Abrams' Clinical Drug Therapy: Rationales for Nursing Practice 12th Edition
Frandsen Test Bank
Chapter 1 The Foundation of Pharmacology: Quality and Safety
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B)
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A woman has been prescribed paroxetine
hydrochloride, which is an antidepressant
agent administered in pill form. The
1.
medication is administered for her obsessivecompulsive disorder. This medication will
produce which of the following effects?
Curative
Systemic
Local
Parenteral
B
Feedback:
Drugs that produce systemic effects are taken
into the body, circulated through the
bloodstream to their sites of action in various
body tissues, and eventually eliminated from
the body. Curative agents are given to cure a
disease process. In this case, paroxetine
hydrochloride will control the symptoms but
not cure the disorder. Drugs with local effects,
such as sunscreen and local anesthetics, act
mainly at the site of application. Paroxetine
hydrochloride is not administered
parenterally. Parenteral agents are
administered subcutaneously, intramuscularly,
or intravenously.
A)
B)
C)
D)
Ans:
A patient has been prescribed an antibiotic.
This medication is a naturally occurring
2. substance that has been chemically modified.
What is another name for this type of
medication?
Synthetic drug
Semisynthetic drug
Biotechnology drug
Prototype drug
B
Feedback:
Semisynthetic drugs (e.g., many antibiotics)
are naturally occurring substances that have
been chemically modified. Synthetic drugs are
more standardized in their chemical
characteristics, more consistent in their
effects, and less likely to produce allergic
Semisynthetic drug
Biotechnology drug
Prototype drug
B
Feedback:
Semisynthetic drugs (e.g., many antibiotics)
are naturally occurring substances that have
been chemically modified. Synthetic drugs are
more standardized in their chemical
characteristics, more consistent in their
effects, and less likely to produce allergic
reactions. Biotechnology drugs involve
manipulating DNA and RNA and
recombining genes into hybrid molecules that
can be inserted into living organisms.
Prototype drugs are the first drug of a
particular group to be developed.
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C)
D)
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B)
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B)
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A patient is administered morphine. Morphine
is a prototypical drug that can be classified in
3.
different ways. Which of the following
classifications applies to morphine?
Central nervous system depressant
Central nervous system stimulant
Anti-inflammatory
Antihypertensive
A
Feedback:
Drugs are classified according to their effects
on particular body systems, their therapeutic
uses, and their chemical characteristics. For
example, morphine can be classified as a
central nervous system depressant and a
narcotic or opioid analgesic. A central nervous
system stimulant increases attention and
raises mood. An anti-inflammatory agent
decreases inflammation at the site of tissue or
joint inflammation. An antihypertensive agent
reduces blood pressure.
A patient is administered amoxicillin
(Amoxil). The generic name of this
4.
medication indicates that it belongs to which
drug group?
Selective serotonin reuptake inhibitors
Diuretics
Penicillins
ACE inhibitors
C
Feedback:
The generic name often indicates the drug
group (e.g., drugs with generic names ending
in “cillin” are penicillins). Selective serotonin
reuptake inhibitors are medications that have
Selective serotonin reuptake inhibitors
Diuretics
Penicillins
ACE inhibitors
C
Feedback:
The generic name often indicates the drug
group (e.g., drugs with generic names ending
in “cillin” are penicillins). Selective serotonin
reuptake inhibitors are medications that have
antidepressant effects; SSRI is a broad
classification, not a generic name. Diuretics
are medications that increase urine output;
diuretic is a broad classification, not a generic
name. ACE inhibitor is the broad
classification for the angiotensin-converting
enzyme inhibitors, not the generic name.
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The administration of diphenhydramine
(Benadryl), which is an over-the-counter
5.
medication, is regulated by which government
agency?
Public Health Service
Federal Trade Commission
Occupational Safety and Health
Administration
Food and Drug Administration
D
Feedback:
The Food and Drug Administration approves
drugs for over-the-counter availability,
including the transfer of drugs from
prescription to OTC status, and may require
clinical trials to determine the safety and
effectiveness of OTC use. The Public Health
Service is regulated by the state to maintain
the health of individual citizens of the state.
The Federal Trade Commission regulates
imports and exports throughout the nation.
The Occupational Safety and Health
Administration regulates safety within the
workplace.
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B)
C)
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The administration of anabolic steroids is
regulated by which of the following laws?
The Food, Drug, and Cosmetic Act of 1938
The Comprehensive Drug Abuse Prevention
and Control Act
The Harrison Narcotic Act
The Shirley Amendment
B
Feedback:
The Comprehensive Drug Abuse Prevention
and Control Act regulates the manufacture
6.
A)
B)
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D)
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regulated by which of the following laws?
The Food, Drug, and Cosmetic Act of 1938
The Comprehensive Drug Abuse Prevention
and Control Act
The Harrison Narcotic Act
The Shirley Amendment
B
Feedback:
The Comprehensive Drug Abuse Prevention
and Control Act regulates the manufacture
and distribution of narcotics, stimulants,
depressants, hallucinogens, and anabolic
steroids. The Food, Drug, and Cosmetic Act
of 1938 revised and broadened FDA powers
and responsibilities, giving the FDA control
over drug safety. The Harrison Narcotic Act
restricted the importation, manufacture, sale,
and use of opium, cocaine, marijuana, and
other drugs that the act defined as narcotics.
The Shirley Amendment of 1912 prohibited
fraudulent claims of drug effectiveness.
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A nurse is responsible for maintaining an
accurate count and record of the controlled
7. substances on the nursing unit. This nursing
action is regulated by which of the following
laws or agencies?
Food, Drug, and Cosmetic Act of 1938
Public Health Service
Drug Enforcement Administration
Shirley Amendment
C
Feedback:
The Drug Enforcement Administration
enforces the Controlled Substances Act.
Under this enforcement, nurses are
responsible for storing controlled substances
in locked containers, administering them only
to the people for whom they are prescribed,
recording each dose given, and maintaining
an accurate inventory. The Food, Drug, and
Cosmetic Act of 1938 revised and broadened
FDA powers and responsibilities, giving the
FDA control over drug safety. The Public
Health Service is regulated by the state to
maintain the health of individual citizens of
the state. The Shirley Amendment of 1912
prohibited fraudulent claims of drug
effectiveness.
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B)
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In Phase I clinical trials, the potential uses and
8. effects of a new drug are determined by
which of the following methods?
Administering doses to healthy volunteers
Administering doses to people with the
disease
Administering in placebo-controlled design
Calculating the risk-to-benefit ratio
A
Feedback:
Phase I studies allow for the administration of
the medication to healthy volunteers to
determine safe dosages, routes of
administration, absorption, metabolism,
excretion, and toxicity. In Phase II studies, a
few doses are given to a certain number of
subjects with the disease or symptom for
which the drug is being studied and responses
are compared with those of healthy subjects.
Placebo-controlled designs are used in the
Phase III studies, in which half of the subjects
receive the new drug and half receive the
placebo. Calculating the risk-to-benefit ratio
is used in Phase II studies to determine
whether the potential benefits of the drug
outweigh the risks.
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B)
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A new medication for the treatment of
Alzheimer's disease is being administered to a
group of subjects with the disease. The
subjects receiving this medication are
9.
unaware of whether they are being
administered the medication or whether they
are receiving a placebo. This testing occurs in
which phase of the drug approval process?
Phase I
Phase II
Phase III
Phase IV
C
Feedback:
In Phase III, the drug is given to a larger and
more representative group of subjects. In
double-blind, placebo-controlled designs, half
of the subjects receive the new drug and half
receive a placebo (an inactive substance
similar in appearance to the actual drug), with
neither subjects nor researchers knowing
which subjects receive which formulation. In
Phase II
Phase III
Phase IV
C
Feedback:
In Phase III, the drug is given to a larger and
more representative group of subjects. In
double-blind, placebo-controlled designs, half
of the subjects receive the new drug and half
receive a placebo (an inactive substance
similar in appearance to the actual drug), with
neither subjects nor researchers knowing
which subjects receive which formulation. In
Phase I, a few doses are given to a certain
number of healthy volunteers to determine
safe dosages, routes of administration,
absorption, metabolism, excretion, and
toxicity. In Phase II, a few doses are given to
a certain number of subjects with the disease
or symptom for which the drug is being
studied and responses are compared with
those of healthy subjects. In Phase IV, the
FDA evaluates the data from the first three
phases for drug safety and effectiveness,
allows the drug to be marketed for general
use, and requires manufacturers to continue
monitoring the drug's effects.
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10.
Which organization is responsible for
approving new drugs in the United States?
American Medical Association
American Pharmaceutical Association
Food and Drug Administration
United States Pharmacopeia
C
Feedback:
The Food and Drug Administration is
responsible for approving new drugs in the
United States. The American Medical
Association represents the physicians of the
United States. The American Pharmaceutical
Association represents the pharmacists of the
United States. The United States
Pharmacopeia was adopted in 1906 and is
issued every 5 years under the supervision of
a national committee of pharmacists,
scientists, and physicians.
Which of the following reference books
11. provides information from the drug
manufacturers' inserts?
American Formulary Service
Drug Facts and Comparisons
Physicians' Desk Reference
Lippincott's Nursing Drug Guide
C
Feedback:
The Physicians' Desk Reference is published
yearly and contains manufacturers' published
inserts for selected drugs. American
Formulary Service is an authoritative source
of drug information. Drug Facts and
Comparisons is an authoritative source of
drug information. Lippincott's Nursing Drug
Guide is an example of a drug handbook, not
a compilation of manufacturers' inserts.
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A nursing student in a pharmacology class
should be encouraged to study the
12.
medications according to which
categorization?
Prototype
Controlled substance
Drug use
Generic names
A
Feedback:
The nursing student should concentrate on
therapeutic classifications and their
prototypes. Controlled substances limit the
medications studied to one broad
classification. Drug use is only one part of the
broad classification. Generic names are only
one aspect of the medication.
A)
B)
C)
D)
A patient with a long-standing dermatological
health problem has been advised to use a drug
13.
with a local effect. The nurse should
recognize what characteristic of this drug?
It affects only the organ system in which it is
metabolized.
The drug requires application at multiple
sites.
It is effective only as long as it is in contact
with skin.
The drug acts primarily at the site where it is
applied.
13.
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B)
C)
D)
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health problem has been advised to use a drug
with a local effect. The nurse should
recognize what characteristic of this drug?
It affects only the organ system in which it is
metabolized.
The drug requires application at multiple
sites.
It is effective only as long as it is in contact
with skin.
The drug acts primarily at the site where it is
applied.
D
Feedback:
Drugs with local effects, such as sunscreen
lotions and local anesthetics, act mainly at the
site of application. Those with systemic
effects are taken into the body, circulated
through the bloodstream to their sites of
action in various body tissues, and eventually
eliminated from the body. A drug with local
effect does not necessarily have to be applied
at multiple sites, and its action may affect
tissues long after contact.
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A patient with an autoimmune disorder has
just been prescribed a synthetic drug. Which
14.
of the following characteristics is a noted
advantage of synthetic drugs?
Synthetic drugs are less likely to cause an
allergic reaction than naturally occurring
substances.
Synthetic drugs typically require less frequent
dosing than naturally occurring substances.
Synthetic drugs are normally available on an
over-the-counter basis.
Synthetic drugs are available in a wider
variety of administration routes than naturally
occurring substances.
A
Feedback:
Synthetic drugs are more standardized in their
chemical characteristics, more consistent in
their effects, and less likely to produce
allergic reactions. They do not necessarily
require less frequent dosing and may or may
not be available OTC. They are not noted to
be available in a wider variety of
administration routes than naturally occurring
substances.
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A patient is confused about her care provider's
advice and has stated to the nurse, “I wasn't
sure whether he recommended Tylenol or
15. whether he recommended acetaminophen.”
The nurse should include which of the
following information in an explanation of
generic and trade names?
Prescribers should refer solely to generic
names in their recommendations and written
prescriptions.
A generic name is independent of any
particular drug manufacturer.
Generic names change frequently, but trade
names are more consistent.
Prescribers should refer solely to trade names
in their recommendations and written
prescriptions.
B
Feedback:
A generic name is related to the chemical or
official name and is independent of the
manufacturer. Drugs may be prescribed and
dispensed by generic or trade name. Generic
names do not change, while trade names vary
according to time and place.
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A nurse is aware that American drug laws
have a long and complex history, with
16. numerous jurisdictions being involved. What
is the primary purpose of drug laws in the
United States?
To ensure maximum choice for consumers
To expedite the workload of care providers
To protect the safety of the public
To enhance the efficient delivery of health
care
C
Feedback:
The main goal of drugs laws is to protect the
public by ensuring that drugs marketed for
therapeutic purposes are safe and effective.
Efficiency and choice are valid considerations
but neither is the primary goal of American
drug legislation.
A)
B)
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C)
A nurse who provides care on a postsurgical
unit frequently administers Schedule II drugs
17. to patients. Which of the following aspects of
administering these drugs falls under the
auspices of the Drug Enforcement Agency?
Performing a thorough patient assessment
prior to administration
Recording each dose administration on an
agency narcotic sheet
Informing patients of the potential risks and
benefits of Schedule II drugs prior to the first
dose
Assessing the patient shortly after
administration to ensure therapeutic effect
B
Feedback:
Nurses are responsible for storing controlled
substances in locked containers, administering
them only to people for whom they are
prescribed, recording each dose given on
agency narcotic sheets and on the patient's
medication administration record, maintaining
an accurate inventory, and reporting
discrepancies to the proper authorities. The
other given actions are appropriate nursing
activities, but they are not within the scope of
the DEA authority.
D)
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B)
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Trials of a new drug are scheduled to soon
begin and the testing methodology will
18. integrate the stipulations of the National
Institutes of Health (NIH) Revitalization Act.
According to this act, the manufacturer must
independently fund the entire testing process.
make the results of the testing process
publicly available.
include women and minorities in the testing
process.
exclude any potential for financial gain during
the testing process.
C
Feedback:
In 1993, Congress passed the National
Institutes of Health (NIH) Revitalization Act,
which formalized a policy of the NIH that
women and minorities be included in human
subject research studies funded by the NIH
and that women and minorities be included in
C)
process.
exclude any potential for financial gain during
the testing process.
C
Feedback:
In 1993, Congress passed the National
Institutes of Health (NIH) Revitalization Act,
which formalized a policy of the NIH that
women and minorities be included in human
subject research studies funded by the NIH
and that women and minorities be included in
clinical drug trials. This act does not
specifically address the financial structure of
testing or the accessibility of information.
D)
A hospital nurse is vigilant in ensuring the
safe use of medications and consistently
applies the rights of medication
19.
administration. Which of the following is one
of the traditional rights of medication
administration?
Right to refuse
Right route
Right education
Right evaluation
B
Feedback:
The traditional rights of medication
administration (right drug, right dose, right
patient, right route, right time, right reason,
and right documentation) now include
additional rights that should also be
considered (right education, right evaluation,
and right to refuse the medication).
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B)
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A patient's current medication administration
record includes a drug that the nurse
recognizes as an Institute for Safe Medication
20.
Practices (ISMP) high-alert medication. This
designation signals the nurse to what
characteristic of the drug?
It can only be administered by a physician or
advanced practice nurse.
Administration must be cosigned by a second
registered nurse or practical/vocational nurse.
It is currently undergoing Phase IV testing
and is pending full FDA approval.
Administration errors carry a heightened risk
of causing significant patient harm.
D
Feedback:
The Institute for Safe Medication Practices
(ISMP) identifies drugs that when used in
error have a heightened risk of causing
B)
C)
D)
Ans:
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registered nurse or practical/vocational nurse.
It is currently undergoing Phase IV testing
and is pending full FDA approval.
Administration errors carry a heightened risk
of causing significant patient harm.
D
Feedback:
The Institute for Safe Medication Practices
(ISMP) identifies drugs that when used in
error have a heightened risk of causing
significant patient harm. Such drugs are not
limited to physician or advanced practice
nurse administration. The drug would have
completed the testing and approval procedure
and administration does not necessarily
require a cosignature.
Chapter 2 Basic Concepts and Processes
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B)
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B)
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Which cellular structure stores hormones and
1. other substances and packages these
substances into secretory granules?
Golgi apparatus
Endoplasmic reticulum
Mitochondria
Lysosome
A
Feedback:
The golgi apparatus stores hormones and
other substances. The endoplasmic reticulum
contains ribosomes, which synthesize
proteins, including enzymes that synthesize
glycogen, triglycerides, and steroids and those
that metabolize drugs and other chemicals.
The mitochondria generate energy for cellular
activities and require oxygen. Lysosomes are
membrane-enclosed vesicles that contain
enzymes capable of digesting nutrients
(proteins, carbohydrates, fats), damaged
cellular structures, foreign substances
(bacteria), and the cell itself.
A patient is suffering from a cough associated
with an upper respiratory infection. Which
2.
oral medication will likely produce the most
therapeutic effect?
A tablet
An expectorant
A topical spray
A timed-release tablet
B
Feedback:
Liquid medications are absorbed faster than
tablets or capsules. Expectorants are liquid
2.
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B)
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with an upper respiratory infection. Which
oral medication will likely produce the most
therapeutic effect?
A tablet
An expectorant
A topical spray
A timed-release tablet
B
Feedback:
Liquid medications are absorbed faster than
tablets or capsules. Expectorants are liquid
medications. A tablet is an oral medication
that has a slower onset of action than a liquid
medication. A topical spray can be sprayed to
the back of the throat and provides only a
local effect. A timed-release tablet is an oral
medication that has a slower onset and longer
duration of action.
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A patient is administered an oral
contraceptive. Which of the following is the
3. process that occurs between the time the drug
enters the body and the time that it enters the
bloodstream?
Absorption
Distribution
Metabolism
Excretion
A
Feedback:
Absorption is the process that occurs from the
time the drug enters the body to the time it
enters the bloodstream to be circulated.
Distribution involves the transport of drug
molecules within the body. Metabolism is the
method by which drugs are inactivated or
biotransformed by the body. Excretion refers
to elimination of a drug from the body.
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B)
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Which of the following sites of drug
absorption is considered to have an
4.
exceptionally large surface area for drug
absorption?
Rectum
Fundus of the stomach
Esophagus
Lungs
D
Feedback:
The lungs have a large surface area for
absorption of anesthetic gases and a few other
drugs. The rectum absorbs the medication
through the mucous membranes and has a
smaller surface area than the lungs. The
Rectum
Fundus of the stomach
Esophagus
Lungs
D
Feedback:
The lungs have a large surface area for
absorption of anesthetic gases and a few other
drugs. The rectum absorbs the medication
through the mucous membranes and has a
smaller surface area than the lungs. The
fundus and esophagus have comparatively
small surface areas.
A nurse is aware of the importance of
adhering to the intended route of a
5.
medication. Which of the following drugs are
formulated to be absorbed through the skin?
Amoxicillin, tetracycline, and penicillin
Clonidine, fentanyl, and nitroglycerin
Digoxin, lidocaine, and propranolol
Insulin, heparin, and morphine
B
Feedback:
Some drugs are formulated in adhesive skin
patches for absorption through the skin.
Clonidine, fentanyl, and nitroglycerin are
examples of drugs that are formulated in
adhesive skin patch form to be absorbed
through the skin. Amoxicillin, tetracycline,
and penicillin are administered orally.
Digoxin and propranolol are administered
orally, and lidocaine can be administered
intravenously, subcutaneously, or topically.
Insulin and heparin are administered
intravenously and subcutaneously. Morphine
is administered orally, intramuscularly, and
intravenously.
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An 85-year-old patient has an elevated serum
creatinine level, indicating impaired kidney
6. function. When the patient is administered a
medication, this patient is at risk for which of
the following medication-related effects?
Toxicity
Increased absorption
Delayed gastric emptying
Idiosyncratic effects
A
Feedback:
An elevated creatinine level is indicative of
diminished kidney function, which will result
in serum drug toxicity. The creatinine level
indicates kidney function, does not affect
Toxicity
Increased absorption
Delayed gastric emptying
Idiosyncratic effects
A
Feedback:
An elevated creatinine level is indicative of
diminished kidney function, which will result
in serum drug toxicity. The creatinine level
indicates kidney function, does not affect
absorption, and has no effect on gastric
emptying.
Protein binding is an important aspect of
pharmacokinetics. Protein binding ultimately
7.
has which of the following effects on drug
action?
Increases the drug's speed of action
Decreases the drug's speed of action
Increases the rate of excretion
Averts adverse effects
B
Feedback:
Protein binding allows part of a drug to be
stored and released as needed. Drugs that are
highly bound to plasma proteins or stored
extensively in other tissues have a long
duration of action. Protein binding does not
increase the speed of action, increase the
excretion rate, or avert adverse effects.
Protein binding decreases the speed of action
by storing the drug to be released when
needed.
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A patient is taking a medication that is
metabolized by the CYP enzymes. Which of
8.
the following medications inhibits several of
the CYP enzymes?
Cisplatin
Acebutolol hydrochloride
Cimetidine
Dicloxacillin sodium
C
Feedback:
Cimetidine is a gastric acid suppressor that
inhibits several CYP enzymes and can greatly
decrease drug metabolism. The other listed
drugs do not have this specific effect.
A nurse is aware that the dosing scheduling of
a patient's new medication takes into account
9.
the serum half-life of the drug. What is the
serum half-life of a medication?
The time required for IV medications to
penetrate the brain tissue
The time needed for the serum level to fall by
50%
The safest margin to prevent toxicity
The dose adjustment that reduces the risk of
adverse effects by one half
B
Feedback:
Serum half-life is the time required for the
serum concentration of a drug to decrease by
50%. Although many IV medications
penetrate the brain tissue, this action does not
describe the half-life. The safest margin to
prevent toxicity depends on the rate of
metabolism and excretion. The half-life of the
medication does not relate directly to a
specific reduction in adverse effects.
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B)
C)
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A patient has increased intracranial pressure
and is ordered to receive a diuretic. Which of
10.
the following diuretics does not act on
receptor sites to produce diuresis?
Furosemide (Lasix)
Hydrochlorothiazide (HCTZ)
Spironolactone (Aldactone)
Mannitol (Osmitrol)
D
Feedback:
Mannitol (Osmitrol) is an osmotic diuretic
that increases the osmolarity of plasma and
pulls water out of the tissues into the
bloodstream. It does not act on receptor sites.
Furosemide (Lasix) is a loop diuretic that
inhibits the reabsorption of sodium and
chloride in the loop of Henle.
Hydrochlorothiazide is associated with drug
interference with absorption of sodium ions
across the distal renal tubule. Spironolactone
acts by competing with aldosterone for
cellular receptor sites.
Hydrochlorothiazide (HCTZ)
Spironolactone (Aldactone)
Mannitol (Osmitrol)
D
Feedback:
Mannitol (Osmitrol) is an osmotic diuretic
that increases the osmolarity of plasma and
pulls water out of the tissues into the
bloodstream. It does not act on receptor sites.
Furosemide (Lasix) is a loop diuretic that
inhibits the reabsorption of sodium and
chloride in the loop of Henle.
Hydrochlorothiazide is associated with drug
interference with absorption of sodium ions
across the distal renal tubule. Spironolactone
acts by competing with aldosterone for
cellular receptor sites.
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B)
C)
D)
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D)
Ans:
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B)
C)
D)
Ans:
A patient older than 65 years is more likely to
experience drug reaction than a much younger
11.
patient. Which of the following factors
accounts for this variation?
Drugs more readily crossing the blood–brain
barrier in older people
Age-related physiologic changes
Increased drug-metabolizing enzymes in older
people
Diminished immune response
B
Feedback:
In older adults (65 years and older),
physiologic changes may alter all
pharmacokinetic processes. Although drugs
crossing the blood–brain barrier affect drug
reaction, this factor is important in all ages.
Increased drug-metabolizing enzymes are key
in all ages and do not relate to age variations.
A diminished immune response is important
in all ages and does not affect all medications.
A patient who is 6 feet tall and weighs 280
12. pounds will require which of the following
doses?
Higher dose than a patient who weighs 180
pounds
Lower dose than a patient who weighs 180
pounds
Same dose as a patient who weighs 180
pounds
A parenteral rather than oral dose
A
Feedback:
In general, people heavier than average may
need larger doses, provided their renal,
A)
pounds
Lower dose than a patient who weighs 180
pounds
Same dose as a patient who weighs 180
pounds
A parenteral rather than oral dose
A
Feedback:
In general, people heavier than average may
need larger doses, provided their renal,
hepatic, and cardiovascular functions are
adequate.
B)
C)
A nurse has provided an oral dose of
morphine, an opioid agonist, to a woman in
13.
early labor. The nurse should be aware of
what characteristic of agonists?
Agonists alter the normal processes of
distribution and metabolism.
Agonists counteract the action of specific
neurotransmitters.
Agonists block the action of specific
neurotransmitters.
Agonists bind to receptors and cause a
physiological effect.
D
Feedback:
Agonists are drugs that produce effects
similar to those produced by naturally
occurring hormones, neurotransmitters, and
other substances by activating (not blocking
or counteracting) a receptor. Classification of
a drug as an agonist does not denote a change
to metabolism or distribution.
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B)
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A nurse is preparing to simultaneously
administer two drugs to a patient. The nurse
14. knows that the drugs have been ordered to be
given together because of their synergistic
effect. This means that
the adverse effects of one of the drugs are
nullified by the other drug.
the combined effects are greater than the
effects of either one of the drugs alone.
one of the drugs enhances metabolism, while
the other drug enhances either distribution or
absorption.
both drugs are toxic in isolation but
therapeutic when administered together.
B
Feedback:
Synergism occurs when two drugs with
different sites or mechanisms of action
produce greater effects when taken together.
the combined effects are greater than the
effects of either one of the drugs alone.
one of the drugs enhances metabolism, while
the other drug enhances either distribution or
absorption.
both drugs are toxic in isolation but
therapeutic when administered together.
B
Feedback:
Synergism occurs when two drugs with
different sites or mechanisms of action
produce greater effects when taken together.
This does not mean that potential toxicity or
adverse effects are “canceled out.” The two
drugs would not individually affect different
aspects of pharmacokinetics.
B)
C)
D)
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A patient has been brought to the emergency
department by ambulance, and his friend
states that he has overdosed on methadone, a
long-acting opioid. The care team is preparing
15.
to administer the appropriate antidote,
naloxone, which has a shorter half-life than
methadone. What are the implications of this
aspect of pharmacokinetics?
Repeated doses of naloxone will likely be
necessary.
A different antidote will be required after the
serum level of naloxone decreases.
An increased dose of naloxone will be
required.
The antidote is unlikely to have a therapeutic
effect on the patient's symptoms.
A
Feedback:
When an antidote is used, its half-life relative
to the toxin's half-life must be considered. For
example, the half-life of naloxone, a narcotic
antagonist, is relatively short compared with
the half-life of the longer-acting opioids such
as methadone, and repeated doses may be
needed to prevent recurrence of the toxic
state.
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A patient tells the nurse, “I took my sleeping
pill yesterday evening, but it didn't seem to
work for me like it usually does.” The nurse
16.
should consider which of the following
variables that can affect drug absorption?
Select all that apply.
GI function
Blood flow to the site of administration
The presence of other drugs
Route of administration
The presence of receptor agonists
A, B, C, D
Feedback:
Numerous factors affect the rate and extent of
drug absorption, including dosage form, route
of administration, blood flow to the site of
administration, GI function, the presence of
food or other drugs, and other variables.
Agonist activity is a relevant variable, but this
is not an aspect of absorption.
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B)
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B)
C)
A nurse has administered a dose of a drug that
17. is known to be highly protein bound. What
are the implications of this characteristic?
The patient must consume adequate protein in
order to achieve a therapeutic effect.
The molecules of the drug that are bound to
protein are inactive.
Increased levels of serum protein will
increase the effect of the drug.
Each molecule of the drug must bind to a
protein molecule to become effective.
B
Feedback:
Drug molecules bound to plasma proteins are
pharmacologically inactive because the large
size of the complex prevents their leaving the
bloodstream through the small openings in
capillary walls and reaching their sites of
action, metabolism, and excretion. Only the
free or unbound portion of a drug acts on
body cells. The patient's protein intake or
levels of protein are not normally relevant.
A patient requires a high dose of his new
antihypertensive medication because the new
18.
medication has a significant first-pass effect.
This means that the drug
must pass through the patient's bloodstream
several times to generate a therapeutic effect.
passes through the renal tubules and is
excreted in large amounts.
is extensively metabolized in the patient's
liver.
is ineffective following the first dose and
increasingly effective with each subsequent
dose.
C
Feedback:
Some drugs are extensively metabolized in
the liver, with only part of a drug dose
reaching the systemic circulation for
distribution to sites of action. This is called
the first-pass effect or presystemic
metabolism. The first-pass effect is not related
to renal function or the need to pass through
the bloodstream multiple times.
A)
B)
C)
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B)
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A patient with a diagnosis of bipolar disorder
has begun lithium therapy, and the nurse has
19. explained the need for regular monitoring of
the patient's serum drug levels. What is the
primary rationale for the nurse's instruction?
It is necessary to regularly test for blood–drug
incompatibilities that may develop during
treatment.
It is necessary to ensure that the patient's drug
levels are therapeutic but not toxic.
It is needed to determine if additional
medications will be needed to potentiate the
effects of lithium.
It is needed in order to confirm the patient's
adherence to the drug regimen.
B
Feedback:
Measuring serum drug levels is useful when
drugs with a narrow margin of safety are
given, because their therapeutic doses are
close to their toxic doses. This is the case
during lithium therapy. Serum levels are not
commonly taken to monitor adherence to
treatment. Blood–drug incompatibilities are
not a relevant consideration.
effects of lithium.
It is needed in order to confirm the patient's
adherence to the drug regimen.
B
Feedback:
Measuring serum drug levels is useful when
drugs with a narrow margin of safety are
given, because their therapeutic doses are
close to their toxic doses. This is the case
during lithium therapy. Serum levels are not
commonly taken to monitor adherence to
treatment. Blood–drug incompatibilities are
not a relevant consideration.
D)
Ans:
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A patient in cardiovascular collapse requires
pharmacological interventions involving a
20.
rapid drug action and response. What route of
administration is most likely appropriate?
Intravenous
Oral
Rectal
Topical
A
Feedback:
For rapid drug action and response, the IV
route is most effective because the drug is
injected directly into the bloodstream.
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B)
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A)
B)
C)
D)
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Chapter 3 Medication Administration and the Nursing Process of Drug Therapy
An infant's current weight indicates that the
maximum safe dose of Tylenol is 30 mg by
mouth. The physician orders 65 mg to be
1. given, and the nurse administers Tylenol 65
mg. Who is legally responsible in the event
that the infant has a toxic reaction to the
medication?
The nurse
The pharmacist
The physician
The pharmacy technician
A
Feedback:
When giving medications, the nurse is legally
responsible for safe and accurate
administration. This regulation means that the
nurse may be held liable for not giving a drug
or for giving a wrong drug or dose. The
pharmacist is responsible for filling the
medication order, but if an error exists in the
order and the medication is still administered
by the nurse, the nurse is the most
responsible. If the physician writes the order
but does not administer the medication, then
The pharmacist
The physician
The pharmacy technician
A
Feedback:
When giving medications, the nurse is legally
responsible for safe and accurate
administration. This regulation means that the
nurse may be held liable for not giving a drug
or for giving a wrong drug or dose. The
pharmacist is responsible for filling the
medication order, but if an error exists in the
order and the medication is still administered
by the nurse, the nurse is the most
responsible. If the physician writes the order
but does not administer the medication, then
the physician is not legally responsible. The
pharmacy technician is not legally
responsible.
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C)
D)
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An 80-year-old patient with risk factors for
thrombophlebitis is to be administered
heparin 5000 units subcutaneously. The
2.
heparin vial is labeled 10,000 units/mL. How
many milliliters will the nurse administer to
the patient?
50 mL
1.5 mL
5 mL
0.5 mL
D
Feedback:
5000 units/X = 10,000 units/1 mL.
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B)
C)
D)
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The physician orders potassium chloride 40
mEq to be added to the patient's IV solution.
3.
The vial reads 10 mEq/5 mL. How many
milliliters will be added to the IV solution?
0.25 mL
20 mL
200 mL
40 mL
B
Feedback:
40 mEq/X mL = 10 mEq/5 mL.
You have received an order for a medication
4. to be administered buccally. Where is the
medication administered?
Eye
Vagina
Cheek
Nose
C
Feedback:
A medication that has been ordered to be
administered buccally is given in the patient's
cheek. The eye, vagina, and nose are not
considered part of the buccal mucosa.
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The nurse is repeatedly unsuccessful in
starting an IV on a patient who requires
antibiotic therapy. The physician then orders
5.
the patient to receive an oral antibiotic. What
is the major disadvantage of the oral route
over the parenteral route?
Slower rate of action
Greater adverse effects
Increased risk of tolerance
Dose must be larger.
A
Feedback:
The oral route of administration has a slower
rate of action. Oral antibiotics do not produce
greater adverse effects. The risk of tolerance
is equal in intravenous and oral antibiotics.
The dose is not necessarily larger in oral
versus intravenous antibiotics.
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B)
C)
D)
Ans:
A)
B)
C)
D)
Ans:
A patient has a gastrostomy tube, and the
pharmacy has delivered an extended-release
6.
tablet. What is the most appropriate action
taken by the nurse?
Administer the medication orally.
Administer the medication through the tube.
Crush the medication and administer half of it
at a time.
Call the pharmacy to obtain an immediaterelease form.
D
Feedback:
The most important nursing action is to call
the pharmacy to determine whether a liquid or
a nonextended-release tablet can be
B)
Administer the medication through the tube.
Crush the medication and administer half of it
at a time.
Call the pharmacy to obtain an immediaterelease form.
D
Feedback:
The most important nursing action is to call
the pharmacy to determine whether a liquid or
a nonextended-release tablet can be
substituted. Extended-release tablets should
never be crushed—the patient would be
placed at risk for overdose or potentially
serious adverse effects or death. If the patient
has a gastrostomy tube, then he or she cannot
swallow and cannot take the pill orally. The
medication cannot be administered through
the tube because it will obstruct the tube.
C)
D)
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The nurse has measured a patient's capillary
blood glucose and is preparing to administer
7.
NPH insulin. Which of the following actions
should the nurse perform?
Administer intramuscularly.
Rotate the liquid.
Vigorously shake the vial.
Administer intradermally.
B
Feedback:
When administering NPH insulin, particles of
active drug are suspended in a liquid; the
liquid must be rotated. NPH insulin is
administered subcutaneously, not
intramuscularly or intradermally. The vial
should be rotated or shaken, but not
vigorously shaken.
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B)
C)
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B)
C)
D)
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A nurse begins a patient interaction by
systematically gathering information on the
8. patient's care and eventually evaluating the
outcomes of care. Which of the following
represents this continuum of care?
Assessment process
Outcomes analysis
Nursing interventions
Nursing process
D
Feedback:
The nursing process is a systematic way of
gathering and using information to plan and
provide individualized patient care and to
evaluate the outcomes of care. The
assessment, outcomes, and nursing
interventions are individual components of
B)
C)
D)
Ans:
Outcomes analysis
Nursing interventions
Nursing process
D
Feedback:
The nursing process is a systematic way of
gathering and using information to plan and
provide individualized patient care and to
evaluate the outcomes of care. The
assessment, outcomes, and nursing
interventions are individual components of
the nursing process.
9.
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Which of the following assessments should be
made before administering a new medication?
Determine the patient's past medication
history.
Evaluate the patient's health beliefs.
Instruct the patient on the effect of the
medication.
Teach the patient about the desired outcomes
of drug therapy.
A
Feedback:
Assessment involves collecting data on
patient characteristics known to affect drug
therapy. This process includes observing and
interviewing the patient, interviewing family
members, completing a physical assessment,
reviewing medical records for pertinent
laboratory and diagnostic reports, and other
methods. Initially (before drug therapy is
started or on first contact), the patient should
be assessed for age, weight, vital signs, health
status, pathologic conditions, and ability to
function in usual activities. It is not
necessarily important to evaluate the patient's
health beliefs at this point. Education is
considered to be an intervention, not an
assessment.
B)
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B)
C)
D)
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A patient states that she takes acetaminophen
(Tylenol) four to five times daily when she is
10.
at home. Which of the following laboratory
tests is a relevant response to this practice?
Cardiac enzymes
Peak and trough
Liver enzymes
White blood cell count
C
Feedback:
Laboratory tests of liver, kidney, and bone
marrow function are often helpful because
some drugs may damage these organs.
tests is a relevant response to this practice?
Cardiac enzymes
Peak and trough
Liver enzymes
White blood cell count
C
Feedback:
Laboratory tests of liver, kidney, and bone
marrow function are often helpful because
some drugs may damage these organs.
Cardiac enzymes are assessed in the event
that the patient has had myocardial infarction
symptoms. The peak and trough indicates the
amount of medication when half the
medication has been excreted and the serum
level of the medication prior to the
administration of the next dose. The white
blood cell count is indicative in the event of
agranulocytosis or infection.
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B)
C)
D)
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A patient who has been diagnosed with type 2
diabetes mellitus is being instructed on her
medication regimen, diet, and exercise. She is
11. having difficulty grasping information about
when exactly she should administer insulin.
Which of the following nursing diagnoses is
most appropriate for this patient?
Deficient knowledge: drug therapy regimen
Noncompliance: overuse
Risk for injury related to adverse effects
Acute confusion related to insulin regimen
A
Feedback:
Deficient knowledge: drug therapy regimen is
the most accurate nursing diagnosis for this
patient. The question does not address
noncompliance: overuse. The patient is not
necessarily at risk for injury based on the
stem of the question. Acute confusion does
not relate to a lack of understanding or
knowledge.
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A)
B)
C)
D)
Ans:
A)
B)
C)
D)
Ans:
A patient is diagnosed with pneumonia and
has been placed on antibiotics to treat the
12.
infection. Which of the following nursing
actions will assist in increasing lung capacity?
Promoting hand hygiene
Increasing rest
Frequent repositioning
Promoting deep breathing
D
Feedback:
Assisting the patient to cough and deep
breathe will increase lung capacity and assist
12.
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B)
C)
D)
Ans:
infection. Which of the following nursing
actions will assist in increasing lung capacity?
Promoting hand hygiene
Increasing rest
Frequent repositioning
Promoting deep breathing
D
Feedback:
Assisting the patient to cough and deep
breathe will increase lung capacity and assist
in fighting the infection. Promoting hand
hygiene is important but will not increase
lung capacity. Increasing rest will assist in
recovery but will not increase lung capacity.
Frequent repositioning does not increase lung
capacity.
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The nurse is providing care for a patient who
has rheumatoid arthritis. Which of the
13.
following herbal supplements is often
combined with chondroitin to repair cartilage?
Ginkgo
Glucosamine
St. John's wort
Saw palmetto
B
Feedback:
Glucosamine is an herbal supplement that is
usually combined with chondroitin to repair
cartilage. Ginkgo is used to improve memory
and cognitive function in people with
Alzheimer's disease. St. John's Wort is used to
treat depression. Saw palmetto is used to treat
urinary symptoms in men with benign
prostatic hyperplasia.
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A)
B)
C)
D)
Ans:
A)
B)
C)
D)
Ans:
The nurse makes an effort to provide highquality care to patients by obtaining and
analyzing the best available scientific
14.
research. This activity demonstrates an
important component of which of the
following?
Evidence-based nursing
Medical justification
Nursing data synthesis
Scientific nursing
A
Feedback:
Evidence-based nursing practice requires a
conscientious and continuing effort to provide
high-quality care to patients by obtaining and
analyzing the best available scientific
evidence from research. Then, the scientific
evidence is integrated with the nurse's clinical
Medical justification
Nursing data synthesis
Scientific nursing
A
Feedback:
Evidence-based nursing practice requires a
conscientious and continuing effort to provide
high-quality care to patients by obtaining and
analyzing the best available scientific
evidence from research. Then, the scientific
evidence is integrated with the nurse's clinical
expertise and the patient's preferences and
values to yield “best practices” for a patient
with a particular disease process or health
problem.
A patient has informed the nurse that he has
begun supplementing his medication regimen
with a series of herbal remedies
15.
recommended by his sister-in-law. Which of
the following is the most important nursing
responsibility regarding herbal supplements?
Research for potential interactions with
medications.
Instruct the patient to discontinue them if
taking prescription medications.
Instruct the patient to take the supplements 1
hour before prescription medications.
Instruct the patient to take the supplements 3
hours after prescription medications.
A
Feedback:
Two major concerns are that the use of
supplements may keep patients from seeking
treatment from a health care provider and that
products may interact with prescription drugs.
Not all herbal supplements should be
discontinued in combination with prescription
medications. The herbal supplements should
be administered in varying quantities and at
varying times based on the medication
regime. They are not always administered 1
hour before prescription medications or 3
hours after prescription medications.
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B)
C)
D)
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A)
B)
C)
D)
Ans:
A patient is being administered a selective
serotonin reuptake inhibitor to treat
16.
depression. Which of the following herbal
supplements is contraindicated?
St. John's wort
Glucosamine
Chondroitin
Melatonin
A
A patient is being administered a selective
serotonin reuptake inhibitor to treat
16.
depression. Which of the following herbal
supplements is contraindicated?
St. John's wort
Glucosamine
Chondroitin
Melatonin
A
Feedback:
St. John's wort should not be combined with
monoamine oxidase inhibitors or selective
serotonin reuptake inhibitor antidepressants.
A pediatric nurse confronts many challenges
when providing medications to children and
17. infants. Which of the following principles is
most appropriate when administering
medication to children?
If a child is resistant to taking the medication,
the nurse should tell the child that it is candy.
Measurement by teaspoons is as accurate as
milliliters.
If a drug is not supplied in liquid form, the
nurse can always crush the pill.
Assess the child's weight prior to initial drug
administration.
D
Feedback:
It is imperative to determine a child's weight
in order to ensure safe dosage. Never describe
the medication to the child as candy. Liquid
medications should always be measured by
milliliters, not teaspoons. Some, but not all,
medications may be safely crushed.
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B)
C)
D)
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B)
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Ans:
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B)
C)
D)
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An 88-year-old woman has developed
syncope (fainting) since an antihypertensive
agent was added to her medication regime.
18.
The development of syncope may be related
to which of the following physiologic
processes?
Interaction of other medications
Ingestion of herbal supplements
Diminished excretion of the medication
Increased metabolism of the medication
C
Feedback:
Adverse effects of medications in an elderly
patient are likely because of physiologic
changes associated with aging, pathologic
changes due to disease processes, multiple
drugs for acute and chronic disorders,
Interaction of other medications
Ingestion of herbal supplements
Diminished excretion of the medication
Increased metabolism of the medication
C
Feedback:
Adverse effects of medications in an elderly
patient are likely because of physiologic
changes associated with aging, pathologic
changes due to disease processes, multiple
drugs for acute and chronic disorders,
impaired memory and cognition, and
difficulty in complying with drug orders. The
question does not address the interaction of
other medications. The question does not
identify any herbal supplements. Based on
physiologic alterations, the patient will not
have increased metabolism of the medication.
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B)
C)
D)
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A nurse is preparing to administer a patient's
scheduled beta-adrenergic blocker. The nurse
is aware that the patient is receiving this drug
19.
for the treatment of hypertension. The nurse
has addressed which of the following rights of
safe medication administration?
Right indication
Right diagnosis
Right reason
Right history
C
Feedback:
“Right reason” is one of the universally
recognized rights of safe drug administration.
The other listed “rights” are not used in
practice.
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B)
C)
D)
Ans:
A)
B)
C)
D)
Ans:
A nurse is preparing to administer an
intramuscular injection of an older adult's
20. seasonal influenza vaccination. What size
needle should the nurse use to administer the
injection?
16 gauge
20 gauge
24 gauge
28 gauge
B
Feedback:
Usually, a 25-gauge, 5/8-inch needle is used
for Sub-Q injections and a 22- or 20-gauge, 1
1/2-inch needle is used for IM injections.
B)
C)
D)
Ans:
20 gauge
24 gauge
28 gauge
B
Feedback:
Usually, a 25-gauge, 5/8-inch needle is used
for Sub-Q injections and a 22- or 20-gauge, 1
1/2-inch needle is used for IM injections.
Chapter 4 Pharmacology and the Care of Infants and Pediatric Patients
Medication Administration in Pediatrics
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B)
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Ans:
A pediatric nurse is well aware of the many
physiological variables that influence safe
1. pharmacotherapy in patients younger than 18.
Which of the following principles should the
nurse integrate into care?
The physiology of patients older than 15 can
be considered to be the same as an adult
patient.
The younger the patient, the greater the
variation in medication action compared to an
adult.
The larger the patient's body mass index, the
more his or her physiology varies from that of
an adult.
Pediatric patients have a greater potential to
benefit from pharmacotherapy than adult
patients.
B
Feedback:
The younger the patient, the greater the
variation in medication action when compared
to an adult. This does not necessarily equate
into a greater potential for benefit, however.
BMI is not the main or sole basis of variations
between adults and children.
An infant who is 3 weeks old was born at full
gestation but was just brought to the
emergency department with signs and
2.
symptoms of failure to thrive. This pediatric
patient will be classified into what pediatric
age group?
Full-term baby
Young infant
Neonate
Early postnatal
C
Feedback:
Neonates are considered to be infants from
full-term newborn 0 to 4 weeks of age.
age group?
Full-term baby
Young infant
Neonate
Early postnatal
C
Feedback:
Neonates are considered to be infants from
full-term newborn 0 to 4 weeks of age.
A)
B)
C)
D)
Ans:
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A pediatric nurse practitioner is aware that
there are many knowledge gaps that still exist
3. in the evidence base that underlies pediatric
pharmacology. Many of these knowledge
gaps are rooted in
a lack of scientific understanding of the
anatomy and physiology of children and
infants.
the historical lack of pediatric participation in
the drug testing process.
the fact that research grants in pharmacology
have traditionally specified adult
participation.
assumptions that there are no physiological
differences between adults and children.
B
Feedback:
Historically, researchers used only adults to
test medications, and prescribers simply
assumed that smaller doses would elicit the
same results in smaller patients. The
knowledge base surrounding anatomical and
physiological differences between adults and
children is substantial, and grant funding is
not typically limited to adult participation.
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B)
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A 3-year-old Asian American boy has had
culture and sensitivity testing performed, and
antibiotic treatment is indicated. The
prescriber knows that the recommended
4.
antibiotic has not been extensively studied in
pediatric patients. Consequently, the
prescriber will be obliged to do which of the
following?
Administer subtherapeutic doses in order to
mitigate the potential for adverse effects
Choose a different antibiotic that has been
extensively tested in children
Apply vigilant clinical judgment when
administering the antibiotic to the child
Have the child's family sign informed consent
forms absolving the care team from
responsibility for adverse effects
C
following?
Administer subtherapeutic doses in order to
mitigate the potential for adverse effects
Choose a different antibiotic that has been
extensively tested in children
Apply vigilant clinical judgment when
administering the antibiotic to the child
Have the child's family sign informed consent
forms absolving the care team from
responsibility for adverse effects
C
Feedback:
Prescribers must continue to treat pediatric
patients with drugs for which they lack
information; therefore, they must practice
good assessment, dosing, and evaluation
during the administration of any medication
to a pediatric patient. Alternative drugs are
not always an option, and a lack of data does
not absolve the care team from responsibility
for adverse outcomes.
A)
B)
C)
D)
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A 9-year-old boy with severe influenza
symptoms will be treated with ribavirin
(Rebetol), an antiviral that is usually taken by
adults twice daily in doses of 600 mg PO.
5.
After learning that the child's body surface
area (BSA) is 1.10, the nurse will anticipate
that the child will likely receive how much
ribavirin for each dose?
110 mg
380 mg
545 mg
660 mg
B
Feedback:
The prescriber calculates a dose based on a
known adult dose by using the following
equation: pediatric dose = BSA/1.73 × adult
dose. Thus, 1.1 ÷ 1.73 × 600 = 381.5 mg. This
would likely be rounded to 380 mg.
A)
B)
C)
D)
Significant pharmacodynamic variations exist
between adult patients and pediatric patients.
Which of the following factors are known to
6.
contribute to differences in the ways that
drugs affect target cells in children and
infants? Select all that apply.
Inability of children to accurately describe
adverse effects
Immaturity of children's organ systems
Differences in the body composition of
children
The lack of active immunity in children
Significant pharmacodynamic variations exist
between adult patients and pediatric patients.
Which of the following factors are known to
6.
contribute to differences in the ways that
drugs affect target cells in children and
infants? Select all that apply.
Inability of children to accurately describe
adverse effects
Immaturity of children's organ systems
Differences in the body composition of
children
The lack of active immunity in children
Differences in the function of humoral
immunity in children
B, C
Feedback:
Immature organ systems and changing body
compositions mean that drugs affect children
differently. Causes of pharmacodynamic
variability across the lifespan include
differences in body composition, immature
systems, and genetic makeup. Total body
water, fat stores, and protein amounts change
throughout childhood and greatly influence
the effectiveness of drugs in the pediatric
population. Children are indeed less able to
describe adverse effects, but this is not a
pharmacodynamics variation. Differences in
the function of the immune system are not
noted to significantly influence
pharmacodynamics.
A)
B)
C)
D)
E)
A)
B)
C)
D)
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A 2-year-old girl with a recent history of
idiopathic nausea and vomiting was
prescribed promethazine (Phenergan) by her
7.
primary care provider. The immaturity of this
child's gastrointestinal system will primarily
influence what aspect of pharmacokinetics?
Absorption
Distribution
Metabolism
Elimination
A
Feedback:
Gastric emptying and intestinal motility
greatly affect the child's drug absorption. The
GI tract is less directly involved in
distribution, metabolism, and elimination.
A neonate has been prescribed a water-soluble
drug for the treatment of an acute infection.
The nurse recognizes that the percentage of
8.
body water in an infant is significantly higher
than that of an adult. What implication does
this have for pharmacotherapy of an infant?
The drug will need to be emulsified before
administration.
The infant's fluid intake will be reduced
before and after administration.
The infant will have a fat-soluble drug
substituted.
The infant may require an increased dose of
the drug.
D
Feedback:
In adults, total body water is approximately
60%, whereas in newborns, it is 80%. This
difference means that water-soluble drugs are
diluted easily and readily moved into
intercellular tissue. As a result, serum drug
concentrations are lower, and increased
dosages of water-soluble drugs may be
necessary to maintain therapeutic drug levels.
Substitutes may not be available, and fluid
restriction does not compensate for this
physiological difference.
A)
B)
C)
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B)
C)
D)
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An infant with recent seizures is being treated
in the neonatal intensive care unit with
9. phenytoin (Dilantin). The infant's low plasma
protein levels during the first year of life have
what consequence?
The infant may have an unpredictable drug
response.
The infant may have an increased risk of
toxicity.
The infant may experience impaired
elimination of the drug.
The infant will have an increased rate of drug
metabolism.
B
Feedback:
In infants, immature liver function leads to
very low plasma protein levels, which limit
the amount of protein binding by drugs.
Consequently, the serum concentrations of
highly protein-bound drugs may be higher,
and toxicity may occur. This is not a result of
differences in elimination or increased
metabolism.
C)
elimination of the drug.
The infant will have an increased rate of drug
metabolism.
B
Feedback:
In infants, immature liver function leads to
very low plasma protein levels, which limit
the amount of protein binding by drugs.
Consequently, the serum concentrations of
highly protein-bound drugs may be higher,
and toxicity may occur. This is not a result of
differences in elimination or increased
metabolism.
D)
Which of the following laboratory tests
10. relates most directly with the impaired drug
elimination that is expected in neonates?
C-reactive protein level
Creatine kinase
Serum albumin level
Glomerular filtration rate
D
Feedback:
Excretion of most drugs occurs via the
kidneys, and elimination in the urine follows.
Young children have immature kidneys, a
reduced glomerular filtration rate, and slower
renal clearance. Neonates are especially prone
to increased levels of drugs that are
eliminated primarily by the kidneys. CK,
albumin, and C-reactive protein levels do not
directly relate to this physiological
characteristic.
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B)
C)
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B)
C)
D)
Ans:
The nurse has experienced challenges in
administering a 3-year-old boy's oral
11. antibiotics due to the boy's resistance. How
can the nurse best ensure that this patient
receives his necessary medication?
Convince the boy that the medication is
actually a treat, especially reserved for him.
Mix the medication with pleasantly flavored
syrup or pureed fruit.
Withdraw some of the child's privileges if he
refuses to take his medication.
Distract the child with a toy and then put it in
his mouth quickly.
B
Feedback:
To make oral medications more palatable, the
nurse may mix them with flavored syrups or
fruit purees. It would be inappropriate to use
negative reinforcement, and medications
should not be characterized as candy or treats.
C)
refuses to take his medication.
Distract the child with a toy and then put it in
his mouth quickly.
B
Feedback:
To make oral medications more palatable, the
nurse may mix them with flavored syrups or
fruit purees. It would be inappropriate to use
negative reinforcement, and medications
should not be characterized as candy or treats.
Sneaking the medication into the child's
mouth will not ensure that it will be
swallowed.
D)
Oral acetaminophen has been ordered for a
young child who has a fever. A liquid form
has been obtained by the nurse to increase the
chance of problem-free administration. Prior
12.
to administration, the nurse is going through
the rights of medication administration. When
confirming the right dose, what term is most
appropriate?
“160 mg”
“One teaspoon”
“One third of a tablespoon”
“5 mL”
A
Feedback:
To ensure accuracy and safety, the nurse
should administer medications based on
individual dosages in milligrams,
micrograms, or units, not on variables such as
tablets, teaspoons, or milliliters, for which the
concentration may vary.
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B)
C)
D)
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A)
B)
C)
D)
Ans:
A nurse is preparing to administer a nebulized
bronchodilator to a young child with asthma.
13. The nurse should be aware that this child's
dosage is based primarily on what
characteristic of the child?
Weight
Age
Body type
Development stage
A
Feedback:
Dosages of pediatric medications are
calculated based on weight.
An emergency department nurse is confirming
that a child's ordered dose of IV analgesia is
congruent with her body surface area (BSA).
14.
In order to calculate the child's BSA, the
nurse must know which of the following
variables? Select all that apply.
The child's height
The child's percentage of body water
The child's weight
The usual adult dose of the drug
The child's age in months
A, C
Feedback:
BSA is calculated using the child's weight and
height. The child's age and the normal adult
dose are normally relevant to dosing, but not
to the calculation of BSA.
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B)
C)
D)
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An infant's antiseizure medication has been
ordered after careful consideration of the
15. unique pharmacokinetics among this
population. What characteristic of neonates
has the greatest bearing on drug metabolism?
The undeveloped state of the blood–brain
barrier
Increased gastric motility in infants
The infant's undeveloped renal function
Immaturity of the infant's liver
D
Feedback:
The enzyme cytochrome P450 (CYP450) in
the liver metabolizes most drugs. In neonates,
the ability to metabolize drugs is very low
because of the immaturity of the liver and the
resultant inability to break down drugs.
Characteristics of the kidneys, the blood–
brain barrier, and GI function do not primarily
affect metabolism.
An infant's mother is reluctant for the nurse to
administer a suppository to her baby, stating,
16. “It just seems so terribly invasive.” What
principle should guide the nurse's use of
suppositories in infant patients?
Suppositories are generally avoided unless
absolutely necessary, due to the risk of
injuring the rectal mucosa.
Suppositories can be an effective means of
administering medications to infants, since
oral administration is often challenging.
Suppositories should only be administered
after the nurse manually clears the infant's
rectum.
Suppositories are poorly absorbed in infants
due to their immature gastrointestinal tract.
B
Feedback:
Suppositories are an effective way of
administering medications to infants. They do
not require manual clearing of the rectum
prior to administration. Suppositories are well
absorbed.
A)
B)
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A public health nurse is preparing to
administer an intramuscular injection of a
vaccine to an 8-year-old girl. The nurse
17. recognizes that the child is
uncharacteristically quiet and appears tense.
The nurse should recognize the possibility of
what nursing diagnosis?
Fear related to IM injection
Acute confusion related to misunderstanding
of the necessity of IM injection
Risk for injury related to IM injection
Ineffective coping related to reluctance to
receive IM injection
A
Feedback:
IM injections are frightening for older
children, and they need praise and
encouragement. Fear is a far more likely
cause of this child's behavior than confusion
or ineffective coping. There is risk for injury
associated with IM injections, but the nurse
can mitigate this risk through proper
technique.
C)
Risk for injury related to IM injection
Ineffective coping related to reluctance to
receive IM injection
A
Feedback:
IM injections are frightening for older
children, and they need praise and
encouragement. Fear is a far more likely
cause of this child's behavior than confusion
or ineffective coping. There is risk for injury
associated with IM injections, but the nurse
can mitigate this risk through proper
technique.
D)
Ans:
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A 4-year-old boy is postoperative day one
following surgery for trauma suffered in a
motor vehicle accident. The boy is in pain,
18.
and the nurse is preparing to administer a
dose of hydromorphone syrup as ordered. To
administer this drug, the nurse should use
a teaspoon.
a transparent, 2-ounce medication cup.
a parenteral syringe with the needle removed.
an oral syringe.
D
Feedback:
The nurse should administer oral medications
only in oral syringes. Other methods have the
potential to be inaccurate.
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Chapter 5 Pharmacology and the Care of Adults and Geriatric Patients
A)
B)
C)
D)
Ans:
An 80-year-old woman has sought care for a
dermatological health problem that most often
requires treatment with an oral corticosteroid.
1. When considering whether to prescribe
steroids to this patient, the care provider
should prioritize which of the following
questions?
“Should this patient receive a medication that
was likely tested on younger adults?”
“Do the potential benefits of this medication
outweigh the potential harm?”
“Are there plausible herbal or complementary
alternatives to this medication?”
“Is there a younger adult who can oversee this
patient's medication regimen?”
B
Feedback:
The nurse and the prescriber must carefully
consider the risk of associated adverse effects
of those medications as well as possible
benefits these medications might have in
changing physiological processes related to
“Are there plausible herbal or complementary
alternatives to this medication?”
“Is there a younger adult who can oversee this
patient's medication regimen?”
B
Feedback:
The nurse and the prescriber must carefully
consider the risk of associated adverse effects
of those medications as well as possible
benefits these medications might have in
changing physiological processes related to
disease. This consideration is a priority over
the specifics of the drug's original testing
procedure or the presence of herbal
alternatives. Not every older adult requires
another person to oversee his or her
medications.
C)
D)
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A nurse is teaching an 81-year-old man about
the risk for potential adverse effects before he
begins a course of antibiotics for an upper
2.
respiratory infection. What characteristic of
older adults predisposes them to adverse drug
reaction?
Increased excretion time due to increased
bowel motility
Impaired distribution due to polypharmacy
A decrease in overall body surface area
A decrease in the number of receptors needed
for distribution
D
Feedback:
Older adults are prone to adverse drug
reactions because of a decrease in the number
of receptors needed for drug distribution. BSA
does not change appreciably with age and
bowel motility slows with age. Polypharmacy
is a valid concern, but this phenomenon does
not primarily involve distribution.
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C)
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A nurse is conducting a medication
reconciliation of a woman who is newly
admitted to a long-term care facility. When
3.
appraising the woman's medication regimen
in light of the Beers Criteria, the nurse will
look for
drugs that are known to cause adverse effects
in older adults.
drugs for which generic equivalents are
available at lower cost.
drugs that have been found to be ineffective
in older adults.
drugs that are known to exacerbate the aging
process.
3.
A)
B)
C)
D)
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appraising the woman's medication regimen
in light of the Beers Criteria, the nurse will
look for
drugs that are known to cause adverse effects
in older adults.
drugs for which generic equivalents are
available at lower cost.
drugs that have been found to be ineffective
in older adults.
drugs that are known to exacerbate the aging
process.
A
Feedback:
Dr. Mark Beers developed the Beers Criteria
list of potentially inappropriate medications
used by the older adult population. The list
confirms that toxic medication effects and
drug-related problems affect the safety of
older adults and names drugs that cause
problems in this population.
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B)
C)
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A nurse has noted that an older adult patient
on an acute care for elders (ACE) unit has an
exceptionally lengthy medication
administration record. The nurse has alerted
4.
the pharmacist because one of the patient's
long-standing medications appears on the
Beers list. What medication is the nurse likely
addressing?
Low-dose enteric-coated ASA
Metoprolol (Lopressor)
Digoxin (Lanoxin)
Vitamin D
C
Feedback:
Digoxin appears on the list of Beers Criteria
due to the risk of adverse effects in older
adults. ASA, metoprolol, and vitamin D do
not appear on this list.
A)
B)
C)
D)
Ans:
A nurse has called an elderly patient's surgeon
to question the order for meperidine
hydrochloride (Demerol) for pain control. The
5.
nurse's action is prompted by the possibility
of what adverse effect associated with the use
of Demerol in older adults?
Confusion
Blood dyscrasias
Gastrointestinal bleeding
Hepatotoxicity
A
Feedback:
Demerol is associated with confusion in older
adults. It is not noted to cause blood
5.
A gerontological nurse is aware that older
adults' abilities to excrete medications
diminish with age. When appraising an older
6.
adult's ability to excrete medications, what
laboratory or diagnostic finding should the
nurse prioritize?
Renal ultrasound
Complete blood count (CBC)
Serum bilirubin and albumin levels
Blood urea nitrogen and creatinine levels
D
Feedback:
The nurse should assess an older adult's blood
urea nitrogen and creatinine clearance (CrCl)
levels to determine the patient's ability to
excrete the medications. Renal ultrasound
identifies structural abnormalities in the
kidneys but is less useful in diagnosing
function. The patient's CBC and bilirubin and
albumin levels do not help the nurse assess
the patient's ability to excrete medications.
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B)
C)
D)
Ans:
nurse's action is prompted by the possibility
of what adverse effect associated with the use
of Demerol in older adults?
Confusion
Blood dyscrasias
Gastrointestinal bleeding
Hepatotoxicity
A
Feedback:
Demerol is associated with confusion in older
adults. It is not noted to cause blood
dyscrasias, GI bleeding, or hepatotoxicity.
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B)
C)
D)
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A)
B)
C)
D)
Ans:
A 90-year-old patient’s most recent blood
work includes the following data: alanine
aminotransferase (ALT) 1.99 µkat/L (high)
7.
and aspartate aminotransferase (AST) 3.1
µkat/L (high). What implication do these data
have for the patient's pharmacokinetics?
Distribution of drugs may be erratic.
Absorption of drugs may be incomplete.
Excretion of drugs may be delayed.
Metabolism of drugs may be impaired.
D
Feedback:
AST and ALT levels are used to determine the
patient's liver function and ability to
metabolize drugs.
B)
C)
D)
Ans:
Absorption of drugs may be incomplete.
Excretion of drugs may be delayed.
Metabolism of drugs may be impaired.
D
Feedback:
AST and ALT levels are used to determine the
patient's liver function and ability to
metabolize drugs.
A 72-year-old woman with a 60-pack-year
history of cigarette smoking has developed
chronic obstructive pulmonary disease
8. (COPD) and has consequently been
prescribed albuterol, a beta2-adrenergic
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B)
C)
agonist. When administering this medication,
the nurse should be aware that
the drug carries a higher potential for
hepatotoxicity in this patient than in a
younger patient.
the drug may be less effective than in a
younger patient due to decreased betareceptor function.
the patient will need to take a beta-adrenergic
blocker concurrently to mitigate the
likelihood of adverse effects.
the patient will need to have serial complete
blood counts (CBCs) drawn following the
initiation of therapy.
B
Feedback:
Beta-adrenergic agonists are less effective in
older adults as a result of the decreased
function of the beta-receptor system. The
potential for hepatotoxicity is not increased,
and a beta-blocker is not indicated. Serial
blood work is not necessary.
The daughter of an 80-year-old woman states
that her mother has been taking alendronate
(Fosamax) for several years for the treatment
of osteoporosis. The daughter tells the nurse
9.
that her mother never had any complaints of
nausea after taking this medication until
recently. How should the nurse respond to the
daughter's statement?
“It could be that your mother's stomach
empties more slowly than it used to, which is
a normal result of aging.”
“As your mother gets older, the medication
travels down her esophagus more slowly than
it used to. This can cause nausea.”
“Because your mother processes drugs more
slowly than when she was younger, there is
more time during which they can cause
recently. How should the nurse respond to the
daughter's statement?
“It could be that your mother's stomach
empties more slowly than it used to, which is
a normal result of aging.”
“As your mother gets older, the medication
travels down her esophagus more slowly than
it used to. This can cause nausea.”
“Because your mother processes drugs more
slowly than when she was younger, there is
more time during which they can cause
nausea.”
“As your mother ages, she has more of the
receptors that trigger nausea. This is a normal
change that accompanies the aging process.”
A
Feedback:
Diminished gastric emptying also plays a role
by causing the medication to be in the
stomach for a longer period. This factor
increases the risk of developing nausea and
vomiting, thus causing elimination of the
medication in emesis and promoting fluid
volume deficit. This phenomenon is not
attributable to receptor changes or decreased
esophageal motility.
A)
B)
C)
D)
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An older adult's most recent blood work
reveals that his serum albumin level is 21 g/L
10.
(low). This will most influence what aspect of
pharmacokinetics?
Absorption
Distribution
Metabolism
Excretion
B
Feedback:
Many medications require serum albumin to
bind, transport, and distribute the medication
to the target organ. In the event that the
amount of serum albumin is insufficient, the
amount of free drug rises and the effect of the
drug is more intense.
A)
B)
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Laboratory testing of an 80-year-old patient
who is well-known to the clinic nurse
indicates that his liver function has been
11.
gradually decreasing over the last several
years. How will this age-related physiological
change influence drug metabolism?
The patient will metabolize drugs more
quickly but derive less of a therapeutic benefit
from them.
The liver will sequester drug molecules in the
hepatocytes, and they will be released at
unpredictable times.
Many of the patient's medications will remain
in his body for a longer time.
The patient's kidneys will be forced to
metabolize a disproportionate quantity of
medications.
C
Feedback:
The hepatic enzymes of the liver are
decreased in the older adult, altering the
ability to remove metabolic by-products. It is
important to understand that because older
adults have a reduced metabolism,
medications with a long half-life will remain
in the body for a greater amount of time. The
kidneys do not compensate for this loss of
function. Drugs are not normally sequestered
in the liver tissue.
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B)
C)
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A gerontological nurse is aware that age is a
salient variable that must be considered
during pharmacotherapy in adults. However,
the nurse knows that many other important
12.
variables must also be considered, including
ethnicity. Members of which of the following
ethnic groups typically require lower doses of
many common medications?
Native Americans
Caucasian Americans
Asian Americans
African Americans
C
Feedback:
Caucasian Americans and African Americans
are poor metabolizers of medication
compared with Asian Americans; Asian
Americans have the ability to metabolize and
excrete medications more quickly than those
of Caucasian and African descent. This often
Caucasian Americans
Asian Americans
African Americans
C
Feedback:
Caucasian Americans and African Americans
are poor metabolizers of medication
compared with Asian Americans; Asian
Americans have the ability to metabolize and
excrete medications more quickly than those
of Caucasian and African descent. This often
means that Asian Americans require lower
doses.
A nurse is reviewing a new patient's
admission blood work, which indicates that
the patient's glomerular filtration rate is 51
13.
2
mL/min/1.73 m (low). What implication
does this have for the patient's subsequent
pharmacotherapy?
The patient may need lower-than-normal
doses of some medications.
The patient may require a fluid challenge
prior to medication administration.
The patient may need IV administration of a
hypotonic solution to aid medication
excretion.
The patient may need to receive medications
by topical and subcutaneous routes rather than
parenteral.
A
Feedback:
With a decreased GFR, it is necessary to
reduce the dosage of the medication. IV fluid
administration and alternative routes do not
adequately compensate for this change in
pharmacokinetics.
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C)
D)
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B)
C)
A 69-year-old man has been prescribed a
nitrate and a calcium channel blocker for the
treatment of unstable angina. When
14. performing health education to promote
adherence to his medication regimen, the
nurse should emphasize which of the
following?
The fact that the patient will likely need
medications until he no longer experiences
the signs of angina
The fact that the patient should take his
medications as ordered even if he feels well in
the short term
The fact that inconsistent medication use will
likely cause the onset of hypertension
The fact that he should gauge his day's dose
nurse should emphasize which of the
following?
The fact that the patient will likely need
medications until he no longer experiences
the signs of angina
The fact that the patient should take his
medications as ordered even if he feels well in
the short term
The fact that inconsistent medication use will
likely cause the onset of hypertension
The fact that he should gauge his day's dose
based on how he feels that morning
B
Feedback:
Being asymptomatic may contribute to
nonadherence to a medication regimen. Many
patients begin to feel better with the initiation
of therapy and then discontinue medications
altogether or miss individual doses. Patients
and their families should be educated about
adherence to medication regimens and taught
to not skip doses, even if they feel well.
Inconsistent use of nitrates and calcium
channel blockers does not normally lead to
hypertension.
A)
B)
C)
D)
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B)
C)
D)
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Mrs. James has been taking a diuretic and a
beta-blocker for the treatment of hypertension
for the past several months. During her latest
clinic visit, she states that she has been
measuring her blood pressure regularly at her
15. local drug store and she claims that it is
usually in the range of 130/80 mm Hg. As a
result, she states that she has cut down on her
doses of both drugs. Mrs. James' actions
should indicate what nursing diagnosis to the
nurse?
Risk for poisoning related to unilateral
changes to medication regimen
Acute confusion related to the necessity for
medication adherence
Readiness for enhanced decision making
related to management of drug therapy
Deficient knowledge related to selfmanagement of drug regimen
D
Feedback:
Mrs. James is evidently unaware of the need
to take her medications consistently. She is
presuming that symptom control means that
the medication is no longer indicated. The
nurse should address this lack of knowledge.
There is no associated risk of poisoning, and
the patient's decision making is deficient, a
fact that she may or may not be willing to
C)
related to management of drug therapy
Deficient knowledge related to selfmanagement of drug regimen
D
Feedback:
Mrs. James is evidently unaware of the need
to take her medications consistently. She is
presuming that symptom control means that
the medication is no longer indicated. The
nurse should address this lack of knowledge.
There is no associated risk of poisoning, and
the patient's decision making is deficient, a
fact that she may or may not be willing to
address. Acute confusion denotes a deficit in
cognitive processes, not a lack of information.
D)
A nurse at a long-term care facility is
surprised to learn that a new resident's
medication administration record runs four
16.
pages in length. The nurse knows that
polypharmacy carries which of the following
risks for older adults? Select all that apply.
Increased risk of complications
Decreased continuity of care
Decreased cognition
Decreased medication adherence
Decreased costs of care
A, C
Feedback:
Polypharmacy and the consequent
interactions of medications can lead to greater
complications and diminished mental status.
It does not necessarily reduce the continuity
of care or medication adherence. Costs to the
patient are likely to be higher, not lower.
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B)
C)
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E)
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Chapter 6 Pharmacology and the Care of Pregnant or Lactating Woman
A)
B)
C)
D)
Ans:
A pregnant woman is experiencing nausea
and vomiting in her first trimester of
1.
pregnancy. Which herbal agent has
traditionally been used as an antiemetic?
Ginger
Garlic
Ginkgo biloba
Green tea
A
Feedback:
Ginger has been used to relieve nausea and
vomiting during pregnancy. Garlic, Ginkgo
biloba, and green tea are not recommended to
relieve nausea and vomiting in pregnancy.
B)
C)
D)
Ans:
Garlic
Ginkgo biloba
Green tea
A
Feedback:
Ginger has been used to relieve nausea and
vomiting during pregnancy. Garlic, Ginkgo
biloba, and green tea are not recommended to
relieve nausea and vomiting in pregnancy.
A pregnant woman asks why she needs to
take a folic acid supplement. What is the
2.
nurse's best explanation for the administration
of folic acid?
“Folic acid prevents the development of
contractions.”
“Folic acid prevents neural tube birth
defects.”
“Folic acid builds strong fetal bones.”
“Folic acid will decrease nausea and
vomiting.”
B
Feedback:
Folic acid prevents neural tube birth defects.
Folic acid does not prevent contractions. Folic
acid will not build fetal bones. Folic acid will
not prevent nausea and vomiting.
A)
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C)
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A woman is being administered IV
magnesium sulfate. What is a desired
3.
outcome related to the administration of
magnesium sulfate?
Increased contractions
Respiratory rate above 18
Decreased blood pressure
Increased uterine tone
C
Feedback:
The administration of magnesium sulfate can
prevent seizure activity and reduce severe
hypertension. Magnesium sulfate is
administered for preterm labor to prevent
contractions and reduce uterine tone, not to
increase respiratory rate.
A woman who began labor several hours ago
4. is to be administered oxytocin. What is the
goal of oxytocin therapy?
Prevent postpartum bleeding
Decrease fetal hyperactivity
Augment weak or irregular contractions
Diminish periods of relaxation
C
Feedback:
Use of this manufactured hormone induces
labor or augments weak, irregular uterine
contractions during labor. It is not used in the
labor phase to prevent bleeding. It is not
administered to decrease fetal hyperactivity.
The administration of oxytocin should allow
for adequate periods of relaxation between
contractions.
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B)
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A woman in labor is being treated with
magnesium sulfate intravenously and is
beginning to show signs and symptoms of
5.
hypermagnesemia. The infusion has been
discontinued, and the nurse should anticipate
administration of what drug?
Metoprolol (Lopressor)
Calcium gluconate
Potassium chloride
Furosemide (Lasix)
B
Feedback:
Overdoses of magnesium sulfate may lead to
hypotension, muscle paralysis, respiratory
depression, and cardiac arrest. Calcium
gluconate, the antidote for magnesium sulfate,
should be readily available for use if
hypermagnesemia occurs.
A)
B)
C)
D)
Ans:
A patient is being administered magnesium
sulfate for preterm labor. The patient's serum
6. magnesium level is elevated at 11 mg/dL.
With what sign or symptom will the patient
likely present?
Tachypnea
Muscle rigidity
Tachycardia
Depressed deep tendon reflexes
D
Feedback:
sulfate for preterm labor. The patient's serum
6. magnesium level is elevated at 11 mg/dL.
With what sign or symptom will the patient
likely present?
Tachypnea
Muscle rigidity
Tachycardia
Depressed deep tendon reflexes
D
Feedback:
Hypermagnesemia will cause depressed deep
tendon reflexes. The serum magnesium level
of 11 mg/dL would result in depressed
respirations. The serum magnesium level of
11 would result in decreased muscle strength.
The serum level of 11 mg/dL would result in
bradycardia, not tachycardia.
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B)
C)
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A woman in preterm labor has been
administered terbutaline sulfate (Brethine).
7.
For what potential adverse effects should the
nurse assess the patient?
Pruritus (itching) and copious diaphoresis
Joint pain and numbness in her extremities
Headache and visual disturbances
Palpitations and shortness of breath
D
Feedback:
Terbutaline sulfate (Brethine) is a betaadrenergic agent that inhibits uterine
contractions by reducing intracellular calcium
levels. Adverse effects may include
hyperkalemia, hyperglycemia, cardiac
dysrhythmias, hypotension, and pulmonary
edema. Women commonly experience hand
tremors, palpitations, and shortness of breath
with chest tightness.
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A)
B)
C)
D)
Ans:
8.
A)
B)
C)
D)
Ans:
When administering magnesium sulfate, for
what should the nurse assess the patient?
Dry, pale skin
Respiratory depression
Agitation
Tachycardia
B
Feedback:
Overdoses of magnesium sulfate may lead to
hypotension, muscle paralysis, respiratory
depression, and cardiac arrest. The nurse
would not anticipate dry, pale skin; agitation;
or tachycardia.
B)
C)
D)
Ans:
Respiratory depression
Agitation
Tachycardia
B
Feedback:
Overdoses of magnesium sulfate may lead to
hypotension, muscle paralysis, respiratory
depression, and cardiac arrest. The nurse
would not anticipate dry, pale skin; agitation;
or tachycardia.
A pregnant woman states that she has been
constipated since becoming pregnant. Which
9.
medication is most appropriate for preventing
constipation related to pregnancy?
Metamucil
Mineral oil
Saline cathartic
Stimulant cathartic
A
Feedback:
A bulk-producing agent, such as Metamucil,
is most physiologic for the mother and safe
for the fetus. Mineral oil is not recommended
because of the lack of absorption of fatsoluble vitamins. Saline cathartics are not
recommended because of hypernatremia.
Stimulant cathartics are not recommended for
the pregnant woman.
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B)
C)
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A woman who is 7 months pregnant is waking
up at night with gastroesophageal reflux.
10.
Which of the following medications is most
highly recommended?
Terbutaline (Brethine)
Diphenoxylate (Lomotil)
Ranitidine (Zantac)
Chlorothiazide (Diuril)
C
Feedback:
A histamine2 receptor antagonist, such as
ranitidine, is used for gastroesophageal reflux
disease. Terbutaline is a tocolytic agent.
Diphenoxylate is not administered for GERD.
Chlorothiazide is a diuretic agent.
A woman who takes highly active
antiretroviral therapy (HAART) for HIV/
11. AIDS has become pregnant. What effect will
the woman's pregnancy have on her drug
regimen?
She must discontinue HAART due to the risk
of teratogenic effects.
Her dosages of HAART must be increased to
reduce the risk of in utero transmission.
She can continue her HAART unchanged.
Some components of her HAART must be
replaced or discontinued.
C
Feedback:
Antiretroviral drug therapy for the pregnant
woman reduces perinatal transmission by
about two thirds. In general, highly active
antiretroviral therapy, or HAART, is safe,
with recommended dosage the same as for
nonpregnant women.
A)
B)
C)
D)
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A woman is at 42 weeks of gestation. Which
12. of the following medications will be
administered to promote cervical ripening?
Calcium gluconate
Magnesium sulfate
Terbutaline (Brethine)
Dinoprostone (Cervidil)
D
Feedback:
Cervidil is administered to ripen the cervix in
a woman who is at 42 weeks of gestation.
Calcium gluconate, magnesium sulfate, and
terbutaline are not administered to ripen the
cervix.
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B)
C)
D)
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A)
B)
C)
D)
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A patient is receiving oxytocin (Pitocin).
13. Which of the following is a maternal adverse
effect of Pitocin?
Acute confusion
Hypertension
Edema
Inverted T wave
B
Feedback:
Hypertension is a maternal adverse effect of
Pitocin. Confusion, edema, and inverted T
wave are not adverse effects of Pitocin.
B)
C)
D)
Ans:
Hypertension
Edema
Inverted T wave
B
Feedback:
Hypertension is a maternal adverse effect of
Pitocin. Confusion, edema, and inverted T
wave are not adverse effects of Pitocin.
A woman was administered misoprostol
(Cytotec) in an effort to induce labor, but the
14. care team is unsatisfied with the results.
Consequently, oxytocin will be used. Prior to
administering oxytocin, what must occur?
Four hours must elapse after the last dose of
misoprostol.
The woman must have a type and cross-match
performed.
The woman must receive a bolus of 500-mL
normal saline.
The woman must have her electrolytes
measured.
A
Feedback:
If the course of treatment changes and
oxytocin is to be given after misoprostol, it is
essential to wait 4 hours from the last
administration of misoprostol before starting
oxytocin. Blood work and IV hydration are
not necessary.
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A patient is being treated for preterm labor.
Which beta-adrenergic medication is
15.
administered orally to decrease uterine
contractions?
Magnesium sulfate
Oxytocin (Pitocin)
Nifedipine (Procardia)
Terbutaline (Brethine)
D
Feedback:
Terbutaline is a beta-adrenergic agent that
inhibits uterine contractions by reducing
intracellular calcium levels; oral doses can be
given as maintenance therapy. Magnesium
sulfate is administered intravenously and not
administered at home. Oxytocin induces
labor. Nifedipine is a calcium channel blocker
that decreases uterine contractions.
Oxytocin (Pitocin)
Nifedipine (Procardia)
Terbutaline (Brethine)
D
Feedback:
Terbutaline is a beta-adrenergic agent that
inhibits uterine contractions by reducing
intracellular calcium levels; oral doses can be
given as maintenance therapy. Magnesium
sulfate is administered intravenously and not
administered at home. Oxytocin induces
labor. Nifedipine is a calcium channel blocker
that decreases uterine contractions.
A couple have been trying unsuccessfully for
nearly a year to become pregnant and have
now sought fertility counseling. The nurse
16.
should be aware of what potential etiological
factors related to infertility? Select all that
apply.
Absence of sperm
Endometriosis
Vaginitis
Blocked fallopian tubes
Fibromyalgia
A, B, D
Feedback:
In women, the most common causes are
ovulation disorders, blocked fallopian tubes,
endometriosis, and advanced maternal age,
which affects egg quality and quantity. In
men, causes include absence of sperm,
declining sperm counts, testicular
abnormalities, and ejaculatory dysfunction.
Vaginitis cannot cause infertility, and
fibromyalgia is not noted as a common
etiological factor.
