognitive Level: Application DIF: Easy TOP: Therapeutic Classification: Anti-infectives REF: Page 158 6. While caring for a patient in hospice who is actively dying, the nurse notes moderate respiratory distress, copious oral secretion, and a frequent moist cough. Which of the following prn medications would most promote comfort for the patient? A. Morphine (morphine sulfate) 2 mg IV bolus B. Atro-Pen (atropine) 0.4 mg IV bolus C. Ativan (lorazepam) 0.5 mg IV bolus D. Benadryl (diphenhydramine) 25 mg IV bolus ANS: B See Action for atropine: Low doses decrease sweating, salivation, and respiratory secretions. Morphine is used for pain control. Lorazepam is used for anxiety. Benadryl is used for itching. KEY: Cognitive Level: Analysis DIF: Medium TOP: Therapeutic Classification: Antiarrhythmics | Therapeutic Classification: Anticholinergics REF: Page 203 7. The nurse is counseling a patient started on Zithromax (azithromycin) for the treatment of an upper respiratory infection. The nurse recognizes that teaching has been effective by which of the following patient statements? A. “The med pack will have five pills, one for each of the next 5 days.” B. “If I don’t feel better next week, I can get a refill from the pharmacist.” C. “I only need to take one pill, but my symptoms may not clear for 3 days.” D. “I can take this medication safely even though I’m allergic to erythromycin.” ANS: A See Route/Dosage for azithromycin: 500 mg on 1st day, then 250 mg/day for 4 more days. Instruct the patent to notify health-care professional if symptoms do not improve. Teach the patient to take medication as directed and to finish the drug completely. Azithromycin is contraindicated in patients with an allergy to erythromycin. KEY: Cognitive Level: Analysis DIF: Easy TOP: Therapeutic Classification: Anti-infectives REF: Page 208 8. The home-care nurse is preparing to see a patient being treated for diabetic foot ulcerations with Regranex (becaplermin). Which of the following instructions will the nurse include in the patient teaching? A. “Apply the wound gel three times daily to promote healing.” B. “Store the gel in the refrigerator.” C. “Complete healing is expected within 3 days.” D. “After applying the wound gel, cover with a transparent adhesive dressing.” ANS: B See Implementation for becaplermin: Calculated amount is applied as a thin layer and covered with a moist saline dressing for 12 hr; dressing is removed, ulcer rinsed, and redressed with moist dressing without becaplermin for rest of day. Process is repeated daily. Store gel in refrigerator; do not freeze. If ulcer does not decrease in size by 30% within 10 wk, continuation of therapy should be reassessed. Cover with a moist saline dressing for 12 hr. Then, remove dressing, rinse ulcer, and redress with moist dressing without becaplermin for rest of day. KEY: Cognitive Level: Analysis DIF: Hard TOP: Therapeutic Classification: Wound/Ulcer/Decubiti healing agents REF: Page 217 9. The nurse is tracking patient symptoms related to acute alcohol intoxication and withdrawal. Which of the following medications would the nurse expect to provide in the management of these symptoms? A. Plavix (clopidogrel) B. Zyban (bupropion) C. Prilosec (omeprazole) D. Tranxene (clorazepate) ANS: D See Indications for clorazepate: Clorazepate is used in the management of simple partial seizures, anxiety disorder, symptoms of anxiety, and acute alcohol withdrawal. Clopidogrel is an antiplatelet agent. Bupropion is an antidepressant. Omeprazole is an antiulcer agent. KEY: Cognitive Level: Application DIF: Medium TOP: Therapeutic Classification: Anticonvulsants REF: D 10. The nurse prepares to provide Colcrys (colchicine) to a patient. The nurse should assess which of the following prior to administration of the medication? A. Blood pressure B. Complete blood count C. Triglyceride level D. Oxygen saturation ANS: B See Nursing Implications/assessment for colchicine: In patients receiving prolonged therapy, monitor baseline and periodic CBC; may cause decreased platelet count, leukopenia, aplastic anemia, and agranulocytosis. No alteration in the blood pressure, triglyceride, or oxygenation is expected. KEY: Cognitive Level: Application DIF: Hard TOP: Therapeutic Classification: Antigout agents REF: Page 343 11. The nurse is transcribing new orders for a patient with multiple sclerosis. Amrix (cyclobenzaprine) 10 mg orally three times daily has been ordered. Which of the following would require an immediate intervention by the nurse? A. The patient has a noted allergy to acetaminophen. B. The patient has a family history of breast cancer. C. The patient is currently taking Nardil (phenelzine). D. The patient is diabetic. ANS: C See Contraindications/Precautions for cyclobenzaprine: Should not be used within 14 days of MAO inhibitor therapy. Phenelzine is an MAO inhibitor. The other factors will not impact the safe provision of cyclobenzaprine. KEY: Cognitive Level: Analysis DIF: Hard TOP: Therapeutic Classification: Skeletal muscle relaxants REF: Page 375 | 12. The nurse is preparing to provide medications for a patient newly admitted with a cerebral vascular accident who reportedly had difficulty swallowing pills during the previous shift. The nurse plans to crush the patient’s medications and provide them in applesauce. Which of the following medications will require an alternative form of administration? A. Aspirin 81 mg daily B. Enablex (darifenacin-XR) 15 mg daily C. Claritin (loratadine) 10 mg daily D. CalCarb (calcium carbonate) 500 mg daily ANS: B See Implementation/Nursing Implications for Enablex: Extended-release tablets must be swallowed whole; do not break or crush. Doing so can result in the immediate release of the full dose. Enablex (darifenacin-XR) is a urinary tract antispasmodic. KEY: Cognitive Level: Application DIF: Easy TOP: Therapeutic Classification: Urinary tract antispasmodics REF: Page 401 13. The nurse receives a call from a patient who recently began taking Zyrtec (cetirizine) 5 mg daily. The patient reports that her mouth frequently feels dry. Which of the following responses by the nurse is best? A. “Dry mouth is a common side effect of Zyrtec. Rinse your mouth frequently, and try using sugarless chewing gum or candy for relief.” B. “You may be taking too strong of a dose. You should take half a pill each day to reduce the risk of side effects.” C. “You might be having an allergic reaction to the medication. Are you able to come to the doctor’s office today?” D. “It is important that you take the medication with a full meal and drink at least 12 glasses of water each day.” ANS: A See Patient/Family Teaching for cetirizine: Advise patient that good oral hygiene, frequent rinsing of the mouth with water, and sugarless gum or candy may minimize dry mouth. It is outside the nursing scope of practice to alter dosage of a medication. Dry mouth is not a symptom of an allergic reaction and the patient does not need to be seen by a physician—if dry mouth persists beyond 2 wk, the patient should notify a dentist. The medication can be taken without regard to food. KEY: Cognitive Level: Analysis DIF: Medium TOP: Therapeutic Classification: Allergy, cold and cough remedies; Antihistamines REF: Page 317 14. The nurse is caring for a patient who takes Dexedrine (dextroamphetamine). The