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C)
D)
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B)
C)
D)
E)
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A)
B)
C)
D)
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A woman has been unable to conceive for
many months and will soon begin treatment
17. with clomiphene (Clomid). What health
education should the nurse provide to this
patient?
Avoid drinking alcohol while taking Clomid.
Perform daily OTC pregnancy tests beginning
the day after taking Clomid.
Take her basal temperature between 5 to 10
days after taking Clomid.
Report any numbness or tingling in her hands
or lips to her care provider.
C
Feedback:
Ovulation occurs 5 to 10 days after the course
of clomiphene treatment has been completed.
A)
Avoid drinking alcohol while taking Clomid.
Perform daily OTC pregnancy tests beginning
the day after taking Clomid.
Take her basal temperature between 5 to 10
days after taking Clomid.
Report any numbness or tingling in her hands
or lips to her care provider.
C
Feedback:
Ovulation occurs 5 to 10 days after the course
of clomiphene treatment has been completed.
Prior to beginning the drug regimen, the nurse
instructs the woman about taking her basal
temperature 5 to 10 days following
administration. An incremental rise in
temperature is an indication of ovulation.
There is no specific contraindication against
alcohol, and neurological adverse effects are
not expected.
B)
C)
D)
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A nurse is performing health education with a
woman who has just learned that she is
pregnant. The nurse has explained the concept
of teratogenic drugs and emphasized the need
18. to have her care provider assess any
medications she should consider taking. The
nurse should teach the woman that druginduced teratogenicity is most likely to occur
at what point in her pregnancy?
During the second half of her third trimester
In the 7 to 10 days after conception
In the first trimester during organogenesis
During 30 to 34 weeks of gestation
C
Feedback:
Drug-induced teratogenicity is most likely to
occur when drugs are taken during the first
three months of pregnancy, during
organogenesis.
A)
B)
C)
A primiparous woman was vigilant in
avoiding medications and herbs during her
pregnancy and states that she is similarly
19. committed to protecting her baby's health now
that she is breast-feeding. What principle
should guide the woman's use of medications
while breast-feeding?
Very few medications are explicitly
contraindicated while breast-feeding.
It is generally safer to use herbs rather than
medications while breast-feeding.
Most women can resume their prepregnancy
medication regimen after delivery.
Most medications are contraindicated while a
that she is breast-feeding. What principle
should guide the woman's use of medications
while breast-feeding?
Very few medications are explicitly
contraindicated while breast-feeding.
It is generally safer to use herbs rather than
medications while breast-feeding.
Most women can resume their prepregnancy
medication regimen after delivery.
Most medications are contraindicated while a
woman is breast-feeding.
D
Feedback:
A wide variety of medications are
contraindicated during pregnancy, and herbs
are not guaranteed to be safe.
A)
B)
C)
D)
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A woman who is in the first trimester of her
pregnancy has told the nurse, “I've stopped
taking my blood pressure pill because I know
20. it could harm the baby. Instead, I've started
taking natural and herbal remedies.” What
nursing diagnosis is suggested by the
woman's statement?
Deficient knowledge related to drug and
herbal effects during pregnancy
Health-seeking behaviors related to protection
of fetal health
Acute confusion related to the potential
teratogenic effects of herbs
Effective therapeutic regimen management
related to use of herbs rather than drugs
A
Feedback:
This patient is evidently unaware of the fact
that herbs pose risks to her fetus and that such
risks are not limited to drugs. The nurse
should address this knowledge gap. Acute
confusion suggests a deficit in cognitive
processes, not a lack of relevant and accurate
information.
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B)
C)
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Chapter 7 Pharmacology and Women's Health
Chapter 8 Pharmacology and Men's Health
Chapter 9 Drug Therapy for Coagulation Disorders
A patient is taking warfarin (Coumadin) after
open heart surgery. The patient tells the home
care nurse she has pain in both knees that
began this week. The nurse notes bruises on
1.
both knees. Based on the effects of her
medications and the complaint of pain, what
does the nurse suspect is the cause of the
pain?
Joint thrombosis
Torn medial meniscus
Degenerative joint disease caused by her
medication
Bleeding
D
Feedback:
The main adverse effect of warfarin
(Coumadin) is bleeding. The sudden onset of
pain in the knees alerts the nurse to assess the
patient for bleeding. Arthritis, torn medical
meniscus, and degenerative joint disease
could all be symptoms of knee pain, but the
onset and combination of anticoagulant
therapy is not an etiology of these types of
injuries and disease.
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B)
C)
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A patient who has been treated with warfarin
(Coumadin) after cardiac surgery is found to
2. have an INR of 9.0. Which medication will be
administered to assist in the development of
clotting factors?
Vitamin K
Vitamin E
Protamine sulfate
Acetylsalicylic acid (Aspirin)
A
Feedback:
Vitamin K is the antidote for warfarin
overdosage. In this case, the patient may be at
the therapeutic level to control thrombus
formation, but, due to the injury, it is
important to control bleeding. Vitamin E is
not used as an antidote for warfarin
overdosage. Protamine sulfate is used as an
antidote to heparin or low molecular-weight
heparin. Acetylsalicylic acid (Aspirin) is used
to decrease coagulation as a preventive
measure for myocardial infarction.
Vitamin E
Protamine sulfate
Acetylsalicylic acid (Aspirin)
A
Feedback:
Vitamin K is the antidote for warfarin
overdosage. In this case, the patient may be at
the therapeutic level to control thrombus
formation, but, due to the injury, it is
important to control bleeding. Vitamin E is
not used as an antidote for warfarin
overdosage. Protamine sulfate is used as an
antidote to heparin or low molecular-weight
heparin. Acetylsalicylic acid (Aspirin) is used
to decrease coagulation as a preventive
measure for myocardial infarction.
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C)
D)
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A patient has a history of clot formation. She
is scheduled for bowel resection due to
3.
colorectal cancer. What anticoagulant agent
will be administered prophylactically?
Acetylsalicylic acid (Aspirin)
Heparin
Warfarin (Coumadin)
Streptokinase (Streptase)
B
Feedback:
Prophylactically, low doses of heparin are
given to prevent thrombus formation in
patients having major abdominal surgery.
Acetylsalicylic acid is not used to prevent
thrombus in patients having major abdominal
surgery. Warfarin takes several days for
therapeutic effects to occur; thus it is not used
prophylactically to prevent thrombus in a
patient with abdominal surgery. Streptokinase
promotes thrombolysis and is not used to
prevent thrombus.
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B)
C)
D)
Ans:
A)
B)
C)
D)
Ans:
A patient has been administered heparin to
prevent thromboembolism development status
postmyocardial infarction. The patient
4.
develops heparin-induced thrombocytopenia.
Which of the following medications will be
administered?
Argatroban (Acova)
Vitamin K
Calcium gluconate
Aminocaproic acid (Amicar)
A
Feedback:
Heparin-induced thrombocytopenia may
occur in 1% to 3% of those receiving heparin
and is a very serious side effect of heparin. In
administered?
Argatroban (Acova)
Vitamin K
Calcium gluconate
Aminocaproic acid (Amicar)
A
Feedback:
Heparin-induced thrombocytopenia may
occur in 1% to 3% of those receiving heparin
and is a very serious side effect of heparin. In
this patient, all heparin administration must be
discontinued and anticoagulation managed
with a direct thrombin inhibitor, such as
argatroban. The patient is not administered
vitamin K, calcium gluconate, or
aminocaproic acid.
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B)
C)
D)
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A patient is receiving low molecular weight
heparin to prevent thromboembolic
complications. The nursing student asks the
5. nursing instructor the reason why this
treatment is given instead of heparin. What is
the instructor's best explanation of the
rationale for LMWH over heparin?
“LMWH is associated with less
thrombocytopenia than standard heparin.”
“LMWH is associated with stronger
anticoagulant effects than standard heparin.”
“LMWH is given to patients who have a
history of blood dyscrasia.”
“LMWH is more effective than standard
heparin for patients with hypertension.”
A
Feedback:
Low molecular weight heparins are associated
with less thrombocytopenia than standard
heparin. Low molecular weight heparin is not
stronger than standard heparin. Low
molecular weight heparin is administered
cautiously in patients with blood dyscrasia
and hypertension.
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A)
B)
C)
D)
Ans:
A patient who is receiving warfarin
(Coumadin) has blood in his urinary catheter
6.
drainage bag. What medication will likely be
ordered by the physician?
Aminocaproic acid (Amicar)
Platelets
Protamine sulfate
Vitamin K
D
Feedback:
Vitamin K is the antidote for warfarin
overdose. Aminocaproic acid is used to
6.
A patient has experienced the formation of
clots and has bruising. It is determined that
there is a depletion of the patient's
7.
coagulation factors and widespread bleeding.
Which of the following medications will be
administered?
Aminocaproic acid (Amicar)
Heparin
Warfarin (Coumadin)
Protamine sulfate
B
Feedback:
The development of clots and widespread
bleeding is indicative of disseminated
intravascular coagulation. The patient should
be administered heparin to slow the formation
of clots. The goal of heparin therapy in DIC is
to prevent blood coagulation long enough for
clotting factors to replenish and control
hemorrhage. Aminocaproic acid is used to
control excessive bleeding from systemic
hyperfibrinolysis. Warfarin is administered
orally to decrease clot formation. Protamine
sulfate would not be administered.
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A)
B)
C)
D)
Ans:
drainage bag. What medication will likely be
ordered by the physician?
Aminocaproic acid (Amicar)
Platelets
Protamine sulfate
Vitamin K
D
Feedback:
Vitamin K is the antidote for warfarin
overdose. Aminocaproic acid is used to
control excessive bleeding from systemic
hyperfibrinolysis. Platelets are a blood
product, not a medication. Protamine sulfate
is the antidote for heparin therapy.
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A)
B)
C)
D)
Ans:
A)
B)
C)
D)
Ans:
A patient is admitted with thrombophlebitis
and sent home on enoxaparin (Lovenox).
8. Which statement indicates a good
understanding of why enoxaparin is being
administered?
Enoxaparin inhibits the formation of
additional clots.
Enoxaparin eliminates certain clotting factors.
Enoxaparin decreases the viscosity of blood.
Enoxaparin will dissolve the existing clots.
A
Feedback:
Low molecular weight heparins prevent the
development of additional clots. They do not
administered?
Enoxaparin inhibits the formation of
additional clots.
Enoxaparin eliminates certain clotting factors.
Enoxaparin decreases the viscosity of blood.
Enoxaparin will dissolve the existing clots.
A
Feedback:
Low molecular weight heparins prevent the
development of additional clots. They do not
eliminate clotting factors. LMWHs do not
dissolve the clot or decrease the viscosity of
blood.
A)
B)
C)
D)
Ans:
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A patient is being discharged from the
hospital with warfarin (Coumadin) to be taken
9.
at home. Which of the following foods should
the patient be instructed to avoid in his diet?
Eggs
Dairy products
Apples
Spinach
D
Feedback:
Spinach is a green leafy vegetable that is high
in vitamin K and will interact to prevent
adequate levels of anticoagulant therapy.
Eggs, dairy products, and apples are not
contraindicated with warfarin.
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B)
C)
D)
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A)
B)
C)
D)
Ans:
A patient is discharged from the hospital with
a prescription of warfarin (Coumadin). Which
10.
of the following statements indicates
successful patient teaching?
“If I miss a dose, I will take two doses.”
“I will avoid herbal remedies.”
“I will eat spinach or broccoli daily.”
“I will discontinue my other medications.”
B
Feedback:
Most commonly used herbs and supplements
have a profound effect on drugs for
anticoagulation. The patient should never
double up on dosing related to a missed dose.
The patient should avoid green leafy
vegetables due to vitamin K. The patient
should not discontinue his or her medications.
A)
B)
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C)
A patient is being administered heparin IV
and has been started on warfarin (Coumadin).
11. The patient asks the nurse why she is taking
both medications. What is the nurse's most
accurate response?
“After a certain period of time, you must start
warfarin and heparin together.”
“You will need both warfarin and heparin for
several days.”
“Warfarin takes 3 to 5 days to develop
anticoagulant effects, and you still need
heparin.”
“Warfarin cannot be given without heparin
due to the amount of clotting you need.”
C
Feedback:
Anticoagulant effects do not occur for 3 to 5
days after warfarin is started because clotting
factors already in the blood follow their
normal pathway of elimination. The statement
“After a certain period of time, you must start
warfarin and heparin together” does not
explain clearly the reason for the two
medications concurrently. The statement “You
will need both warfarin and heparin for
several days” does not explain clearly the
reason for the two medications. The statement
“Warfarin cannot be given without heparin
due to the amount of clotting you need” is not
accurate.
D)
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A)
B)
C)
D)
Ans:
A patient asks the nurse what dose of
acetylsalicylic acid (Aspirin) is needed each
12. day for antiplatelet effects to prevent heart
attacks. What dose is most appropriate to
reduce platelet aggregation?
10 mg
30 mg
625 mg
1000 mg
B
Feedback:
A single dose of 300 to 600 mg or multiple
doses of 30 mg inhibit cyclooxygenase in
circulating platelets almost completely. The
dose of 10 mg is too small. The doses of 625
mg and 1000 mg are too large.
30 mg
625 mg
1000 mg
B
Feedback:
A single dose of 300 to 600 mg or multiple
doses of 30 mg inhibit cyclooxygenase in
circulating platelets almost completely. The
dose of 10 mg is too small. The doses of 625
mg and 1000 mg are too large.
A patient is prescribed eptifibatide
(Integrilin), which inhibits platelet
aggregation by preventing activation of GP
IIb/IIIa receptors on the platelet surface and
13.
the subsequent binding of fibrinogen and von
Willebrand factor to platelets. Which of the
following syndromes are treated with
eptifibatide?
Blocked carotid arteries
Intermittent claudication
Hypertension
Unstable angina
D
Feedback:
Eptifibatide (Integrilin) inhibits platelet
aggregation by preventing activation of GP
IIb/IIIa receptors on the platelet surface and
the subsequent binding of fibrinogen and von
Willebrand factor to platelets. Eptifibatide is
used for acute coronary syndromes, including
unstable angina, myocardial infarction, and
non–Q wave MI. Blocked carotid arteries,
intermittent claudication, and hypertension
are not treated with eptifibatide.
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B)
C)
D)
Ans:
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A)
B)
C)
D)
Ans:
A)
B)
C)
D)
Ans:
A patient is receiving IV heparin every 6
hours. An activated partial thromboplastin
14. time (aPTT) is drawn 1 hour before the 08:00
dose. The PTT is 92 seconds. What is the
most appropriate action by the nurse?
Give the next two doses at the same time.
Give the dose and chart the patient response.
Check the patient's vital signs and give the
dose.
Hold the dose and call the aPTT result to the
physician's attention.
D
Feedback:
The normal control value is 25 to 35 seconds;
therefore, therapeutic values are 45 to 70
seconds, approximately. A result of 92
seconds is a risk for bleeding, and the dose
should be held until approval to administer is
C)
dose.
Hold the dose and call the aPTT result to the
physician's attention.
D
Feedback:
The normal control value is 25 to 35 seconds;
therefore, therapeutic values are 45 to 70
seconds, approximately. A result of 92
seconds is a risk for bleeding, and the dose
should be held until approval to administer is
provided by the physician. The nurse should
not give the next two doses at the same time.
The nurse should not give the dose and
document the patient's response. The nurse
should not check the patient's vital signs and
give the dose.
D)
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A patient is taking warfarin (Coumadin) to
prevent clot formation related to atrial
15.
fibrillation. How are the effects of the
warfarin (Coumadin) monitored?
RBC
aPTT
PT and INR
Platelet count
C
Feedback:
The warfarin dose is regulated according to
the INR. The INR is based on the
prothrombin time. The red blood cell count is
not indicative of warfarin dosage. The aPTT
is utilized to determine heparin dose. The
platelet count is required to determine
warfarin dose.
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B)
C)
D)
Ans:
A)
B)
C)
D)
Ans:
A patient who is recovering in hospital from a
bilateral mastectomy has developed minor
bleeding at one of her incision sites. During
16.
the process of clot formation, plasminogen
will become part of a clot by which of the
following means?
By binding with fibrin
By binding with platelets
By activating plasmin
By activating factor VII
A
Feedback:
When a blood clot is being formed,
plasminogen, an inactive protein present in
many body tissues and fluids, is bound to
fibrin and becomes a component of the clot.
Plasminogen does not bind to platelets,
activate plasmin, or active factor VII.
By binding with platelets
By activating plasmin
By activating factor VII
A
Feedback:
When a blood clot is being formed,
plasminogen, an inactive protein present in
many body tissues and fluids, is bound to
fibrin and becomes a component of the clot.
Plasminogen does not bind to platelets,
activate plasmin, or active factor VII.
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A)
B)
C)
D)
Ans:
A 55-year-old man has been diagnosed with
coronary artery disease and begun antiplatelet
therapy. The man has asked the nurse why he
17. is not taking a “blood thinner like warfarin.”
What is the most likely rationale for the
clinician's use of an antiplatelet agent rather
than an anticoagulant?
Antiplatelet agents do not require the man to
undergo frequent blood work; anticoagulants
require constant blood work to ensure safety.
Antiplatelet agents are more effective against
arterial thrombosis; anticoagulants are more
effective against venous thrombosis.
Antiplatelet agents are most effective in large
vessels; anticoagulants are most effective in
the small vessels of the peripheral circulation.
Antiplatelet agents have fewer adverse effects
than anticoagulants.
B
Feedback:
Anticoagulants are more effective in
preventing venous thrombosis than arterial
thrombosis. Antiplatelet drugs are used to
prevent arterial thrombosis. CAD has an
arterial rather than venous etiology. The
rationale for the use of antiplatelet agents in
CAD is not likely related to the need for
blood work or the presence of adverse effects.
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B)
C)
D)
Ans:
A nurse at a long-term care facility is
conducting a medication reconciliation for a
man who has just moved into the facility. The
18.
man is currently taking clopidogrel (Plavix).
The nurse is most justified is suspecting that
this man has a history of
hemorrhagic cerebrovascular accident.
hemophilia A.
idiopathic thrombocytopenic purpura (ITP).
myocardial infarction.
D
Feedback:
Indications for use of Plavix include reduction
18.
A 79-year-old woman has been brought to the
emergency department by ambulance with
19. signs and symptoms of ischemic stroke. The
care team would consider the STAT
administration of what drug?
Low molecular weight heparin
Vitamin K
Clopidogrel (Plavix)
Alteplase (Activase)
D
Feedback:
Alteplase (Activase) is used as first-line
therapy for the treatment of acute ischemic
stroke in selected people. Vitamin K would
exacerbate the woman's symptoms, and
LMWH and Plavix would be ineffective.
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A)
B)
C)
D)
Ans:
man is currently taking clopidogrel (Plavix).
The nurse is most justified is suspecting that
this man has a history of
hemorrhagic cerebrovascular accident.
hemophilia A.
idiopathic thrombocytopenic purpura (ITP).
myocardial infarction.
D
Feedback:
Indications for use of Plavix include reduction
of myocardial infarction, stroke, and vascular
death in patients with atherosclerosis and in
those after placement of coronary stents. It is
not indicated in the treatment of ITP, CVA, or
hemophilia.
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B)
C)
D)
Ans:
A)
B)
C)
D)
Ans:
A 50-year-old man has undergone a
bunionectomy and has been admitted to the
20. postsurgical unit. What aspect of the man's
medical history would contraindicate the use
of heparin for DVT prophylaxis?
The man is morbidly obese.
The man has a diagnosis of ulcerative colitis.
The man had a myocardial infarction 18
months ago.
The man has a diagnosis of type 2 diabetes
mellitus.
B
Feedback:
GI ulcerations contraindicate the use of
heparin. Obesity, diabetes, and previous MI
do not rule out the safe use of heparin.
C)
months ago.
The man has a diagnosis of type 2 diabetes
mellitus.
B
Feedback:
GI ulcerations contraindicate the use of
heparin. Obesity, diabetes, and previous MI
do not rule out the safe use of heparin.
D)
Ans:
Chapter 10 Drug Therapy for Dyslipidemia
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A)
B)
C)
D)
Ans:
An obese patient who has an elevated
triglyceride level and reduced high-density
1. lipoprotein cholesterol is seen by her primary
care physician. What do these data suggest in
this patient?
The development of arthritic syndrome
The development of metabolic syndrome
The development of Reye's syndrome
The development of Tay-Sachs disease
B
Feedback:
Metabolic syndrome is noted when the patient
has elevated waist circumference, elevated
triglycerides, reduced high-density lipoprotein
cholesterol, elevated blood pressure, and
elevated fasting glucose. Elevated triglyceride
level and reduced high-density lipoprotein
cholesterol are not indicative of arthritic
syndrome. Reye's syndrome is marked by
acute encephalopathy and seen in children
under the age of 15 years after an acute viral
infection. Tay-Sachs is a genetic disease
characterized by neurological deterioration in
the first year of life.
A)
B)
C)
D)
Ans:
A patient has an elevated total serum
cholesterol of 260 mg/dL. Which of the
2. following aspects of patient teaching of
lifestyle changes is most important for the
patient?
Eat organic foods.
Stop smoking.
Increase rest periods.
Drink whole milk.
B
Feedback:
Therapeutic lifestyle changes to lower serum
cholesterol, including exercise, smoking
cessation, change in diet, and drug therapy,
are recommended to lower serum cholesterol.
The patient with an elevated serum
cholesterol should increase exercise and not
increase rest periods. The patient should
B)
C)
D)
Ans:
Stop smoking.
Increase rest periods.
Drink whole milk.
B
Feedback:
Therapeutic lifestyle changes to lower serum
cholesterol, including exercise, smoking
cessation, change in diet, and drug therapy,
are recommended to lower serum cholesterol.
The patient with an elevated serum
cholesterol should increase exercise and not
increase rest periods. The patient should
consume low-fat dairy products and avoid
whole milk. Organic foods are not specifically
recommended.
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A patient with a diagnosis of cardiovascular
disease is taking atorvastatin calcium (Lipitor)
3. to reduce serum cholesterol. What is the goal
of therapy for LDL cholesterol for a patient
taking atorvastatin calcium (Lipitor)?
100 to 115 mg/dL
75 to 85 mg/dL
Less than 60 mg/dL
Less than 100 mg/dL
D
Feedback:
In patients with a diagnosis of cardiovascular
disease, the goal of therapy is an LDL below
100 mg/dL.
D)
Ans:
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B)
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B)
C)
D)
Ans:
A male patient is taking atorvastatin calcium
(Lipitor) to reduce serum cholesterol. Which
4.
of the following aspects of patient teaching is
most important?
Call his physician if he develops muscle pain.
It is unacceptable to eat dietary fats.
Decrease the dose if lethargy occurs.
Eat two eggs per day to increase protein
stores.
A
Feedback:
Patients should be advised to notify their
health care provider if unexplained muscle
pain or tenderness occurs. The patient should
avoid saturated fats when taking statins but
should not entirely eliminate fats from his
diet. The patient should not decrease the dose
of statins without the physician's knowledge.
The patient should not increase the intake of
eggs due to the increase in cholesterol.
C)
Decrease the dose if lethargy occurs.
Eat two eggs per day to increase protein
stores.
A
Feedback:
Patients should be advised to notify their
health care provider if unexplained muscle
pain or tenderness occurs. The patient should
avoid saturated fats when taking statins but
should not entirely eliminate fats from his
diet. The patient should not decrease the dose
of statins without the physician's knowledge.
The patient should not increase the intake of
eggs due to the increase in cholesterol.
D)
Ans:
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A patient has begun taking cholestyramine.
5. Which of the following are noted as the most
common adverse effects?
Nausea, flatulence, and constipation
Increased appetite and blood pressure
Fatigue and mental disorientation
Hiccups, nasal congestion, and dizziness
A
Feedback:
Cholestyramine is not absorbed systemically,
so the main adverse effects are
gastrointestinal (GI) ones (abdominal fullness,
flatulence, diarrhea, and constipation).
Constipation is especially common, and a
bowel program may be necessary to control
this problem.
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A)
B)
C)
D)
Ans:
A)
B)
C)
D)
Ans:
A patient who has been taking a statin has
seen an improvement in his cholesterol
laboratory values; however, the low-density
6.
lipoprotein remains elevated. What
medication will be added to the medication
regimen?
Digoxin (Lanoxin)
Vitamin D
Cholestyramine (Questran)
Calcium carbonate
C
Feedback:
Cholestyramine is administered to patients to
reduce LDL cholesterol in patients who are
already taking a statin drug. Digoxin is not
given to lower LDL cholesterol. Vitamin D is
not given to lower LDL cholesterol. Calcium
carbonate is not given to lower LDL
cholesterol.
B)
C)
D)
Ans:
Vitamin D
Cholestyramine (Questran)
Calcium carbonate
C
Feedback:
Cholestyramine is administered to patients to
reduce LDL cholesterol in patients who are
already taking a statin drug. Digoxin is not
given to lower LDL cholesterol. Vitamin D is
not given to lower LDL cholesterol. Calcium
carbonate is not given to lower LDL
cholesterol.
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A patient is taking cholestyramine (Questran)
to reduce LDL cholesterol. Cholestyramine
7.
will cause a decrease in absorption of which
of the following medications?
Digoxin (Lanoxin)
Ibuprofen (Motrin)
Aspirin
Acetaminophen (Tylenol)
A
Feedback:
Bile acid sequestrants may decrease
absorption of digoxin (Lanoxin).
Cholestyramine will not decrease the
ibuprofen, aspirin, or acetaminophen.
C)
D)
Ans:
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B)
C)
D)
Ans:
A patient is prescribed fenofibrate (TriCor).
When providing patient teaching, which of
8.
the following accurately describes the action
of fenofibrate?
It binds to bile acids in the intestinal lumen.
It increases oxidation of fatty acids in the
liver.
It inhibits an enzyme required for hepatic
synthesis.
It inhibits mobilization of free fatty acids
from peripheral tissues.
B
Feedback:
Fibrates increase oxidation of fatty acids in
the liver. Bile acid sequestrants bind to bile
acids in the intestinal lumen. HMG-CoA
reductase inhibitors inhibit an enzyme
required for hepatic synthesis. Niacin inhibits
mobilization of free fatty acids from
peripheral tissues.
Which single drug class is known to be most
9. effective in reducing the major types of
dyslipidemia?
Statins
Bile acid sequestrants
Fibrates
Niacin
A
Feedback:
For single-drug therapy, a statin is preferred
for the treatment of dyslipidemia. To lower
cholesterol and triglycerides, a statin, a
cholesterol absorption inhibitor, gemfibrozil, a
fibrate, or the vitamin niacin may be used. To
lower triglycerides, gemfibrozil, ezetimibe, a
cholesterol absorption inhibitor, or niacin may
be given.
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A)
B)
C)
D)
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B)
C)
A patient is taking cholestyramine (Questran)
and ezetimibe (Zetia). What administration
10.
guideline is most important to teach this
patient?
The two medications should be taken
together.
The ezetimibe inhibits cholesterol in the liver.
The cholestyramine (Questran) is
administered 1 hour after ezetimibe.
The administration of ezetimibe (Zetia) is 2
hours before cholestyramine.
D
Feedback:
Ezetimibe (Zetia) should be taken 2 hours
before or 4 hours after a bile acid sequestrant.
The two medications should not be taken
together. Ezetimibe acts in the small intestine
to inhibit absorption of cholesterol and
decrease the delivery of intestinal cholesterol
in the liver. They do not inhibit the absorption
of cholesterol. Cholestyramine should not be
administered 1 hour after ezetimibe.
A patient has been reading about the use of
flax seed to lower cholesterol. What should
11.
the patient be taught about the use of flax seed
and cholestyramine (Questran)?
Cholestyramine absorption will be increased
with flax seed.
Cholestyramine absorption will be decreased
with flax seed.
Bleeding will be increased with flax seed and
cholestyramine.
Hypoglycemia will result from flax seed and
cholestyramine.
B
Feedback:
Absorption of cholestyramine is decreased
with flax seed. Bleeding is not increased with
flax seed and cholestyramine. Hypoglycemia
will not result from flax seed and
cholestyramine.
A)
B)
C)
D)
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Which herbal and dietary supplement has
12. shown proven success in lowering LDL and
total cholesterol in research studies?
Soy
Ginkgo biloba
Green tea
Garlic
A
Feedback:
Soy is used as a food source and has been
researched extensively to lower cholesterol.
Ginkgo biloba, green tea, and garlic do not
have extensive scientific research to support
the lowering of cholesterol.
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A)
B)
C)
D)
Ans:
A)
B)
C)
D)
Ans:
A patient is scheduled to have her serum
triglyceride level assessed. How long should
13.
the patient be without food or fluids prior to
the serum triglyceride test?
6 hours
8 to 10 hours
12 hours
24 hours
C
Feedback:
For accurate interpretation of a patient's lipid
profile, blood samples for laboratory testing
of triglycerides should be drawn after the
patient has fasted for 12 hours.
6 hours
8 to 10 hours
12 hours
24 hours
C
Feedback:
For accurate interpretation of a patient's lipid
profile, blood samples for laboratory testing
of triglycerides should be drawn after the
patient has fasted for 12 hours.
Mr. Burris is a 66-year-old man who leads a
sedentary lifestyle and who has recently been
diagnosed with dyslipidemia. Mr. Burris is
disappointed to learn of this apparent
deterioration in his health, stating, “First it
was the diabetes and then the arthritis, now
14.
this.” The nurse has performed health
education with Mr. Burris and has described
metabolic syndrome. In addition to his
elevated cholesterol levels, what aspect of Mr.
Burris' health is congruent with a diagnosis of
metabolic syndrome?
Sedentary lifestyle
Age over 65 coupled with male gender
Arthritis
Diabetes mellitus
D
Feedback:
Diagnostic criteria for metabolic syndrome
include a cluster of several cardiovascular risk
factors linked with obesity: increased waist
circumference, elevated triglycerides, reduced
high-density lipoprotein cholesterol, elevated
blood pressure, and elevated fasting glucose.
Age, gender, and joint disorders are not
among these criteria.
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A)
B)
C)
D)
Ans:
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A)
B)
C)
D)
Ans:
A)
B)
C)
D)
E)
Ans:
A male patient has been diagnosed with
moderately increased LDL, and his primary
care provider wishes to begin him on a statin.
15.
What is a potential disadvantage of statins
that the care provider should consider? Select
all that apply.
Statins are nephrotoxic.
Statins are expensive.
Statins are contraindicated in patients with a
history of myocardial infarction.
Statins require regularly scheduled blood
work.
Statins have an immunosuppressive effect.
B, D
Feedback:
Because liver enzymes may be elevated
all that apply.
Statins are nephrotoxic.
Statins are expensive.
Statins are contraindicated in patients with a
history of myocardial infarction.
Statins require regularly scheduled blood
work.
Statins have an immunosuppressive effect.
B, D
Feedback:
Because liver enzymes may be elevated
during atorvastatin use, patients need liver
function tests and repeat lipid profile testing
on a routine basis. These drugs are also
expensive. They are not nephrotoxic and do
not suppress the immune system. Previous MI
is an indication for their use, not a
contraindication.
A)
B)
C)
D)
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A patient will begin taking atorvastatin
(Lipitor), and the nurse is conducting relevant
16.
health education. The nurse should emphasize
the need to report any new onset of
muscle pain.
dry mouth.
pruritus (itching).
increased thirst.
A
Feedback:
Myopathy is an important adverse effect of
statins. Statins can injure muscle tissue,
resulting in muscle ache or weakness; this
should be reported promptly. Dry mouth,
pruritus, and thirst are not reported adverse
effects of statins.
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A 74-year-old male patient is being treated in
the hospital for a stroke and is undergoing an
extended stay on a rehabilitation unit. The
patient's wife has been participating actively
in his care and performs much of his feeding
17. and hygiene. This evening, the patient's wife
has brought in a number of healthy snacks to
keep at his bedside. Knowing that the patient's
medication regimen includes simvastatin, the
nurse would remove which of the following
items?
Purple grapes
Cranberry cocktail
Grapefruit juice
Trail mix (salted nuts and seeds)
C
Feedback:
It is important to avoid taking simvastatin
medication regimen includes simvastatin, the
nurse would remove which of the following
items?
Purple grapes
Cranberry cocktail
Grapefruit juice
Trail mix (salted nuts and seeds)
C
Feedback:
It is important to avoid taking simvastatin
with grapefruit juice. None of the other listed
foods is contraindicated.
A patient has been largely unsuccessful in
achieving adequate control of dyslipidemia
through lifestyle changes and the use of a
statin. As a result, the patient has been
18.
prescribed cholestyramine (Prevalite,
Questran). What change in this patient's lipid
profile will the nurse identify as the most
likely goal of therapy?
Reduction in triglycerides
Reduction in total serum cholesterol levels
Increase in HDL levels
Reduction in LDL cholesterol levels
D
Feedback:
Cholestyramine (Prevalite, Questran), the
prototype bile acid sequestrant, has the ability
to reduce LDL cholesterol. It has little or no
effect on HDL cholesterol and either no effect
or an increased effect on triglyceride levels.
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A 66-year-old woman's most recent physical
assessment and diagnostic workup reveal the
presence of dyslipidemia. The woman is a
19. candidate for monotherapy with a statin, and
she will soon begin treatment with
atorvastatin (Lipitor). The nurse should
anticipate what order?
“Lipitor 150 mg PO BID”
“Lipitor 10 mg PO OD”
“Lipitor 50 mg PO TID with meals”
“Lipitor 75 mg PO BID”
B
Feedback:
Lipitor is normally administered PO 10 to 80
mg daily in a single dose.
An elderly patient with dyslipidemia has had
fenofibrate (TriCor) added to her existing
medication regimen. In addition to having her
20. lipid profile drawn on a regular basis, the
nurse should educate the patient about the
need for what ongoing laboratory testing
during therapy?
Complete blood count (CBC)
Liver panel
INR and aPTT
Reticulocyte count
B
Feedback:
Because of the risk for hepatotoxicity, patients
taking fenofibrate (TriCor) require serial
testing of liver enzyme levels. There is no
specific need for follow-up with CBCs,
coagulation tests, or reticulocyte counts.
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Chapter 11 Drug Therapy for Hematopoietic Disorders
A patient has a low erythrocyte count. How
1. may a colony-stimulating factor affect the
patient's erythrocyte count?
It stimulates growth of red blood cells.
It suppresses T-cell production.
It inhibits protein synthesis.
It stimulates antibody production.
A
Feedback:
Colony-stimulating factors stimulate the
production of red blood cells, platelets,
granulocytes, granulocyte–macrophages, and
monocyte–macrophages. Colony-stimulating
factors will not suppress the T-cell production,
inhibit protein production, or stimulate
antibody production.
A patient is exposed to a viral infection. What
2. role will interferon most likely play during
this exposure?
It will stimulate B-lymphocyte activity.
It will interfere with stem cell multiplication.
It will stimulate growth of lymphoid cells.
It will interfere with virus replication.
D
A patient is exposed to a viral infection. What
2. role will interferon most likely play during
this exposure?
It will stimulate B-lymphocyte activity.
It will interfere with stem cell multiplication.
It will stimulate growth of lymphoid cells.
It will interfere with virus replication.
D
Feedback:
Interferons interfere with the ability of viruses
in infected cells to replicate and spread to
uninfected cells. Interferons will not stimulate
B-lymphocyte activity, stem cell
multiplication, or growth of lymphoid cells.
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A patient has developed a decubitus ulcer on
3. the coccyx. What defense mechanism is most
affected by this homeostatic change?
The mucous membrane is affected.
The respiratory tract is affected.
The skin is affected.
The gastrointestinal tract is affected.
C
Feedback:
The body's primary external defense
mechanism is intact skin. The development of
a decubitus ulcer allows for entry of microbial
growth. The mucous membranes, respiratory
tract, and gastrointestinal tract are not affected
primarily.
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A patient is being administered
chemotherapeutic agents for the treatment of
cancer. Which of the following blood cells
4.
will be stimulated by the colony-stimulating
factors in response to the effects of the
chemotherapy?
White blood cells
Red blood cells
Phagocytes
Myocardial cells
B
Feedback:
Chemotherapeutic agents have the potential to
decrease red blood cells and will result in the
colony-stimulating factors stimulating the
production of red blood cells. The colonystimulating factors do not affect the white
blood cell production, phagocytes, or cardiac
cells.
B)
C)
D)
Ans:
Red blood cells
Phagocytes
Myocardial cells
B
Feedback:
Chemotherapeutic agents have the potential to
decrease red blood cells and will result in the
colony-stimulating factors stimulating the
production of red blood cells. The colonystimulating factors do not affect the white
blood cell production, phagocytes, or cardiac
cells.
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A patient with chronic renal failure is
5. prescribed filgrastim (Neupogen). What is the
major effect of filgrastim (Neupogen)?
Decreases neutropenia related to
chemotherapy
Decreases white blood cells related to
infection
Decreases growth of blood vessels due to
ischemia
Decreases platelet count related to bleeding
A
Feedback:
Filgrastim (Neupogen) is used to stimulate
blood cell production by the bone marrow in
places with bone marrow transplantation or
chemotherapy-induced neutropenia.
Filgrastim does not decrease white blood cells
in response to infection. Filgrastim increases
growth of blood vessels related to ischemic
heart disease. Filgrastim does not decrease
platelet count related to bleeding.
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A patient has been diagnosed with chronic
renal failure. Which of the following agents
6.
will assist in raising the patient's hemoglobin
levels?
Epoetin alfa (Epogen, Procrit)
Pentoxifylline (Pentoxil)
Estazolam (ProSom)
Dextromethorphan hydrobromide
A
Feedback:
Uses of epoetin include the prevention and
treatment of anemia associated with chronic
renal failure, hepatic impairment, or
anticancer chemotherapy. Pentoxifylline is
used for intermittent claudication to maintain
the flexibility of red blood cells. Estazolam is
a benzodiazepine agent used short term for
insomnia. Dextromethorphan hydrobromide is
used to relieve cough.
Pentoxifylline (Pentoxil)
Estazolam (ProSom)
Dextromethorphan hydrobromide
A
Feedback:
Uses of epoetin include the prevention and
treatment of anemia associated with chronic
renal failure, hepatic impairment, or
anticancer chemotherapy. Pentoxifylline is
used for intermittent claudication to maintain
the flexibility of red blood cells. Estazolam is
a benzodiazepine agent used short term for
insomnia. Dextromethorphan hydrobromide is
used to relieve cough.
A patient is undergoing a bone marrow
transplant. Which of the following
7. medications is most effective in stimulating
the production of granulocytes and
macrophages?
Bacillus Calmette-Guérin (BCG)
Epoetin alfa (Epogen)
Aldesleukin (Proleukin)
Sargramostim (Leukine)
D
Feedback:
Sargramostim (Leukine) is a formulation of
granulocyte colony-stimulating factor (GCSF)
and granulocyte macrophage colonystimulating factor (GM-CSF). Bacillus
Calmette-Guérin is a vaccine used to treat
bladder cancer. Epoetin alfa stimulates bone
marrow production of red blood cells.
Aldesleukin (Proleukin) is a recombinant
DNA version of interleukin-2. It activates
cellular immunity.
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A hospital patient's complex medical history
includes a recent diagnosis of kidney cancer.
8.
Which of the following medications is used to
treat metastatic kidney cancer?
Filgrastim (Neupogen)
Aldesleukin (Proleukin)
Interferon alfa-2b (Intron A)
Darbepoetin alfa (Aranesp)
B
Feedback:
Aldesleukin (Proleukin) is used to treat
metastatic kidney cancer but is
contraindicated in patients with serious
pulmonary impairment. Filgrastim is a
colony-stimulating factor that is not used for
the treatment of kidney cancer. Darbepoetin
alfa is a hormone that stimulates the
Aldesleukin (Proleukin)
Interferon alfa-2b (Intron A)
Darbepoetin alfa (Aranesp)
B
Feedback:
Aldesleukin (Proleukin) is used to treat
metastatic kidney cancer but is
contraindicated in patients with serious
pulmonary impairment. Filgrastim is a
colony-stimulating factor that is not used for
the treatment of kidney cancer. Darbepoetin
alfa is a hormone that stimulates the
production of red blood cells by the bone
marrow. Interferon alfa-2b (Intron A) is
normally used to treat leukemia.
A patient is diagnosed with ischemic heart
disease. She is prescribed filgrastim
9. (Neupogen). What effect will this medication
provide in the treatment of ischemic heart
disease?
Increase platelets
Decrease platelets
Promote angiogenesis
Prevent thrombus formation
C
Feedback:
Experts believe that filgrastim promotes the
growth of arterioles around blocked areas in
coronary arteries. Filgrastim does not increase
or decrease platelets. Filgrastim does not
prevent thrombus formation.
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A patient with a diagnosis of renal failure is
being treated with epoetin alfa (Epogen).
10. Frequent assessment of which of the
following laboratory values should be
prioritized before and during treatment?
AST
C-reactive protein
CBC
ALT
C
Feedback:
With the use of hematopoietic and
immunostimulant drugs, a CBC with WBC
differential and platelet count should be done
before and during treatment to monitor
response and prevent avoidable adverse
reactions. It is less imperative to monitor liver
enzymes or CRP levels.
B)
C)
D)
Ans:
C-reactive protein
CBC
ALT
C
Feedback:
With the use of hematopoietic and
immunostimulant drugs, a CBC with WBC
differential and platelet count should be done
before and during treatment to monitor
response and prevent avoidable adverse
reactions. It is less imperative to monitor liver
enzymes or CRP levels.
A patient is receiving epoetin alfa (Epogen)
11. for anemia. Which of the following adjunctive
therapies is imperative with epoetin alfa?
Potassium supplements
Sodium restriction
Iron supplement
Renal dialysis
C
Feedback:
When administering darbepoetin and epoetin,
an adequate intake of iron is required for drug
effectiveness and an iron supplement is
usually necessary. It is not necessary to
provide the patient with potassium
supplements, restrict sodium, or place the
patient on renal dialysis.
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A patient is administered a granulocyte
12. colony-stimulating factor (G-CSF). What is
the expected outcome of a G-CSF?
Red blood cell count of 3000 mm3
Decreased number of infections
Decreased fatigue and increased energy
White blood cell count of 20,000 mm3
B
Feedback:
G-CSFs help to prevent infection by reducing
the incidence, severity, and duration of
neutropenia associated with several
chemotherapy regimens. The administration
of a G-CSF should not lower red blood cell
count or raise white blood cell count. They
assist in the prevention of infection but do not
necessarily resolve fatigue.
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An oncology nurse is providing for an adult
patient who is currently
immunocompromised. The nurse is aware of
13. the physiology involved in hematopoiesis and
immune function, including the salient role of
cytokines. What is the primary role of
cytokines in maintaining homeostasis?
Cytokines perform phagocytosis in response
to bacterial and protozoal infection.
Cytokines perform a regulatory role in the
development of diverse blood cells.
Cytokines can be considered to be the basic
“building blocks” of all blood cells.
Cytokines are formed in response to the
presence of antibodies.
B
Feedback:
Hematopoietic cytokines are diverse
substances produced mainly by bone marrow
and white blood cells (WBCs). They regulate
many cellular activities by acting as chemical
messengers among cells and as growth factors
for blood cells. Blood cells are not made up of
cytokines, and they do not perform
phagocytosis. The presence of antigens, not
antibodies, can prompt the expression of
certain cytokines.
D)
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A patient's current medical condition is
suggestive of impaired erythropoiesis. Which
14. of the following laboratory studies would be
most clinically relevant in diagnosing this
health problem?
White blood cell count with differential
RBC, hemoglobin, and hematocrit
INR and aPTT
d-dimer and C-reactive protein
B
Feedback:
Parameters used to measure erythropoiesis
include RBC count, hemoglobin
concentration and hematocrit, and mean
corpuscular volume. Tests related to immune
function, hemostasis, and inflammation are
not used to diagnose erythropoiesis.
RBC, hemoglobin, and hematocrit
INR and aPTT
d-dimer and C-reactive protein
B
Feedback:
Parameters used to measure erythropoiesis
include RBC count, hemoglobin
concentration and hematocrit, and mean
corpuscular volume. Tests related to immune
function, hemostasis, and inflammation are
not used to diagnose erythropoiesis.
An adult patient has developed renal failure
secondary to an overdose of a nephrotoxic
15. drug. Which of the following assessment
findings would the nurse recognize as being
most suggestive of impaired erythropoiesis?
Frequent infections and low neutrophil levels
Fatigue and increased heart rate
Agitation and changes in cognition
Increased blood pressure and peripheral
edema
B
Feedback:
As RBCs decrease, conditions related to
inadequate hematopoiesis develop. Clinical
manifestations of inadequate erythropoiesis
include anemia. This results in a decrease in
the oxygen-carrying capacity of blood and
consequently a decreased oxygen availability
to the tissues. A compensatory increase in
heart rate and cardiac output initially
increases cardiac output, offsetting the lower
oxygen-carrying capacity of the blood.
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A patient with a diagnosis of chronic renal
failure will soon begin a regimen of epoetin
that will administered by the patient at home.
16.
Which of the following statements indicates
that the nurse's initial health education has
been successful?
“I'll make sure to take my Epogen pill on a
strict schedule and make sure I never miss a
dose.”
“I'm glad that Epogen can help to protect me
from getting an infection.”
“I'm excited that there's a medication that can
help my kidneys work better.”
“I'm not all that comfortable with giving
myself an injection, but I'm sure I'll be able to
learn.”
D
Feedback:
Epogen is administered parenterally, not
dose.”
“I'm glad that Epogen can help to protect me
from getting an infection.”
“I'm excited that there's a medication that can
help my kidneys work better.”
“I'm not all that comfortable with giving
myself an injection, but I'm sure I'll be able to
learn.”
D
Feedback:
Epogen is administered parenterally, not
orally. It acts by stimulating erythroid
progenitor cells to produce RBCs but does not
enhance overall renal function. Epogen does
not enhance immune function.
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Which of the following patients would likely
17. be the most appropriate candidate for
treatment with filgrastim (Neupogen)?
A patient who has undergone a mastectomy
for the treatment of breast cancer
A patient with acquired immune deficiency
syndrome (AIDS) who has been diagnosed
with Kaposi's sarcoma
A patient who developed acute renal failure
secondary to rhabdomyolysis
A patient whose acute myelogenous leukemia
necessitated a bone marrow transplant
D
Feedback:
Indications for filgrastim include preventing
infection in patients with neutropenia induced
by cancer chemotherapy or bone marrow
transplantation. Surgical patients, patients
with AIDS, and patients with renal failure are
not typically treated with G-CSFs.
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A 69-year-old female patient has been
diagnosed with malignant melanoma. The
care team has collaborated with the patient
and her family and agreed on a plan of care
18. that includes administration of interferon
alfa-2b. After administering interferon
alfa-2b, the oncology nurse should anticipate
that the patient may develop which of the
following adverse effects?
Profound diaphoresis
Decreased level of consciousness
Flu-like symptoms
Cyanosis and pallor
C
Feedback:
In the majority of patients, flu-like symptoms
(e.g., fever, chills, fatigue, muscle aches,
that the patient may develop which of the
following adverse effects?
Profound diaphoresis
Decreased level of consciousness
Flu-like symptoms
Cyanosis and pallor
C
Feedback:
In the majority of patients, flu-like symptoms
(e.g., fever, chills, fatigue, muscle aches,
headache, tachycardia) develop within 2
hours of administration of interferon alfa-2b
and last up to 24 hours. Diaphoresis, changes
in LOC, and changes in oxygenation are not
associated with the use of interferon alfa-2b.
Which of the following nursing diagnoses
would provide the most plausible indication
19.
for the use of epoetin alfa (Epogen) in a
patient with renal failure?
Risk for infection related to decreased
erythropoiesis
Activity intolerance related to decreased
oxygen-carrying capacity
Powerlessness-related sequelae of renal
failure
Ineffective breathing pattern related to
inadequate erythropoietin synthesis
B
Feedback:
The impaired erythropoiesis that accompanies
renal failure results in fatigue and decreased
stamina, symptoms that can be addressed with
the administration of epoetin alfa. Decreased
erythropoiesis does not constitute a risk for
infection, and the patient may or may not
experience feelings of powerlessness.
Inadequate erythropoietin synthesis causes
impaired oxygenation, but this does not
normally manifest as breathing problems.
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A patient who is undergoing chemotherapy
for the treatment of non-Hodgkin's lymphoma
will soon begin treatment with epoetin alfa
20.
(Epogen). The nurse should be aware that this
drug may be administered by which of the
following routes? Select all that apply.
Subcutaneous
Intramuscular
Oral
Buccal
Intravenous
A, E
Feedback:
20.
A)
B)
C)
D)
E)
Ans:
(Epogen). The nurse should be aware that this
drug may be administered by which of the
following routes? Select all that apply.
Subcutaneous
Intramuscular
Oral
Buccal
Intravenous
A, E
Feedback:
Epogen is administered by either IV or sub-Q
routes.
Chapter 12 Drug Therapy: Immunizations
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An infant is being administered an
immunization. Which of the following
1.
provides an accurate description of an
immunization?
It should be administered to a pregnant
woman prior to the infant's birth.
It is the administration of an antigen for an
antibody response.
It produces many adverse reactions,
particularly autism, in the infant.
It protects the infant from exposure to
infectious antibodies.
B
Feedback:
Immunization involves administration of an
antigen to induce antibody formation. Live,
attenuated vaccines should not be
administered to the pregnant woman. There
are limited adverse effects associated with
immunization. The immunization protects the
infant from infectious antigens, producing an
antibody response. It does not protect from
antibodies.
A patient is scheduled to receive an
immunization. In which of the following
2.
patients may the administration of a live
vaccine be contraindicated?
Patient with renal insufficiency
Patient with hepatic failure
Patient taking steroid therapy
Patient over the age of 65 years
C
Feedback:
Patients receiving a systemic corticosteroid in
high doses (e.g., prednisone 20 mg or
equivalent daily) or for longer than 2 weeks
should wait at least 3 months before receiving
Patient with renal insufficiency
Patient with hepatic failure
Patient taking steroid therapy
Patient over the age of 65 years
C
Feedback:
Patients receiving a systemic corticosteroid in
high doses (e.g., prednisone 20 mg or
equivalent daily) or for longer than 2 weeks
should wait at least 3 months before receiving
a live-virus vaccine. No evidence supports
withholding immunizations related to renal
insufficiency or hepatic failure. Patients over
the age of 65 should receive immunizations as
needed to protect from infectious disease.
A patient is to be administered an
immunization. The serum contains aluminum
3.
phosphate. What route is most appropriate to
administer this immunization?
Intramuscularly
Subcutaneously
Intravenously
Orally
A
Feedback:
Products containing aluminum should be
given intramuscularly only because they
cannot be given intravenously and greater
tissue irritation occurs with subcutaneous
injections. Immunizations containing
aluminum are not administered orally.
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A patient has received a rubella
immunization. The patient was unaware that
4. she was pregnant. What risk is associated
with the administration of the rubella
immunization in this patient?
Risk of development of the disease in the
newborn
Risk of low infant birth weight
Risk of preterm labor
Risk of birth defects
D
Feedback:
Rubella during the first trimester of pregnancy
is associated with a high incidence of birth
defects in the newborn. Rubella is not
associated with the development of disease.
Rubella is not associated with low birth
weight or preterm labor.
B)
C)
D)
Ans:
Risk of low infant birth weight
Risk of preterm labor
Risk of birth defects
D
Feedback:
Rubella during the first trimester of pregnancy
is associated with a high incidence of birth
defects in the newborn. Rubella is not
associated with the development of disease.
Rubella is not associated with low birth
weight or preterm labor.
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The college health nurse is providing health
education for freshmen. Which of the
5. following pieces of information about
immunizations is applicable to individuals of
this age group?
The oral polio should be updated.
The yearly administration of flu vaccine is
recommended.
The tetanus toxoid must be within 2 years.
The administration of hepatitis A vaccine is
mandatory.
B
Feedback:
An annual flu vaccine is recommended for all
adults. The administration of oral polio will
not need to be updated in this population. The
administration of tetanus toxoid should be
every 10 years. HAV vaccination is not
mandatory.
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B)
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A nursing student is scheduled to receive the
6. hepatitis B series. What type of immunity will
this immunization provide?
Active immunity
Passive immunity
Innate immunity
Natural immunity
B
Feedback:
The hepatitis B series produces passive
immunity. Passive immunity occurs when
antibodies are formed by the immune system
of another person or animal and transferred to
the host. Active immunity is produced by the
person's own immune system in response to a
disease caused by a specific antigen or
administration of an antigen from a source
outside the body, usually by injection. Innate
or natural immunity, which is not produced by
the immune system, includes the general
protective mechanisms.
Passive immunity
Innate immunity
Natural immunity
B
Feedback:
The hepatitis B series produces passive
immunity. Passive immunity occurs when
antibodies are formed by the immune system
of another person or animal and transferred to
the host. Active immunity is produced by the
person's own immune system in response to a
disease caused by a specific antigen or
administration of an antigen from a source
outside the body, usually by injection. Innate
or natural immunity, which is not produced by
the immune system, includes the general
protective mechanisms.
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It is important for the nurse to stay informed
of the most current recommendations for
7. immunizations. Which of the following
sources is most accurate regarding
immunization guidelines?
American Academy of Pediatrics
American Academy of Family Physicians
American Academy of Infectious Disease
Physicians
Centers for Disease Control and Prevention
D
Feedback:
The best source of information for current
recommendations is the Centers for Disease
Control and Prevention. The American
Academy of Pediatrics, American Academy
of Family Physicians, and American Academy
of Infectious Disease Physicians are all
sources of immunization information, but
their information is based on the CDC's
information.
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An infant is seen in the clinic for her first
immunizations. When providing patient
8.
teaching to the parent, which of the following
is no longer recommended for administration?
Rubella and mumps vaccine
Polio vaccine
Diphtheria, pertussis, and tetanus vaccine
Smallpox vaccine
D
Feedback:
Smallpox has been largely eradicated and is
no longer administered to children. By 4 to 6
years of age, children should have received
vaccinations for chickenpox, diphtheria,
Rubella and mumps vaccine
Polio vaccine
Diphtheria, pertussis, and tetanus vaccine
Smallpox vaccine
D
Feedback:
Smallpox has been largely eradicated and is
no longer administered to children. By 4 to 6
years of age, children should have received
vaccinations for chickenpox, diphtheria,
hepatitis A and B, influenza, measles, mumps,
pertussis, polio, pneumococcal diseases,
rubella, tetanus, and Haemophilus influenzae
and rotavirus infections.
The nurse is preparing to administer a vaccine
9. to a newborn. Before administering the
vaccine, the nurse should
warm the vaccine to well above room
temperature.
vigorously massage the chosen injection site.
check the infant's temperature.
divide the dose for administration to three
injection sites.
C
Feedback:
The nurse should check the infant's
temperature before administering any vaccine.
Three injection sites are not normally
required, and vigorous massage is not
indicated. Warming the vaccine is not
normally necessary.
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B)
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A nurse is administering a mumps vaccine to
an adolescent. Which of the following
10.
medications should be available when
administering an immunization?
Diphenhydramine (Benadryl)
Hydroxyzine (Vistaril)
Physostigmine
Epinephrine
D
Feedback:
The administration of vaccines for
immunization possesses the risk of an allergic
reaction and anaphylaxis. The nurse should
have aqueous epinephrine available in the
event of an anaphylactic reaction. The
administration of diphenhydramine or
hydroxyzine will reduce the allergic reaction
but will not be effective in the event of
anaphylaxis. Physostigmine is not
administered.
Hydroxyzine (Vistaril)
Physostigmine
Epinephrine
D
Feedback:
The administration of vaccines for
immunization possesses the risk of an allergic
reaction and anaphylaxis. The nurse should
have aqueous epinephrine available in the
event of an anaphylactic reaction. The
administration of diphenhydramine or
hydroxyzine will reduce the allergic reaction
but will not be effective in the event of
anaphylaxis. Physostigmine is not
administered.
A public health nurse is responsible for the
administration of numerous immunizations.
11.
Which of the following guidelines regarding
anaphylaxis should the nurse adhere to?
The patient should be observed for
anaphylaxis for 1 minute after administration.
The patient should be observed for
anaphylaxis for 5 minutes after
administration.
The patient should be observed for
anaphylaxis for 30 minutes after
administration.
The patient should be observed for
anaphylaxis for 90 minutes after
administration.
C
Feedback:
The nurse should observe for allergic
reactions, which usually occur within 30
minutes. The patient should be observed
longer than 1 or 5 minutes, and it is not
necessary to observe for longer than 30
minutes.
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When instructing the parents of a child who
has received immunization in the vastus
12.
lateralis, which reaction is most common in
the days after the administration?
Nausea, vomiting, and diarrhea
Rash and edema
Weakness and difficulty walking
Tenderness and redness at the site
D
Feedback:
Pain, tenderness, and redness at the injection
site are associated with the administration of
immunizations. Nausea, vomiting, diarrhea,
rash, edema, weakness, or difficulty walking
A)
B)
C)
D)
Ans:
Nausea, vomiting, and diarrhea
Rash and edema
Weakness and difficulty walking
Tenderness and redness at the site
D
Feedback:
Pain, tenderness, and redness at the injection
site are associated with the administration of
immunizations. Nausea, vomiting, diarrhea,
rash, edema, weakness, or difficulty walking
are not general reactions to immunizations.
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A 1-year-old child will receive her scheduled
MMR vaccination shortly. The nurse should
13. teach the child's parents that she may develop
what possible adverse effect related to the
administration of this medication?
Cough and fever
Pallor and listlessness
Serum sickness
Nausea and vomiting
A
Feedback:
Adverse effects associated with MMR
vaccine include fever and cough. Nausea and
vomiting, pallor and listlessness, and serum
sickness are not among the noted adverse
effects of the MMR vaccine.
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B)
C)
D)
Ans:
A 70-year-old patient is seen in the family
practice clinic. Which of the following
14.
vaccines should be administered to prevent
shingles?
Zoster vaccine
Haemophilus influenzae Type b (Hib) vaccine
Human papillomavirus (HPV)
Pneumococcal polyvalent
A
Feedback:
Zoster vaccine is administered to adults 60
years and older to prevent herpes zoster
(shingles). The Haemophilus influenzae Type
b is not administered to prevent herpes zoster.
HPV and pneumococcal vaccine do not
address the risk factors for shingles.
A)
B)
C)
D)
Ans:
A patient is seen in the emergency room for a
laceration sustained on broken glass. The
16. nurse assesses the patient for the last tetanus
toxoid he received. How often should the
patient be administered a tetanus toxoid?
Every year
Every 10 years
Every 2 years
Every 5 years
B
Feedback:
The patient should receive a tetanus toxoid
every 10 years according to the CDC. It is not
necessary to receive tetanus toxoid yearly,
every 2 years, or every 5 years.
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B)
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Ans:
When providing patient teaching to parents
regarding measles, mumps, and rubella
15. vaccine administration, which of the
following is most important regarding the
schedule for administration?
It is administered at 1 to 2 months.
It is administered at 3 to 4 months.
It is administered at 5 to 6 months.
It is administered at 12 to 15 months.
D
Feedback:
Measles, mumps, and rubella immunization is
administered initially at 12 to 15 months of
age. The vaccine is not administered under
the age of 1 year.
A)
B)
C)
D)
Ans:
When providing a health promotion
presentation to a group of seniors, how often
17.
should you instruct the senior group to obtain
influenza vaccines?
One time only
Every 10 years
Two times per year
Yearly
D
Feedback:
The influenza vaccine should be administered
yearly. It is not administered as a single dose,
every 10 years, or two times per year.
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A)
A primiparous woman tells the nurse that she
and her partner are highly reluctant to have
their infant vaccinated, stating, “We've read
18. that vaccines can potentially cause a lot of
harm, so we're not sure we want to take that
risk.” How should the nurse respond to this
family's concerns?
“Vaccinations are not without some risks, but
these are far exceeded by the potential
benefits.”
“The potential risks of vaccinations have been
investigated and determined to be
nonexistent.”
“Unfortunately, state laws mandate that your
child receive the full schedule of vaccines.”
“Vaccines indeed cause several serious
adverse effects, but these are usually treated
at the site where your child receives the
vaccination.”
A
Feedback:
Mild reactions to vaccinations are common,
but serious reactions are rare. Consequently,
the benefits of vaccinations exceed the risks.
Parental choice is still respected in most
instances.
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A health care worker has received her annual
influenza vaccination and has remained at the
clinic after administration so that the nurse
19. may observe for adverse reactions. The
worker complains of pain at the site of IM
injection. The nurse should recommend which
of the following?
ASA
Acetaminophen
Meperidine (Demerol)
Heat application
B
Feedback:
Most vaccines can cause fever and soreness at
the site of injection. Acetaminophen (e.g.,
Tylenol) can be taken two to three times daily
for 24 to 48 hours if needed to decrease fever
and discomfort. Aspirin and heat are not
explicitly recommended; opioids are not
necessary.
B)
C)
D)
Ans:
Acetaminophen
Meperidine (Demerol)
Heat application
B
Feedback:
Most vaccines can cause fever and soreness at
the site of injection. Acetaminophen (e.g.,
Tylenol) can be taken two to three times daily
for 24 to 48 hours if needed to decrease fever
and discomfort. Aspirin and heat are not
explicitly recommended; opioids are not
necessary.
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When teaching new parents about the benefits
of adhering to the recommended vaccination
20. schedule, the nurse should cite protection
against which of the following diseases?
Select all that apply.
HIV
Measles
Varicella
Poliomyelitis
Hepatitis B
B, C, D, E
Feedback:
Measles, varicella, polio, and HBV are all
within the schedule of infant vaccinations.
There is currently no vaccine against HIV.
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Chapter 13 Drug Therapy to Decrease Immunity
Which of the following is the most likely
1. indication for the use of immunosuppressant
agents?
Intractable seizure disorders
Increased intracranial pressure
Organ transplantation
HIV/AIDS with multiple drug resistance
C
Feedback:
Immunosuppressant agents are used for
inflammatory autoimmune disorders or to
prevent or treat tissue rejection reactions in
organ transplantation. Immunosuppressant
agents are not administered for seizure
disorders, increased intracranial pressure, or
HIV/AIDS.
A patient has received a bone marrow
transplant. What will occur if the patient
2.
receives inadequate immunosuppression after
the transplant?
Graft-versus-host disease
Hepatotoxicity
Acute kidney injury
Sepsis
A
Feedback:
The goal after bone marrow transplantation is
to provide adequate immunosuppression. If
immunosuppression is inadequate, graftversus-host disease will occur with bone
marrow transplantation. The patient will not
suffer from hepatic or renal failure.
Inadequate immunosuppression will not place
the patient at risk for serious infection.
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A patient with Crohn's disease is given a
corticosteroid to decrease inflammation.
3.
Which of the following effects will occur with
the use of corticosteroids?
Increased joint pain
Increased C-reactive protein levels
Increased T-cell counts
Decreased antibody production
D
Feedback:
The administration of corticosteroids will
decrease T-cell and antibody production.
Corticosteroids do not cause joint pain or
increase a patient's C-reactive protein levels.
A patient is to begin treatment for rheumatoid
arthritis with infliximab (Remicade). What
4.
potential risk should the nurse identify as
being associated with this drug?
Risk for infection
Risk for decreased level of consciousness
Risk for nephrotoxicity
Risk for hepatotoxicity
A
Feedback:
All TNF-alpha blockers carry a risk for
infection. This risk supersedes the risks of
kidney or liver damage. Changes in LOC are
being associated with this drug?
Risk for infection
Risk for decreased level of consciousness
Risk for nephrotoxicity
Risk for hepatotoxicity
A
Feedback:
All TNF-alpha blockers carry a risk for
infection. This risk supersedes the risks of
kidney or liver damage. Changes in LOC are
not typically noted.
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A patient is administered mycophenolate
(CellCept) to prevent rejection of his
transplanted heart. It is recommended that he
5.
have a CBC drawn weekly. He asks the nurse
the reason for the weekly CBC. Which of the
following is the nurse's best response?
“The weekly CBC is routine and ordered for
all patients.”
“The weekly CBC assesses for the
development of bleeding.”
“The weekly CBC assesses for the
development of infection.”
“The weekly CBC assesses for changes in
your blood’s oxygen carrying capacity.”
C
Feedback:
The weekly CBC is to assess for infection,
neutropenia, and thrombocytopenia. Stating to
the patient that the CBC is routine is a
belittling response that does not provide
patient education. The weekly CBC is not
indicated to assess for bleeding or a decrease
in erythrocytes.
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B)
C)
D)
Ans:
A patient is administered cyclosporine
(Sandimmune, Neoral) to prevent rejection of
6.
a kidney transplant. Which of the following is
a major adverse effect of cyclosporine?
Congestive heart failure
Nephrotoxicity
Anaphylaxis
Respiratory arrest
B
Feedback:
The major adverse effect of cyclosporine is
nephrotoxicity. Congestive heart failure is not
noted as an adverse effect of cyclosporine.
Anaphylaxis and respiratory arrest are not
common adverse effects of cyclosporine.
B)
C)
D)
Ans:
Nephrotoxicity
Anaphylaxis
Respiratory arrest
B
Feedback:
The major adverse effect of cyclosporine is
nephrotoxicity. Congestive heart failure is not
noted as an adverse effect of cyclosporine.
Anaphylaxis and respiratory arrest are not
common adverse effects of cyclosporine.
A patient is receiving immunosuppressant
therapy and is preparing for discharge. For
7.
which of the following should the patient be
educated?
The importance of a high-protein diet
The need to maximize fluid intake
The need for regular physical activity
The importance of keeping the home clean
D
Feedback:
Meticulous environmental cleansing and
personal and hand hygiene will protect from
the development of serious infection. The
importance of this infection control measure
is greater than that of dietary or exercise
guidelines.
D)
Ans:
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B)
C)
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B)
C)
D)
Ans:
A patient has been discharged from the
hospital after a kidney transplant. Which of
8. the following nursing interventions is the first
line of defense against the immunosuppressed
patient developing an infection?
Ensure visitors do not come to the home.
Teach the patient to wear a mask consistently.
Administer prophylactic antibiotics.
Teach the patient the importance of personal
hygiene.
D
Feedback:
With patients who are taking
immunosuppressant drugs, a major role of the
home care nurse is to assess the environment
for potential sources of infection, assist
patients and other members of the household
to understand the patient's susceptibility to
infection, and teach ways to decrease risks of
infection. Meticulous environmental
cleansing as well as personal and hand
hygiene are required. Visitors do not
necessarily need to be wholly barred from the
home, and a mask is not always required.
Prophylactic antibiotics are not normally
used.
C)
Administer prophylactic antibiotics.
Teach the patient the importance of personal
hygiene.
D
Feedback:
With patients who are taking
immunosuppressant drugs, a major role of the
home care nurse is to assess the environment
for potential sources of infection, assist
patients and other members of the household
to understand the patient's susceptibility to
infection, and teach ways to decrease risks of
infection. Meticulous environmental
cleansing as well as personal and hand
hygiene are required. Visitors do not
necessarily need to be wholly barred from the
home, and a mask is not always required.
Prophylactic antibiotics are not normally
used.
D)
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A patient has been placed on tacrolimus, and
the route will be changed from IV to oral
9. prior to discharge home from the hospital.
How will this change in administration route
affect the patient's plan of care?
The patient's dose of tacrolimus will have to
be increased.
The patient will receive the drug QID rather
than BID
The patient will have to be monitored more
closely for adverse effects.
The patient will have to take tacrolimus
concurrently with an antiemetic.
A
Feedback:
Tacrolimus, like cyclosporine, is not well
absorbed orally, so it is necessary to give
higher oral doses than IV doses to obtain
similar blood levels. Increased frequency is
not necessarily required. Concurrent dosing
with an antiemetic is not required. Regardless
of the route by which the drug is provided, the
patient needs to be closely monitored for
adverse effects.
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B)
C)
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A patient is ordered to receive cyclosporine
intravenously, and the nurse has explained the
10.
need for frequent blood work. This blood
work is required because cyclosporine
decreases erythropoiesis.
has a narrow therapeutic range.
has been linked to spontaneous hemolysis.
can precipitate a thyroid storm.
B
A patient is ordered to receive cyclosporine
intravenously, and the nurse has explained the
10.
need for frequent blood work. This blood
work is required because cyclosporine
decreases erythropoiesis.
has a narrow therapeutic range.
has been linked to spontaneous hemolysis.
can precipitate a thyroid storm.
B
Feedback:
Cyclosporine has a very narrow therapeutic
index; therefore, prescribers use serum drug
levels to regulate cyclosporine dosing, and
close monitoring is necessary. Cyclosporine
does not have a significant bearing on RBC
production and has not been closely linked to
thyroid function of hemolysis.
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B)
C)
D)
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Sirolimus and cyclosporine are being used to
prevent renal transplant rejection in an adult
11.
patient. What principle should guide the
nurse's administration of these two drugs?
Sirolimus should be given orally;
cyclosporine should be administered IV.
The two drugs should be administered
together to potentiate their effects.
The two drugs should be given at least 4
hours apart.
The drugs should be administered in a single
intramuscular injection.
C
Feedback:
Sirolimus may have synergistic effects with
cyclosporine because it has a different
mechanism of action, and prescribers may
order both drugs in combination. However,
because the two drugs are metabolized by the
same liver CYP3A4 enzymes, cyclosporine
can increase blood levels of sirolimus,
potentially to toxic levels. Consequently, it is
essential that the drugs not be given at the
same time; patients should take sirolimus 4
hours after a dose of cyclosporine.
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A patient is to be administered antithymocyte
globulin (ATG) to treat renal transplant
12. rejection. What skin test should be assessed
prior to the administration of the first dose of
medication?
Allergy to horse serum
Allergy to ragweed
Allergy to dust mites
Tuberculosis
A
Feedback:
Antithymocyte globulin is obtained from
horse serum, and, prior to administration, the
patient should be tested for allergy to horse
serum. The patient will not need to be
assessed for allergy to ragweed. The patient
will not be assessed for an allergy to dust
mites. The patient will not be assessed for
tuberculosis.
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B)
C)
D)
Ans:
D)
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A patient is receiving omalizumab (Xolair) to
treat allergic asthma, which is not relieved by
13. inhaled corticosteroids. Which nursing
intervention is appropriate with each dose
administration of omalizumab?
Administer high-flow oxygen prior to
administration.
Avoid high-fat foods during the course of
treatment.
Have epinephrine available during
administration.
Administer a corticosteroid prior to
administration.
C
Feedback:
Because of the risk of anaphylaxis, the FDA
has issued a black box warning for
omalizumab. Administration should occur
only in a health care setting under direct
medical supervision by provider who can
initiate treatment of life-threatening
anaphylaxis. The patient will not require
oxygen therapy with every dose
administration. The patient will not need to
avoid high-fat foods. The patient will not
receive corticosteroid agents.
C)
administration.
Administer a corticosteroid prior to
administration.
C
Feedback:
Because of the risk of anaphylaxis, the FDA
has issued a black box warning for
omalizumab. Administration should occur
only in a health care setting under direct
medical supervision by provider who can
initiate treatment of life-threatening
anaphylaxis. The patient will not require
oxygen therapy with every dose
administration. The patient will not need to
avoid high-fat foods. The patient will not
receive corticosteroid agents.
D)
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A)
B)
C)
D)
Ans:
A)
B)
C)
D)
Ans:
An adult male patient is being administered
immunosuppressant agents on a long-term
14. basis. Which of the following assessments
should be made routinely with the use of
long-term immunosuppressant therapy?
Yearly bronchoscopy
Yearly skin assessment
Yearly bladder biopsy
Yearly prostate examination
B
Feedback:
The most common malignancies among
transplant recipients are skin cancers and
lymphomas. The patient should be assessed
annually for skin cancer. The patient will not
require a yearly bronchoscopy. The patient
will not require a yearly bladder biopsy. The
male patient should have a yearly prostate
examination, but this examination is not
required for immunosuppressant therapy.
A patient is administered methotrexate for the
treatment of severe rheumatoid arthritis.
15. Administration of this drug should be
performed with particular care because of the
associated high risk of
intracapsular bleeding.
thrombophlebitis.
hepatotoxicity.
myocardial infarction or CVA.
C
Feedback:
Even in the low doses used in rheumatoid
arthritis and psoriasis, methotrexate may
cause hepatotoxicity. Consequently, many
clinicians recommend serial liver biopsies for
patients on long-term, low-dose methotrexate.
thrombophlebitis.
hepatotoxicity.
myocardial infarction or CVA.
C
Feedback:
Even in the low doses used in rheumatoid
arthritis and psoriasis, methotrexate may
cause hepatotoxicity. Consequently, many
clinicians recommend serial liver biopsies for
patients on long-term, low-dose methotrexate.
This drug is not closely associated with
bleeding disorders, MI, or stroke.
A 71-year-old woman has experienced a sharp
decline in her mobility and quality of life due
to severe rheumatoid arthritis. As a result, her
16. care provider has recently prescribed
abatacept (Orencia). This fusion protein
inhibitor will achieve a therapeutic effect by
what means?
Preventing the activation of T cells
Increasing antibody production by B cells
Antagonizing histamine receptors
Inhibiting the production of mast cells
A
Feedback:
Abatacept (Orencia) is a fusion protein
inhibitor synthesized from an IgG antibody
fused to a cell protein that binds to antigenpresenting molecules. This action prevents the
activation of T lymphocytes and the
production of inflammatory cytokines.
Abatacept does not increase antibody
production, antagonize histamine receptors, or
inhibit mast cell production.
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B)
C)
D)
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A)
B)
C)
D)
Ans:
A)
B)
C)
D)
Ans:
The nurse's medication reconciliation
performed on a patient who is newly admitted
to the hospital reveals that he regularly takes
17. infliximab (Remicade), a humanized IgG
monoclonal antibody. The nurse is justified in
suspecting that this patient may have a history
of which of the following?
Osteoporosis
Crohn's disease
Organ transplant
Severe seasonal allergies
B
Feedback:
Infliximab (Remicade) is a humanized IgG
monoclonal antibody used to treat rheumatoid
arthritis and Crohn's disease.
B)
C)
D)
Ans:
Crohn's disease
Organ transplant
Severe seasonal allergies
B
Feedback:
Infliximab (Remicade) is a humanized IgG
monoclonal antibody used to treat rheumatoid
arthritis and Crohn's disease.
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A)
An adult male patient is postoperative day 2
following a kidney transplant, and his
18. regimen of antirejection drugs began just
prior to surgery. What nursing action should
be integrated into this patient's plan of care?
Place the patient in a single, positive-pressure
room.
Arrange for the patient to receive a raw-food,
organic diet.
Wash the patient's skin with chlorhexidine
twice daily.
Have the patient wear a gown and gloves
when outside his room.
A
Feedback:
Patients receiving antirejection therapy are at
a greatly heightened risk of infection;
protective isolation is warranted. Raw foods
are normally contraindicated, and the use of a
gown and gloves does not protect the patient
sufficiently from infectious microorganisms.
It is not necessary to perform twice-daily
antiseptic washes.
B)
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D)
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Ans:
A)
B)
C)
D)
Ans:
Following a successful kidney transplant in
1999, a 59-year-old woman has presented to
the clinic for one of her regularly scheduled
19. follow-up appointments. The nurse at the
clinic should assess the patient in the
knowledge that long-term use of antirejection
drugs has been associated with
early onset of dementia.
increased risk of malignancy.
atherosclerosis.
increased risk of venous thromboembolism.
B
Feedback:
As a consequence of long-term survival and
chronic immunosuppression, patients on longterm immunosuppressants have an increased
risk of developing a malignancy. These drugs
have not been linked to dementia, VTE, or
atherosclerosis.
B)
C)
D)
Ans:
increased risk of malignancy.
atherosclerosis.
increased risk of venous thromboembolism.
B
Feedback:
As a consequence of long-term survival and
chronic immunosuppression, patients on longterm immunosuppressants have an increased
risk of developing a malignancy. These drugs
have not been linked to dementia, VTE, or
atherosclerosis.
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A transplant nurse is aware of the need to
closely monitor a patient's serum levels of
20. cyclosporine. In order to do this, the nurse
should ensure that blood is drawn at what
time?
30 minutes before a scheduled dose
Simultaneous to the administration of a dose
2 hours after a dose
At the halfway point between two scheduled
doses
C
Feedback:
Cyclosporine has a very narrow therapeutic
index; therefore, prescribers use serum drug
levels to regulate cyclosporine dosing, and
close monitoring is necessary. They use blood
levels measured 2 hours after a dose for
dosage adjustments.
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Chapter 14 Drug Therapy for the Treatment of Cancer
A)
B)
C)
D)
Ans:
A patient has been diagnosed with a brain
tumor and is dealing with this diagnosis by
seeking detailed information about cancer.
1.
The nurse would explain to the patient that
cancer is essentially a result of the disruption
of the
cell cycle.
cell wall.
lymphatic system.
immune system.
A
Feedback:
Malignant cells have lost the normal genetic
regulation that controls cell growth, invading
normal tissues and taking blood and nutrients
away from these tissues. In essence, the cell
cycle has been pathologically disrupted.
B)
C)
D)
Ans:
cell wall.
lymphatic system.
immune system.
A
Feedback:
Malignant cells have lost the normal genetic
regulation that controls cell growth, invading
normal tissues and taking blood and nutrients
away from these tissues. In essence, the cell
cycle has been pathologically disrupted.
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A)
A 49-year-old patient is diagnosed with
ovarian cancer. What is a characteristic of
2.
malignant cells that differentiates them from
normal body cells?
Cancerous cells do not require an energy
source in order to proliferate.
Cancerous cells grow in an uncontrollable
fashion.
Cancerous cells have a theoretically infinite
lifespan.
Cancerous cells are not responsive to the
presence of drugs.
B
Feedback:
Malignant cells have lost the normal genetic
regulation that controls cell growth, invading
normal tissues and taking blood and nutrients
away from these tissues. They grow in an
uncontrolled fashion without regard to growth
regulation signals (e.g., contact with other
cells) that stop the growth of normal cells.
Cancerous cells, like all cells, have a finite
lifespan and need energy. Cancerous cells are
responsive to drugs; this is the rationale for
treatment with antineoplastics.
B)
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A)
B)
C)
D)
Ans:
A patient with a diagnosis of bladder cancer is
started on a chemotherapeutic regimen that
3.
includes three agents. What is the rationale
for using multiple antineoplastic agents?
The use of three agents decreases the
development of cell resistance.
The use of three agents increases adherence to
treatment.
The use of three agents increases the serum
levels of one of the agents.
The use of three agents decreases the total
adverse effects.
A
Feedback:
Most chemotherapy regimens involve a
combination of drugs with different actions at
the cellular level, which destroys a greater
B)
treatment.
The use of three agents increases the serum
levels of one of the agents.
The use of three agents decreases the total
adverse effects.
A
Feedback:
Most chemotherapy regimens involve a
combination of drugs with different actions at
the cellular level, which destroys a greater
number of cancer cells and reduces the risk of
the cancer developing drug resistance.
C)
D)
A patient has undergone an aggressive
chemotherapeutic regimen to treat leukemia.
4. The patient develops gastrointestinal upset,
hypertension, and paresthesias. What
syndrome is the patient developing?
Fröhlich's syndrome
Epidermal nevus syndrome
Irritable bowel syndrome
Tumor lysis syndrome
D
Feedback:
With the treatment of leukemias and
lymphomas, a serious, life-threatening
adverse effect called tumor lysis syndrome
may occur. This syndrome occurs when large
numbers of cancer cells are killed or
damaged, releasing their contents into the
blood stream. The patient may have metabolic
imbalances, which include gastrointestinal
upset, hypertension, and paresthesias.
Fröhlich's syndrome is noted in adolescent
boys who have an increase in fat and atrophy
of the genitals. Epidermal nevus syndrome is
associated with multiple nevi. Irritable bowel
syndrome is marked by abdominal pain and
disturbances of evacuation.
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B)
C)
D)
Ans:
A)
B)
C)
D)
Ans:
A patient develops tumor lysis syndrome
during the administration of chemotherapy
5.
agents. Which of the following treatments is
implemented to resolve this health problem?
Administration of potassium IV
Administration of anti-inflammatory agents
Limiting of fluid intake and reduction in IV
fluid rate
Administration of IV normal saline and
sodium bicarbonate
D
Feedback:
The patient experiencing lysis syndrome
should receive regular insulin and IV sodium
implemented to resolve this health problem?
Administration of potassium IV
Administration of anti-inflammatory agents
Limiting of fluid intake and reduction in IV
fluid rate
Administration of IV normal saline and
sodium bicarbonate
D
Feedback:
The patient experiencing lysis syndrome
should receive regular insulin and IV sodium
bicarbonate. The patient suffers from
hyperkalemia and should not be administered
potassium. The patient would not be
administered anti-inflammatory agents. The
patient should be aggressively hydrated and
thus should not have fluids limited or
decreased.