nurse should be most concerned by which of the following patient statements? A. “I seem to be able to focus better and I’m less distracted now.” B. “I’ve been having some trouble falling asleep at night lately.” C. “I started taking St. John’s wort this week to help with my depression.” D. “I forgot to take my medication in the morning last week so I took it at lunch time.” ANS: C See Interactions for dextroamphetamine: St. John’s wort may increase serious side effects; concurrent use is not recommended. Dextroamphetamine is used in the treatment of ADHD, so improved focus is a desired effect. Insomnia is commonly seen and the patient should be instructed to take the medication at least 6 hr prior to bedtime. The medication is generally given 1–2 times each day, and missed doses should be taken as soon as remembered up to 6 hr prior to bedtime. KEY: Cognitive Level: Analysis DIF: Medium TOP: Therapeutic Classification: Central nervous system stimulants REF: D 15. The nurse receives orders to begin Cardura (doxazosin) 1 mg daily with the first dose to start today. Which of the following assessments is the highest priority within the first 2 to 4 hr after provision? A. Urinary output B. Respiratory rate C. Pain relief D. Orthostatic hypotension ANS: D See Nursing Implications for doxazosin: Assess for first-dose orthostatic hypotension and syncope. The medication can be used in the treatment of benign prostatic hyperplasia, but orthostatic hypotension is a bigger concern and should be the first concern. No effect on the respiratory rate or pain is anticipated. KEY: Cognitive Level: Application DIF: Easy TOP: Therapeutic Classification: Antihypertensives REF: Page 461 16. The nurse is providing care for a patient who returned from surgery 4 hr earlier. The patient reports adequate pain control with the use of patient-controlled analgesia but states she is having significant nausea. Which of the following medications should the nurse provide? A. Inapsine (droperidol) 2.5 mg IV B. Benadryl (diphenhydramine) 25 mg IV C. Morphine (morphine sulfate) 2 mg IV D. Colace 100 mg po ANS: A See Indications for droperidol: Used to produce tranquilization and as an adjunct to general and regional anesthesia; useful in decreasing postoperative or postprocedure nausea and vomiting. Benadryl is an antihistamine used to treat itching. Morphine sulfate is a narcotic used to treat pain. Colace is a stool softener. KEY: Cognitive Level: Application DIF: Medium TOP: Therapeutic Classification: Sedative/hypnotics REF: D 17. The nurse is counseling a patient with diabetes, hypertension, and chronic obstructive pulmonary disease on his medications. To verify patient understanding of his medications, the nurse states, “You are taking Cymbalta (duloxetine) 60 mg once a day; do you know why you take that medication?” The nurse determines the patient has a good understanding of his medications if which of the following responses is given? A. “I take that one to keep my blood sugar under control.” B. “I don’t know honey, is that my little blue pill?” C. “That helps with the pain in my feet.” D. “I think that is to lower my blood pressure.” ANS: C See Indications for duloxetine: Duloxetine is used for major depressive disorder, diabetic peripheral neuropathic pain, generalized anxiety disorder and fibromyalgia. Patient education and verification of his or her understanding regarding medication use and purpose is an important component of health care. KEY: Cognitive Level: Analysis DIF: Medium TOP: Therapeutic Classification: Antidepressants REF: Page 474 18. While providing care for patients on a neuroscience unit, which of the following medications should the nurse provide first? A. Dantrium (dantrolene) 1 mg/kg IV to a patient with malignant hyperthermia B. Norpramin (desipramine) 100 mg orally to a patient admitted with syncope C. Enablex (darifenacin) 15 mg orally to a patient admitted for cerebrovascular accident D. Cymbalta (duloxetine) 20 mg to a patient with diabetes ANS: A See Indications for dantrolene: Emergency treatment of malignant hyperthermia, which can cause seizures. This is an emergency situation and must be the nurse’s highest priority. Desipramine is an antidepressant. It is not a priority. Darifenacin is used to treat overactive bladder spasms. It is not a priority. Duloxetine is an antidepressant. It is not a priority. KEY: Cognitive Level: Analysis DIF: Hard TOP: Therapeutic Classification: Skeletal muscle relaxants REF: Page 393 | Page 412 | Page 401 | Page 474 19. The nurse is caring for a patient with a history of Parkinson disease who recently started taking Comtan (entacapone). The nurse notes the patient’s urine has a brownish-orange discoloration. Which of the following actions should the nurse take next? A. Notify the physician. B. Determine the patient’s current weight. C. Ask the patient what he or she ate for breakfast. D. Note the assessment finding in the chart. ANS: D See Adverse Reactions/Side Effects GU for entacapone: This is a normal finding for patients taking entacapone. There is no need to take a specific action, and the assessments listed will not help determine the presence of other side effects or concerns. KEY: Cognitive Level: Analysis DIF: Hard TOP: Therapeutic Classification: Antiparkinson agents REF: Page 498 20. A young woman reports to the emergency department with frank vaginal bleeding and a stated history of being 10 wk pregnant. Ultrasound confirms an incomplete miscarriage, and the woman is scheduled for a dilatation and curettage. Which of the following medications should the nurse anticipate being provided after the surgical procedure? A. Rheumatrex (methotrexate) B. Methergine (methylergonovine) C. Magnesium sulfate D. Terbutaline ANS: B See indications for methylergonovine: Prevention and treatment of postpartum or postabortion hemorrhage caused by uterine atony or involution. Methotrexate is a neoplastic agent that has been used to induce chemical abortion. Magnesium sulfate is given in the treatment of preeclampsia. Terbutaline is used off label to reduce uterine contraction in the prevention of preterm labor. KEY: Cognitive Level: Application DIF: Medium TOP: Therapeutic Classification: Oxytocics REF: Pages 837 21. The nurse is assisting in the discharge of a patient with a peripherally inserted central catheter (PICC) who will receive antibiotic therapy with Invanz (ertapenem) at home under the direction of a home health-care agency. The nurse recognizes that teaching has been effective by which of the following client statements? A. “The nurses will come out every 6 hours to provide the IV antibiotic.” B. “If the dressing over the PICC line pulls back, the nurse will change it the next day.” C. “I will have to get the antibiotic once a day, usually for 2 weeks.” D. “Since I’m not allergic to penicillin, I won’t be allergic to this medication.” ANS: C See Route/Dosage and Nursing Implications for ertapenem: Ertapenem dosage is 1 g daily for up to 14 days (IV). The dressing on a PICC line must remain occlusive to prevent infection—if the dressing should pull back, the home care nurse should be notified immediately. Ertapenem is given once daily. Persons with a negative history of penicillin sensitivity may still have an allergic response. KEY: Cognitive Level: Analysis DIF: Medium