A)
B)
C)
D)
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A patient is being treated with
cyclophosphamide (Cytoxan). Which of the
6.
following laboratory values should the nurse
follow most closely?
D-dimer
Complete blood count
C-reactive protein level
Arterial blood gases
B
Feedback:
The patient's complete blood count should be
assessed frequently because of the adverse
effect of bone marrow depression. The other
listed lab values may be important to assess at
different points but are not normally as
critical as the CBC.
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A)
B)
C)
D)
Ans:
A)
B)
C)
D)
Ans:
A patient with colorectal cancer is being
treated with oxaliplatin (Eloxatin). Which of
7.
the following potential adverse effects should
the nurse explain to the patient?
Dysuria
Diarrhea
Insomnia
Cold-induced neuropathy
D
Feedback:
Cold-induced neuropathy is an adverse effect
of oxaliplatin. Dysuria, diarrhea, and
insomnia are not closely associated with
Eloxatin.
B)
C)
D)
Ans:
Diarrhea
Insomnia
Cold-induced neuropathy
D
Feedback:
Cold-induced neuropathy is an adverse effect
of oxaliplatin. Dysuria, diarrhea, and
insomnia are not closely associated with
Eloxatin.
A patient has been administered methotrexate,
which is a purine antagonist used to treat a
rapidly growing tumor. The patient develops
8.
stomatitis. What is the priority nursing
diagnosis for a patient suffering from
stomatitis?
Impaired skin integrity
Activity intolerance
Self-care deficit: hygiene
Risk for disuse syndrome
A
Feedback:
Toxic effects of methotrexate include
stomatitis, which is an alteration in skin
integrity. Disuse syndrome, lack of hygiene,
and activity intolerance are less directly
related to stomatitis.
C)
D)
Ans:
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B)
C)
D)
Ans:
A patient is administered bevacizumab
(Avastin) to treat tumor growth in a breast
9.
tumor. What is the action of a monoclonal
antibody such as bevacizumab (Avastin)?
It changes the RNA of the tumor cell to a
normal form.
It binds to the 30S ribosome.
It prevents the activation of intracellular
growth factors.
It blocks the cell wall synthesis.
C
Feedback:
Bevacizumab (Avastin) binds to growth factor
receptors found on blood vessels to prevent
intracellular growth factors from becoming
activated and stimulating cell growth.
Bevacizumab does not change the RNA of the
tumor cell. Bevacizumab does not bind to the
30S ribosome or block cell wall synthesis.
An oncology nurse is preparing to administer
cytotoxic chemotherapy medications. Which
10.
of the following measures best protects the
nurse from harm related to the chemotherapy?
Wearing protective equipment
Performing thorough hand hygiene
Mixing medication in a 1000-mL bag
Administering medication intramuscularly
whenever possible
A
Feedback:
Because of the drugs' toxicity, nurses who
administer IV cytotoxic chemotherapy should
be specially trained to administer the
medications safely and use protective
equipment when handling the medication.
Hand hygiene is important during care but
will only minimally protect from harm. The
medication is mixed in a variety of solutions
and amounts. The medication is not normally
administered intramuscularly.
A)
B)
C)
D)
C)
D)
Ans:
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A 32-year-old female patient is being treated
with a cytotoxic antineoplastic agent. Which
11. of the following is the most important
instruction related to the potential for
teratogenicity?
The medication will be completely eliminated
24 hours after the administration.
The patient should protect herself from
infections and take Bactrim.
The patient should not become pregnant for
several months.
The patient will not get pregnant due to the
elimination of ova.
C
Feedback:
Most cytotoxic antineoplastic drugs are
potentially teratogenic, and pregnancy should
be avoided during and for several months
after drug therapy is stopped. The medication
is not completely eliminated in 24 hours. The
patient should be protected from infection, but
this characteristic is not related to pregnancy.
The patient can get pregnant after the
medication is administered.
C)
several months.
The patient will not get pregnant due to the
elimination of ova.
C
Feedback:
Most cytotoxic antineoplastic drugs are
potentially teratogenic, and pregnancy should
be avoided during and for several months
after drug therapy is stopped. The medication
is not completely eliminated in 24 hours. The
patient should be protected from infection, but
this characteristic is not related to pregnancy.
The patient can get pregnant after the
medication is administered.
D)
Ans:
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Fewer adverse effects are associated with
monoclonal antibody therapy than those of
cytotoxic drugs. However, some of the
12.
potential adverse effects of monoclonal
antibodies can be life threatening, including
which of the following?
Heart failure and bleeding problems
Changes in cognition and personality changes
Ischemic heart disease
Bronchoconstriction and pulmonary edema
B
Feedback:
Although some adverse effects of monoclonal
antibodies are rare, they are serious (e.g.,
heart failure, bleeding problems, electrolyte
imbalances) and vary with a particular drug.
A)
B)
C)
D)
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B)
C)
D)
Ans:
A patient is undergoing a cytotoxic
chemotherapy regimen for the treatment of
13. stage III lung cancer. What effect will this
regimen likely have on the patient's
hemostatic function?
The patient's platelet count will decline.
The patient will be at increased risk of deep
vein thrombosis.
The patient will require prophylactic heparin.
The patient will likely experience
thrombocytosis.
A
Feedback:
Thrombocytopenia is a common adverse
effect of cytotoxic chemotherapy. Heparin is
consequently contraindicated, and DVT is not
a priority risk.
C)
The patient will require prophylactic heparin.
The patient will likely experience
thrombocytosis.
A
Feedback:
Thrombocytopenia is a common adverse
effect of cytotoxic chemotherapy. Heparin is
consequently contraindicated, and DVT is not
a priority risk.
D)
Ans:
A patient has chosen to receive palliative care
after his lung cancer metastasized to his bones
14.
and liver. Which of the following is most
appropriate during palliative cancer care?
Abrupt cessation of chemotherapy
immediately prior to entering palliative care
Aggressive chemotherapy to reduce
malignant cell proliferation
The use of chemotherapy to reduce pain
The replacement of chemotherapy with
complementary and alternative treatments
C
Feedback:
Palliative chemotherapy is used in advanced
cancer to prevent or treat pain and
obstruction. Chemotherapy does not need to
be stopped abruptly or replaced with CAM.
Aggressive chemotherapy would not normally
be administered in a palliative context.
A)
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C)
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B)
C)
D)
Ans:
An adult patient has recently begun cancer
treatment with methotrexate (MTX). The
nurse is aware of the importance of
monitoring the patient closely for adverse
15.
effects of treatment. When reviewing this
patient's laboratory work, the nurse should
consequently prioritize assessment of which
of the following?
Sodium and potassium
BUN and creatinine
Calcium and magnesium
Arterial blood gases
B
Feedback:
The antimetabolites may also be nephrotoxic.
MTX use in patients with impaired renal
function may lead to accumulation of toxic
amounts or additional renal damage.
Evaluation of the patient's renal status should
take place before and during MTX therapy.
This adverse effect of MTX treatment
supersedes the importance of electrolytes and
ABGs, though these would also be
considered.
BUN and creatinine
Calcium and magnesium
Arterial blood gases
B
Feedback:
The antimetabolites may also be nephrotoxic.
MTX use in patients with impaired renal
function may lead to accumulation of toxic
amounts or additional renal damage.
Evaluation of the patient's renal status should
take place before and during MTX therapy.
This adverse effect of MTX treatment
supersedes the importance of electrolytes and
ABGs, though these would also be
considered.
A patient is being treated on the oncology unit
and has developed worsening adverse effects
16. over the past several days of chemotherapy.
Administration of filgrastim (Neupogen) may
aid in achieving what desired outcome?
Resolution of mucositis
Increased leukocytes
Increased platelet levels
Prevention of hemorrhagic cystitis
B
Feedback:
Severe neutropenia can be prevented or its
extent and duration minimized by
administering filgrastim or sargramostim to
stimulate the bone marrow to produce
leukocytes. Filgrastim does not address the
patient's risk for bleeding.
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C)
D)
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B)
C)
D)
Ans:
A)
B)
C)
D)
Ans:
A 50-year-old man has just been diagnosed
with liver cancer, and the care team is
finalizing the chemotherapy regimen that will
17.
begin imminently. Administration of
chemotherapeutic drugs is best achieved
through which of the following?
An intramuscular depot
A peripheral IV in the nondominant forearm
Peripheral intravenous access in the
antecubital fossa
A central venous catheter
D
Feedback:
Insertion of an indwelling central venous
catheter is often appropriate for patients who
have poor peripheral venous access, who
require many doses of chemotherapy, or who
require continuous infusions. Overall, a CVC
is preferable to peripheral access. IM
administration is uncommon.
Peripheral intravenous access in the
antecubital fossa
A central venous catheter
D
Feedback:
Insertion of an indwelling central venous
catheter is often appropriate for patients who
have poor peripheral venous access, who
require many doses of chemotherapy, or who
require continuous infusions. Overall, a CVC
is preferable to peripheral access. IM
administration is uncommon.
C)
A 79-year-old woman has recently moved to a
long-term care facility, and the nurse at the
facility is conducting a medication
reconciliation. The nurse notes that the
18.
woman has recently been taking tamoxifen
(Nolvadex). The nurse is justified in
concluding that the woman has a history of
what malignancy?
Ovarian cancer
Breast cancer
Malignant melanoma
Cervical cancer
B
Feedback:
Tamoxifen is an antiestrogen that has been
widely used to prevent recurrence of breast
cancer after surgical excision in women aged
40 and older and to treat metastatic breast
cancer in postmenopausal women with
estrogen receptor–positive disease.
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A)
B)
C)
D)
Ans:
A)
B)
C)
D)
Ans:
An oncology nurse is reviewing the
medication administration record of a patient
being treated for advanced prostate cancer. In
19. addition to two chemotherapeutic agents, the
nurse reads that the patient has been ordered a
cytoprotective agent. The goal of this agent is
to
buffer the cytotoxins that result from the
metabolism of chemotherapeutic agents.
protect the patient from pathophysiological
effects of his malignancy.
potentiate the beneficial effects of
chemotherapy.
reduce the incidence or severity of adverse
drug effects.
D
Feedback:
Cytoprotectant agents reduce the adverse
effects of cytotoxic drugs, some of which can
be severe, debilitating, or life threatening.
B)
effects of his malignancy.
potentiate the beneficial effects of
chemotherapy.
reduce the incidence or severity of adverse
drug effects.
D
Feedback:
Cytoprotectant agents reduce the adverse
effects of cytotoxic drugs, some of which can
be severe, debilitating, or life threatening.
Cytoprotectant drugs do not potentiate
chemotherapy, protect the patient from the
effects of cancer, or buffer cytotoxins.
C)
D)
A patient's chemotherapy regimen has been
deemed successful, but the patient is
experiencing debilitating nausea and
20.
vomiting. These adverse effects should signal
the nurse to the possibility of what nursing
diagnosis?
Acute pain
Adult failure to thrive
Ineffective therapeutic regimen management
Imbalanced nutrition: less than body
requirements
D
Feedback:
Nausea and vomiting are major threats to the
patient's nutrition. Failure to thrive is
typically a chronic, rather than acute, health
problem. Pain does not necessarily
accompany nausea, and there is no indication
that this patient is not maintaining the
necessary regimen.
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B)
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Chapter 15 Inflammation, Infection, and the Use of Antimicrobial Agents
A)
B)
C)
D)
Ans:
A female patient has been treated for strep
throat with ampicillin by mouth. She visits the
1. occupational health nurse and states she has
vaginal itching. What organism is the cause of
the vaginal itching?
Klebsiella
Enterobacter
Candida albicans
Proteus
C
Feedback:
The yeast Candida albicans is a normal
resident of the vagina and the intestinal tract.
An antibacterial drug may destroy the normal
bacterial flora without affecting the fungal
organism. Klebsiella, Enterobacter, and
Proteus will not contribute to the
Enterobacter
Candida albicans
Proteus
C
Feedback:
The yeast Candida albicans is a normal
resident of the vagina and the intestinal tract.
An antibacterial drug may destroy the normal
bacterial flora without affecting the fungal
organism. Klebsiella, Enterobacter, and
Proteus will not contribute to the
development of a yeast infection.
An elderly patient is treated for pneumonia
with clindamycin (Cleocin). One week after
2. the completion of the medication, she
develops diarrhea. What is the most probable
cause of the diarrhea?
Change in normal flora
Food-borne illness
Crohn's disease
Incontinence
A
Feedback:
Much of the normal flora can cause disease
under certain conditions, especially in the
elderly, debilitated, or immunosuppressed
people. The development of infectious
diarrhea is related to the change in the normal
flora of the bowel. Food-borne illness,
Crohn's disease, and incontinence do not
contribute to this particular development of
diarrhea.
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B)
C)
D)
Ans:
A)
B)
C)
D)
Ans:
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B)
C)
D)
Ans:
A patient with burns has developed a wound
3. infection. This patient is experiencing what
type of wound infection?
Fungal infection
Opportunistic infection
Nosocomial infection
Food-borne infection
B
Feedback:
Opportunistic infections are likely to occur in
people with severe burns, cancer, human
immunodeficiency virus, and indwelling
catheters and are often caused by drugresistant microorganisms, are usually serious,
and may be life threatening. The patient may
be at risk for a fungal, nosocomial, or foodborne infection, but the risk for all infections
is high due to the patient's opportunistic
nature of the burn.
B)
C)
D)
Ans:
Opportunistic infection
Nosocomial infection
Food-borne infection
B
Feedback:
Opportunistic infections are likely to occur in
people with severe burns, cancer, human
immunodeficiency virus, and indwelling
catheters and are often caused by drugresistant microorganisms, are usually serious,
and may be life threatening. The patient may
be at risk for a fungal, nosocomial, or foodborne infection, but the risk for all infections
is high due to the patient's opportunistic
nature of the burn.
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An elderly man who is a resident of a skilled
nursing facility develops methicillin-resistant
4.
Staphylococcus aureus. What type of
infection has this man developed?
Community acquired
Postoperative
Sustained infection
Nosocomial infection
D
Feedback:
Nosocomial infections are infections acquired
from microorganisms in hospitals and other
health care facilities. The patient's infection is
not community acquired, postoperative, or
sustained.
A)
B)
C)
D)
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B)
C)
D)
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A nurse is instructing a patient on the
antibiotic regimen for the treatment of
5.
pneumonia. Which of the following is most
important to teach the patient?
Take the medication with orange juice.
Supplement the medication with
multivitamins.
Complete the entire prescription of
medication.
Administer the medication with dairy
products.
C
Feedback:
Interruption or inadequate antimicrobial
treatment of infections may also contribute to
the emergences of antibiotic-resistant
organisms. The administration of an antibiotic
with orange juice is not recommended in all
instances. The medication does not need to be
supplemented with vitamins. Antibiotics need
not be administered with dairy products.
C)
medication.
Administer the medication with dairy
products.
C
Feedback:
Interruption or inadequate antimicrobial
treatment of infections may also contribute to
the emergences of antibiotic-resistant
organisms. The administration of an antibiotic
with orange juice is not recommended in all
instances. The medication does not need to be
supplemented with vitamins. Antibiotics need
not be administered with dairy products.
D)
Ans:
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A patient is to be started on an antibiotic.
Which of the following is most important to
6.
take into consideration before beginning the
antibiotic regimen?
Duration of symptoms
Culture and sensitivity
The patient's hydration status
The patient's age and weight
B
Feedback:
Culture identifies the causative organism, and
susceptibility tests determine which drugs are
likely to be effective against the organism.
The duration of symptoms and the patient's
hydration status, age, and weight are
important, but not imperative, in determining
the antibiotic of choice.
A)
B)
C)
D)
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B)
C)
D)
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A patient has presented to the emergency
department after suffering a severe laceration
7. to his hand in a workplace accident. During
the subsequent process of acute inflammation,
what physiological event took place first?
The patient's B cells produced antibodies.
The patient's blood vessels constricted.
Neutrophils migrated to the injury site.
Opsonization occurred.
B
Feedback:
The process of acute inflammation occurs in
three stages. The first stage is the vascular
stage; notable changes occur in the small
blood vessels at the site of the cellular and
tissue injury. At the time of the injury,
vasoconstriction results, followed by
vasodilation of the capillaries and venules to
increase capillary blood flow, increasing
temperature and redness at the site.
Opsonization, neutrophil migration, and
antibody production take place in later stages
The patient's blood vessels constricted.
Neutrophils migrated to the injury site.
Opsonization occurred.
B
Feedback:
The process of acute inflammation occurs in
three stages. The first stage is the vascular
stage; notable changes occur in the small
blood vessels at the site of the cellular and
tissue injury. At the time of the injury,
vasoconstriction results, followed by
vasodilation of the capillaries and venules to
increase capillary blood flow, increasing
temperature and redness at the site.
Opsonization, neutrophil migration, and
antibody production take place in later stages
of inflammation.
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C)
D)
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A)
B)
C)
D)
Ans:
A 12-year-old boy was bitten by a dog, and
inflammation took place at the site of the
8.
injury. During the process of opsonization,
what physiological event occurred?
The boy's blood vessels dilated, allowing
rapid peripheral blood flow.
Viscosity of the boy's blood decreased,
facilitating the migration of neutrophils.
Antigens were coated, marking them for
phagocytosis.
T cells were released from the boy's thymus
gland.
C
Feedback:
The third stage of inflammation involves
opsonization, which facilitates phagocytosis.
During opsonization, a substance coats the
foreign antigens, producing inflammation.
This inflammation makes the antigens more
susceptible to the macrophages and
leukocytes, thus increasing phagocytic
activity. Opsonization is not characterized by
T-cell activity or changes in blood flow and
viscosity.
An adult patient with an autoimmune disorder
regularly takes oral corticosteroids. The nurse
9. knows that corticosteroids can be used in the
successful treatment of inflammation but that
they also create a risk for
bleeding.
leukocytosis.
infection.
electrolyte imbalances.
C
Feedback:
regularly takes oral corticosteroids. The nurse
9. knows that corticosteroids can be used in the
successful treatment of inflammation but that
they also create a risk for
bleeding.
leukocytosis.
infection.
electrolyte imbalances.
C
Feedback:
Corticosteroids impair phagocytosis by
preventing phagocytic cells from leaving the
bloodstream. They decrease the amount of
lymphocytes, fibroblasts, and collagen needed
for tissue repair. This causes a reduction in
inflammation but a commensurate increase in
the patient's risk for infection.
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B)
C)
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The family members of a geriatric patient are
angered that she has been colonized with
methicillin-resistant Staphylococcus aureus
10.
during her stay in the hospital. The nurse
should explain what characteristic of
colonization to the members of the family?
The bacteria are present but are not causing
infection.
The bacteria are causing an infection, but the
infection is not spreading.
The bacteria are causing tissue injury at the
site of colonization.
The bacteria are spreading within a clearly
defined body region.
A
Feedback:
Colonization is the presence and growth of
microorganisms. The microorganisms do not
necessarily cause tissue injury or elicit an
immune response in the human body.
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B)
C)
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B)
C)
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An adult female patient has been living with
human immunodeficiency virus (HIV) for
several years but has recently been admitted
11.
to the hospital after being diagnosed with
herpes simplex. How would this patient's
herpes infection most likely be characterized?
Community-acquired infection
Opportunistic infection
Secondary infection
Nosocomial infection
B
Feedback:
Microorganisms may become pathogens in
hosts whose defense mechanisms are
impaired. Opportunistic infections are likely
herpes simplex. How would this patient's
herpes infection most likely be characterized?
Community-acquired infection
Opportunistic infection
Secondary infection
Nosocomial infection
B
Feedback:
Microorganisms may become pathogens in
hosts whose defense mechanisms are
impaired. Opportunistic infections are likely
to occur in people whose defenses are
compromised due to human
immunodeficiency virus (HIV) infection. This
is not characterized as a nosocomial infection
(hospital-acquired infection) or a secondary
infection. The infection was likely to have
been acquired in the community, but the
patient's HIV diagnosis means that it would
be considered to be an opportunistic infection.
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A group of nursing students are learning about
the factors that underlie recent increases in the
12. incidence and prevalence of antibioticresistant microorganisms. What factor is
known to contribute to antibiotic resistance?
Increased survival rates from acute infections
Increased population density
Use of antibiotics that are ineffective against
the infectious microorganism
Overuse of antibiotics
D
Feedback:
Antibiotic overuse can contribute to antibiotic
resistance. Resistance is not typically
attributable to increased age of patients,
increased population density, or the use of
ineffective antibiotics.
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A 4-month-old baby has been brought to the
emergency department by her parents, and
initial assessment is highly suggestive of
bacterial meningitis. Consequently, the baby
13.
has been admitted, and empiric antibiotic
therapy has been ordered. The nurse should
understand what characteristic of this infant's
current treatment plan?
Success or failure of treatment will not be
apparent for several weeks.
The infant will receive aggressive treatment
with a narrow-spectrum antibiotic.
Culture and sensitivity results of the infant's
cerebrospinal fluid are still pending.
The infant is suspected of having an
therapy has been ordered. The nurse should
understand what characteristic of this infant's
current treatment plan?
Success or failure of treatment will not be
apparent for several weeks.
The infant will receive aggressive treatment
with a narrow-spectrum antibiotic.
Culture and sensitivity results of the infant's
cerebrospinal fluid are still pending.
The infant is suspected of having an
antibiotic-resistant infection.
C
Feedback:
Empiric therapy is based on an informed
estimate of the most likely pathogen(s) given
the patient's signs and symptoms and the site
of infection, as well as knowledge of
communicable diseases currently infecting
other people in the community. Because
laboratory tests used to definitively identify
causative organisms and to determine
susceptibility to antibiotics usually require 48
to 72 hours, the prescriber usually initiates
treatment with an antimicrobial drug that is
likely to be effective. The other listed
statements are not true of empiric therapy.
A)
B)
C)
D)
C)
D)
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A patient with an infection has not responded
appreciably to antibiotic therapy, and the
14. nurse suspects antibiotic resistance. What
phenomenon is known to contribute to
acquired antibiotic resistance?
Bacteria take on genetic material from healthy
body cells, reducing antigen recognition.
Microorganisms remain in resting (G0) phase
during antibiotic treatment.
Distribution of an antibiotic is insufficient to
cause resolution of the infection.
The strongest microorganisms survive
antibiotic treatment while the weakest are
eradicated.
D
Feedback:
Selective pressure, or natural selection, refers
to the survival of the fittest bacteria. When
antibiotic therapy is initially begun, the
weakest bacteria are killed first while the
strongest bacteria, which are best able to
withstand the effects of antibiotic therapy,
remain. This contributes to antibiotic
resistance. Resistance is not the result of an
extended G0 phase, impaired distribution, or
bacterial appropriation of human genetic
material.
The strongest microorganisms survive
antibiotic treatment while the weakest are
eradicated.
D
Feedback:
Selective pressure, or natural selection, refers
to the survival of the fittest bacteria. When
antibiotic therapy is initially begun, the
weakest bacteria are killed first while the
strongest bacteria, which are best able to
withstand the effects of antibiotic therapy,
remain. This contributes to antibiotic
resistance. Resistance is not the result of an
extended G0 phase, impaired distribution, or
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bacterial appropriation of human genetic
material.
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When participating in the care of a patient
who is being treated with antimicrobials, the
15. nurse can promote the appropriate use of
these medications in which of the following
ways?
Encouraging the use of narrow-spectrum,
rather than broad-spectrum, antibiotics
Promoting the use of prophylactic antibiotics
for patients possessing risk factors for
infection
Initiating empiric therapy for all older adult
patients admitted to a health care facility
Promoting the use of herbal treatment for
infection rather than antimicrobial drugs
A
Feedback:
Guidelines to promote more appropriate use
of antimicrobial drugs include using a
narrow-spectrum antibacterial drug instead of
a broad-spectrum drug, whenever possible, in
order to decrease the risk of a superinfection.
Herbal alternatives are frequently not
available. Antibiotics should not normally be
administered in the absence of a diagnosed
infection.
A critically ill patient has developed a fever of
38.9°C, and blood cultures have been drawn
16. and sent to the laboratory for culture and
sensitivity testing. Determination of the
culture will tell the care team
whether the infection is antibiotic resistant.
the exact identity of the infectious
microorganism.
the most likely location of the infection.
the most likely origin of the infection.
B
38.9°C, and blood cultures have been drawn
16. and sent to the laboratory for culture and
sensitivity testing. Determination of the
culture will tell the care team
whether the infection is antibiotic resistant.
the exact identity of the infectious
microorganism.
the most likely location of the infection.
the most likely origin of the infection.
B
Feedback:
Culture identifies the causative
microorganism. It does not necessarily
indicate the presence of antibiotic resistance.
The origin or location of the infection may
often been indirectly determined by the
culture, but this is not always the case.
A)
B)
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A medical nurse on a night shift is reviewing
a patient's medication administration record
for the following day. The nurse notes that a
17.
combination antimicrobial drug is ordered.
What is implied by the fact that the patient
has been ordered a combination drug?
The patient's infection likely has a fungal or
protozoal etiology.
The patient likely has a history of recurrent,
multisystemic infections.
The patient may be unable to tolerate
treatment with a single antimicrobial.
The patient may have an infection caused by
multiple microorganisms.
D
Feedback:
Indications for combination therapy may
include infections caused by multiple
microorganisms. A fungal or protozoal
infection is not implied, and the patient may
or may not have a history of recurrent
infections. Intolerance of single antibiotics is
not normally an indication for combination
therapy.
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A)
B)
C)
D)
A hospital nurse is aware that nosocomial
infections pose a significant threat to many
patients' health status. In order to reduce the
18.
spread of nosocomial infections, the nurse
should prioritize which of the following
actions?
Increased use of empiric antibiotic therapy
Use of disinfectants when providing patient
hygiene
Vigilant and thorough hand hygiene
Patient education on the causes of infection
A hospital nurse is aware that nosocomial
infections pose a significant threat to many
patients' health status. In order to reduce the
18.
spread of nosocomial infections, the nurse
should prioritize which of the following
actions?
Increased use of empiric antibiotic therapy
Use of disinfectants when providing patient
hygiene
Vigilant and thorough hand hygiene
Patient education on the causes of infection
C
Feedback:
Good hand hygiene is probably the most
effective method of preventing infections.
This supersedes the importance of education
regarding the causes of infection or the use of
disinfectants. Antibiotic therapy should only
be used on patients who clearly need this
treatment.
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B)
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An 81-year-old female patient has been
admitted to the hospital after a urinary tract
infection developed into urosepsis. What
19.
assessments should the nurse prioritize when
monitoring the course of this patient's
infection? Select all that apply.
Blood urea nitrogen and creatinine
White blood cell count
Heart rhythm
Temperature
Liver panel
B, D
Feedback:
For patients with an infection, the nurse
should prioritize assessment of WBCs and
temperature. Cardiac, renal, and liver function
are important measures of health, but these
are less directly affected by the presence of
infection.
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B)
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B)
C)
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Mr. Garcia has been taking antibiotics at
home for the treatment of a respiratory
infection for the past 6 days, and there is no
20.
evident improvement in his infection. Which
of the following nursing assessments is most
appropriate?
Assess Mr. Garcia's adherence to his
medication regimen.
Assess Mr. Garcia's home hygiene.
Assess Mr. Garcia's understanding of his
illness.
Assess Mr. Garcia's use of herbal or
alternative remedies.
A
20.
A)
B)
C)
D)
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evident improvement in his infection. Which
of the following nursing assessments is most
appropriate?
Assess Mr. Garcia's adherence to his
medication regimen.
Assess Mr. Garcia's home hygiene.
Assess Mr. Garcia's understanding of his
illness.
Assess Mr. Garcia's use of herbal or
alternative remedies.
A
Feedback:
Nonadherence to antibiotic therapy can result
in a continuation or exacerbation of the
infection. Poor hygiene is a risk factor for the
development of infection but is less likely to
perpetuate an existing infection that is being
treated appropriately with antibiotics. Herbs
may be contraindicated but are unlikely to
negate the therapeutic effects of an antibiotic.
The nurse should gauge the patient's
understanding of his illness, but this does not
have a bearing on his lack of improvement.
Chapter 16 Drug Therapy to Decrease Pain, Fever, and Inflammation
C)
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A patient is receiving acetaminophen
(Tylenol) for fever. The patient also has
inflammation in the knees and elbows with
1.
pain. Why will acetaminophen (Tylenol)
assist in reducing fever but not in decreasing
the inflammatory process?
Prostaglandin inhibition is limited to the
central nervous system.
Acetaminophen inhibits cyclooxygenase
(COX-1 and COX-2) only.
Acetaminophen has an antiplatelet effect to
decrease edema.
Prostaglandins decrease the gastric acid
secretion.
A
Feedback:
The action of acetaminophen on prostaglandin
inhibition is limited to the central nervous
system. Aspirin and other nonselective
NSAIDs inhibit COX-1 and COX-2.
Acetaminophen does not produce an
antiplatelet effect. Prostaglandins do not
affect gastric secretions.
A patient suffers from pain in the elbow
2. related to inflammation. What are the
chemical mediators of inflammation?
Insulin, thyroid hormone, and calcitonin
Bradykinin, histamine, and leukotrienes
Phospholipids, arachidonic acid, and platelets
Red blood cells, lymph, and serosa
B
Feedback:
Prostaglandins sensitize pain receptors and
increase the pain associated with other
chemical mediators of inflammation and
immunity, such as bradykinin, histamine, and
leukotrienes. Insulin, thyroid hormone, and
calcitonin are not chemical mediators of
inflammation. Phospholipids, arachidonic
acid, and platelets are not chemical mediators
of inflammation. Red blood cells, lymph, and
serosa are not chemical mediators of
inflammation.
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B)
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A patient is administered acetylsalicylic acid
3. (aspirin) for fever and headache. What is the
action of acetylsalicylic acid (aspirin)?
Inhibiting prostaglandin synthesis in the
central and peripheral nervous system
Providing selective action by inhibiting
prostaglandin synthesis in the CNS
Inhibiting the release of norepinephrine to
increase blood pressure
Suppressing the function of the hypothalamus
to decrease inflammation
A
Feedback:
Aspirin inhibits prostaglandin synthesis in the
central nervous system and the peripheral
nervous system. Acetylsalicylic acid does not
provide selective action by inhibiting
prostaglandin synthesis in the CNS. Aspirin
does not inhibit the release of norepinephrine
to increase blood pressure. Aspirin does not
suppress the function of the hypothalamus to
decrease inflammation.
When acetylsalicylic acid (aspirin) is
administered in low doses, it blocks the
4. synthesis of thromboxane A . What
2
physiological effect results from this action?
Inflammation is relieved.
Core body temperature is reduced.
Pain is relieved.
Platelet aggregation is inhibited.
D
Feedback:
At low doses, aspirin blocks the synthesis of
thromboxane A2 to inhibit platelet
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aggregation; this lasts for the life of the
platelet.
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A patient began taking acetylsalicylic acid
(aspirin) several years ago to prevent platelet
5. aggregation following a myocardial
infarction. Which dose of aspirin is most
likely appropriate for this patient?
80 mg
180 mg
325 mg
650 mg
A
Feedback:
The dose of aspirin given depends mainly on
the condition being treated. Low doses (325
mg initially and 80 mg daily) are used for the
drug's antiplatelet effects in preventing
arterial thrombotic disorders such as
myocardial infarction and stroke.
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B)
C)
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A patient is suffering from bursitis in the right
elbow. Which of the following orally
6. administered medications is most likely to
diminish inflammation and assist in relieving
pain?
Acetaminophen (Tylenol)
Morphine sulfate
Acetylsalicylic acid (aspirin)
Codeine
C
Feedback:
Aspirin is widely used to prevent and treat
mild to moderate pain and inflammation
diminish inflammation and assist in relieving
pain?
Acetaminophen (Tylenol)
Morphine sulfate
Acetylsalicylic acid (aspirin)
Codeine
C
Feedback:
Aspirin is widely used to prevent and treat
mild to moderate pain and inflammation
associated with musculoskeletal disorders.
Aspirin is administered orally.
Acetaminophen (Tylenol) will only relieve
pain and not affect inflammation. Morphine
sulfate will relieve pain but not affect
inflammation. Codeine will relieve pain but
not affect inflammation.
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B)
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A patient is diagnosed with familial
adenomatous polyposis. Which of the
following nonsteroidal anti-inflammatory
7.
agents has the potential to reduce the number
of polyps and decrease the risk of colon
cancer?
Ibuprofen (Motrin)
Nabumetone (Relafen)
Celecoxib (Celebrex)
Probenecid (Benemid)
C
Feedback:
Celecoxib (Celebrex), a COX-2 inhibitor, is
used to treat familial adenomatous polyposis,
in which the drug reduces the number of
polyps and may decrease risk of colon cancer.
Ibuprofen (Motrin) and nabumetone (Relafen)
are not recommended for use in preventing
familial adenomatous polyposis. Probenecid
(Benemid) is used to treat gouty arthritis, not
for the prevention of adenomatous polyposis.
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B)
C)
D)
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A)
B)
C)
D)
Ans:
A patient is taking ibuprofen (Motrin) for
knee pain. The patient is admitted to the
8. hospital with abdominal pain. Which of the
following assessments should the nurse
prioritize?
Assessment for diarrhea
Assessment for occult blood in the patient's
stool
Assessment of the patient's urine for
hematuria
Assessment for hemoptysis
B
Feedback:
Nonsteroidal anti-inflammatory agents that
following assessments should the nurse
prioritize?
Assessment for diarrhea
Assessment for occult blood in the patient's
stool
Assessment of the patient's urine for
hematuria
Assessment for hemoptysis
B
Feedback:
Nonsteroidal anti-inflammatory agents that
block COX-1 and COX-2 place the patient at
risk for gastrointestinal bleed. Patients who
have symptoms of abdominal pain and are
taking NSAIDs should be assessed for signs
and symptoms of gastrointestinal bleed.
Assessing the patient for diarrhea is not
related to ibuprofen (Motrin) administration.
Assessing the patient for hematuria or
hemoptysis is not a priority.
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B)
C)
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A child has symptoms of influenza, including
a fever. Which of the following medications
9.
should not be administered to the child
because of the risk of Reye's syndrome?
Acetaminophen (Tylenol)
Acetylsalicylic acid (aspirin)
Ibuprofen (Motrin)
Ascorbic Acid (vitamin C)
B
Feedback:
In children and adolescents, aspirin is
contraindicated in the presence of viral
infections, such as influenza or chickenpox,
because of its association with Reye's
syndrome. Acetaminophen (Tylenol) and
ibuprofen (Motrin) are safe to administer for
fever reduction and pain relief in children and
adolescents. Ascorbic acid (vitamin C) is safe
to administer to children but is not used to
reduce fever or pain.
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B)
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D)
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B)
C)
D)
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A perinatal nurse is preparing a dose of IV
indomethacin for administration to a neonate.
10.
What is the most plausible indication for this
treatment?
Patent ductus arteriosus
Tetralogy of Fallot
Patent foramen ovale
Cardiomyopathy
A
Feedback:
The FDA has approved IV indomethacin for
treatment of patent ductus arteriosus in
10.
A patient is admitted to a neurological unit
with a confirmed cerebrovascular bleed.
11. Which of the following medications used to
treat inflammation is contraindicated in this
patient?
Furosemide (Lasix)
Hydrochlorothiazide with triamterene
Digoxin (Lanoxin)
Ketorolac (Toradol)
D
Feedback:
Ketorolac (Toradol) should not be
administered to a patient with a suspected or
confirmed cerebrovascular bleed. Furosemide
(Lasix) is administered to reduce fluid volume
and is not administered to treat inflammation.
Hydrochlorothiazide with triamterene is
administered to reduce fluid volume and is not
administered to treat inflammation. Digoxin
(Lanoxin) is administered to increase cardiac
output, not to treat inflammation.
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B)
C)
D)
Ans:
indomethacin for administration to a neonate.
What is the most plausible indication for this
treatment?
Patent ductus arteriosus
Tetralogy of Fallot
Patent foramen ovale
Cardiomyopathy
A
Feedback:
The FDA has approved IV indomethacin for
treatment of patent ductus arteriosus in
premature infants.
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B)
C)
D)
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B)
C)
D)
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An elderly patient has taken ibuprofen
(Motrin) 800 mg two times per day for the
12.
past 3 years. Which of the following
laboratory tests is the priority assessment?
Renin and aldosterone levels
24-hour urine for microalbumin
Blood urea nitrogen and serum creatinine
Complete blood count
C
Feedback:
Nonsteroidal anti-inflammatory agents in
long-term use can cause renal impairment.
The patient should be assessed for renal
impairment with the elevation of the serum
BUN and creatinine. NSAIDs do not affect
renin and aldosterone levels. A 24-hour urine
for microalbumin is not recommended when
administering ibuprofen. A complete blood
count may not be necessary.
24-hour urine for microalbumin
Blood urea nitrogen and serum creatinine
Complete blood count
C
Feedback:
Nonsteroidal anti-inflammatory agents in
long-term use can cause renal impairment.
The patient should be assessed for renal
impairment with the elevation of the serum
BUN and creatinine. NSAIDs do not affect
renin and aldosterone levels. A 24-hour urine
for microalbumin is not recommended when
administering ibuprofen. A complete blood
count may not be necessary.
A patient is allergic to acetylsalicylic acid
(aspirin). Which of the following medications
13.
is contraindicated due to crosshypersensitivity reactions?
Acetaminophen (Tylenol)
Naproxen sodium (Naprosyn)
Morphine sulfate (MS Contin)
Naloxone (Narcan)
B
Feedback:
In people who have demonstrated
hypersensitivity to aspirin, all nonaspirin
NSAIDs are contraindicated because crosshypersensitivity reactions may occur with any
drugs that inhibit prostaglandin synthesis.
Acetaminophen (Tylenol) does not have
cross-sensitivity with acetylsalicylic acid
(aspirin) because it is not an NSAID.
Morphine sulfate (MS Contin) does not have
a cross-sensitivity to aspirin because it is an
opioid, not an NSAID. Naloxone (Narcan) is
an opioid antagonist and does not have crosssensitivity with aspirin.
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D)
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B)
C)
D)
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B)
C)
D)
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A patient with osteoarthritis has been
prescribed meloxicam (Mobic). Which of the
14.
following instructions should the patient be
given?
Take the medication with orange juice.
Crush enteric-coated tablets to aid
swallowing.
Take the medication with food.
Take the medication at bedtime.
C
Feedback:
Meloxicam should be taken with food.
Enteric-coated tablets are never crushed, and
it is not always necessary to take this
medication at bedtime. Orange juice is not of
Crush enteric-coated tablets to aid
swallowing.
Take the medication with food.
Take the medication at bedtime.
C
Feedback:
Meloxicam should be taken with food.
Enteric-coated tablets are never crushed, and
it is not always necessary to take this
medication at bedtime. Orange juice is not of
particular benefit.
B)
C)
D)
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A patient enters the emergency room with
complaints of visual changes, drowsiness, and
15. tinnitus. The patient is confused and
hyperventilating. These symptoms may be
attributable to which of the following?
Acute acetaminophen toxicity
Salicylism
Ibuprofen overdose
Caffeine overdose
B
Feedback:
Salicylism, toxicity due to salicylates that
may be associated with chronic use, is
characterized by dizziness, tinnitus, difficulty
hearing, and mental confusion. Ibuprofen
overdose will cause gastric mucosal damage.
Caffeine overdose will produce tachycardia.
A)
B)
C)
D)
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A)
B)
C)
D)
Ans:
A patient is admitted to the emergency
department with a suspected overdose of
16. acetaminophen (Tylenol). What adverse effect
is most common in acute or chronic overdose
of acetaminophen (Tylenol)?
Nephrotoxicity
Hepatotoxicity
Pulmonary insufficiency
Pancreatitis
B
Feedback:
In acute or chronic overdose of
acetaminophen (Tylenol), the patient can
develop hepatotoxicity. Nephrotoxicity is not
an adverse effect associated with Tylenol
overdose. Pulmonary insufficiency is not an
adverse effect associated with Tylenol
overdose. Pancreatitis is not an adverse effect
associated with Tylenol overdose.
B)
C)
D)
Ans:
Hepatotoxicity
Pulmonary insufficiency
Pancreatitis
B
Feedback:
In acute or chronic overdose of
acetaminophen (Tylenol), the patient can
develop hepatotoxicity. Nephrotoxicity is not
an adverse effect associated with Tylenol
overdose. Pulmonary insufficiency is not an
adverse effect associated with Tylenol
overdose. Pancreatitis is not an adverse effect
associated with Tylenol overdose.
17.
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B)
C)
D)
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A patient suffers from gouty arthritis. Why is
probenecid (Benemid) administered?
To increase urinary excretion of uric acid
To decrease the level of liver enzymes
To diminish the temperature
To increase protein metabolism
A
Feedback:
Probenecid (Benemid) increases the urinary
excretion of uric acid. Probenecid (Benemid)
will not decrease the level of liver enzymes,
diminish temperature, or increase protein
metabolism.
A patient is diagnosed with salicylate
overdose. Which of the following medications
18.
will be administered for the treatment of
salicylate overdose?
Intravenous meperidine (Demerol)
Intravenous sodium bicarbonate
Intravenous furosemide (Lasix)
Inhaled acetylcysteine (Mucomyst)
B
Feedback:
Intravenous sodium bicarbonate produces
alkaline urine in which salicylates are more
rapidly excreted in patients with salicylism.
19.
A)
B)
C)
D)
Ans:
Which of the following is the antidote for
acetaminophen (Tylenol) poisoning?
Acetylcysteine (Mucomyst)
Allopurinol (Zyloprim)
Diclofenac sodium (Voltaren)
Ketorolac (Toradol)
A
Feedback:
A specific antidote, acetylcysteine
(Mucomyst), is a mucolytic agent given for
19.
A nurse is conducting a medication
reconciliation for a 79-year-old man who has
just relocated to the long-term care facility.
The nurse notes that the man has been taking
20.
colchicine (Colcrys) on a regular basis. This
aspect of the man's medication regimen
should signal the nurse to the possibility that
he has a diagnosis of
osteoarthritis.
gout.
inflammatory bowel disease.
bursitis or tendonitis.
B
Feedback:
Colchicine (Colcrys), the prototype agent for
the treatment and prevention of gout, is the
most commonly administered antigout
medication. Colchicine is not indicated in the
treatment of osteoarthritis, IBD, tendonitis, or
bursitis.
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A)
B)
C)
D)
Ans:
Which of the following is the antidote for
acetaminophen (Tylenol) poisoning?
Acetylcysteine (Mucomyst)
Allopurinol (Zyloprim)
Diclofenac sodium (Voltaren)
Ketorolac (Toradol)
A
Feedback:
A specific antidote, acetylcysteine
(Mucomyst), is a mucolytic agent given for
acetaminophen poisoning.
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B)
C)
D)
Ans:
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Chapter 17 Drug Therapy With Corticosteroids
A)
B)
C)
D)
Ans:
A patient is in the admission department prior
to outpatient surgery, and she states that she is
1. exceptionally nervous. Which of the
following actions increases this patient's
stress-related release of cortisol?
Negative feedback mechanism
Stimulation of the hypothalamus
Release of epinephrine and norepinephrine
Atrophy of the adrenal cortex
C
Feedback:
The stress response activates the sympathetic
nervous system to produce more epinephrine
and norepinephrine and the adrenal cortex to
produce as much as 10 times the normal
amount of cortisol. The negative feedback
mechanism does not accelerate the stress
response. Cortisol production is not based on
Stimulation of the hypothalamus
Release of epinephrine and norepinephrine
Atrophy of the adrenal cortex
C
Feedback:
The stress response activates the sympathetic
nervous system to produce more epinephrine
and norepinephrine and the adrenal cortex to
produce as much as 10 times the normal
amount of cortisol. The negative feedback
mechanism does not accelerate the stress
response. Cortisol production is not based on
the stimulation of the hypothalamus. The
stress response will not cause atrophy of the
adrenal cortex.
A patient is diagnosed with an adrenal tumor.
With which of the following abnormalities of
2.
the adrenal gland will the patient most likely
be diagnosed?
Primary adrenocortical insufficiency
Secondary adrenocortical insufficiency
Adrenocortical hyperfunction
Hyperaldosteronism
C
Feedback:
Adrenocortical hyperfunction (Cushing's
disease) may be a result of a primary adrenal
tumor. Primary adrenocortical insufficiency is
associated with destruction of the adrenal
cortex by disorders such as tuberculosis,
cancer, or hemorrhage. Secondary
adrenocortical insufficiency is produced by
inadequate secretion of corticotropin.
Hyperaldosteronism is a rare disorder caused
by adenoma or hyperplasia of the adrenal
cortex cells that produce aldosterone.
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C)
D)
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B)
C)
D)
Ans:
A)
B)
C)
D)
Ans:
A patient is seen in the primary care
provider's office with complaints of
polydipsia and polyuria without polyphagia.
3.
He has very edematous ankles, and his blood
pressure is elevated. From which disorder of
the adrenal cortex is the patient suffering?
Hyperaldosteronism
Adrenocortical hyperfunction
Androgen-producing tumors
Adrenal hyperplasia
A
Feedback:
Hyperaldosteronism is characterized by
hypokalemia, hypernatremia, hypertension,
thirst, and polyuria. Adrenocortical
hyperfunction causes the secretion of several
Hyperaldosteronism
Adrenocortical hyperfunction
Androgen-producing tumors
Adrenal hyperplasia
A
Feedback:
Hyperaldosteronism is characterized by
hypokalemia, hypernatremia, hypertension,
thirst, and polyuria. Adrenocortical
hyperfunction causes the secretion of several
corticosteroids. Androgen-producing tumors
of the adrenal cortex, which are usually
benign, produce masculinizing effects.
Adrenal hyperplasia results from deficiencies
in one or more enzymes required for cortisol
production.
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B)
C)
D)
Ans:
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A patient is receiving hydrocortisone 40 mg
PO daily for treatment of severe autoimmune
4.
inflammation. Which of the following nursing
interventions is most important to implement?
Increase dietary sodium.
Limit dietary protein.
Assess BUN and creatinine regularly.
Implement infection control measures.
D
Feedback:
Corticosteroids create a risk for infection due
to immune suppression; infection control
measures are a priority. When taking
hydrocortisone daily, the patient should limit
dietary sodium due to fluid retention. The
patient should maintain a diet high in protein.
The patient should not alter fluid intake unless
the patient shows signs of fluid volume
overload. Renal function may or may not be
an assessment priority.
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B)
C)
D)
Ans:
A)
B)
C)
D)
Ans:
A male patient has been on chronic
corticosteroid therapy for several years and
has been scheduled for a colonoscopy. How
5.
should the patient's corticosteroid therapy be
altered to accommodate this impending
stressful event?
The patient should stop taking the
corticosteroid 7 days prior to the procedure.
The patient should continue taking the regular
dose of his corticosteroid.
The patient should temporarily change to IV
administration of his corticosteroid.
The patient should temporarily take a higher
dose of his corticosteroid.
D
Feedback:
stressful event?
The patient should stop taking the
corticosteroid 7 days prior to the procedure.
The patient should continue taking the regular
dose of his corticosteroid.
The patient should temporarily change to IV
administration of his corticosteroid.
The patient should temporarily take a higher
dose of his corticosteroid.
D
Feedback:
For people receiving chronic corticosteroid
therapy, dosage must be increased during
periods of stress or illness. Some common
sources of stress for most people include
surgery and anesthesia, infections, anxiety,
and extremes of temperature.
A)
B)
C)
D)
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A 50-year-old male is admitted to the
emergency room with a head injury after a
motorcycle crash. He is unconscious with one
6.
eye dilated and one constricted. He has a
widened pulse pressure. What corticosteroid
will most likely be administered parenterally?
Cortisone
Prednisone
Dexamethasone (Decadron)
Fluticasone (Flonase)
C
Feedback:
Dexamethasone is considered the
corticosteroid of cerebral edema. It is thought
to penetrate the blood–brain barrier more
readily and achieve higher concentrations in
cerebrospinal fluid. Cortisone is the drug of
choice for adrenal insufficiency. Prednisone is
the glucocorticoid of choice in nonendocrine
disorders in which anti-inflammatory,
antiallergic, antistress, and
immunosuppressive effects are desired.
Fluticasone (Flonase) is administered by oral
inhalation.
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A)
B)
C)
D)
Ans:
A)
B)
C)
D)
Ans:
A patient is being treated with corticosteroids
for chronic adrenocortical insufficiency.
7.
When should the patient be instructed to take
the medication?
Between 06:00 and 09:00
12:00
Between 13:00 and 14:00
21:00
A
Feedback:
Daily administration of corticosteroids is
7.
A patient is to be discharged on prednisone to
be administered every other day at 9:00 AM.
8. When implementing discharge teaching, what
should the nurse explain as the rationale for
giving the medication every other day?
It reduces adverse effects.
It prolongs therapeutic effects.
It prevents steroid tolerance.
It increases effectiveness.
A
Feedback:
Alternate-day therapy allows rest periods so
that adverse effects are decreased.
Alternative-day therapy will not prolong the
therapeutic effects, prevent steroid tolerance,
or increase effectiveness.
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A)
B)
C)
D)
Ans:
for chronic adrenocortical insufficiency.
When should the patient be instructed to take
the medication?
Between 06:00 and 09:00
12:00
Between 13:00 and 14:00
21:00
A
Feedback:
Daily administration of corticosteroids is
required in cases of chronic adrenocortical
insufficiency. The entire daily dose can be
taken each morning, between 06:00 and 09:00
AM. This schedule stimulates normal
endogenous corticosteroid secretion.
A)
B)
C)
D)
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B)
C)
D)
Ans:
A child is prescribed therapy with
glucocorticoids. The child is placed on
9.
alternate-day therapy. What is the advantage
of alternate-day therapy in this child?
The child will have less chance of infection.
It will protect the child from hyperglycemia.
The child will have less chance of
hypertension.
Adherence will be increased.
A
Feedback:
Intermediate-acting glucocorticoids are the
drugs of choice for alternate-day therapy and
will decrease the susceptibility of infection.
Alternative-day therapy will not protect from
hyperglycemia. Alternate-day therapy will not
affect blood pressure. Alternate-day therapy is
not used as a strategy for improving
adherence.
The child will have less chance of
hypertension.
Adherence will be increased.
A
Feedback:
Intermediate-acting glucocorticoids are the
drugs of choice for alternate-day therapy and
will decrease the susceptibility of infection.
Alternative-day therapy will not protect from
hyperglycemia. Alternate-day therapy will not
affect blood pressure. Alternate-day therapy is
not used as a strategy for improving
adherence.
C)
A 71-year-old woman with a history of
chronic obstructive pulmonary disease
(COPD) and congestive heart failure (CHF)
10. has begun tapering off of prednisone. The
nurse should prioritize which of the following
assessments during this phase of the woman's
care?
Daily weights
Level of consciousness assessment
Nonstress cardiac testing
Positional blood pressure measurement
A
Feedback:
When caring for a patient with COPD and a
history of heart failure who takes a tapering
dose of prednisone, it is necessary to instruct
the patient to check his or her weight daily.
The patient should also assess his or her
extremities for edema. If the patient's weight
increases, edema is evident, and shortness of
breath develops, the patient should notify the
primary health provider. This potential
alteration in fluid balance is more likely than
blood pressure changes, decreased LOC, or
acute cardiac changes.
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B)
C)
D)
Ans:
A)
B)
C)
D)
Ans:
A patient has long-standing pain in her right
hip, and the orthopedic surgeon has prepared
11. an intra-articular injection. How long will it
take for the patient to see improvement in her
pain and mobility?
Approximately 10 days
1 to 3 weeks
2 to 8 weeks
1 to 4 months
C
Feedback:
An intra-articular injection of corticosteroid
provides decreased pain and improved
movement in 2 to 8 weeks.
pain and mobility?
Approximately 10 days
1 to 3 weeks
2 to 8 weeks
1 to 4 months
C
Feedback:
An intra-articular injection of corticosteroid
provides decreased pain and improved
movement in 2 to 8 weeks.
A patient is admitted with an acute asthma
attack. He has been using inhaled
corticosteroids two times daily. Based on this
12.
information in the patient's history, what
should you anticipate will be required in his
care?
The patient will require an antibiotic to treat
infection.
The patient will require high doses of
systemic drugs.
The patient will need to be treated with an
oral opioid.
The patient will have diminished tidal volume
after treatment.
B
Feedback:
The patient who has taken inhaled steroids
will require high doses of systemic drugs
during acute attacks because aerosols are not
effective. The patient will only require
antibiotics in the presence of infection. The
patient's tidal volume should be increased
with the administration of systemic
corticosteroids. Opioids are not likely
indicated.
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B)
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B)
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A patient with a diagnosis of breast cancer is
administered a corticosteroid in addition to
13. chemotherapy agents. What effect will the
corticosteroids have on this patient's course of
recovery?
The corticosteroid will decrease signs and
symptoms of cancer.
The corticosteroid will alter the action of the
chemotherapy agent.
The corticosteroid will decrease metastasis to
distant sites.
The corticosteroid will decrease hepatic
effects of the chemotherapy.
A
Feedback:
The administration of corticosteroid agents in
cancer will assist in decreasing symptoms
A)
symptoms of cancer.
The corticosteroid will alter the action of the
chemotherapy agent.
The corticosteroid will decrease metastasis to
distant sites.
The corticosteroid will decrease hepatic
effects of the chemotherapy.
A
Feedback:
The administration of corticosteroid agents in
cancer will assist in decreasing symptoms
associated with cancer. The administration of
the corticosteroid will not alter the action of
the chemotherapy agent. The corticosteroid
will not affect metastasis. The corticosteroid
will not decrease hepatic effects.
B)
C)
D)
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B)
C)
D)
Ans:
A patient has a tumor of the spinal cord and is
administered a corticosteroid. What statement
14.
by the patient demonstrates an accurate
understanding of this treatment?
“This drug will cause my tumor to be more
susceptible to treatment.”
“This drug will decrease my chance of
infection and meningitis.”
“This drug won't cure my cancer, but it may
help me feel much better.”
“This drug will stop my cancer cells from
growing further.”
C
Feedback:
Patients tend to feel better when taking
corticosteroids, although the basic disease
process may be unchanged. The corticosteroid
will not allow the tumor to be more
susceptible to treatment. The corticosteroid
will not prevent meningitis.
A patient who is receiving chemotherapy is
administered a corticosteroid agent. What is
15.
the mostly likely intended effect of this drug
administration?
Increased pulmonary function
Decreased diarrhea
Decreased infection susceptibility
Decreased nausea
D
Feedback:
Corticosteroids have strong antiemetic
effects; the mechanism is unknown.
Corticosteroids diminish pulmonary
inflammation, but this reaction is not related
to chemotherapy administration. The
administration of corticosteroids will decrease
Decreased diarrhea
Decreased infection susceptibility
Decreased nausea
D
Feedback:
Corticosteroids have strong antiemetic
effects; the mechanism is unknown.
Corticosteroids diminish pulmonary
inflammation, but this reaction is not related
to chemotherapy administration. The
administration of corticosteroids will decrease
gastric inflammation but will not decrease
diarrhea. The administration of corticosteroids
will diminish the patient's ability to fight
infection.
An adult patient has been taking oral
prednisone for the treatment of an acute
16. dermatological condition. When teaching this
patient about this course of treatment, what
teaching point should the nurse emphasize?
The need to supplement prednisone with high
doses of vitamin D
The need to avoid drinking grapefruit juice
for the duration of treatment
The importance of gradually reducing rather
than abruptly stopping the drug
The importance of matching each day's dose
to the severity of symptoms
C
Feedback:
Gradually tapering the dose is necessary for
any systemic corticosteroid. It is not
imperative to avoid grapefruit juice or take
vitamin D supplements. Daily doses are not
normally adjusted on the basis of short-term
symptoms.
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C)
D)
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A)
B)
C)
D)
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A patient has questioned why she cannot stop
taking her prescribed corticosteroid as soon as
she achieves relief of her symptoms. The
17.
nurse should explain the rationale for the
patient's regimen based on which of the
following?
The serum half-life of many corticosteroids
can exceed 3 months.
Corticosteroids are sequestered in hepatocytes
and released over several weeks.
The HPA axis does not normally resume full
function for several months.
Abrupt cessation of corticosteroid therapy can
cause nephrotoxicity.
C
Feedback:
following?
The serum half-life of many corticosteroids
can exceed 3 months.
Corticosteroids are sequestered in hepatocytes
and released over several weeks.
The HPA axis does not normally resume full
function for several months.
Abrupt cessation of corticosteroid therapy can
cause nephrotoxicity.
C
Feedback:
When steroids are given for purposes other
than replacement and then discontinued, the
HPA axis usually recovers within several
weeks to months, but recovery may take a
year. The necessity for tapering is not based
on the half-life of the drugs, storage in the
liver, or the potential for nephrotoxicity.
A)
B)
C)
D)
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An adult patient is preparing to begin
corticosteroid treatment for rheumatoid
18. arthritis. When teaching this patient about the
appropriate use of corticosteroids, the nurse
should include what teaching point?
“You will likely gain some weight after you
start taking this drug.”
“Try to eat as many organic and natural foods
as possible while taking this drug.”
“You might have some slight bleeding in your
stool after you start this drug.”
“Ensure that you vary the times that you take
your drug in order to maximize
effectiveness.”
A
Feedback:
An initial weight gain is likely to occur with
steroid treatment and is usually attributed to
increased appetite. Organic foods are not
necessary, and a consistent schedule of
administration is imperative. Bleeding is not
expected.
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B)
C)
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D)
A)
B)
C)
A 12-year-old boy was recently diagnosed
with asthma, and his primary care provider
has prescribed a corticosteroid to be
19.
administered by metered-dose inhaler. This
drug achieves a therapeutic effect by which of
the following means?
By increasing the number of beta-adrenergic
receptors
By increasing the muscle tone in the smooth
muscle of the trachea
By increasing the permeability of the alveolar
membrane
A 12-year-old boy was recently diagnosed
with asthma, and his primary care provider
has prescribed a corticosteroid to be
19.
administered by metered-dose inhaler. This
drug achieves a therapeutic effect by which of
the following means?
By increasing the number of beta-adrenergic
receptors
By increasing the muscle tone in the smooth
muscle of the trachea
By increasing the permeability of the alveolar
membrane
By increasing the number of binding sites on
erythrocytes
A
Feedback:
Corticosteroids increase the number of betaadrenergic receptors and increase or restore
responsiveness of beta receptors to betaadrenergic bronchodilating drugs. They do not
influence the permeability of alveoli, muscle
tone, or the structure of red blood cells.
A)
B)
C)
D)
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A 22-year-old male patient has been living
with Crohn's disease for several years and is
20. experiencing an exacerbation of symptoms.
The nurse should anticipate the use of what
corticosteroid?
Oral fludrocortisone (Florinef)
Topical hydrocortisone
Oral dexamethasone (Decadron)
Oral prednisone
D
Feedback:
In moderate Crohn's disease, oral prednisone,
40 mg daily, is usually given until symptoms
subside. The other listed corticosteroids are
not normally used in the treatment of IBD.
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B)
C)
D)
Ans:
Chapter 18 Drug Therapy With Beta-Lactam Antibacterial Agents
A)
B)
C)
D)
Ans:
A patient is administered penicillin V orally
1. for a strep throat. What is the mechanism of
action of this medication?
It inhibits protein synthesis.
It lowers the pH of cellular contents.
It causes mutations.
It inhibits cell wall synthesis.
D
Feedback:
Beta-lactam antibacterial drugs inhibit
synthesis of bacterial cell walls by binding to
proteins in bacterial cell membranes.
Penicillin V does not inhibit protein synthesis,
It inhibits protein synthesis.
It lowers the pH of cellular contents.
It causes mutations.
It inhibits cell wall synthesis.
D
Feedback:
Beta-lactam antibacterial drugs inhibit
synthesis of bacterial cell walls by binding to
proteins in bacterial cell membranes.
Penicillin V does not inhibit protein synthesis,
cause mutations, or lower the pH of a
bacterium's cellular contents.
A patient previously experienced an
anaphylactic reaction to penicillin G. Which
2. of the following medications should not be
administered to this patient due to the
potential for cross-sensitivity?
Lactulose (Chronulac)
Ketoconazole (Nizoral)
Kanamycin (Kantrex)
Cefadroxil (Duricef)
D
Feedback:
Cefadroxil (Duricef) is a cephalosporin.
Administration of cephalosporins or
carbapenems should be avoided if possible in
people with life-threatening allergic reactions
to penicillin. Lactulose reduces blood
ammonia by resident intestinal bacteria. It is
not contraindicated in the event of penicillin
anaphylaxis. Ketoconazole is an antifungal
and does not possess cross-sensitivity to
penicillin. Kanamycin is an aminoglycoside
and does not possess cross-sensitivity to
penicillin.
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B)
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B)
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B)
C)
D)
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An adult patient has a history of rheumatic
fever. Which of the following medications
3.
should be administered as prophylaxis for
rheumatic fever?
Cyclacillin (Cyclapen)
Amoxicillin (Augmentin)
Dicloxacillin
Penicillin G benzathine (Bicillin LA)
D
Feedback:
Penicillin G benzathine (Bicillin LA) is
administered as prophylaxis for rheumatic
fever. Cyclacillin, amoxicillin, and
dicloxacillin are not routinely administered
for prophylaxis of rheumatic fever.
B)
C)
D)
Ans:
Amoxicillin (Augmentin)
Dicloxacillin
Penicillin G benzathine (Bicillin LA)
D
Feedback:
Penicillin G benzathine (Bicillin LA) is
administered as prophylaxis for rheumatic
fever. Cyclacillin, amoxicillin, and
dicloxacillin are not routinely administered
for prophylaxis of rheumatic fever.
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A)
A patient has been prescribed an oral
penicillin for an infection caused by gram4. negative bacilli. When conducting health
education for this patient, the nurse should
emphasize which of the following?
The need to take the medication on an empty
stomach
The fact that a mild rash frequently follows
the first few doses
The need to increase fluid intake for the
duration of treatment
The fact that the drug should be discontinued
once symptoms subside
A
Feedback:
Most penicillins should be best taken on an
empty stomach. Increased fluid intake is not
normally necessary. A rash is an unexpected
finding that should be reported promptly. The
patient should take the full course of
antibiotics.
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C)
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A)
B)
C)
D)
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Unasyn is being administered to a patient with
an infection caused by Staphylococcus
5.
aureus. What type of anti-infective is
Unasyn?
Extended-spectrum antipseudomonal
penicillin
Penicillin–beta-lactamase inhibitor
combination
Cephalosporin
Aminopenicillin
B
Feedback:
Unasyn is a penicillin–beta-lactamase
inhibitor combination. It is ampicillin and
sulbactam. Unasyn is not classified as an
extended-spectrum antipseudomonal
penicillin, cephalosporin, or aminopenicillin.
B)
combination
Cephalosporin
Aminopenicillin
B
Feedback:
Unasyn is a penicillin–beta-lactamase
inhibitor combination. It is ampicillin and
sulbactam. Unasyn is not classified as an
extended-spectrum antipseudomonal
penicillin, cephalosporin, or aminopenicillin.
C)
D)
Ans:
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A)
A patient is administered Augmentin
(amoxicillin and clavulanate potassium) to
6.
treat otitis media. How does a beta-lactamase
inhibitor agent achieve a therapeutic effect?
It extends the spectrum of antibacterial
activity of penicillin.
It extends the spectrum of the beta-lactamase
inhibitor.
It decreases the side effects of high-dose
penicillin.
It increases the absorption of the penicillin.
A
Feedback:
When combined with a penicillin, the betalactamase inhibitor protects the penicillin
from destruction by the enzymes and extends
the penicillin's spectrum of antimicrobial
activity. Augmentin does not extend the
spectrum of beta-lactamase inhibitor.
Augmentin does not decrease the side effects
of high-dose penicillin. Augmentin does not
increase the absorption of penicillin.
B)
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B)
C)
D)
Ans:
A patient is administered a third-generation
cephalosporin. Which of the following
7.
microorganisms are cephalosporins most
effective in treating?
Gram-positive
Gram-negative
Fungi
Virus
B
Feedback:
Cephalosporins are broad-spectrum agents
with activity against both gram-positive and
gram-negative bacteria. Compared with
penicillins, they are, in general, less active
against gram-positive organisms but more
active against gram-negative ones.
Cephalosporins are not effective against fungi
or viruses.
B)
C)
D)
Ans:
Gram-negative
Fungi
Virus
B
Feedback:
Cephalosporins are broad-spectrum agents
with activity against both gram-positive and
gram-negative bacteria. Compared with
penicillins, they are, in general, less active
against gram-positive organisms but more
active against gram-negative ones.
Cephalosporins are not effective against fungi
or viruses.
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A patient is diagnosed with infective
endocarditis. Which of the following
8.
medications is most effective in treating this
patient?
Dicloxacillin
Ampicillin
Nafcillin
Oxacillin
B
Feedback:
Health care providers use ampicillin in the
treatment or prophylaxis of infective
endocarditis. Dicloxacillin, nafcillin, and
oxacillin are typically used to treat
methicillin-resistant Staphylococcus aureus.
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B)
C)
D)
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B)
C)
D)
Ans:
A patient with septicemia is administered
cefotaxime sodium (Claforan), a second9.
generation cephalosporin. How is this
medication excreted?
It is excreted by the lungs.
It is excreted by the liver.
It is excreted by the kidneys.
It is excreted through the GI tract.
C
Feedback:
Cefotaxime sodium, like all cephalosporins, is
excreted by the kidneys. Cefotaxime is not
excreted by the lungs, liver, or GI tract.
A patient is scheduled for a vaginal
hysterectomy. Which of the following
10.
medications is the drug of choice for surgical
prophylaxis?
Cefadroxil (Duricef)
Cefazolin sodium (Ancef)
Cephalexin (Keflex)
Cephradine (Velosef)
B
Feedback:
Cefazolin sodium (Ancef) is the drug of
choice for surgical prophylaxis in most
surgical procedures. Cefadroxil, cephalexin,
and cephradine are all first-generation
cephalosporins, but they are not utilized as the
drug of choice for surgical prophylaxis.
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A)
B)
C)
D)
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A patient is diagnosed with B. fragilis, an
anaerobic organism resistant to most drugs.
11.
What is the drug of choice to treat this
microorganism?
Cefaclor (Ceclor)
Cefamandole nafate (Mandol)
Cefoxitin (Mefoxin)
Cefuroxime sodium (Zinacef)
C
Feedback:
Cefoxitin (Mefoxin) is active against B.
fragilis, an anaerobic organism resistant to
most drugs. Cefaclor, cefamandole nafate, and
cefuroxime sodium are all second-generation
cephalosporins but not the drug of choice for
B. fragilis.
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B)
C)
D)
Ans:
A)
B)
C)
D)
Ans:
A patient is to receive imipenem–cilastatin
(Primaxin) IM to treat P. aeruginosa. What
12.
should imipenem–cilastatin be mixed with
prior to administering intramuscularly?
Meropenem (Merrem)
Gentamicin (Garamycin)
Lidocaine
Epinephrine
C
Feedback:
When preparing imipenem–cilastatin for IM
injection, lidocaine is added to decrease pain.
Meropenem, gentamicin, and epinephrine are
not added to imipenem–cilastatin.
A)
B)
C)
D)
Ans:
Meropenem (Merrem)
Gentamicin (Garamycin)
Lidocaine
Epinephrine
C
Feedback:
When preparing imipenem–cilastatin for IM
injection, lidocaine is added to decrease pain.
Meropenem, gentamicin, and epinephrine are
not added to imipenem–cilastatin.
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A)
A patient is administered imipenem–cilastatin
for the treatment of an E. coli infection. The
13. nurse should be aware that cilastatin is
combined with the imipenem for what
purpose?
To eliminate adverse effects of imipenem
administration
To inhibit the destruction of imipenem
To potentiate the therapeutic effects of
imipenem
To allow imipenem to cross the blood–brain
barrier
B
Feedback:
Cilastatin inhibits the destruction of
imipenem, increasing the urinary
concentration of imipenem and reducing its
potential renal toxicity. It does not allow the
drug to cross the blood–brain barrier, and
cilastatin does not eliminate all adverse
effects.
B)
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A)
B)
C)
D)
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A patient is administered aztreonam
(Azactam). What is the major advantage of
14.
this monobactam over the aminoglycosides in
treating P. aeruginosa?
It is a lower-cost medication.
It is administered orally.
It causes less GI distress.
It has lower risk for hearing loss.
D
Feedback:
Aztreonam is effective against gram-negative
bacteria similar to aminoglycosides, but the
drug does not cause kidney damage or hearing
loss. Aztreonam is not a lower-cost
medication. Aztreonam is not administered
orally. Aztreonam does not cause less GI
upset.
B)
C)
D)
Ans:
It is administered orally.
It causes less GI distress.
It has lower risk for hearing loss.
D
Feedback:
Aztreonam is effective against gram-negative
bacteria similar to aminoglycosides, but the
drug does not cause kidney damage or hearing
loss. Aztreonam is not a lower-cost
medication. Aztreonam is not administered
orally. Aztreonam does not cause less GI
upset.
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A 71-year-old man with a history of
osteoarthritis is scheduled for hip replacement
surgery, and the surgeon has ordered a first15. generation cephalosporin to be administered
before and after surgery as prophylaxis.
Which of the following drugs is a firstgeneration cephalosporin?
Cefotetan (Cefotan)
Cefoxitin (Mefoxin)
Ceftriaxone (Rocephin)
Cefazolin (Ancef)
D
Feedback:
Cefazolin (Ancef) is a first-generation
cephalosporin. Cefotetan (Cefotan) and
cefoxitin (Mefoxin) belong to the second
generation, and ceftriaxone (Rocephin) is a
third-generation cephalosporin.
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A)
B)
C)
D)
Ans:
A)
B)
C)
D)
Ans:
Oral ampicillin has been ordered for a female
patient whose urinary tract infection will be
treated in a home setting. When teaching this
16.
patient about her antibiotic, the nurse should
instruct the patient to do which of the
following?
Take the first dose together with
diphenhydramine to reduce the chance of an
allergic reaction.
Take the drug immediately before a meal,
unless the meal will contain large amounts of
fat.
Drink a full glass of water when taking a dose
of the drug.
Taper off the drug rather than abruptly
stopping it.
C
Feedback:
Patients taking penicillins should take oral
doses with a full glass of water. The drugs
should otherwise be taken on an empty
stomach. Tapering is unnecessary, and it is not
Drink a full glass of water when taking a dose
of the drug.
Taper off the drug rather than abruptly
stopping it.
C
Feedback:
Patients taking penicillins should take oral
doses with a full glass of water. The drugs
should otherwise be taken on an empty
stomach. Tapering is unnecessary, and it is not
advised to take the drug with
diphenhydramine in an effort to reduce the
allergy risk.
C)
D)
An older adult patient has just been diagnosed
with community-acquired pneumonia and
17. aztreonam (Azactam) has been ordered. What
action should the nurse perform before
administering the first dose?
Administer a 500 mL bolus of normal saline.
Confirm the patient's allergy status.
Swab the patient's nares for the presence of
MRSA.
Teach the patient to expect discolored urine
during treatment.
B
Feedback:
As with all antibiotics, it is important to
assess the patient's allergy status prior to drug
administration. This is especially important
before the initial dose. An IV bolus is
unnecessary, and discoloration of urine is not
expected. MRSA testing is not relevant to
aztreonam administration.
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B)
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Ans:
A)
B)
C)
D)
Ans:
An intensive care unit (ICU) nurse is
preparing to administer an intravenous dose
of imipenem–cilastatin to a patient who is
18.
being treated for sepsis. What aspect of this
patient's history would contraindicate the use
of this drug?
The patient has a history of type 1 diabetes
mellitus.
The patient is showing signs and symptoms of
fluid volume excess.
The patient's most recent creatinine level was
140 µmol/L (high).
The patient has a documented allergy to
penicillin.
D
Feedback:
It is important to avoid administering
imipenem–cilastatin and the other
carbapenems to people with life-threatening
B)
fluid volume excess.
The patient's most recent creatinine level was
140 µmol/L (high).
The patient has a documented allergy to
penicillin.
D
Feedback:
It is important to avoid administering
imipenem–cilastatin and the other
carbapenems to people with life-threatening
allergic reactions to penicillin. Diabetes,
slightly increased creatinine levels, and fluid
overload do not necessarily contraindicate the
use of imipenem–cilastatin.
C)
D)
A nurse has established intravenous access in
a patient whose infection necessitates
19. treatment with IV cefazolin. What potential
adverse reaction is most likely during this
patient's course of treat?
Gastrointestinal upset
Dry skin and pruritus
Drowsiness
Orthostatic hypotension
A
Feedback:
Adverse effects to cefazolin and the other
cephalosporins are similar to those of most
other antibiotics: abdominal pain, diarrhea,
gastritis, nausea, and vomiting.
Integumentary, neurological, and blood
pressure changes are atypical.
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B)
C)
D)
Ans:
A)
B)
C)
D)
Ans:
A 69-year-old female responded well to
inpatient treatment with a third-generation
cephalosporin. After being largely symptom
20. free for 48 hours, the woman has developed a
fever of 38.6°C and an elevated white cell
count. What phenomenon may account for
this patient's current clinical presentation?
The patient may be infected with
microorganisms that were resistant to the
cephalosporin.
The patient may be experiencing a delayed
(type IV) hypersensitivity reaction to the
cephalosporin.
The patient may be developing
glomerulonephritis secondary to the
nephrotoxic cephalosporin.
The cephalosporin may have initially caused
leukopenia and made the patient susceptible
to secondary infection.
A
Feedback:
B)
(type IV) hypersensitivity reaction to the
cephalosporin.
The patient may be developing
glomerulonephritis secondary to the
nephrotoxic cephalosporin.
The cephalosporin may have initially caused
leukopenia and made the patient susceptible
to secondary infection.
A
Feedback:
Patients treated with cephalosporins may be
vulnerable to superinfections (infection after a
previous infection, typically caused by
microorganisms that are resistant to the
antibiotics used earlier). Delayed
hypersensitivity and renal involvement are
highly unlikely. Antibiotics do not cause
leukopenia.
C)
D)
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Chapter 19 Drug Therapy With Aminoglycosides and Fluoroquinolones
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A patient is diagnosed with an infection
attributable to the gram-negative
1. microorganism Pseudomonas. Which of the
following anti-infective agents is most
reliable in treating this microorganism?
Aminoglycoside
Antifungal
Aminopenicillin
GABA analog
A
Feedback:
Aminoglycosides are used to treat infections
caused by gram-negative microorganisms,
such as Pseudomonas. Antifungal and
aminopenicillin agents are not used to treat
Pseudomonas. A GABA analog is used to
treat pain related to neuropathy.
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B)
C)
D)
Ans:
A)
B)
C)
D)
Ans:
A patient is diagnosed with a gram-negative
infection and is prescribed an
2.
aminoglycoside. What is the action of an
aminoglycoside?
It blocks protein synthesis of the cell wall.
It blocks DNA replication.
It destroys the integrity of the cell wall
structure.
It increases white blood cell viability.
A
Feedback:
Aminoglycosides penetrate the cell walls of
susceptible bacteria and bind irreversibly to
30S and 50S ribosomes, intracellular
A)
B)
It blocks protein synthesis of the cell wall.
It blocks DNA replication.
It destroys the integrity of the cell wall
structure.
It increases white blood cell viability.
A
Feedback:
Aminoglycosides penetrate the cell walls of
susceptible bacteria and bind irreversibly to
30S and 50S ribosomes, intracellular
structures that synthesize proteins.
Aminoglycosides do not block DNA
replication, destroy cell wall structure, or
increase white blood cells.
C)
The nurse is preparing to administer
gentamicin (Garamycin) to a patient when he
3. mentions that he has recently been
experiencing diminished hearing. What action
should the nurse take based on this statement?
Administer the dosage and notify the
physician of the alteration in hearing.
Hold the dosage and notify the physician of
the alteration in hearing.
Administer the dosage and report the
alteration in hearing to the audiologist.
Hold the dosage and document the finding in
the nurses' notes.
B
Feedback:
Aminoglycosides accumulate in high
concentrations in the inner ear, damaging
sensory cells in the cochlea and vestibular
apparatus. The medication should be held and
alteration in hearing reported to the physician.
The administration of the medication will
only cause more damage to the cochlea and
vestibular apparatus. Holding the medication
and documenting the information in the
nurses' notes will not allow for a new antiinfective to be administered and for the
hearing to be assessed.
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B)
C)
D)
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A patient is diagnosed with multidrugresistant tuberculosis. Which of the following
4.
aminoglycoside medications is used in a 4- to
6-drug regimen?
Tetracycline hydrochloride (Achromycin)
Amoxicillin (Amoxil)
Sulfadiazine (Sulfisoxazole)
Streptomycin (Sulfate)
D
Feedback:
Streptomycin may be used as part of a 4- to 6-
4.
A patient is scheduled for a bowel resection.
He is to receive neomycin sulfate (NeoFradin) by mouth. The patient asks the nurse
5.
the purpose of this medication. What is the
most appropriate response the nurse can
provide to the patient?
“The administration by mouth will prevent
renal damage.”
“The administration by mouth will prevent
ototoxicity.”
“The administration will decrease the risk of
contamination.”
“The administration decreases the risk of
airborne contamination.”
C
Feedback:
Neomycin can be given before bowel surgery
to suppress intestinal bacterial growth. The
administration of neomycin will not prevent
renal damage or ototoxicity. It will also not
affect the risk of airborne contamination.
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A)
B)
C)
D)
Ans:
resistant tuberculosis. Which of the following
aminoglycoside medications is used in a 4- to
6-drug regimen?
Tetracycline hydrochloride (Achromycin)
Amoxicillin (Amoxil)
Sulfadiazine (Sulfisoxazole)
Streptomycin (Sulfate)
D
Feedback:
Streptomycin may be used as part of a 4- to 6drug regimen for treatment of multidrugresistant tuberculosis. Tetracycline,
amoxicillin, and sulfadiazine are not
aminoglycosides or drugs of choice for
multidrug-resistant tuberculosis.
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B)
C)
D)
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A patient has been administered an
aminoglycoside. It is time for his next dose,
6. and the nurse learns his creatinine level is
elevated at 3.9 mg/dL. What action should the
nurse take regarding this assessment?
Administer the medication and report the
creatinine level.
Hold the dose until another creatinine level is
assessed.
Administer the medication with 100 mL of
fluids.
Hold the medication and assess the urine
output.
D
Feedback:
Aminoglycosides are nephrotoxic and should
nurse take regarding this assessment?
Administer the medication and report the
creatinine level.
Hold the dose until another creatinine level is
assessed.
Administer the medication with 100 mL of
fluids.
Hold the medication and assess the urine
output.
D
Feedback:
Aminoglycosides are nephrotoxic and should
not be administered in the presence of renal
impairment. It is important to hold the
medication, assess the urine output, and notify
the physician. The medication should not be
administered. The medication should be held,
but the creatinine level cannot be reassessed
without a doctor's order. The administration
with fluids will not protect the patient from
renal impairment.
A)
B)
C)
D)
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A patient has a genitourinary infection and is
being treated with a fluoroquinolone. What is
7.
the advantage of a fluoroquinolone over an
aminoglycoside?
The fluoroquinolone does not have adverse
effects.
The fluoroquinolone can be given orally.
The fluoroquinolone has a nearly immediate
peak.
The fluoroquinolone has a broader spectrum.
B
Feedback:
Fluoroquinolones are often given orally. Like
all drugs, they have adverse effects. Peak
levels are not immediately achieved, and they
do not have a broader spectrum than an
aminoglycoside.
A)
B)
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A)
B)
C)
D)
Ans:
A patient is receiving gentamicin (Garamycin)
to treat meningitis. The physician has ordered
a peak serum level be drawn in association
8.
with the 07:00 dose, which will finish
infusing at 07:30. When should the peak
serum level be drawn?
08:00
09:00
10:00
12:00
A
Feedback:
With conventional dosing, it is necessary to
take gentamicin peak levels 30 minutes after
8.
A)
B)
C)
D)
Ans:
with the 07:00 dose, which will finish
infusing at 07:30. When should the peak
serum level be drawn?
08:00
09:00
10:00
12:00
A
Feedback:
With conventional dosing, it is necessary to
take gentamicin peak levels 30 minutes after
the end of a 30-minute IV infusion. Thus,
8:00 AM is the optimal peak time to assess
the serum level of gentamicin.
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A patient has been prescribed a once-daily
9. aminoglycoside. What is the advantage of this
method of administration?
It is associated with less hepatotoxicity.
It is significantly more cost-effective.
It reduces the risk of nephrotoxicity.
It increases adherence to treatment.
C
Feedback:
The use of once-daily aminoglycoside dosing
has replaced the common multiple daily
dosing. The rationale for this dosing approach
is a potential increase in efficacy with a
reduced incidence of nephrotoxicity.
B)
C)
D)
Ans:
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B)
C)
D)
Ans:
A patient is prescribed ciprofloxacin (Cipro).
10. Which of the following nursing interventions
will best prevent crystalluria?
The nurse should limit oral fluids to 500 mL/
day.
The nurse should administer 2000 mL of oral
fluids per day.
The nurse should insert a urinary catheter.
The nurse should administer phenazopyridine
(Pyridium).
B
Feedback:
Guidelines to decrease the incidence and
severity of adverse effects include keeping
patients well hydrated to decrease drug
concentrations in serum body tissues. The
administration of 500 mL is not a sufficient
amount to prevent crystalluria. The
administration of Pyridium will not prevent
crystalluria. A urinary catheter is not
indicated.
C)
The nurse should insert a urinary catheter.
The nurse should administer phenazopyridine
(Pyridium).
B
Feedback:
Guidelines to decrease the incidence and
severity of adverse effects include keeping
patients well hydrated to decrease drug
concentrations in serum body tissues. The
administration of 500 mL is not a sufficient
amount to prevent crystalluria. The
administration of Pyridium will not prevent
crystalluria. A urinary catheter is not
indicated.
D)
A nurse has informed the laboratory
technician that a patient's gentamicin has
finished infusing and the technician will soon
11.
draw a blood sample to determine the
patient's serum drug concentration. Why is
assessment of gentamicin levels necessary?
To identify possible changes in the patient's
serum osmolality
To identify whether the drug is at a
therapeutic level
To identify whether the drug is causing
hepatotoxicity
To identify possible hemolysis following
administration
B
Feedback:
Measurement of both peak and trough levels
of gentamicin helps maintain therapeutic
serum levels without excessive toxicity.
Gentamicin is nephrotoxic, not hepatotoxic.
Hematological changes are not assessed by
measuring serum drug levels.
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B)
C)
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An adult male patient with a diagnosis of
osteomyelitis will soon begin treatment with
12. gentamicin. Which of the following schedules
is most likely to maximize efficacy and
minimize nephrotoxicity?
Gentamicin 500 mg IV OD at 1200
Gentamicin 250 mg PO BID at 07:30 and
19:30
Gentamicin 500 mg PO TID at 08:00, 12:00,
and 17:00
Gentamicin 125 mg IV QID at 06:00, 1200,
18:00, and 24:00
A
Feedback:
The ODA method uses higher doses (e.g., 4 to
7 mg/kg) to produce high initial drug
A)
Gentamicin 500 mg IV OD at 1200
Gentamicin 250 mg PO BID at 07:30 and
19:30
Gentamicin 500 mg PO TID at 08:00, 12:00,
and 17:00
Gentamicin 125 mg IV QID at 06:00, 1200,
18:00, and 24:00
A
Feedback:
The ODA method uses higher doses (e.g., 4 to
7 mg/kg) to produce high initial drug
concentrations, with no repeat dosing until the
serum concentration is quite low (typically 24
hours later). The rationale for this dosing
approach is a potential increase in efficacy
with a reduced incidence of nephrotoxicity.
Gentamicin is not administered orally.
B)
C)
D)
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A medical nurse is aware of the need to assess
for potential ototoxicity in patients who are
being treated with gentamicin. Which of the
13.
following patients is likely most susceptible
to developing ototoxicity secondary to
gentamicin?
A man who received his first dose of IV
gentamicin 12 hours ago
A man who has required repeated courses of
gentamicin over the past several months
A woman who has a Pseudomonas infection
but who has a hypersensitivity to penicillins
A woman who is immunocompromised and
who is being treated with gentamicin
B
Feedback:
Ototoxicity (auditory or vestibular) may
develop after extended use of gentamicin and
may not be reversible. Penicillin allergies and
immunocompromised status are not risk
factors for ototoxicity.
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B)
C)
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B)
C)
D)
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A patient with sepsis is being treated with
gentamicin, and her medication regimen takes
14.
into account the phenomenon of postantibiotic
effects. What are postantibiotic effects?
The tendency for patients to exhibit
symptoms mimicking hypersensitivity after
drug administration
The tendency for adverse effects of a drug to
be masked during administration
The ability of microorganisms to proliferate
between doses of antibiotics
The ability of an antibiotic to kill bacteria
even when serum concentrations are low
D
The tendency for patients to exhibit
symptoms mimicking hypersensitivity after
drug administration
The tendency for adverse effects of a drug to
be masked during administration
The ability of microorganisms to proliferate
between doses of antibiotics
The ability of an antibiotic to kill bacteria
even when serum concentrations are low
D
Feedback:
Postantibiotic effects mean that
aminoglycosides continue killing
microorganisms even at low serum
concentrations.
A)
B)
C)
D)
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B)
C)
D)
Ans:
Extreme caution would be necessary with the
15. use of gentamicin in which of the following
patients?
A patient who is morbidly obese and who has
primary hypertension
A patient who has chronic renal failure
secondary to diabetes mellitus
A patient who has bipolar disorder and who is
on long-term lithium therapy
A patient who has an atrioventricular block
B
Feedback:
Gentamicin is nephrotoxic, and with impaired
renal function, a reduction in dosage is
essential. Heart blocks, obesity, and lithium
therapy do not severely complicate, or
contraindicate, the use of an aminoglycoside.
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Ans:
A patient has been prescribed ciprofloxacin
after being diagnosed with a sinus infection.
16.
Which of the following should the patient
avoid taking concurrently with ciprofloxacin?
Antacids
Calcium channel blockers
Beta-adrenergic blockers
Diuretics
A
Feedback:
Patients should space out ciprofloxacin
administration 4 to 6 hours with any of the
following: antacids, multivitamins, sucralfate,
or other products containing calcium, iron, or
zinc. Absorption of ciprofloxacin may be
impaired when these substances are
administered together with ciprofloxacin,
resulting in a decreased antibiotic effect.
Calcium channel blockers
Beta-adrenergic blockers
Diuretics
A
Feedback:
Patients should space out ciprofloxacin
administration 4 to 6 hours with any of the
following: antacids, multivitamins, sucralfate,
or other products containing calcium, iron, or
zinc. Absorption of ciprofloxacin may be
impaired when these substances are
administered together with ciprofloxacin,
resulting in a decreased antibiotic effect.
An older adult patient is recovering in
hospital from an ischemic stroke and has a
feeding tube in place due to dysphagia. The
17. patient has developed an infected pressure
ulcer, and ciprofloxacin suspension has been
ordered as empiric therapy. How should the
nurse follow up this order?
The nurse should flush the patient's feeding
tube with free water before and after
administration of the ciprofloxacin
suspension.
The nurse should dilute the suspension
thoroughly before administration.
The nurse should liaise with the care provider
to provide an alternative route of
administration.
The nurse should administer small, frequent
doses of the drug to minimize GI upset.
C
Feedback:
Administration of the oral suspension of
ciprofloxacin via feeding tubes should not
occur, because the oil-based formulation tends
to adhere to the feeding tube. An alternative
route is consequently necessary.
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B)
C)
D)
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A hospital patient has been prescribed
ciprofloxacin IV for the treatment of cellulitis.
After initiating the infusion of the patient's
18.
first scheduled dose, the patient develops a
pronounced rash to her chest and arms. How
should the nurse respond to this event?
Discontinue the infusion and inform the care
provider promptly
Slow down the rate so that the infusion takes
place over 2 hours
Administer oral diphenhydramine to the
patient during the infusion
Administer a STAT dose of acetylcysteine
A
18.
A)
B)
C)
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D)
Ans:
first scheduled dose, the patient develops a
pronounced rash to her chest and arms. How
should the nurse respond to this event?
Discontinue the infusion and inform the care
provider promptly
Slow down the rate so that the infusion takes
place over 2 hours
Administer oral diphenhydramine to the
patient during the infusion
Administer a STAT dose of acetylcysteine
A
Feedback:
Severe hypersensitivity reactions have
occurred with the administration of
fluoroquinolones. The nurse discontinues the
antibiotic immediately if skin rash or other
signs or symptoms occur. Administration of
acetylcysteine or diphenhydramine is not
indicated.
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Chapter 20 Drug Therapy With Tetracyclines, Sulfonamides, and Urinary
Antiseptics
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A patient has been prescribed
phenazopyridine (Pyridium) for urinary tract
1. symptoms related to the infection. The patient
asks why she is taking this medication. What
is the most appropriate response by the nurse?
“This medicine is used to treat urinary
retention.”
“This medicine will stop the blood in your
urine.”
“This medicine will decrease the pain of your
infection.”
“This medicine will prevent hesitancy when
you're passing urine.”
C
Feedback:
Phenazopyridine (Pyridium) is given to
relieve pain associated with urinary tract
infection. It is not administered for urinary
retention, hematuria, or hesitancy.
A)
Ans:
A)
B)
C)
D)
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A patient is given tetracycline (Sumycin) to
2. treat acne-related skin eruptions. How does
tetracycline work?
It binds to the 30S ribosome to inhibit protein
synthesis.
It reduces central nervous system stimulation.
It is a beta-lactam antibiotic inhibiting cell
wall synthesis.
It works on the final stage of cell wall
synthesis.
A patient is given tetracycline (Sumycin) to
2. treat acne-related skin eruptions. How does
tetracycline work?
It binds to the 30S ribosome to inhibit protein
synthesis.
It reduces central nervous system stimulation.
It is a beta-lactam antibiotic inhibiting cell
wall synthesis.
It works on the final stage of cell wall
synthesis.
A
Feedback:
Tetracycline binds with the 30S ribosome to
inhibit protein synthesis. It has no effect on
the central nervous system. The penicillin
agents are beta-lactam antibiotics. Ampicillin
works in the final stage of cell wall synthesis.
A)
B)
C)
D)
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B)
C)
D)
Ans:
A)
B)
C)
D)
Ans:
A patient is seen in the clinic after a bite from
a tick. She has a rash over her arms and legs
3.
and arthritic pain in the joints. What is the
drug of choice for Lyme's disease?
Ibuprofen (Motrin)
Tetracycline (Sumycin)
Phenazopyridine (Pyridium)
Nitrofurantoin (Macrodantin)
B
Feedback:
Tetracyclines are useful in treating some
animal bites and Lyme's disease. Ibuprofen is
administered for the inflammation associated
with the arthritic pain, but not to treat the
infection. Phenazopyridine is not
administered for Lyme's disease.
Nitrofurantoin is administered for urinary
tract infections.
A teenager asks the nurse how tetracycline
(Sumycin) will improve her acne. Which of
4. the following is the best statement the nurse
can provide to the patient regarding the action
of tetracycline?
“Tetracycline decreases redness and swelling
of the pustules.”
“Tetracycline treats the Chlamydia organism
that causes acne.”
“Tetracycline is used in combination with
doxycycline to treat acne.”
“Tetracycline interferes with the production of
free fatty acids.”
D
Feedback:
Tetracyclines interfere with the production of
free fatty acids and decrease Corynebacterium
A)
of the pustules.”
“Tetracycline treats the Chlamydia organism
that causes acne.”
“Tetracycline is used in combination with
doxycycline to treat acne.”
“Tetracycline interferes with the production of
free fatty acids.”
D
Feedback:
Tetracyclines interfere with the production of
free fatty acids and decrease Corynebacterium
in sebum. Tetracycline will decrease redness
and swelling, but this response is not the
direct action of the medication. Tetracycline
treats Chlamydia but is not the cause of acne.
Tetracycline is not combined with
doxycycline.
B)
C)
D)
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A patient has sustained a burn from a gas
grill. She has been prescribed a sulfonamide
5. to prevent a burn infection. What route is
preferred in the prevention of a burn
infection?
Intrathecal
Topical
Parenteral
Oral
B
Feedback:
Topical sulfonamides are used in prevention
of burn wound infections. Sulfonamides are
not administered intrathecally. Parenteral and
oral administrations are not recommended for
the prevention of a burn infection.
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A)
B)
C)
D)
Ans:
A)
B)
C)
D)
Ans:
A 70-year-old woman is assessed in the clinic
for signs and symptoms of chronic bronchitis
6. related to pneumococci. Which of the
following is a sulfonamide that will most
likely be prescribed?
Trimethoprim–sulfamethoxazole (Bactrim)
Tetracycline (Sumycin)
Doxycycline (Vibramycin)
Demeclocycline (Declomycin)
A
Feedback:
Trimethoprim–sulfamethoxazole is used to
treat chronic bronchitis due to pneumococci.
Tetracycline, doxycycline, and
demeclocycline are not sulfonamides.
B)
C)
D)
Ans:
Tetracycline (Sumycin)
Doxycycline (Vibramycin)
Demeclocycline (Declomycin)
A
Feedback:
Trimethoprim–sulfamethoxazole is used to
treat chronic bronchitis due to pneumococci.
Tetracycline, doxycycline, and
demeclocycline are not sulfonamides.
A patient is being treated for a urinary tract
infection with trimethoprim–
7. sulfamethoxazole (Bactrim). What assessment
should the nurse make prior to the
administration of the medication?
Assessing for the presence of asthma
Assessing for hypertension
Assessing for diabetes mellitus
Assessing for renal insufficiency
D
Feedback:
Both tetracyclines and sulfonamides are
contraindicated in patients with renal failure.
These medications are not contraindicated in
patients with asthma, hypertension, or
diabetes mellitus.
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B)
C)
D)
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B)
C)
D)
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A patient has been prescribed doxycycline
(Vibramycin). Which of the following
8.
teaching instructions is a priority with this
medication?
Avoid sun exposure.
Avoid unprotected sexual activity.
Administer with an antacid.
Chew the tablets.
A
Feedback:
The administration of doxycycline increases
photosensitivity, which is a common side
effect. Avoidance of sexual activity is not
taught. The medication should not be
administered with an antacid; the
administration of an antacid will result in
diminished absorption of the medication. The
doxycycline tablets should not be chewed.
A patient is started on sulfamethoxazole–
trimethoprim (Bactrim) for a urinary
9.
infection. What would contraindicate the use
of Bactrim with this patient?
Liver failure
Rheumatoid arthritis
Bone marrow depression
Congestive heart failure
A
Feedback:
Hepatic disease contraindicates the use of
Bactrim. The other listed health problems do
not necessarily preclude the safe use of
Bactrim.
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B)
C)
D)
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B)
C)
D)
Ans:
A)
B)
C)
D)
Ans:
A patient is administered a sulfonamide for a
urinary tract infection. Which of the following
10.
nursing interventions is most appropriate to
increase the alkalinity of the patient's urine?
Provide at least 2000 mL of water daily.
Administer sodium bicarbonate.
Recommend a tub bath every evening.
Provide orange juice daily.
B
Feedback:
The urine can be alkalinized by giving sodium
bicarbonate. The administration of water is
important but will not increase alkalinity. The
taking of tub baths is not recommended due to
the fact that doing so increases the risk of
urinary tract infection. The administration of
orange juice increases acid, not alkalinity.
What is the rationale for not administering
11. tetracycline (Sumycin) to children under the
age of 8 years?
It will not treat the infection.
It will increase the risk of heart failure.
It will interfere with enamel development.
It will increase the risk for future infections.
C
Feedback:
Tetracyclines should not be used in children
younger than 8 years because of their effects
on teeth and bones. In teeth, the drugs
interfere with enamel development. The
medication can treat the infection.
Tetracycline does not increase the risk of
It will increase the risk of heart failure.
It will interfere with enamel development.
It will increase the risk for future infections.
C
Feedback:
Tetracyclines should not be used in children
younger than 8 years because of their effects
on teeth and bones. In teeth, the drugs
interfere with enamel development. The
medication can treat the infection.
Tetracycline does not increase the risk of
heart failure. The administration of
tetracycline will not increase the risk of future
infections.
A 64-year-old female patient sought care for
the treatment of a urinary tract infection, and
her primary care provider prescribed
12.
nitrofurantoin. What change in the patient's
health status would prompt the use of an
alternative medication?
The patient develops a fluid volume deficit.
Urinalysis reveals the presence of ketones.
The patient develops leukocytosis.
The patient's UTI progresses to urosepsis.
D
Feedback:
Urinary antiseptics may be bactericidal for
sensitive organisms in the urinary tract
because these drugs are concentrated in renal
tubules and reach high levels in urine. They
are not used in systemic infections because
they do not attain therapeutic plasma levels.
Consequently, the development of urosepsis
would necessitate a systemic antibiotic. Fluid
deficit, ketones in the urine, and elevated
white cells would not necessarily
contraindicate the use of nitrofurantoin.
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B)
C)
D)
Ans:
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B)
C)
D)
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A)
B)
C)
D)
Ans:
A public health nurse interacts with many
members of the community who are at risk
13. for sexually transmitted infections (STIs). The
nurse should anticipate the use of tetracycline
in a patient who is diagnosed with what STI?
Vaginitis
Chlamydia
Human papillomavirus
Trichomoniasis
B
Feedback:
Tetracycline is effective for treating
Mycoplasma, Chlamydia, and Rickettsia. It is
not efficacious in the treatment of
trichomoniasis, HPV, or vaginitis.
A)
B)
C)
D)
Ans:
Vaginitis
Chlamydia
Human papillomavirus
Trichomoniasis
B
Feedback:
Tetracycline is effective for treating
Mycoplasma, Chlamydia, and Rickettsia. It is
not efficacious in the treatment of
trichomoniasis, HPV, or vaginitis.
A nurse is preparing to administer a patient's
first scheduled dose of tetracycline. The nurse
14.
should first ensure that the patient has not
recently eaten
dairy products.
leafy green vegetables.
any high-fat foods.
acidic foods.
A
Feedback:
It is important not to take tetracycline with
dairy products, antacids, or iron supplements.
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B)
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D)
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C)
D)
Ans:
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A young adult patient's acne has responded
well to treatment with tetracycline. However,
the patient has now returned to the clinical
15. with signs and symptoms of oral candidiasis.
The nurse should recognize that this patient's
current health problem is likely attributable to
which of the following?
A delayed (type IV) hypersensitivity reaction
The fact that the patient may have chewed the
capsules prior to swallowing them
Superinfection following the eradication of
normal oral flora
A type I hypersensitivity reaction
C
Feedback:
Candidal superinfections may result from the
use of tetracycline. The superinfection results
from the elimination of normal flora and is
not a hypersensitivity reaction. This is not the
result of physical contact between the drug
and the oral mucosa.
A 9-year-old boy has been admitted to the
pediatric unit after being diagnosed with
pertussis. The pediatric nurse is processing
the boy's admission orders and notes that IV
16.
demeclocycline (Declomycin) has been
ordered. After beginning this treatment, the
nurse should confirm the results of what
laboratory test?
Mean corpuscular volume (MCV)
D-dimer
Bilirubin
Blood urea nitrogen (BUN)
D
Feedback:
When administering demeclocycline, it is
important to monitor the patient's BUN.
Increases in the BUN are secondary to
antianabolic effects. D-dimer and MCV
values are not relevant. Bilirubin levels would
only be important in the presence of liver
toxicity.
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B)
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Chapter 21 Drug Therapy With Macrolides and Miscellaneous Anti-infective
Agents
A patient is admitted to the emergency room
with a diagnosis of Legionnaires' disease and
1. is placed on isolation. Which of the following
medications is the drug of choice for
Legionnaires' disease?
Erythromycin (Ery-Tab)
Loxapine hydrochloride (Loxitane)
Meclizine (Antivert)
Pravastatin (Pravachol)
A
Feedback:
Erythromycin is the prototype macrolide used
to treat Legionnaires' disease. Loxapine
hydrochloride is an antipsychotic agent.
Meclizine (Antivert) is used to treat nausea
and dizziness. Pravastatin is used to treat
hypercholesterolemia.
The nurse is administering telithromycin
(Ketek) to a child with Streptococcus
2. pneumoniae infection. What nursing
intervention is implemented when
administering this medication?
Administer the medication with or without
food.
Administer the medication with grapefruit
juice.
Increase the dose in the event of QT
elongation.
Administer the medication with lovastatin.
A
Feedback:
When administering telithromycin, food does
not affect the absorption of the medication.
The administration of the medication with
grapefruit juice may increase the plasma
concentration and cause adverse effects.
Telithromycin can cause an elongation of the
QT interval; thus, the dose should not be
increased. The administration of telithromycin
and lovastatin can cause an increase in the QT
interval.
A)
B)
C)
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B)
C)
D)
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A patient is allergic to penicillin and has been
diagnosed with a genitourinary infection
3. caused by Chlamydia trachomatis. Which of
the following medications will most likely be
administered?
Acamprosate calcium (Campral)
Atazanavir (Reyataz)
Erythromycin (Ery-Tab)
Flumazenil (Mazicon)
C
Feedback:
A patient who is diagnosed with a
genitourinary infection that is caused by
trachomatis and who is allergic to penicillin
should be administered erythromycin (EryTab). Acamprosate calcium is administered as
a substance abuse deterrent, not in place of
penicillin. Atazanavir (Reyataz) is an antiviral
agent that is used to treat HIV infection, not
Chlamydia trachomatis. Flumazenil is a
benzodiazepine antagonist and not used for
Chlamydia trachomatis.
Atazanavir (Reyataz)
Erythromycin (Ery-Tab)
Flumazenil (Mazicon)
C
Feedback:
A patient who is diagnosed with a
genitourinary infection that is caused by
trachomatis and who is allergic to penicillin
should be administered erythromycin (EryTab). Acamprosate calcium is administered as
a substance abuse deterrent, not in place of
penicillin. Atazanavir (Reyataz) is an antiviral
agent that is used to treat HIV infection, not
Chlamydia trachomatis. Flumazenil is a
benzodiazepine antagonist and not used for
Chlamydia trachomatis.
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C)
D)
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A patient is diagnosed with peptic ulcer
disease. He has been prescribed
4. clarithromycin (Biaxin). Which of the
following organisms is this medication used
to treat?
Streptococcus pneumoniae
Haemophilus influenzae
Mycobacterium avium complex
Helicobacter pylori
D
Feedback:
Clarithromycin is approved to treat H. pylori
infections associated with peptic ulcer
disease. Clarithromycin is also approved to
treat Streptococcus pneumoniae, Haemophilus
influenza, and Mycobacterium avium
complex, but these organisms do not cause
peptic ulcer disease.
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A)
B)
C)
D)
Ans:
A)
B)
C)
D)
Ans:
A patient is administered telithromycin
(Ketek) to treat a community-acquired
5.
pneumonia. A change in what blood level may
necessitate a reduction in the dosage?
Creatinine
AST and ALT
CPK
Differential
A
Feedback:
For patients who have renal impairment,
together with hepatic impairment, it is
essential to reduce the dosage to 400 mg once
daily. Alterations in CPK, white cell
differential, and liver enzymes may not
require a change in the dosage.
B)
C)
D)
Ans:
AST and ALT
CPK
Differential
A
Feedback:
For patients who have renal impairment,
together with hepatic impairment, it is
essential to reduce the dosage to 400 mg once
daily. Alterations in CPK, white cell
differential, and liver enzymes may not
require a change in the dosage.
A patient has been prescribed
chloramphenicol (Chloromycetin) for
6.
vancomycin-resistant enterococci. How is this
medication eliminated from the body?
Through the liver
Exhaled through the lungs
Excreted in the urine
Excreted in the bile
C
Feedback:
Chloramphenicol is metabolized in the liver
and excreted in the urine. It is not eliminated
in the liver, exhaled through the lungs, or
excreted in the bile.
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B)
C)
D)
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B)
C)
D)
Ans:
Which of the following miscellaneous
7. antibacterial drugs is administered topically in
the treatment of acne?
Chloramphenicol (Chloromycetin)
Clindamycin (Cleocin)
Daptomycin (Cubicin)
Tigecycline (Tygacil)
B
Feedback:
Clindamycin is administered topically for the
treatment of acne. Chloramphenicol,
daptomycin, and tigecycline are not
administered topically for the treatment of
acne.
A patient is administered daptomycin
(Cubicin) to treat a gram-negative infection
caused by Staphylococcus aureus. Which of
8.
the following symptoms should be reported
immediately to the physician based on the
known adverse effects of daptomycin?
Weakness of the legs and arms
Decreased wound drainage
Hematuria
Shortness of breath
A
Feedback:
The nurse should report weakness of legs and
arms due to increased serum creatine kinase
levels. Decrease in wound drainage,
hematuria, and shortness of breath are not
adverse effects of daptomycin.
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B)
C)
D)
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B)
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A patient has been diagnosed with a
community-acquired skin infection and has
9. been prescribed linezolid (Zyvox). Which of
the following foods should not be eaten
during the administration of this medication?
Pasta
Garlic
Green leafy vegetables
Cheddar cheese
D
Feedback:
Because linezolid is a weak monoamine
oxidase inhibitor, patients should avoid food
high in tyramine content, such as aged
cheeses. Pasta, garlic, and green leafy
vegetables are not contraindicated with
linezolid.
A)
B)
C)
D)
Ans:
A patient has developed Clostridium difficile
associated with pseudomembranous colitis.
10. Which of the following medications is
effective in the treatment of Clostridium
difficile?
Linezolid (Zyvox)
Cladribine (Leustatin)
Clarithromycin (Biaxin)
Metronidazole (Flagyl)
D
Feedback:
Metronidazole (Flagyl) is indicated for use in
10. Which of the following medications is
effective in the treatment of Clostridium
difficile?
Linezolid (Zyvox)
Cladribine (Leustatin)
Clarithromycin (Biaxin)
Metronidazole (Flagyl)
D
Feedback:
Metronidazole (Flagyl) is indicated for use in
the treatment of Clostridium difficile.
Linezolid (Zyvox) is not used to treat C.
difficile. Cladribine (Leustatin) is an
antineoplastic agent that is not used for C.
difficile. Clarithromycin (Biaxin) is not used
to treat C. difficile.
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B)
C)
D)
Ans:
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A patient returns from a trip to the Caribbean
and is suffering from severe diarrhea related
11.
to E. coli. Which of the following medications
is the drug of choice for traveler's diarrhea?
Rifaximin (Xifaxan)
Spectinomycin (Trobicin)
Chloramphenicol (Chloromycetin)
Erythromycin (Ery-Tab)
A
Feedback:
Rifaximin (Xifaxan) is administered for the
treatment of traveler's diarrhea related to E.
coli. Spectinomycin is used to treat
gonococcal infections. Chloramphenicol is
not administered to treat traveler's diarrhea
related to E. coli. Erythromycin is not used to
treat traveler's diarrhea related to E. coli.
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B)
C)
D)
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A)
B)
C)
D)
Ans:
A patient who is being administered
metronidazole (Flagyl) to treat Clostridium
12. difficile will also be administered which
medication orally to assist in restructuring the
flora of the intestinal tract?
Spectinomycin (Trobicin)
Rifaximin (Xifaxan)
Vancomycin (Vancocin)
Quinupristin–dalfopristin
C
Feedback:
Oral vancomycin is used to treat
pseudomembranous colitis caused by C.
difficile. Spectinomycin (Trobicin), rifaximin
(Xifaxan), and quinupristin–dalfopristin are
not administered to treat pseudomembranous
colitis caused by C. difficile.
Rifaximin (Xifaxan)
Vancomycin (Vancocin)
Quinupristin–dalfopristin
C
Feedback:
Oral vancomycin is used to treat
pseudomembranous colitis caused by C.
difficile. Spectinomycin (Trobicin), rifaximin
(Xifaxan), and quinupristin–dalfopristin are
not administered to treat pseudomembranous
colitis caused by C. difficile.
A patient who is being treated in the intensive
care unit has been diagnosed with ventilatorassociated pneumonia. Culture and sensitivity
13. testing of the patient's sputum indicates that
erythromycin is a treatment option. The nurse
knows that this drug is likely contraindicated
for what reason?
Erythromycin inhibits normal liver function.
Erythromycin is associated with
gastrointestinal upset.
Erythromycin is nephrotoxic.
Erythromycin cannot be administered orally.
A
Feedback:
Erythromycin is seldom used in critical care
settings, partly because broader spectrum
bactericidal drugs are usually needed in
critically ill patients and partly because it
inhibits liver metabolism and slows
elimination of several other drugs.
Erythromycin is not nephrotoxic. The drug is
administered orally, and GI upset does not
contraindicate use.
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C)
D)
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B)
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D)
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B)
C)
D)
Ans:
An adult patient has been diagnosed with
bacterial sinusitis, and her care provider has
14. prescribed oral erythromycin. The nurse has
cautioned the patient against taking the drug
together with antacids because this practice
delays metabolism of the drug.
can exacerbate nausea and reflux.
causes a dangerous rise in gastric pH.
decreases the absorption of the drug.
D
Feedback:
People should not take erythromycin after
taking antacids. Antacids decrease the
absorption of both the tablet and suspension
form of erythromycin. Antacids do not cause
a dangerous rise in pH, exacerbate GI upset,
or delay the metabolism of the drug.
B)
C)
D)
Ans:
can exacerbate nausea and reflux.
causes a dangerous rise in gastric pH.
decreases the absorption of the drug.
D
Feedback:
People should not take erythromycin after
taking antacids. Antacids decrease the
absorption of both the tablet and suspension
form of erythromycin. Antacids do not cause
a dangerous rise in pH, exacerbate GI upset,
or delay the metabolism of the drug.
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A 22-year-old college student is allergic to
penicillin. Consequently, her current
chlamydial infection is being treated with oral
15.
erythromycin. What assessment should the
nurse prioritize during this patient's course of
treatment?
Assessment of the patient's apical heart rate
Assessment of the patient's hearing
Assessment of the patient's peripheral pulses
Assessment of the patient's renal function
B
Feedback:
With erythromycin, it is important to assess
the patient's hearing. The loss of hearing is
reversible with the discontinuation of the
medication. Erythromycin does not typically
affect renal function or circulation. The IV
form has been associated with dysrhythmias,
but this is not the case with the oral form.
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A)
B)
C)
D)
Ans:
A)
B)
C)
D)
Ans:
An older adult patient has been prescribed
telithromycin for community-acquired
pneumonia. The nurse has contacted the
patient's primary care provider because the
16.
patient is on replacement corticosteroid
therapy. Why is concomitant use of
telithromycin and corticosteroids
contraindicated?
The woman may be unable to adequately
metabolize her corticosteroid.
The effect of the corticosteroid may be greatly
increased.
The woman may have an increased risk of
thromboembolism.
The corticosteroid may negate the efficacy of
the telithromycin.
A
Feedback:
Telithromycin is a potent CYP3A4 inhibitor.
Combination of this drug with several
medications, including corticosteroids, results
in an increased serum concentration of these
The woman may have an increased risk of
thromboembolism.
The corticosteroid may negate the efficacy of
the telithromycin.
A
Feedback:
Telithromycin is a potent CYP3A4 inhibitor.
Combination of this drug with several
medications, including corticosteroids, results
in an increased serum concentration of these
other drugs.
C)
D)
A patient states that he has been taking his
prescribed clindamycin as ordered, but that it
17. has been causing him to have frequent
diarrhea. How should the nurse best respond
to this patient's statement?
Reemphasize the importance of taking
clindamycin with food.
Encourage the patient to temporarily use an
over-the-counter antidiarrheal.
Encourage the patient to increase his fluid
intake until the course of treatment is
complete.
Liaise with the patient's care provider to have
the drug discontinued.
D
Feedback:
The FDA has issued a black box warning for
clindamycin regarding the potential of severe
and possible fatal colitis. If diarrhea develops
in a patient receiving clindamycin,
discontinuation of the drug is essential.
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A)
B)
C)
D)
Ans:
Numerous residents of a long-term care
facility have developed Clostridium difficile–
associated diarrhea over the past week. The
18.
nurses at this facility would anticipate that
many residents would require which of the
following drugs?
Linezolid (Zyvox)
Daptomycin (Cubicin)
Metronidazole (Flagyl)
Chloramphenicol (Chloromycetin)
C
Feedback:
Clinical indications for metronidazole include
prevention or treatment of anaerobic bacterial
infections (e.g., in colorectal surgery, intraabdominal infections) and treatment of C.
difficile infections associated with
pseudomembranous colitis. The other listed
antibiotics are not used for the treatment of
Clostridium difficile–associated diarrhea.
Daptomycin (Cubicin)
Metronidazole (Flagyl)
Chloramphenicol (Chloromycetin)
C
Feedback:
Clinical indications for metronidazole include
prevention or treatment of anaerobic bacterial
infections (e.g., in colorectal surgery, intraabdominal infections) and treatment of C.
difficile infections associated with
pseudomembranous colitis. The other listed
antibiotics are not used for the treatment of
Clostridium difficile–associated diarrhea.
A nurse has returned to a patient's hospital
room for a follow-up assessment during the
intravenous infusion of vancomycin. What
19.
assessment finding would signal the nurse to
the possibility that the patient's infusion is
running too quickly?
The patient is flushed and has a visible skin
rash.
The patient's apical heart rate is irregular.
The patient is difficult to rouse and has dilated
pupils.
The patient complains of pain at the
intravenous access site.
A
Feedback:
It is very important to give IV infusions
slowly, over 1 to 2 hours, to avoid an adverse
reaction characterized by hypotension,
flushing, and skin rash. This reaction,
sometimes called red man syndrome, is
attributed to histamine release.
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B)
C)
D)
Ans:
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B)
C)
D)
Ans:
A nurse is preparing a patient's scheduled
dose of oral vancomycin. This patient's
20.
current illness was most likely manifested by
what sign or symptom?
Vomiting
Inflamed, swollen skin
Shortness of breath
Diarrhea
D
Feedback:
Oral vancomycin is useful only to treat
staphylococcal enterocolitis and
pseudomembranous colitis caused by C.
difficile. These illnesses are always
characterized by diarrhea, not vomiting, skin
inflammation, or shortness of breath.
B)
C)
D)
Ans:
Inflamed, swollen skin
Shortness of breath
Diarrhea
D
Feedback:
Oral vancomycin is useful only to treat
staphylococcal enterocolitis and
pseudomembranous colitis caused by C.
difficile. These illnesses are always
characterized by diarrhea, not vomiting, skin
inflammation, or shortness of breath.
Chapter 22 Drug Therapy for Tuberculosis and Mycobacterium avium Complex
Disease
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A patient seen in the clinic has symptoms of
persistent cough, fever, and night sweats. He
recently entered the United States from the
1.
Philippines. Which of the following is the
most plausible explanation for the patient's
condition?
Latent tuberculosis
Bacterial pneumonia
Active tuberculosis
Emphysema
C
Feedback:
Emigration from countries where the disease
occurs, such as the Philippines, places
patients at risk for tuberculosis. Active
tuberculosis is characterized by symptoms of
cough, fever, and night sweats. Patients with
latent tuberculosis exhibit no symptoms and
do not feel sick. Bacterial pneumonia is not
commonly noted with night sweats.
Emphysema is not noted with fever.
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B)
C)
D)
Ans:
A)
B)
C)
D)
Ans:
A college student has a TB test prior to
starting the semester. The tuberculin test site
2. is noted with a reddened, raised area. What
condition will the student be diagnosed with if
the chest radiograph is negative?
Transmission
Primary infection
Latent tuberculosis
Active tuberculosis
C
Feedback:
People with inactive or latent TB have no
symptoms and do not feel sick. The
transmission of the infection occurs when an
uninfected person inhales infected airborne
particles that are exhaled by an infected
person. Primary infection occurs 6 to 8 weeks
Primary infection
Latent tuberculosis
Active tuberculosis
C
Feedback:
People with inactive or latent TB have no
symptoms and do not feel sick. The
transmission of the infection occurs when an
uninfected person inhales infected airborne
particles that are exhaled by an infected
person. Primary infection occurs 6 to 8 weeks
after exposure. The patient has a mild,
pneumonia-like illness that often is
undiagnosed. Active tuberculosis is a result
from reactivation of a latent infection.
A patient is hospitalized with active
tuberculosis. The patient is receiving
3. antitubercular drug therapy and is not
responding to the medications. What do you
suspect the patient is suffering from?
Human immunodeficiency virus
Drug-resistant tuberculosis
Methicillin-resistant Staphylococcus aureus
Vancomycin-resistant Staphylococcus aureus
B
Feedback:
A patient who is being treated with
antitubercular drug therapy and is not
responding to the medication regime is most
likely experiencing drug-resistant
tuberculosis. Human immunodeficiency virus
causes tuberculosis to move more rapidly.
This scenario does not provide any indication
that the tuberculosis is related to the
diminished patient response. The scenario
does not identify methicillin- or vancomycinresistant Staphylococcus aureus.
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B)
C)
D)
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B)
C)
D)
Ans:
A)
B)
C)
D)
Ans:
A patient being treated for tuberculosis is
determined to be drug resistant. Which of the
4. following medications will the patient be
resistant to in the treatment of the
tuberculosis?
Isoniazid (INH) and rifampin
Carbamazepine (Tegretol) and phenytoin
(Dilantin)
Dextroamphetamine (Dexedrine) and
doxapram (Dopram)
Propranolol (Inderal) and sotalol (Betapace)
A
Feedback:
Isoniazid (INH) and rifampin are used to treat
tuberculosis. In multidrug resistance, the most
A)
Isoniazid (INH) and rifampin
Carbamazepine (Tegretol) and phenytoin
(Dilantin)
Dextroamphetamine (Dexedrine) and
doxapram (Dopram)
Propranolol (Inderal) and sotalol (Betapace)
A
Feedback:
Isoniazid (INH) and rifampin are used to treat
tuberculosis. In multidrug resistance, the most
effective drugs the patient is resistant to are
isoniazid and rifampin. Carbamazepine and
phenytoin are used to control seizures.
Dextroamphetamine and doxapram are central
nervous system stimulants. Propranolol and
sotalol are beta-adrenergic blocking agents.
B)
C)
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D)
Ans:
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A patient who was frequently homeless over
the past several years has begun a drug
5.
regimen consisting solely of isoniazid (INH).
What is this patient's most likely diagnosis?
Active tuberculosis
Latent tuberculosis
Mycobacterium avium complex
Human immunodeficiency virus
B
Feedback:
Although use of INH by itself for treatment of
latent TB is appropriate, use with other antiTB drugs is essential for treatment of active
TB. INH would not be used exclusively in the
treatment of HIV or MAC.
A)
B)
C)
D)
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B)
C)
D)
Ans:
A patient is administered isoniazid (INH) for
tuberculosis. Which of the following adverse
6.
effects will result in discontinuation of the
medication?
Weight gain
Jaundice
Fever
Arthralgia
B
Feedback:
Potentially serious adverse effects of INH
include hepatotoxicity and peripheral
neuropathy. Hepatotoxicity may be
manifested by symptoms of hepatitis (e.g.,
anorexia, nausea, fatigue, malaise, jaundice)
or elevated liver enzymes. Weight gain, fever,
and arthralgia are not the most known adverse
effects of isoniazid (INH).
Jaundice
Fever
Arthralgia
B
Feedback:
Potentially serious adverse effects of INH
include hepatotoxicity and peripheral
neuropathy. Hepatotoxicity may be
manifested by symptoms of hepatitis (e.g.,
anorexia, nausea, fatigue, malaise, jaundice)
or elevated liver enzymes. Weight gain, fever,
and arthralgia are not the most known adverse
effects of isoniazid (INH).
A patient receiving isoniazid (INH) and
rifampin (Rifadin) has a decreased urinary
7. output and decreased sensation in his great
toes. Which laboratory values should be
assessed?
Hematocrit and hemoglobin
ALT and AST
Urine culture and sensitivity
Erythrocyte count and differential
B
Feedback:
Hepatotoxicity and peripheral neuropathy are
important adverse effects of isoniazid and
rifampin. The ALT/AST will assess liver
function. The hematocrit and hemoglobin are
not indicated with the described symptoms.
Erythrocyte count and differential are not
indicated with these symptoms.
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B)
C)
D)
Ans:
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B)
C)
D)
Ans:
A)
B)
C)
D)
Ans:
A nursing student is learning about the effects
of bactericidal agents. How does rifampin
8. (Rifadin) achieve a therapeutic action against
both intracellular and extracellular
tuberculosis organisms?
It is metabolized in the liver.
It binds to acetylcholine.
It inhibits synthesis of RNA.
It causes phagocytosis.
C
Feedback:
Rifampin kills Mycobacterium by inhibiting
synthesis of RNA. It is metabolized in the
liver, but this characteristic does not represent
its action. It does not bind to acetylcholine. It
does not cause phagocytosis.
B)
C)
D)
Ans:
It binds to acetylcholine.
It inhibits synthesis of RNA.
It causes phagocytosis.
C
Feedback:
Rifampin kills Mycobacterium by inhibiting
synthesis of RNA. It is metabolized in the
liver, but this characteristic does not represent
its action. It does not bind to acetylcholine. It
does not cause phagocytosis.
A)
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B)
A patient is administered rifampin (Rifadin).
9. Which of the following facts should the
patient be taught?
When taking it with warfarin (Coumadin), an
increased anticoagulant effect occurs.
It decreases hepatic enzymes and decreases
metabolism of drugs.
It has an increased serum half-life, so it is
more effective than rifabutin (Mycobutin).
The urine, tears, sweat, and other body fluids
will be a discolored red-orange.
D
Feedback:
The patient's urine, tears, sweat, and other
body fluids will be a discolored red-orange.
This adverse effect is harmless, but the patient
should be instructed on this adverse effect.
The administration of this medication with
warfarin will decrease the anticoagulant
effect. The medication increases hepatic
cytochrome P450 3A4 enzyme and decreases
serum concentrations. The serum half-life of
rifampin is shorter than that of the medication
rifabutin.
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D)
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A)
B)
C)
D)
Ans:
A patient who is being administered isoniazid
(INH) for tuberculosis has a yellow color in
10. the sclera of her eye. What other finding
would lead you to believe that hepatotoxicity
has developed?
Diarrhea
Numbness
Diminished vision
Light-colored stools
D
Feedback:
The presence of light-colored stools is
suggestive of hepatotoxicity. Diarrhea,
numbness, and diminished vision are not
related to hepatotoxicity of isoniazid (INH).
B)
C)
D)
Ans:
Numbness
Diminished vision
Light-colored stools
D
Feedback:
The presence of light-colored stools is
suggestive of hepatotoxicity. Diarrhea,
numbness, and diminished vision are not
related to hepatotoxicity of isoniazid (INH).
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A patient is being treated for active
tuberculosis with ethambutol (Myambutol).
The patient states to the nurse that he cannot
11. identify the red and green on the traffic lights
when he is driving. Based on this finding,
what medical intervention is most
appropriate?
Assess for photosensitivity.
Discontinue ethambutol (Myambutol).
Decrease the ethambutol (Myambutol) dose.
Administer vitamin B12.
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B)
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D)
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B
Feedback:
The administration of ethambutol should be
discontinued if optic neuritis develops. Optic
neuritis is an inflammatory, demyelinating
disorder of the optic nerve that decreases
visual acuity and ability to differentiate red
and green. The inability to distinguish red and
green is not indicative of photosensitivity. The
ethambutol should not be decreased. There is
no indication for the administration of vitamin
B12.
A)
B)
C)
D)
Ans:
A patient is hospitalized due to nonadherence
to an antitubercular drug treatment. Which of
12.
the following is most important for the nurse
to do?
Observe the patient taking the medications.
Administer the medications parenterally.
Instruct the family on the medication regime.
Count the number of tablets in the bottle
daily.
A
Feedback:
Directly observed therapy in which a health
care provider observes the patient taking each
dose of anti-TB drugs is recommended for all
drug regimens and is considered mandatory in
this case. The medications are not
administered parenterally. The family should
be instructed on the medication regime, but
this action is not imperative in maintaining
C)
Instruct the family on the medication regime.
Count the number of tablets in the bottle
daily.
A
Feedback:
Directly observed therapy in which a health
care provider observes the patient taking each
dose of anti-TB drugs is recommended for all
drug regimens and is considered mandatory in
this case. The medications are not
administered parenterally. The family should
be instructed on the medication regime, but
this action is not imperative in maintaining
compliance. Tablets missing from the bottle
may not necessarily have been taken correctly
by the patient.
D)
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A patient with HIV has been infected with
Mycobacterium avium complex from an
13. indoor pool. Which of the following
medications is the recommended treatment for
MAC?
Clarithromycin
Isoniazid (INH)
Rifabutin
Azithromycin
A
Feedback:
The main drugs used in prevention of MAC
disease in patients with HIV are the
macrolides azithromycin and clarithromycin.
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B)
C)
D)
Ans:
A)
B)
C)
D)
Ans:
A homeless man was screened for
tuberculosis (TB) during a health consultation
at a shelter, and the results indicate latent TB.
14. The community health nurse who is liaising
with the providers of the shelter would
anticipate what component of this man's plan
of care?
The man will undergo conservative treatment
for TB using adjuvant medications.
The man will be treated for TB using first-line
antitubercular drugs.
The man will be monitored closely to
determine if treatment is necessary.
The man will be screened again in 10 to 12
weeks to determine whether he has developed
active TB.
B
Feedback:
Patients with latent TB cannot spread the
disease to others, but treatment of the latent
disease prevents progression of the disease to
an active state. It is particularly important to
C)
determine if treatment is necessary.
The man will be screened again in 10 to 12
weeks to determine whether he has developed
active TB.
B
Feedback:
Patients with latent TB cannot spread the
disease to others, but treatment of the latent
disease prevents progression of the disease to
an active state. It is particularly important to
treat latent TB in those patients who are at
high risk for progression to active TB.
Homelessness is a major risk factor for active
TB.
D)
A female patient has been diagnosed with
tuberculosis and begun multiple-drug therapy.
The woman has asked the nurse why it is
15. necessary for her to take several different
drugs instead of one single drug. How should
the nurse best respond to the patient's
question?
“Multiple drugs are used because doctors
aren't sure which drug will kill a particular TB
strain.”
“The use of multiple drugs prevents the
development of drug-resistant TB.”
“Multiple drugs are prescribed because the
final testing results for TB can take up to 3
months.”
“Multiple drugs are used in order to speed up
the course of treatment.”
B
Feedback:
Use of multiple drugs to treat TB is necessary
to prevent the development of drug-resistant
TB. This approach to treatment is not
necessitated by delays in testing, questionable
diagnostic results, or the need to hasten the
course of treatment.
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B)
C)
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A)
B)
C)
A patient is being treated for latent
tuberculosis on an outpatient basis and tells
the nurse during a scheduled follow-up visit,
16. “I've been feeling pretty good lately, so I
haven't actually been all that consistent with
taking my drugs.” Subsequent health
education should focus on what subject?
The fact that nonadherence to treatment
exacerbates the risks of adverse effects
The need to consistently take the prescribed
drugs in order to cure TB
The need to match drug dosages carefully to
signs and symptoms
tuberculosis on an outpatient basis and tells
the nurse during a scheduled follow-up visit,
16. “I've been feeling pretty good lately, so I
haven't actually been all that consistent with
taking my drugs.” Subsequent health
education should focus on what subject?
The fact that nonadherence to treatment
exacerbates the risks of adverse effects
The need to consistently take the prescribed
drugs in order to cure TB
The need to match drug dosages carefully to
signs and symptoms
The fact that nonadherence will necessitate
the use of antiretrovirals
B
Feedback:
Consistent adherence to treatment is
imperative to ensure successful treatment of
TB. Nonadherence leads to resistance and
unsuccessful treatment, not increased adverse
effects. Antivirals are ineffective against TB.
A)
B)
C)
D)
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A patient has been diagnosed with
tuberculosis and will soon begin first-line
17.
drug treatment. How will rifampin most likely
be administered to this patient by the nurse?
Orally, with food
Orally, on an empty stomach
Intramuscularly
Intravenously, as bolus
B
Feedback:
Rifampin should be taken on an empty
stomach, either 1 hour before or 2 hours after
a meal. IV administration is possible, but this
takes place as a three-hour infusion, not as a
bolus. Rifampin is not administered IM.
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B)
C)
D)
Ans:
A)
B)
C)
D)
Ans:
The nurse is providing care for a patient who
is taking isoniazid and rifampin (Rifadin) for
18. the treatment of active tuberculosis. The
patient should be taught that an improvement
in symptoms will likely be noticed within
48 hours.
a week to 10 days.
2 to 3 weeks.
4 to 6 weeks.
C
Feedback:
Therapeutic effects are usually apparent with
the first 2 to 3 weeks of drug therapy for
active TB.
B)
C)
D)
Ans:
a week to 10 days.
2 to 3 weeks.
4 to 6 weeks.
C
Feedback:
Therapeutic effects are usually apparent with
the first 2 to 3 weeks of drug therapy for
active TB.
A patient with a diagnosis of active TB has
begun second-line therapy that includes the
use of pyrazinamide. When monitoring this
19.
patient, the nurse should suspect that adverse
effects of this drug may account for which of
the following laboratory values?
Low hematocrit and mean corpuscular
volume (MCV)
Increased INR and aPTT
Increased blood urea nitrogen and creatinine
Increased AST, ALT, and GGT
D
Feedback:
The most severe adverse effect of
pyrazinamide is hepatotoxicity. Consequently,
liver enzymes such as GGT, ALT, and AST
should be monitored. Changes in
erythrocytes, coagulation, and renal function
are less likely to result from pyrazinamide
therapy.
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C)
D)
Ans:
A)
B)
C)
D)
E)
Ans:
A 40-year-old man has been living with HIV
for several years but experienced a significant
decrease in his CD4+ levels a few months
ago. The patient has just been diagnosed with
20.
Mycobacterium avium complex disease. The
nurse should anticipate administering which
of the following medications? Select all that
apply.
Clarithromycin
Pyrazinamide
Rifapentine (Priftin)
Azithromycin
Bactrim
A, D
Feedback:
The main drugs used in prevention of MAC
disease in patients with HIV are the
macrolides azithromycin and clarithromycin.
Pyrazinamide, Bactrim, and Priftin are not
used to treat MAC.
C)
D)
E)
Ans:
Rifapentine (Priftin)
Azithromycin
Bactrim
A, D
Feedback:
The main drugs used in prevention of MAC
disease in patients with HIV are the
macrolides azithromycin and clarithromycin.
Pyrazinamide, Bactrim, and Priftin are not
used to treat MAC.
Chapter 23 Drug Therapy for Viral Infections
A patient is prescribed acyclovir (Zovirax) for
1. the treatment of genital herpes. What is the
expected outcome of this medication?
Decreased testosterone production
Decreased libido
Decreased viral shedding
Decreased bacterial replication
C
Feedback:
Acyclovir is used to treat genital herpes, in
which it decreases viral shedding and the
duration of skin lesions and pain. Acyclovir
does not decrease testosterone or libido.
Acyclovir is used to treat viral, not bacterial,
infections.
B)
C)
D)
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A)
B)
C)
D)
Ans:
A patient suffers from an autoimmune
disorder. Which of the following represents a
2.
potential result of a viral infection in a patient
with an autoimmune disorder?
Lymphocytes recognize the host's tissue as
foreign.
Erythrocytes destroy the T cells in the host.
The involution of the thymus gland increases
infection cause.
The differential decreases the sedimentation
rate.
A
Feedback:
Autoimmune diseases may be caused by viral
alteration of host cells so that lymphocytes
recognize the host's own tissues as being
foreign.
An 80-year-old patient with chronic renal
failure is admitted to the hospital with herpes
simplex. The acyclovir (Zovirax) is to be
3.
administered parenterally. When preparing to
administer this medication, what would the
nurse expect in regard to the dose?
The dose is smaller due to the herpes simplex.
The dose is smaller based on the patient's
kidney function.
The dose is higher in treating genital herpes.
The dose is higher if the creatinine is above
4.0 mg/dL.
B
Feedback:
Oral and IV acyclovir are excreted in the
urine, and the dose should be decreased in
patients who are older or have renal
impairment. The dose is not smaller due to
herpes simplex. The dose is not higher in
treating genital herpes. The dose should be
lower if the creatinine level is above 4.0 mg/
dL.
A)
B)
C)
D)
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D)
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Ans:
A patient who has been diagnosed with
human immune deficiency syndrome is given
ganciclovir (Cytovene) to prevent
4. cytomegalovirus. The patient develops
granulocytopenia. How long will it take for
the granulocytes to regenerate after the
ganciclovir is discontinued?
5 days
7 days
10 days
14 days
B
Feedback:
Ganciclovir causes granulocytopenia and
thrombocytopenia in 20% to 40% of
recipients, often during the first 2 weeks of
therapy. If severe bone marrow depression
occurs, ganciclovir should be discontinued;
recovery usually occurs within a week of
stopping the drug. Five days after
discontinuing the drug is too soon to see a
change in granulocytopenia. Ten to fourteen
days is too long for change to occur. It should
have occurred within 1 week.
7 days
10 days
14 days
B
Feedback:
Ganciclovir causes granulocytopenia and
thrombocytopenia in 20% to 40% of
recipients, often during the first 2 weeks of
therapy. If severe bone marrow depression
occurs, ganciclovir should be discontinued;
recovery usually occurs within a week of
stopping the drug. Five days after
discontinuing the drug is too soon to see a
change in granulocytopenia. Ten to fourteen
days is too long for change to occur. It should
have occurred within 1 week.
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B)
C)
D)
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A patient has been diagnosed with
cytomegalovirus (CMV). Which of the
5.
following drugs would be ineffective in the
treatment of this disease?
Ribavirin (Rebetol)
Ganciclovir (Cytovene) IV
Foscarnet (Foscavir) IV
Valganciclovir hydrochloride (Valcyte)
A
Feedback:
Ribavirin is administered to treat respiratory
syncytial virus. Ganciclovir, foscarnet, and
valganciclovir are used in the treatment of
CMV.
A)
B)
C)
D)
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B)
C)
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A 21-year-old male is being started on
zidovudine (AZT) for treatment of HIV/
6. AIDS. Which of the following statements
made by the patient indicates that he has
understood the patient teaching?
“AZT inactivates the virus and prevents
recurrence of the disease.”
“AZT therapy may result in the development
of AZT-resistant strains.”
“AZT slows the progression of the disease but
does not cure it.”
“AZT prevents the occurrence of
opportunistic infections.”
C
Feedback:
Zidovudine slows the progression of the
disease but does not cure the disease.
Zidovudine does not inactivate the virus.
Zidovudine does not result in resistant strains.
Zidovudine does not prevent the occurrence
of opportunistic infections.
C)
does not cure it.”
“AZT prevents the occurrence of
opportunistic infections.”
C
Feedback:
Zidovudine slows the progression of the
disease but does not cure the disease.
Zidovudine does not inactivate the virus.
Zidovudine does not result in resistant strains.
Zidovudine does not prevent the occurrence
of opportunistic infections.
D)
A patient is administered a nucleotide reverse
transcriptase inhibitor in combination with a
7. nonnucleotide reverse transcriptase inhibitor.
What is the main rationale for administering
these medications together?
They facilitate increased adherence to
treatment.
They decrease the length of illness.
They have synergistic antiviral effects.
They prevent the development of
opportunistic infections.
C
Feedback:
Because the two types of drugs inhibit reverse
transcriptase by different mechanisms, they
may have synergistic antiviral effects. The use
of two medications may decrease adherence
because of the burden of taking two
medications. The use of two medications will
not decrease the length of the illness. They
will not decrease all opportunistic infections.
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B)
C)
D)
Ans:
A patient is prescribed zanamivir (Relenza) to
treat influenza B. The patient has a history of
8.
asthma. For which of the following symptoms
should the nurse assess?
Bradycardia
Pneumonia
Bronchospasm
Pulmonary embolism
C
Feedback:
A patient is administered zanamivir for the
treatment of influenza B. The patient has
asthma and should be observed or assessed
for decreased respiratory function, including
bronchospasm. Bradycardia, pneumonia, and
pulmonary embolism are not adverse effects
the nurse should expect.
B)
C)
D)
Ans:
Pneumonia
Bronchospasm
Pulmonary embolism
C
Feedback:
A patient is administered zanamivir for the
treatment of influenza B. The patient has
asthma and should be observed or assessed
for decreased respiratory function, including
bronchospasm. Bradycardia, pneumonia, and
pulmonary embolism are not adverse effects
the nurse should expect.
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A neonatal intensive care unit nurse is caring
for an infant with RSV. What route of
9.
delivery will the nurse use when ribavirin
(Virazole) is administered?
Oral suspension
Topical
Intravenous
Inhaled
D
Feedback:
Ribavirin is inhaled systemically.
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A)
B)
C)
D)
Ans:
A)
B)
C)
D)
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A young woman is seen in the physician's
office and wants to ensure that she is
10. vaccinated against hepatitis. Vaccines are
available for which of the following types of
hepatitis? Select all that apply.
Hepatitis A virus
Hepatitis B virus
Hepatitis C virus
Hepatitis D virus
Hepatitis G virus
A, B
Feedback:
Vaccines are available for hepatitis A and B.
A patient is prescribed indinavir sulfate
(Crixivan) for the treatment of HIV infection.
11.
What patient teaching should be provided
regarding renal function?
Drink grape juice daily for antioxidants.
Drink grapefruit juice to enhance absorption.
Assess for pulmonary edema.
Consume at least 48 ounces of fluid per day.
D
Feedback:
When taking indinavir, the patient should be
instructed to consume 48 ounces of water or
fluid per day to prevent nephrolithiasis. The
regarding renal function?
Drink grape juice daily for antioxidants.
Drink grapefruit juice to enhance absorption.
Assess for pulmonary edema.
Consume at least 48 ounces of fluid per day.
D
Feedback:
When taking indinavir, the patient should be
instructed to consume 48 ounces of water or
fluid per day to prevent nephrolithiasis. The
consumption of grape juice with antioxidants
will assist in preventing nephrolysis but must
be in sufficient amounts. The consumption of
grapefruit juice is usually contraindicated.
The nurse would not need to assess for
pulmonary edema.
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B)
C)
D)
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A patient has sought care from her primary
care provider after feeling “under the
weather” for several days. The care provider
12. suspects that the patient is suffering from a
viral illness. What signs and symptoms
typically accompany viral infections? Select
all that apply.
Increased white cell count
Idiopathic bleeding
Malaise
Fever
Headache
C, D, E
Feedback:
Symptoms usually associated with acute viral
infections include fever, headache, cough,
malaise, muscle pain, nausea and vomiting,
diarrhea, insomnia, and photophobia. White
blood cell counts usually remain normal, and
bleeding is uncharacteristic.
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B)
C)
D)
E)
Ans:
A)
B)
C)
D)
Ans:
A young adult male who has had multiple sex
partners in the preceding months has been
diagnosed with hepatitis B virus (HBV) and
begun treatment with lamivudine (Epivir).
13. Shortly after beginning treatment, the man
complains of a 24-hour history of intense
abdominal pain. The nurse should recognize
the possibility of what adverse effect of
lamivudine therapy?
Gastroenteritis
Gastroesophageal reflux disease
Bowel obstruction
Pancreatitis
D
Feedback:
A main adverse effect of lamivudine is
abdominal pain. The nurse should recognize
the possibility of what adverse effect of
lamivudine therapy?
Gastroenteritis
Gastroesophageal reflux disease
Bowel obstruction
Pancreatitis
D
Feedback:
A main adverse effect of lamivudine is
pancreatitis. GERD, obstruction, and
gastroenteritis do not typically result from
lamivudine therapy. As well, these problems
do not typically manifest with intense and
sudden abdominal pain.
An influenza outbreak has spread through a
long-term care residence, affecting many of
the residents with severe malaise, fever, and
14. nausea and vomiting. In an effort to curb the
outbreak, the nurse has liaised with a
physician to see if residents may be
candidates for treatment with what drug?
Saquinavir mesylate
Oseltamivir phosphate
Lamivudine
Ribavirin
B
Feedback:
Oseltamivir phosphate (Tamiflu) is used to
treat active influenza. Saquinavir mesylate is a
protease inhibitor. Lamivudine is used to treat
hepatitis B. Ribavirin treats RSV.
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B)
C)
D)
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B)
C)
D)
Ans:
A)
B)
C)
D)
Ans:
A patient who is undergoing treatment for
cytomegalovirus received his first dose of IV
ganciclovir 3 days ago. When reviewing this
15.
patient's most recent blood work, what
abnormality should the nurse most likely
attribute to the use of this drug?
Hemoglobin 17 g/dL (high normal)
INR 3.8 (high)
Platelet count 118,000/mm3 (low)
Leukocytes 11,900/mm3 (high)
C
Feedback:
Ganciclovir causes granulocytopenia and
thrombocytopenia in 20% to 40% of
recipients, often during the first 2 weeks of
therapy. Leukocytosis, increased hemoglobin,
and hypocoagulation are not typical adverse
effects associated with ganciclovir.
Platelet count 118,000/mm3 (low)
3
Leukocytes 11,900/mm (high)
C
Feedback:
Ganciclovir causes granulocytopenia and
thrombocytopenia in 20% to 40% of
recipients, often during the first 2 weeks of
therapy. Leukocytosis, increased hemoglobin,
and hypocoagulation are not typical adverse
effects associated with ganciclovir.
C)
D)
A 42-year-old female patient with HIV has
been receiving antiretroviral therapy for
several years, and her care team has recently
added raltegravir (Isentress) to her drug
16. regimen. When appraising the success or
failure of this change in treatment and the
patient's ability to fight infection, the nurse
should prioritize which of the following
laboratory values?
The patient's C-reactive protein levels
The patient's erythrocyte sedimentation rate
(ESR)
The patient's viral load
The patient's CD4 count
D
Feedback:
The nurse assesses for an increase in T-helper
CD4 cells. The CD4 count measures the
ability to fight against infections. CD4 count
is more important than viral load in this
regard. CRP levels and ESR do not reflect the
patient's immune function.
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B)
C)
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When administering the fusion protein
17. inhibitor enfuvirtide (Fuzeon) to a patient
with HIV, the nurse should
have the patient gargle with normal saline
immediately after taking the drug.
flush the patient's central venous catheter with
100 Unit/mL heparin prior to administration.
inject the drug into the patient's ventrogluteal
site using the z-track method.
regularly rotate the subcutaneous injection
sites that are used.
D
Feedback:
The nurse injects enfuvirtide subcutaneously
into the upper arm, abdomen, or anterior
thigh. Injection of the drug into blood vessels,
navel, moles, scars, or other areas of skin
change should never occur. Rotation of
injection sites and assessment of the sites for
C)
site using the z-track method.
regularly rotate the subcutaneous injection
sites that are used.
D
Feedback:
The nurse injects enfuvirtide subcutaneously
into the upper arm, abdomen, or anterior
thigh. Injection of the drug into blood vessels,
navel, moles, scars, or other areas of skin
change should never occur. Rotation of
injection sites and assessment of the sites for
reactions are necessary.
D)
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A patient's antiretroviral therapy has not been
as efficacious as her care team had predicted,
and maraviroc (Selzentry) has consequently
18.
been added to her drug regimen. The nurse
should recognize this drug as belonging to
what category of antiretroviral?
Fusion protein inhibitors
Protease inhibitors
CCR5 antagonists
Integrase strand transfer inhibitors
C
Feedback:
Currently, maraviroc is the only member of
the class of CCR5 antagonists.
A)
B)
C)
D)
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B)
C)
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A school nurse is meeting with a high school
student who mentions that she is frustrated
with her repeated outbreaks of cold sores. The
student states that she tried an over-the19.
counter topical cream but that it failed to
produce an appreciable improvement. The
nurse should recognize that this student used
what drug?
Ganciclovir
Valacyclovir (Valtrex)
Famciclovir (Famvir)
Docosanol (Abreva)
D
Feedback:
Docosanol (Abreva) is an over-the-counter
topical antiviral agent that works in the early
stages of intracellular events of viral entry
into the target cells. Famciclovir (Famvir) is
an oral antiviral agent administered for herpes
zoster and recurrent genital herpes.
Valacyclovir (Valtrex) is not an over-thecounter medication. Cold sores are not treated
with ganciclovir.
Valacyclovir (Valtrex)
Famciclovir (Famvir)
Docosanol (Abreva)
D
Feedback:
Docosanol (Abreva) is an over-the-counter
topical antiviral agent that works in the early
stages of intracellular events of viral entry
into the target cells. Famciclovir (Famvir) is
an oral antiviral agent administered for herpes
zoster and recurrent genital herpes.
Valacyclovir (Valtrex) is not an over-thecounter medication. Cold sores are not treated
with ganciclovir.
A patient began antiretroviral therapy several
weeks ago for the treatment of HIV, and he
has now presented to the clinic for a
scheduled follow-up appointment. He states
20. to the nurse, “I've been pretty good about
taking all my pills on time, though it was a bit
hit and miss over the holiday weekend.” How
should the nurse best respond to this patient's
statement?
“Remember that if you miss a dose, you need
to take a double dose at the next scheduled
time.”
“It's acceptable to miss an occasional dose as
long as your symptoms don't get worse, but
it's not really recommended.”
“Remember that your antiretroviral drugs will
only be effective if you take them very
consistently.”
“If you're not consistent with taking your
medications, you're likely to develop more
side effects.”
C
Feedback:
Effective treatment of HIV infection requires
close adherence to drug therapy regimens
involving several drugs and daily doses.
Missing as few as one or two doses can
decrease blood levels of antiretroviral drugs
and result in increased HIV replication and
development of drug-resistant viral strains.
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Chapter 24 Drug Therapy for Fungal Infections
A patient develops itching and burning of the
vaginal vault while taking an anti-infective to
1.
treat strep throat. What fungal agent has most
likely caused the burning and itching?
Cryptococcus neoformans
Candida albicans
Aspergillus
Dermatophytes
B
Feedback:
Growth of Candida organisms is normally
restrained by intact immune mechanisms and
bacterial competition of nutrients. When these
restraining forces are altered (antibacterial
drug therapy), fungal overgrowth and
opportunistic infection can occur.
Cryptococcus neoformans organisms evade
normal immune defense of phagocytosis.
Aspergillus organisms produce protease.
Dermatophytes grow on cool body surfaces.
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B)
C)
D)
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A patient is being treated with amphotericin B
2. for a fungal infection of the urinary tract.
What is the action of amphotericin B?
It binds to ergosterol and forms holes in the
membrane.
It binds to an enzyme required for synthesis
of ergosterol.
It disrupts the fungal cell walls rather than the
cell membrane.
It inhibits glucan synthetase required for
glucan synthesis.
A
Feedback:
Amphotericin B binds to ergosterol and forms
holes in the membrane, causing leakage of
fungal cell contents and lysis of the cell. The
azole drugs bind to an enzyme that is required
for synthesis of ergosterol. This action causes
production of a defective cell membrane,
which allows leakage of intracellular contents
and destruction of the cell. Echinocandins
disrupt fungal cell walls rather than fungal
cell membranes. They inhibit glycan
synthetase, an enzyme required for synthesis
of glucan.
A)
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A patient is being treated for a severe fungal
3. infection with amphotericin B. What is the
expected length of treatment for this patient?
1 to 2 weeks
3 to 6 weeks
4 to 12 weeks
15 to 18 weeks
C
Feedback:
Because of the toxicity of amphotericin B, the
drug is used only for serious infections. It is
usually given for 4 to 12 weeks. Amphotericin
B is not given for 1 to 2 weeks, 3 to 6 weeks,
or 15 to 18 weeks.
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B)
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A patient is given Abelcet instead of
4. amphotericin B. What is the advantage of
Abelcet over amphotericin B?
It is a newer medication with a lower cost.
It is the same as amphotericin B in
hepatotoxicity.
It reaches higher concentration in diseased
tissue.
It constricts afferent renal arterioles to reduce
blood flow.
C
Feedback:
Lipid formulations, such as Abelcet, reach
higher concentrations in diseased tissues than
in normal tissues, so larger doses can be given
to increase therapeutic effects. Abelcet does
not cost less than amphotericin B. Abelcet has
fewer side effects than amphotericin B.
Amphotericin B constricts afferent renal
arterioles to reduce blood flow.
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A)
B)
C)
D)
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A child with a serious fungal infection is
receiving amphotericin B parenterally. Which
5.
of the following minerals will the patient most
likely be required to receive?
Chloride
Magnesium
Glucose
Sodium
B
Feedback:
A child with a serious fungal infection is
receiving amphotericin B parenterally. Which
5.
of the following minerals will the patient most
likely be required to receive?
Chloride
Magnesium
Glucose
Sodium
B
Feedback:
Hypomagnesemia may occur, which will
require the administration of magnesium. The
patient is less at risk for changes in chloride,
glucose, or sodium.
A patient is receiving oral nystatin suspension
for a fungal infection of the mouth. Which of
6.
the following adverse effects is most likely to
be experienced with this form of nystatin?
Local irritation
Burning
Nausea
Urinary urgency
C
Feedback:
Oral use of nystatin produces the following
adverse effects: nausea, vomiting, and
diarrhea. The vaginal application of nystatin
produces the following adverse effects: local
irritation and burning. Urinary urgency is not
an adverse effect associated with nystatin.
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A)
B)
C)
D)
Ans:
A)
B)
C)
D)
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B)
C)
D)
Ans:
A woman is seen in the clinic for vaginal
itching and discharge. Which of the following
7. medications can be administered in a single
dose to treat her discomfort and vaginal
discharge?
Caspofungin (Cancidas)
Terbinafine (Lamisil)
Ketoconazole (Nizoral)
Fluconazole (Diflucan)
D
Feedback:
Fluconazole (Diflucan) is used for vaginal
candidiasis in a single oral dose of 150 mg.
Caspofungin is not used for vaginal
candidiasis, but for invasive aspergillosis.
Terbinafine is used for interdigital tinea pedis.
Ketoconazole is used for patients with organ
transplants.
Terbinafine (Lamisil)
Ketoconazole (Nizoral)
Fluconazole (Diflucan)
D
Feedback:
Fluconazole (Diflucan) is used for vaginal
candidiasis in a single oral dose of 150 mg.
Caspofungin is not used for vaginal
candidiasis, but for invasive aspergillosis.
Terbinafine is used for interdigital tinea pedis.
Ketoconazole is used for patients with organ
transplants.
A patient has been diagnosed with a fungal
infection and is to be treated with itraconazole
(Sporanox). Prior to administration, the nurse
8. notes that the patient is taking carbamazepine
(Tegretol) for a seizure disorder. Based on this
medication regime, which of the following
will be true regarding the medications?
The serum level of carbamazepine will be
increased.
The patient's carbamazepine should be
discontinued.
The patient's antiseizure medication should be
changed.
The patient will require a higher dosage of
itraconazole (Sporanox).
D
Feedback:
Drugs that induce drug-metabolizing enzymes
(e.g., carbamazepine, phenytoin, rifampin)
decrease serum concentrations of
itraconazole. The serum level of
carbamazepine will not need to be increased.
The carbamazepine should not be
discontinued or changed.
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C)
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A patient is being treated with caspofungin for
a systemic fungal infection related to
Aspergillus. Prior to the administration of the
9. first parenteral dose, the nurse notes that the
patient's AST and ALT levels are elevated.
How will these serum hepatic enzymes affect
the administration of caspofungin?
The dose will need to be increased.
The dose will need to be decreased.
The dose will require a serum trough.
The medication should not be given.
B
Feedback:
The dose of caspofungin will need to be
reduced due to the risk of hepatotoxicity. The
dose of caspofungin should not be increased.
the administration of caspofungin?
The dose will need to be increased.
The dose will need to be decreased.
The dose will require a serum trough.
The medication should not be given.
B
Feedback:
The dose of caspofungin will need to be
reduced due to the risk of hepatotoxicity. The
dose of caspofungin should not be increased.
The peak and trough are not as vital as the
reduction of the dose. The medication should
be administered at a lower dose.
A)
B)
C)
D)
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A patient is being treated for a fungal
infection with IV amphotericin B. In order to
10.
prevent drug discomfort, the nurse should
consistently monitor the patient's levels of
sodium.
hemoglobin.
calcium.
leukocytes.
A
Feedback:
It is essential to assess the sodium balance
throughout the administration of
amphotericin. By maintaining the serum
sodium level within normal range, the patient
has decreased symptoms of drug discomfort.
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B)
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A patient is receiving intravenous
amphotericin. Which of the following
11.
assessments warrants the discontinuation of
the antifungal agent?
Sodium of 138 mEq/L
Hematocrit of 39%
Blood urea nitrogen of 60 mg/dL
AST 10 Unit/L
C
Feedback:
If the patient's BUN exceeds 40 mg/dL or
serum creatinine exceeds 3 mg/dL, the drug
should be stopped or dosage should be
reduced until renal function recovers. The
hematocrit is in normal range and will not
affect the medication administration. The AST
and sodium levels are within normal range
and will not affect the administration.
A patient is being treated with amphotericin
B. Which of the following statements
12.
indicates that the patient has understood the
patient teaching?
“The medication may cause diabetes.”
“The medication will cause liver necrosis.”
“The medication may cause kidney damage.”
“The medication will cause pancreatitis.”
C
Feedback:
The main concern with the administration of
amphotericin B is the risk of nephrotoxicity.
Thus, the statement that the medication may
cause kidney damage is the most appropriate.
The medication will not cause diabetes, liver
necrosis, or pancreatitis.
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Amphotericin B is being used in the treatment
of cryptococcosis in a patient who has HIV.
13. When assessing for potential signs and
symptoms of cryptococcosis, the nurse should
prioritize what assessment?
Neurological assessment
Functional assessment
Nutritional assessment
Cardiac assessment
A
Feedback:
Cryptococcosis may involve the lungs, skin,
and other body organs. In patients with AIDS
or other immunosuppressant disorders, it
often involves the CNS and produces mental
status changes, headache, dizziness, and neck
stiffness. Neurological assessment is
consequently a priority.
An adult patient was recently diagnosed with
a tinea infection, and her primary care
provider promptly began treatment with
griseofulvin. During a scheduled clinic visit,
the patient states to the nurse, “I'm pretty
14.
good at reading my body's signals, so I make
sure to take a bit extra when I think my
infection is getting worse.” This patient's
statement is suggestive of what nursing
diagnosis?
Deficient knowledge related to correct use of
griseofulvin
Effective therapeutic regimen management
related to symptom identification
Disturbed thought processes related to
appropriate use of griseofulvin
Ineffective coping related to self-medication
A
Feedback:
In order to achieve maximum therapeutic
benefit, it is important for the patient to take
the drug exactly as ordered. The patient's
statement suggests that she does not
appreciate or understand this fact. There is no
evidence of pathological thought patterns or
ineffective coping.
A)
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C)
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A patient with systemic candidiasis has been
prescribed flucytosine. The nurse should be
15.
aware of the need to administer this drug with
which of the following?
Vitamin D and calcium supplements
Fluconazole (Diflucan)
Amphotericin B
Penicillin G
C
Feedback:
Flucytosine is used as an adjunctive agent
with amphotericin B for the treatment of
systemic fungal infections caused by Candida
and Cryptococcus.
An adult patient has begun treatment with
fluconazole. The nurse should recognize the
16. need to likely discontinue the drug if the
patient develops which of the following signs
or symptoms?
Jaundice
Weight gain
Iron deficiency anemia
Hematuria
A
Feedback:
The azoles may cause hepatotoxicity, and the
development of jaundice usually accompanies
liver damage, which may necessitate
discontinuing the drug. Fluconazole is not
associated with weight gain, anemia, or
hematuria.
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B)
C)
D)
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An older adult patient has asked her primary
care provider for a prescription that will help
to resolve her “warped toenails.” The care
17. provider has diagnosed the woman with
onychomycosis. The nurse should anticipate
that this patient will be treated with what
drug?
Micafungin (Mycamine)
Terbinafine (Lamisil)
Voriconazole (Vfend)
Fluconazole (Diflucan)
B
Feedback:
Terbinafine (Lamisil) is used for the treatment
of onychomycosis of the fingernails or
toenails.
A)
B)
C)
D)
Ans:
A 43-year-old man has tested positive for
systemic candidiasis, and the care team has
18. decided on IV fluconazole as a first-line
treatment. When administering this
medication, the nurse should
administer the drug with lactated Ringer's.
infuse the drug no faster than 200 mg/h.
avoid administering the drug through a
peripheral IV.
administer prophylactic heparin prior to the
fluconazole.
B
Feedback:
18. decided on IV fluconazole as a first-line
treatment. When administering this
medication, the nurse should
administer the drug with lactated Ringer's.
infuse the drug no faster than 200 mg/h.
avoid administering the drug through a
peripheral IV.
administer prophylactic heparin prior to the
fluconazole.
B
Feedback:
Continuous infusion of fluconazole occurs at
a maximum rate of 200 mg/h. The drug is not
administered with lactated Ringer's or
heparin. A peripheral IV may be used.
A)
B)
C)
D)
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When administering the azoles in the home
setting, the home health nurse should
19.
prioritize educational interventions that
address what nursing diagnosis?
Risk for injury related to antifungal therapy
Risk for acute confusion related to antifungal
therapy
Risk for infection related to antifungal
therapy
Risk for falls related to antifungal therapy
C
Feedback:
When administering the azoles in the home
setting, it is important that the home care
nurse instruct the patient and family on the
management of the environment with the
implementation of good hand hygiene,
household cleanliness, removal of potted
plants and fresh flowers, and the use of air
conditioning and air filtration systems. The
nurse should also tell the patient and family
about measures to prevent the reinfection and
spread of the fungal infection. Falls,
confusion, and injury are less likely
consequences of using the azoles in the home
setting.
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Ans:
Caspofungin has been ordered in the
treatment of a patient who is being treated in
20. the acute medicine unit for invasive
aspergillosis. The nurse should teach the
patient to promptly report what symptoms?
Cardiac symptoms
Diaphoresis
Dry mouth
Muscle pain
A
Feedback:
A)
B)
C)
D)
Ans:
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Chapter 25 Drug Therapy for Parasitic Infections
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treatment of a patient who is being treated in
20. the acute medicine unit for invasive
aspergillosis. The nurse should teach the
patient to promptly report what symptoms?
Cardiac symptoms
Diaphoresis
Dry mouth
Muscle pain
A
Feedback:
Caspofungin is administered in the acute care
setting. The patient should receive instruction
about the histamine reaction to the medication
and the necessity of reporting any cardiac
symptoms. Diaphoresis, dry mouth, and
muscle pain are not normally associated with
the administration of caspofungin.
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A child who attends a day care center has
been admitted to the pediatric unit with
diarrhea and abdominal cramping. He has
1.
been diagnosed with giardiasis. How long
does it take for the symptoms of giardiasis to
develop after ingestion of cysts?
12 to 24 hours
3 to 5 days
1 to 2 weeks
2 to 3 months
C
Feedback:
Giardia infections occur 1 to 2 weeks after the
ingestion of the cysts and may be
asymptomatic or produce diarrhea, abdominal
cramps, and distention.
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B)
C)
D)
Ans:
A)
B)
C)
D)
Ans:
A teacher in a preschool is diagnosed with
giardiasis. Which of the following
2.
medications will be administered to treat the
diarrhea and abdominal distention?
Sulfasalazine (Azulfidine)
Metronidazole (Flagyl)
Trimethoprim–sulfamethoxazole (Bactrim)
Doxycycline (Vibramycin)
B
Feedback:
Adults and children older than 8 years of age
with symptomatic giardiasis are usually
treated with oral metronidazole. The
administration of sulfasalazine is used to treat
ulcerative colitis. Trimethoprim–
sulfamethoxazole is used to treat urinary tract
Metronidazole (Flagyl)
Trimethoprim–sulfamethoxazole (Bactrim)
Doxycycline (Vibramycin)
B
Feedback:
Adults and children older than 8 years of age
with symptomatic giardiasis are usually
treated with oral metronidazole. The
administration of sulfasalazine is used to treat
ulcerative colitis. Trimethoprim–
sulfamethoxazole is used to treat urinary tract
infections. Doxycycline is a tetracycline
agent. It is not used for giardiasis.
A group of nursing students and their
professor are engaged in a service learning
3. project and will be caring for patients in Haiti.
What medication should be administered to
prevent the development of malaria?
Metronidazole (Flagyl)
Oprelvekin (Neumega)
Chloroquine phosphate (Aralen)
Chloroprocaine hydrochloride (Nesacaine)
C
Feedback:
Chloroquine phosphate (Aralen) is
administered to prevent malaria when
traveling to the countries where malaria is a
risk because of infected mosquitoes.
Metronidazole is not administered to prevent
malaria. Oprelvekin is used in the prevention
of severe thrombocytopenia with
antineoplastic chemotherapy. Chloroprocaine
hydrochloride is a local anesthetic agent.
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C)
D)
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B)
C)
D)
Ans:
A)
B)
C)
D)
Ans:
A woman is diagnosed with Trichomonas
vaginalis. She is being treated with
4.
metronidazole (Flagyl) orally. What factor is
most important in the care of this patient?
Instruct her on safe sex.
Instruct her to drink red wine.
Instruct her to take two tablets if a dose is
missed.
Instruct her to have her partner treated.
D
Feedback:
The woman should be instructed that her
partner should also be treated. Because
trichomoniasis is transmitted by sexual
intercourse, partners should be treated
simultaneously to prevent reinfection.