TOP: Therapeutic Classification: Anti-infectives REF: Page 516 22. A nursing faculty is observing a student nurse prepare and provide morning medications including delayed-released Nexium (esomeprazole) capsules to a patient with a nasogastric (NG) tube. The nurse should intervene if which of the following is noted? A. The student asks the patient to state his name and birth date prior to preparing the medication. B. The student opens the capsule and mixes the granules with 50 mL of water. C. The student uses a 60 mL cath-tipped syringe to instill the medication into the NG tube. D. The student waited for the granules to dissolve to prevent clogging of the NG tube. ANS: D See Nursing Implications/Implementation for esomeprazole: The NG must be flushed after medication provision, and tube feeding should be held for at least 1 hr. Verifying patient identity with two unique identifiers is the correct way to ensure safe medication administration. For patients with an NG tube, delayed-release capsules can be opened and intact granules emptied into a 60 mL syringe and mixed with 50 mL of water. Replace plunger and shake vigorously for 15 sec. Hold syringe with tip up and check for granules in tip. Attach syringe to NG tube and administer solution. After administering, flush syringe with additional water. Do not administer if granules have dissolved or disintegrated. Administer immediately after mixing. Provide at least 1 hr before meals. The NG tube must be flushed after medication provision, and tube feeding should be held for at least 1 hr. KEY: Cognitive Level: Analysis DIF: Medium TOP: Therapeutic Classification: Anti-ulcer agents REF: Pages 525-526 23. The nurse caring for patients on a gynecological surgery unit would monitor which of the following women most closely for evidence of a deep vein thrombosis? A. A 64-year-old patient taking Apriso (mesalamine) who has a history of ulcerative colitis. B. A 47-year-old patient admitted for lumpectomy with a family history of breast cancer. C. A 58-year-old patient taking Estrace (estradiol) with a 42-pack-per-year history of smoking. D. A 61-year-old patient who had a bladder-sling procedure whose platelet count is 167,000 cells/mm3. ANS: C See Adverse Reactions/Side effects for estradiol: CV risk for MI and thromboembolism; smoking increases risk of adverse CV reactions. Mesalamine is a GI anti-inflammatory agent used in the treatment of ulcerative colitis and does not increase risk of thromboembolism. The platelet count is normal and although all surgical patients have an increased risk for thromboembolism, the patient taking estradiol is at higher risk. KEY: Cognitive Level: Analysis DIF: Medium TOP: Therapeutic Classification: Hormones REF: Page 527 24. A student nurse is taking care of patients on a medical unit and receives new orders for Lunesta (eszopiclone) 2 mg orally each evening. In transcribing this order, the student should take which of the following actions? A. Schedule the medication routinely at 6 p.m. B. Schedule the medication 1 hr prior to the evening meal. C. Call the pharmacy to ask what time the medication should be given. D. Schedule the medication at bedtime. ANS: D See Route/Dosage for eszopiclone: 2 mg immediately before bedtime. KEY: Cognitive Level: Application DIF: Easy TOP: Therapeutic Classification: Sedative/hypnotics REF: Page 532 25. While reviewing medications to be provided by a student nurse, the instructor notes a patient is scheduled to take famciclovir 500 mg orally every 8 hr. The instructor suspects the patient most likely has which of the following diagnoses? A. Methicillin-resistant Staphylococcus aureus (MRSA) infection B. Hepatic encephalopathy C. Herpes zoster D. Bacterial pneumonia ANS: C See Indications for famciclovir: Famciclovir is given for acute herpes zoster infection (shingles). KEY: Cognitive Level: Analysis DIF: Easy TOP: Therapeutic Classification: Antivirals REF: Page 547 26. A nurse working in hospice is providing care for a patient reporting increased instances of pain. Which of the following factors would indicate the patient is a good candidate for Fentanyl /transmucosal (ACTIQ) therapy? A. The patient reports breakthrough pain 8 out of 10. B. The patient currently takes greater than 60 mg of oral morphine scheduled around the clock per day. C. The patient has pancreatic cancer. D. The patient has an allergy to hydromorphone. ANS: B See Indications and Implementation for Fentanyl transmucosal: Used in the management of breakthrough pain in cancer patients already receiving and tolerant to around-the-clock opioid therapy for persistent cancer pain (60 mg/day of oral morphine or equivalent). The patient’s ranking of pain, cancer diagnosis, and allergy to hydromorphone do not necessarily indicate that buccal fentanyl is an appropriate therapy. KEY: Cognitive Level: Analysis DIF: Hard TOP: Therapeutic Classification: Opioid analgesics REF: Pages 561-562 27. While working with a patient who takes Dalmane (flurazepam), the nurse should be most concerned by which of the following patient statements? A. “I usually take the medication at 10 P.M.” B. “I have to take it every night or I won’t get any sleep.” C. “I work out at the gym three to four times per week.” D. “I stopped drinking coffee at dinner now.” ANS: B See flurazepam Patient/Family Teaching: Advise patient to take medication as prescribed (at bedtime). Teach sleep hygiene techniques (dark room, quiet, bedtime ritual, limit daytime napping, avoid nicotine and caffeine). Prolonged use may lead to psychological or physical dependence. KEY: Cognitive Level: Analysis DIF: Easy TOP: Therapeutic Classification: Sedative/hypnotics REF: D 28. The nurse caring for a patient who takes Simponi (golimumab) recognizes this as a relatively new agent in the class of monoclonal antibodies. In addition to their usefulness in the treatment of some tumor types, these agents play a role in the treatment of which of the following disease states? A. Viral hepatitis B. Rheumatoid arthritis C. Pancreatitis D. Multiple sclerosis ANS: B See Indications for golimumab: Golimumab is used in the treatment of moderately to severely active rheumatoid arthritis (with methotrexate), treatment of active psoriatic arthritis (alone or with methotrexate), and treatment of active ankylosing spondylitis. KEY: Cognitive Level: Knowledge DIF: Medium TOP: Therapeutic Classification: Antirheumatics REF: Page 621 29. The nurse providing therapy with Simponi (golimumab) recognizes the patient must be meticulously screened for which of the following? A. A history of active or latent tuberculosis B. The presence of orthostatic hypotension C. Risk factors associated with acute respiratory distress syndrome D. A history of poorly controlled diabetes mellitus ANS: A See Contraindications/Precautions, Nursing Implication/Assessment for golimumab: Use cautiously in patient with history of latent or active tuberculosis, when adequate treatment cannot be confirmed, antitubercular therapy should be considered. An increased risk of hypotension is not associated with this medication. An increased risk of ARDS is not associated with this medication. An increased risk of uncontrolled blood glucose levels is not associated with this medication. KEY: Cognitive Level: Analysis DIF: Hard TOP: Therapeutic Classification: Antirheumatics REF: Page 622 30. The nurse is caring for a patient receiving treatment for viral pneumonia. The nurse notes the patient has a persistent cough that is interfering with the patient’s ability to sleep. Which of the following medications should the nurse provide? A. Ativan (lorazepam) 1 mg orally prn B. Guiatuss (guaifenesin) 200 mg every 4 hr prn C. Tylenol (acetaminophen) 325 mg orally prn D. Sustol (granisetron) 2 mg orally prn ANS: B See Indications for guaifenesin: Guaifenesin is used for cough associated with viral upper respiratory tract infections. Lorazepam is a sedative. Acetaminophen is an analgesic. Granisetron is an antiemetic. KEY: Cognitive Level: Application DIF: Medium TOP: Therapeutic Classification: Allergy, cold and cough remedies; Expectorants REF: Page 628 31. A nurse on the cardiac unit is providing care to a 67-year-old patient who has recently been started on BiDil (hydralazine/isosorbide dinitrate) 1 tablet orally three times daily. The patient informs the nurse that he has a headache and rates his headache pain as 4 on a scale of 1–10. Which of the following actions by the nurse is best? A. Hold all future doses of BiDil and notify the pharmacy that the patient is allergic to the medication. B. Determine the patient’s oxygen saturation and call the physician. C. Inform the patient this is a common side effect and provide Tylenol (acetaminophen) prn as ordered. D. Provide earphones and teach the patient to use distraction techniques. ANS: C See Patient/Family Teaching for hydralazine/isosorbide dinitrate: Inform the patient that headache is a common side effect that should decrease with continuing therapy. Aspirin or acetaminophen may be ordered to treat headache. Notify the health-care provider if headache is persistent or severe. Do not later dose to avoid headache. Valid assessment would include vital signs and neurological examination because the medication is used in the treatment of heart failure; however, headache is not a symptom of allergic reaction, and there is no immediate need to notify the physician. Distraction techniques may be helpful but will not be the highest priority. KEY: Cognitive Level: Analysis DIF: Hard TOP: Therapeutic Classification: Vasodilators REF: Page 654 32. A nursing student is preparing to join a college expedition in the tropics. Which of the following medications is most likely to be included in the medical preparation for this trip? A. Keppra (levetiracetam) B. Remicade (infliximab) C. Namenda (memantine) D. Plaquenil (hydroxychloroquine) ANS: D See indications for hydroxychloroquine. It is an antimalarial agent used in the suppression/chemoprophylaxis of malaria, which is common in tropical areas. See indications for levetiracetam. It is an anti-seizure medication. See indications for infliximab. It is a monoclonal antibody used as an antirheumatic. See indications for memantine. It is an anti-Alzheimer’s agent. KEY: Cognitive Level: Application DIF: Medium TOP: Therapeutic Classification: Antimalarial REF: Page 765 | Page 685 | Page 812 | Page 661 33. The nurse is providing discharge instructions to a patient taking Boniva (ibandronate). The nurse should intervene if the client makes which of the following statements? A. “I usually walk 2 miles a day.” B. “I take that every morning when I get up and can’t eat for an hour.” C. “I realized at lunch time that I’d forgotten to take it once last week, so I just skipped the dose.” D. “I always take that with my morning coffee.” ANS: D See Implementation for Ibandronate: Ibandronate should be taken with 6–8 oz of plain water (mineral water, orange juice, coffee, and other beverages decrease absorption) 60 min before beverages or food. Encourage patient to participate in regular exercise. Instruct patient on the importance of taking as directed, first thing in the morning, 60 min before other medications, beverages, or food. If a dose is missed, skip dose and resume the next morning. KEY: Cognitive Level: Analysis DIF: Medium TOP: Therapeutic Classification: Bone resorption inhibitors REF: Pages 665-666 34. A nurse caring for a patient who takes Tofranil (imipramine) 150 mg orally at bedtime would be most concerned by which of the following observations? A. The patient’s urine has a blue-green tinge. B. The patient reports fuzzy vision and difficulty seeing. C. The patient reports feeling dizzy when getting out of bed. D. The patient reports she has gained 2 pounds in the last 3 weeks. ANS: B See Patient/Family Teaching for imipramine: Instruct the patient to notify health-care professional if visual changes occur. Inform patient that periodic glaucoma testing may be needed during long-term therapy. Alert patient that urine may turn blue-green in color. Caution patient to change positions slowly to minimize orthostatic hypotension. Inform patient of need to monitor dietary intake, as possible increase in appetite may lead to undesired weight gain. KEY: Cognitive Level: Analysis DIF: Medium TOP: Therapeutic Classification: Antidepressants REF: Pages 680-681 35. A patient with asthma has multiple inhalants prescribed including Ventolin (albuterol), Pulmicort Flexhaler (budesonide), and Atrovent (ipratropium). The nurse verifies teaching is effective if which of the following is observed? A. The patient takes the Atrovent (ipratropium) inhaler first B. The patient waits 1 min between each medication C. The patient rinses her mouth after using the inhalers D. The patient reports using ipratropium when experiencing severe, acute bronchospasms ANS: C See Nursing Implications and Patient/Family Teaching for albuterol: Advise patient that rinsing mouth after using inhaler, good oral hygiene, and sugarless gum or candy may minimize dry mouth. When ipratropium is administered concurrently with other inhalation medications, administer adrenergic bronchodilators (albuterol) first, followed by ipratropium, then corticosteroids. Wait 5 min between medications. Albuterol is the inhaler of choice with acute bronchospasm because the onset of action of ipratropium is too slow for patients in acute distress. KEY: Cognitive Level: Analysis DIF: Medium TOP: Therapeutic Classification: Bronchodilators REF: Page 119-120 36. The nurse is caring for a patient recently started on Seroquel (quetiapine). Which assessment finding would indicate that treatment was effective? A. BP = 178/82 B. Patient denies hearing voices in his head. C. Urine output was 350 mL in 8 hr. D. Patient reported pain was a 2 on a 1–10 scale. ANS: B See Evaluation/Desired Outcomes for quetiapine: Decrease in positive symptoms (delusions, hallucinations) of schizophrenia. KEY: Cognitive Level: Analysis DIF: Medium TOP: Therapeutic Classification: Antipsychotics, Mood stabilizers REF: Page 1073 37. The nurse is providing care for a patient diagnosed with candidiasis. The nurse expects the medication record to include which of the following medications? A. Lamictal (lamotrigine) B. Trandate (labetalol) C. Sprix (ketorolac) D. Nizoral (ketoconazole) ANS: D See Indications for ketoconazole: Ketoconazole is indicated in the treatment of candidiasis. See Indications for lamotrigine. It is an anticonvulsant. See Indications for labetalol. It is an anti-anginal beta blocker. See Indications for ketorolac. It is a nonsteroidal anti-inflammatory analgesic. KEY: Cognitive Level: Application DIF: Hard TOP: Therapeutic Classification: Anti-fungals REF: Page 742 | Page 735 | Page 730 | Page 174 38. The nurse is caring for a patient on the operative day for a laparoscopic-assisted vaginal hysterectomy. The patient complains of pain and the nurse notes orders for ketorolac) 30 mg intravenously every 6 hr as needed for pain. Which of the following actions should the nurse take? A. Mix the ketorolac with 10 mL sterile normal saline prior to administration. B. Check the patient’s magnesium level prior to administration. C. Draw up the medication and administer in the nearest IV port over 15 seconds. D. Check to determine if the patient has an allergy to morphine. ANS: C See IV administration for Ketorolac: Administer undiluted. Ketorolac may alter BUN, serum lipoproteins, potassium, triglycerides, and uric acid levels, but no effect on magnesium is expected. Allergy to morphine is not a contraindication for the use of ketorolac. KEY: Cognitive Level: Application DIF: Medium TOP: Therapeutic Classification: Nonsteroidal anti-inflammatory agents; Nonopioid analgesics REF: Page 732 39. The nurse is caring for a patient admitted with hepatic encephalopathy who is receiving Constilac (lactulose). The nurse should be prepared to assist the patient in managing which of the following side effects? A. Headache B. Somnolence C. Muscle aches D. Frequent loose stools ANS: D See Side Effects for lactulose: Belching, cramps, distention, flatulence, diarrhea, and hyperglycemia. KEY: Cognitive Level: Application DIF: Medium TOP: Therapeutic Classification: Laxatives REF: Page 739 40. The nurse is caring for a patient who reports taking Prevacid (lansoprazole) 15 mg orally each day. The nurse expects the pharmacy to substitute which of the following medications during hospitalization? A. Prilosec (omeprazole) B. Zofran (ondansetron) C. Carafate (sucralfate) D. Tums (calcium carbonate) ANS: A See Action for calcium carbonate, lansoprazole, omeprazole, ondansetron, and sucralfate. While each of the medications may be used in the treatment of gastric ulcer, the action of lansoprazole and omeprazole are similar; both are proton pump inhibitors, and therefore substitution based on availability per hospital pharmacy registry is possible. KEY: Cognitive Level: Analysis DIF: Easy TOP: Therapeutic Classification: Anti-ulcer agents REF: Page 266 | Page 745 | Page 945 | Page 947 | Page 1154 41. The nurse is caring for a patient experiencing dysphagia and weight loss due to oral mucositis. Which of the following should be the nurse’s highest priority? A. Instruct the patient to use hydrogen-peroxide-based mouthwash three times daily. B. Provide Xylocaine (viscous lidocaine) topically prior to meals. C. Encourage normal saline rinses each morning. D. Order a puree diet. ANS: B See Indications for lidocaine: Local infiltration/mucosal/topical anesthetic. Mouth rinses containing hydrogen peroxide help prevent infection but will not relieve the pain associated with oral mucositis. Normal saline rinses should be recommended frequently (every 2–4 hr) to keep the mouth clean but will not help reduce pain with meals. Puree diet may be helpful but will not address the patient’s report of pain. KEY: Cognitive Level: Application DIF: Medium TOP: Therapeutic Classification: Anesthetics—topical/local REF: Page 774 42. The nurse is caring for a pediatric patient who needs to have an IV line started. The nurse plans to provide EMLA cream (lidocaine/prilocaine) to the patient’s arm. Which of the following actions should the nurse take? A. Rub the cream onto a 2-inch surface of the arm 15 min prior to the procedure. B. Rub the cream onto a 6-inch surface of the arm 30–45 min prior to the procedure. C. Place a thick layer of cream under an occlusive dressing on a 2-inch site 1 hr prior to the procedure. D. Place a thin layer of cream under an occlusive dressing on a 6-inch site 20 min prior to the procedure. ANS: C See Implementation for lidocaine/prilocaine: Apply the 2.5 g tube of cream (one-half of the 5 g tube) to each 2-inch by 2-inch area of skin in a thick layer. Cover so there is a thick layer of cream under the occlusive dressing. Do not spread out or rub in the cream. It must be applied at least 1 hr before the start of the procedure. KEY: Cognitive Level: Analysis DIF: Medium TOP: Therapeutic Classification: Anesthetics—topical/local REF: Page 774 43. The nurse is caring for a patient admitted from an extended care facility who has developed a moist, productive cough. A chest x ray was ordered and new orders for Zyvox (linezolid) 600 mg IV every 12 hr has been received. Which of the following orders should the nurse also complete prior to providing the first dose of medication? A. Daily weight B. Sputum culture and sensitivity C. Complete blood count (CBC) D. Chemistry profile ANS: B See Nursing Implications for linezolid: Obtain specimens for culture and sensitivity prior to initiating therapy. KEY: Cognitive Level: Application DIF: Easy TOP: Therapeutic Classification: Anti-infectives REF: Page 778 44. The nurse is caring for a patient who is to receive 1 mg of Ativan (lorazepam) intravenously as conscious sedation prior to a bedside procedure. Which of the following actions should the nurse take? A. Infuse the medication using an insulin syringe directly into the nearest Y port of the IV. B. Dilute the medication with 10 mL of Lactated Ringer’s solution prior to administration. C. Administer the medication over at least 1 min. D. Monitor the patient for hypertension immediately following administration. ANS: C See IV Administration for lorazepam: Administer at a rate not to exceed 2 mg/min or 0.05 mg/kg over 2–5 min. The medication should be diluted. Insulin syringes are reserved for insulin and are generally not used to provide IV medication. Dilute immediately before use with an equal amount of sterile water for injection, D5W or 0.9NS for injection. Rapid administration may result in apnea, hypotension, bradycardia, or cardiac arrest—hypertension is not expected. KEY: Cognitive Level: Analysis DIF: Medium TOP: Therapeutic Classification: Anesthetic adjuncts REF: Page 791 45. The nurse is working with a client who is undergoing a bowel prep prior to a scheduled colonoscopy. Which of the following medications should the nurse expect to provide? A. Magnesium chloride sustained-release tablets 535 mg/each, 2 tablets B. Magnesium citrate oral solution, 300 mL bottle C. Magnesium hydroxide chewable tablets, 300 mg D. Magnesium sulfate 1 g intravenously ANS: B See Indications for Magnesium citrate oral solution: Bowel evacuant in preparation for surgical/radiographic procedures. Magnesium citrate oral solution is used as a bowel prep. Sustained-release tablets will not aid in the evacuation of bowel contents. Chewable tablets are used as electrolyte replacement or as an antacid. IV provision is used for electrolyte replacement. KEY: Cognitive Level: Application DIF: Easy TOP: Therapeutic Classification: Mineral and electrolyte replacements, laxatives REF: Page 800 46. The nurse is caring for a patient in the intensive care unit. The patient is receiving Osmitrol (mannitol) 0.5 g/kg infused over 60 min. Which of the following would indicate an effective response to the treatment? A. Urine output is 50 mL over the next hour. B. White blood cell count is 6.4 cells/mm3. C. Patient oxygen status is 89% on 3 L of oxygen. D. Patient’s blood pressure is 148/42. ANS: A See Indications and Evaluation for mannitol: Mannitol is used in the treatment of acute oliguric renal failure, edema, and increased intracranial or intra-ocular pressure. Urine output of at least 30–50 mL/hr or an increase in urine output in accordance with parameters set by physician should be seen. Mannitol will have no effect on the WBC. Oxygenation may improve if intracranial pressure or fluid overload is effecting oxygenation, but this saturation is below normal and not indicative of effective treatment. Wide pulse pressures are indicative of increased intracranial pressure that should improve with mannitol treatment. KEY: Cognitive Level: Analysis DIF: Hard TOP: Therapeutic Classification: Diuretics REF: Pages 804-805 47. The nurse is caring for a patient admitted with chronic pain who has been receiving meperidine 100 mg orally every 3–4 hr as needed for pain for the past 4 days. Which of the following actions is the highest priority in the patient’s care? A. Monitor the patient for irritability or seizure activity. B. Determine when the patient last moved his bowels. C. Ask the patient if he is experiencing insomnia. D. Check the patient’s labs to determine triglyceride levels. ANS: A See Nursing Implications for Meperidine: Monitor patients on chronic or high-dose therapy for CNS stimulation (restlessness, irritability, or seizures) due to accumulation of normeperidine metabolite. Risk of toxicity increases with doses greater than 600 mg/24 hr. Constipation is a concern for the patient but is not the highest priority. Insomnia is not expected because meperidine causes sedation. Triglyceride levels are not affected by meperidine. KEY: Cognitive Level: Analysis DIF: Medium TOP: Therapeutic Classification: Opioid analgesics REF: Pages 815-816 48. The nurse recognizes that Apriso (mesalamine) would most likely be included in the plan of care for which of the following patients? A. A 52-year-old patient with chronic obstructive pulmonary disease (COPD). B. A 49-year-old patient with acute cholelithiasis. C. A 37-year-old patient with ruptured ectopic pregnancy. D. A 27-year-old patient with ulcerative colitis. ANS: D See Indications for mesalamine: Mesalamine is used for inflammatory bowel disease including ulcerative colitis, proctitis, and proctosigmoiditis. KEY: Cognitive Level: Analysis DIF: Medium TOP: Therapeutic Classification: Gastrointestinal anti-inflammatories REF: Page 821 49. The nurse is caring for a patient who has been receiving chemotherapy for the past 4 months. The patient takes Reglan (metoclopramide) 10 mg every 4 hr as needed for nausea and vomiting. The nurse should be most concerned with which of the following patient statements? A. “I’m losing my balance a lot and I noticed my hands are shaky.” B. “I’ve lost 5 pounds in the past month.” C. “I’m not sure what I’m going to do when I don’t have to come in here all of the time.” D. “My kids are really struggling with the fact that I just don’t have any energy anymore.” ANS: A See Nursing Implications for metoclopramide: Assess patient for extrapyramidal side effects—difficulty speaking or swallowing, loss of balance, pill rolling, mask-like face, shuffling gait, rigidity, tremors, and dystonic reactions. Weight loss is concerning but not the highest priority. Psychosocial concerns are important but are not the highest priority. Psychosocial concerns are important but are not the highest priority. KEY: Cognitive Level: Analysis DIF: Medium TOP: Therapeutic Classification: Anti-emetics REF: Pages 844-845 50. The nurse is caring for a patient who reports long-term use of nonsteroidal anti-inflammatory agents for the treatment of osteoarthritis. Which of the following medications would the nurse also expect as part of the patient’s treatment plan? A. Cytotec (misoprostol) B. Lopressor (metoprolol) C. Flagyl (metronidazole) D. Remeron (mirtazapine) ANS: A See Indications for misoprostol. Misoprostol is used in the prevention of gastric mucosal injury from NSAIDs in high-risk patients. See Indications for metoprolol. Metoprolol is a beta blocker. See Indications for metronidazole. Metronidazole is an anti-infective. See Indications for mirtazapine. Mirtazapine is an antidepressant. KEY: Cognitive Level: Analysis DIF: Hard TOP: Therapeutic Classification: Anti-ulcer agent REF: Page 867 | Page 847 | Page 850 | Page 865 51. The nurse is counseling the parent of a 14-year-old patient with asthma who is to initiate maintenance therapy with Singulair (montelukast). Which of the following should the nurse include in the teaching? A. “This medication can be helpful in acute asthmatic attacks.” B. “Monitor your child for any behavior that indicates depression or suicidal thoughts.” C. “If your child is not experiencing any asthma symptoms, she will not need to take the medication that day.” D. “Now that your child is taking this medication, she will not need her other asthma medications.” ANS: B See Nursing Implications and Patient/Family Teaching for montelukast: Monitor closely for changes in behavior that could indicate the emergence or worsening of depression or suicidal thoughts. Montelukast is not to be used to treat acute asthmatic attacks. Take medication daily even if not experiencing symptoms of asthma. Instruct patient not to discontinue or reduce other asthma medications without consulting a health-care professional. KEY: Cognitive Level: Analysis DIF: Medium TOP: Therapeutic Classification: Allergy, cold and cough remedies; Bronchodilators REF: Pages 874-875 52. The student nurse is participating in discharge teaching for the parents of a 2-year-old patient diagnosed with impetigo who have been given a prescription for Bactroban (mupirocin). The student understands that this medication is provided in which of the following forms? A. As an oral pill B. As a rectal suppository C. As a topical ointment D. As a liquid suspension ANS: C See Availability for Bactroban: Ointment or cream. Impetigo is a skin infection characterized by honey-colored crusts often involving the nose or around the oral mucosa; treatment is topical. KEY: Cognitive Level: Application DIF: Medium TOP: Therapeutic Classification: Anti-infectives REF: Page 879 53. The nurse is caring for a patient who has been started on Corgard (nadolol). Which of the following assessment findings would be most concerning to the nurse? A. A fasting blood sugar of 92 g/dL B. A blood pressure of 116/70 mm Hg C. Noted jugular vein distension D. A resting pulse of 64 bpm ANS: C See Nursing Implications for nadolol: Assess patient routinely for evidence of fluid overload (including jugular vein distention). The fasting blood sugar is within accepted normal limits. Blood pressure is of a normal finding. Pulse is of a normal finding. KEY: Cognitive Level: Analysis DIF: Medium TOP: Therapeutic Classification: Anti-anginals; Anti-hypertensives REF: Pages 883-884 54. The nurse is caring for a patient who has been on multiple antibiotics for the treatment of pneumonia. The patient reports having a sore throat. The nurse notes a white coating on the patient’s tongue as well as redness to the lips and gums. The nurse would most likely contact the physician to