Although instruction on safe sexual practices
is always important, it will not prevent
reinfection, and the partner is infected
Instruct her to take two tablets if a dose is
missed.
Instruct her to have her partner treated.
D
Feedback:
The woman should be instructed that her
partner should also be treated. Because
trichomoniasis is transmitted by sexual
intercourse, partners should be treated
simultaneously to prevent reinfection.
Although instruction on safe sexual practices
is always important, it will not prevent
reinfection, and the partner is infected
asymptomatically. The patient should not
drink while taking metronidazole. The woman
should not double the dose if it is missed.
C)
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A home care nurse visits a patient who is bed
bound and lives in a 12-story high rise
apartment complex. Her daughter states that
5. she has small red skin lesions over her body
and she has been itching. What parasite is
most likely responsible for this patient's skin
lesions?
Sarcoptes scabiei
Pediculosis corporis
Pediculosis pubis
Toxoplasma gondii
A
Feedback:
Scabies are parasitic infestations of the skin.
Scabies is caused by the itch mite (Sarcoptes
scabiei), which burrows into the skin and lays
eggs that hatch in 4 to 8 days. Pediculosis
corporis is body lice. Pediculosis pubis is
diagnosed by the presence of nits in the pubic
and genital areas. Toxoplasma gondii is a
parasite spread by ingesting undercooked
meat or other food containing encysted forms
of the organism.
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B)
C)
D)
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B)
C)
D)
The administration of benzene hexachloride
(Lindane) for the treatment of scabies is
6. applied in small quantities. What is the
rationale for instructing the patient to apply
the medication in small quantities?
Excessive applications will lead to central
nervous system toxicity.
Excessive applications will cause irritation,
rash, and inflammation.
Excessive applications will cause headaches,
dizziness, and diarrhea.
Excessive applications will lead to anorexia
and cachexia.
6. applied in small quantities. What is the
rationale for instructing the patient to apply
the medication in small quantities?
Excessive applications will lead to central
nervous system toxicity.
Excessive applications will cause irritation,
rash, and inflammation.
Excessive applications will cause headaches,
dizziness, and diarrhea.
Excessive applications will lead to anorexia
and cachexia.
A
Feedback:
Lindane is applied topically, and substantial
amounts are absorbed through intact skin.
Central nervous toxicity has been reported
with excessive use. The application of
Lindane will not cause irritation, rash, or
inflammation. The application of Lindane will
not cause headaches, dizziness, or diarrhea.
The application of Lindane will not lead to
anorexia or cachexia.
A)
B)
C)
D)
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A patient is receiving chloroquine (Aralen)
for extraintestinal amebiasis. Which of the
7.
following medications should be administered
with chloroquine?
Iodoquinol (Yodoxin)
Metronidazole (Flagyl)
Metyrosine (Demser)
Carbamazepine (Tegretol)
B
Feedback:
Chloroquine is used mainly for its
antimalarial effects. When used as an
amebicide, the drug is effective in
extraintestinal amebiasis, but usually
ineffective in intestinal amebiasis. Treatment
is usually combined with an intestinal
amebicide. Metronidazole is an intestinal
amebicide. Iodoquinol is an iodine compound
that acts against amebae in the intestinal
lumen. Metyrosine is an enzyme inhibitor.
Carbamazepine is an antiseizure medication.
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B)
C)
D)
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B)
C)
D)
Ans:
A patient has been prescribed iodoquinol
(Yodoxin). Prior to administering iodoquinol
8.
(Yodoxin), what assessment should the nurse
make?
Assess for allergy to iodine.
The time the patient ate
Assess for skin eruptions.
Assess for ophthalmic symptoms.
A
A patient has been prescribed iodoquinol
(Yodoxin). Prior to administering iodoquinol
8.
(Yodoxin), what assessment should the nurse
make?
Assess for allergy to iodine.
The time the patient ate
Assess for skin eruptions.
Assess for ophthalmic symptoms.
A
Feedback:
Iodoquinol (Yodoxin) is an iodine compound;
so, prior to administration, the nurse should
assess the patient for an iodine allergy. The
administration of this medication is not
dependent on the time the patient ate. The
nurse should assess for skin eruptions after
the administration of the medication. The
nurse should assess for ophthalmic symptoms
after the administration of the medication.
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B)
C)
D)
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A nurse is educating a patient on the
administration of tinidazole (Tindamax).
9. Which of the following indicates that the
patient understands the administration of
tinidazole?
“I will report to the doctor if I have a slow
heart rate.”
“The medicine will leave a bitter or metallic
taste in my mouth.”
“I will report urinary urgency and
incontinence.”
“The medication is given in two doses every
day.”
B
Feedback:
Tinidazole (Tindamax) will produce a bitter
or metallic taste in the mouth. Tinidazole will
cause tachycardia as an adverse effect.
Tinidazole will cause urinary retention, not
urgency. Tinidazole should be administered in
one dose, not two doses.
A)
B)
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B)
A 9-year-old boy's mother is anxious about
the fact that he will soon begin treatment for
worms using mebendazole. The mother asks
10.
the nurse about the way in which the drug will
eradicate her son's parasitic worms. How
should the nurse best respond to the mother?
“Mebendazole will stop the worms from
being able to reproduce.”
“Mebendazole robs the worms of the glucose
they need to survive.”
“This drug will prompt your son's body to
the fact that he will soon begin treatment for
worms using mebendazole. The mother asks
10.
the nurse about the way in which the drug will
eradicate her son's parasitic worms. How
should the nurse best respond to the mother?
“Mebendazole will stop the worms from
being able to reproduce.”
“Mebendazole robs the worms of the glucose
they need to survive.”
“This drug will prompt your son's body to
expel the worms.”
“This drug causes the cells in each worm's
body to burst.”
B
Feedback:
Mebendazole blocks glucose uptake by
susceptible helminths. The drug depletes
glycogen stores that the worms need for
survival and reproduction, resulting in their
death.
A)
B)
C)
D)
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A young adult has been diagnosed with
hookworm and has begun taking
11. mebendazole. When monitoring this patient's
health status during treatment, what
diagnostic value should the nurse prioritize?
Aspartate aminotransferase (AST) and alanine
aminotransferase (ALT)
White blood cell differential
International normalized ratio (INR) and
activated partial thromboplastin time (aPTT)
Hemoglobin, hematocrit, and red blood cell
levels
A
Feedback:
Because mebendazole is potentially
hepatotoxic, it is important to assess the
hepatic enzymes AST and ALT for elevations
leading to hepatic failure. The other listed
laboratory values are relevant indicators of
the patient's health status, but neither relates
directly to the specific risks of mebendazole.
A)
B)
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A school nurse is teaching the mother of a 7year-old girl how to safely and effectively
apply permethrin after her daughter was
12.
diagnosed with head lice. The nurse should
teach the mother to do which of the
following?
Apply permethrin twice daily until the lice are
eradicated.
Avoid using shampoo for the duration of
treatment.
Apply the cream only to those locations
A school nurse is teaching the mother of a 7year-old girl how to safely and effectively
apply permethrin after her daughter was
12.
diagnosed with head lice. The nurse should
teach the mother to do which of the
following?
Apply permethrin twice daily until the lice are
eradicated.
Avoid using shampoo for the duration of
treatment.
Apply the cream only to those locations
where nits or lice are visible.
Wear gloves when applying the permethrin
cream.
D
Feedback:
When administering permethrin for head lice,
it is necessary to wear gloves. Administration
should occur again in 1 week if lice and nits
are present. The cream should be applied to
the entire scalp, and there is no need to avoid
using shampoo.
A)
B)
C)
D)
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Ivermectin (Stromectol) appears on a list of a
patient's recent medications. The nurse who is
reviewing the medications is justified in
13.
suspecting that the patient may have been
receiving treatment for a parasitic infection
with
Entamoeba histolytica.
Giardia lamblia.
Strongyloides stercoralis.
Plasmodium falciparum.
C
Feedback:
Ivermectin (Stromectol), which is used for
numerous parasitic infections, is most active
against strongyloidiasis (caused by the
roundworm Strongyloides stercoralis).
Entamoeba histolytica causes amebiasis.
Plasmodium falciparum causes malaria, and
Giardia lamblia causes giardiasis.
A)
B)
C)
D)
Ans:
A 24-year-old man is planning a trip to
Southeast Asia and has obtained a
14. prescription for chloroquine for malaria
prophylaxis. While taking this drug, the nurse
should likely encourage the patient to avoid
soy products.
unpeeled vegetables.
high-fat food.
alcohol.
D
Feedback:
When chloroquine is combined with alcohol,
Southeast Asia and has obtained a
14. prescription for chloroquine for malaria
prophylaxis. While taking this drug, the nurse
should likely encourage the patient to avoid
soy products.
unpeeled vegetables.
high-fat food.
alcohol.
D
Feedback:
When chloroquine is combined with alcohol,
the risk of GI distress increases. There is no
particular need for this patient to avoid soy,
dietary fat, or unpeeled vegetables.
A nature photographer will be embarking on a
trip to sub-Saharan Africa and is beginning a
protocol for malaria prophylaxis involving
15.
500 mg of chloroquine phosphate (Aralen).
What instruction should the nurse include in
this patient's health education?
“Make sure you take your pill on the same
day each week.”
“It's not unusual to develop a rash on your
trunk and arms, but this isn't cause for
concern.”
“You'll need to plan ahead so that you take
your chloroquine on an empty stomach.”
“We'll need to provide you with enough
syringes and teach you how to inject the
drug.”
A
Feedback:
For malaria prophylaxis, chloroquine is taken
weekly. It is administered orally and may be
taken with food. A rash is not expected and
would necessitate further follow-up.
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B)
C)
D)
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B)
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A child has been taking mebendazole for the
past 3 weeks after being diagnosed with
16. roundworm. The nurse will determine the
efficacy of the child's treatment by
referencing what diagnostic test?
Liver enzymes
Stool for ova and parasites
Colonoscopy or sigmoidoscopy
Rectal swab for culture
B
Feedback:
The nurse obtains a stool sample for culture
for ova and parasites after 3 weeks of drug
administration. A negative stool culture is the
optimum outcome of drug therapy.
Colonoscopy, liver enzyme levels, and rectal
Liver enzymes
Stool for ova and parasites
Colonoscopy or sigmoidoscopy
Rectal swab for culture
B
Feedback:
The nurse obtains a stool sample for culture
for ova and parasites after 3 weeks of drug
administration. A negative stool culture is the
optimum outcome of drug therapy.
Colonoscopy, liver enzyme levels, and rectal
swabs are not used to ascertain whether
treatment has been successful.
A primary care provider has completed an
assessment of a patient who recently returned
from a trip to Nepal with a nongovernmental
organization. The care provider has liaised
17.
with the nurse to create a plan of care that will
focus on treatment for amebiasis. What signs
and symptoms most likely prompted this
patient to initially seek care?
Malaise and fatigue
Severe diarrhea
Intermittent fever
Dizziness and confusion
B
Feedback:
Trophozoites (active amebae) produce an
enzyme that allows them to invade body
tissues. They may form erosions and
ulcerations in the intestinal wall with resultant
diarrhea. This is a characteristic symptom of
amebiasis.
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B)
C)
D)
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B)
C)
D)
Ans:
A)
B)
C)
D)
Ans:
A patient who is taking metronidazole for the
past 4 days for the treatment of a parasitic
infection reports to the nurse that his most
18. recent dose made him “flushed, sweaty, and
sick in the stomach.” What assessment is
most likely to address the cause of this
phenomenon?
“Do you know if you've ever had an allergic
reaction to penicillin?”
“Did you drink any alcoholic beverages
around the time of taking the drug?”
“Did you take this dose on an empty
stomach?”
“Are you taking any over-the-counter
antihistamines?”
B
Feedback:
Flushing, headache, nausea, sweating, and
vomiting may occur if alcohol is ingested
A)
B)
C)
D)
Ans:
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reaction to penicillin?”
“Did you drink any alcoholic beverages
around the time of taking the drug?”
“Did you take this dose on an empty
stomach?”
“Are you taking any over-the-counter
antihistamines?”
B
Feedback:
Flushing, headache, nausea, sweating, and
vomiting may occur if alcohol is ingested
with metronidazole. This reaction is unlikely
attributable to an allergy, since he has been
taking the drug for 4 days. Taking Flagyl on
an empty stomach or with antihistamines
would not likely have this effect.
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Chapter 26 Drug Therapy for Hypertension
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A community health nurse is facilitating a
health promotion session to a group of
1.
seniors. Which of the following is most
important to instruct regarding hypertension?
Hypertension will increase the risk of cancer.
An increase in sodium is recommended with
hypertension.
Vigorous exercise will increase the risk of
hypertension.
Hypertension will increase the risk of heart
disease.
D
Feedback:
Hypertension increases risks of myocardial
infarction, heart failure, cerebral infarction
and hemorrhage, and renal disease.
Hypertension does not increase the risk of
cancer. An increase in sodium in a patient's
diet is not recommended with hypertension.
Exercise will decrease the risk of
hypertension.
A patient is diagnosed with high blood
2. pressure. Which of the following events
occurs in a patient with hypertension?
The kidneys excrete more fluid in response to
increased blood pressure.
Fluid loss increases blood volume in the
patient with hypertension.
Decreased blood volume increases blood
pressure.
Cardiac output increases and in turn causes an
increase in blood pressure.
A patient is diagnosed with high blood
2. pressure. Which of the following events
occurs in a patient with hypertension?
The kidneys excrete more fluid in response to
increased blood pressure.
Fluid loss increases blood volume in the
patient with hypertension.
Decreased blood volume increases blood
pressure.
Cardiac output increases and in turn causes an
increase in blood pressure.
A
Feedback:
When arterial blood pressure is elevated, the
kidneys excrete more fluid. The loss of fluid
will reduce, not increase, blood volume. The
decreased blood volume will decrease cardiac
output. The decreased cardiac output
decreases blood pressure.
A)
B)
C)
D)
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A patient has had multiple blood pressure
3. readings that indicate he has hypertension.
How is hypertension defined?
Systolic pressure above 140 mm Hg or
diastolic pressure above 90 mm Hg
Systolic pressure above 160 mm Hg or
diastolic pressure above 110 mm Hg
Systolic pressure above 130 mm Hg or
diastolic pressure above 95 mm Hg
Systolic pressure above 150 mm Hg or
diastolic pressure above 100 mm Hg
A
Feedback:
Hypertension is defined as a systolic pressure
above 140 mm Hg or a diastolic pressure
above 90 mm Hg on multiple blood pressure
measurements. The blood pressure of 160/110
mm Hg is considered hypertensive but does
not define hypertension. The blood pressure
of 130/95 mm Hg is hypertensive but does not
define hypertension. The blood pressure of
150/100 mm Hg is hypertensive but does not
define hypertension.
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A patient has recently been diagnosed with
4. hypertension. Which of the following
outcomes is most important in this patient?
Verbalization of an understanding of medical
regimen
Compliance with antihypertensive
medications
Multiple diastolic blood pressure readings
<90 mm Hg
Compliance with a low-sodium diet
A patient has recently been diagnosed with
4. hypertension. Which of the following
outcomes is most important in this patient?
Verbalization of an understanding of medical
regimen
Compliance with antihypertensive
medications
Multiple diastolic blood pressure readings
<90 mm Hg
Compliance with a low-sodium diet
C
Feedback:
The diastolic blood pressure below 90 mm Hg
is the most important outcome in this patient.
Verbalization of understanding of the medical
regime is a patient-related outcome that is
important but not the most important
outcome. Compliance with antihypertensive
medications is important but does not confirm
a decreased blood pressure. Compliance with
a low-sodium diet will assist in decreasing
blood pressure but will not confirm that the
blood pressure is decreased.
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B)
C)
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A patient is diagnosed with hypertension and
is being treated with captopril (Capoten).
5. Which of the following patients should be
administered captopril as the first-line
treatment?
A patient with diabetes mellitus
A patient with asthma
A patient with glaucoma
A patient with angina pectoris
A
Feedback:
Captopril (Capoten) is the first-line agent for
treating hypertension in diabetic patients,
particularly those with type 1 diabetes.
Captopril can be used for hypertension in
patients with asthma, glaucoma, and angina
pectoris but is not the first-line agent, as noted
in diabetes mellitus.
A)
B)
C)
D)
Ans:
A patient with diabetes mellitus is prescribed
captopril (Capoten) to treat hypertension.
6.
What electrolyte imbalance might the patient
be prone to develop?
Hyperkalemia
Hypokalemia
Hypernatremia
Hypermagnesemia
A
Feedback:
Hyperkalemia may develop in patients who
A patient with diabetes mellitus is prescribed
captopril (Capoten) to treat hypertension.
6.
What electrolyte imbalance might the patient
be prone to develop?
Hyperkalemia
Hypokalemia
Hypernatremia
Hypermagnesemia
A
Feedback:
Hyperkalemia may develop in patients who
have diabetes mellitus or renal impairment.
Hypokalemia is not a risk in patients with
diabetes mellitus. Hypernatremia is not a
major risk in patients with diabetes who are
taking captopril. Hypermagnesemia is not a
risk in patients with diabetes who are taking
captopril.
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B)
C)
D)
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A patient is prescribed losartan (Cozaar). The
medication alone is not effective in
7. controlling blood pressure. What medication
will best increase the effectiveness of blood
pressure control in this patient?
Atorvastatin calcium (Lipitor)
Hydrochlorothiazide (HCTZ)
Hydralazine hydrochloride
Digoxin (Lanoxin)
B
Feedback:
If losartan alone does not control blood
pressure, a low dose of diuretic may be added.
Hydrochlorothiazide is a diuretic agent.
Atorvastatin calcium is not a diuretic agent.
Hydralazine is not a diuretic agent. Digoxin is
not a diuretic agent.
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A)
B)
C)
D)
Ans:
A)
B)
C)
D)
Ans:
A patient who is malnourished and has
hypertension is being treated with losartan
8.
(Cozaar). How should the dose of the
medication be adjusted in this patient?
The dose should be higher than normal.
The dose should be lower than normal.
The dose should remain the same as normal.
The medication should be combined with a
diuretic.
B
Feedback:
Both losartan and the metabolite are highly
bound to plasma albumin, and losartan has a
shorter duration of action. Due to
malnutrition, a low dose of losartan should be
prescribed. The dose should not be higher
than normal due to possible toxicity. The dose
C)
The dose should remain the same as normal.
The medication should be combined with a
diuretic.
B
Feedback:
Both losartan and the metabolite are highly
bound to plasma albumin, and losartan has a
shorter duration of action. Due to
malnutrition, a low dose of losartan should be
prescribed. The dose should not be higher
than normal due to possible toxicity. The dose
should not be the same as normal due to
possible toxicity. The medication will not be
combined with a diuretic unless the blood
pressure is not controlled.
D)
Ans:
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A patient is prescribed trandolapril (Mavik).
What adverse effect should the patient be
9.
instructed on that can occur with angiotensinconverting enzyme (ACE) inhibitors?
Sedation
Persistent cough
Tachycardia
Rash
B
Feedback:
A persistent cough can develop with the use
of ACE inhibitors. Sedation, tachycardia, and
rash are not noted with ACE Inhibitors.
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B)
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D)
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B)
C)
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A patient is being administered enalapril
maleate (Vasotec). Which of the following
10. diuretics can be combined with ACE
inhibitors to increase effectiveness in
decreasing blood pressure?
Loop diuretics
Osmotic diuretics
Potassium-sparing diuretics
Thiazide diuretics
D
Feedback:
ACE inhibitors may be used alone or in
combination with other antihypertensive
agents, such as thiazide diuretics. ACE
inhibitors are not routinely combined with
loop, osmotic, or potassium-sparing diuretics.
A patient is diagnosed with hypertension, and
the care team is establishing the best
medication regimen to match the patient's
11.
decreased level of function. Which of the
following medications can be administered by
transdermal patch?
Amlodipine (Norvasc)
Candesartan (Atacand)
Enalapril (Vasotec)
Clonidine (Catapres)
D
Feedback:
Clonidine is available as a transdermal patch.
Enalapril, candesartan, and amlodipine are not
available by this route.
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B)
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B)
C)
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B)
C)
D)
Ans:
An African American patient is being treated
for a new diagnosis of hypertension. What
12.
antihypertensive agent is the most likely drug
of choice for this patient?
Diuretic
Vasodilator
Calcium channel blocker
Beta-adrenergic blocker
A
Feedback:
In African Americans, diuretics are effective
and recommended as initial drug therapy.
A patient is prescribed a potassium-sparing
13. diuretic. What electrolyte imbalance would
the patient be prone to develop?
Hypernatremia
Hyponatremia
Hypokalemia
Hyperkalemia
D
Feedback:
Potassium-sparing diuretics may precipitate
hyperkalemia. Potassium-sparing diuretics
would not precipitate hypernatremia,
hyponatremia, or hypokalemia.
When providing dietary instruction on a low14. sodium diet, which dietary choice is most
appropriate for a patient with hypertension?
Hot dog, baked beans, and coleslaw
Grilled hamburger, french fries, and cola
Grilled chicken, green salad, and apple
Ham sandwich, potato chips, and cookie
C
Feedback:
Therapeutic regimes include sodium
restriction. The grilled chicken, green salad,
and apple represent low-sodium dietary
choices. Hot dog, baked beans, and coleslaw
are high in sodium. Grilled hamburger, french
fries, and cola are high in sodium. Ham
sandwich, potato chips, and cookie are high in
sodium.
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B)
C)
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A patient of Asian descent has been diagnosed
with hypertension. He is placed on a beta15.
blocker. Why is the dose lower than in most
other patients?
Asians metabolize and excrete beta-blockers
slower.
Asians metabolize beta-blockers in the small
intestine.
Asians have a diminished renal excretion of
beta-blockers.
Asians are more likely to have a lower
albumin level.
A
Feedback:
Asians in general need much smaller doses of
beta-blockers because they metabolize and
excrete beta-blockers slowly. They do not
metabolize beta-blockers in the small
intestine. They do not have diminished renal
excretion of beta-blockers. They do not have
a lower albumin level.
A)
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C)
After obtaining several elevated blood
pressure readings from the automated
sphygmomanometer in his local drugstore, a
51-year-old man sought care from his primary
care provider. The patient has been diagnosed
16.
with hypertension following several elevated
blood pressure readings. The nurse at the
clinic should recognize which of the
following drug regimens as being most
likely?
Monotherapy with a loop diuretic
Monotherapy with an ACE inhibitor
A beta-blocker combined with a calcium
channel blocker
A thiazide diuretic combined with a betablocker
D
Feedback:
The JNC 7 guidelines suggest thiazide
diuretics be used as first-line therapy, either
alone (monotherapy) or with a beta-blocker,
ACE inhibitor, ARB, or calcium channel
blocker. Consequently, the other listed drug
regimens are less likely to be implemented.
A)
B)
C)
D)
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An elderly man who resides in a care facility
has been prescribed antihypertensives for the
first time following many years of generally
17.
good health. When administering the first
dose of the prescribed medications, the nurse
should recognize what nursing diagnosis?
Risk for falls related to antihypertensive
medications
Risk for infection related to antihypertensive
medications
Risk for acute confusion related to
antihypertensive medications
Risk for impaired oxygenation related to
antihypertensive medications
A
Feedback:
Initiation of antihypertensive therapy creates a
risk of acute hypotension and consequent
falls. Infection, confusion, or impaired
oxygenation is much less likely.
C)
D)
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A patient is being treated in the hospital for a
femoral fracture and is scheduled to receive
his daily dose of metoprolol (Lopressor) that
he has been taking for the treatment of
18.
hypertension for several years. Prior to
administering this drug, the nurse should
assess and document which of the following?
Select all that apply.
Oxygen saturation level
Heart rate
Potassium level
Blood pressure
Capillary refill
B, D
Feedback:
Beta-blockers reduce heart rate and blood
pressure; both parameters should be assessed
prior to administration. Beta-blockers do not
significantly affect potassium levels, oxygen
levels, or peripheral circulation.
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A nurse is working with an adult patient who
has recently been diagnosed with
hypertension and begun combination therapy.
19.
Which of the patient's following statements
would suggest a need for further health
education?
“I'm going to make up a schedule for
checking my blood pressure on a regular
basis.”
“I'll only need to take these drugs on days
when my blood pressure is particularly high.”
“My wife and I are thinking of ways that we
can cut down the amount of salt in our diet.”
“I've made plans with my best friend to start
going for walks in the morning four times a
week.”
B
Feedback:
Antihypertensive drug therapy is usually long
term and is taken regularly, except in
instances of hypotension or bradycardia.
Therapy should not be seen as a response to
short-term hypertensive readings. The other
listed statements are appropriate responses to
diagnosis and treatment.
D)
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A patient started taking ramipril earlier in the
week for the treatment of hypertension. At her
20. latest clinic visit, she has stated that she now
has a “nagging, dry cough.” How should the
nurse best follow up the patient's statement?
Inform the patient that the drug should be
immediately discontinued.
Inform the patient that this is an adverse
effect of the medication that may lead to
pneumonitis.
Explain why it will be necessary to obtain a
sputum sample.
Explain that drugs like ramipril often cause a
cough.
D
Feedback:
ACE inhibitors may precipitate a cough and
may necessitate discontinuation of the drug.
This is not, however, an emergency or an
indication of lung infection or lung
inflammation.
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B)
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Chapter 27 Drug Therapy for Dysrhythmias
A nurse is teaching a cardiac patient about the
ability of the heart to generate an electrical
1.
impulse. Which of the following teaching
points should the nurse convey to the patient?
“There are many different parts of your heart
that can initiate an electrical impulse.”
“Electrical signals travel along the blood
vessels that provide oxygen to your heart.”
“Your heart depends on your brainstem to
initiate electrical signals.”
“The lining of your left ventricle is the site
where electrical signals usually originate.”
A
Feedback:
Any part of the conduction system can
spontaneously start an impulse, but the
sinoatrial (SA) node normally has the fastest
rate of automaticity and therefore the faster
rate of spontaneous impulse formation. The
SA node is located in the right atrium. The
brain does not initiate the electrical signal.
Conduction does not exclusively follow blood
vessels.
C)
initiate electrical signals.”
“The lining of your left ventricle is the site
where electrical signals usually originate.”
A
Feedback:
Any part of the conduction system can
spontaneously start an impulse, but the
sinoatrial (SA) node normally has the fastest
rate of automaticity and therefore the faster
rate of spontaneous impulse formation. The
SA node is located in the right atrium. The
brain does not initiate the electrical signal.
Conduction does not exclusively follow blood
vessels.
D)
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A patient is administered medications for the
2. treatment of a rapid dysrhythmia. What is the
mechanism of action for these medications?
Reducing automaticity
Increasing conduction
Repolarizing myocardial cells
Reducing refractory period
A
Feedback:
Drugs used for the treatment of rapid
dysrhythmias mainly reduce automaticity.
They slow the conduction of electrical
impulses through the heart. They
spontaneously depolarize myocardial cells.
They prolong the refractory period of
myocardial cells.
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B)
C)
D)
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B)
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A patient is being treated with quinidine to
reduce automaticity. The nurse should
3.
advocate for a lower-than-normal dose if the
patient has a history of
type 1 or type 2 diabetes.
primary hypertension.
liver disease.
chronic obstructive pulmonary disease.
C
Feedback:
Hepatic impairment increases the plasma halflife of several antidysrhythmic drugs,
including quinidine, and patients with hepatic
impairment usually receive a reduced dosage.
A patient has been prescribed disopyramide
(Norpace) to treat chronic ventricular
tachycardia. The nurse's subsequent cardiac
4.
assessments and monitoring should be
planned in the knowledge that this drug has
the potential to cause what health problem?
New-onset chest pain
Mitral valve regurgitation
Acute renal failure
New dysrhythmias
C
Feedback:
For disopyramide, the Food and Drug
Administration (FDA) has issued a black box
warning because of the drug's known
prodysrhythmic properties. It is not
specifically linked to chest pain, valvular
regurgitation, or renal failure.
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A patient is admitted to the emergency room
with a ventricular dysrhythmia associated
with an acute myocardial infarction. The
5.
physician has ordered a bolus of lidocaine IV.
What assessment should the nurse make prior
to administering this medication?
Assess for lidocaine administration in the
patient's history.
Determine the patient's ability to swallow.
Assess the patient's nutritional history for
allergies.
Determine if the patient has had a reaction to
local anesthesia.
D
Feedback:
Lidocaine is contraindicated in patients
allergic to local anesthetic agents. It is
important to determine if the patient has been
administered lidocaine in the past, but it is
imperative to ascertain any untoward effects.
The medication will be administered
intravenously, so it is not necessary to assess
the patient's ability to swallow. However,
swallowing can be impaired after
administration and should be assessed. It is
not necessary to do a nutritional assessment at
this time.
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B)
A physician has ordered lidocaine IV for a
patient with a ventricular dysrhythmia. The
6. nurse has administered a bolus of lidocaine.
What is the recommended rate for continuous
infusion of lidocaine IV?
0.25 to 0.75 mg/min
10 to 20 mg/min
1 to 4 mg/min
6 to 8 mg/min
C
Feedback:
A continuous infusion of lidocaine IV after a
bolus is 1 to 4 mg/min. The administration of
0.25 to 0.75 mg/min would be too small of a
dosage. The administration of 10 to 20 or 6 to
8 mg/min would be too large.
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B)
C)
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A patient is receiving an antidysrhythmic
7. medication intravenously. How often should
the patient's blood pressure be assessed?
Once per shift
Every 1 to 5 minutes
Every 15 minutes
Every 2 hours
B
Feedback:
During intravenous administration of
antidysrhythmic drugs, maintain continuous
cardiac monitoring and check blood pressure
every 1 to 5 minutes depending on the onset
of action. Assessment of the blood pressure
one time per shift, every 15 minutes, and
every 2 hours would be too limited for safe
nursing practice.
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A)
B)
C)
D)
Ans:
Intravenous verapamil has been ordered STAT
in the treatment of a patient with a
supraventricular tachycardia. In order to
8. ensure patient safety, the nurse should be
aware that concurrent use of which of the
following medications is absolutely
contraindicated?
Sodium bicarbonate
Propranolol
Diltiazem
Lidocaine
B
Feedback:
Use of IV verapamil with IV propranolol
should not take place; it may result in
potentially fatal bradycardia and hypotension.
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B)
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An adult male patient with a long-standing
dysrhythmia has been taking oral propranolol
for the last several months, resulting in
9.
acceptable symptom control. What is a
priority teaching point for the nurse to
communicate to this patient?
The need to measure his radial pulse for 1
minute prior to each dose of propranolol
The importance of not stopping the
medication abruptly
The need to avoid taking over-the-counter
antacids
The need to limit his intake of high-potassium
foods
B
Feedback:
Patients need to realize that they should not
stop taking propranolol abruptly because this
action can cause the dysrhythmia to worsen.
There is no need to restrict potassium intake,
to avoid antacids, or to measure his radial
pulse prior to each dose of propranolol.
A)
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A patient is admitted to the emergency
department in ventricular fibrillation. The
10. patient is administered amiodarone
hydrochloride (Cordarone). What is a major
effect of this medication?
It produces skeletal muscle relaxation.
It decreases automaticity in the ventricles.
It stimulates the sympathetic nervous system.
It slows the process of repolarization.
D
Feedback:
Potassium channel blockers such as
amiodarone prolong duration of the action
potential, slow repolarization, and prolong the
refractory period in both the atria and
ventricles. Amiodarone blocks the effects of
the sympathetic nervous system instead of
stimulating it. Amiodarone and the other
potassium channel blockers do not directly
decrease automaticity.
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C)
A patient is administered amiodarone
(Cordarone) intravenously. Which of the
11.
following assessments should the nurse
consequently prioritize?
Assess urine output every 5 minutes.
Assess blood pressure at least every 5
minutes.
Assess for increased bronchovesicular lung
sounds.
Assess for muscle rigidity.
B
Feedback:
The nurse should assess the blood pressure
every 5 minutes with the IV administration of
amiodarone and other antidysrhythmics. It is
important to assess urine output, but it is not
necessary to assess it every 5 minutes.
Amiodarone may diminish lungs sounds, but
it will not cause an increase in lung sounds.
The effect of amiodarone is to decrease
muscle strength, not cause rigidity.
A critical care nurse is well aware that
amiodarone (Cordarone) is normally reserved
for use in patients with life-threatening
12.
dysrhythmias. In some cases, however, lowdose amiodarone may be used to prevent
recurrence of
atrial fibrillation.
angina pectoris.
ventricular hypertrophy.
mitral valve regurgitation.
A
Feedback:
Low-dose amiodarone may be a
pharmacologic choice for preventing
recurrent atrial fibrillation after electrical or
pharmacologic conversion. Potassium channel
blockers are not used to prevent valvular
disorders, ventricular hypertrophy, or angina.
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A patient is admitted in atrial flutter. Which of
the following nonpharmacological
13.
interventions will best assist in long-term
maintenance of a normal sinus rhythm?
Implantation of a cardioverter–defibrillator
Initiation of an isometric exercise program
A high-potassium diet
Surgical intervention with a new mitral valve
A
Feedback:
The implantable cardioverter–defibrillator
provides nonpharmacological management of
atrial flutter to maintain normal sinus rhythm.
Surgical intervention with a new mitral valve
will not prevent atrial flutter. Exercise and
potassium intake will ensure NSR.
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A)
B)
C)
D)
Ans:
A)
B)
C)
D)
Ans:
A patient is diagnosed with acute
supraventricular tachycardia, and a critical
care nurse is contributing to his plan of care.
14.
Which of the following class IV calcium
channel blockers is exclusively administered
to treat acute supraventricular tachycardia?
Bethanechol chloride (Urecholine)
Chlorambucil (Leukeran)
Diltiazem (Cardizem)
Midazolam hydrochloride
C
Feedback:
Diltiazem is administered intravenously to
treat acute supraventricular tachycardia.
14.
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B)
C)
D)
Ans:
Which of the following class IV calcium
channel blockers is exclusively administered
to treat acute supraventricular tachycardia?
Bethanechol chloride (Urecholine)
Chlorambucil (Leukeran)
Diltiazem (Cardizem)
Midazolam hydrochloride
C
Feedback:
Diltiazem is administered intravenously to
treat acute supraventricular tachycardia.
Bethanechol is used to treat neurogenic
bladder. Chlorambucil (Leukeran) is an
antineoplastic agent used to treat chronic
lymphocytic leukemia. Midazolam
hydrochloride is administered to reduce
anxiety.
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A patient is administered diltiazem
(Cardizem) IV, which is followed by
15. propranolol (Inderal) IV. The nurse should
assess for what potential effect of this
medication combination?
Hypertensive crisis
Anaphylaxis
Valve regurgitation
Impaired contractility
D
Feedback:
If diltiazem is used with propranolol or
digoxin, it is necessary to exercise caution to
avoid further impairment of myocardial
contractility. The administration of IV
diltiazem and propranolol will not produce
hypertensive crisis, anaphylaxis, or valve
regurgitation.
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A)
B)
C)
D)
Ans:
A)
B)
C)
D)
Ans:
A patient has been diagnosed with digitalisinduced dysrhythmia. The patient is
16. administered magnesium sulfate IV to resolve
a low potassium level. What effect does
hypomagnesemia have?
Decreased QRS complex
Increased stroke volume
Myocardial irritability
Elevated ST segment
C
Feedback:
Hypomagnesemia increases myocardial
irritability. Magnesium deficit prolongs the
QRS complex instead of decreasing the QRS
complex. Hypomagnesemia does not increase
stroke volume. Hypomagnesemia will depress
the ST segment, not elevate the ST segment.
Increased stroke volume
Myocardial irritability
Elevated ST segment
C
Feedback:
Hypomagnesemia increases myocardial
irritability. Magnesium deficit prolongs the
QRS complex instead of decreasing the QRS
complex. Hypomagnesemia does not increase
stroke volume. Hypomagnesemia will depress
the ST segment, not elevate the ST segment.
The electrocardiogram of a patient in distress
reveals the presence of paroxysmal
supraventricular tachycardia. The cardiologist
17. has consequently ordered adenosine, an
unclassified antidysrhythmic that is specific to
the treatment of this disorder. The nurse
should prepare to facilitate what intervention?
Cardiac catheterization
Inserting a central venous catheter
Holter monitoring
Nonstress testing
B
Feedback:
Adenosine has a very short duration of action
(serum half-life of less than 10 seconds) and a
high degree of effectiveness. It must be given
by a rapid bolus injection, preferably through
a central venous line. Cardiac catheterization
is not indicated in this patient's care. Holter
monitoring and nonstress testing are not used
in the immediate assessment of patients in
cardiac decompensation.
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C)
D)
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B)
C)
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A)
B)
C)
D)
Ans:
A 48-year-old male patient with no known
history of cardiovascular disease has
presented to the emergency department in
18. atrial flutter. The on-call cardiologist has
ordered propafenone PO 150 mg every 8
hours for 24 hours. What is the cardiac care
nurse's priority assessment during this period?
Every 1 hour monitoring of potassium levels
Blood pressure monitoring every 10 minutes
Echocardiography
Continuous ECG monitoring
D
Feedback:
Propafenone may cause new dysrhythmias or
aggravate preexisting dysrhythmias,
sometimes causing sustained ventricular
tachycardia or ventricular fibrillation. As a
result, continuous ECG monitoring is
necessary at the initiation of treatment. This is
Blood pressure monitoring every 10 minutes
Echocardiography
Continuous ECG monitoring
D
Feedback:
Propafenone may cause new dysrhythmias or
aggravate preexisting dysrhythmias,
sometimes causing sustained ventricular
tachycardia or ventricular fibrillation. As a
result, continuous ECG monitoring is
necessary at the initiation of treatment. This is
a priority over serial potassium levels or
echocardiography. Blood pressure should
ideally be monitored more frequently than
every 10 minutes.
A 59-year-old man with a history of coronary
artery disease is undergoing cardiac
catheterization. The procedure has been
19. proceeding as planned, but the patient
suddenly begins exhibiting ventricular
tachycardia. What drug should the nurse most
likely prepare for administration?
Lidocaine
Magnesium sulfate
Digoxin
Epinephrine
A
Feedback:
Lidocaine is the drug of choice for treating
serious ventricular dysrhythmias associated
with acute myocardial infarction, cardiac
catheterization, cardiac surgery, and digitalisinduced ventricular dysrhythmias. Digoxin,
MgSO4, and epinephrine are not used in this
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C)
D)
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B)
C)
D)
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A)
B)
C)
D)
Ans:
clinical situation.
Oral quinidine has been ordered for a patient
who has a diagnosis of chronic ventricular
tachycardia without heart block. In order to
20.
assess for the safety and efficacy of this
treatment, the nurse should prioritize
assessment of the patient's
radial and brachial pulse.
level of consciousness.
serum drug levels.
blood pressure.
C
Feedback:
While all of the listed assessments are
relevant and appropriate, the nurse must
assess the patient's serum quinidine level to
ensure it is between 2 and 6 mcg/mL.
A)
B)
C)
D)
Ans:
radial and brachial pulse.
level of consciousness.
serum drug levels.
blood pressure.
C
Feedback:
While all of the listed assessments are
relevant and appropriate, the nurse must
assess the patient's serum quinidine level to
ensure it is between 2 and 6 mcg/mL.
Chapter 28 Drug Therapy for Coronary Heart Disease
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A patient has substernal chest pain that
radiates to the neck. The pain lasts 5 minutes
1.
and then subsides with relaxation. What is the
most likely cause of the chest pain?
Myocardial infarction
Intermittent claudication
Hypertension
Angina pectoris
D
Feedback:
Classic angina pain related to angina pectoris
is substernal chest pain that can radiate to the
jaw. Chest pain that lasts longer than 5
minutes is not associated with angina but is
associated with myocardial infarction.
Hypertension is usually a condition in which
the patient is pain free. Intermittent
claudication is not associated with chest pain.
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B)
C)
D)
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A)
B)
C)
D)
Ans:
A patient is experiencing episodes of chest
pain. He smokes one pack of cigarettes per
day and has done so for many years. When
2. teaching him about the effect of smoking on
the cardiovascular system, the nurse will
teach the patient about the effects of nicotine,
including which of the following?
It increases catecholamines to increase heart
rate.
It diminishes the blood's ability to clot.
It increases myocardial contractility of the
heart.
It increases high-density lipoproteins.
A
Feedback:
Nicotine increases catecholamines to increase
heart rate and blood pressure. It increases
platelet adhesiveness and aggregation to
increase, not decrease, clotting. It decreases
myocardial contractility. It does not increase
myocardial contractility. It decreases good
cholesterol, which is the high-density
It increases myocardial contractility of the
heart.
It increases high-density lipoproteins.
A
Feedback:
Nicotine increases catecholamines to increase
heart rate and blood pressure. It increases
platelet adhesiveness and aggregation to
increase, not decrease, clotting. It decreases
myocardial contractility. It does not increase
myocardial contractility. It decreases good
cholesterol, which is the high-density
lipoprotein.
C)
The nurse is teaching the patient about angina
pectoris. Which of the following statements
3.
by the patient indicates that he has understood
the teaching?
“I will avoid exercise because it will
precipitate my angina.”
“As long as I take my medicines, I will not
need to decrease my fat intake.”
“My high blood pressure has no effect on my
episodes of chest pain.”
“High fat in the diet and smoking can cause
my episodes of chest pain.”
D
Feedback:
A diet high in fat and calories will precipitate
episodes of chest pain. The implementation of
an exercise routine prevents cardiac pain and
should be adhered to. The patient will need to
alter his lifestyle to maintain heart health.
High blood pressure will affect episodes of
chest pain.
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B)
C)
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A patient is admitted to the emergency
department with chest pain that is unrelieved
4.
with sublingual organic nitrates. What
medication will most likely be administered?
Intravenous morphine sulfate
Intravenous nitroglycerin
Oral nonsteroidal anti-inflammatory agents
Duragesic topical patch
B
Feedback:
Intravenous nitroglycerin is used to manage
angina that is unresponsive to organic nitrates
via other routes. The use of intravenous
morphine sulfate will decrease pain but will
not increase blood flow. Oral nonsteroidal
anti-inflammatory agents will not assist in
decreasing pain or increasing blood flow. The
application of a Duragesic patch will not
Intravenous nitroglycerin
Oral nonsteroidal anti-inflammatory agents
Duragesic topical patch
B
Feedback:
Intravenous nitroglycerin is used to manage
angina that is unresponsive to organic nitrates
via other routes. The use of intravenous
morphine sulfate will decrease pain but will
not increase blood flow. Oral nonsteroidal
anti-inflammatory agents will not assist in
decreasing pain or increasing blood flow. The
application of a Duragesic patch will not
increase blood flow.
A patient with a history of angina has
sustained a mild head injury in a motor
vehicle accident. He has nitroglycerin tablets
5. for chest pain and asks the nurse for one due
to chest pain. What effect will the
nitroglycerin have on the patient's current
status?
Nitroglycerin will raise the patient's blood
pressure.
Nitroglycerin will cause decreased cerebral
edema.
Nitroglycerin will increase intracranial
pressure.
Nitroglycerin will decrease blood glucose.
C
Feedback:
Nitroglycerin should be used cautiously in the
presence of a head injury or cerebral
hemorrhage because it may increase
intracranial pressure. Nitroglycerin will lower
blood pressure. Nitroglycerin can increase
cerebral edema. Nitroglycerin does not have a
direct effect on blood glucose.
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C)
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B)
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A patient is diagnosed with erectile
dysfunction. He asks what effect sildenafil
(Viagra) has because he is taking
6.
nitroglycerin for chest pain. What is the best
explanation for why nitrates are
contraindicated with sildenafil (Viagra)?
“Nitroglycerin and Viagra cause a severe
decrease in blood pressure.”
“Nitroglycerin and Viagra can lead to prostate
cancer.”
“Nitroglycerin decreases the effect of Viagra
for erectile dysfunction.”
“Nitroglycerin and Viagra will diminish the
effectiveness of chest pain relief.”
A
contraindicated with sildenafil (Viagra)?
“Nitroglycerin and Viagra cause a severe
decrease in blood pressure.”
“Nitroglycerin and Viagra can lead to prostate
cancer.”
“Nitroglycerin decreases the effect of Viagra
for erectile dysfunction.”
“Nitroglycerin and Viagra will diminish the
effectiveness of chest pain relief.”
A
Feedback:
Nitrates and phosphodiesterase enzyme type 5
inhibitors decrease blood pressure, and the
combined effect can produce profound, lifethreatening hypotension.
A)
B)
C)
D)
A patient is experiencing chest pain and
administers her nitroglycerin sublingually.
7.
When should the patient expect to notice
relief of her chest pain?
1 to 3 minutes
5 to 10 minutes
15 to 20 minutes
30 to 60 minutes
A
Feedback:
When given sublingually, nitroglycerin is
absorbed directly into the systemic circulation
and acts within 1 to 3 minutes. If the
medication has not produced an effect in 5
minutes, it should be repeated. The
nitroglycerin tablets have an onset of action of
1 to 3 minutes, not 5 to 60 minutes.
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A)
B)
C)
D)
Ans:
A)
B)
C)
D)
Ans:
When instructing a patient on the use of a
nitroglycerin patch, what should the patient be
8.
taught regarding the advantage of the
nitroglycerin patch?
It is only administered one time per week.
It is more effective than the tablets.
It has a longer duration of action.
It has a faster action than the tablets.
C
Feedback:
When applied topically, nitroglycerin is
absorbed directly into the systemic
circulation. Absorption occurs at a slower rate
and has a longer duration of action. The
topical form is usually administered more
frequently than one time per week. It is not
more effective than the tablets. It does not
have a faster action.
It is more effective than the tablets.
It has a longer duration of action.
It has a faster action than the tablets.
C
Feedback:
When applied topically, nitroglycerin is
absorbed directly into the systemic
circulation. Absorption occurs at a slower rate
and has a longer duration of action. The
topical form is usually administered more
frequently than one time per week. It is not
more effective than the tablets. It does not
have a faster action.
A patient is beginning therapy with isosorbide
9. dinitrate (Isordil). When will the nurse know
that the patient has maximal tolerance?
When nausea develops
When halos are seen around lights
When a headache develops
When the heart rate increases to 100
C
Feedback:
Isosorbide dinitrate's effective dose is usually
determined by increasing the dose until the
patient experiences a headache, which will
indicate maximum tolerable dose. The
development of nausea does not indicate
maximum tolerable dose. The patient should
not see halos around lights with isosorbide
dinitrate. The patient will not have an increase
in heart rate.
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C)
D)
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B)
C)
D)
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A)
B)
C)
D)
Ans:
A patient with a long-standing diagnosis of
asthma is prescribed a beta-blocker for the
10. treatment of angina. The nurse should
consequently prioritize assessment for what
health problem?
Bronchospasm
Hyperglycemia
Pleural effusion
Pneumonia
A
Feedback:
Patients with asthma should be observed for
bronchospasm from blockage of beta2
receptors in the lung. The patient will not
likely experience hyperglycemia, pleural
effusion, or pneumonia.
B)
C)
D)
Ans:
Hyperglycemia
Pleural effusion
Pneumonia
A
Feedback:
Patients with asthma should be observed for
bronchospasm from blockage of beta2
receptors in the lung. The patient will not
likely experience hyperglycemia, pleural
effusion, or pneumonia.
A patient with angina is prescribed
11. propranolol (Inderal). Following absorption of
the drug, the nurse should expect to assess
relief of fatigue.
increased oxygen saturation levels.
mild to moderate drowsiness.
decreased heart rate.
D
Feedback:
Beta-blockers cause a slowing of the heart
rate. They do not normally result in
drowsiness, short-term relief from fatigue, or
a notable increase in SaO2.
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B)
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B)
C)
D)
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A)
B)
C)
A patient is prescribed ranolazine (Ranexa) to
treat chronic angina. Which of the following
12.
electrocardiogram changes will contraindicate
the use of ranolazine?
Normal ST segment
Inverted P wave
Shortened QRS
QT prolongation
D
Feedback:
Ranolazine is contraindicated in patients with
preexisting QT prolongation. It is not
contraindicated with a normal ST segment,
inverted P wave, or shortened QRS.
A medical nurse has administered an oral dose
of 30 mg nifedipine long-acting to a patient
13. with a diagnosis of angina. What principle
should guide the nurse's follow-up assessment
after administering this drug?
Nifedipine has the potential to induce
prodysrhythmic effects.
Nifedipine does not affect heart rate, so
assessment after administration is not
normally necessary.
The patient's heart rate will be at its lowest
approximately 45 minutes to 1 hour after oral
13. with a diagnosis of angina. What principle
should guide the nurse's follow-up assessment
after administering this drug?
Nifedipine has the potential to induce
prodysrhythmic effects.
Nifedipine does not affect heart rate, so
assessment after administration is not
normally necessary.
The patient's heart rate will be at its lowest
approximately 45 minutes to 1 hour after oral
administration of nifedipine.
The patient's blood pressure, heart rate, and
oxygen saturation level should be assessed 30
minutes after administration of nifedipine.
B
Feedback:
Nifedipine inhibits the influx of calcium
entering through slow channels, producing
vasodilation of the peripheral blood vessels
and coronary arteries. However, the drug has
a minimal effect on the sinoatrial and
atrioventricular nodes. Therefore, it does not
affect the heart rate.
A)
B)
C)
D)
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B)
C)
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Oral atenolol has been ordered for a resident
of a long-term care facility who has a
diagnosis of angina. Which of the following
14.
assessment findings would prompt the nurse
to withhold a scheduled dose of the drug?
Select all that apply.
Heart rate of 68 beats per minute
Blood pressure of 88/49 mm Hg
Heart rate of 58 beats per minute
Blood pressure of 141/92 mm Hg
Oxygen saturation of 90% on room air
B, C
Feedback:
It is important to withhold atenolol and notify
the prescriber for a resting heart rate of 60
beats per minute and/or systolic blood
pressure less than 90 mm Hg. Low SaO2 does
not require withholding atenolol.
A)
B)
C)
D)
An elderly patient has begun taking bisoprolol
(Zebeta) 10 mg PO once daily for the
15. treatment of angina. The nurse should
administer this drug in the knowledge that it
achieves a therapeutic effect in what way?
Decreasing heart rate
Increasing the force of myocardial
contractions
Prolonging the QT interval
Shortening the time required for
An elderly patient has begun taking bisoprolol
(Zebeta) 10 mg PO once daily for the
15. treatment of angina. The nurse should
administer this drug in the knowledge that it
achieves a therapeutic effect in what way?
Decreasing heart rate
Increasing the force of myocardial
contractions
Prolonging the QT interval
Shortening the time required for
repolarization
A
Feedback:
Bisoprolol reduces the workload of the heart
and decreases myocardial oxygen demand by
decreasing heart rate and the force of
myocardial contractions. It does not prolong
the QT interval or shorten the time required
for repolarization.
A)
B)
C)
D)
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A 69-year-old woman has been diagnosed
with angina pectoris, and her primary care
provider has prescribed nifedipine (Adalat,
16.
Procardia). After administering a dose of the
drug at 08:00, the nurse should anticipate
maximum effect at what time?
Between 08:30 and 09:00
09:00 to 10:00
Between 12:00 and 14:00
11:30 to 12:30
B
Feedback:
Except for sustained release forms, nifedipine
reaches peak plasma levels within 1 to 2
hours.
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B)
C)
D)
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A)
B)
C)
D)
Ans:
A 59-year-old male patient has a long history
of heavy alcohol use and was diagnosed with
liver cirrhosis several months earlier. The
patient's medical history includes numerous
17.
other health problems, including angina.
When considering the use of nifedipine in the
management of this patient's angina, what
consideration should the nurse be aware of?
The patient is likely to experience an
increased effect of the medication.
This patient will require a higher dose than a
patient without this medical history.
Nifedipine is contraindicated because it is
highly hepatotoxic.
The patient's increased albumin levels will
negate the therapeutic effect.
A
Feedback:
consideration should the nurse be aware of?
The patient is likely to experience an
increased effect of the medication.
This patient will require a higher dose than a
patient without this medical history.
Nifedipine is contraindicated because it is
highly hepatotoxic.
The patient's increased albumin levels will
negate the therapeutic effect.
A
Feedback:
In patients with cirrhosis, bioavailability of
oral drugs is greatly increased and
metabolism (of both oral and parenteral
drugs) is greatly decreased. Both of these
effects increase plasma levels of drug from a
given dose (essentially an overdose).
A)
B)
C)
D)
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An older adult patient whose medical history
includes angina is gardening outside his home
when he experiences a sudden onset of chest
18.
pain. This patient would most likely
administer a dose of nitroglycerin by what
route?
Subcutaneous injection
Oral sustained-release tablet
Nebulized inhalation
Transmucosal spray
D
Feedback:
For relief of sudden-onset angina, fast-acting
preparations of nitroglycerin include SL and
chewable tablets and transmucosal spray.
Sub-Q injections, sustained-release tablets,
and nebulizers are not used.
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B)
C)
D)
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A)
B)
C)
D)
Ans:
A patient with coronary artery disease is
prescribed nitroglycerin ointment. When
19. teaching the patient to safely administer this
medication, the nurse should convey which of
the following instructions?
“The backs of your hands and the tops of your
feet are ideal sites for applying the ointment.”
“Make sure you squeeze the ointment on to a
paper measuring scale before applying it.”
“Massage the ointment into your skin for 10
to 15 seconds after applying it.”
“Don't apply the ointment unless you're
experiencing chest pain at the time.”
B
Feedback:
Application of nitroglycerin ointment requires
using the dose-measuring application papers
supplied with ointment. It is necessary to
A)
feet are ideal sites for applying the ointment.”
“Make sure you squeeze the ointment on to a
paper measuring scale before applying it.”
“Massage the ointment into your skin for 10
to 15 seconds after applying it.”
“Don't apply the ointment unless you're
experiencing chest pain at the time.”
B
Feedback:
Application of nitroglycerin ointment requires
using the dose-measuring application papers
supplied with ointment. It is necessary to
squeeze the ointment onto a measuring scale
printed on paper. The ointment should be
applied onto a nonhairy area of skin; distal
extremities should be avoided. The area
should not be massaged.
B)
C)
D)
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A nurse has administered a scheduled dose of
50-mg atenolol PO for the treatment of
20.
angina. Following administration, the nurse
should prioritize what assessment?
Level of consciousness
Blood pressure
SaO2
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B)
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B
Feedback:
Atenolol and other beta-blockers have an
antihypertensive effect. They are unlikely to
affect temperature, LOC, or oxygen saturation
levels.
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Chapter 29 Drug Therapy for Shock and Hypotension
A)
B)
C)
D)
Ans:
A patient is experiencing anaphylaxis. Which
1. of the following medications will most likely
be administered?
Epinephrine
Norepinephrine
Acetylcysteine (Mucomyst)
Dantrolene sodium (Dantrium)
A
Feedback:
Epinephrine is the adrenergic drug of choice
for relief of anaphylactic shock, the most
serious allergic reaction, as well as in
treatment of cardiac arrest. Norepinephrine is
not administered. Acetylcysteine (Mucomyst)
is used for acetaminophen overdose.
Dantrolene sodium is used to treat malignant
hyperthermia.
Norepinephrine
Acetylcysteine (Mucomyst)
Dantrolene sodium (Dantrium)
A
Feedback:
Epinephrine is the adrenergic drug of choice
for relief of anaphylactic shock, the most
serious allergic reaction, as well as in
treatment of cardiac arrest. Norepinephrine is
not administered. Acetylcysteine (Mucomyst)
is used for acetaminophen overdose.
Dantrolene sodium is used to treat malignant
hyperthermia.
A patient is suffering from hypovolemic
shock. Which agents are administered if fluid
2.
volume replacement does not restore
sufficient blood pressure?
First-line agents
Second-line agents
Beta-blockers
Antianginal drugs
B
Feedback:
In hemorrhagic or hypovolemic shock, the
drugs are second-line agents that may be used
if adequate fluid volume replacement does not
restore sufficient blood pressure and
circulation to maintain organ perfusion. Firstline agents are not used; the first-line therapy
is fluid replacement. Beta-blockers decrease
heart rate and are not administered with
hypovolemic shock. Antianginals are not
administered in hypovolemia.
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C)
D)
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B)
C)
D)
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B)
C)
D)
Ans:
A patient has been diagnosed with narrowangle glaucoma. What ocular effect will be
3.
produced if the patient is prescribed an
adrenergic agent?
Hypothyroidism
Decreased heart rate
Mydriasis
Hypertension
C
Feedback:
Narrow-angle glaucoma is a contraindication
to adrenergic agents because the drugs result
in mydriasis, closure of the filtration angle of
the eye, and increased intraocular pressure.
Hypothyroidism will not occur with the
administration of adrenergic agents.
Decreased heart rate will not occur with the
administration of adrenergic agents and is not
an ocular effect. Hypertension is not an ocular
Decreased heart rate
Mydriasis
Hypertension
C
Feedback:
Narrow-angle glaucoma is a contraindication
to adrenergic agents because the drugs result
in mydriasis, closure of the filtration angle of
the eye, and increased intraocular pressure.
Hypothyroidism will not occur with the
administration of adrenergic agents.
Decreased heart rate will not occur with the
administration of adrenergic agents and is not
an ocular effect. Hypertension is not an ocular
effect.
A patient is administered epinephrine in
4. conjunction with a local anesthetic. What
effect will epinephrine produce?
Decreased cerebral circulation
Decreased coronary circulation
Increased vasoconstrictive effects
Increased bronchoconstriction
C
Feedback:
Epinephrine is added to local anesthetics for
vasoconstrictive effects, which include
prolonging the action of the local anesthetic
drug, preventing systemic absorption, and
minimizing bleeding. Epinephrine will not
decrease cerebral circulation or coronary
circulation. Epinephrine will not increase
bronchoconstriction.
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C)
D)
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A)
B)
C)
D)
Ans:
A)
B)
C)
D)
Ans:
An emergency department nurse enters a
patient's room with an order to administer
epinephrine subcutaneously to treat his
5. asthma attack. The patient's wife asks the
nurse why it could not be given by mouth.
Which of the following is the best response
by the nurse?
“The medication he is to receive is only given
by an injection in the arm.”
“The medication is administered this way
because it works faster than by mouth.”
“The medication is given many ways, but this
is the way it was ordered.”
“The medication will not absorb in the GI
tract if given by mouth.”
D
Feedback:
Epinephrine is not given orally because
enzymes in the GI tract and liver destroy it.
The medication can be given through
B)
because it works faster than by mouth.”
“The medication is given many ways, but this
is the way it was ordered.”
“The medication will not absorb in the GI
tract if given by mouth.”
D
Feedback:
Epinephrine is not given orally because
enzymes in the GI tract and liver destroy it.
The medication can be given through
inhalation, intravenously, and subcutaneously.
The medication will work more quickly in a
parenteral form but is not given orally. Stating
to the patient that this method is the way the
physician ordered it to be given will belittle
the patient and not provide adequate patient
teaching.
C)
D)
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A patient suffers from bronchial asthma.
Which of the following medications is a
6.
mixed-acting adrenergic drug that may be
administered?
Epinephrine
Ephedrine
Pseudoephedrine
Isoproterenol
B
Feedback:
Ephedrine is a mixed-acting adrenergic drug
that acts by stimulating alpha1 and beta
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A)
B)
C)
D)
Ans:
receptors and causing release of
norepinephrine from presynaptic terminals. It
is used in the treatment of bronchial asthma.
Epinephrine is not a mixed-acting adrenergic
drug. Pseudoephedrine is a related drug,
stimulating alpha1 and beta receptors. It is
used as a nasal decongestant. Isoproterenol is
a synthetic catecholamine that acts on beta1and beta2-adrenergic receptors.
A)
B)
C)
D)
Ans:
A home care nurse is visiting a patient, and
the assessment will include blood pressure
and heart rate. The patient's grandson has a
7. large amount of pseudoephedrine (Sudafed) in
the kitchen. For what might the nurse suspect
the patient's grandson is using the
pseudoephedrine?
Methamphetamine production
Treatment of bronchial asthma
Treatment of sinusitis
To increase appetite
A
the assessment will include blood pressure
and heart rate. The patient's grandson has a
7. large amount of pseudoephedrine (Sudafed) in
the kitchen. For what might the nurse suspect
the patient's grandson is using the
pseudoephedrine?
Methamphetamine production
Treatment of bronchial asthma
Treatment of sinusitis
To increase appetite
A
Feedback:
Pseudoephedrine and ephedrine are
ingredients used in making
methamphetamine, a highly addictive and
illegal drug of abuse. Pseudoephedrine is used
in the treatment of bronchospasm but is not
the drug of choice. Pseudoephedrine is used
in the treatment of sinusitis, but, in large
quantities, the nurse should suspect
methamphetamine production.
Pseudoephedrine will increase basal
metabolic rate but is not the drug of choice to
increase appetite.
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B)
C)
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A patient suffers from bradycardia. Which of
the following medications is a synthetic
8.
catecholamine for the treatment of
bradycardia?
Isoproterenol (Isuprel)
Pseudoephedrine (Sudafed)
Ephedrine
Epinephrine
A
Feedback:
Isoproterenol (Isuprel) is a synthetic
catecholamine that acts on beta1- and beta2-
A)
B)
C)
D)
Ans:
adrenergic receptors to stimulate heart rate.
Pseudoephedrine (Sudafed) is not a synthetic
catecholamine. Ephedrine and epinephrine are
not synthetic catecholamines.
A patient has been using phenylephrine (NeoSynephrine) for nasal congestion. He states to
9. the nurse that he is using more every day
because his nose is so congested. What effect
is the medication producing?
Reflex bradycardia
Mucosal hemorrhage
Tachycardia
Rebound congestion
D
Feedback:
Overuse of nasal decongestants leads to
9. the nurse that he is using more every day
because his nose is so congested. What effect
is the medication producing?
Reflex bradycardia
Mucosal hemorrhage
Tachycardia
Rebound congestion
D
Feedback:
Overuse of nasal decongestants leads to
decreased effectiveness (tolerance), irritation
and ischemic changes in the nasal mucosa,
and rebound congestion. These effects can be
minimized by using small doses only when
necessary and for no longer than 3 to 5 days.
Phenylephrine will not produce reflex
bradycardia, mucosal irritation, or
tachycardia.
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B)
C)
D)
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A pediatric patient is administered
epinephrine to treat bronchospasm as a result
10.
of acute asthma. What effect should the
patient be monitored for?
Edema
Syncope
Bradycardia
Hemorrhage
B
Feedback:
Epinephrine is mainly used in children for
treatment of bronchospasm due to asthma or
allergic reactions. Parenteral epinephrine may
cause syncope when given to asthmatic
children. Epinephrine will not increase edema
or cause bradycardia or hemorrhage.
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B)
C)
D)
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A)
B)
C)
D)
Ans:
A nurse is participating in a “code blue”
response to a patient who lost consciousness
after a short period of distress. The physician
leading the code has ordered the
11.
administration of IV epinephrine. When
preparing this drug for administration, the
nurse should recognize what goal of this
treatment?
Increased cardiac contractility
Increased blood flow to the heart and brain
Increased peripheral blood circulation
Increased release of dopamine
B
Feedback:
Epinephrine is often administered during
cardiopulmonary resuscitation (CPR). The
most important action of epinephrine during
cardiac arrest is constriction of peripheral
treatment?
Increased cardiac contractility
Increased blood flow to the heart and brain
Increased peripheral blood circulation
Increased release of dopamine
B
Feedback:
Epinephrine is often administered during
cardiopulmonary resuscitation (CPR). The
most important action of epinephrine during
cardiac arrest is constriction of peripheral
blood vessels, which shunts blood to the
central circulation and increases blood flow to
the heart and brain. The goal of epinephrine
administration is not increased contractility or
dopamine release.
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Epinephrine is indicated in the treatment of a
79-year-old patient whose blood pressure has
plummeted in the postanesthesia recovery
12.
room following prostate surgery. Epinephrine
should be used with caution in a patient of
this age because of the risk of
exacerbating chronic cardiac conditions.
causing cerebral ischemia.
increasing intracranial pressure.
causing Stevens-Johnson's syndrome
A
Feedback:
Clinicians use adrenergic agents to treat
asthma, hypotension, shock, cardiac arrest,
and anaphylaxis in older adults. These drugs
stimulate the heart to increase rate and force
of contraction and blood pressure. Because
older adults often have chronic cardiovascular
conditions (e.g., angina, dysrhythmias, heart
failure, coronary artery disease, hypertension,
peripheral vascular disease) that are
aggravated by adrenergic drugs, careful
monitoring by the nurse is required.
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B)
C)
D)
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A)
B)
C)
D)
A teenage boy has been brought to the
emergency department (ED) by his football
coach, who states that the boy has not
responded to his normal rescue inhaler. The
13.
care team has opted for the administration of
subcutaneous epinephrine. The ED nurse
should anticipate what assessment finding
subsequent to the administration of this drug?
Increased level of consciousness within 2 to 5
minutes
Immediate bronchodilation
An immediate decrease in respiratory rate
Bronchodilation within 5 to 10 minutes
coach, who states that the boy has not
responded to his normal rescue inhaler. The
13.
care team has opted for the administration of
subcutaneous epinephrine. The ED nurse
should anticipate what assessment finding
subsequent to the administration of this drug?
Increased level of consciousness within 2 to 5
minutes
Immediate bronchodilation
An immediate decrease in respiratory rate
Bronchodilation within 5 to 10 minutes
D
Feedback:
For acute asthma attacks, subcutaneous (SubQ) administration of epinephrine usually
produces bronchodilation within 5 to 10
minutes; maximal effects may occur within
20 minutes. An increase in LOC is not a
priority, and respiratory rate would not likely
decrease.
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A clinic nurse is teaching the parents of
toddler about the safe and effective use of an
14. EpiPen after the child was diagnosed with
severe nut allergies. What instruction should
the nurse convey to the parents?
“It's prudent to administer a small dose of
epinephrine if you want to prevent a future
reaction.”
“Only use your EpiPen if you've tried oral
medications and they've been ineffective.”
“The thigh is usually the ideal place to inject
the EpiPen.”
“Keep administering repeated doses of
epinephrine until your child's symptoms
abate.”
C
Feedback:
The thigh is the preferred site for
autoinjection, providing more rapid
absorption and higher blood levels of
epinephrine than the arm in children and
adults for either intramuscular or
subcutaneous administration. Epinephrine is
not administered as a prophylactic treatment.
Emergencies preclude the use of oral
medications, and repeated injections may
result in toxicity.
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Epinephrine is being considered in the
treatment of an adult hospital patient. In
anticipation, the nurse has reviewed the
15. patient's current medication regimen. The
presence of a drug from which of the
following drug categories would
contraindicate the safe use of epinephrine?
Potassium-wasting diuretics
Sulfonamide antibiotics
Selective serotonin reuptake inhibitors
(SSRIs)
Monoamine oxidase (MAO) inhibitors
D
Feedback:
It is essential not to give MAO inhibitors with
adrenergic drugs because the combination
may cause death. Use of adrenergics with
diuretics, SSRIs, or sulfa antibiotics is not
necessarily contraindicated.
A)
B)
C)
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A 19-year-old has been brought to the
emergency department (ED) by ambulance
after a suspected overdose of a herbal
16.
preparation that contained ephedra. Due to the
risk of seizures and intracranial hemorrhage,
the nurse should prioritize what assessment?
Continuous oxygen saturation monitoring
Blood pressure monitoring
Respiratory auscultation
Assessing extremities for color, warmth,
movement, and sensation
B
Feedback:
Ephedrine and ephedra-containing herbal
preparations (e.g., ma huang, herbal ecstasy)
are often abused as an alternative to
amphetamines. The primary clinical
manifestation of this adrenergic drug toxicity
is severe hypertension, which may lead to
headache, confusion, seizures, and
intracranial hemorrhage. Vigilant blood
pressure monitoring is thus a high priority.
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B)
C)
An adult patient with diagnoses of liver
cirrhosis and hepatitis C is exhibiting signs
and symptoms of hypovolemic shock. How
17.
will the patient's compromised hepatic
function affect the possible use of
epinephrine?
The patient will require a higher-than-normal
dose.
The patient's hepatic function is not a priority
consideration.
The patient should not receive epinephrine by
a parenteral route.
The patient should receive a small fraction of
the normal dose.
B
Feedback:
Liver disease is not usually considered a
contraindication to administering adrenergic
drugs. Dosages do not normally need to be
adjusted.
A)
B)
C)
D)
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A patient has been resuscitated using
epinephrine following an episode of asystole
and is now being monitored in the intensive
18. care unit (ICU). When monitoring the
patient's status, the nurse should anticipate
which of the following effects of epinephrine
administration? Select all that apply.
Decreased urine output
Hyperglycemia
Increased serum potassium levels
Hypercapnia
Increased blood pressure
A, B, E
Feedback:
Administration of epinephrine is associated
with decreased urine output, increased blood
glucose, hyperkalemia, and increased blood
pressure. Excess CO2 levels are not
anticipated.
Chapter 30 Drug Therapy for Heart Failure
The home care nurse sees a patient for the
first time. The patient has crackles in the
lower lobes of the lungs, an audible S3, and
1.
pitting edema in the feet and ankles. What
condition is the patient most likely
experiencing?
Pneumonia
Liver disease
Heart failure
Myocardial infarction
C
Feedback:
The cardinal manifestations of heart failure
are dyspnea and fatigue, which can lead to
exercise intolerance and fluid retention. Fluid
retention results in the development of
pulmonary congestion and peripheral edema.
An audible S3 is often present. The patient is
not presenting with myocardial infarction
symptoms.
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B)
A patient is diagnosed with heart failure. She
asks the nurse for further details about heart
2.
failure. Which of the following statements is
most accurate?
“Heart failure can be caused by
atherosclerotic plaque due to high-fat diets.”
“Hypothyroidism will result in decreased
heart rate and development of heart failure.”
“The administration of diuretics increases
blood volume, causing symptoms to abate.”
“The use of digoxin will slow heart rate to
make your heart more efficient.”
D
Feedback:
Endothelial dysfunction allows processes that
narrow the blood vessel lumen and lead to
blood clot formation and vasoconstriction that
further narrow the blood vessel lumen. These
are major factors in coronary artery disease
and hypertension, the most common
conditions leading to heart failure.
Hyperthyroidism, not hypothyroidism, is a
cause of heart failure. The administration of
diuretics decreases fluid volume, which
prevents the symptoms of heart failure. The
use of digoxin increases the force of
myocardial contraction and prevents the
development of congestive heart failure in
patients whose heart cannot pump blood to
C)
blood volume, causing symptoms to abate.”
“The use of digoxin will slow heart rate to
make your heart more efficient.”
D
Feedback:
Endothelial dysfunction allows processes that
narrow the blood vessel lumen and lead to
blood clot formation and vasoconstriction that
further narrow the blood vessel lumen. These
are major factors in coronary artery disease
and hypertension, the most common
conditions leading to heart failure.
Hyperthyroidism, not hypothyroidism, is a
cause of heart failure. The administration of
diuretics decreases fluid volume, which
prevents the symptoms of heart failure. The
use of digoxin increases the force of
myocardial contraction and prevents the
development of congestive heart failure in
patients whose heart cannot pump blood to
meet tissue needs. A high-fat diet does not
directly cause heart failure.
D)
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A patient states that he is seeing halos around
lights. The patient takes digoxin (Lanoxin) by
mouth every day. The physician orders the
3. patient to have serum digoxin level drawn. At
what digoxin level would the care team first
suspect that the patient is experiencing
toxicity?
0.5 ng/mL
1.5 ng/mL
3.0 ng/mL
6.0 ng/mL
C
Feedback:
The therapeutic serum digoxin level is 0.8 to
2.0 ng/mL.
A)
B)
C)
D)
Ans:
A patient has an elevated BUN and creatinine.
The patient has been prescribed digoxin
4.
(Lanoxin) for heart failure. What aspect of
care is the priority regarding this patient?
The patient should be taught to increase
sodium in her diet.
The dose should be increased when her heart
rate is below 60.
The dose should be decreased in this patient.
The dosage should be 1.0 mg PO daily.
C
Feedback:
The dose must be reduced in the presence of
renal failure because most of the digoxin is
excreted unchanged by the kidneys, leading to
A)
sodium in her diet.
The dose should be increased when her heart
rate is below 60.
The dose should be decreased in this patient.
The dosage should be 1.0 mg PO daily.
C
Feedback:
The dose must be reduced in the presence of
renal failure because most of the digoxin is
excreted unchanged by the kidneys, leading to
drug accumulation and toxicity. The patient
should be taught to limit sodium intake in the
diet. The patient's heart rate should remain
above 60. If the heart rate falls below 60, the
digoxin should be held. The dose of 1.0 mg is
too large for a patient with altered renal
function.
B)
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A patient with a history of heart failure is
being treated with digoxin (Lanoxin). The
5. nurse knows that this medication increases the
force of contractions of the heart. What effect
improves the contractility of the heart?
Positive chronotropic effect
Positive inotropic effect
Negative inotropic effect
Negative dromotropic effect
B
Feedback:
In heart failure, digoxin exerts cardiotonic or
positive inotropic effect that improves the
contractility and pumping ability of the heart.
A positive chronotropic effect accelerates the
rate of the heart, which is not recommended
in a patient with heart failure. A negative
inotropic effect accelerates the heart, which is
not recommended in a patient with heart
failure. A negative dromotropic effect changes
the conductivity of muscle fiber, increasing
heart rate.
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B)
C)
D)
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A)
B)
C)
D)
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A patient is admitted to the intensive care unit
with an electrolyte imbalance. Which of the
6.
following imbalances will contraindicate the
administration of digoxin (Lanoxin)?
Hyperkalemia
Hypokalemia
Hypermagnesemia
Hypocalcemia
B
Feedback:
Digoxin is contraindicated in patients with
hypokalemia. Digoxin is not contraindicated
in patients with hyperkalemia,
administration of digoxin (Lanoxin)?
Hyperkalemia
Hypokalemia
Hypermagnesemia
Hypocalcemia
B
Feedback:
Digoxin is contraindicated in patients with
hypokalemia. Digoxin is not contraindicated
in patients with hyperkalemia,
hypermagnesemia, or hypocalcemia.
A)
B)
C)
D)
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A patient with heart failure is admitted to the
emergency department. The physician orders
7. digoxin (Lanoxin) intravenously. What is the
onset of action when digoxin (Lanoxin) is
administered intravenously?
5 minutes
10 minutes
45 minutes
1 hour
B
Feedback:
Digoxin administered intravenously will have
an onset of action within 10 to 30 minutes.
Five minutes after administration is too soon
to provide an onset of action. Forty-five
minutes to one hour is after the onset of
action.
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B)
C)
D)
Ans:
A patient is in the intensive care unit to be
digitalized. This patient is to be digitalized
8.
rapidly. What is the total dose range of
digoxin (Lanoxin) for rapid digitalization?
0.75 to 1.5 mg
2.0 to 2.5 mg
3.75 to 4 mg
0.125 to 0.05 mg
A
Feedback:
Digitalization may be accomplished rapidly
by giving a total dose of 0.75 to 1.5 mg of
digoxin in divided doses. A digoxin dose
range of 2.0 to 4.0 mg is too large. A digoxin
dose range of 0.125 to 0.5 mg is too small.
A patient has been taking digoxin (Lanoxin)
for 5 years for the treatment of heart failure.
In the last 3 months, she has noticed she is
tired all the time, her heart rate is very slow,
and she is always cold. The nurse assessing
9. the patient notes her blood pressure at 88/50
and pulse rate is 44. The nurse instructs the
patient not to take her digoxin. What
condition may the patient be suffering from
that would contraindicate the administration
of digoxin?
Hypothyroidism
Myocardial infarction
Cerebrovascular accident
Intermittent claudication
A
Feedback:
Hypothyroidism slows digoxin metabolism
and further slows the heart rate. The patient is
presenting with signs and symptoms of
hypothyroidism. The patient is not
experiencing characteristic signs and
symptoms of myocardial infarction,
cerebrovascular accident, or intermittent
claudication.
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B)
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D)
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A)
B)
C)
D)
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A patient who has been prescribed digoxin
(Lanoxin) is also taking furosemide (Lasix)
10. 20 mg daily. Which of the following
electrolyte imbalances will precipitate the
development of digoxin toxicity?
Hyperkalemia
Hypokalemia
Hypermagnesemia
Hyponatremia
B
Feedback:
Hypokalemia will contribute to the patient
developing digoxin toxicity. Hyperkalemia,
hypermagnesemia, and hyponatremia will not
contribute to the development of digoxin
toxicity.
A patient is admitted to the emergency
department with severe heart failure.
11. Milrinone (Primacor) is administered IV. For
what adverse effect should the patient be
assessed?
Hypertension
Bradycardia
Atrial dysrhythmias
Lethargy
C
Feedback:
Dose-limiting adverse effects of the drugs
include tachycardia, atrial or ventricular
dysrhythmias, and hypotension.
Hypertension, bradycardia, and lethargy are
not adverse effects of milrinone.
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A patient has been administered nesiritide
12. (Natrecor) to manage symptoms of acute
heart failure. How does the drug act?
Nesiritide (Natrecor) exhibits mild inotropic
action and decreased platelet aggregation.
Nesiritide (Natrecor) compensates for cardiac
deterioration by reducing preload and
afterload.
Nesiritide (Natrecor) corrects
hyperthyroidism by inhibiting synthesis of the
thyroid hormone.
Nesiritide (Natrecor) increases the
concentration of acetylcholine to potentiate
the action of ACE.
B
Feedback:
Nesiritide (Natrecor) compensates for cardiac
deterioration by reducing preload and
afterload. Dipyridamole (Persantine) exhibits
mild inotropic action and decreased platelet
aggregation. It would not be used in acute
heart failure. Methimazole (Tapazole) corrects
hyperthyroidism by inhibiting synthesis of the
thyroid hormone. Physostigmine (Antilirium)
increases the concentration of acetylcholine to
potentiate the action of ACE on the skeletal
muscle.
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When instructing a patient on a no-added-salt
diet, the nurse should instruct the patient on
13. foods with hidden salt. Which of the
following foods has hidden salt and should be
avoided?
Ice cream
Dehydrated apple chips
Bread
Canned soup
D
Feedback:
Canned soup is very high in sodium and
should be avoided. Ice cream contains a small
amount of sodium but should be avoided due
to the fat content. Dehydrated apple chips are
an acceptable food. Bread is an acceptable
food.
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B)
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A patient is being treated for heart failure.
14. Which of the following is most indicative of
improved health status?
Decreased pedal edema
Increased skin turgor
Heart rate of 52
Improved sensorium
A
Feedback:
Decreased pedal edema improves cardiac
output due to the fact that the patient has
diminished fluid volume. Increased skin
turgor indicates that the patient is well
hydrated and does not have fluid volume
excess. A heart rate of 52 is too slow to
provide good contractility. Improved
sensorium indicates adequate perfusion but is
not the most indicative of improved heart
failure status.
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A)
B)
C)
D)
Ans:
A)
B)
C)
D)
Ans:
A patient is being administered digoxin
(Lanoxin) for treatment of heart failure. At
15.
what level should the serum potassium level
be maintained?
1.5 to 2.0 mEq/L
3.5 to 5.0 mEq/L
6.0 to 8.0 mEq/L
8.5 to 10 mEq/L
B
Feedback:
A patient is being administered digoxin
(Lanoxin) for treatment of heart failure. At
15.
what level should the serum potassium level
be maintained?
1.5 to 2.0 mEq/L
3.5 to 5.0 mEq/L
6.0 to 8.0 mEq/L
8.5 to 10 mEq/L
B
Feedback:
Electrolyte imbalance must be monitored
during digoxin therapy, and the potassium
level should be maintained at 3.5 to 5.0 mEq/
L. A potassium level of 1.5 to 2.0 mEq/L is
too low. Potassium levels of 6.0 to 8.0 and 8.5
to 10 mEq/L are too high.
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B)
C)
D)
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A)
B)
C)
D)
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A)
B)
C)
D)
Ans:
A patient is experiencing nausea and visual
disturbances when taking digoxin (Lanoxin).
16.
Which of the following medications will be
administered?
Acetylsalicylic acid (aspirin)
Nesiritide (Natrecor)
Felbamate (Felbatol)
Digoxin immune fab (Digibind)
D
Feedback:
A patient who has nausea and visual changes
while taking digoxin will most likely be
administered digoxin immune fab (Digibind).
Acetylsalicylic acid is not administered for
digoxin toxicity. Nesiritide is not
administered when the patient is experiencing
digoxin toxicity. Felbamate is administered
for the treatment of seizures.
A 77-year-old patient was diagnosed with
heart failure 3 years ago, and he had achieved
reasonable symptom control with digoxin. In
the last several months, his cardiac function
has decreased significantly and his
17.
cardiologist has prescribed nesiritide during
his current admission. What aspect of this
patient's health status would potentially
contraindicate the administration of
nesiritide?