request which of the following? A. Pamelor (nortriptyline) 25 mg capsules three times daily B. Nimodipine 30 mg capsules every 4 hr C. Zyprexa (olanzapine) 5 mg tablet daily D. Nilstat (nystatin) 400,000 unit lozenge four times daily ANS: D See Indications, Dosage, and Availability for nystatin. Nystatin is used for local treatment of oropharyngeal candidiasis and can be taken as an oral suspension or as a lozenge. See Indications, Dosage, and Availability for nortriptyline. Nortriptyline is an antidepressant. See Indications, Dosage, and Availability for nimodipine. Nimodipine is a calcium channel blocker. See Indications, Dosage and Availability for olanzapine. Olanzapine is an antipsychotic. KEY: Cognitive Level: Application DIF: Medium TOP: Therapeutic Classification: Antifungals REF: Page 924 | Page 911 | Pages 932 | Page 927 55. A nurse working in the chemotherapy outpatient department is providing antiemetic therapy using Zofran (ondansetron). The ordered dose is 32 mg. Which of the following actions should the nurse take to optimize the efficacy of the medication? A. Provide the dose as an intramuscular injection 10 min prior to starting chemotherapy. B. Provide the dose undiluted intravenously over 2 min just prior to starting chemotherapy. C. Provide the dose diluted in 50 mL of D5W infused intravenously over 15 min at least 30 min prior to starting chemotherapy. D. Provide the dose diluted in 50 mL of 0.9 NaCl infused intravenously over 5 min, 60 min prior to starting chemotherapy. ANS: C See Route/Dosage and IV administration for ondansetron: Prevention of chemotherapy-induced nausea/vomiting can be given as a single 32 mg dose 30 min prior to chemotherapy. Ondansetron can be diluted in D5W and 0.9 NaCl. KEY: Cognitive Level: Application DIF: Medium TOP: Therapeutic Classification: Anti-emetics REF: Pages 947-948 56. A nurse in an outpatient clinic receives a call from a patient who reports having had symptoms of the flu for the past 4 days. The patient is seeking an appointment with the physician and wants, “the medication that treats the flu [Tamiflu (oseltamivir)].” Which of the following responses by the nurse is best? A. “Tamiflu is only helpful for those who have had symptoms for 2 days or less.” B. “Did you receive the flu shot this season?” C. “What is your current temperature?” D. “Do you have an allergy to eggs?” ANS: A See Indications for oseltamivir: Oseltamivir is used in the treatment of uncomplicated acute illness due to influenza infection in adults and children who have had symptoms for ≤ 2 days. Flu shot, current temperature, and egg allergy are not contraindications for Tamiflu. KEY: Cognitive Level: Analysis DIF: Medium TOP: Therapeutic Classification: Antivirals REF: Page 950 57. The student nurse is caring for a patient who currently takes Ditropan XL (oxybutynin). The student should include which of the following statements in the patient’s teaching? A. “This medication will help reduce your pain.” B. “Some people who take this develop ringing in their ears.” C. “This medication helps you control your bladder.” D. “Some people complain of night sweats with this medication.” ANS: C See Indications for oxybutynin: Oxybutynin is used for urinary symptoms that may be associated with neurogenic bladder including frequent urination, urgency, nocturia, urge incontinence. The side effect profile does not include ringing in the ears or night sweats. KEY: Cognitive Level: Analysis DIF: Medium TOP: Therapeutic Classification: Urinary tract antispasmodics REF: Page 960 58. While reviewing a patient’s medications for the day, the nurse notes the patient is prescribed Creon (pancrelipase) three times daily. Which of the following actions by the nurse is best? A. Provide the medication 30 min after the patient’s meals. B. Provide the medication immediately before or with the patient’s meals. C. Provide the medication at least 60 min before the patient’s meals. D. Provide the medication evenly spaced throughout the day with no correlation with meals. ANS: B See Route/Dosage for Creon: One to three capsules before or with meals. KEY: Cognitive Level: Application DIF: Medium TOP: Therapeutic Classification: Digestive agent REF: Page 979 59. The nurse receives a call from a client who recently started taking Paxil (paroxetine). The parent reports the child has lost 6 pounds in the past 10 days. Which of the following statements by the nurse is best? A. “Are you able to come into the clinic today?” B. “That’s great news, the treatment must be working.” C. “Weight loss is expected with this medication, so there is no reason for concern.” D. “Has your child had any vomiting?” ANS: A See Nursing Implications for Paxil: Paxil is an antianxiety/antidepressant. It is important to monitor appetite and nutritional intake, weigh weekly, and notify health-care professional of continued weight loss. KEY: Cognitive Level: Analysis DIF: Medium TOP: Therapeutic Classification: Anti-anxiety agents, Anti-depressants REF: Pages 988 60. The nurse is caring for a patient who needs emergency surgery. The patient’s history includes daily use of Coumadin (warfarin). Which of the following medications should the nurse anticipate being ordered? A. Dilantin (phenytoin) B. Vitamin K (phytonadione) C. Luminal (phenobarbital) D. Protamine sulfate ANS: B See Indications for Vitamin K: Phytonadione (vitamin K) is the antidote to oral anticoagulants. Phenytoin is an anticonvulsant. Phenobarbital is an anticonvulsant. Protamine sulfate is the antidote to heparin. KEY: Cognitive Level: Application DIF: Easy TOP: Therapeutic Classification: Antidotes REF: Pages 1027 and 1283 61. The nurse receives a call from a patient who recently started taking Actos (pioglitazone) 15 mg every morning. The patient states, “I forgot to take it for the past 2 days. What should I do?” Which of the following is the best response by the nurse? A. “Simply take the medication as planned today.” B. “Take two today and then one a day from this point forward.” C. “You will need to come in and have some blood drawn.” D. “Are you experiencing any pain today?” ANS: A See Patient/Family Teaching for Actos: Instruct the patient to take the medication as directed. If the dose for 1 day is missed, do not double the dose the next day. Pioglitazone improves sensitivity to insulin and is used in the control of diabetes. Pain is not a side effect or the indication for treatment so assessing pain is not pertinent to the stated problem. KEY: Cognitive Level: Analysis DIF: Medium TOP: Therapeutic Classification: Antidiabetics (oral) REF: Pages 1033 62. The nurse is caring for a patient in the intensive care unit with an NG tube to low intermittent suction after bowel surgery. Morning lab results include the following: Na+ = 136 mEq, K+ = 3.3 mEq, Cl– = 100 mEq, Ca++ = 10 mg/dL. The patient has scheduled medications, which include potassium bicarbonate/potassium chloride 40 mEq via NG and Lasix (furosemide) 20 mg intravenous push daily. Which of the following actions should the nurse take next? A. Evaluate the patient’s telemetry reading. B. Hold the patient’s daily dose of potassium chloride. C. Assess the amount and color of the NG output over the past 2 hr. D. Provide the patient’s scheduled Lasix (furosemide). ANS: A See Evaluation/Desired Outcomes and Nursing Implications for Potassium bicarbonate/potassium chloride: Potassium bicarbonate/potassium chloride is used to prevent or correct serum potassium depletion. The patient’s serum potassium is low, and this places the patient at risk for cardiac arrhythmias. The medication should be given. While the NG output is important, it is not the highest priority. While the scheduled furosemide dose is important, it is not the highest priority. KEY: Cognitive Level: Analysis DIF: Medium TOP: Therapeutic Classification: Mineral and electrolyte replacements/supplements REF: Pages 63. The nurse is providing care for a patient who is being considered for treatment with Actonel (risedronate). Prior to initiating therapy, the nurse should evaluate the results from which of the following diagnostic tests? A. Echocardiogram B. Pulmonary function tests C. Fasting blood sugar D. Bone density study ANS: D See Nursing Implications for Actonel: Assess patient via bone density study for low bone mass before and periodically during therapy. KEY: Cognitive Level: Application DIF: Medium TOP: Therapeutic Classification: Bone resorption inhibitors REF: Pages 1100 64. The nurse is caring for a patient who takes rosiglitazone 4 mg daily. The nurse should be most concerned by which of the following assessment findings? A. Random glucose = 142 mg/dL B. Urine output is 200 mL in the past 4 hr C. Inspiratory crackles noted on auscultation D. Apical pulse = 72 bpm ANS: C See Nursing Implications for rosiglitazone: Assess patient for edema and sings of CHF (dyspnea, rales/crackles, peripheral edema, weight gain, jugular venous distention). Rosiglitazone is used in the treatment of diabetes mellitus, so an elevated serum glucose of 142 mg/dL is expected. Urine output is within normal limits. Apical pulse is within normal limits. KEY: Cognitive Level: Analysis DIF: Medium TOP: Therapeutic Classification: Antidiabetics REF: D 65. The nurse is providing Serevent Diskus (salmeterol) to a patient on the medical unit who has a long-term history of chronic obstructive pulmonary disease. The nurse would intervene if which of the following were observed? A. The patient did not attach a spacer prior to inspiration. B. The patient closes the device after inhalation without washing the mouthpiece. C. The patient held the diskus level in a horizontal position. D. The patient exhaled into the diskus device. ANS: D See Patient/Family Teaching for salmeterol: Instruct patient using powder for inhalation never to exhale into diskus device and to always hold the device in a level, horizontal position. The mouthpiece should be kept dry; never wash. KEY: Cognitive Level: Analysis DIF: Medium TOP: Therapeutic Classification: Bronchodilators REF: Page 1123 66. The nurse is providing care for a patient who is taking Senokot (sennoside) two tablets orally each day. Which of the following actions by the nurse will most promote effective treatment with this planned medication? A. Give the medication with breakfast at 8 a.m. B. Give the medication with a full glass of water. C. Determine the patient’s resting pulse rate prior to provision. D. Assess the patient’s level of consciousness 2 hr after provision. ANS: B See Implementation sennoside: Take with a full glass of water. Administer medication at bedtime for evacuation 6–12 hr later. Administer on an empty stomach for more rapid results. Determining resting pulse is not necessary or related to the medications action or side effects. Determining level of consciousness is not necessary or related to the medication’s action or side effects. KEY: Cognitive Level: Analysis DIF: Medium TOP: Therapeutic Classification: Laxatives REF: Page 1132 67. While providing care for a patient who takes Januvia (sitagliptin), the nurse should be most concerned by which of the following findings? A. Patient reports persistent abdominal pain that radiates to the back B. Patient reports having a headache C. Hemoglobin A1C = 5% D. Patient takes Glucophage (metformin) concurrently ANS: A See Nursing Implications for sitagliptin: Monitor for signs of pancreatitis (nausea, vomiting, anorexia, persistent severe abdominal pain, sometimes radiating to the back). Sitagliptin is used to improve glycemic control in type 2 diabetes. Headache is a recognized side effect and is not the highest priority. Sitagliptin can be taken as monotherapy or in combination with metformin and a thiazolidinedione and/or a sulfonylurea. The hemoglobin A1C is normal. KEY: Cognitive Level: Analysis DIF: Medium TOP: Therapeutic Classification: Antidiabetics REF: Pages 68. While talking to a teen who stopped taking tetracycline) a couple of weeks ago, the nurse learns the teenager has been having diarrhea and abdominal cramping for the past few days. Which of the following responses by the nurse is best? A. “Does anyone else in your family have the flu?” B. “Did you get a flu vaccine this year?” C. “How much water are you drinking each day?” D. “You need to contact your physician right away. This could be a serious complication of your medication.” ANS: D See Nursing Implications for tetracycline: Monitor bowel function. Diarrhea, abdominal cramping, fever, and bloody stools should be reported to the health-care professional promptly as a sign of pseudomembranous colitis. It may begin up to several weeks following cessation of therapy. KEY: Cognitive Level: Analysis DIF: Medium TOP: Therapeutic Classification: Anti-infectives REF: Pages 69. The nurse is preparing to provide routine morning medications, which include Synthroid (levothyroxine). Which of the following assessments should be done prior to administration? A. Apical pulse rate B. Serum sodium level C. Deep tendon reflexes D. Pupils’ response to light ANS: A See Nursing Implications for levothyroxine: Assess apical pulse and blood pressure prior to and periodically during therapy. Assess for tachyarrhythmias and chest pain. KEY: Cognitive Level: Application DIF: Medium TOP: Therapeutic Classification: Hormones REF: Page 770 70. A nurse working in a physician’s office is collecting history information from a patient who reports experiencing erectile dysfunction and is seeking treatment with Levitra (vardenafil). This medication would be contraindicated if the patient is currently taking which of the following? A. Vitamin B12 (cyanocobalamin) B. Nitro-Dur (nitroglycerin patch) C. Chantix (varenicline) D. Effexor (venlafaxine) ANS: B See Interactions for vardenafil: Concurrent use of nitrates may cause serious life-threatening hypotension and is contraindicated. Concurrent use of Class IA antiarrhythmics (such as quinidine or procainamide) or Class III antiarrhythmics (such as amiodarone or sotalol) increase risk of serious arrhythmias and should be avoided. KEY: Cognitive Level: Application DIF: Hard TOP: Therapeutic Classification: Erectile dysfunction agents REF: Page 1251 71. While working on a medical unit, the nurse answers a call light for a woman who asks to take her Ambien (zolpidem) 10 mg orally as ordered before going to sleep. After providing the medication, which of the following actions should the nurse take next? A. Instruct the patient to drink at least two full glasses of water in the next 30 min. B. Instruct the patient to wear her slippers if she gets up during the night. C. Raise the patient’s bed side rail. D. Document