Blood pressure of 88/50 mm Hg
Jaundice
Presence of +2 peripheral edema
Irregular apical heart rate
A
Feedback:
Nesiritide should not be administered if the
his current admission. What aspect of this
patient's health status would potentially
contraindicate the administration of
nesiritide?
Blood pressure of 88/50 mm Hg
Jaundice
Presence of +2 peripheral edema
Irregular apical heart rate
A
Feedback:
Nesiritide should not be administered if the
systolic blood pressure is less than 90 mm Hg.
The presence of jaundice, edema, or an
irregular heart rate does not necessarily
contraindicate the use of this drug.
An older adult patient has been receiving
treatment for heart failure and has been
experiencing frequent episodes of peripheral
edema. As a result, her care provider has
18.
added furosemide (Lasix) to her medication
regimen. What assessment should the nurse
perform on a daily basis for the duration of
treatment?
Body weights
Arterial blood gases
Magnesium level
Pupillary response
A
Feedback:
When a patient is being treated with
furosemide, the nurse weighs the patient daily
and reports any increase in weight of greater
than 2 pounds in 24 hours to the health care
provider. Electrolyte levels must be assessed,
but sodium and potassium levels are the
priority. There is no particular need to assess
ABGs or pupillary response.
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B)
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A)
B)
C)
D)
Ans:
A nurse has poured a hospital patient's
scheduled dose of hydrochlorothiazide
19. (HCTZ). The nurse should know that this
drug reduces preload by which of the
following means?
Exerting a direct relaxant effect on the
vascular smooth muscle
Increasing renal excretion of sodium and
water
Increasing the contractility of myocardial
fibers
Stimulating the SA node to fire more
frequently
B
Feedback:
following means?
Exerting a direct relaxant effect on the
vascular smooth muscle
Increasing renal excretion of sodium and
water
Increasing the contractility of myocardial
fibers
Stimulating the SA node to fire more
frequently
B
Feedback:
Hydrochlorothiazide inhibits the reabsorption
of sodium and chloride in the distal renal
tubule, increasing the excretion of sodium and
water by the kidneys. Thiazide diuretics do
not relax smooth muscle, increase
contractility, or stimulate the SA node.
A)
B)
C)
D)
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A gerontological nurse is aware that increased
aldosterone is a major factor in the
20. pathophysiology of heart failure. Which of the
following medications reduces aldosteroneinduced retention of sodium and water?
Hydrochlorothiazide
Enalapril maleate
Spironolactone
Losartan potassium
C
Feedback:
Spironolactone (Aldactone) is an aldosterone
antagonist that reduces aldosterone-induced
retention of sodium and water and impaired
vascular function. Thiazide diuretics, ACE
inhibitors, and angiotensin II–receptor
blockers do not have this mechanism of
action.
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B)
C)
D)
Ans:
Chapter 31 Drug Therapy for Nasal Congestion and Cough
A)
B)
C)
D)
Ans:
A patient presents at the clinic with sneezing
and coughing. He is diagnosed with the
1.
common cold. Which type of microorganism
causes the common cold?
Gram-positive bacteria
Gram-negative bacteria
Virus
Fungus
C
Feedback:
The common cold, a viral infection of the
upper respiratory tract, is the most common
respiratory tract infection. The common cold
causes the common cold?
Gram-positive bacteria
Gram-negative bacteria
Virus
Fungus
C
Feedback:
The common cold, a viral infection of the
upper respiratory tract, is the most common
respiratory tract infection. The common cold
is not caused by gram-negative or grampositive bacteria. Fungal infections are not the
cause of the common cold.
You are the school nurse educating a group of
parents on the prevention of the common cold
2. among their children. Which of the following
preventive measures is most important to
teach the parents?
Frequent handwashing
Maintaining vaccinations
Taking 1200 mg of vitamin C
Taking Echinacea daily
A
Feedback:
Because of the way cold viruses are spread,
frequent and thorough hand hygiene is the
most important protective and preventive
measure. There is vaccine against the
common cold. The ingestion of vitamin C and
Echinacea is not the most effective preventive
measure for the common cold.
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B)
C)
D)
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B)
C)
D)
Ans:
A)
B)
C)
D)
Ans:
A 3-year-old child is seen in the pediatric
office for a dry, hacking cough. The mother is
requesting a prescription for
3. dextromethorphan. In providing patient
education, which of the following provides
the most effective teaching regarding the use
of dextromethorphan in children?
Dextromethorphan suppresses cough in
children.
Dextromethorphan is ineffective in children.
Dextromethorphan must be combined with
codeine.
Dextromethorphan raises blood pressure in
children.
B
Feedback:
Although antitussives continue to be used and
adults report beneficial effect in reducing
cough, antitussives, particularly
dextromethorphan, have not been
demonstrated to be effective in children and
Dextromethorphan must be combined with
codeine.
Dextromethorphan raises blood pressure in
children.
B
Feedback:
Although antitussives continue to be used and
adults report beneficial effect in reducing
cough, antitussives, particularly
dextromethorphan, have not been
demonstrated to be effective in children and
adolescents. Adverse effects of
dextromethorphan in children include
behavioral disturbances and respiratory
depression, not high blood pressure.
C)
D)
A patient is using oxymetazoline (Afrin) to
relieve nasal congestion. Which of the
4.
following conditions would contraindicate the
use of this drug?
Nasal congestion
Cough
Hypertension
Skin rash
C
Feedback:
Oxymetazoline is contraindicated in patients
with severe hypertension or coronary artery
disease because of its cardiac stimulating and
vasoconstricting effects. Oxymetazoline is
prescribed for nasal congestion.
Oxymetazoline is not contraindicated in
cough or skin rash.
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B)
C)
D)
Ans:
A)
B)
C)
D)
Ans:
A patient is admitted to the emergency room
after consuming 50 acetaminophen tablets in
5. a suicide attempt. What medication will be
administered to counteract the effect of the
acetaminophen?
Oxymetazoline hydrochloride (Afrin)
Acetylcysteine (Mucomyst)
Daptomycin (Cubicin)
Darbepoetin alfa (Aranesp)
B
Feedback:
Acetylcysteine is effective in the treatment of
acetaminophen overdose. Oxymetazoline
hydrochloride is used for nasal congestion,
not acetaminophen overdose. Daptomycin and
darbepoetin alfa are not used for
acetaminophen overdose.
B)
C)
D)
Ans:
Acetylcysteine (Mucomyst)
Daptomycin (Cubicin)
Darbepoetin alfa (Aranesp)
B
Feedback:
Acetylcysteine is effective in the treatment of
acetaminophen overdose. Oxymetazoline
hydrochloride is used for nasal congestion,
not acetaminophen overdose. Daptomycin and
darbepoetin alfa are not used for
acetaminophen overdose.
A patient is taking a nasal decongestant.
Which of the following medications may
6.
dangerously increase the effects of nasal
decongestants?
Anti-infective agents
Anti-inflammatory agents
Proton pump inhibitors
Thyroid preparations
D
Feedback:
The administration of thyroid preparations
should be done cautiously with nasal
decongestants due to their increased effects.
PPIs, anti-infectives, and anti-inflammatories
do not have this effect.
C)
D)
Ans:
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B)
C)
D)
Ans:
A patient is prescribed an antitussive agent
with codeine. Which of the following
7.
statements by the patient indicates that the
nurse's teaching has been effective?
“I will take this medication whenever I am
coughing.”
“This medication may make me anxious and
nervous.”
“I will call my physician if I develop diarrhea
when I take it.”
“This medication will cause drowsiness, and I
will not drive.”
D
Feedback:
Antitussive agents suppress cough by
depressing the cough center in the medulla
oblongata or the cough receptors in the throat,
trachea, or lungs. Since they are combined
with codeine, they will also depress the CNS
and induce drowsiness. The medication
should not be given every time the patient
coughs. The medication will not cause anxiety
and nervousness. The medication will cause
constipation, not diarrhea.
C)
when I take it.”
“This medication will cause drowsiness, and I
will not drive.”
D
Feedback:
Antitussive agents suppress cough by
depressing the cough center in the medulla
oblongata or the cough receptors in the throat,
trachea, or lungs. Since they are combined
with codeine, they will also depress the CNS
and induce drowsiness. The medication
should not be given every time the patient
coughs. The medication will not cause anxiety
and nervousness. The medication will cause
constipation, not diarrhea.
D)
A patient has hypertension and wants to take a
nasal decongestant for cold symptoms. Which
8. of the following statements by the nurse best
describes the effect of decongestants on blood
pressure?
“The administration of a nasal decongestant
will increase blood pressure due to
vasoconstriction of blood vessels.”
“The administration of a nasal decongestant
will cause bradycardia and increase peripheral
blood pressure.”
“The administration of a nasal decongestant
will decrease the thyroid production and
increase blood pressure.”
“The administration of nasal decongestant
will act on the central nervous system to
cause vasodilation of blood vessels.”
A
Feedback:
“The administration of nasal decongestants
will increase blood pressure due to
vasoconstriction of blood vessels” is
indicative of good patient teaching. Nasal
decongestants do not cause bradycardia to
increase blood pressure. The administration of
nasal decongestants will not decrease thyroid
production and increase blood pressure. The
administration of a nasal decongestant does
not act on the central nervous system.
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A patient has expressed frustration at the fact
that he has been taking Sudafed for several
9. days and “it still hasn't really cured my cold.”
What teaching point should the nurse convey
to the patient?
“Drugs like this can often relieve some of the
symptoms of a cold, but they won't cure it.”
“Most people find that cold medications are
essentially ineffective.”
“It usually takes between 6 and 8 days for
Sudafed to cure your cold.”
“Sudafed can sometimes mask the effects of
your cold, essentially prolonging it.”
A
Feedback:
Patients should be made aware that cold
medications do not cure the common cold;
they only relieve some symptoms. Such
medications do not inhibit healing by masking
symptoms.
A)
B)
C)
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An elderly patient has presented to the clinic
for a scheduled visit and states that he has
been taking a combination antitussive/
decongestant/expectorant for several weeks in
10.
order to prevent the common cold. The nurse
should cite which of the following effects of
long-term use of OTC cold remedies? Select
all that apply.
Chronic epistaxis
Anticholinergic effects
Chronic congestion
Damage to the nasal mucosa
Hepatotoxicity
C, D
Feedback:
Over-the-counter (OTC) cold remedies should
not be used longer than 1 week. Do not use
nose drops or sprays more often or longer
than recommended. Excessive or prolonged
use may damage nasal mucosa and produce
chronic nasal congestion. These drugs are not
associated with chronic epistaxis,
anticholinergic effects, or hepatotoxicity.
A)
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An adult patient has asked the nurse to
recommend an OTC cold remedy because she
is unsure which of the many options available
11.
is most appropriate. Before making a
recommendation, the nurse should do which
of the following?
Consult with a pharmacist or pharmacy
technician.
Assess the patient's understanding of the
epidemiology of the common cold and upper
respiratory infections.
Assess the patient for health problems that
may contraindicate the use of a particular
remedy.
Ensure that the patient has tried some of the
more common herbal and natural remedies.
C
Feedback:
Before recommending a particular product,
the nurse needs to assess the intended
recipient for conditions or other medications
that contraindicate the product's use. Herbal
options do not need to precede
pharmaceuticals, and the nurse does not
necessarily need to consult with a pharmacist
or pharmacy technician. The patient's
understanding of the epidemiology of the
common cold is not a high priority.
C)
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B)
C)
D)
Ans:
A community health nurse is cautious when
recommending the use of OTC cold remedies
12. to patients. The use of pseudoephedrine
would most likely be contraindicated in which
of the following patients?
A woman who is breast-feeding
A man with a history of angina and
hypertension
A man who has diagnoses of chronic
obstructive pulmonary disease and diabetes
A woman who has myasthenia gravis
B
Feedback:
Contraindications to pseudoephedrine use
include severe hypertension or coronary
artery disease because of the drug's cardiac
stimulating and vasoconstricting effects.
Breast-feeding does not necessarily
contraindicate the use of pseudoephedrine,
though caution would be warranted. The other
A man who has diagnoses of chronic
obstructive pulmonary disease and diabetes
A woman who has myasthenia gravis
B
Feedback:
Contraindications to pseudoephedrine use
include severe hypertension or coronary
artery disease because of the drug's cardiac
stimulating and vasoconstricting effects.
Breast-feeding does not necessarily
contraindicate the use of pseudoephedrine,
though caution would be warranted. The other
listed medical diagnoses do not contraindicate
the use of pseudoephedrine.
C)
A 30-year-old woman with two preschoolers
has sought the nurse's advice because she has
heard conflicting reports about the safety and
13.
efficacy of cough and cold products in young
children. The nurse should inform the woman
that
cough and cold remedies are generally safe
and effective for children over the age of 2.
there are concerns among health professionals
about how safe and effective these
medications are.
media reports about the risks of cough and
cold medications in children have greatly
exaggerated the risks.
it is imperative to use age-specific
preparations of cough and cold remedies.
B
Feedback:
Certain organizations have expressed caution
about the use of pseudoephedrine in young
children. The use of age-specific preparations
does not guarantee safety or effectiveness.
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B)
C)
A 55-year-old male patient has been living
with type 1 diabetes for many years and has
begun to experience diabetic nephropathy
14. over the past year. How will this patient's
current health status influence the possible use
of pseudoephedrine in the treatment of cold
symptoms?
The patient should monitor his blood glucose
levels more frequently when taking
pseudoephedrine.
The use of pseudoephedrine is absolutely
contraindicated by the fact that the patient has
diabetes and takes insulin.
The patient may require a higher-than-average
dose of pseudoephedrine because of excess
fluid volume secondary to renal failure.
of pseudoephedrine in the treatment of cold
symptoms?
The patient should monitor his blood glucose
levels more frequently when taking
pseudoephedrine.
The use of pseudoephedrine is absolutely
contraindicated by the fact that the patient has
diabetes and takes insulin.
The patient may require a higher-than-average
dose of pseudoephedrine because of excess
fluid volume secondary to renal failure.
The patient should use caution and will likely
require a lower dose of pseudoephedrine
because of his impaired renal function.
D
Feedback:
Because pseudoephedrine is excreted
primarily via the kidneys, caution in patients
with renal impairment is important. It may be
necessary to reduce the dosage to avoid
potential drug accumulation and drug toxicity.
The presence of diabetes warrants caution, but
it is not an absolute contraindication.
A)
B)
C)
D)
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A patient has asked the nurse if it would be
appropriate to use dextromethorphan to treat
15.
her cough. What type of cough is best suited
to treatment with dextromethorphan?
An occasional, productive cough
A cough that is nearly continuous and that is
accompanied by copious secretions
A cough that occurs when the patient is
exposed to airborne irritants
A dry, nonproductive cough
D
Feedback:
The major clinical indication for use of
dextromethorphan is a dry, hacking,
nonproductive cough that interferes with rest
and sleep. It is not desirable to suppress a
productive cough because the secretions need
to be removed.
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A)
B)
C)
D)
Ans:
A 17-year-old boy has been brought to the
emergency department by his mother who is
distraught by the fact that she caught him and
16.
his friend “guzzling cough syrup.” What
assessment finding is suggestive of an
overdose of dextromethorphan?
Hallucinations
Dysrhythmias
Kussmaul's respirations
Profound diaphoresis
A
emergency department by his mother who is
distraught by the fact that she caught him and
16.
his friend “guzzling cough syrup.” What
assessment finding is suggestive of an
overdose of dextromethorphan?
Hallucinations
Dysrhythmias
Kussmaul's respirations
Profound diaphoresis
A
Feedback:
The nurse observes for excessive suppression
of the cough reflex (inability to cough
effectively when secretions are present) or
hallucinations with dosages that exceed
recommendations of dextromethorphan.
Kussmaul's respirations, dysrhythmias, and
diaphoresis are not characteristic adverse
effects.
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B)
C)
D)
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A patient with a persistent and debilitating
cough is confused that his physician has
prescribed codeine. He tells the nurse, “I was
17. sure that codeine was a narcotic that people
take for pain.” The nurse should cite what
mechanism of action when describing this use
of codeine?
Depression of the cough center in the medulla
oblongata
Vasodilation of the alveolar capillaries
Stimulation of the reticular activating system
(RAS)
Desensitization of the cough receptors in the
sinuses and trachea
A
Feedback:
Antitussives such as codeine suppress cough
by depressing the cough center in the medulla
oblongata. They do not influence blood flow
or desensitize peripheral cough receptors. The
RAS is not involved in the cough reflex.
A)
B)
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A)
B)
C)
D)
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A nurse has taught an adult patient about the
fact that guaifenesin is not necessarily an
effective way of liquefying secretions. To help
18.
liquefy the patient's secretions, the nurse
should encourage which of the following
measures?
Reducing salt intake
Deep breathing and exercises
Gargling with normal saline
Increasing fluid intake
D
Feedback:
A nurse has taught an adult patient about the
fact that guaifenesin is not necessarily an
effective way of liquefying secretions. To help
18.
liquefy the patient's secretions, the nurse
should encourage which of the following
measures?
Reducing salt intake
Deep breathing and exercises
Gargling with normal saline
Increasing fluid intake
D
Feedback:
Drinking plenty of water while taking
guaifenesin may help loosen mucus in the
lungs. Deep breathing, gargling with normal
saline, and reducing salt intake do not
necessarily help liquefy and mobilize
secretions.
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B)
C)
D)
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A critically ill patient with a diagnosis of
ventilator-associated pneumonia has been
administered acetylcysteine by inhalation.
19.
The critical care nurse knows that this
medication helps to liquefy secretions in the
respiratory tract by
increasing the osmolality of mucus.
decreasing the osmolality of mucus
breaking the protein bonds that exist in
mucus.
drawing increased amounts of water from
interstitial spaces into mucus.
C
Feedback:
Mucolytics such as acetylcysteine are drugs
that liquefy mucus in the respiratory tract by
attacking the protein bonds of the mucus.
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B)
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B)
C)
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A patient has purchased an OTC cold remedy
that advertises a “nondrowsy” formulation.
20.
The nurse should recognize that this produce
likely contains which of the following?
A nasal decongestant but not an antihistamine
An expectorant, a mucolytic, and a
benzodiazepine
An expectorant but not a decongestant
A narcotic analgesic and a decongestant
A
Feedback:
“Nondrowsy” or “daytime” cold formulas
typically contain a nasal decongestant but not
an antihistamine. Such medications would not
contain an opioid or a benzodiazepine.
B)
benzodiazepine
An expectorant but not a decongestant
A narcotic analgesic and a decongestant
A
Feedback:
“Nondrowsy” or “daytime” cold formulas
typically contain a nasal decongestant but not
an antihistamine. Such medications would not
contain an opioid or a benzodiazepine.
C)
D)
Ans:
Chapter 32 Drug Therapy to Decrease Histamine Effects and Allergic Response
A patient is stung by a bee. What is the
1. chemical mediator released in immune and
inflammatory response to the bee sting?
Norepinephrine
Mast cells
Epinephrine
Histamine
D
Feedback:
Histamine is the chemical mediator released
in immune and inflammatory response to the
bee sting.
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B)
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B)
C)
D)
Ans:
A)
B)
C)
D)
Ans:
A patient is experiencing allergy symptoms
after being exposed to environmental dust.
2.
This reaction involves the action of histamine,
which is released by what cells?
Lymphocytes
CD4 T cells
Basophils
Platelets
C
Feedback:
Histamine is discharged from mast cells and
basophils in response to certain stimuli, such
as allergic reactions, cellular injury, and
extreme cold. Lymphocytes and platelets do
not release histamine.
A patient is being administered epinephrine
for the treatment of anaphylaxis. This patient
3.
is experiencing what type of hypersensitivity
reaction?
Type I
Type II
Type III
Type IV
A
Feedback:
Anaphylaxis is a type I response, which can
3.
A)
B)
C)
D)
Ans:
for the treatment of anaphylaxis. This patient
is experiencing what type of hypersensitivity
reaction?
Type I
Type II
Type III
Type IV
A
Feedback:
Anaphylaxis is a type I response, which can
be mild or life threatening.
An elderly patient is given diphenhydramine
(Benadryl) for allergic response to mold. The
4.
nurse should consequently assess the patient
for
anticholinergic effects.
dysrhythmias.
increased muscle tone.
respiratory depression.
A
Feedback:
Diphenhydramine (Benadryl) is the prototype
of first-generation antihistamines and causes a
high incidence of drowsiness and
anticholinergic effects. It is not associated
with dysrhythmias, increased muscle tone, or
respiratory depression.
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B)
C)
D)
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A second-generation H1 receptor antagonist
5. antihistamine formulated as a nasal spray for
topical use is
chlorpheniramine (Chlor-Trimeton).
clemastine (Tavist).
cyproheptadine (Periactin).
azelastine (Astelin).
D
Feedback:
Azelastine (Astelin) and olopatadine (Patanol)
are second-generation H1 receptor antagonists
that have been formulated as nasal sprays for
topical use. Each of the other listed drugs is a
first-generation H1 receptor antagonist.
A patient is instructed to take
diphenhydramine (Benadryl) after an allergic
reaction. Which of the following statements
6.
by the patient indicates successful teaching
concerning the safe and effective use of
diphenhydramine?
“I will still be able to have my after-dinner
drink with this medication.”
“I will eat a diet low in sodium while taking
this medication.”
“I should not drive my car after taking this
medication.”
“I can take this medication every 2 hours until
I feel better.”
C
Feedback:
The administration of diphenhydramine
(Benadryl) causes drowsiness, and the patient
should not operate machinery, such as
driving. The patient should not combine
diphenhydramine with alcohol due to central
nervous system depression. The patient will
not need to limit sodium with this medication.
The patient should adhere to the dosing
schedule and not take the medication every 2
hours.
A)
B)
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B)
C)
D)
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A patient is having an allergic reaction to
mold. The patient describes chest tightness
7.
and difficulty breathing. Which of the
following body effects is occurring?
Contraction of smooth muscle in the bronchi
Suppression of the vagus nerve endings
producing tachycardia
Decreased permeability of the veins and
capillaries
Decreased secretion of the mucous glands
A
Feedback:
An allergic reaction produces contraction of
the smooth muscle in the bronchi and
bronchioles. The patient will have
stimulation, not suppression, of the vagus
nerve endings. The patient will have
increased, not decreased, permeability of the
veins and capillaries. The patient will have
increased secretion from the mucous glands,
producing nasal congestion.
Decreased permeability of the veins and
capillaries
Decreased secretion of the mucous glands
A
Feedback:
An allergic reaction produces contraction of
the smooth muscle in the bronchi and
bronchioles. The patient will have
stimulation, not suppression, of the vagus
nerve endings. The patient will have
increased, not decreased, permeability of the
veins and capillaries. The patient will have
increased secretion from the mucous glands,
producing nasal congestion.
C)
A patient is diagnosed with allergic rhinitis.
8. What type of hypersensitivity reaction is
causing allergic rhinitis?
Type I
Type II
Type III
Type IV
A
Feedback:
A type I response to cell-mediated invasion is
mild and characterized by allergic rhinitis.
Type II response is mediated by IgG or IgM
generating direct damage to the cell surface.
The patient with hemolytic anemia is having a
type II response. Type III is an IgG- or IgMmediated reaction characterized by formation
of antigen–antibody complexes that induce an
acute inflammatory reaction in tissues. Type
IV hypersensitivity is a delayed
hypersensitivity.
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B)
C)
D)
Ans:
A)
B)
C)
D)
Ans:
A patient has been suffering from repeated
sinus infections and is diagnosed with allergic
9. rhinitis. The patient is prescribed a firstgeneration H1 receptor antagonist. What is
one of the effects of this medication?
It depletes norepinephrine and serotonin.
It decreases capillary permeability.
It catalyzes the enzymatic oxidation of uric
acid.
It raises the seizure threshold by impairing
vitamin D.
B
Feedback:
Decreased capillary permeability is among the
effects of first-generation drugs. H1 receptor
antagonists do not affect vitamin D, uric acid,
or neurotransmitters.
It catalyzes the enzymatic oxidation of uric
acid.
It raises the seizure threshold by impairing
vitamin D.
B
Feedback:
Decreased capillary permeability is among the
effects of first-generation drugs. H1 receptor
C)
D)
Ans:
antagonists do not affect vitamin D, uric acid,
or neurotransmitters.
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A)
A patient has been taking cephalexin (Keflex)
for an upper respiratory infection. On the
10. seventh day of treatment, the patient develops
myalgia and fever. What reaction is the
patient likely having?
The patient has developed a new infection.
The patient has developed an autoimmune
disease.
The patient has become septic.
The patient has serum sickness.
D
Feedback:
Serum sickness is a delayed hypersensitivity
reaction most often caused by drugs, such as
antimicrobials. Within initial exposure to the
antigen, symptoms usually develop within 7
to 10 days and include urticaria,
lymphadenopathy, myalgia, arthralgia, and
fever. Although the patient has a fever, the
patient does not present with all the symptoms
of a new infection or sepsis. An autoimmune
disease is not likely.
B)
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C)
D)
Ans:
A)
B)
C)
D)
Ans:
A patient is scheduled to receive one unit of
packed red blood cells. The patient states that
she has had an allergic reaction to a
11.
transfusion in the past. What class of
medication will assist in preventing a reaction
to the packed red blood cell transfusion?
Antipyretics
Antimicrobials
Antianginals
Antihistamines
D
Feedback:
Premedication with an antihistamine may be
used to prevent allergic reactions with the
administration of a transfusion of packed red
blood cells. The administration of
antimicrobial or antianginal is not
recommended for a transfusion reaction.
B)
C)
D)
Ans:
Antimicrobials
Antianginals
Antihistamines
D
Feedback:
Premedication with an antihistamine may be
used to prevent allergic reactions with the
administration of a transfusion of packed red
blood cells. The administration of
antimicrobial or antianginal is not
recommended for a transfusion reaction.
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A hospital patient is complaining of nausea
and vomiting that has failed to respond to
12. first-line antiemetics. Which of the following
medications may be administered for the
treatment of nausea and vomiting?
First-generation antihistamine agent:
chlorpheniramine (Chlor-Trimeton)
First-generation antihistamine agent:
hydroxyzine (Vistaril)
Second-generation antihistamine agent:
loratadine (Claritin)
Second-generation antihistamine agent:
cetirizine (Zyrtec)
B
Feedback:
Hydroxyzine is a first-generation H1 receptor
A)
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B)
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Ans:
antagonist that can be administered as an
antiemetic agent. Chlorpheniramine is not
administered as an antiemetic agent.
Loratadine and cetirizine are not administered
as antiemetic agents.
A patient who suffers from allergies to grass
and mold is getting ready to cut grass. Prior to
13. cutting grass, he takes cetirizine (Zyrtec).
When will the patient expect the medication
to reach maximum effects?
1 hour
2 to 3 hours
8 to 12 hours
12 to 24 hours
A
Feedback:
Cetirizine (Zyrtec) reaches maximal serum
concentration in 1 hour.
A child is experiencing severe flu-like
symptoms with nausea and vomiting and is
14. admitted to the hospital. Which disorder in
children will contraindicate the administration
of promethazine?
Chickenpox
Endocarditis
Reye's syndrome
Hypertensive crisis
C
Feedback:
Promethazine should not be used in children
with hepatic disease or Reye's syndrome. The
use of promethazine is not contraindicated
with chickenpox, endocarditis, or
hypertensive crisis. Promethazine would not
be treated with chickenpox unless nausea or
vomiting was noted. Endocarditis would not
be treated with promethazine. This drug
would not be administered with hypertensive
crisis.
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B)
C)
D)
Ans:
Antihistamines are used to treat nasal
15. congestion. Which of the following patients
should not be administered an antihistamine?
A male patient with Parkinson's disease
A female patient with asthma
A male patient with diabetes mellitus
A male patient with prostatic hypertrophy
D
Feedback:
Antihistamines are contraindicated in patients
with prostatic hypertrophy. Antihistamine
agents can be administered to patients with
Parkinson's disease, asthma, and diabetes
mellitus.
An unlicensed care provider administered
Benadryl to an elderly resident who has been
suffering from seasonal pollen allergies.
16. Which of the following assessment findings
should prompt the nurse at the facility to
suspect that the resident is experiencing
anticholinergic effects of this drug?
Blurry vision
Tinnitus
Wheezing on expiration
Urticaria
A
Feedback:
First-generation H1 receptor antagonists are
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B)
C)
D)
Ans:
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associated with anticholinergic effects such as
dry mouth, urinary retention, constipation,
and blurred vision. Wheezing, urticaria, and
tinnitus are not anticholinergic effects.
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B)
C)
D)
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An adult patient has questioned whether
fexofenadine (Allegra) would be preferable to
the first-generation H1 receptor antagonists
17. that he has long taken in the treatment of his
environmental allergies. When describing the
benefits of second-generation drugs such as
Allegra, the nurse should cite what
advantage?
Lower cost
Decreased sedation
Absence of adverse effects
Once-weekly dosing
B
Feedback:
Unlike the first-generation H1 receptor
antagonists, the second-generation H1
receptor antagonists do not readily enter the
brain from the blood. This selectivity
significantly reduces the occurrence of
adverse drug reactions, such as drowsiness
and sedation, while still providing effective
relief of allergic conditions. Adverse effects
are not wholly absent, however. Duration of
action is 12 to 24 hours, and these drugs are
more expensive than first-generation drugs.
B)
C)
D)
Ans:
Decreased sedation
Absence of adverse effects
Once-weekly dosing
B
Feedback:
Unlike the first-generation H1 receptor
antagonists, the second-generation H1
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receptor antagonists do not readily enter the
brain from the blood. This selectivity
significantly reduces the occurrence of
adverse drug reactions, such as drowsiness
and sedation, while still providing effective
relief of allergic conditions. Adverse effects
are not wholly absent, however. Duration of
action is 12 to 24 hours, and these drugs are
more expensive than first-generation drugs.
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A gerontological nurse has encouraged a
group of caregivers who work with older
adults to avoid administering first-generation
18. H1 receptor antagonists to these patients. The
nurse's cautionary message is an
acknowledgment of what possible nursing
diagnosis?
Risk for infection related to adverse effects of
antihistamines
Risk for falls related to sedation
Risk for deficient fluid volume related to
diuresis
Risk for impaired skin integrity related to
urticaria
B
Feedback:
First-generation antihistamines cause
drowsiness and impaired cognition that can
result in falls. These drugs do not cause
diuresis, impaired skin integrity, or infection.
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An adult patient has complained to the nurse
that she has been experiencing a dry mouth
and urinary retention after several nights of
19.
taking an OTC sleep aid. The nurse should
suspect that this medication contains what
antihistamine?
Loratadine (Claritin)
Promethazine (Phenergan)
Diphenhydramine (Benadryl)
Olopatadine (Patanol)
C
Feedback:
The active ingredient in OTC sleep aids is a
sedating antihistamine, usually
diphenhydramine (Benadryl).
antihistamine?
Loratadine (Claritin)
Promethazine (Phenergan)
Diphenhydramine (Benadryl)
Olopatadine (Patanol)
C
Feedback:
The active ingredient in OTC sleep aids is a
sedating antihistamine, usually
diphenhydramine (Benadryl).
A patient with a long-standing history of
seasonal allergies has sought care during the
spring and been advised to take a second20.
generation antihistamine. Which of the
patient's following statements suggests a need
for the nurse to perform health education?
“I know these can be a bit expensive, but
hopefully it will be worth it for me.”
“I'm really hoping that these pills will cure
my allergies before summer starts.”
“I'll check with my doctor to make sure that
the diet supplements I'm taking are okay to
take at the same time as these pills.”
“It's handy that I don't necessarily have to
take these pills at bedtime.”
B
Feedback:
Antihistamines mitigate the signs and
symptoms of allergies, but they do not cure
the problem. Second-generation
antihistamines are more expensive than earlier
drugs. It is prudent to screen for potential
interactions with herbal remedies. Because
second-generation drugs do not cause
sedation, they may generally be taken at any
time.
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B)
C)
D)
Ans:
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Chapter 33 Drug Therapy for Asthma and Bronchoconstriction
A)
B)
C)
D)
Ans:
A patient has been diagnosed with asthma.
1. Which of the following health education
topics is most important?
“Do not become fatigued. It will trigger
asthma attacks.”
“Exposure to cold temperatures can trigger
asthma.”
“Do not consume foods high in sodium.”
“Prolonged exposure to direct sunlight will
trigger asthma.”
B
Feedback:
Exposure to cold air can exacerbate asthma
symptoms due to the bronchoconstriction of
“Do not become fatigued. It will trigger
asthma attacks.”
“Exposure to cold temperatures can trigger
asthma.”
“Do not consume foods high in sodium.”
“Prolonged exposure to direct sunlight will
trigger asthma.”
B
Feedback:
Exposure to cold air can exacerbate asthma
symptoms due to the bronchoconstriction of
airways. Fatigue is not a direct trigger of
asthma. The consumption of high quantities
of sodium will not trigger asthma. The
exposure to direct sunlight will not trigger
asthma.
A)
B)
C)
D)
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A patient with asthma has been taking
ibuprofen (Advil) twice daily for 2 weeks
after an ankle injury. The patient calls her
2. health care provider and states she is bothered
by shortness of breath and rapid breathing.
What will the patient's health care provider
suspect?
The patient is having an anxiety attack.
The patient has a sensitivity to the drug.
The patient is experiencing hypoglycemia.
The patient is suffering from a myocardial
infarction.
B
Feedback:
In about 25% of patients with asthma, aspirin
and other nonsteroidal anti-inflammatory
drugs can precipitate an asthma attack. The
patient is experiencing a hypersensitivity
reaction. The patient is not experiencing
hypoglycemia or a myocardial infarction.
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B)
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A patient is using an albuterol (Proventil)
inhaler, which is a bronchodilator. Which of
the following patient teaching interventions is
3.
a priority for the patient who experiences
shortness of breath related to constriction of
airways?
Administer insulin to decrease hand shaking.
Administer ibuprofen (Advil) to decrease
inflammation.
Exercise should be limited to one time per
week.
Stop smoking due to the bronchoconstriction.
D
Feedback:
Cigarette smoking will increase
bronchoconstriction, so the patient should be
A)
Administer insulin to decrease hand shaking.
Administer ibuprofen (Advil) to decrease
inflammation.
Exercise should be limited to one time per
week.
Stop smoking due to the bronchoconstriction.
D
Feedback:
Cigarette smoking will increase
bronchoconstriction, so the patient should be
encouraged to stop. The albuterol causes hand
shaking. Insulin will not decrease hand
shaking. The patient will not require
ibuprofen (Advil). The patient should be
encouraged to exercise, and it should not be
limited to one time per week.
B)
C)
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D)
Ans:
A patient is started on albuterol (Proventil).
4. Of what adverse reaction should the patient be
warned?
Polydipsia
Tachycardia
Hypotension
Diarrhea
B
Feedback:
The symptoms of cardiac stimulation,
including tachycardia, are noted with the
administration of albuterol. The patient will
not experience polydipsia, hypotension, or
diarrhea.
A)
B)
C)
D)
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A)
B)
C)
D)
Ans:
A patient is admitted to the emergency room
with inspiratory stridor and air hunger after a
5.
bee sting. Which of the following medications
will the nurse prepare for administration?
Ipratropium bromide (Atrovent)
Epinephrine (Adrenalin)
Cromolyn (Intal)
Pseudoephedrine
B
Feedback:
Epinephrine may be injected subcutaneously
in an acute attack of bronchoconstriction.
Ipratropium is administered by inhalation for
maintenance therapy of bronchoconstriction
related to chronic bronchitis and
inflammation. It is not administered for an
acute attack of bronchoconstriction.
Cromolyn stabilizes mast cells and prevents
the release of bronchoconstrictive and
inflammatory substances when mast cells are
confronted with allergens and other stimuli. It
is not used for acute attacks. Pseudoephedrine
Epinephrine (Adrenalin)
Cromolyn (Intal)
Pseudoephedrine
B
Feedback:
Epinephrine may be injected subcutaneously
in an acute attack of bronchoconstriction.
Ipratropium is administered by inhalation for
maintenance therapy of bronchoconstriction
related to chronic bronchitis and
inflammation. It is not administered for an
acute attack of bronchoconstriction.
Cromolyn stabilizes mast cells and prevents
the release of bronchoconstrictive and
inflammatory substances when mast cells are
confronted with allergens and other stimuli. It
is not used for acute attacks. Pseudoephedrine
is not administered for acute
bronchoconstriction.
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C)
D)
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A patient is instructed on the administration of
inhaled corticosteroid agents to treat asthma.
6.
How do inhaled corticosteroid agents assist in
the treatment of asthma?
Inhaled corticosteroid agents will depress the
central nervous system.
Inhaled corticosteroid agents will reduce
respiratory rate.
Inhaled corticosteroid agents will reduce
bronchodilation.
Inhaled corticosteroid agents will reduce
airway inflammation.
D
Feedback:
Inhaled corticosteroid agents suppress the
release of inflammatory mediators, block the
generations of cytokines, and decrease the
recruitment of airway eosinophils. Inhaled
corticosteroid agents do not depress the
central nervous system. Inhaled corticosteroid
agents do not affect bronchodilation or
constriction.
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B)
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A patient is prescribed an adrenergic
bronchodilator for airway constriction. Which
7.
of the following conditions will require it to
be administered cautiously?
Liver failure
Renal failure
Respiratory constriction
Seizure disorder
D
Feedback:
The administration of adrenergic
7.
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A)
B)
C)
D)
Ans:
bronchodilator for airway constriction. Which
of the following conditions will require it to
be administered cautiously?
Liver failure
Renal failure
Respiratory constriction
Seizure disorder
D
Feedback:
The administration of adrenergic
bronchodilators should be used cautiously in
patients with hypertension, hyperthyroidism,
diabetes mellitus, and seizure disorders. The
patient with liver failure and renal failure can
be administered adrenergic bronchodilators.
The patient with respiratory constriction
should receive adrenergic bronchodilators.
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A)
B)
C)
D)
Ans:
A)
B)
C)
D)
Ans:
A patient is experiencing an acute asthma
attack. Which of the following medications is
8.
contraindicated for the treatment of acute
bronchospasm?
Aminophylline
Cromolyn (Intal)
Albuterol (Proventil)
Formoterol (Foradil)
B
Feedback:
Cromolyn stabilizes mast cells and is not used
in acute bronchospasm. Aminophylline is
used in limited cases but is administered for
acute asthma attack. Albuterol and formoterol
are used for acute asthma attack.
A child is prescribed an inhaled corticosteroid
agent to decrease respiratory inflammation.
9. The child's parent administers high doses of
the drug after 2 days of administration. What
is the patient at risk for?
Adrenal insufficiency
Tachycardia
Edema
Hypoglycemia
A
Feedback:
Adrenal insufficiency is most likely to occur
with systemic or high doses of inhaled
corticosteroids. The patient is not at risk for
tachycardia, edema, or hypoglycemia unless
related to adrenal insufficiency.
B)
C)
D)
Ans:
Tachycardia
Edema
Hypoglycemia
A
Feedback:
Adrenal insufficiency is most likely to occur
with systemic or high doses of inhaled
corticosteroids. The patient is not at risk for
tachycardia, edema, or hypoglycemia unless
related to adrenal insufficiency.
A patient is experiencing an acute asthma
10. attack. What is the most common first-line
therapy for relief of an acute asthma attack?
Inhaled steroid
Leukotriene modifier
Beta2-adrenergic agonist
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B)
C)
D)
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Xanthine
C
Feedback:
A patient experiencing an acute asthma attack
should be administered a beta2-adrenergic
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agonist. The patient can receive an inhaled
steroid, but it is not the first-line therapy.
Leukotriene modifiers are used for
maintenance in asthma, not during acute
exacerbation. Xanthines are not the drug of
choice in acute asthma attack.
Albuterol (Proventil) is administered to a
patient to promote bronchodilation.
11. Administration of this beta -adrenergic
2
agonist results in increased production of
leukotrienes.
cortisol.
cyclic AMP.
glucagon.
C
Feedback:
Beta-adrenergic drugs increase the production
of cyclic AMP to produce bronchodilation.
They do not increase the release of
leukotrienes, cortisol, or glucagon.
A patient is being assessed by the home care
nurse on the appropriate use of her metered12.
dose inhalers. Which of the following will
assist in proper administration of the inhaler?
Use of a spacer
Administration of a corticosteroid first
Pushing fluids
Exhaling immediately after administration
A
Feedback:
The patient should be instructed to use a
spacer to increase compliance and accuracy of
administration. The corticosteroid should be
administered after the bronchodilator. The
increase in fluids will not affect the
administration of the inhaler. The patient
should hold her breath for several seconds
after administration of the inhaler.
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B)
C)
D)
Ans:
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B)
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A patient is admitted to the intensive care unit
with status asthmaticus. The patient is
administered high doses of nebulized
13.
albuterol (Proventil). What electrolyte
imbalance should the nurse assess for this
patient?
Hyperkalemia
Hypermagnesemia
Hypocalcemia
Hypokalemia
D
Feedback:
High doses of nebulized albuterol have been
associated with tachycardia, hypokalemia,
and hyperglycemia. The patient will not have
alterations of magnesium or calcium levels.
A)
B)
C)
D)
Ans:
A patient is bothered with nighttime episodes
of bronchoconstriction related to asthma.
14. Which of the following medications can be
administered to decrease the nighttime
episodes and prevent asthma attacks?
Xanthines
Beta2-adrenergic agonists
Anticholinergics
Leukotriene modifiers
D
Feedback:
The leukotriene modifiers improve symptoms
14. Which of the following medications can be
administered to decrease the nighttime
episodes and prevent asthma attacks?
Xanthines
Beta2-adrenergic agonists
A)
B)
C)
D)
Ans:
Anticholinergics
Leukotriene modifiers
D
Feedback:
The leukotriene modifiers improve symptoms
and pulmonary function tests, decrease
nighttime symptoms, and decrease the use of
beta2-adrenergic drugs. Xanthines treat acute
attacks but do not prevent asthma from
occurring. Beta2-adrenergic agonists treat
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acute attacks but do not prevent asthma from
occurring. Anticholinergics block the action
of acetylcholine in bronchial smooth muscle
when given by inhalation.
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B)
C)
D)
Ans:
A)
B)
C)
D)
A patient has begun taking antiasthmatic
15. drugs. The patient should avoid excessive
intake of what beverage?
Coffee
Grapefruit
Green tea
Acai juice
A
Feedback:
Patients taking antiasthmatic drugs should
generally avoid excessive intake of caffeinecontaining fluids such as coffee, tea, and cola
drinks. These beverages may increase
bronchodilation but also may increase heart
rate and cause palpitations, nervousness, and
insomnia with bronchodilating drugs.
A patient with a recent diagnosis of asthma is
anxious because she experienced an asthma
attack and was unable to relieve the
16.
symptoms despite taking several puffs of her
prescribed salmeterol (Serevent). How should
the nurse respond to the patient's concerns?
“Remember that your Serevent isn't effective
when you take it at the time of an asthma
attack.”
“It's important to take your Serevent as soon
as you feel the first sensation of an asthma
attack.”
“Unfortunately, Serevent can take up to 15
minutes to relieve your difficulty breathing.”
“It's best to take repeated doses of Serevent,
every 5 minutes, until your symptoms
prescribed salmeterol (Serevent). How should
the nurse respond to the patient's concerns?
“Remember that your Serevent isn't effective
when you take it at the time of an asthma
attack.”
“It's important to take your Serevent as soon
as you feel the first sensation of an asthma
attack.”
“Unfortunately, Serevent can take up to 15
minutes to relieve your difficulty breathing.”
“It's best to take repeated doses of Serevent,
every 5 minutes, until your symptoms
subside.”
A
Feedback:
Formoterol (Foradil) and salmeterol
(Serevent) are long-acting beta2-adrenergic
A)
B)
C)
D)
Ans:
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agonists used only for prophylaxis of acute
bronchoconstriction. They are not effective in
acute attacks because they have a slower
onset of action than the short-acting drugs.
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A patient with asthma has been prescribed
ipratropium (Atrovent) 2 puffs QID. The
17. nurse should recognize which of the
following as the most likely goal of this
treatment?
Promoting short-term relief of acute asthma
symptoms
Relieving acute bronchoconstriction
Promoting long-term management of asthma
symptoms
Promoting blood flow in the alveolar
capillaries
C
Feedback:
The anticholinergic bronchodilators are most
useful in the long-term management of
asthma and other conditions producing
bronchoconstriction. These drugs are not used
in the management of acute exacerbations of
asthma. They do not promote alveolar blood
flow.
A)
B)
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A hospital patient's medication administration
record specifies concurrent doses of nebulized
18. ipratropium and albuterol at 08:00 and 20:00.
When administering these drugs, which of the
following statements is true?
The two drugs should be administered at least
30 minutes apart, with ipratropium
administered first.
The two drugs can be mixed in the nebulizer
immediately before administration.
The two drugs should be administered at least
30 minutes apart, with albuterol administered
first.
The nurse should contact the prescriber due to
the increased risk of adverse effects when
these drugs are administered concurrently.
B
Feedback:
It is appropriate to mix ipratropium bromide
inhalation solution in the nebulizer with
albuterol or metaproterenol if the mixture is
used within 1 hour. These drugs have a
synergistic effect.
A)
B)
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C)
D)
A)
B)
C)
D)
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A patient with a long-standing history of
asthma has failed to achieve adequate
symptom control with first-line drugs. As a
result, her care provider has prescribed
19. theophylline. The nurse is aware of the
narrow therapeutic range of this drug and has
taught the patient to recognize the signs and
symptoms of toxicity. These include which of
the following?
Polyuria and polyphagia
Confusion and decreased level of
consciousness
Agitation and dysrhythmias
Chest pain and shortness of breath
C
Feedback:
Signs and symptoms of theophylline overdose
include anorexia, nausea, vomiting, agitation,
nervousness, insomnia, tachycardia and other
dysrhythmias, and tonic–clonic convulsions.
Ventricular dysrhythmias or convulsions may
be the first sign of toxicity. Chest pain,
shortness of breath, polyuria, polyphagia, and
decreased level of consciousness do not
accompany theophylline overdose.
B)
consciousness
Agitation and dysrhythmias
Chest pain and shortness of breath
C
Feedback:
Signs and symptoms of theophylline overdose
include anorexia, nausea, vomiting, agitation,
nervousness, insomnia, tachycardia and other
dysrhythmias, and tonic–clonic convulsions.
Ventricular dysrhythmias or convulsions may
be the first sign of toxicity. Chest pain,
shortness of breath, polyuria, polyphagia, and
decreased level of consciousness do not
accompany theophylline overdose.
An adult patient with a diagnosis of asthma
has been prescribed montelukast (Singulair).
20.
The nurse should teach the patient that this
drug will help relieve symptoms by
reducing the muscle tone in the alveoli and
facilitating gas exchange.
relaxing smooth muscle in the bronchi and
bronchioles.
preventing the bronchoconstriction and
inflammation that is caused by leukotrienes.
preventing mast cells from releasing
histamine.
C
Feedback:
Montelukast prevents leukotrienes from
binding to its receptors reducing the
bronchoconstriction and ultimate
inflammation caused by leukotrienes.
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D)
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Chapter 34 Drug Therapy for Fluid Volume Excess
A)
B)
C)
D)
Ans:
The physician has ordered the patient
hydrochlorothiazide. What assessment should
1.
the nurse make before administering the first
dose of hydrochlorothiazide?
Pulse rate
Hemoglobin level
Sulfonamide allergy
Neutrophil level
C
Feedback:
Thiazide diuretics must be used cautiously in
patients allergic to sulfonamide drugs because
there is a known cross-sensitivity of some
sulfonamide-allergic patients to sulfonamide
nonantibiotic. It is not imperative to assess
pulse, hemoglobin, or neutrophil levels.
B)
C)
D)
Ans:
Hemoglobin level
Sulfonamide allergy
Neutrophil level
C
Feedback:
Thiazide diuretics must be used cautiously in
patients allergic to sulfonamide drugs because
there is a known cross-sensitivity of some
sulfonamide-allergic patients to sulfonamide
nonantibiotic. It is not imperative to assess
pulse, hemoglobin, or neutrophil levels.
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A)
A patient has edema of the lower extremities
and abdomen. What is the reason for
2.
administering a stronger diuretic than a
thiazide diuretic to this patient?
A thiazide diuretic will reabsorb potassium in
the distal tubule.
A thiazide diuretic will be ineffective for
immediate diuresis.
A thiazide diuretic will provide peak effects in
2 hours.
A thiazide diuretic will be excreted in more
than 72 hours.
B
Feedback:
Thiazide diuretics are ineffective when
immediate diuresis is required. A thiazide
diuretic acts to reabsorb sodium, not
potassium, in the distal convoluted tubule. A
thiazide diuretic reaches its peak in 4 to 6
hours. A thiazide diuretic is excreted in 72
hours maximum.
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C)
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A)
B)
C)
D)
Ans:
A patient is admitted to the hospital with a
diagnosis of heart failure. The patient is
ordered to receive furosemide (Lasix) 40 mg
3.
IV. How soon after administration should the
nurse expect to see evidence of diuretic
effects?
1 minute
5 minutes
30 minutes
2 hours
B
Feedback:
After IV administration, diuretic effects occur
within 5 minutes. The diuretic effect is not
seen in 1 minute. The peak of the action
occurs in 30 minutes, not the onset of action.
The duration of action is 2 hours, not the
onset of action.
B)
C)
D)
Ans:
5 minutes
30 minutes
2 hours
B
Feedback:
After IV administration, diuretic effects occur
within 5 minutes. The diuretic effect is not
seen in 1 minute. The peak of the action
occurs in 30 minutes, not the onset of action.
The duration of action is 2 hours, not the
onset of action.
A patient is administered furosemide (Lasix)
4. 20 mg PO every morning. What effect will a
diet high in sodium have on the patient?
Decreased blood pressure
Decreased diuresis
Hyperkalemia
Hyperglycemia
B
Feedback:
A high dietary intake of sodium can cause
sodium retention and reduce or cancel the
diuretic-induced sodium loss. A high dietary
intake of sodium will not increase diuresis. A
high dietary intake of sodium will not cause
hyperkalemia. A high dietary intake of sodium
will not cause hyperglycemia.
B)
C)
D)
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A)
B)
C)
D)
Ans:
A patient is switched from furosemide (Lasix)
to spironolactone (Aldactone). The patient
5. asks the nurse why she has been switched to a
new medicine. What is the nurse's best
response?
“You will lose less potassium with
spironolactone than with furosemide.”
“You will have greater potassium losses with
spironolactone than with furosemide.”
“You will have greater water losses with
spironolactone than with furosemide.”
“You will have greater sodium losses with
spironolactone than with furosemide.”
A
Feedback:
Spironolactone promotes retention of sodium
and water and excretion of potassium by
stimulating the sodium–potassium exchange
mechanism in the distal tubule. The patient
will not have greater potassium losses, water
losses, or sodium losses with spironolactone
rather than furosemide.
C)
spironolactone than with furosemide.”
“You will have greater sodium losses with
spironolactone than with furosemide.”
A
Feedback:
Spironolactone promotes retention of sodium
and water and excretion of potassium by
stimulating the sodium–potassium exchange
mechanism in the distal tubule. The patient
will not have greater potassium losses, water
losses, or sodium losses with spironolactone
rather than furosemide.
D)
Ans:
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A patient is taking spironolactone
(Aldactone). When providing patient teaching
6.
about this medication, what foods should the
patient be instructed to avoid?
Fish
Apples
Crackers
Bananas
D
Feedback:
Bananas are high in potassium and should be
avoided with potassium-sparing diuretics. It is
acceptable for the patient to eat fish, apples,
and crackers.
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B)
C)
D)
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B)
C)
D)
Ans:
A patient is admitted to the emergency
department and is unconscious as a result of a
7. head injury. The patient's intracranial pressure
is increased. What type of diuretic will the
nurse most likely administer to the patient?
Loop diuretic
Potassium-sparing diuretic
Thiazide diuretic
Osmotic diuretic
D
Feedback:
An osmotic diuretic is used to reduce
intracranial pressure related to a head injury.
Loop diuretics, potassium-sparing diuretics,
and thiazide diuretics do not reduce
intracranial pressure.
A patient with hypertension has been
prescribed a combination diuretic. What is the
8.
major purpose in administering a combination
diuretic agent?
It prevents sodium imbalance.
It is less expensive than two medications.
It prevents potassium imbalance.
It prevents allergic reactions.
C
Feedback:
The major purpose of the diuretic
combinations is to prevent potassium
imbalances. The combination products do not
prevent sodium imbalance. The combination
products are not less expensive than taking
two medications. The combination products
do not prevent allergic reactions.
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B)
C)
D)
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A patient asks the nurse why she has to take
two diuretics when her friend only takes one
with a combination medication. The patient
9.
takes hydrochlorothiazide 75 mg every day
with a potassium-sparing diuretic. What is the
nurse's best response?
“Maybe you should speak with your doctor
about the combination.”
“I do not know why your doctor prefers that
you take two medications.”
“It could be that you need a larger dose than
is available in the combination medications.”
“The combination medications are not as
effective as two medications.”
C
Feedback:
The fixed-dose combination of
hydrochlorothiazide and a potassium-sparing
diuretic contains 50 mg of
hydrochlorothiazide, and this patient requires
75 mg of hydrochlorothiazide. The statement
“It could be that you need a larger dose than
is available in the combination medications”
is the best answer. The statement “Maybe you
should speak with your doctor about the
combination” does not provide adequate
teaching. The statement “I do not know why
your doctor prefers that you take two
medications” does not provide adequate
patient education. The combination
medications are very effective, and the
statement that they are not as effective is
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C)
is available in the combination medications.”
“The combination medications are not as
effective as two medications.”
C
Feedback:
The fixed-dose combination of
hydrochlorothiazide and a potassium-sparing
diuretic contains 50 mg of
hydrochlorothiazide, and this patient requires
75 mg of hydrochlorothiazide. The statement
“It could be that you need a larger dose than
is available in the combination medications”
is the best answer. The statement “Maybe you
should speak with your doctor about the
combination” does not provide adequate
teaching. The statement “I do not know why
your doctor prefers that you take two
medications” does not provide adequate
patient education. The combination
medications are very effective, and the
statement that they are not as effective is
inaccurate.
D)
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A)
B)
C)
D)
Ans:
A)
B)
C)
D)
Ans:
A patient has edema of the lower extremities
10. with crackles in the lung bases. What diuretic
is the nurse most likely to administer?
Hydrochlorothiazide
Furosemide
Spironolactone
Mannitol
B
Feedback:
Acute pulmonary edema is an indication for
the use of Lasix. HCTZ, spironolactone, and
mannitol are not used for this purpose, largely
due to their slower onset of action.
A patient has been prescribed digoxin
(Lanoxin) and furosemide (Lasix) for
11. treatment of congestive heart failure. What is
the patient at risk for developing with this
combination of medications?
Hyperkalemia
Hyperglycemia
Tachycardia
Digoxin toxicity
D
Feedback:
When digoxin and diuretics are used
concomitantly, the risk of digoxin toxicity is
increased. The patient is at risk for
hypokalemia, not hyperkalemia. The patient is
not at a particular risk for hyperglycemia or
tachycardia.
B)
C)
D)
Ans:
Hyperglycemia
Tachycardia
Digoxin toxicity
D
Feedback:
When digoxin and diuretics are used
concomitantly, the risk of digoxin toxicity is
increased. The patient is at risk for
hypokalemia, not hyperkalemia. The patient is
not at a particular risk for hyperglycemia or
tachycardia.
A patient is receiving furosemide (Lasix) and
a potassium supplement. When monitoring
12.
daily laboratory values, what should the
potassium level be for this patient?
1.5 to 3.0 mEq/L
3.5 to 5.0 mEq/L
5.0 to 7.5 mEq/L
6.0 to 6.5 mEq/L
B
Feedback:
The normal serum potassium level is 3.5 to
5.0 mEq/L. A serum potassium level of 1.5 to
3.0 mEq/L is too low. A serum potassium
level of 5.0 to 7.5 mEq/L is indicative of
hyperkalemia. A serum potassium level of 6.0
to 6.5 mEq/L is indicative of hyperkalemia.
A)
B)
C)
D)
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A)
B)
C)
D)
Ans:
An elderly patient with a history of heart
failure has presented to the emergency
department in respiratory distress. Assessment
reveals the presence of pulmonary edema, and
13.
an infusion of IV furosemide (Lasix) has been
ordered. For the duration of treatment, the
nurse should prioritize assessments related to
what nursing diagnosis?
Risk for deficient fluid volume related to
diuretic administration
Risk for decreased cardiac output related to
adverse effects of furosemide
Ineffective health maintenance related to
pulmonary edema
Functional urinary incontinence related to
diuretic administration
A
Feedback:
Increased diuresis creates a risk of deficient
fluid volume. Impaired health maintenance
and urinary incontinence are not priorities at
this time. Lasix will not reduce cardiac
output.
C)
pulmonary edema
Functional urinary incontinence related to
diuretic administration
A
Feedback:
Increased diuresis creates a risk of deficient
fluid volume. Impaired health maintenance
and urinary incontinence are not priorities at
this time. Lasix will not reduce cardiac
output.
D)
A hospital patient with a diagnosis of liver
failure has been prescribed a low dose of
spironolactone in order to treat ascites. The
14.
nurse who is providing this patient's care
should prioritize assessments for the signs and
symptoms of what health problem?
Peritonitis
Liver cancer
Cirrhosis
Hepatic encephalopathy
D
Feedback:
Spironolactone is used in the treatment of
ascites. However, it should be used cautiously
and carefully monitored in patients with
significant hepatic impairment because a rapid
change in fluid and electrolyte balance may
lead to hepatic coma. It is important to
monitor susceptible patients carefully for
signs and symptoms of hepatic
encephalopathy. There is no risk for liver
cancer, cirrhosis, or peritonitis that results
directly from the use of spironolactone.
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A)
B)
C)
D)
Ans:
A)
B)
C)
D)
Ans:
A clinical nurse educator on a nephrology and
dialysis unit is reviewing renal physiology
with a nursing student who is completing a
15.
preceptorship on the unit. The student should
be aware that a majority of reabsorption takes
place in what anatomical location?
Ureters
Proximal tubule
Efferent arteriole
Afferent arteriole
B
Feedback:
Most reabsorption occurs in the proximal
tubule. Almost all glucose and amino acids
are reabsorbed; about 80% of water, sodium,
potassium, chloride, and most other
substances is reabsorbed. Arterial blood enters
the glomerulus by the afferent arteriole, and
blood that does not become part of the
Proximal tubule
Efferent arteriole
Afferent arteriole
B
Feedback:
Most reabsorption occurs in the proximal
tubule. Almost all glucose and amino acids
are reabsorbed; about 80% of water, sodium,
potassium, chloride, and most other
substances is reabsorbed. Arterial blood enters
the glomerulus by the afferent arteriole, and
blood that does not become part of the
glomerular filtrate leaves the glomerulus
through the efferent arteriole. The ureters
connect the kidneys to the bladder.
A hospital patient with peripheral edema has
been prescribed furosemide (Lasix). How
16.
should the nurse best determine the extent of
the patient's desired fluid loss?
Assess the patient's skin turgor on a daily
basis.
Test the osmolarity of the patient's urine
regularly.
Weigh the patient daily.
Auscultate the patient's chest each morning.
C
Feedback:
The nurse should measure and record weights
to assist in determining the amount of
mobilization of excess fluid. This is a more
accurate gauge of changes in fluid status than
skin turgor, urine osmolarity, or chest
auscultation.
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B)
C)
D)
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A)
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C)
D)
Ans:
A)
B)
C)
D)
Ans:
An adult patient with a diagnosis of
hypertension has had oral Lasix added to his
medication regimen by his primary care
provider. The nurse is planning a brief health
17.
education session with the patient in light of
this change in his treatment plan. What goal
should the nurse specify when planning this
teaching session?
The patient will identify strategies for limiting
his sodium intake.
The patient will describe the rationale for
increasing his fluid intake.
The patient will be able to demonstrate
correct technique for blood glucose
monitoring.
The patient will accurately describe the basic
structure and functions of the kidneys.
A
Feedback:
teaching session?
The patient will identify strategies for limiting
his sodium intake.
The patient will describe the rationale for
increasing his fluid intake.
The patient will be able to demonstrate
correct technique for blood glucose
monitoring.
The patient will accurately describe the basic
structure and functions of the kidneys.
A
Feedback:
The reason for furosemide use should guide
patient teaching. In most instances, it is
necessary to initiate measures to limit sodium
intake. Key considerations should include not
adding salt to food during preparation or at
the dinner table, reading food labels carefully
to be aware of hidden sources of sodium, and
avoiding processed or high-sodium foods.
Blood glucose monitoring is not indicated,
and there is no need for increased fluid intake.
Renal anatomy and physiology are not
priority teaching points.
A)
B)
C)
D)
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B)
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An older adult patient has a complex medical
history that includes heart failure, type 1
diabetes, and diabetic nephropathy. The nurse
18.
has questioned a care provider's order for oral
spironolactone because the patient's health
problems would contribute to a high risk of
metabolic acidosis.
hypocalcemia.
hemolytic anemia.
hyperkalemia.
D
Feedback:
The presence of renal insufficiency is also a
contraindication to the use of spironolactone
because use of spironolactone may cause
hyperkalemia through the inhibition of
aldosterone and the subsequent retention of
potassium. This patient does not face a greatly
increased risk of anemia, hypocalcemia, or
acidosis.
A nurse is reviewing a newly admitted
patient's medication administration record and
notes that the patient takes a loop diuretic as
19.
well as a thiazide diuretic. The nurse
understands what primary rationale for the
concurrent use of these two drugs?
Increased diuretic effect
Reduced risk of potassium imbalances
Decreased blood pressure without a risk of
bradycardia
Increased adherence to treatment
A
Feedback:
When an inadequate diuretic response occurs
with one drug, people sometimes take two
potassium-losing diuretics concurrently. The
combination of a loop and a thiazide diuretic
has synergistic effects because the drugs act
in different segments of the renal tubule.
Thus, the rationale for this particular
combination is not rooted in prevention of
potassium imbalances, increased adherence,
or maintenance of a normal heart rate.
A)
B)
C)
A)
B)
C)
D)
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D)
Ans:
A patient has been taking an ACE inhibitor
and a beta-blocker for the treatment of
hypertension but has been consistently
obtaining blood pressure readings in the
20. vicinity of 145/90 mm Hg. As a result, the
patient's primary care provider has prescribed
furosemide (Lasix). What order would be
most consistent with this patient's health
needs?
Lasix 125 mg PO OD
Lasix 40 mg IV TID
Lasix 20 mg IV OD
Lasix 40 mg PO BID
D
Feedback:
For hypertension, Lasix is commonly given as
40 mg PO twice daily and gradually increased
if necessary.
Chapter 35 Nutritional Support Products, Vitamins, and Mineral Supplements
A patient has suffered from several infections
in the last 6 months and unexplained impaired
1.
wound healing. What assessment should the
nurse prioritize?
Assess for pain.
Assess for nutritional deficiencies.
Assess genetic tendency for infection.
Assess for edema and decreased hemoglobin.
B
Feedback:
Nutritional deficiencies may impair the
function of essentially every body function.
Signs and symptoms include unintended
weight loss, increased susceptibility to
infection, and impaired wound healing. The
development of infection and impaired wound
healing would require assessment for pain but
would not provide evidence of cause. The
nurse would not be able to assess genetic
tendency. Edema and decreased hemoglobin
would not explain the etiology of suffering
infections and impaired wound healing.
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B)
C)
D)
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B)
C)
D)
Ans:
2.
An adult patient is experiencing deficiencies
in folic acid and vitamin B12. This patient's
compromised health status creates a risk for
which of the following?
Hyperuricemia
Hepatitis
Non-Hodgkin's lymphoma
Megaloblastic anemia
D
Feedback:
Deficiency states of both vitamin B12 and
folic acid present similarly as megaloblastic
anemia (characterized by abnormally large,
immature red blood cells). These deficiencies
do not contribute to hyperuricemia, hepatitis,
or lymphoma.
An elderly patient's compromised nutritional
status has necessitated the use of a nutritional
3. formula. When reviewing this patient's
laboratory findings, the nurse should prioritize
which of the following values?
Erythrocyte sedimentation rate (ESR)
Serum albumin
GGT, AST, and ALT
Blood urea nitrogen
B
Feedback:
For patients receiving nutritional formulas,
the nurse observes for weight gain and
increased serum albumin. In a patient with
compromised nutrition, there is less emphasis
placed on BUN, liver enzymes, and ESR.
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A)
B)
C)
D)
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B)
C)
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A patient with a history of atrial fibrillation
has been brought to the emergency
department (ED) by his wife after
4. inadvertently taking 22 mg of warfarin rather
than 2 mg, which is the patient's prescribed
daily dose. The ED nurse should anticipate
the administration of
vitamin K.
vitamin B12.
A)
B)
C)
D)
Ans:
vitamin A.
vitamin B1.
A
Feedback:
Vitamin K is used to reverse the effects of
warfarin (Coumadin).
When providing nutritional teaching to
5. adolescent girls, which aspect of teaching is
most important?
Limit the amount of foods high in fiber.
Increase potassium chloride in the diet.
Calcium intake should be 1300 mg daily.
Increase sodium in the diet.
C
Feedback:
Adolescent females should consume 1000 to
1300 mg of calcium per day. Adolescent
females should not limit fiber or increase
potassium chloride or sodium in the diet.
B)
C)
D)
Ans:
Increase potassium chloride in the diet.
Calcium intake should be 1300 mg daily.
Increase sodium in the diet.
C
Feedback:
Adolescent females should consume 1000 to
1300 mg of calcium per day. Adolescent
females should not limit fiber or increase
potassium chloride or sodium in the diet.
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A)
A patient is admitted to the hospital with
hyperkalemia. The patient is prescribed
6. sodium polystyrene sulfonate (Kayexalate).
How does this medication lower the patient's
potassium level?
It decreases the absorption of exogenous
potassium.
It increases urinary excretion of potassium.
It combines with potassium ions for
elimination.
It releases sodium to acidify urine with
potassium.
C
Feedback:
Sodium polystyrene sulfonate (Kayexalate), a
cation exchange resin, administered orally,
removes potassium from the body in the stool.
Kayexalate does not decrease the absorption
of potassium. Kayexalate does not increase
urinary excretion of potassium. Kayexalate
does not release sodium to acidify urine with
potassium.
B)
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A)
B)
C)
D)
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A patient has an increased serum potassium
level and has developed a cardiac arrhythmia.
7.
How do insulin and glucose assist in
decreasing the serum potassium level?
Insulin and glucose drive potassium into the
cells.
Insulin and glucose bind potassium to sodium.
Insulin and glucose increase urinary excretion
of potassium.
Insulin and glucose increase fecal excretion of
potassium.
A
Feedback:
Insulin and glucose lower serum potassium
levels by driving potassium into the cells.
Insulin and glucose do not bind potassium to
sodium or increase urinary excretion of
potassium or fecal excretion of potassium.
C)
of potassium.
Insulin and glucose increase fecal excretion of
potassium.
A
Feedback:
Insulin and glucose lower serum potassium
levels by driving potassium into the cells.
Insulin and glucose do not bind potassium to
sodium or increase urinary excretion of
potassium or fecal excretion of potassium.
D)
Ans:
A 4-year-old child has eaten many of his
8. mother's prenatal vitamins. Which medication
is indicated for iron toxicity?
Deferoxamine (Desferal)
Penicillamine (Cuprimine)
Sucralfate (Carafate)
Magnesium sulfate
A
Feedback:
Deferoxamine is a parenteral drug used to
remove excess iron from storage sites in the
body. Penicillamine, sucralfate, and
magnesium sulfate are not administered for
iron toxicity.
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B)
C)
D)
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A)
B)
C)
D)
Ans:
A patient with thalassemia requires frequent
blood transfusions. The patient develops iron
9.
overload. Which of the following medications
will be administered?
Calcium gluconate
Deferoxamine (Desferal)
Sodium polystyrene sulfonate (Kayexalate)
Deferasirox (Exjade)
D
Feedback:
Deferasirox (Exjade) is an oral iron chelating
agent that is used to treat chronic iron
overload in patients who require frequent
blood transfusions for severe chronic anemia.
Calcium gluconate, deferoxamine (Desferal),
and sodium polystyrene sulfonate
(Kayexalate) are not used to treat chronic iron
overload.
A toddler lives in a home that was built in the
1960s. The child has been diagnosed with
10. lead poisoning after eating chips of flaking
paint. Which medication will be administered
to decrease lead levels?
Succimer (Chemet)
Folic acid
Deferoxamine (Desferal)
Deferasirox (Exjade)
A
Feedback:
Succimer (Chemet) chelates lead to form
water-soluble complexes that are excreted in
the urine. Succimer is used to treat lead
poisoning in children. Folic acid is not used to
treat lead poisoning. Deferoxamine is not
used to treat lead poisoning. Deferasirox is
not used to treat lead poisoning.
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B)
C)
D)
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A new mother asks why her baby receives
vitamin K IM at birth. What is the best
11.
statement to explain the need for vitamin K in
a newborn?
“The administration of vitamin K prevents her
from bleeding.”
“Your infant will need multiple injections of
vitamin K to prevent health problems.”
“Your infant will need the conjugated iron in
vitamin K to protect her from infection.”
“Vitamin K helps boost her nutrition until
she's able to feed more efficiently.”
A
Feedback:
A single IM dose of vitamin K is given to
newborn infants to prevent hemorrhagic
disease of newborns. The infant does not need
multiple injections of vitamin K to prevent
hemorrhage. The administration of vitamin K
will not protect from infection. Vitamin K is
not used to enhance nutrition.
A)
Ans:
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B)
A woman in her last trimester of pregnancy is
diagnosed with toxemia. The patient is
12. admitted to labor and delivery and suffers a
seizure. What medication will be
administered parenterally?
Magnesium oxide
Magnesium sulfate
Potassium chloride
Calcium gluconate
B
Feedback:
Magnesium sulfate is given parenterally for
convulsions related to pregnancy. Magnesium
oxide is given orally for mild
hypomagnesemia. Potassium chloride is not
given for convulsions related to pregnancy.
Calcium gluconate is not given for convulsion
related to pregnancy.
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A patient's fluid overload has required several
doses of furosemide (Lasix). Which
13.
medication will be administered if the
patient's serum potassium level is 2.8 mEq/L?
Potassium chloride
Calcium gluconate
Potassium carbonate
Sodium polystyrene sulfonate (Kayexalate)
A
Feedback:
Furosemide is a potassium-depleting diuretic
in which potassium chloride will be
administered to prevent hypokalemia.
Calcium gluconate and zinc gluconate will
not be administered to the patient. Sodium
polystyrene sulfonate would be administered
with hyperkalemia not hypokalemia.
A)
B)
C)
D)
Ans:
A patient with alcoholism has been admitted
to the hospital following an injury.
Assessment of the patient's overall health
14.
reveals significant nutritional deficits. The
patient is likely to require which of the
following due to inadequate dietary intake?
Sodium
Vitamin A
Vitamin K
Thiamine
D
Feedback:
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absorbed.”
“Oral ingestion of vitamin B12 causes
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irritation and bleeding.”
“Pernicious anemia causes changes in the
mucous membrane.”
“In severe pernicious anemia, vitamin B12 is
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B)
C)
D)
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injection. What is the best response to the
patient?
“Oral forms of vitamin B12 will not be
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A patient diagnosed with pernicious anemia
asks why vitamin B12 is administered by
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B)
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to the hospital following an injury.
Assessment of the patient's overall health
14.
reveals significant nutritional deficits. The
patient is likely to require which of the
following due to inadequate dietary intake?
Sodium
Vitamin A
Vitamin K
Thiamine
D
Feedback:
Thiamine deficiency is common in patients
with alcoholism because of inadequate dietary
intake and use of large amounts of thiamine to
metabolize ethanol. Sodium, vitamin A, and
vitamin K are important but not as crucial to
this particular patient as thiamine.
not effective.”
A
Feedback:
In pernicious anemia, vitamin B12 must be
given by injection because oral forms are not
absorbed from the GI tract. Vitamin B12 is
not administered orally and thus will not
cause irritation and bleeding. Pernicious
anemia causes changes in the mucous
membrane, but these changes do not explain
why vitamin B12 is administered by injection.
A 3-year-old child has been diagnosed with an
acute gastrointestinal infection that has caused
16.
her severe diarrhea for the past 36 hours. The
pediatric nurse should anticipate the use of
magnesium gluconate.
Pedialyte.
sodium bicarbonate.
50% dextrose.
B
Feedback:
A 3-year-old child has been diagnosed with an
acute gastrointestinal infection that has caused
16.
her severe diarrhea for the past 36 hours. The
pediatric nurse should anticipate the use of
magnesium gluconate.
Pedialyte.
sodium bicarbonate.
50% dextrose.
B
Feedback:
Oral electrolyte solutions (e.g., Pedialyte)
contain several electrolytes and a small
amount of dextrose. They are especially
useful in children for treatment of diarrhea
and may prevent severe fluid and electrolyte
depletion. Magnesium gluconate, 50%
dextrose, and sodium bicarbonate are not
typically used for this purpose.
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B)
C)
D)
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A middle-aged woman with a family history
of breast cancer has told the nurse that she has
17. begun taking 250 mg of vitamin E each day in
an effort to prevent cancer. How should the
nurse best respond to this woman's statement?
“Good for you. You're to be commended for
being so proactive with your health.”
“If you do this, it's best to take several smaller
doses during the day rather than one big
dose.”
“Unfortunately, high doses of vitamins
haven't been shown to protect against
disease.”
“This is actually quite a dangerous practice,
and might increase, rather than decrease, your
cancer risk.”
C
Feedback:
People should never self-prescribe
megavitamins, large doses of vitamins in
excess of the recommended dietary allowance
(RDA). This practice does not, however,
increase an individual's risk of cancer.
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B)
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A)
B)
C)
D)
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A patient with a history of homelessness has
been diagnosed with nutritional deficits that
include a vitamin E deficiency. What aspect of
18.
the patient's current health status would
contraindicate the safe and effective use of
vitamin E supplements?
Cirrhosis
Thrombocytopenia
Low serum albumin
IV opioid abuse
B
A patient with a history of homelessness has
been diagnosed with nutritional deficits that
include a vitamin E deficiency. What aspect of
18.
the patient's current health status would
contraindicate the safe and effective use of
vitamin E supplements?
Cirrhosis
Thrombocytopenia
Low serum albumin
IV opioid abuse
B
Feedback:
Patients with a history of bleeding disorders
or thrombocytopenia should not take vitamin
E. Opioid use and liver disease do not
necessarily contraindicate the use of vitamin
E supplements.
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B)
C)
D)
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B)
C)
D)
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A patient with iron deficiency anemia has
begun taking daily supplements of oral
19. ferrous sulfate. The nurse who is planning this
patient's care should add what nursing
diagnosis to the nursing care plan?
Risk for excess fluid volume related to use of
iron supplements
Risk for unstable blood glucose related to use
of iron supplements
Risk for constipation related to use of iron
supplements
Risk for peripheral neurovascular dysfunction
related to use of iron supplements
C
Feedback:
Constipation is a common adverse effect of
iron supplements. Neurovascular dysfunction,
fluid volume excess, and unstable blood
glucose are unlikely to result from iron
supplements.
An older adult has been admitted to the
hospital with failure to thrive. Assessment
suggests that the patient is in a severely
20.
malnourished state. Which of the following
assessment findings is most suggestive of a
vitamin A deficiency?
Night blindness
Manic episodes
Nonblanching erythema
Petechiae
A
Feedback:
Night blindness is characteristic of vitamin A
deficiency. Mania and integumentary changes
are not normally associated with this vitamin
deficiency.
vitamin A deficiency?
Night blindness
Manic episodes
Nonblanching erythema
Petechiae
A
Feedback:
Night blindness is characteristic of vitamin A
deficiency. Mania and integumentary changes
are not normally associated with this vitamin
deficiency.
A)
B)
C)
D)
Ans:
Chapter 36 Drug Therapy for Weight Management
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A patient has a body mass index of 27 and
1. weighs 160 pounds. What is this patient
considered to be?
Underweight
Overweight
Obese
Desired weight
B
Feedback:
Overweight is defined as a body mass index
of 25 to 29.9 kg/m2. The patient is not
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B)
C)
D)
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underweight, obese, or at the desired weight.
Obesity cannot be determined solely on the
basis of body weight.
When the nurse is educating a women's group
2. on obesity and healthy eating, which of the
following statements is most accurate?
Consuming 3500 extra calories in a week will
result in 1 pound of fat.
Extra calories are converted to amino acids or
protein.
Food that contains large amounts of fat
stimulates energy.
Women will typically expend more energy
than men because of muscle tissue.
A
Feedback:
Consuming an extra 500 calories each day for
a week results in 3500 excess calories, or 1
pound of fat. Excess calories are converted to
triglycerides, not amino acids. Foods that
contain carbohydrates and protein stimulate
energy expenditure. Men expend more energy
than women.
C)
stimulates energy.
Women will typically expend more energy
than men because of muscle tissue.
A
Feedback:
Consuming an extra 500 calories each day for
a week results in 3500 excess calories, or 1
pound of fat. Excess calories are converted to
triglycerides, not amino acids. Foods that
contain carbohydrates and protein stimulate
energy expenditure. Men expend more energy
than women.
D)
A school nurse is in the planning stages of a
health promotion campaign that will address
childhood obesity. Of the following, which is
3.
an environmental factor believed to have
contributed most to increased weight in
children?
Playing video games
Genetic changes
Increased social acceptance of obesity
Increased incidence of depression
A
Feedback:
For both adults and children, increased time
watching television, playing video and
computer games, and working on computers
contributes to less physical activity and
promotes weight gain. Depression, social
factors, and genetic factors are not
environmental influences.
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B)
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B)
C)
D)
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A nurse is instructing parents about health and
nutrition. The nurse should state that
4. overweight children are more likely than
normal-weight children to develop which
disease process?
Glaucoma
Migraine headache
Scoliosis
Diabetes mellitus
D
Feedback:
Overweight and obese children are at risk for
developing type 2 diabetes. Overweight
children are not particularly prone to
developing glaucoma, migraine headache, or
scoliosis.
B)
C)
D)
Ans:
Migraine headache
Scoliosis
Diabetes mellitus
D
Feedback:
Overweight and obese children are at risk for
developing type 2 diabetes. Overweight
children are not particularly prone to
developing glaucoma, migraine headache, or
scoliosis.
A patient is prescribed phentermine (Ionamin)
in an effort to promote weight loss. What is
5.
the most common adverse effect of
phentermine?
Dry mouth
Hypernatremia
Fatigue
Hypoglycemia
A
Feedback:
The most commonly reported adverse effects
of phentermine are nervousness, dry mouth,
constipation, and hypertension.
Hypernatremia, fatigue, and hypoglycemia
are not adverse effects of phentermine.
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B)
C)
D)
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D)
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A)
An obese patient has asked her nurse
6. practitioner to prescribe sibutramine. What
variable will most affect the nurse's decision?
Sibutramine has been taken off the market
due to adverse cardiovascular effects.
Sibutramine is prohibitively expensive and is
not covered by most insurers.
The use of sibutramine requires weekly blood
work.
Sibutramine must be combined with an
anticholinergic drug in order to potentiate its
effects.
A
Feedback:
Until recently, health care providers used
sibutramine, a drug that suppresses appetite
by inhibiting the reuptake of the
neurotransmitters norepinephrine and
serotonin, in the management of obesity. The
drug is no longer available in the United
States because a clinical study demonstrated
an increased risk of cardiovascular events
such as heart attack and stroke with its use.
Sibutramine must be combined with an
anticholinergic drug in order to potentiate its
effects.
A
Feedback:
Until recently, health care providers used
sibutramine, a drug that suppresses appetite
by inhibiting the reuptake of the
neurotransmitters norepinephrine and
serotonin, in the management of obesity. The
drug is no longer available in the United
States because a clinical study demonstrated
an increased risk of cardiovascular events
such as heart attack and stroke with its use.
D)
Which of the following patients would be the
7. most appropriate candidate for treatment with
orlistat?
A 31-year-old woman who has been unable to
lose her “baby fat” in the months following
the birth of her child
A patient with a body mass index of 25.5
A man who is morbidly obese and who has
osteoarthritis in his knees
A 66-year-old man who was previously
healthy but who has been gradually gaining
weight since retirement
C
Feedback:
Orlistat is intended for people who are
clinically obese, not for those who want to
lose a few pounds. A patient with a BMI of
25.5 is nominally overweight.
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B)
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B)
C)
D)
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A patient is prescribed orlistat (Xenical) to
8. promote weight loss. What is the action of
orlistat?
It increases central nervous system
stimulation.
It inhibits the reuptake of serotonin and
norepinephrine.
It decreases fat absorption, which leads to
decreased caloric intake.
It decreases appetite because of the caffeine
contained in the medication.
C
Feedback:
Orlistat decreases fat absorption, which leads
to decreased caloric intake. Orlistat does not
increase central nervous system stimulation.
Orlistat does not inhibit reuptake of serotonin
and norepinephrine. Orlistat does not decrease
appetite because of the caffeine contained in
the medication.
C)
decreased caloric intake.
It decreases appetite because of the caffeine
contained in the medication.
C
Feedback:
Orlistat decreases fat absorption, which leads
to decreased caloric intake. Orlistat does not
increase central nervous system stimulation.
Orlistat does not inhibit reuptake of serotonin
and norepinephrine. Orlistat does not decrease
appetite because of the caffeine contained in
the medication.
D)
A 40-year-old patient has a body mass index
that classifies him as being severely obese.
For several months, the patient has been
working with an interdisciplinary team in an
effort to lose weight, but he has experienced
9.
nominal success. His physician has proposed
the use of orlistat, and the nurse has
conducted appropriate health education. What
statement by the patient indicates a need for
further teaching?
“They explained to me that I have to take the
medicine with my meals.”
“I'm excited that I won't have to cut down on
my favorite fried foods anymore.”
“It still amazes me that you can take a pill that
will actually help you lose weight.”
“If I understand correctly, these pills will help
me lower my cholesterol as well as lose
weight.”
B
Feedback:
It is necessary to decrease consumption of
high-fat foods when taking orlistat because
total caloric intake is a major determinant of
weight, and adverse effects (e.g., diarrhea;
fatty, malodorous stools) worsen with
consumption of a large amount of fat. The
patient's other listed statements are accurate.
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A mother is distraught that her 13-year-old
son weighs 260 pounds and continues to gain
weight. She has asked her family's primary
care provider if her child would be a
10.
candidate for treatment with orlistat, which
she read about on the Internet. What fact
should primarily guide the care provider's
decision?
Orlistat is not approved for use in children
under the age of 18.
Orlistat can only be administered to children
in an inpatient setting.
Alternatives such as increased activity and
decreased caloric intake should first be
exhausted.
The drug is not likely to be effective until the
boy completes puberty.
C
Feedback:
Although experts do not generally
recommend drug therapy for treatment of
childhood obesity, the FDA has approved
orlistat for use in children aged 12 and older
and considers the drug to be safe and effective
for weight reduction in overweight
adolescents. Orlistat is not limited to inpatient
use, and puberty does not negate efficacy.
A)
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C)
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B)
C)
D)
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A team of community health nurses have been
commissioned to plan and implement a
community-based health promotion initiative
11. aimed at addressing obesity. During the
planning stages, the nurses should be aware
that the prevalence of obesity is highest in
which of the following groups?
Caucasian women
Caucasian men
African American women
African American men
C
Feedback:
African American women and Mexican
American men and women have the highest
rates of overweight and obesity in the United
States.
An obese patient has been receiving extensive
health education prior to beginning treatment
with phentermine. The nurse has taught the
12.
patient about the varied factors that contribute
to obesity. Which of these factors is addressed
by the use of phentermine?
Psychosocial factors
Environmental factors
Genetic factors
Physiologic factors
D
Feedback:
Because phentermine inhibits the reuptake of
both serotonin and norepinephrine, it directly
affects physiologic factors related to obesity.
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B)
C)
D)
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A nurse who works with patients in a bariatric
clinic is teaching a man about the potentially
13. beneficial effects of phentermine. How should
the nurse best explain this drug's mechanism
of action?
“This drug will cause you to have less of an
appetite.”
“This drug will cause you to absorb less of the
fat that you eat.”
“This drug will cause you to burn more
calories than you normally do.”
“This drug prevents fat from being deposited
in your tissues.”
A
Feedback:
Phentermine inhibits the reuptake of both
serotonin and norepinephrine. It is an
anorexiant, causing appetite suppression,
which is thought to result from direct
stimulation of the satiety center in the
hypothalamic and limbic region. It does not
increase calorie metabolism or fat deposition.
A)
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A patient has been taking phentermine for the
past month and a half. During the patient's
most recent follow-up visit to the clinic, she
tells the nurse, “The pills seemed to work
14.
wonders for me for the first few weeks, but
now I feel like they don't really make much of
a difference.” The nurse should anticipate that
the prescriber will take what action?
Increasing the daily dosage of the drug by
approximately 50%
Ordering blood work to ascertain the serum
level of phentermine
Discontinuing the drug
Changing the route and schedule of
administration
C
Feedback:
Tolerance to phentermine usually occurs
within 4 to 6 weeks and is an indication for
discontinuing drug administration. Continued
administration or use of large doses does not
maintain appetite-suppressant effects. Instead,
it increases the incidence of adverse effects.
Blood work is unnecessary, and changing the
route is not an option.
A)
B)
C)
D)
C)
D)
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An adult patient with long-standing obesity
has been deemed an appropriate candidate for
treatment with phentermine. When teaching
15.
the patient to safely and effectively administer
the drug, the nurse should convey what
message to the patient?
Take phentermine with food, preferably at
mealtimes.
Take the medication on an empty stomach.
Take the medication 15 minutes after meals to
reduce fat absorption.
Take an increased dose of phentermine if a
large meal is anticipated.
B
Feedback:
It is necessary to take phentermine on an
empty stomach. Recipients should take
single-dose drugs in the early morning; they
should take multiple-dose preparations 30
minutes before meals, with the last dose of the
day about 6 hours before going to bed. Doses
are not increased when large meals are
anticipated. Phentermine does not affect fat
absorption.
C)
reduce fat absorption.
Take an increased dose of phentermine if a
large meal is anticipated.
B
Feedback:
It is necessary to take phentermine on an
empty stomach. Recipients should take
single-dose drugs in the early morning; they
should take multiple-dose preparations 30
minutes before meals, with the last dose of the
day about 6 hours before going to bed. Doses
are not increased when large meals are
anticipated. Phentermine does not affect fat
absorption.
D)
Ans:
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A female patient with obesity will soon begin
16. treatment with orlistat. The nurse should teach
the patient that
there will be fat present in her stools.
her appetite will decline over the next 48
hours.
she will have to increase her fiber intake.
she will need to temporarily eliminate fats
from her diet.
A
Feedback:
Fatty stools are a notable adverse effect of
orlistat. This drug does not reduce appetite. A
reduced-fat diet may be of benefit, but it is not
necessary to wholly eliminate fats from the
diet.
A)
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B)
C)
D)
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A nurse educator is working with a patient of
a bariatric clinic who has just begun taking
17. orlistat. The nurse should encourage the
patient to supplement her diet with which of
the following?
An iron supplement
A multivitamin
An omega-3 fatty acid supplement
A potassium supplement
B
Feedback:
Because orlistat prevents absorption of the
fat-soluble vitamins A, D, E, and K, people
who take it should also take a multivitamin
daily 2 hours before or after orlistat. Iron
supplements, potassium supplements, and
omega-3 fatty acid supplements are not
necessarily required.
A multivitamin
An omega-3 fatty acid supplement
A potassium supplement
B
Feedback:
Because orlistat prevents absorption of the
fat-soluble vitamins A, D, E, and K, people
who take it should also take a multivitamin
daily 2 hours before or after orlistat. Iron
supplements, potassium supplements, and
omega-3 fatty acid supplements are not
necessarily required.
A 34-year-old woman with a body mass index
of 56 has recently started to take orlistat. The
nurse has educated the patient about the
common adverse effects of this medication,
18.
including the potential for diarrhea and
flatulence. Which of the following meals
would be most likely to exacerbate the
adverse effects of orlistat?
A Cobb salad with romaine lettuce, boiled
egg, chicken breast, tomato, and cheese
A tomato, green pepper, and ham omelet
A salami, sausage, and pepperoni pizza
topped with mozzarella and parmesan
A bowl of beef chili con carne topped with
diced onions
C
Feedback:
To minimize GI effects, the nurse encourages
patients to distribute fat calories over the three
main meals and to avoid high-fat meals. The
fat content of a meat-laden pizza exceeds that
of a Cobb salad, omelet, or bowl of chili.
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B)
C)
D)
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A)
B)
C)
D)
Ans:
A young adult man is despondent that he has
been unable to lose weight and keep it off.
Now that his weight has crested 350 pounds,
he has sought advice from the nurse. He states
19. that obesity runs in his family but that his
mother had great success in losing weight
with the use of amphetamines in the late
1970s. The nurse should explain to the man
that this is not a treatment option because
amphetamines have been shown to be largely
ineffective in clinical studies.
amphetamines have been superseded by more
modern lipase inhibitors.
amphetamines carry a high risk of
dependence and abuse.
amphetamines are prohibitively expense and
are not covered by most health insurers.
C
that this is not a treatment option because
amphetamines have been shown to be largely
ineffective in clinical studies.
amphetamines have been superseded by more
modern lipase inhibitors.
amphetamines carry a high risk of
dependence and abuse.
amphetamines are prohibitively expense and
are not covered by most health insurers.
C
Feedback:
Experts do not recommend using
amphetamines because they are controlled
substances (Schedule II) with a high potential
for abuse and dependence. Amphetamines do
not inhibit lipase.
A)
B)
C)
D)
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A nurse has begun the assessment process
with an obese patient who states that he is
20. highly motivated to lose weight. How can the
nurse most accurately gauge the patient's
normal eating and drinking patterns?
Have the patient keep a detailed food diary
for 2 or 3 days.
Ask the patient to describe a typical meal and
snack.
Check laboratory reports of total and LDL
cholesterol, triglycerides, and blood sugar.
Have the patient describe the differences
between a healthy meal and an unhealthy
meal.
A
Feedback:
The best way to assess dietary habits is to ask
the patient to keep a food diary for 2 or 3
days. If food intake is not written down,
people tend to underestimate the amount and
caloric content. Blood work is a relevant
assessment datum but does not necessarily
indicate the patient's eating and drinking
habits. Having the patient describe a healthy
or unhealthy meal does not allow the nurse to
assess eating habits.
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Chapter 37 Drug Therapy for Peptic Ulcer Disease and Hyperacidity
A patient is taking nonsteroidal antiinflammatory agents for arthritis of the knees
1. and hips. Which of the following diseases is a
result of cellular destruction of the
gastrointestinal tract from this medication?
Esophageal cancer
Bowel obstruction
Liver cancer
Peptic ulcer disease
D
Feedback:
Cell destruction will occur from the ingestion
of NSAIDs, which can lead to the
development of peptic ulcer disease.
Nonsteroidal anti-inflammatory agents do not
cause esophageal cancer, bowel obstruction,
or liver cancer.
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B)
C)
D)
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A patient has Maalox ordered for
administration as needed. Which of the
2.
following conditions contraindicates the
administration of Maalox?
Hypertension
Heart rate of 68
Renal dysfunction
Stress ulcer
C
Feedback:
Magnesium-based antacids are
contraindicated in patients with renal failure.
Magnesium-based antacids are not
contraindicated with hypertension, regular
heart rate, or stress ulcer.
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A)
B)
C)
D)
Ans:
A)
B)
C)
D)
Ans:
A patient is diagnosed with peptic ulcer
disease complicated by H. pylori. What is the
3.
rationale for adding bismuth to the patient's
medication regimen?
Increases pepsin activity
Decreases gastrin secretion
Prevents metabolic alkalosis
Protects gastric mucosa from stomach acid
D
Feedback:
Health care providers use bismuth
subsalicylate to coat ulcers, protecting them
from stomach acid to treat H. pylori. Bismuth
does not increase pepsin activity, decrease
A)
B)
C)
D)
Ans:
Increases pepsin activity
Decreases gastrin secretion
Prevents metabolic alkalosis
Protects gastric mucosa from stomach acid
D
Feedback:
Health care providers use bismuth
subsalicylate to coat ulcers, protecting them
from stomach acid to treat H. pylori. Bismuth
does not increase pepsin activity, decrease
gastrin secretion, or prevent metabolic
alkalosis.
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A patient is in the intensive care unit and
being administered ranitidine (Zantac)
4. parenterally. How long will it take for
ranitidine (Zantac) to reach peak blood
levels?
15 minutes
30 minutes
1 hour
2 hours
A
Feedback:
Parenteral ranitidine reaches peak blood level
in 15 minutes. Parenteral ranitidine reaches its
peak prior to 30 minutes, 1 hour, and 2 hours.
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B)
C)
D)
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A)
B)
C)
D)
Ans:
The nurse practitioner instructs the patient to
use over-the-counter ranitidine (Zantac)
5. instead of cimetidine (Tagamet). What risk is
decreased when using ranitidine rather than
cimetidine?
Headache
Drug-to-drug interaction
Diarrhea
Bradycardia
B
Feedback:
Unlike cimetidine, ranitidine (Zantac),
famotidine (Pepcid, Pepcid RPD), and
nizatidine (Axid) do not affect the
cytochrome P450 drug-metabolizing system
in the liver and therefore do not interfere with
the metabolism of other drugs. Use of these
other drugs may be preferable in patients who
are critically ill because they often require
numerous other drugs with which cimetidine
may interact.
Drug-to-drug interaction
Diarrhea
Bradycardia
B
Feedback:
Unlike cimetidine, ranitidine (Zantac),
famotidine (Pepcid, Pepcid RPD), and
nizatidine (Axid) do not affect the
cytochrome P450 drug-metabolizing system
in the liver and therefore do not interfere with
the metabolism of other drugs. Use of these
other drugs may be preferable in patients who
are critically ill because they often require
numerous other drugs with which cimetidine
may interact.
A patient is taking cimetidine (Tagamet) for
increased gastric pain and hypersecretion.
6. Nurses should use extreme caution when
administering cimetidine to patients with
which of the following conditions?
Hepatic disease
Cancer
Hypertension
Diabetes mellitus
A
Feedback:
No absolute contraindications exist, but
cimetidine should be used cautiously in
patients with impaired hepatic and renal
function. The patient with cancer,
hypertension, and diabetes mellitus can take
cimetidine safely.
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B)
C)
D)
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A)
B)
C)
D)
Ans:
A)
B)
C)
D)
Ans:
A male patient is taking cimetidine (Tagamet).
Which adverse effect is more likely to occur
7. with cimetidine than with other histamine
2
receptor antagonists?
Hypoxia
Hypertension
Gynecomastia
Seizures
C
Feedback:
Gynecomastia is an adverse effect that is
more likely to occur with cimetidine than with
other histamine2 antagonists. Hypoxia,
hypertension, and seizures are not adverse
effects of cimetidine.
B)
C)
D)
Ans:
Hypertension
Gynecomastia
Seizures
C
Feedback:
Gynecomastia is an adverse effect that is
more likely to occur with cimetidine than with
other histamine2 antagonists. Hypoxia,
hypertension, and seizures are not adverse
effects of cimetidine.
A patient is prescribed a proton pump
inhibitor to treat erosive gastritis. How soon
8.
will the patient's symptoms most likely be
abolished?
1 to 2 weeks
4 weeks
1 month
6 weeks
A
Feedback:
The symptoms of gastroesophageal reflux
disease will be abolished in 1 to 2 weeks after
the start of the proton pump inhibitor
medication regime. It will not take 4 weeks, 1
month, or 6 weeks to see a change with the
proton pump inhibitor.
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D)
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A)
B)
C)
D)
Ans:
A 23-year-old female patient is prescribed
misoprostol (Cytotec). Which of the
9.
following patient teaching interventions is
most important?
Supplement therapy with magnesium
antacids.
Report postmenopausal bleeding.
Use effective contraceptive measures.
Administer the drug one time per day.
C
Feedback:
Misoprostol (Cytotec) is used to prevent
NSAID gastric ulcer development. The
medication can cause spontaneous abortion;
thus, the medication should be administered
with a good form of birth control. It should
not be administered with magnesium antacids.
It is not necessary for a patient aged 23 years
to report postmenopausal bleeding. The
medication should be administered two to
four times per day.
Report postmenopausal bleeding.
Use effective contraceptive measures.
Administer the drug one time per day.
C
Feedback:
Misoprostol (Cytotec) is used to prevent
NSAID gastric ulcer development. The
medication can cause spontaneous abortion;
thus, the medication should be administered
with a good form of birth control. It should
not be administered with magnesium antacids.
It is not necessary for a patient aged 23 years
to report postmenopausal bleeding. The
medication should be administered two to
four times per day.
A 62-year-old man is surprised to learn that
his recurrent indigestion has been attributed to
a new diagnosis of peptic ulcer disease. The
patient states, “I've never been a really
10. anxious type of person, so I never thought I'd
develop ulcers.” The nurse has responded
with health education addressing the etiology
of peptic ulcer disease. What causative factors
should the nurse cite? Select all that apply.
Physiologic or psychological stress
Diabetes mellitus
Cigarette smoking
Infections
Nonsteroidal anti-inflammatory drugs
A, C, D, E
Feedback:
There are multiple etiologic factors implicated
in PUD. These include smoking, H. pylori
infection, NSAID use, and stress. Diabetes is
not an identified cause.
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B)
C)
D)
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A)
B)
C)
D)
E)
Ans:
A)
B)
C)
D)
Ans:
A critically ill patient is being treated in a
burn unit following a workplace accident. The
patient's current treatment includes an
11. intragastric drip of an antacid through a
nasogastric tube. How should the critical care
nurse most accurately titrate the dose and
frequency of administration?
By assessing the pH of a 24-hour urine
sample
By aspirating stomach contents and
measuring the pH
By measuring the pH of urine after each void
By swabbing the patient's buccal mucosa and
testing for pH daily
B
Feedback:
For patients with a nasogastric tube in place,
By assessing the pH of a 24-hour urine
sample
By aspirating stomach contents and
measuring the pH
By measuring the pH of urine after each void
By swabbing the patient's buccal mucosa and
testing for pH daily
B
Feedback:
For patients with a nasogastric tube in place,
antacid dosage may be titrated by aspirating
stomach contents, determining pH, and then
basing the dose on the pH. Accurate
measurement of gastric pH cannot be
determined from the buccal mucosa or urine.
A)
B)
C)
D)
An adult patient has been taking Titralac
(Tums) on an increasingly frequent basis.
12. When teaching this patient, the nurse should
include suggestions for the prevention of
which of the following adverse effects?
Constipation
Urinary frequency
Fatty stools
Nausea
A
Feedback:
With the antacid Titralac (Tums), which
contains calcium, it is important to observe
for constipation. Combining this antacid with
other antacids containing magnesium may
prevent this effect. Frequency, fatty stools,
and nausea are not noted adverse effects.
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A)
B)
C)
D)
Ans:
A)
B)
C)
D)
Ans:
A patient who has been experiencing
heartburn has begun taking OTC ranitidine
(Zantac). The nurse who is working with this
13.
patient should be aware that this drug
achieves a therapeutic effect by which of the
following means?
Raising the pH of gastric secretions
Inhibiting the secretion of gastric acid
Binding to proton pumps
Decreasing gastric motility
B
Feedback:
The histamine2 receptor antagonists (H2RAs)
inhibit both basal secretion of gastric acid and
the secretion stimulated by histamine,
acetylcholine, and gastrin. These drugs, such
as ranitidine, do not change the pH of
secretions, bind to the proton pumps, or
decrease gastric motility.
B)
C)
D)
Ans:
Inhibiting the secretion of gastric acid
Binding to proton pumps
Decreasing gastric motility
B
Feedback:
The histamine2 receptor antagonists (H2RAs)
inhibit both basal secretion of gastric acid and
the secretion stimulated by histamine,
acetylcholine, and gastrin. These drugs, such
as ranitidine, do not change the pH of
secretions, bind to the proton pumps, or
decrease gastric motility.
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A patient has sought care for follow-up to his
recent diagnosis of peptic ulcer disease. The
patient states that he has achieved adequate
14. symptom relief with the use of OTC antacids
but has asked the nurse about the optimal
schedule for taking these drugs. What should
the nurse recommend?
Taking the drugs at the earliest appearance of
symptoms
Immediately prior to each meal and at
bedtime
Every 4 hours during all waking hours
One hour and three hours after each meal and
at bedtime
D
Feedback:
For treatment of peptic ulcer disease, patients
should take antacids 1 and 3 hours after meals
and at bedtime (four to seven doses daily), 1
to 2 hours before or after other medications.
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B)
C)
D)
Ans:
A patient has been prescribed omeprazole by
her primary care provider. When questioned
by the nurse about her perceived effectiveness
15. of the drug, the patient states, “I think it's
working quite well, and I've gotten in the
routine of taking it every morning before
breakfast.” How should the nurse respond?
“That's good, but remember that you shouldn't
take it on days when you're not having any
symptoms.”
“I'm glad it's working for you, but you'll
probably find it works even better if you take
it after eating.”
“That's great. If you find later that it's not
working as well, you might want to try taking
it at bedtime.”
“I'm glad to hear that. It sounds like you're
taking it exactly like it should be taken.”
D
Feedback:
A)
take it on days when you're not having any
symptoms.”
“I'm glad it's working for you, but you'll
probably find it works even better if you take
it after eating.”
“That's great. If you find later that it's not
working as well, you might want to try taking
it at bedtime.”
“I'm glad to hear that. It sounds like you're
taking it exactly like it should be taken.”
D
Feedback:
It is important that omeprazole be
administered before food intake. Once-daily
dosing is typical. The drug is not taken solely
as a response to acute symptoms.
B)
C)
D)
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A patient with a complex medical history
states that his primary care provider has
changed his proton pump inhibitor from
omeprazole (Prilosec) to esomeprazole
16.
(Nexium). The patient is unsure of the
rationale for this change in medication and
has raised this question with the nurse. What
rationale is most plausible?
Nexium has fewer adverse effects.
Nexium can be used long term.
Nexium has fewer drug interactions.
Nexium can be taken on an outpatient basis.
C
Feedback:
The actions and pharmacokinetics of the other
PPIs—esomeprazole (Nexium), lansoprazole
(Prevacid), pantoprazole (Protonix), and
rabeprazole (AcipHex)—are similar to those
of omeprazole. However, the drug
interactions associated with omeprazole
reportedly do not occur with these other PPIs.
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A)
B)
C)
D)
Ans:
A)
B)
C)
D)
Ans:
A patient who has a diagnosis of peptic ulcer
disease has begun taking sucralfate
17.
(Carafate). The nurse should caution the
patient against the concurrent use of
antacids.
NSAIDs.
acetaminophen.
probiotics.
A
Feedback:
Antacids decrease the effects of sucralfate,
and people should not take them within 30
minutes before or after administration of
sucralfate.
A)
B)
C)
D)
Ans:
antacids.
NSAIDs.
acetaminophen.
probiotics.
A
Feedback:
Antacids decrease the effects of sucralfate,
and people should not take them within 30
minutes before or after administration of
sucralfate.
A patient with ulcers has asked the nurse if it
would be acceptable for him to take bismuth
18. subsalicylate. Before recommending an OTC
formulation of this drug, the nurse should
assess the patient's
immunization history.
allergy status.
cognition.
normal bowel pattern.
B
Feedback:
Because it is a salicylate, this drug can cause
serious bleeding problems when used alone in
patients with ulcers. People with an allergy to
aspirin or other salicylates should not take
bismuth subsalicylate. The patient's bowel
pattern, immunization history, and cognition
are not central considerations.
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B)
C)
D)
Ans:
A)
B)
C)
D)
Ans:
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Chapter 38 Drug Therapy for Nausea and Vomiting
A patient is experiencing nausea and vomiting
as a response to radiation therapy. Which of
1. the following antiemetic agents is a
phenothiazine administered to control nausea
and vomiting?
Prochlorperazine (Compazine)
Metoclopramide (Reglan)
Mesna (Mesnex)
Dexamethasone
A
Feedback:
Prochlorperazine (Compazine) is a commonly
used phenothiazine administered for nausea
and vomiting related to radiation therapy.
Metoclopramide is a prokinetic agent that
increases GI motility and the rate of gastric
emptying by increasing the release of
acetylcholine from nerve endings in the GI
tract. Mesna is used for thrombocytopenia.
Dexamethasone is a corticosteroid.
B)
C)
D)
Ans:
Metoclopramide (Reglan)
Mesna (Mesnex)
Dexamethasone
A
Feedback:
Prochlorperazine (Compazine) is a commonly
used phenothiazine administered for nausea
and vomiting related to radiation therapy.
Metoclopramide is a prokinetic agent that
increases GI motility and the rate of gastric
emptying by increasing the release of
acetylcholine from nerve endings in the GI
tract. Mesna is used for thrombocytopenia.
Dexamethasone is a corticosteroid.
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A pregnant woman suffers from morning
2. sickness. Which of the following should be
considered a first-line treatment?
Vitamin B6
A)
B)
C)
D)
Ans:
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Promethazine (Phenergan)
Vitamin E
Diphenhydramine (Benadryl)
A
Feedback:
For pregnant women, taking pyridoxine
(vitamin B6) 30 to 75 mg daily in three
A)
B)
C)
D)
Ans:
divided doses with or without the
antihistamine doxylamine 12.5 mg every 8
hours as needed is considered a first-line
treatment option that is safe and effective.
Phenergan is not a first-line treatment for
morning sickness. Benadryl and vitamin E are
not used to treat nausea.
A patient with Parkinson's disease develops
nausea and vomiting. Promethazine may be
3.
contraindicated because it depletes levels of
what neurotransmitter?
Acetylcholine
Serotonin
Dopamine
Adenosine
C
Feedback:
Promethazine and other phenothiazines have
widespread effects on the body. The
therapeutic effects in nausea and vomiting are
attributed to their ability to block dopamine
from receptor sites in the brain and CTZ. This
blockage of dopamine has the potential to
exacerbate parkinsonian effects.
B)
C)
D)
Ans:
Serotonin
Dopamine
Adenosine
C
Feedback:
Promethazine and other phenothiazines have
widespread effects on the body. The
therapeutic effects in nausea and vomiting are
attributed to their ability to block dopamine
from receptor sites in the brain and CTZ. This
blockage of dopamine has the potential to
exacerbate parkinsonian effects.
What is a nonpharmacological measure that is
4. effective in treating nausea and vomiting in
pregnant women?
Ginkgo biloba
Ginger
Garlic
Ginseng
B
Feedback:
Clinical trials indicate that ginger can
effectively reduce nausea and vomiting
associated with motion sickness, pregnancy,
and surgery.
A)
B)
C)
D)
Ans:
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B)
C)
D)
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A)
B)
C)
D)
Ans:
A patient is administered promethazine
(Phenergan) for nausea and vomiting. Which
5.
of the following is an adverse effect of
promethazine (Phenergan)?
Urinary incontinence
Tachycardia
Taste alteration
Extrapyramidal symptoms
D
Feedback:
Extrapyramidal symptoms are adverse effects
of promethazine. Urinary retention is an
adverse effect, not urinary incontinence.
Tachycardia is not an adverse effect of
promethazine. Taste alteration is not an
adverse effect of promethazine.
A patient is administered an antihistamine for
6. nausea. Which of the following is an adverse
effect of this classification of medication?
Diarrhea
Prolonged QRS complex
Urinary retention
Inverted T wave
C
A patient is administered an antihistamine for
6. nausea. Which of the following is an adverse
effect of this classification of medication?
Diarrhea
Prolonged QRS complex
Urinary retention
Inverted T wave
C
Feedback:
Adverse anticholinergic effects of
antihistamines are dizziness, confusion, dry
mouth, and urinary retention. Diarrhea,
prolonged QRS complex, and inverted T
wave are not adverse effects of
antihistamines.
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A)
B)
C)
D)
Ans:
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A patient is administered a phenothiazine for
7. nausea and vomiting. What is the action of
phenothiazine?
Increases gastric motility
Antagonizes dopamine receptors
Blocks histamine receptors
Antagonizes serotonin receptors
B
Feedback:
Phenothiazines act on the CTZ and vomiting
center by blocking dopamine. They do not
increase gastric motility. Phenothiazines do
not block histamine receptors. Phenothiazines
do not antagonize serotonin receptors.
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A)
B)
C)
D)
Ans:
A)
B)
C)
D)
Ans:
A patient has been administered hydroxyzine
for the treatment of nausea. Which of the
8. following statements indicates that she has
understood the teaching provided by the
nurse?
“I will take repeated doses of this medication
until my nausea resolves.”
“I may experience drowsiness with this
medication.”
“I should eat before I take this medication.”
“I will need to take potassium with this
medication.”
B
Feedback:
Hydroxyzine will produce drowsiness in the
patient. Repeated doses are unsafe. The
patient should not eat with nausea. The
patient does not need to take potassium with
hydroxyzine.
C)
“I should eat before I take this medication.”
“I will need to take potassium with this
medication.”
B
Feedback:
Hydroxyzine will produce drowsiness in the
patient. Repeated doses are unsafe. The
patient should not eat with nausea. The
patient does not need to take potassium with
hydroxyzine.
D)
Ans:
A pediatric patient is receiving chemotherapy.
What is the recommended treatment of nausea
9.
and vomiting with pediatric chemotherapy
agents?
Corticosteroids and 5-HT3 receptor
A)
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antagonists
Phenothiazines and benzodiazepines
Proton pump inhibitors and antacids
Prokinetic agents and antihistamines
A
Feedback:
5-HT3 receptor antagonists and
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C)
D)
Ans:
A)
B)
C)
D)
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B)
C)
D)
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corticosteroids are used to treat nausea and
vomiting in pediatric oncology patients.
A 1-year-old postoperative patient has been
experiencing repeated vomiting. What
10.
antiemetic drug has a black box warning
against use in a patient of this age?
Promethazine (Phenergan)
Benzquinamide (Emete-Con)
Buclizine (Bucladin-S)
Cyclizine (Marezine)
A
Feedback:
A black box warning alerts nurses that
promethazine is contraindicated in children
younger than 2 years of age because of the
risk of potentially fatal respiratory depression.
Benzquinamide, buclizine, and cyclizine do
not have such warnings.
An adult patient is administered hydroxyzine
11. for nausea. What adverse effect is most likely
with this medication?
Thrombocytopenia
Palpitations
Hypertonic muscle tone
Dry mouth
D
Feedback:
An adult patient is administered hydroxyzine
11. for nausea. What adverse effect is most likely
with this medication?
Thrombocytopenia
Palpitations
Hypertonic muscle tone
Dry mouth
D
Feedback:
Anticholinergic effects, including dry mouth,
can result from the use of hydroxyzine. This
drug is not associated with thrombocytopenia,
palpitations, or hypertonicity.
An 85-year-old patient is administered
12. dimenhydrinate (Dramamine). Which of the
following is the priority nursing intervention?
Encourage fluids with this patient.
Have the patient void after administration.
Maintain IV access.
Protect from injury.
D
Feedback:
Dimenhydrinate (Dramamine) causes
drowsiness, especially in older adults, and
therefore should be used cautiously. The nurse
should protect the patient from injury. The
nurse should not force fluids. The patient will
not require IV access unless fluid replacement
is ordered.
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A)
B)
C)
D)
Ans:
A)
B)
C)
D)
Ans:
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A)
B)
C)
D)
Ans:
A patient is administered promethazine. The
patient has an elevated creatinine level.
13.
Which of the following is important when
administering promethazine to this patient?
Administer the routine dose.
Administer a lower dose.
Administer a higher dose.
Hold the medication.
B
Feedback:
A dose reduction may be necessary in patients
with renal impairment to avoid the possibility
of adverse effects, toxicity, or increased
sensitivity to phenothiazines.
A patient who is scheduled to begin
chemotherapy for the treatment of breast
cancer is anxious about the possibility of
experiencing nausea and has asked the nurse
14. multiple questions about the physiology of the
phenomenon. When explaining the
physiology of nausea and vomiting, the nurse
should include which of the following
statements?
The vomiting center is a cluster of cells in the
cerebellum.
The vomiting center sends afferent signals to
the chemoreceptor trigger zone (CTZ).
The chemoreceptor trigger zone CTZ is
composed of neurons in the fourth ventricle.
The CTZ is located partly within the central
nervous system and partly in the peripheral
nervous system.
C
Feedback:
The CTZ is composed of neurons in the
fourth ventricle. The vomiting center is a
nucleus of cells in the medulla oblongata.
Stimuli are relayed to the vomiting center by
afferent signals from the chemoreceptor
trigger zone (CTZ).
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C)
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A)
B)
C)
D)
Ans:
An adult hospital patient has been
experiencing intractable nausea and vomiting
for several hours, so the nurse has obtained an
order for an antiemetic from the primary care
15.
provider. The order reads: “Promethazine 25
mg sub-Q every 6 hours PRN.” The nurse
should contact the care provider to question
what aspect of this order?
The drug
The dose
The route
The frequency
C
Feedback:
A black box warning alerts nurses that
promethazine is contraindicated for
subcutaneous administration. The other
parameters of the order are within
recommendations.
B)
C)
D)
Ans:
The dose
The route
The frequency
C
Feedback:
A black box warning alerts nurses that
promethazine is contraindicated for
subcutaneous administration. The other
parameters of the order are within
recommendations.
An older adult's physician has recommended
the occasional use of hydroxyzine for relief of
16.
nausea. Following administration, the nurse
should assess the patient for
pruritus.
drowsiness.
urinary frequency.
bradycardia.
B
Feedback:
The use of hydroxyzine is associated with
drowsiness. Antihistamines do not typically
cause pruritus, frequency, or bradycardia.
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A)
B)
C)
D)
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B)
C)
D)
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A patient has been admitted to the
postsurgical unit from postanesthetic recovery
following a transurethral prostatic resection.
17. The patient is experiencing nausea subsequent
to anesthesia. What antiemetic is the most
common first-line drug for the treatment of
postoperative nausea and vomiting?
Ondansetron (Zofran)
Dronabinol (Marinol)
Dimenhydrinate (Dramamine)
Hydroxyzine (Vistaril, Atarax)
A
Feedback:
The 5-HT3 receptor antagonists are usually
considered drugs of first choice for
postoperative nausea and vomiting.
Ondansetron (Zofran) is the prototype of the
5-HT3 receptor antagonists.
A patient is undergoing a course of
radiotherapy for the treatment of leukemia.
Treatments in the past have caused the patient
18.
severe nausea and vomiting. The oncology
nurse should normally administer antiemetics
on what schedule?
Simultaneous with radiation treatment
The night before a scheduled radiation
treatment
30 to 60 minutes before the treatment
10 to 15 minutes before the treatment
C
Feedback:
The nurse should normally administer
antiemetic drugs 30 to 60 minutes before a
nausea-producing event, when possible.
A)
B)
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D)
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B)
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When reviewing a newly admitted patient's
previous medication record, the nurse notes
that the patient has previously been treated
19. with aprepitant (Emend). The nurse is
justified is suspecting that this patient's
medical history includes which of the
following?
Placement of a nasogastric tube
Chemotherapy
Endoscopy
Radiation therapy
B
Feedback:
Prescribers often order aprepitant as part of
combination therapy along with a 5-HT3
A)
B)
C)
D)
receptor antagonist and corticosteroids to treat
both acute and delayed nausea and vomiting
associated with chemotherapy. NG tube
insertion, radiation therapy, and endoscopy
are not typical indications for the use of
aprepitant.
A hospital patient has a standing order for
aprepitant on an as-needed basis. The patient
20.
should be encouraged to request a dose of the
drug
when she anticipates that she will become
nauseous.
at the same time each day.
as soon as she senses the onset of nausea.
when her nausea results in vomiting.
A hospital patient has a standing order for
aprepitant on an as-needed basis. The patient
20.
should be encouraged to request a dose of the
drug
when she anticipates that she will become
nauseous.
at the same time each day.
as soon as she senses the onset of nausea.
when her nausea results in vomiting.
A
Feedback:
The nurse instructs patients to take aprepitant
as prescribed before the onset of nausea and
vomiting. It does not need to be taken on a
regular schedule and should not be withheld
until the onset or peak of symptoms.
A)
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C)
D)
Ans:
Defecation is normally stimulated by what
physiologic trigger?
Movements and reflexes in the
gastrointestinal tract
Stimulation from the medulla oblongata
Synthesis and release of digestive enzymes
Changes in the osmolarity of bowel contents
A
Feedback:
Defecation is normally stimulated by
movements and reflexes in the gastrointestinal
tract. It does not result from changes in
osmolarity, CNS stimulation, or the release of
enzymes.
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Chapter 39 Drug Therapy for Constipation and Elimination Problems
A)
A)
B)
C)
D)
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C)
D)
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2. Constipation is defined as
the passage of fewer than three stools in any
7-day period.
the passage of fewer than five stools in any 7day period.
the infrequent and painful expulsion of hard,
dry stools.
a subjective sensation of bowel fullness.
C
Feedback:
Constipation is the infrequent and painful
expulsion of hard, dry stools. It is not defined
by a particular number of stools or in terms of
an individual's subjective sensation.
the infrequent and painful expulsion of hard,
dry stools.
a subjective sensation of bowel fullness.
C
Feedback:
Constipation is the infrequent and painful
expulsion of hard, dry stools. It is not defined
by a particular number of stools or in terms of
an individual's subjective sensation.
C)
D)
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A)
A patient is using psyllium hydrophilic
mucilloid (Metamucil) to promote evacuation
3.
of stool. What is the action of this
medication?
It reduces the surface tension of bowel
contents.
It irritates the intestinal mucosa, thus
increasing intestinal motility.
It increases mass and water content of stool,
promoting evacuation.
It creates a barrier between the colon wall and
feces.
C
Feedback:
Bulk-forming laxatives increase mass and
water content of the stool, promoting
evacuation. Bulk-forming laxatives do not
reduce surface tension of bowel contents.
Bulk-forming laxatives do not irritate the
intestinal mucosa to increase intestinal
motility. Bulk-forming laxatives do not create
a barrier between the colon wall and feces.
B)
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D)
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B)
C)
D)
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Which of the following statements by your
patient leads you to believe that he has
4.
understood how to safely and effectively use
bulk-forming laxatives?
“I will mix the medication with around a cup
of fluid and then drink the mixture.”
“I will mix the dry medication with
applesauce and then eat prunes before
bedtime.”
“I will use milk of magnesia in conjunction
with Metamucil until I have a bowel
movement.”
“I will decrease the roughage in my diet while
I am taking the bulk-forming laxative and eat
rice.”
A
Feedback:
Bulk-forming laxatives increase mass and
water content of the stool, promoting
evacuation. Mixing the bulk-forming laxative
with applesauce will not provide the needed
movement.”
“I will decrease the roughage in my diet while
I am taking the bulk-forming laxative and eat
rice.”
A
Feedback:
Bulk-forming laxatives increase mass and
water content of the stool, promoting
evacuation. Mixing the bulk-forming laxative
with applesauce will not provide the needed
fluid, and the applesauce can have a binding
effect. It is not necessary to mix milk of
magnesia with Metamucil. The patient should
not decrease roughage in the diet or eat rice,
which is binding.
D)
Your patient is taking psyllium hydrophilic
mucilloid (Metamucil) daily. What
5.
information should be included in the
discharge plan?
Drink at least 8 ounces of fluid with the
medication.
Mix the medication with your food at the
evening meal.
Combine all of your medications with the
mucilloid.
Discontinue the mucilloid if you do not have
a bowel movement daily.
A
Feedback:
Bulk-forming laxatives increase mass and
water content of the stool, promoting
evacuation. The patient should drink at least 8
ounces of fluid with the medication. The
patient should not mix the medication with
food or other medications. The mucilloid
should not be discontinued if the patient does
not have a bowel movement.
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D)
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B)
C)
D)
Ans:
When assessing a patient's bowel habits,
6. which of the following descriptions is the best
indication of normal bowel elimination?
One bowel movement daily in the AM
One bowel movement daily in the PM
Soft, formed stool
Liquid stool
C
Feedback:
Normal bowel elimination should produce
soft, formed stool. One bowel movement in
the AM or PM may not be a regular bowel
pattern for all patients. Liquid stool is not an
indication of normal bowel elimination.
B)
C)
D)
Ans:
One bowel movement daily in the PM
Soft, formed stool
Liquid stool
C
Feedback:
Normal bowel elimination should produce
soft, formed stool. One bowel movement in
the AM or PM may not be a regular bowel
pattern for all patients. Liquid stool is not an
indication of normal bowel elimination.
A patient is suffering from constipation. He is
a truck driver and does not always have
7. access to a toilet. When providing patient
teaching, what will result when the patient
fails to respond to the defecation reflex?
Involuntary evacuation
Increased defecation reflex
Decreased defecation reflex
Diarrhea
C
Feedback:
In people who often inhibit the defecation
reflex or fail to respond to the urge to
defecate, constipation develops as the reflex
weakens. The patient will not have
involuntary evacuation. The patient will not
have increased sensory stimulation. The
patient will not have diarrhea.
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B)
C)
D)
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B)
C)
D)
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The nurse has an order to administer a saline
cathartic to a patient who has a history of
8.
congestive heart failure. Why is this type of
cathartic contraindicated with this patient?
The patient is at risk for hypomagnesemia.
The patient is at risk for excess fluid volume.
The patient is at risk for third spacing.
The patient is at risk for hyperphosphatemia.
B
Feedback:
Patients with congestive heart failure are at
risk for fluid retention and edema with
sodium-containing laxatives. The patient is
not at risk for hypomagnesemia,
hypochloremia, or hyperphosphatemia.
A patient is scheduled for a colonoscopy in
the morning. Which laxative is most likely
9.
prescribed the evening before the
colonoscopy?
Psyllium (Metamucil)
Polyethylene glycol–electrolyte solution
(NuLYTELY)
Castor oil
Lactulose (Cephulac)
B
Feedback:
Polyethylene glycol–electrolyte solution
(NuLYTELY) is a nonabsorbable oral solution
that induces diarrhea within 30 to 37 minutes
and rapidly evacuates the bowel, usually
within 4 hours for a colonoscopy. Psyllium is
not strong enough for a colonoscopy
preparation. Castor oil is not the most
commonly prescribed preparation for a
colonoscopy. Lactulose is normally used only
when the serum ammonium level is elevated.
A)
B)
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B)
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D)
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A patient is administered a stimulant cathartic.
10. Which of the following is the most common
adverse effect of a stimulant cathartic?
Nausea
Vomiting
Diarrhea
Rectal bleeding
C
Feedback:
The stimulant cathartics are the strongest and
most abused laxative products. These drugs
act by irritating the GI mucosa and pulling
water into the bowel lumen. As a result, feces
are moved through the bowel too rapidly to
allow colonic absorption of fecal water, so a
watery stool is eliminated. Nausea, vomiting,
and rectal bleeding should not routinely occur.
A patient with alcoholism and chronic liver
failure is admitted to the medical unit. He is
11. confused and has an elevated serum ammonia
level. What laxative will the nurse administer
to lower the serum ammonia level?
Docusate sodium (Colace)
Polyethylene glycol–electrolyte solution
(NuLYTELY)
Lactulose (Cephulac)
Sorbitol
C
Feedback:
Lactulose decreases production of ammonia
in the intestine. Lactulose is a disaccharide
that is not absorbed from the GI tract. It is
used to treat hepatic encephalopathy.
Docusate sodium only provides stool
softening and has no effect on serum
ammonia levels. Polyethylene glycol–
electrolyte solution (NuLYTELY) is not used
to decrease serum ammonia. Sorbitol is not
used to decrease serum ammonia.
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B)
C)
D)
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D)
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An older adult's constipation has not
responded to first-line laxatives, so lactulose
12. has been prescribed. The nurse should know
that this medication achieves a therapeutic
effect by which of the following means?
Decreasing the viscosity of intestinal contents
in the duodenum
Pulling water into the intestinal lumen by
osmotic pressure
Irritating the intestinal mucous membrane
Relaxing the muscle tone of the ileocecal
valve and anal sphincter
B
Feedback:
Lactulose (Chronulac, Cephulac) is a
disaccharide that is not absorbed from the GI
tract. It exerts laxative effects by pulling
water into the intestinal lumen. It does not
change muscle tone, change the viscosity of
bowel contents, or irritate the intestinal
epithelium.
A hospice patient is receiving opioids for
13. treatment of cancer pain. Which laxative will
best assist in the prevention of constipation?
Lactulose (Cephulac)
Stimulant
Saline
Bulk-forming
B
Feedback:
Stimulant laxatives are the most commonly
used laxative with these patients. Lactulose is
not usually recommended. Saline laxatives
are not recommended due to electrolyte
imbalance. Bulk-forming laxatives are not
usually recommended for patients with cancer
because they may not be able to drink
adequate amounts of fluid required with these
medications.
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B)
C)
D)
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B)
C)
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You are the nurse educating new parents on
prevention and treatment of constipation with
14. infants. What is the most effective and safest
way to treat constipation in infants prior to
bowel training?
Milk of magnesia
Sorbitol
Dulcolax suppositories
Glycerin suppositories
D
Feedback:
Glycerin suppositories are often effective in
infants and children. Milk of magnesia,
sorbitol, and Dulcolax suppositories are not
recommended.
15.
A)
B)
C)
D)
Ans:
Which of the following patients is at highest
risk for alteration in bowel elimination?
A patient who is paralyzed from a spinal cord
injury
A patient who has a diagnosis of type 2
diabetes
A patient who has hypertension
A patient who takes thyroid replacements
A
Feedback:
Spinal lesions can often result in constipation.
Thyroid replacements, high blood pressure,
A patient who is paralyzed from a spinal cord
injury
A patient who has a diagnosis of type 2
diabetes
A patient who has hypertension
A patient who takes thyroid replacements
A
Feedback:
Spinal lesions can often result in constipation.
Thyroid replacements, high blood pressure,
and hypertension are not risk factors for
constipation.
A)
B)
C)
D)
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A middle-aged patient is frustrated by her
increasingly frequent episodes of
constipation. She tells the nurse that she is
16.
highly reluctant to take medications. What
nonpharmacologic measure should the nurse
recommend?
Adoption of a low-fat diet
Use of a fiber supplement
Daily consumption of 6 to 8 L of fluids
Use of a ginger or ginseng supplement
B
Feedback:
There is some evidence that fiber supplements
improve the frequency and consistency of
stools. No effectiveness data support
increasing fluids beyond normal intake. Low
fat intake, ginger, and ginseng are not noted to
benefit patients with constipation.
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B)
C)
D)
Ans:
A)
B)
C)
D)
Ans:
An older adult has told the nurse practitioner
that she has regularly drunk mineral oil to
treat occasional episodes of constipation. The
17.
nurse should encourage the patient to explore
other treatments because the use of oral
mineral oil can result in
edema from changes in intestinal solute
content.
paralytic ileus.
rebound constipation.
decreased absorption of drugs and vitamins.
D
Feedback:
Oral use of mineral oil may cause potentially
serious adverse effects, including decreased
absorption of fat-soluble vitamins and some
drugs and lipid pneumonia if aspirated into
the lungs. Thus, mineral oil is not an oral
laxative of choice in any condition. It is not
noted to cause rebound constipation, paralytic
ileus, or edema.
paralytic ileus.
rebound constipation.
decreased absorption of drugs and vitamins.
D
Feedback:
Oral use of mineral oil may cause potentially
serious adverse effects, including decreased
absorption of fat-soluble vitamins and some
drugs and lipid pneumonia if aspirated into
the lungs. Thus, mineral oil is not an oral
laxative of choice in any condition. It is not
noted to cause rebound constipation, paralytic
ileus, or edema.
A surgical patient's postoperative orders
include the twice-daily administration of
docusate sodium. The patient is concerned
18. about developing diarrhea from this
medication, so the nurse has begun patient
education. What should the nurse teach the
patient about docusate sodium?
“This medication will soften your stools over
the next couple of days.”
“You'll usually have a bowel movement
within 2 to 3 hours of taking this.”
“This medication will cause your bowels to
contract more strongly than they normally
do.”
“This drug will help you pass regular stools
while you're in the hospital, but you should
not take it for more than 5 days.”
A
Feedback:
Surfactant laxatives (e.g., docusate calcium or
docusate sodium) decrease the surface tension
of the fecal mass to allow water to penetrate
into the stool. They also act as a detergent to
facilitate admixing of fat and water in the
stool. As a result, stools are softer and easier
to expel. These agents have little, if any,
laxative effect. Their main value is to prevent
straining while expelling stool. They usually
act within 1 to 3 days and should be taken
daily.
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C)
D)
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A community health is conducting a health
promotion session with a group from a local
seniors' center. The nurse has addressed the
19.
issue of laxative overuse in this population.
The nurse should highlight what consequence
of the overuse of laxatives?
Dependence
Impaired absorption of water-soluble vitamins
Fecal incontinence
Abdominal pain
A
Feedback:
Overuse of laxatives results in dependence.
This is a significant problem among older
adults and is more common than fecal
incontinence, impaired vitamin absorption, or
abdominal pain.
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B)
C)
D)
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An adult resident of an assisted living facility
has not responded appreciably to bulkforming laxatives so the primary care
20. provider has prescribed bisacodyl. The nurse
who oversees the care at the facility should
know that this drug may be administered by
what routes? Select all that apply.
Oral
Intravenous
Subcutaneous injection
Suppository
Intramuscular injection
A, D
Feedback:
Bisacodyl can be administered orally or by
suppository. Parenteral administration is not
possible.
Chapter 40 Drug Therapy for Diarrhea
A)
B)
C)
D)
Ans:
A patient with anorexia nervosa has taken a
1. saline cathartic to lose weight. What is the
patient at risk for?
Constipation
Diarrhea
Bowel obstruction
Hyponatremia
B
Feedback:
A patient who uses laxatives, such as saline
A patient with anorexia nervosa has taken a
1. saline cathartic to lose weight. What is the
patient at risk for?
Constipation
Diarrhea
Bowel obstruction
Hyponatremia
B
Feedback:
A patient who uses laxatives, such as saline
laxatives, and suffers from anorexia nervosa
will be prone to diarrhea. The patient who
takes a saline laxative will not suffer from
constipation. The patient who takes a saline
laxative will not be at risk for bowel
obstruction. The patient who takes a saline
cathartic will be at risk for hypernatremia, not
hyponatremia.
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B)
C)
D)
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A grade school has an outbreak of
gastroenteritis and vomiting with nearly half
2. of the school—both students and staff—
affected. Which organism is most likely the
cause?
Norwalk-like virus (calicivirus)
Clostridium difficile
Vibrio vulnificus
E. coli
A
Feedback:
An outbreak of gastroenteritis that is
accompanied by vomiting and that affects
both staff and students is most predominately
caused by the Norwalk-like virus
(calicivirus). Clostridium difficile is a
nosocomial diarrhea that would not be
characteristic of this population. Vibrio
vulnificus is contamination of raw shellfish
and would not be the cause of gastroenteritis.
E. coli is a less likely cause.
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B)
C)
D)
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A)
B)
C)
D)
Ans:
A cancer patient has intractable diarrhea that
is not of an infectious nature. Which of the
3.
following medications will most likely be
prescribed?
Bismuth
Pepto-Bismol
Psyllium
Opioids
D
Feedback:
Opioids are the most effective agents for
symptomatic treatment of diarrhea. Bismuth
and Pepto-Bismol are the same agents and
3.
A)
B)
C)
D)
Ans:
following medications will most likely be
prescribed?
Bismuth
Pepto-Bismol
Psyllium
Opioids
D
Feedback:
Opioids are the most effective agents for
symptomatic treatment of diarrhea. Bismuth
and Pepto-Bismol are the same agents and
would not be used for intractable, severe
diarrhea. Psyllium would not be administered
for diarrhea, except if there were a need to
absorb toxins.
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An older adult patient is experiencing
4. diarrhea. Which of the following is a likely
cause of diarrhea?
Fluid volume deficit
Antihypertensive agents
Laxative abuse
Anemia
C
Feedback:
Laxative abuse is associated with diarrhea.
This phenomenon is particularly common
among older adults. Antihypertensive agents
and anemia are not associated with diarrhea.
Fluid volume deficit is a result, not cause, of
diarrhea.
A)
B)
C)
D)
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B)
C)
D)
Ans:
The physician orders bismuth subsalicylate
(Pepto-Bismol) for your patient. What
5.
assessment is most important to make before
administering this medication?
Assess for pain
Assess electrolytes
Assess for allergy to aspirin
Assess for allergy to opioids
C
Feedback:
Bismuth salts have antibacterial and antiviral
activity. Bismuth subsalicylate contains
salicylate, and the patient should be assessed
for an aspirin allergy before administration. It
is important to assess for pain and electrolyte
balance, but this is not the primary assessment
to be made. The nurse would not need to
assess for allergy to opioids because bismuth
does not contain opioids.
Assess electrolytes
Assess for allergy to aspirin
Assess for allergy to opioids
C
Feedback:
Bismuth salts have antibacterial and antiviral
activity. Bismuth subsalicylate contains
salicylate, and the patient should be assessed
for an aspirin allergy before administration. It
is important to assess for pain and electrolyte
balance, but this is not the primary assessment
to be made. The nurse would not need to
assess for allergy to opioids because bismuth
does not contain opioids.
A patient diagnosed with HIV/AIDS has
diarrhea that is not responding to antidiarrheal
6.
agents. Which medication will best assist in
treating this patient's diarrhea?
Bismuth salts (Pepto-Bismol)
Ciprofloxacin (Cipro)
Cholestyramine (Questran)
Octreotide acetate (Sandostatin)
D
Feedback:
Octreotide acetate (Sandostatin) is a synthetic
form of somatostatin that is effective in
diarrhea related to HIV/AIDS. Bismuth salts
are not used for diarrhea that does not respond
to other agents. Ciprofloxacin will not be used
to treat diarrhea. Cholestyramine will not be
used to treat diarrhea.
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B)
C)
D)
Ans:
A)
B)
C)
D)
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B)
C)
D)
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A patient who has been experiencing liquid
stools is prescribed polycarbophil (FiberCon).
7.
What is the reason for administering a bulkforming laxative?
Polycarbophil absorbs large amounts of water
and decreases fluidity of stools.
Polycarbophil will diminish the absorption of
intestinal fiber and water.
Polycarbophil will provide pain relief and
decrease cramping and bloating.
Polycarbophil will increase bile and diminish
bacterial flora in the intestines.
A
Feedback:
Polycarbophil is an adsorbent drug that works
by absorbing large amounts of water and
produces stools of gelatin-like consistency.
Polycarbophil will not diminish the
absorption of intestinal fiber and water.
Polycarbophil will cause abdominal
discomfort and bloating. Polycarbophil has no
C)
decrease cramping and bloating.
Polycarbophil will increase bile and diminish
bacterial flora in the intestines.
A
Feedback:
Polycarbophil is an adsorbent drug that works
by absorbing large amounts of water and
produces stools of gelatin-like consistency.
Polycarbophil will not diminish the
absorption of intestinal fiber and water.
Polycarbophil will cause abdominal
discomfort and bloating. Polycarbophil has no
effect on bacterial flora in the intestines.
D)
Ans:
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A patient with Crohn's disease is experiencing
diarrhea during an exacerbation of symptoms.
8.
What medication will the nurse most likely
administer?
Bismuth salts (Pepto-Bismol)
Ciprofloxacin (Cipro)
Cholestyramine (Questran)
Octreotide acetate (Sandostatin)
C
Feedback:
Bile-binding drugs, such as cholestyramine
(Questran) or colestipol, are useful in treating
diarrheas due to bile salt accumulation in
conditions such as Crohn's disease. Bismuth
salts, ciprofloxacin, and octreotide are not
typically administered to the patient with
Crohn's disease.
A)
B)
C)
D)
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B)
C)
D)
Ans:
A 20-month-old child is experiencing
diarrhea. When planning the child's care, the
9.
nurse should prioritize assessments related to
what health problem?
Electrolyte deficiencies
Anorectal bleeding
Anal fissures
Nausea
A
Feedback:
If severe or prolonged, acute diarrhea may
lead to serious fluid and electrolyte depletion,
especially in young children and older adults.
A patient is discharged with octreotide
(Sandostatin) and has been given minimal
10.
patient teaching. What is the most important
aspect of patient teaching for this patient?
The importance of maintaining a diet high in
fiber
The administration of subcutaneous injections
The concurrent use of bismuth subsalicylate
and octreotide
The administration of morphine to decrease
pain
B
Feedback:
If octreotide is taken at home, the home care
nurse may need to teach the patient or a
caregiver how to administer subcutaneous
injections; this drug is not available orally.
The patient should limit the intake of fiber.
The patient would not be administered
bismuth subsalicylate with octreotide. The
patient would not be administered morphine
to decrease pain related to diarrhea.
A)
B)
C)
D)
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B)
C)
D)
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A woman is seen in the primary care
provider's office with chronic severe diarrheapredominant irritable bowel syndrome, which
11.
has not responded to conventional therapy.
Which medication should the nurse anticipate
administering?
Rifaximin (Xifaxan)
Nitazoxanide (Alinia)
Alosetron (Lotronex)
Cholestyramine (Questran)
C
Feedback:
Alosetron (Lotronex) is a selective 5-HT3
receptor antagonist indicated for treating
women with chronic severe diarrheapredominant irritable bowel syndrome that
has not responded to conventional therapy.
Rifaximin (Xifaxan) is a nonsystemic
antibiotic that would not be prescribed for this
patient. Nitazoxanide (Alinia) is an
antiprotozoal agent used for Giardia lamblia.
Cholestyramine (Questran) is a bile-binding
drug and is not the drug of choice for this
patient.
B)
C)
D)
Ans:
Nitazoxanide (Alinia)
Alosetron (Lotronex)
Cholestyramine (Questran)
C
Feedback:
Alosetron (Lotronex) is a selective 5-HT3
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receptor antagonist indicated for treating
women with chronic severe diarrheapredominant irritable bowel syndrome that
has not responded to conventional therapy.
Rifaximin (Xifaxan) is a nonsystemic
antibiotic that would not be prescribed for this
patient. Nitazoxanide (Alinia) is an
antiprotozoal agent used for Giardia lamblia.
Cholestyramine (Questran) is a bile-binding
drug and is not the drug of choice for this
patient.
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A patient has been treated successfully for
diarrhea and has had only one loose bowel
12. movement during the day. Which of the
following foods should be introduced back
into the diet first?
Chicken breast
Beef stew
Baked potato
Lentils
C
Feedback:
Following diarrhea, bland foods should be
introduced back into the diet, such as baked
potato. The patient should not resume a diet
with chicken, beef stew, or lentils until later.
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B)
C)
D)
Ans:
A)
B)
C)
D)
Ans:
A patient is experiencing diarrhea and being
treated with diphenoxylate (Lomotil). The
13. presence of which condition requires that
diphenoxylate (Lomotil) be administered
cautiously?
Edema
Hepatorenal disease
Congestive heart failure
Cardiovascular insufficiency
B
Feedback:
Diphenoxylate should be used with extreme
caution in patients with severe hepatorenal
disease because hepatic coma may be
precipitated. Edema, congestive heart failure,
and cardiovascular insufficiency are not
conditions in which cautious administration
with diphenoxylate is needed.
Hepatorenal disease
Congestive heart failure
Cardiovascular insufficiency
B
Feedback:
Diphenoxylate should be used with extreme
caution in patients with severe hepatorenal
disease because hepatic coma may be
precipitated. Edema, congestive heart failure,
and cardiovascular insufficiency are not
conditions in which cautious administration
with diphenoxylate is needed.
A middle-aged female has presented to the
emergency department (ED) after 36 hours of
severe diarrhea that shows no sign of abating.
The patient's family members are asking that
14. the care team provide medications to resolve
her diarrhea. The ED nurse should be aware
that the use of diphenoxylate (Lomotil) would
be contraindicated in which of the following
circumstances?
The patient has a documented history of
laxative abuse.
The patient's diarrhea is caused by the
ingestion of toxins.
The patient's diarrhea is attributable to
psychosocial stress.
The patient has an allergy to aspirin.
B
Feedback:
Contraindications to the use of diphenoxylate
with atropine include diarrhea caused by toxic
materials, microorganisms that penetrate
intestinal mucosa (e.g., pathogenic E. coli,
Salmonella, Shigella), and antibioticassociated colitis. Laxative abuse, allergies to
aspirin, and the presence of stress do not
contraindicate the safe use of Lomotil.
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B)
C)
D)
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Ans:
A)
B)
C)
D)
Ans:
An older adult patient has received his third
dose of diphenoxylate (Lomotil) and the nurse
is monitoring the patient's bowel patterns
15.
closely. In addition to monitoring the number
and consistency of the patient's stools, the
nurse should prioritize what assessment?
Assessment of cognition and neurological
status
Assessment of oxygen saturation and
respiratory rate
Assessment of nutritional status
Assessment of fluid and electrolyte balance
D
Feedback:
15.
A)
B)
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C)
D)
Ans:
closely. In addition to monitoring the number
and consistency of the patient's stools, the
nurse should prioritize what assessment?
Assessment of cognition and neurological
status
Assessment of oxygen saturation and
respiratory rate
Assessment of nutritional status
Assessment of fluid and electrolyte balance
D
Feedback:
After drug administration, the nurse monitors
the number and consistency of stools and fluid
and electrolyte balance. The patient's fluid and
electrolyte balance is more vulnerable during
prolonged diarrhea than neurological,
nutritional, or respiratory status.
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A patient has contacted the clinic, stating to
the nurse, “I've been taking Imodium for the
past day-and-a-half, and my diarrhea shows
16. no signs of slowing down.” The nurse should
respond to the patient in the knowledge that
Imodium should be discontinued if her
diarrhea does not improve in the next
12 hours.
2 days.
3 to 4 days.
week.
A
Feedback:
In general, it is necessary to discontinue
loperamide after 48 hours if clinical
improvement has not occurred.
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B)
C)
D)
Ans:
A)
B)
C)
D)
Ans:
Which of the following patients with diarrhea
17. would be most likely to be prescribed
octreotide (Sandostatin)?
A child who has been diagnosed with E. coli
infection
An older adult who has been abusing
laxatives for several months
A teenage patient who has been diagnosed
with ulcerative colitis
A patient with HIV/AIDS who has developed
intractable diarrhea
D
Feedback:
Diarrhea secondary to HIV/AIDS is an
indication for treatment with octreotide.
Laxative abuse, IBS, and E. coli infections
would likely be treated with alternative
antidiarrheal medications.
C)
with ulcerative colitis
A patient with HIV/AIDS who has developed
intractable diarrhea
D
Feedback:
Diarrhea secondary to HIV/AIDS is an
indication for treatment with octreotide.
Laxative abuse, IBS, and E. coli infections
would likely be treated with alternative
antidiarrheal medications.
D)
Ans:
A patient's severe diarrhea has necessitated
treatment with polycarbophil (FiberCon). The
18.
nurse should caution the patient about the
possibility of what adverse effect?
Nausea and vomiting
Headache and visual disturbances
Abdominal fullness and bloating
Gastroesophageal reflux
C
Feedback:
Polycarbophil may cause abdominal
discomfort and bloating and may reduce the
absorption of coadministered medications. It
is not noted to cause nausea and vomiting,
reflux, or headache.
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B)
C)
D)
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A)
B)
C)
D)
Ans:
When reviewing a patient's medication
history, the nurse observes that the patient has
recently completed a course of treatment with
19.
nitazoxanide (Alinia). The nurse is justified in
suspecting that the patient was infected with
what microorganism?
Giardia lamblia
E. coli
Salmonella
Campylobacter jejuni
A
Feedback:
Nitazoxanide (Alinia) is an antiprotozoal
agent used specifically for treating diarrhea
resulting from infection with Giardia lamblia
or Cryptosporidium parvum. It is not used in
the treatment of diarrhea associated with E.
coli, Salmonella, or Campylobacter jejuni.
Cholestyramine (Questran) and colestipol
20. (Colestid) are useful in treating diarrhea due
to which of the following causes?
Gram-positive bacterial infection
Bile salt accumulation
Retroviruses
Autoimmune processes
B
Feedback:
Cholestyramine (Questran) and colestipol
(Colestid) are useful in treating diarrhea due
to bile salt accumulation in conditions such as
Crohn's disease or surgical excision of the
ileum.
Chapter 41 Drug Therapy for Diabetes Mellitus
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B)
C)
D)
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A patient with a diagnosis of diabetes is
prescribed pramlintide (Symlin). How will
1.
this drug assist in controlling the patient's
blood sugar?
It slows gastric emptying.
It blocks the absorption of food.
It is absorbed by insulin.
It increases the release of insulin.
A
Feedback:
Pramlintide slows gastric emptying, helping
to regulate the postprandial rise in blood
sugar. Pramlintide does not block the
absorption of food. Pramlintide is not
absorbed by insulin. Pramlintide does not
increase the release of insulin.
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A)
B)
C)
D)
Ans:
A)
B)
C)
D)
Ans:
A patient is diagnosed with type 1 diabetes.
2. What distinguishing characteristic is
associated with type 1 diabetes?
Blood glucose levels can be controlled by
diet.
Exogenous insulin is required for life.
Oral agents can control blood sugar.
The disease always starts in childhood.
B
Feedback:
Type 1 diabetes will result in eventual
destruction of beta cells, and no insulin is
produced. The blood glucose level can only
be controlled by diet in type 2 diabetes. In
A)
diet.
Exogenous insulin is required for life.
Oral agents can control blood sugar.
The disease always starts in childhood.
B
Feedback:
Type 1 diabetes will result in eventual
destruction of beta cells, and no insulin is
produced. The blood glucose level can only
be controlled by diet in type 2 diabetes. In
type 2 diabetes, oral agents can be
administered. Type 1 diabetes is diagnosed at
many ages, not only in childhood.
A patient is in diabetic ketoacidosis. The
patient blood glucose level is over 600 mg/
dL. The physician has ordered the patient to
3.
receive an initial dose of 25 units of insulin
intravenously. What type of insulin will most
likely be administered?
NPH insulin
Lente insulin
Ultralente insulin
Regular insulin
D
Feedback:
Regular insulin has rapid onset of action and
can be given via IV. It is the drug of choice
for acute situations, such as diabetic
ketoacidosis. Isophane insulin (NPH) is used
for long-term insulin therapy. Lente insulin is
an intermediate-acting insulin. Ultralente
insulin is a long-acting insulin.
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B)
C)
D)
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A)
B)
C)
D)
Ans:
A)
B)
C)
D)
Ans:
During a teaching session on the care of the
diabetic patient, a family member asks why
her daughter has a different insulin than her
4.
best friend. The nurse should make which of
the following statements to explain the
differences in insulin?
“Insulin is prescribed based on the insurer's
criteria for reimbursement.”
“Insulin is prescribed based on the patient's
age.”
“Insulins have different onsets and durations
of action.”
“Insulin type is matched with the appropriate
oral hypoglycemic agent.”
C
Feedback:
When insulin therapy is indicated, the
physician may choose from several
preparations that vary in composition, onset,
duration of action, and other characteristics.
“Insulins have different onsets and durations
of action.”
“Insulin type is matched with the appropriate
oral hypoglycemic agent.”
C
Feedback:
When insulin therapy is indicated, the
physician may choose from several
preparations that vary in composition, onset,
duration of action, and other characteristics.
Insulin is not prescribed based solely on cost.
Insulin is not prescribed based solely on the
patient's age. Insulin is not usually matched
with oral hypoglycemic agents.
C)
D)
A patient asks the nurse why a quick-acting
sugar given by mouth is better in the
regulation of insulin than the use of
5. intravenous glucose for a low blood sugar.
Which of the following statements by the
nurse represents the most appropriate
response to this question?
“The ingestion of food allows the digestive
tract to stimulate vagal activity and the release
of incretins.”
“The combination of insulin and food will
yield a higher blood sugar than intravenous
glucose.”
“Both food and intravenous glucose will
produce changes similarly in the
gastrointestinal tract to increase blood sugar.”
“You are mistaken. The intravenous glucose
yields a higher blood glucose through the
release of incretins.”
A
Feedback:
Oral glucose is more effective than
intravenous glucose because glucose or food
in the digestive tract stimulates vagal activity
and induces the release of gastrointestinal
hormones called incretins. The combination
of insulin and food does not yield a higher
blood glucose than intravenous insulin. Food
stimulates the vagal nerve activity, but
intravenous glucose does not. A statement that
indicates that the patient is mistaken will
belittle the patient and should be rephrased.
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D)
A 58-year-old patient who has been living
with diabetes since age 14 states he has pain
6.
in his feet and hands. What is this pain most
likely a result of?
A diabetes-related infectious process
Peripheral neuropathy
An autoimmune disorder
Hypertension resulting from diabetes
B
Feedback:
Pain in the feet and hands is related to
changes in small blood vessels resulting in
neuropathy. The long-term effect of diabetes
can result in an infectious process, but the
pain described is not indicative of an
infection. Latent autoimmune diabetes of the
adult has an onset in adulthood and thus is not
a long-term disorder. Hypertension is a longterm chronic effect of diabetes but is not what
has been described with pain in the feet and
hands.
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B)
C)
D)
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B)
C)
D)
Ans:
A patient is to be administered glipizide
(Glucotrol). Which of the following factors
7.
would contraindicate the administration of
glipizide (Glucotrol) to this patient?
A diagnosis of hypertension
The ingestion of carbohydrates
Allergy to sulfonamides
Increase in alkaline phosphatase
C
Feedback:
Sulfonylureas are contraindicated in patients
with hypersensitivity to them, with severe
renal or hepatic impairment, and who are
pregnant. A diagnosis of hypertension does
not cause contraindication of sulfonylureas.
The patient should consume carbohydrates in
association with the oral hypoglycemic agent.
An increase in alkaline phosphatase does not
result in the contraindication of glipizide
(Glucotrol).
A patient has been prescribed acarbose
8. (Precose). What is the advantage of acarbose
over alternative drugs?
It can replace the use of insulin.
The patient does not have to limit food intake.
It delays the digestion of complex
carbohydrates.
It prevents alkalosis.
C
Feedback:
Acarbose delays the digestion of complex
carbohydrates into glucose and other simple
sugars. Acarbose may be combined with
insulin or an oral agent, usually a
sulfonylurea. The patient will still need to
remain on a diabetic dietary regime. The drug
does not directly prevent acid–base
imbalances.
A)
B)
C)
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A patient who regularly takes metformin has
9. developed a severe infection. How will the
infection change his diabetic regimen?
Metformin is contraindicated in the presence
of an infection.
Metformin will be given more frequently to
decrease blood sugar.
Metformin will result in better regulation of
blood sugar.
Metformin will allow the patient to decrease
the absorption of glucose.
A
Feedback:
Metformin is contraindicated in patients with
diabetes complicated by fever, severe
infections, severe trauma, major surgery,
acidosis, and pregnancy. Metformin will not
be given more frequently to decrease blood
sugar. Metformin should be discontinued and
is not administered for better regulation of
blood sugar. Metformin will not decrease the
absorption of glucose in this patient.
A)
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C)
Sitagliptin (Januvia) is prescribed for a patient
10. who has been diagnosed with type 2 diabetes.
What is the action of sitagliptin (Januvia)?
It blocks the S phase of the cell cycle.
It slows the rate of inactivation of the incretin
hormones.
It is a synthetically prepared monosodium
salt.
It inhibits hydrogen, potassium, and ATPase.
B
Feedback:
Sitagliptin (Januvia) minimizes the rate of
inactivation of the incretin hormones to
increase hormone levels and prolong their
activity. Sitagliptin does not block the S phase
of the cell cycle. Sitagliptin is not a
synthetically prepared monosodium salt.
Sitagliptin does not inhibit hydrogen,
potassium, and ATPase.
A)
B)
C)
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B)
C)
D)
Ans:
A)
B)
C)
D)
Ans:
A patient of Italian descent has been
prescribed antidiabetic medications. Heavy
11.
intake of which of the following herbs should
be avoided by this patient?
Garlic
Anise
Basil
Oregano
A
Feedback:
Garlic has been known to cause
hypoglycemia when taken with antidiabetic
medications. Anise, basil, and oregano are not
noted to carry this risk.
A patient has suffered from hypoglycemia
twice in the past week. She states she eats one
12. meal per day and snacks the rest of the day.
What patient education will you provide for
this patient?
She should limit her alcohol with meals.
She should increase her caloric intake.
She should increase her protein intake during
snacks.
She should not eat at sporadic times.
D
Feedback:
A regular dietary intake associated with the
12. meal per day and snacks the rest of the day.
What patient education will you provide for
this patient?
She should limit her alcohol with meals.
She should increase her caloric intake.
She should increase her protein intake during
snacks.
She should not eat at sporadic times.
D
Feedback:
A regular dietary intake associated with the
administration of insulin or oral
hypoglycemic will prevent episodes of
hypoglycemia. The patient should limit her
alcohol consumption, but alcohol
consumption does not contribute to
hypoglycemia. The patient should not
necessarily increase her caloric or protein
intake. The patient should coordinate her
exercise with her dietary intake, but dietary
intake is not the cause of her hypoglycemia.
A)
B)
C)
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B)
C)
D)
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An 8-month-old infant is admitted to the
pediatric floor of the community hospital with
a new diagnosis of diabetes. The patient is to
13.
receive 1 unit of regular insulin
subcutaneously. How will that 1 unit be
administered?
It is administered orally.
It is administered as U-5.
It is administered with a TB syringe.
It is administered as U-10.
D
Feedback:
An infant should receive the dosage in a
dilution strength of U-10. It is not
administered orally, as U-5, or in a TB
syringe.
A)
B)
C)
A patient in his mid-30s has received a
diagnosis of type 2 diabetes. Following his
diagnosis, he has been meeting with a nurse
14. regularly as well as performing extensive
online research. Which of the patient's
statements should prompt the nurse to
perform further teaching?
“I don't like getting this diagnosis, but I know
that treatment now can prevent future health
consequences.”
“I'm disappointed, but I take some solace in
the fact that I won't ever have to have insulin
injections.”
“People always tried to encourage me to lose
weight, and I suppose they might have been
statements should prompt the nurse to
perform further teaching?
“I don't like getting this diagnosis, but I know
that treatment now can prevent future health
consequences.”
“I'm disappointed, but I take some solace in
the fact that I won't ever have to have insulin
injections.”
“People always tried to encourage me to lose
weight, and I suppose they might have been
right.”
“From what I've learned, I know that the basic
problem is that my pancreas can't keep up
with my insulin needs.”
B
Feedback:
Among people with type 2 diabetes, 20% to
30% require exogenous insulin at some point
in their lives. Obesity is a major cause, and
vigilant treatment can prevent future sequelae.
The essence of type 2 diabetes is the pancreas'
inability to meet insulin needs.
A)
B)
C)
D)
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A nurse educator is explaining the
pathophysiology of diabetes to a newly
diagnosed patient. The patient does not
15. understand why she had a “constant,
insatiable thirst” in the months preceding her
diagnosis. What phenomenon should the
nurse describe?
“The excess glucose in your blood
accumulates in your blood vessels and
neurons, including the neurons that control
thirst.”
“Excess glucose pulled more water through
your kidneys and the increased urination
caused thirst.”
“Increased thirst is your body's attempt to
dilute your blood because it contains too
much glucose.”
“When your body cells are starved for useful
glucose, they signal your body to increase
food and fluid intake.”
B
Feedback:
When large amounts of glucose are present,
water is pulled into the renal tubule. This
results in a greatly increased urine output
(polyuria). The excessive loss of fluid in urine
leads to increased thirst (polydipsia). Glucose
does not directly affect the thirst center.
C)
D)
Ans:
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“When your body cells are starved for useful
glucose, they signal your body to increase
food and fluid intake.”
B
Feedback:
When large amounts of glucose are present,
water is pulled into the renal tubule. This
results in a greatly increased urine output
(polyuria). The excessive loss of fluid in urine
leads to increased thirst (polydipsia). Glucose
does not directly affect the thirst center.
D)
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A hospital patient with a diagnosis of type 1
diabetes is ordered Humulin R on a sliding
scale. Based on the patient's blood glucose
reading, the nurse administered 8 units of
insulin at 07:45. The nurse recognizes the
16.
need to follow up this intervention and will
reassess the patient's blood glucose level
when the insulin reaches peak efficacy. The
nurse should consequently check the patient's
blood glucose level at what time?
08:15
Between 08:45 and 09:45
Between 09:45 and 10:45
Between 11:15 and 11:45
C
Feedback:
Humulin R peaks between 2 and 3 hours after
administration.
A)
B)
C)
D)
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A)
B)
C)
D)
Ans:
A patient's medication administration record
specifies that the patient is to receive 20 units
17. of NPH insulin at 08:00. Before administering
this medication, the nurse must do which of
the following?
Massage the chosen injection site.
Assess the patient's understanding of diabetes.
Assess the patient's urine for the presence of
glucose.
Have a colleague confirm the dosage.
D
Feedback:
Before administering insulin, patient safety
requires that two nurses always check the
dosage. Assessing the patient's understanding
of the disease may or may not be appropriate
or necessary at this time. Injection sites are
not massaged before administration. It is not
necessary to assess urine for the presence of
glucose.
Assess the patient's urine for the presence of
glucose.
Have a colleague confirm the dosage.
D
Feedback:
Before administering insulin, patient safety
requires that two nurses always check the
dosage. Assessing the patient's understanding
of the disease may or may not be appropriate
or necessary at this time. Injection sites are
not massaged before administration. It is not
necessary to assess urine for the presence of
glucose.
C)
D)
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A hospital patient is to receive 4 units of
regular insulin prior to lunch. The nurse
knows that the lunch trays are usually
18.
distributed at approximately 12:15. The nurse
should plan to administer the patient's insulin
at what time?
12:15
12:10
11:45
11:15
C
Feedback:
With regular insulin before meals, it is very
important that the medication be injected 30
to 45 minutes before meals so that the insulin
is available when blood sugar increases after
meals.
A)
B)
C)
D)
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A)
B)
C)
D)
Ans:
A patient will soon begin treatment for
diabetes using glyburide. Which of the
19.
following conditions must be met in order for
treatment to be effective?
The patient must have functioning pancreatic
beta cells.
The patient must have hemoglobin A1C of
≤7%.
The patient must not have hyperglycemia.
The patient must be able to self-administer the
medication.
A
Feedback:
Because glyburide stimulates pancreatic beta
cells to produce more insulin, it is effective
only when functioning pancreatic beta cells
are present. The presence of normal blood
glucose levels would render the medication
unnecessary. Self-administration is common
but not absolutely necessary.
C)
The patient must not have hyperglycemia.
The patient must be able to self-administer the
medication.
A
Feedback:
Because glyburide stimulates pancreatic beta
cells to produce more insulin, it is effective
only when functioning pancreatic beta cells
are present. The presence of normal blood
glucose levels would render the medication
unnecessary. Self-administration is common
but not absolutely necessary.
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A 69-year-old woman has been taking
metformin for the treatment of type 2 diabetes
for several years. Which of the following
20.
changes in the woman's laboratory values
may demonstrate a need to discontinue the
medication?
A decrease in hemoglobin and hematocrit
A decrease in glomerular filtration rate
A decrease in potassium accompanied by an
increase in sodium
An increase in white blood cells
B
Feedback:
It is essential to discontinue metformin if
renal impairment occurs. The other listed
changes in laboratory values do not
necessarily indicate that metformin should be
discontinued.
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B)
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B)
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Chapter 42 Drug Therapy for Hyperthyroidism and Hypothyroidism
A child is born with cretinism. What element
1. was lacking in the mother's diet during
pregnancy?
Potassium
Iodine
Sodium
Magnesium
B
Feedback:
Cretinism is uncommon in the United States
but may occur with a lack of iodine in the
mother's diet. A lack of potassium, sodium,
and magnesium in the mother's diet will not
cause cretinism.
A patient suffers from hyponatremia,
hypoglycemia, and lactic acidosis. What
2.
condition is most consistent with this clinical
presentation?
Myxedema coma
Psychotic depression
Cretinism
Congenital hypothyroidism
A
Feedback:
Myxedema coma is severe, life-threatening
hypothyroidism characterized by coma,
hypothermia, cardiovascular collapse,
hypoventilation, and severe metabolic
disorders, such as hyponatremia,
hypoglycemia, and lactic acidosis.
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B)
C)
D)
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A woman is started on propylthiouracil
3. (PTU). What is the primary mode of action
for propylthiouracil?
Destroys part of the thyroid gland
Inhibits production of thyroid hormone
Suppresses the anterior pituitary hormones
Stimulates the thyroid cells
B
Feedback:
The thioamide drugs inhibit synthesis of
thyroid hormone. Iodine preparations inhibit
the release of thyroid hormones and cause
them to be stored within the thyroid gland.
Propylthiouracil does not destroy part of the
thyroid gland. Propylthiouracil does not
suppress the anterior pituitary hormones.
Propylthiouracil does not sedate the central
nervous system or suppress the cardiac
output.
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B)
C)
D)
Ans:
A)
B)
C)
D)
Ans:
A patient with hypothyroidism is started on
levothyroxine (Synthroid). What should the
4.
patient be taught regarding medication
administration in the home setting?
Take medication with milk or food.
Do not exercise with the medication.
Take the medication on an empty stomach.
Levothyroxine has a short half-life.
C
Feedback:
A patient with hypothyroidism is started on
levothyroxine (Synthroid). What should the
4.
patient be taught regarding medication
administration in the home setting?
Take medication with milk or food.
Do not exercise with the medication.
Take the medication on an empty stomach.
Levothyroxine has a short half-life.
C
Feedback:
Levothyroxine (Synthroid) should be taken on
an empty stomach to increase absorption. The
medication should not be taken with food.
Exercise has no effect on the administration
of the medication. Levothyroxine has a long
half-life of about 6 to 7 days.
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B)
C)
D)
Ans:
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A 5-year-old child is diagnosed with
5. hypothyroidism. What will the patient likely
develop if the condition is left untreated?
Mental retardation
Renal dysfunction
An immune disorder
Paralytic ileus
A
Feedback:
If cretinism is untreated until the child is
several months old, permanent mental
retardation is likely to result. The patient will
not suffer from renal dysfunction, an immune
disorder, or paralytic ileus.
A)
B)
C)
D)
Ans:
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B)
C)
D)
Ans:
A patient has been diagnosed with myxedema.
She currently takes ibuprofen (Motrin) for
6.
knee pain. For what is this patient at increased
risk?
Nephrotoxicity
Pulmonary congestion
Tachycardia
Apnea
A
Feedback:
A patient diagnosed with myxedema cannot
metabolize and excrete drugs, so she is at an
increased risk of developing nephrotoxicity.
Pulmonary congestion, tachycardia, and
apnea are not adverse effects related to
myxedema or the administration of ibuprofen
(Motrin).
B)
C)
D)
Ans:
Pulmonary congestion
Tachycardia
Apnea
A
Feedback:
A patient diagnosed with myxedema cannot
metabolize and excrete drugs, so she is at an
increased risk of developing nephrotoxicity.
Pulmonary congestion, tachycardia, and
apnea are not adverse effects related to
myxedema or the administration of ibuprofen
(Motrin).
A patient is scheduled for a thyroidectomy to
7. treat thyroid cancer. What is the medication of
choice administered preoperatively?
Sodium iodide 131I (Iodotope)
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B)
C)
D)
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Methimazole (Tapazole)
Propylthiouracil (PTU)
Propranolol (Inderal)
C
Feedback:
Propylthiouracil (PTU) is administered
preoperatively for thyroidectomy. Sodium
iodide131 (Iodotope) is a radioactive iodide
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that is used to destroy thyroid tissue.
Methimazole (Tapazole) is similar to PTU but
is not the drug of choice preoperatively.
Propranolol (Inderal) is used to treat
cardiovascular conditions, such as
hypertension. It is not used in the preoperative
phase of thyroidectomy.
A)
B)
C)
D)
Ans:
A patient is to receive a medication that the
nurse recognizes as an expectorant that is
8. normally administered for the treatment of
hyperthyroidism. Which medication will be
administered?
Propylthiouracil (PTU)
Methimazole (Tapazole)
Saturated solution of potassium iodide (SSKI)
Sodium iodide131I (Iodotope)
C
Feedback:
Saturated solution of potassium iodide (SSKI)
is more often used as an expectorant but may
be given as a preparation for thyroidectomy.
Propylthiouracil (PTU) is not administered as
an expectorant. Methimazole (Tapazole) is
not administered as an expectorant. Sodium
iodide 131I (Iodotope) is not administered as
an expectorant.
B)
C)
Methimazole (Tapazole)
Saturated solution of potassium iodide (SSKI)
131
Sodium iodide I (Iodotope)
C
Feedback:
Saturated solution of potassium iodide (SSKI)
is more often used as an expectorant but may
be given as a preparation for thyroidectomy.
Propylthiouracil (PTU) is not administered as
an expectorant. Methimazole (Tapazole) is
not administered as an expectorant. Sodium
iodide 131I (Iodotope) is not administered as
D)
Ans:
an expectorant.
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A patient has been diagnosed with
hyperthyroidism. She is scheduled to receive
9.
a medication to destroy the thyroid gland.
Which medication will be administered?
Propylthiouracil (PTU)
Methimazole (Tapazole)
Saturated solution of potassium iodide (SSKI)
Sodium iodide 131I (Iodotope)
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B)
C)
D)
D
Feedback:
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Sodium iodide 131I (Iodotope) is a
radioactive isotope of iodine. Therapeutic
doses act by emitting beta and gamma rays,
which destroy thyroid tissue and thereby
decrease the production of thyroid hormones.
Propylthiouracil (PTU) is not administered to
destroy thyroid tissue. Methimazole
(Tapazole) is not administered to destroy
thyroid tissue. Saturated solution of potassium
iodide (SSKI) is not administered to destroy
thyroid tissue.
A)
B)
C)
D)
Ans:
A patient is being administered propranolol
(Inderal) to treat hypertension related to
10. hyperthyroidism. Which condition will
warrant the tapering and discontinuation of
the propranolol (Inderal)?
Hyperthyroidism
Hypertension
Angina pectoris
Euthyroid state
D
Feedback:
When the patient becomes euthyroid and
hyperthyroid symptoms are controlled by
definitive treatment measures, propranolol
should be tapered and discontinued.
Hyperthyroidism, hypertension, and angina
pectoris all warrant the administration of
Hypertension
Angina pectoris
Euthyroid state
D
Feedback:
When the patient becomes euthyroid and
hyperthyroid symptoms are controlled by
definitive treatment measures, propranolol
should be tapered and discontinued.
Hyperthyroidism, hypertension, and angina
pectoris all warrant the administration of
propranolol (Inderal).
A patient is started on levothyroxine
(Synthroid) for treatment of hypothyroidism.
11. During patient teaching, how frequently can
the dosage be increased until symptoms are
relieved?
Every 3 to 5 days
Weekly
Every 2 weeks
Monthly
C
Feedback:
Dosage is influenced by the choice of drug.
As a general rule, initial dosage is relatively
small. Dosage is gradually increased at
approximately 2-week intervals until
symptoms are relieved. The dosage is not
increased in 3 to 5 days. The dosage is not
increased in 1 week. The dosage is not
increased monthly.
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C)
D)
Ans:
A)
B)
C)
D)
Ans:
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B)
C)
D)
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A patient is being treated for hypothyroidism
and has developed symptoms of adrenal
12.
insufficiency. What medication will be added
to the patient's medication regimen?
Anti-infective agent
Corticosteroid agent
Nonsteroidal anti-inflammatory agent
Antiadrenergic agent
B
Feedback:
When hypothyroidism and adrenal
insufficiency coexist, the adrenal insufficiency
should be treated with a corticosteroid drug
before starting thyroid replacement. Antiinfective agents, nonsteroidal antiinflammatory agents, or antiadrenergic agents
are not administered for adrenal insufficiency.
Corticosteroid agent
Nonsteroidal anti-inflammatory agent
Antiadrenergic agent
B
Feedback:
When hypothyroidism and adrenal
insufficiency coexist, the adrenal insufficiency
should be treated with a corticosteroid drug
before starting thyroid replacement. Antiinfective agents, nonsteroidal antiinflammatory agents, or antiadrenergic agents
are not administered for adrenal insufficiency.
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B)
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A patient has been diagnosed with
hypothyroidism and admits to the nurse that
she has heard of her thyroid gland but does
13.
not know the function of thyroid hormone.
The nurse should explain the fact that thyroid
hormone is responsible for
regulating the levels of most other hormones
in the body.
stimulating the brain and sex organs.
controlling the rate of cell metabolism
throughout the body.
regulating levels of glucose in the blood and
body tissues.
C
Feedback:
Thyroid hormones control the rate of cellular
metabolism and thus influence the functioning
of virtually every cell in the body. The heart,
skeletal muscle, liver, and kidneys are
especially responsive to the stimulating
effects of thyroid hormones. The brain,
spleen, and gonads are less responsive.
Thyroid hormone does not primarily influence
glucose levels or the function of the endocrine
system.
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B)
C)
D)
Ans:
Following the completion of diagnostic
testing, an adult patient has received a
14. diagnosis of hyperthyroidism. What nursing
diagnosis should the nurse prioritize in this
patient's care?
Risk for hypothermia related to
hyperthyroidism
Constipation related to hyperthyroidism
Risk for imbalanced nutrition: less than body
requirements related to hyperthyroidism
Anxiety related to hyperthyroidism
D
Feedback:
Anxiety is characteristic of a hyperthyroid
state. Constipation, cold intolerance, and loss
Risk for hypothermia related to
hyperthyroidism
Constipation related to hyperthyroidism
Risk for imbalanced nutrition: less than body
requirements related to hyperthyroidism
Anxiety related to hyperthyroidism
D
Feedback:
Anxiety is characteristic of a hyperthyroid
state. Constipation, cold intolerance, and loss
of appetite are associated with
hypothyroidism.
A)
B)
C)
D)
Ans:
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A 55-year-old female patient was successfully
treated for thyroid storm earlier in the year. In
15. subsequent health education, the nurse should
caution the patient against excessive intake of
what foods?
Seafood and kelp
Leafy green vegetables and beef
Purine-rich foods
Red wine and aged cheeses
A
Feedback:
Iodine is associated with thyroid storm and is
present in foods (especially seafood and kelp)
and in radiographic contrast dyes. Reports of
iodine-induced hyperthyroidism have been
reported after ingestion of dietary sources of
iodine.
A)
B)
C)
D)
Ans:
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B)
C)
D)
Ans:
Laboratory testing reveals that a patient is in a
severely hyperthyroid state and
propylthiouracil (PTU) has been prescribed.
16.
When providing health education related to
this drug, what should the nurse teach the
patient?
“You'll need to take these pills every 8 hours.”
“I'm going to show you how to perform your
daily injection.”
“At first, you'll come to the outpatient clinic
for your IV infusion once per day.”
“It's best to inject PTU into your abdomen
rather than your arm.”
A
Feedback:
PTU is well absorbed with oral
administration. Because the half-life in the
thyroid is relatively short, PTU must be given
every 8 hours.
C)
for your IV infusion once per day.”
“It's best to inject PTU into your abdomen
rather than your arm.”
A
Feedback:
PTU is well absorbed with oral
administration. Because the half-life in the
thyroid is relatively short, PTU must be given
every 8 hours.
D)
Ans:
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B)
C)
D)
Ans:
A patient is scheduled to begin a drug
regimen for the treatment of hyperthyroidism.
Prior to administering propylthiouracil (PTU),
17.
the nurse has reviewed the relevant black box
warning and should teach the patient about
the need for what form of follow-up?
Serial complete blood counts
Routine liver function testing
Daily nonfasting blood glucose testing
Chest radiographs every 3 months
B
Feedback:
The FDA has issued a black box warning for
PTU stating that severe liver injury resulting
in death or acute liver failure may occur
within 6 months of treatment. All patients
should receive instructions about the signs
and symptoms of acute liver failure. Routine
liver function testing to assess for liver failure
is important. There is no specific need for
chest radiographs, CBCs, or glucose
monitoring.
A)
B)
C)
D)
Ans:
A nurse who provides care at a long-term care
facility is preparing to administer a resident's
18. scheduled dose of levothyroxine (Synthroid).
What assessment should the nurse perform
prior to administration?
Level of consciousness and orientation
Oxygen saturation level
Heart rate
Respiratory rate
C
Feedback:
Regular monitoring of blood pressure and
pulse is essential in older adults receiving
Synthroid. As a general rule, levothyroxine
should not be given if the resting heart rate is
more than 100 beats per minute.
B)
C)
D)
Ans:
Oxygen saturation level
Heart rate
Respiratory rate
C
Feedback:
Regular monitoring of blood pressure and
pulse is essential in older adults receiving
Synthroid. As a general rule, levothyroxine
should not be given if the resting heart rate is
more than 100 beats per minute.
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B)
C)
D)
Ans:
A home care nurse observes that a client's
supply of Synthroid has run out in less than
19. half the time that it should have. What
assessment findings would be most consistent
with overuse of Synthroid?
Constipation and abdominal distention
Hyperactivity and insomnia
Bradycardia and hypotension
Joint pain and decreased mobility
B
Feedback:
Adverse effects of levothyroxine include
signs and symptoms of hyperthyroidism.
Other more serious adverse effects are
tachycardia, cardiac dysrhythmias, angina
pectoris, myocardial infarction, and heart
failure. Nervousness, hyperactivity, insomnia,
diarrhea, abdominal cramps, nausea,
vomiting, weight loss, fever, and an
intolerance to heat have also been reported.
Bradycardia and constipation are associated
with hypothyroidism.
A)
B)
C)
D)
Ans:
An older adult patient has been using
levothyroxine (Synthroid) for several years on
an outpatient basis. The patient has recently
sought care, with complaints that are
20.
consistent with hypothyroidism. To which of
the patient's following statements may the
nurse attribute the decreased effect of
Synthroid?
“I've been using a lot of antacids lately
because of my indigestion.”
“My daughter and I have started the Atkin's
diet to try to lose some weight.”
“Overall, I'd say that I'm under a lot of stress
lately.”
“I've stopped taking aspirin for my arthritis
and started using Tylenol.”
A
Feedback:
Antacids may decrease the effect of
levothyroxine. Acetaminophen, stress, and
A)
because of my indigestion.”
“My daughter and I have started the Atkin's
diet to try to lose some weight.”
“Overall, I'd say that I'm under a lot of stress
lately.”
“I've stopped taking aspirin for my arthritis
and started using Tylenol.”
A
Feedback:
Antacids may decrease the effect of
levothyroxine. Acetaminophen, stress, and
high protein intake do not have this effect.
B)
C)
D)
Ans:
Chapter 43 Drug Therapy for Pituitary and Hypothalamic Dysfunction
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A patient is scheduled for an exploratory
surgery for cancer. What will cause the
1. release of adrenocorticotropic hormone in
response to this patient's psychological and
physiological stress?
Growth hormone release–inhibiting hormone
(Somatostatin)
Corticotropin-releasing hormone or factor
(CRH or CRF)
Growth hormone–releasing hormone (GHRH)
Thyrotropin-releasing hormone (TRH)
B
Feedback:
Corticotropin-releasing hormone or factor
(CRH or CRF) causes release of corticotropin
(adrenocorticotropic hormone) in response to
stress and threatening stimuli. Growth
hormone release–inhibiting hormone
(somatostatin) inhibits release of growth
hormone. Growth hormone–releasing
hormone causes the release of growth
hormone in response to low blood levels of
GH. Thyrotropin-releasing hormone causes
the release of TSH in response to stress, such
as cold.
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B)
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B)
C)
D)
Ans:
A patient has had surgery. After the surgical
procedure, the patient starts to shiver and
2.
chill. What hormone will be released in
response to the reaction to cold?
Thyroid-stimulating hormone
Luteinizing hormone
Corticotropin
Somatostatin
A
Feedback:
Thyroid-stimulating hormone is released in
response to stress, such as exposure to cold.
2.
A patient is suspected of having Cushing's
3. disease. What hormone is used in the
diagnosis of this disorder?
Growth hormone
Adrenocorticotropic hormone
Thyroid-stimulating hormone
Corticotropin-releasing hormone
D
Feedback:
Corticotropin-releasing hormone can be used
in the diagnosis of Cushing's disease. Growth
hormone is released in response to low blood
levels of growth hormone. Corticotropinreleasing hormone causes the release of
corticotropin (adrenocorticotropic hormone)
in response to stress. Thyroid-stimulating
hormone regulates the secretion of thyroid
hormones.
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A)
B)
C)
D)
Ans:
chill. What hormone will be released in
response to the reaction to cold?
Thyroid-stimulating hormone
Luteinizing hormone
Corticotropin
Somatostatin
A
Feedback:
Thyroid-stimulating hormone is released in
response to stress, such as exposure to cold.
Luteinizing hormone is released in response
to gonadotropin-releasing hormone.
Corticotropin stimulates the adrenal cortex to
produce corticosteroids. Somatostatin inhibits
the release of growth hormone.
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B)
C)
D)
Ans:
A)
B)
C)
D)
Ans:
A young man has begun weight training.
Which hormone will be released in response
4.
to the increase in the size and number of
muscle cells?
Growth hormone
Adrenocorticotropic hormone
Thyroid-stimulating hormone
Corticotropin-releasing hormone
A
Feedback:
Growth hormone stimulates the growth of
body tissues, including growth of muscle
cells. Corticotropin-releasing hormone causes
the release of corticotropin
(adrenocorticotropic hormone) in response to
stress. Thyroid-stimulating hormone regulates
the secretion of thyroid hormones.
B)
C)
D)
Ans:
Adrenocorticotropic hormone
Thyroid-stimulating hormone
Corticotropin-releasing hormone
A
Feedback:
Growth hormone stimulates the growth of
body tissues, including growth of muscle
cells. Corticotropin-releasing hormone causes
the release of corticotropin
(adrenocorticotropic hormone) in response to
stress. Thyroid-stimulating hormone regulates
the secretion of thyroid hormones.
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An adult is diagnosed with an increased lowdensity lipoprotein cholesterol level. What
5.
hormone level may be low based on this
diagnosis?
Adrenocorticotropic hormone (ACTH)
Oxytocin
Growth hormone
Somatostatin
C
Feedback:
In adults, deficient growth hormone can cause
increased fat, reduced skeletal and heart
muscle mass, reduced strength, reduced
ability to exercise, and worsened cholesterol
levels (increased low-density lipoprotein
cholesterol). Adrenocorticotropic hormone,
oxytocin, and somatostatin do not affect lowdensity lipoprotein.
A)
B)
C)
D)
Ans:
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A)
B)
C)
D)
Ans:
When teaching young women about the
hormones of reproduction, the nurse explains
6. how the follicle matures and ruptures in
ovulation. Which hormone is needed for this
change?
Luteinizing hormone (LH)
Thyrotropin (TSH)
Follicle-stimulating hormone (FSH)
Leydig's cells
A
Feedback:
LH is important in the maturation and rupture
of the ovarian follicle. TSH regulates the
secretion of thyroid hormones. FSH
stimulates the functions of sex glands.
Leydig's cells are stimulated by LH in men to
secrete androgens.
B)
C)
D)
Ans:
Thyrotropin (TSH)
Follicle-stimulating hormone (FSH)
Leydig's cells
A
Feedback:
LH is important in the maturation and rupture
of the ovarian follicle. TSH regulates the
secretion of thyroid hormones. FSH
stimulates the functions of sex glands.
Leydig's cells are stimulated by LH in men to
secrete androgens.
A patient has been involved in a motor
7. vehicle accident. Which hormone will be
released in response to his blood loss?
Luteinizing hormone (LH)
Antidiuretic hormone (ADH)
Oxytocin
Melanocyte-stimulating hormone
B
Feedback:
Antidiuretic hormone is also called
vasopressin and is released in response to
blood loss. Luteinizing hormone is important
in ovulation. Oxytocin functions in childbirth
and lactation. Melanocyte-stimulating
hormone plays a role in skin pigmentation.
A)
B)
C)
D)
Ans:
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B)
C)
D)
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A)
B)
C)
D)
Ans:
A patient has been diagnosed with
acromegaly. Which of the following
8.
medications may be ordered to treat this
endocrine disorder?
Gonadorelin hydrochloride (Factrel)
Octreotide (Sandostatin)
Nafarelin (Synarel)
Gonadorelin acetate (Lutrepulse)
B
Feedback:
Prescribers order octreotide for patients with
acromegaly to reduce levels of GH.
Gonadorelin hydrochloride, nafarelin, and
gonadorelin acetate are not administered to
treat acromegaly.
A patient is suspected of having adrenal
9. insufficiency. Which hormone may be
administered to diagnose Addison's disease?
Corticotropin (ACTH)
Somatotropin (Humatrope)
Octreotide (Sandostatin)
Leuprolide (Lupron)
A
A patient is suspected of having adrenal
9. insufficiency. Which hormone may be
administered to diagnose Addison's disease?
Corticotropin (ACTH)
Somatotropin (Humatrope)
Octreotide (Sandostatin)
Leuprolide (Lupron)
A
Feedback:
Corticotropin (ACTH) is sometimes used as a
diagnostic test to differentiate primary adrenal
insufficiency (Addison's disease).
Somatotropin is therapeutically equivalent to
endogenous growth hormone. Octreotide
(Sandostatin) is used for acromegaly.
Leuprolide causes a decrease in testosterone
and estrogen.
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A)
B)
C)
D)
Ans:
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A patient is diagnosed with infertility. What
10. medication may the nurse administer for the
treatment of infertility?
Thyrotropin alfa (Thyrogen)
Pegvisomant (Somavert)
Menotropins (Pergonal)
Somatotropin (Humatrope)
C
Feedback:
Menotropins (Pergonal) is administered in
combination with HCG to induce ovulation.
Thyrotropin alfa (Thyrogen) is a synthetic
formulation of TSH used as a diagnostic
adjunct for serum thyroglobulin. Pegvisomant
(Somavert) is a growth hormone receptor
antagonist used in the treatment of
acromegaly in adults. Somatotropin
(Humatrope) is administered to children for
impaired growth.
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B)
C)
D)
Ans:
A)
B)
C)
D)
Ans:
An adolescent is being treated with growth
hormone. When assessing for potential
11.
adverse effects, what assessment should the
nurse prioritize?
Deep tendon reflexes
Level of anxiety
Respiratory rate
Blood glucose
D
Feedback:
Somatropin decreases insulin sensitivity,
resulting in hyperglycemia. Patients most at
risk for increased insulin sensitivity are those
with obesity, Turner's syndrome, or a family
nurse prioritize?
Deep tendon reflexes
Level of anxiety
Respiratory rate
Blood glucose
D
Feedback:
Somatropin decreases insulin sensitivity,
resulting in hyperglycemia. Patients most at
risk for increased insulin sensitivity are those
with obesity, Turner's syndrome, or a family
history of diabetes mellitus. Growth hormone
can cause anxiety, but is not a priority
assessment in this case. The respiratory rate is
not the most important objective assessment
in this case.
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B)
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D)
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B)
C)
D)
Ans:
An adult patient has been diagnosed with a
posterior pituitary lesion that has resulted in
12.
diabetes insipidus. The characteristic sign of
this health problem is
blood glucose levels ≥ 400 mg/dL.
copious urine production.
hyperglycemia that is unresponsive to
exogenous insulin.
hematuria.
B
Feedback:
Characteristic features of DM include
polyuria, with excretion of dilute urine
ranging from 4 L to as much as 30 L.
Hematuria does not normally occur, and
blood glucose levels are not directly affected.
A patient with a traumatic head injury and a
diagnosis of diabetes insipidus is being
treated with intravenous vasopressin
13.
(Pitressin). What change in the patient's status
would prompt the immediate cessation of the
drug infusion?
Infiltration at the IV site
A sudden decrease in urine output
The appearance of blood in the patient's urine
A rapid increase in blood glucose
A
Feedback:
When administering vasopressin
intravenously, it is essential to use extreme
caution due to the risk of extravasation of the
medication, leading to tissue necrosis.
Decreased urine output is a goal of treatment.
Blood in the urine and changes in blood
glucose levels are atypical events.
B)
C)
D)
Ans:
A sudden decrease in urine output
The appearance of blood in the patient's urine
A rapid increase in blood glucose
A
Feedback:
When administering vasopressin
intravenously, it is essential to use extreme
caution due to the risk of extravasation of the
medication, leading to tissue necrosis.
Decreased urine output is a goal of treatment.
Blood in the urine and changes in blood
glucose levels are atypical events.
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Somatropin has been prescribed for a child
who has been diagnosed with growth
14. hormone deficiency. When providing health
education to the child's parents, what teaching
point should then nurse prioritize?
The correct technique for daily injections of
the drug
The importance of regular blood pressure
monitoring
The rationale for not crushing the extendedrelease tablet
The need to limit the child's activity level for
the duration of treatment
A
Feedback:
Somatropin is administered by daily
injections. Blood pressure monitoring and
activity limitations are not necessary.
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B)
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A girl who is 7 1/2 years old has received a
diagnosis of precocious puberty from the
15. pediatric endocrinologist. The nurse who
collaborates with this physician should
anticipate the administration of what drug?
Menotropins (Pergonal)
Thyrotropin alfa (Thyrogen)
Cosyntropin (Cortrosyn
Leuprolide acetate (Lupron)
D
Feedback:
Leuprolide is useful for the treatment of
central precocious puberty in children.
Menotropins (Pergonal) stimulates ovulation.
Cosyntropin (Cortrosyn) stimulates the
adrenal cortex to synthesize and secrete
adrenocortical hormones. Thyrotropin alfa
(Thyrogen) stimulates the secretion of
thyroglobulin.
Thyrotropin alfa (Thyrogen)
Cosyntropin (Cortrosyn
Leuprolide acetate (Lupron)
D
Feedback:
Leuprolide is useful for the treatment of
central precocious puberty in children.
Menotropins (Pergonal) stimulates ovulation.
Cosyntropin (Cortrosyn) stimulates the
adrenal cortex to synthesize and secrete
adrenocortical hormones. Thyrotropin alfa
(Thyrogen) stimulates the secretion of
thyroglobulin.
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B)
C)
D)
Ans:
A 13-year-old boy who is in the first
percentile of height for his age has been
referred for care. Which of the following
16.
assessment findings would contraindicate the
safe and effective use of somatropin to treat
his growth deficiency?
The boy has not yet begun puberty.
The boy has low serum albumin levels.
The epiphyses of the boy's long bones have
closed.
The sutures of the boy's skull have not yet
fully closed.
C
Feedback:
Somatropin is ineffective when impaired
growth is present after puberty, when the
epiphyses of the long bones have closed. Low
albumin is not a contraindication to the use of
somatropin. The sutures of the skull close
early in life.
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C)
D)
Ans:
A patient's current drug regimen includes
intranasal administration of desmopressin
17. acetate (DDAVP, Stimate). In this patient's
plan of nursing care, what is the most likely
desired outcome of treatment?
The patient's urine output will not exceed 80
mL/h.
The patient will gain 2 cm in height over the
next 6 months.
The patient will ovulate at least once over the
next 8 weeks.
The patient's vertical growth will cease in the
next 4 weeks.
A
Feedback:
Desmopressin acetate (DDAVP, Stimate) is
the prototype posterior pituitary hormone
medication. It is used to treat diabetes
insipidus. Consequently, reduced urine output
The patient will ovulate at least once over the
next 8 weeks.
The patient's vertical growth will cease in the
next 4 weeks.
A
Feedback:
Desmopressin acetate (DDAVP, Stimate) is
the prototype posterior pituitary hormone
medication. It is used to treat diabetes
insipidus. Consequently, reduced urine output
is the primary goal of treatment. The drug
does not influence growth or ovulation.
C)
D)
A nurse reviews the current medication
administration record of a patient who has
recently been prescribed octreotide. The nurse
18.
performs this important safety action in order
to prevent drug interactions that could result
in
increased growth.
anaphylaxis.
cardiac complications.
respiratory arrest.
C
Feedback:
Numerous medications combine with
octreotide to result in a prolonged QT interval
with an increased risk of ventricular
dysrhythmia and cardiac arrest. Increased
growth, anaphylaxis, and respiratory arrest are
not noted adverse effects or the result of drug
interactions with octreotide.
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B)
C)
D)
Ans:
A)
B)
C)
D)
Ans:
A child has been referred to a pediatric
endocrinologist and has begun treatment with
19. octreotide acetate. What nursing diagnosis
should be noted in the child's plan of nursing
care?
Delayed growth and development
Excess fluid volume
Risk for deficient fluid volume
Altered growth and development
D
Feedback:
Acromegaly is the major clinical indication
for the use octreotide. In this condition,
growth is excessive, not delayed. Fluid
volume is not directly affected.
A patient who is being cared for in the
intensive care unit (ICU) is receiving
desmopressin. In light of the black box
20.
warning that accompanies this drug, the ICU
nurse should prioritize the assessment of
which of the patient's laboratory values?
Hematocrit
Platelets
Sodium
Calcium
C
Feedback:
The FDA has issued a black box warning
stating that patients taking desmopressin can
develop hyponatremia, leading to seizures.
Consequently, assessment of sodium levels
takes precedence over hematocrit, calcium,
and platelet levels.
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Chapter 44 Drug Therapy to Regulate Calcium and Bone Metabolism
An elderly patient has been diagnosed with
1. Paget's disease. Which serum electrolyte is
altered in this disease process?
Sodium
Potassium
Chloride
Calcium
D
Feedback:
Disorders of calcium and bone metabolism
include hypocalcemia, hypercalcemia,
osteoporosis, Paget's disease, and bone
breakdown associated with breast cancer and
multiple myeloma. Sodium, potassium, and
chloride alterations are not primarily
associated with Paget's disease.
A patient has been diagnosed with hyperplasia
of the parathyroid gland. Which of the
2.
following alterations in blood values will you
expect to observe?
Hypercalcemia
Hypoparathyroidism
Hyperthyroidism
Hypocalcemia
A
Feedback:
Hyperparathyroidism is most often caused by
a tumor or hyperplasia of a parathyroid gland.
Hypoparathyroidism, hyperthyroidism, and
hypothyroidism are not associated with
hyperplasia of the parathyroid gland. Clinical
manifestations and treatment of
hyperparathyroidism are the same as those of
hypercalcemia.
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When a patient has an increased serum level
3. of ionized calcium, which hormone will be
released?
Insulin
Estrogen
PTH
Calcitonin
D
Feedback:
Calcitonin is a hormone from the thyroid
gland whose secretion is controlled by the
concentration of ionized calcium in the blood
flowing through the thyroid gland. When the
serum level of ionized calcium is increased,
secretion of calcitonin is increased. The serum
level of calcium will not affect the release of
insulin or estrogen. PTH is a response to low
calcium levels.
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D)
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A)
B)
C)
D)
Ans:
A patient has a decreased calcium level.
4. Which of the following will participate in
raising the patient's calcium level?
Vitamin D
Vitamin C
Ferrous sulfate
Vitamin B12
A
Feedback:
Vitamin D is a fat-soluble vitamin that plays
A patient has a decreased calcium level.
4. Which of the following will participate in
raising the patient's calcium level?
Vitamin D
Vitamin C
Ferrous sulfate
Vitamin B12
A)
B)
C)
D)
Ans:
A
Feedback:
Vitamin D is a fat-soluble vitamin that plays
an important role in calcium and bone
metabolism. Vitamin C, ferrous sulfate, and
vitamin B12 do not play a role in calcium and
bone metabolism.
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A 55-year-old woman is diagnosed with a
5. vitamin D deficit. What disorder results from
this deficit?
Chondromalacia
Chondritis
Osteomalacia
Osteopenia
C
Feedback:
In adults, vitamin D deficiency causes
osteomalacia, a condition characterized by
decreased bone density and strength.
Chondromalacia is characterized as a
softening of the patella. Chondritis is an
inflammation of the cartilage. Osteopenia is a
decrease in bone tissue.
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B)
C)
D)
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A)
B)
C)
D)
Ans:
The nurse is providing health education to an
80-year-old woman who has just been
6. diagnosed with osteoporosis. Which of the
following represents an accurate statement
when teaching her about this diagnosis?
“Osteoporosis is usually a result of a bone
injury.”
“Osteoporosis causes a risk for fractures.”
“Osteoporosis results from nonmodifiable risk
factors.”
“Osteoporosis occurs only in women.”
B
Feedback:
Osteoporosis results when bone strength is
impaired, leading to increased porousness and
vulnerability to fracture. Osteoporosis is not a
result of fracture. Osteoporosis is partially
preventable. Osteoporosis is not limited to the
female gender.
“Osteoporosis results from nonmodifiable risk
factors.”
“Osteoporosis occurs only in women.”
B
Feedback:
Osteoporosis results when bone strength is
impaired, leading to increased porousness and
vulnerability to fracture. Osteoporosis is not a
result of fracture. Osteoporosis is partially
preventable. Osteoporosis is not limited to the
female gender.
C)
A patient suffers from numbness and tingling
around the mouth and has a positive
7. Trousseau's sign after a thyroidectomy. Which
of the following medications will be
administered?
Parenteral normal saline
Parenteral potassium chloride
Parenteral digoxin (Lanoxin)
Parenteral calcium gluconate
D
Feedback:
The patient has acute hypocalcemia as
evidenced by numbness and tingling around
the mouth and a positive Trousseau's sign. An
intravenous calcium salt, such as calcium
gluconate, is given for acute symptomatic
hypocalcemia. Parenteral normal saline may
be administered, but it will not increase the
calcium level. The administration of
potassium chloride parenterally must be
diluted and will not affect the calcium level.
Parenteral digoxin (Lanoxin) will not be
administered.
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B)
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B)
C)
D)
Ans:
A 75-year-old patient with overall good health
is to begin taking vitamin D supplements.
8.
What is the recommended supplement for her
age?
100 International Units daily
200 International Units daily
600 International Units daily
800 International Units daily
D
Feedback:
The recommended dietary allowance, or
RDA, for vitamin D is 600 International Units
for people 1 to 70 years of age and 800
International Units daily for adults 71 years
and older to prevent and treat osteoporosis.
B)
C)
D)
Ans:
200 International Units daily
600 International Units daily
800 International Units daily
D
Feedback:
The recommended dietary allowance, or
RDA, for vitamin D is 600 International Units
for people 1 to 70 years of age and 800
International Units daily for adults 71 years
and older to prevent and treat osteoporosis.
An older adult patient has been on oral
corticosteroids to decrease the symptoms of
9.
chronic obstructive pulmonary disease. What
is the patient at risk for developing?
Osteoporosis
Osteoarthritis
Oat cell carcinoma
Paget's disease
A
Feedback:
Drugs used for hypercalcemia, such as
corticosteroids, place the patient at risk for
developing osteoporosis due to the
demineralization of the bone. The patient is
not at risk for developing osteoarthritis or oat
cell carcinoma. Paget's disease is an
inflammatory condition and is not caused by
corticosteroid use.
B)
C)
D)
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B)
C)
D)
Ans:
A patient has been prescribed alendronate
(Fosamax). Which of the following
10. instructions should the patient be given
regarding the administration of this
medication?
Take the medication with whole milk.
Take the medication and lie down for 30
minutes.
Take the medication on an empty stomach.
Take the medication to increase bone
resorption.
C
Feedback:
Alendronate (Fosamax) must be taken on an
empty stomach. Alendronate (Fosamax)
should not be taken with milk or food. The
patient should be sitting up or ambulatory for
30 minutes after taking the medication. The
medication decreases bone resorption, not
increases it.
C)
Take the medication on an empty stomach.
Take the medication to increase bone
resorption.
C
Feedback:
Alendronate (Fosamax) must be taken on an
empty stomach. Alendronate (Fosamax)
should not be taken with milk or food. The
patient should be sitting up or ambulatory for
30 minutes after taking the medication. The
medication decreases bone resorption, not
increases it.
D)
Ans:
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A patient has undergone a thyroidectomy in
which his parathyroid glands were also
inadvertently removed. The patient's morning
11.
blood work reveals a serum calcium level of
3.1 mg/dL (normal 8.5 to 10.5 mg/dL). The
nurse should consequently assess this patient's
muscle tone.
level of consciousness.
respiratory rhythm.
respiratory rate.
A
Feedback:
Low calcium levels can result in tetany.
Decreased LOC and altered respiratory
function are not characteristic of
hypocalcemia.
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B)
C)
D)
Ans:
A)
B)
C)
D)
E)
Ans:
A community health nurse is leading a health
promotion workshop during a community
health fair. A participant has asked the nurse
for advice on the necessity of calcium
12.
supplements. The nurse should respond in the
knowledge that which of the following
demographic groups frequently have low
calcium levels? Select all that apply.
Elementary-aged children
Young women
Middle-aged men
Middle-aged women
Older women
B, E
Feedback:
Experts believe that the diets of most people
of all ages, but especially of young women
and older adults, are deficient in calcium.
An older adult resident of a long-term care
facility has been prescribed calcium citrate to
address her decreasing bone density. The
13. nurse should review the resident's medication
administration record knowing that what
medication may decrease the effects of
calcium?
Hydrochlorothiazide
Ibuprofen
Prednisone
Diltiazem (Cardizem)
C
Feedback:
Corticosteroids reduce the effects of calcium
by various mechanisms. Thiazide diuretics
have the opposite effect. NSAIDs and calcium
channel blockers do not appreciably affect the
pharmacokinetics of calcium supplements.
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A patient's low ionized calcium levels have
necessitated an infusion of an IV calcium
14. preparation. During the administration of this
medication, the nurse should prioritize what
assessment?
Oxygen saturation levels
Cardiac monitoring
Assessment of cognition
Assessment for visual changes
B
Feedback:
Calcium imbalances can result in alterations
in heart rate and rhythm; cardiac monitoring
is thus necessary. The patient is less likely to
experience alterations in respiratory function,
cognition, or vision.
A middle-aged patient is proud of the fact that
she is proactive with her health maintenance
and tells the nurse that she has been taking
2400 International Units of vitamin D daily,
15.
stating, “More is better when it comes to
vitamins.” The nurse should provide health
teaching to the patient because her current
vitamin D intake creates a risk for
hypercalcemia.
hyperphosphatemia.
hypocalcemia.
tetany.
A
Feedback:
It is important to take vitamin D supplements
cautiously and not overuse them; excessive
amounts can cause serious problems,
including hypercalcemia. Tetany is associated
with hypocalcemia. Hypophosphatemia
typically accompanies hypercalcemia.
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B)
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A 72-year-old woman has been diagnosed
with osteoporosis and has begun taking
alendronate (Fosamax). The nurse should be
16.
aware that this drug can increase the woman's
bone density by which of the following
means?
Decreasing renal excretion of calcium
Increasing the binding of vitamin D to
calcium ions
Suppressing the function of osteoclasts
Enhancing the function of osteoblasts
C
Feedback:
Alendronate suppresses osteoclast activity on
newly formed resorption surfaces, which
reduces bone turnover. This means that bone
formation exceeds resorption at remodeling
sites, leading to progressive gains in bone
mass. Fosamax does not enhance osteoblast
function or affect the renal excretion of
calcium. It does not influence the chemical
interaction between vitamin D and calcium.
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C)
An 80-year-old woman has experienced
recent declines in bone density and has
consequently been deemed a candidate for
17.
treatment with alendronate (Fosamax). During
health education, what teaching point should
the nurse emphasize?
“Your Fosamax will be most effective if you
couple it with an increase in your
consumption of dairy products.”
“It's important that you not lie down for half
an hour after taking your Fosamax.”
“Make sure to let your care provider know
promptly if you experience bone pain.”
“You'll have less stomach upset if you take
your Fosamax with some bland food.”
B
Feedback:
The person must remain upright (with head
elevated 90 degrees if in bed, sitting upright
in a chair, or standing) for at least 30 minutes
after administration of Fosamax. It is always
necessary to take the drug with a full glass of
water, not juice or coffee, at least 30 minutes
before breakfast and before taking other
drugs. Bone pain is a possible adverse effect,
but prevention of esophageal ulceration is a
priority. Increased dairy consumption is not
vital.
D)
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B)
C)
D)
Ans:
A 79-year-old woman has been diagnosed
with osteoporosis, and the nurse is reviewing
the risks and benefits of Fosamax, which her
18. care provider has prescribed. The patient
should be instructed to seek prompt medical
attention if she develops which of the
following?
Esophageal bleeding
Fever
Sudden fatigue
Musculoskeletal pain
A
Feedback:
Esophageal erosion and ulcers can result in
hemorrhage, which is a medical emergency.
Fever, fatigue, and musculoskeletal pain
warrant follow-up, but none is an emergency.
B)
C)
D)
Ans:
Fever
Sudden fatigue
Musculoskeletal pain
A
Feedback:
Esophageal erosion and ulcers can result in
hemorrhage, which is a medical emergency.
Fever, fatigue, and musculoskeletal pain
warrant follow-up, but none is an emergency.
A patient has been admitted in acute
hypercalcemia and has been determined to
19. have a serum calcium level of 12.9 mg/dL.
The emergency department nurse's priority
intervention is
administration of IV calcitonin.
administration of IV normal saline.
oxygen supplementation.
subcutaneous administration of exogenous
parathyroid hormone (PTH).
B
Feedback:
Acute hypercalcemia is a medical emergency,
and rehydration is a priority; it is essential to
administer an IV saline solution. Calcitonin is
not administered by the IV route. PTH is not
administered exogenously and would
exacerbate hypercalcemia.
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B)
C)
D)
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An elderly adult woman has been diagnosed
with postmenopausal osteoporosis and has
20.
been prescribed calcitonin. The nurse should
anticipate administration by what route?
Oral
Topical
Intranasal
Intravenous
C
Feedback:
Calcitonin can be administered by the
intranasal route for the treatment of
osteoporosis. It is not given orally, topically,
or intravenously.
Chapter 45 Drug Therapy for Addison's Disease and Cushing's Disease
An adult patient has been experiencing severe
lethargy and fatigue over the past several
days, and she describes herself as feeling
“shaky.” Random blood glucose testing
1.
reveals a glucose level of 38 mg/dL, but the
woman denies any significant change in her
diet. The care team should suspect the
possibility of what health problem?
Chronic renal failure
Acute renal failure
Cushing's disease
Adrenal insufficiency
D
Feedback:
Any patient with unexplained severe
hypoglycemia requires assessment for adrenal
insufficiency. Cushing's disease and kidney
disease do not result in hypoglycemia.
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B)
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A patient who has been taking oral prednisone
for several months abruptly ceased treatment
several days ago on the advice of a family
member. The patient has now been admitted
2.
to the emergency department with signs and
symptoms that are characteristic of addisonian
crisis. When assessing this patient, the nurse
should prioritize what assessment?
Assessment of urine for ketones
Assessment of serum potassium levels
Assessment for adventitious lung sounds
Assessment for venous thromboembolism
B
Feedback:
In addisonian crisis, the loss of sodium leads
to retention of potassium, resulting in
symptoms of hyperkalemia. As a result,
vigilant monitoring of serum potassium levels
is more important than respiratory effects,
urinalysis, or hypercoagulation.
A 38-year-old patient has been living with
Addison's disease for many years and has
achieved adequate symptom control through
lifestyle modifications and drug therapy.
3.
However, the patient has now been admitted
to the hospital in addisonian crisis. Which of
the nurse's following assessment questions is
most appropriate?
“Have you been under an unusual amount of
stress lately?”
“How would you describe your diet over the
last few days?”
“When was the last time that you drank any
alcohol?”
“Has your urine output been typical for the
past few days?”
A
Feedback:
Acute adrenal crisis, or addisonian crisis, is a
life-threatening condition that occurs when
Addison's disease is the underlying problem
and the patient is exposed to minor illness or
increased stress. Diet, alcohol use, and
impaired urinary function are less likely
contributors.
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B)
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B)
C)
D)
Ans:
A patient's recent symptoms of unexplained
fatigue and listlessness have prompted a
referral to the endocrinology department. A
plasma corticotropin (ACTH) stimulation test
4.
for adrenal insufficiency is being performed.
Following the administration of ACTH, what
finding would confirm the suspected
diagnosis?
Low cortisol levels
Stupor
Increased levels of CRH
Signs of Cushing's disease
A
Feedback:
Confirming the diagnosis of adrenocortical
insufficiency requires a short plasma
corticotropin (ACTH) stimulation test. The
examiner administers corticotropin in the
morning, and a subnormal blood cortisol level
in the morning and afternoon confirms the
diagnosis. CRH is a precursor to ACTH, and
would not be directly affected. Cushing's
disease is adrenocortical excess, with high
cortisol levels.
Stupor
Increased levels of CRH
Signs of Cushing's disease
A
Feedback:
Confirming the diagnosis of adrenocortical
insufficiency requires a short plasma
corticotropin (ACTH) stimulation test. The
examiner administers corticotropin in the
morning, and a subnormal blood cortisol level
in the morning and afternoon confirms the
diagnosis. CRH is a precursor to ACTH, and
would not be directly affected. Cushing's
disease is adrenocortical excess, with high
cortisol levels.
A patient with suspected adrenal insufficiency
has been administered 1 mcg of cosyntropin
(Cortrosyn) as an IV bolus. Serum testing 30
5.
minutes later reveals a markedly elevated
level of cortisol. What conclusion should the
nurse infer from this finding?
The patient has normal adrenocortical
function.
The patient has primary adrenal insufficiency.
The patient has secondary adrenal
insufficiency.
The patient has Addison's disease.
A
Feedback:
The low-dose test involves the administration
of 1 mcg of cosyntropin (Cortrosyn) as an IV
bolus. In people with normal adrenocortical
function, an increase in cortisol occurs in 20
minutes.
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C)
D)
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A)
B)
C)
D)
A 26-year-old woman's gradual development
of a “moon face,” coupled with protracted
weight gain, has caused the nurse practitioner
6.
to suspect the possibility of Cushing's disease.
When explaining this health problem to the
patient, how should the nurse describe it?
“Cushing's disease happens when your
pituitary gland doesn't stimulate your other
glands enough.”
“Cushing's disease is a result of an
overproduction of steroid hormones by your
kidneys.”
“Cushing's disease most often happens when
people are taking corticosteroid medications
and stop them abruptly.”
“Cushing's disease often results from a
growth on your kidney that causes inadequate
production of steroids.”
A)
pituitary gland doesn't stimulate your other
glands enough.”
“Cushing's disease is a result of an
overproduction of steroid hormones by your
kidneys.”
“Cushing's disease most often happens when
people are taking corticosteroid medications
and stop them abruptly.”
“Cushing's disease often results from a
growth on your kidney that causes inadequate
production of steroids.”
B
Feedback:
The cause of Cushing's disease is
adrenocortical excess. Cessation of exogenous
steroids can precipitate addisonian crisis.
Dysfunction of pituitary gland is an atypical
cause. Tumors may cause overproduction, not
underproduction, of corticosteroids.
B)
C)
D)
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A patient with a diagnosis of Cushing's
disease has been admitted to the emergency
department after taking a fall on the sidewalk
7.
outside her apartment building. This patient's
underlying disease process creates increased
risks of
hemorrhage and impaired hemostasis.
fractures and impaired wound healing.
neurovascular complications and
rhabdomyolysis.
bruising and hematoma.
B
Feedback:
Cushing's disease results in low bone density
and impaired wound healing. It does not
typically cause impaired hemostasis or
neurovascular problems.
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B)
C)
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B)
C)
The results of a young man's plasma
corticotropin (ACTH) stimulation test have
confirmed a diagnosis of Addison's disease.
The nurse has consequently provided health
8. education around the necessity of hormone
replacement therapy. The patient has asked
the nurse, “How long am I going to have to
take these medications?” How should the
nurse best respond?
“You'll need to take these for the rest of your
life.”
“You'll have to take these until you can pass
the corticotropin stimulation test without
them.”
“You'll have to take these until your kidneys
regain their normal level of function.”
the nurse, “How long am I going to have to
take these medications?” How should the
nurse best respond?
“You'll need to take these for the rest of your
life.”
“You'll have to take these until you can pass
the corticotropin stimulation test without
them.”
“You'll have to take these until your kidneys
regain their normal level of function.”
“You'll need to take these until your
symptoms have been stable for at least 6
months.”
A
Feedback:
Lifetime hormone replacement is necessary in
persons with Addison's disease.
A)
B)
C)
D)
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A child has received a diagnosis of Addison's
disease, and the nurse is providing health
education to the child's family around
9. hormone replacement therapy. When planning
this child's care, the nurse should know that
hormone replacement therapy constitutes a
risk for what nursing diagnosis?
Latex allergic response
Deficient fluid volume
Delayed growth and development
Impaired gas exchange
C
Feedback:
Hydrocortisone may affect growth velocity. It
is unlikely to affect allergy response, or
respiration. Fluid volume excess, not deficit,
is a possibility.
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A)
B)
C)
D)
Ans:
A)
B)
C)
D)
Ans:
Hydrocortisone has been prescribed to a
patient for the treatment of Addison's disease,
10. and the patient will soon be discharged. The
nurse should encourage the patient to take this
medication
at least 30 minutes before or 2 hours after
meals.
at bedtime.
before 9 AM
with an antacid.
C
Feedback:
Administration of hydrocortisone should take
place every morning before 9 AM. This
minimizes HPA suppression. People should
take the oral preparation with food to decrease
gastric irritation.
B)
C)
D)
Ans:
at bedtime.
before 9 AM
with an antacid.
C
Feedback:
Administration of hydrocortisone should take
place every morning before 9 AM. This
minimizes HPA suppression. People should
take the oral preparation with food to decrease
gastric irritation.
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A patient will soon begin long-term treatment
with hydrocortisone after being diagnosed
with Addison's disease. In order to mitigate
11.
the potentially adverse effect of this treatment
regimen, the nurse should encourage the
patient to increase her intake of what nutrient?
Water
Calcium
Sodium
Potassium
B
Feedback:
Due to the potential for reduced bone density,
patients should be encouraged to increase
calcium intake if hydrocortisone is
administered for a prolonged period.
Increased sodium, potassium, and water
intake are not recommended.
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A)
B)
C)
D)
Ans:
A)
B)
C)
D)
Ans:
A patient with a long-standing diagnosis of
Addison's disease has been taking
hydrocortisone for several years, achieving
adequate symptom control. In recent weeks,
the patient has experienced profound stress
12.
resulting from the collapse of his small
business and subsequent conflict with his
business partner. How might the presence of
these stressors affect the patient's medication
regimen?
The patient should take his scheduled
hydrocortisone later in the day.
The ratio of mineralocorticoids to
glucocorticoids should be adjusted.
The patient's hydrocortisone should be
temporarily withheld.
The patient may temporarily require a higher
dose of hydrocortisone.
D
Feedback:
During times of increased stress, the dosage
of the medication may need to be increased.
There would be no need to change the ratio of
mineralocorticoids to glucocorticoids or to
The patient's hydrocortisone should be
temporarily withheld.
The patient may temporarily require a higher
dose of hydrocortisone.
D
Feedback:
During times of increased stress, the dosage
of the medication may need to be increased.
There would be no need to change the ratio of
mineralocorticoids to glucocorticoids or to
take the medications later in the day.
C)
D)
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B)
C)
D)
Ans:
A patient with a diagnosis of Addison's
disease has had fludrocortisone acetate
(Florinef Acetate) added to his medication
13.
regimen by his endocrinologist. What is the
most plausible rationale for this change in
treatment?
The patient's anterior pituitary gland is
overstimulated.
The patient requires increased
mineralocorticoid supplementation.
The patient's adrenal cortex has become
resistant to hydrocortisone.
The patient's GI tract is unable to tolerate
hydrocortisone.
B
Feedback:
If a patient with Addison's disease requires
additional mineralocorticoid supplementation,
then fludrocortisone acetate (Florinef Acetate)
may be indicated. Pituitary dysfunction, GI
intolerance, and resistance to hydrocortisone
are not plausible rationales.
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A patient with Cushing's disease will soon
begin treatment with ketoconazole. When
planning the patient's care, the nurse should
14.
be cognizant of the black box warning for this
drug and consequently monitor what
laboratory values?
White blood cell differential
Blood urea nitrogen and creatinine
AST, ALT, and GGT
Hemoglobin, hematocrit, and red blood cell
count
C
Feedback:
The FDA has issued a black box warning
stating that ketoconazole can cause
hepatotoxicity. As a result, monitoring of liver
function may be a priority over assessment of
white cells, red cells, and renal function.
C)
AST, ALT, and GGT
Hemoglobin, hematocrit, and red blood cell
count
C
Feedback:
The FDA has issued a black box warning
stating that ketoconazole can cause
hepatotoxicity. As a result, monitoring of liver
function may be a priority over assessment of
white cells, red cells, and renal function.
D)
Ans:
When assessing for therapeutic effects of
15. mitotane in a patient with adrenocortical
carcinoma, the nurse should expect to identify
a decrease in agitation.
an audible S3.
A)
B)
C)
D)
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a decrease in blood pressure.
a decrease in urine output.
C
Feedback:
A decrease in blood pressure is an expected
therapeutic effect of mitotane. An audible S3
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is not expected. Mitotane does not address
agitation or high urine output.
C)
D)
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Chapter 46 Physiology of the Autonomic and Central Nervous Systems and
Indications for the Use of Drug Therapy
A patient is scheduled for an exploratory
surgery for cancer. What will cause the
1. release of adrenocorticotropic hormone in
response to this patient's psychological and
physiological stress?
Growth hormone release–inhibiting hormone
(Somatostatin)
Corticotropin-releasing hormone or factor
(CRH or CRF)
Growth hormone–releasing hormone (GHRH)
Thyrotropin-releasing hormone (TRH)
B
Feedback:
Corticotropin-releasing hormone or factor
(CRH or CRF) causes release of corticotropin
(adrenocorticotropic hormone) in response to
stress and threatening stimuli. Growth
hormone release–inhibiting hormone
(somatostatin) inhibits release of growth
hormone. Growth hormone–releasing
hormone causes the release of growth
hormone in response to low blood levels of
GH. Thyrotropin-releasing hormone causes
the release of TSH in response to stress, such
as cold.
B)
(CRH or CRF)
Growth hormone–releasing hormone (GHRH)
Thyrotropin-releasing hormone (TRH)
B
Feedback:
Corticotropin-releasing hormone or factor
(CRH or CRF) causes release of corticotropin
(adrenocorticotropic hormone) in response to
stress and threatening stimuli. Growth
hormone release–inhibiting hormone
(somatostatin) inhibits release of growth
hormone. Growth hormone–releasing
hormone causes the release of growth
hormone in response to low blood levels of
GH. Thyrotropin-releasing hormone causes
the release of TSH in response to stress, such
as cold.
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D)
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A patient has had surgery. After the surgical
procedure, the patient starts to shiver and
2.
chill. What hormone will be released in
response to the reaction to cold?
Thyroid-stimulating hormone
Luteinizing hormone
Corticotropin
Somatostatin
A
Feedback:
Thyroid-stimulating hormone is released in
response to stress, such as exposure to cold.
Luteinizing hormone is released in response
to gonadotropin-releasing hormone.
Corticotropin stimulates the adrenal cortex to
produce corticosteroids. Somatostatin inhibits
the release of growth hormone.
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B)
C)
D)
Ans:
A)
B)
C)
D)
Ans:
A patient is suspected of having Cushing's
3. disease. What hormone is used in the
diagnosis of this disorder?
Growth hormone
Adrenocorticotropic hormone
Thyroid-stimulating hormone
Corticotropin-releasing hormone
D
Feedback:
Corticotropin-releasing hormone can be used
in the diagnosis of Cushing's disease. Growth
hormone is released in response to low blood
levels of growth hormone. Corticotropinreleasing hormone causes the release of
corticotropin (adrenocorticotropic hormone)
in response to stress. Thyroid-stimulating
hormone regulates the secretion of thyroid
hormones.
Adrenocorticotropic hormone
Thyroid-stimulating hormone
Corticotropin-releasing hormone
D
Feedback:
Corticotropin-releasing hormone can be used
in the diagnosis of Cushing's disease. Growth
hormone is released in response to low blood
levels of growth hormone. Corticotropinreleasing hormone causes the release of
corticotropin (adrenocorticotropic hormone)
in response to stress. Thyroid-stimulating
hormone regulates the secretion of thyroid
hormones.
A young man has begun weight training.
Which hormone will be released in response
4.
to the increase in the size and number of
muscle cells?
Growth hormone
Adrenocorticotropic hormone
Thyroid-stimulating hormone
Corticotropin-releasing hormone
A
Feedback:
Growth hormone stimulates the growth of
body tissues, including growth of muscle
cells. Corticotropin-releasing hormone causes
the release of corticotropin
(adrenocorticotropic hormone) in response to
stress. Thyroid-stimulating hormone regulates
the secretion of thyroid hormones.
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B)
C)
D)
Ans:
A)
B)
C)
D)
Ans:
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B)
C)
D)
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An adult is diagnosed with an increased lowdensity lipoprotein cholesterol level. What
5.
hormone level may be low based on this
diagnosis?
Adrenocorticotropic hormone (ACTH)
Oxytocin
Growth hormone
Somatostatin
C
Feedback:
In adults, deficient growth hormone can cause
increased fat, reduced skeletal and heart
muscle mass, reduced strength, reduced
ability to exercise, and worsened cholesterol
levels (increased low-density lipoprotein
cholesterol). Adrenocorticotropic hormone,
oxytocin, and somatostatin do not affect lowdensity lipoprotein.
B)
C)
D)
Ans:
Oxytocin
Growth hormone
Somatostatin
C
Feedback:
In adults, deficient growth hormone can cause
increased fat, reduced skeletal and heart
muscle mass, reduced strength, reduced
ability to exercise, and worsened cholesterol
levels (increased low-density lipoprotein
cholesterol). Adrenocorticotropic hormone,
oxytocin, and somatostatin do not affect lowdensity lipoprotein.
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When teaching young women about the
hormones of reproduction, the nurse explains
6. how the follicle matures and ruptures in
ovulation. Which hormone is needed for this
change?
Luteinizing hormone (LH)
Thyrotropin (TSH)
Follicle-stimulating hormone (FSH)
Leydig's cells
A
Feedback:
LH is important in the maturation and rupture
of the ovarian follicle. TSH regulates the
secretion of thyroid hormones. FSH
stimulates the functions of sex glands.
Leydig's cells are stimulated by LH in men to
secrete androgens.
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B)
C)
D)
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A)
B)
C)
D)
Ans:
A patient has been involved in a motor
7. vehicle accident. Which hormone will be
released in response to his blood loss?
Luteinizing hormone (LH)
Antidiuretic hormone (ADH)
Oxytocin
Melanocyte-stimulating hormone
B
Feedback:
Antidiuretic hormone is also called
vasopressin and is released in response to
blood loss. Luteinizing hormone is important
in ovulation. Oxytocin functions in childbirth
and lactation. Melanocyte-stimulating
hormone plays a role in skin pigmentation.
A patient has been diagnosed with
acromegaly. Which of the following
8.
medications may be ordered to treat this
endocrine disorder?
Gonadorelin hydrochloride (Factrel)
Octreotide (Sandostatin)
Nafarelin (Synarel)
Gonadorelin acetate (Lutrepulse)
B
Feedback:
Prescribers order octreotide for patients with
acromegaly to reduce levels of GH.
Gonadorelin hydrochloride, nafarelin, and
gonadorelin acetate are not administered to
treat acromegaly.
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B)
C)
D)
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A patient is suspected of having adrenal
9. insufficiency. Which hormone may be
administered to diagnose Addison's disease?
Corticotropin (ACTH)
Somatotropin (Humatrope)
Octreotide (Sandostatin)
Leuprolide (Lupron)
A
Feedback:
Corticotropin (ACTH) is sometimes used as a
diagnostic test to differentiate primary adrenal
insufficiency (Addison's disease).
Somatotropin is therapeutically equivalent to
endogenous growth hormone. Octreotide
(Sandostatin) is used for acromegaly.
Leuprolide causes a decrease in testosterone
and estrogen.
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A)
B)
C)
D)
Ans:
A)
B)
C)
D)
Ans:
A patient is diagnosed with infertility. What
10. medication may the nurse administer for the
treatment of infertility?
Thyrotropin alfa (Thyrogen)
Pegvisomant (Somavert)
Menotropins (Pergonal)
Somatotropin (Humatrope)
C
Feedback:
Menotropins (Pergonal) is administered in
combination with HCG to induce ovulation.
Thyrotropin alfa (Thyrogen) is a synthetic
formulation of TSH used as a diagnostic
Thyrotropin alfa (Thyrogen)
Pegvisomant (Somavert)
Menotropins (Pergonal)
Somatotropin (Humatrope)
C
Feedback:
Menotropins (Pergonal) is administered in
combination with HCG to induce ovulation.
Thyrotropin alfa (Thyrogen) is a synthetic
formulation of TSH used as a diagnostic
adjunct for serum thyroglobulin. Pegvisomant
(Somavert) is a growth hormone receptor
antagonist used in the treatment of
acromegaly in adults. Somatotropin
(Humatrope) is administered to children for
impaired growth.
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B)
C)
D)
Ans:
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An adolescent is being treated with growth
hormone. When assessing for potential
11.
adverse effects, what assessment should the
nurse prioritize?
Deep tendon reflexes
Level of anxiety
Respiratory rate
Blood glucose
D
Feedback:
Somatropin decreases insulin sensitivity,
resulting in hyperglycemia. Patients most at
risk for increased insulin sensitivity are those
with obesity, Turner's syndrome, or a family
history of diabetes mellitus. Growth hormone
can cause anxiety, but is not a priority
assessment in this case. The respiratory rate is
not the most important objective assessment
in this case.
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A)
B)
C)
D)
Ans:
A)
B)
C)
D)
Ans:
An adult patient has been diagnosed with a
posterior pituitary lesion that has resulted in
12.
diabetes insipidus. The characteristic sign of
this health problem is
blood glucose levels ≥ 400 mg/dL.
copious urine production.
hyperglycemia that is unresponsive to
exogenous insulin.
hematuria.
B
Feedback:
Characteristic features of DM include
polyuria, with excretion of dilute urine
ranging from 4 L to as much as 30 L.
Hematuria does not normally occur, and
blood glucose levels are not directly affected.
hyperglycemia that is unresponsive to
exogenous insulin.
hematuria.
B
Feedback:
Characteristic features of DM include
polyuria, with excretion of dilute urine
ranging from 4 L to as much as 30 L.
Hematuria does not normally occur, and
blood glucose levels are not directly affected.
C)
D)
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A patient with a traumatic head injury and a
diagnosis of diabetes insipidus is being
treated with intravenous vasopressin
13.
(Pitressin). What change in the patient's status
would prompt the immediate cessation of the
drug infusion?
Infiltration at the IV site
A sudden decrease in urine output
The appearance of blood in the patient's urine
A rapid increase in blood glucose
A
Feedback:
When administering vasopressin
intravenously, it is essential to use extreme
caution due to the risk of extravasation of the
medication, leading to tissue necrosis.
Decreased urine output is a goal of treatment.
Blood in the urine and changes in blood
glucose levels are atypical events.
A)
B)
C)
D)
Ans:
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A)
B)
C)
D)
Ans:
Somatropin has been prescribed for a child
who has been diagnosed with growth
14. hormone deficiency. When providing health
education to the child's parents, what teaching
point should then nurse prioritize?
The correct technique for daily injections of
the drug
The importance of regular blood pressure
monitoring
The rationale for not crushing the extendedrelease tablet
The need to limit the child's activity level for
the duration of treatment
A
Feedback:
Somatropin is administered by daily
injections. Blood pressure monitoring and
activity limitations are not necessary.
C)
release tablet
The need to limit the child's activity level for
the duration of treatment
A
Feedback:
Somatropin is administered by daily
injections. Blood pressure monitoring and
activity limitations are not necessary.
D)
Ans:
A girl who is 7 1/2 years old has received a
diagnosis of precocious puberty from the
15. pediatric endocrinologist. The nurse who
collaborates with this physician should
anticipate the administration of what drug?
Menotropins (Pergonal)
Thyrotropin alfa (Thyrogen)
Cosyntropin (Cortrosyn
Leuprolide acetate (Lupron)
D
Feedback:
Leuprolide is useful for the treatment of
central precocious puberty in children.
Menotropins (Pergonal) stimulates ovulation.
Cosyntropin (Cortrosyn) stimulates the
adrenal cortex to synthesize and secrete
adrenocortical hormones. Thyrotropin alfa
(Thyrogen) stimulates the secretion of
thyroglobulin.
C)
D)
Ans:
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B)
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A)
B)
C)
D)
Ans:
A 13-year-old boy who is in the first
percentile of height for his age has been
referred for care. Which of the following
16.
assessment findings would contraindicate the
safe and effective use of somatropin to treat
his growth deficiency?
The boy has not yet begun puberty.
The boy has low serum albumin levels.
The epiphyses of the boy's long bones have
closed.
The sutures of the boy's skull have not yet
fully closed.
C
Feedback:
Somatropin is ineffective when impaired
growth is present after puberty, when the
epiphyses of the long bones have closed. Low
albumin is not a contraindication to the use of
somatropin. The sutures of the skull close
early in life.
C)
closed.
The sutures of the boy's skull have not yet
fully closed.
C
Feedback:
Somatropin is ineffective when impaired
growth is present after puberty, when the
epiphyses of the long bones have closed. Low
albumin is not a contraindication to the use of
somatropin. The sutures of the skull close
early in life.
D)
A patient's current drug regimen includes
intranasal administration of desmopressin
17. acetate (DDAVP, Stimate). In this patient's
plan of nursing care, what is the most likely
desired outcome of treatment?
The patient's urine output will not exceed 80
mL/h.
The patient will gain 2 cm in height over the
next 6 months.
The patient will ovulate at least once over the
next 8 weeks.
The patient's vertical growth will cease in the
next 4 weeks.
A
Feedback:
Desmopressin acetate (DDAVP, Stimate) is
the prototype posterior pituitary hormone
medication. It is used to treat diabetes
insipidus. Consequently, reduced urine output
is the primary goal of treatment. The drug
does not influence growth or ovulation.
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A)
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Ans:
A)
B)
C)
D)
Ans:
A nurse reviews the current medication
administration record of a patient who has
recently been prescribed octreotide. The nurse
18.
performs this important safety action in order
to prevent drug interactions that could result
in
increased growth.
anaphylaxis.
cardiac complications.
respiratory arrest.
C
Feedback:
Numerous medications combine with
octreotide to result in a prolonged QT interval
with an increased risk of ventricular
dysrhythmia and cardiac arrest. Increased
growth, anaphylaxis, and respiratory arrest are
not noted adverse effects or the result of drug
interactions with octreotide.
B)
C)
D)
Ans:
anaphylaxis.
cardiac complications.
respiratory arrest.
C
Feedback:
Numerous medications combine with
octreotide to result in a prolonged QT interval
with an increased risk of ventricular
dysrhythmia and cardiac arrest. Increased
growth, anaphylaxis, and respiratory arrest are
not noted adverse effects or the result of drug
interactions with octreotide.
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A child has been referred to a pediatric
endocrinologist and has begun treatment with
19. octreotide acetate. What nursing diagnosis
should be noted in the child's plan of nursing
care?
Delayed growth and development
Excess fluid volume
Risk for deficient fluid volume
Altered growth and development
D
Feedback:
Acromegaly is the major clinical indication
for the use octreotide. In this condition,
growth is excessive, not delayed. Fluid
volume is not directly affected.
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B)
C)
D)
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B)
C)
D)
Ans:
A patient who is being cared for in the
intensive care unit (ICU) is receiving
desmopressin. In light of the black box
20.
warning that accompanies this drug, the ICU
nurse should prioritize the assessment of
which of the patient's laboratory values?
Hematocrit
Platelets
Sodium
Calcium
C
Feedback:
The FDA has issued a black box warning
stating that patients taking desmopressin can
develop hyponatremia, leading to seizures.
Consequently, assessment of sodium levels
takes precedence over hematocrit, calcium,
and platelet levels.
Chapter 47 Drug Therapy for Myasthenia Gravis, Alzheimer's Disease, and
Urinary Retention
A patient has atony of the smooth muscle of
the gastrointestinal tract. Which type of
1.
medication may be administered to increase
smooth muscle strength?
Anticholinergic drugs
Cholinergic drugs
Muscle relaxants
Selective serotonin reuptake inhibitors
B
Feedback:
Cholinergic drugs are used to treat atony of
the smooth muscle of the gastrointestinal tract
and urinary systems. Anticholinergic agents
will decrease muscle strength. Muscle
relaxants will decrease muscle strength.
Selective serotonin reuptake inhibitors are not
used for atony of the smooth muscle of the
gastrointestinal tract.
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B)
C)
D)
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B)
C)
D)
Ans:
A patient is diagnosed with Alzheimer's
disease. The nurse should anticipate
2.
administering which of the following
medications?
Bethanechol (Urecholine)
Neostigmine (Prostigmin)
Donepezil (Aricept)
Physostigmine salicylate (Antilirium)
C
Feedback:
Donepezil (Aricept) is used to treat mild to
moderate Alzheimer's disease. Bethanechol
(Urecholine) produces smooth muscle
contractions and is not used to treat
Alzheimer's disease. Neostigmine
(Prostigmin) is not used to treat Alzheimer's
disease; it is used to treat myasthenia gravis.
Physostigmine is not used to treat Alzheimer's
disease; it is an antidote for overdose of
anticholinergic drugs.
A patient with myasthenia gravis is
3. administered neostigmine (Prostigmin). How
does this drug produce its therapeutic effect?
It stimulates the sympathetic nervous system.
It stimulates the parasympathetic nervous
system.
It stimulates the cardiac smooth muscle.
It stimulates the respiratory system.
B
Feedback:
Neostigmine (Prostigmin) stimulates the
parasympathetic nervous system. It does not
stimulate the sympathetic nervous system,
cardiac system, or respiratory system.
A)
B)
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D)
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A patient is administered edrophonium
(Tensilon) to confirm the diagnosis of
myasthenia gravis. What effect will the
4.
edrophonium (Tensilon) have 30 minutes after
the medication administration, which will
confirm the diagnosis?
Improved breathing
Decreased fatigue
Decreased muscle spasms
Increased urinary output
A
Feedback:
Edrophonium (Tensilon) is used to diagnose
myasthenia gravis. After administration, it
will improve breathing in patients who have
myasthenia gravis. Edrophonium will not
decrease fatigue. Edrophonium will not
decrease muscle spasms or increase urinary
output.
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B)
C)
D)
Ans:
A)
B)
C)
A patient with myasthenia gravis is
administered pyridostigmine (Mestinon) for
the first time. She asks the nurse the reason
5.
why she has been changed to this medication.
Which of the following is the nurse's best
response?
“Pyridostigmine (Mestinon) will allow you to
awaken with the ability to swallow.”
“Pyridostigmine (Mestinon) can be taken
every other day.”
“Pyridostigmine (Mestinon) is a faster-release
form of cholinergic agent.”
“Pyridostigmine (Mestinon) is taken one time
A patient with myasthenia gravis is
administered pyridostigmine (Mestinon) for
the first time. She asks the nurse the reason
5.
why she has been changed to this medication.
Which of the following is the nurse's best
response?
“Pyridostigmine (Mestinon) will allow you to
awaken with the ability to swallow.”
“Pyridostigmine (Mestinon) can be taken
every other day.”
“Pyridostigmine (Mestinon) is a faster-release
form of cholinergic agent.”
“Pyridostigmine (Mestinon) is taken one time
per day for better control.”
A
Feedback:
Pyridostigmine is a slow-release form that is
taken at bedtime and allows the patient the
ability to swallow in the morning.
Pyridostigmine is usually taken two times per
day, not every other day. Pyridostigmine is a
slow-release form, not a fast-release form.
Pyridostigmine is taken two times per day, not
one time per day.
A)
B)
C)
D)
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A patient is diagnosed with a paralytic ileus.
6. Which of the following medications will be
administered to treat a paralytic ileus?
Neostigmine (Prostigmin)
Donepezil (Aricept)
Bethanechol (Urecholine)
Ambenonium (Mytelase)
C
Feedback:
Bethanechol (Urecholine) produces smooth
muscle contractions and is used for
obstructive conditions of the gastrointestinal
tract. Neostigmine is used to treat myasthenia
gravis. Donepezil is used to treat Alzheimer's
disease. Ambenonium is used to treat
myasthenia gravis.
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B)
C)
D)
Ans:
A)
B)
C)
D)
Ans:
When administering anticholinesterase drugs,
what assessment finding would indicate the
7.
patient is experiencing a toxic effect of the
medication?
Loss of consciousness
Abdominal distention
Hypertension
Muscle weakness
D
Feedback:
The administration of anticholinesterase
medications can result in profound muscle
weakness. Decreased LOC, abdominal
7.
A patient has been receiving bethanechol
(Urecholine) for 1 week. One hour after the
dose is administered, he develops sweating,
8.
flushing, abdominal cramps, and nausea.
What is the rationale for the development of
these symptoms?
Myasthenic crisis
Cholinergic overdose
Anaphylactic reaction
Pulmonary edema
B
Feedback:
A patient who suffers cholinergic overdose
will experience sweating, flushing, abdominal
cramps, and nausea. An accurate diagnosis
may be determined from timing in relation to
medication. Signs and symptoms having an
onset within approximately 1 hour after a
dose of anticholinesterase drug are likely to
be caused by cholinergic crisis. Signs and
symptoms beginning 3 hours or more after a
drug dose are more likely to be caused by
myasthenic crisis. These symptoms are not
the result of anaphylaxis or pulmonary edema.
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A)
B)
C)
D)
Ans:
patient is experiencing a toxic effect of the
medication?
Loss of consciousness
Abdominal distention
Hypertension
Muscle weakness
D
Feedback:
The administration of anticholinesterase
medications can result in profound muscle
weakness. Decreased LOC, abdominal
distention, and hypertension are not
characteristic adverse effects of the
anticholinesterase medications.
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B)
C)
D)
Ans:
A)
B)
C)
D)
Ans:
A patient who is being treated for myasthenia
gravis is receiving neostigmine, and her pulse
9. drops to 50 after the administration. Which
medication should be administered to treat the
bradycardia?
Atropine
Pseudoephedrine
Propranolol (Inderal)
Bethanechol (Urecholine)
A
Feedback:
Atropine will reverse the muscarinic effects
of cholinergic crisis. Pseudoephedrine will
not affect bradycardia in this patient.
medication should be administered to treat the
bradycardia?
Atropine
Pseudoephedrine
Propranolol (Inderal)
Bethanechol (Urecholine)
A
Feedback:
Atropine will reverse the muscarinic effects
of cholinergic crisis. Pseudoephedrine will
not affect bradycardia in this patient.
Propranolol (Inderal) will not affect the
bradycardia. Bethanechol will increase the
bradycardia.
A)
B)
C)
D)
Ans:
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Which of the following medications is
10. administered for ingestion of clitocybe
mushrooms?
Pyridostigmine (Mestinon)
Donepezil (Aricept)
Rivastigmine (Exelon)
Atropine sulfate
D
Feedback:
Atropine sulfate is the specific antidote for
mushroom poisoning. Pyridostigmine,
donepezil, and rivastigmine are all cholinergic
agents that would contribute to the symptoms
of toxicity.
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A)
B)
C)
D)
Ans:
A)
B)
C)
D)
Ans:
A 33-year-old female patient with a recent
history of visual disturbances and dysphagia
has just been diagnosed with myasthenia
11. gravis. The nurse should recognize that this
patient's health problem is ultimately
attributable to what pathophysiological
process?
Idiopathic overproduction of
anticholinesterase
Autoimmune destruction of acetylcholine
receptors
Demyelination of parasympathetic nerve
pathways
Deficient synthesis of dopamine by the
substantia nigra
B
Feedback:
Myasthenia gravis occurs when antibodies
produced by the body's own immune system
block, alter, or destroy the receptors for
acetylcholine at the neuromuscular junction,
which prevents muscle contraction from
occurring. The disease does not involve
dopamine deficits, demyelination, or excess
C)
pathways
Deficient synthesis of dopamine by the
substantia nigra
B
Feedback:
Myasthenia gravis occurs when antibodies
produced by the body's own immune system
block, alter, or destroy the receptors for
acetylcholine at the neuromuscular junction,
which prevents muscle contraction from
occurring. The disease does not involve
dopamine deficits, demyelination, or excess
anticholinesterase.
D)
A 40-year-old woman has received a
diagnosis of myasthenia gravis (MG) and is
scheduled to begin treatment with oral
12. neostigmine in her home. When providing
relevant health education, the nurse should
emphasize that successful control of MG
symptoms will primarily depend on
matching each dose of neostigmine to the
severity of symptoms at that time.
making lifestyle modifications to prioritize a
healthy diet and regular activity.
adhering strictly to the prescribed
administration schedule.
developing acceptance of the functional
deficits that result from MG.
C
Feedback:
Strict adherence to timely medication
administration promotes optimal blood levels
of neostigmine and optimal symptom control.
Doses are not typically matched to short-term
symptom severity, except in emergencies.
Lifestyle modifications and acceptance may
be of benefit, but pharmacologic therapy is of
paramount importance in the treatment of
MG.
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B)
C)
D)
Ans:
An accidental overdose of neostigmine has
prompted the emergency administration of
atropine. When assessing the patient, the
13.
emergency department nurse should take into
account that this intervention will not relieve
the effects of neostigmine on
skeletal muscle.
smooth muscle.
the heart.
glands.
A
Feedback:
Atropine reverses only the muscarinic effects
13.
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A)
B)
C)
D)
Ans:
emergency department nurse should take into
account that this intervention will not relieve
the effects of neostigmine on
skeletal muscle.
smooth muscle.
the heart.
glands.
A
Feedback:
Atropine reverses only the muscarinic effects
of cholinergic drugs, primarily in the heart,
smooth muscle, and glands. Atropine does not
interact with nicotinic receptors and therefore
cannot reverse the nicotinic effects of skeletal
muscle weakness due to overdose of indirect
anticholinergic drugs.
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A middle-aged female patient has been
admitted to the outpatient treatment unit of
the hospital for an edrophonium (Tensilon)
test. Shortly after the administration of the
14. medication, the patient reports that her muscle
strength is significantly weaker than before
the test. The nurse who is participating in the
test should recognize that this finding is
suggestive of what diagnosis?
Alzheimer's disease
Anticholinergic crisis
Myasthenia gravis
Cholinergic crisis
D
Feedback:
If the edrophonium test makes the patient
even weaker, the diagnosis is cholinergic
crisis.
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B)
C)
D)
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A)
B)
C)
D)
E)
Ans:
Following recent changes in memory and
personality, a 72-year-old man is undergoing
neurological testing to rule out Alzheimer's
15.
disease. The nurse is aware that this disease is
characterized by what pathophysiological
phenomena? Select all that apply.
Meningiomas
Neuritic plaques
Neurofibrillary tangles
Arteriovenous malformations (AVMs)
Gliomas
C, D
Feedback:
The neuropathologic hallmarks of Alzheimer's
disease are neuritic plaques and
neurofibrillary tangles. Gliomas,
meningiomas, and AVMs are not associated
with Alzheimer's disease.
B)
C)
D)
E)
Ans:
Neuritic plaques
Neurofibrillary tangles
Arteriovenous malformations (AVMs)
Gliomas
C, D
Feedback:
The neuropathologic hallmarks of Alzheimer's
disease are neuritic plaques and
neurofibrillary tangles. Gliomas,
meningiomas, and AVMs are not associated
with Alzheimer's disease.
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An 80-year-old man has been diagnosed with
early-stage Alzheimer's disease and has begun
treatment with donepezil (Aricept). When
16.
providing health education to the patient and
his wife, the nurse should identify what goal
of treatment?
Remission of Alzheimer's disease
Cure of Alzheimer's disease
Improvement of cognition and function
Resolution of memory and cognitive deficits
C
Feedback:
The goal of drug therapy for Alzheimer's
disease is to slow the loss of memory and
cognition, thus preserving the independence
of the individual person for as long as
possible. Remission, cure, and resumption of
preillness levels of memory and cognition are
unrealistic goals.
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B)
C)
D)
Ans:
A)
B)
C)
D)
Ans:
An older adult patient with a diagnosis of
moderate Alzheimer's disease will soon return
home with her husband. How can the nurse
17.
best facilitate the safe and effective
administration of donepezil in the home
setting?
Have the patient explain the rationale for drug
therapy repeatedly before discharge.
Provide a detailed drug monograph to the
patient and her husband and offer to answer
any questions.
Assess the patient's need for home care.
Teach the patient's husband to administer the
medication in a timely and safe manner.
D
Feedback:
It is important for the home care nurse to
work with responsible family members in
such cases to ensure accurate drug
administration. Assessing the family's need
for home care may be warranted, but this
action does not necessarily ensure safe drug
C)
Assess the patient's need for home care.
Teach the patient's husband to administer the
medication in a timely and safe manner.
D
Feedback:
It is important for the home care nurse to
work with responsible family members in
such cases to ensure accurate drug
administration. Assessing the family's need
for home care may be warranted, but this
action does not necessarily ensure safe drug
administration. The presence of moderate
Alzheimer's disease may preclude effective
patient teaching. Written teaching materials
must normally be supplemented by other
forms of teaching.
D)
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A nurse is conducting health education with a
man who has Alzheimer's disease and his
daughter, who is his primary caregiver. The
18. man has been deemed to be a good candidate
for treatment with donepezil (Aricept) and
will soon begin taking this medication. What
teaching point should the nurse convey?
“Aricept should be taken 1 hour before or 2
hours after any dairy products.”
“It's important to take this medication at
bedtime.”
“Aricept should be taken with food to reduce
the chance of stomach upset.”
“If you don't notice any cognitive
improvement within 2 weeks, the drug should
be discontinued.”
B
Feedback:
Aricept should normally be taken at bedtime.
It does not have to be taken with food. Dairy
does not interfere with pharmacokinetics. The
drug should be continued even if
improvement is not noticeable.
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A)
B)
C)
A man with a neurogenic bladder secondary
to a spinal tumor has been taking bethanechol.
The patient has illuminated his call light, and
19. the nurse has found him anxious, diaphoretic,
and visibly flushed. Following a safety
assessment, what action should the nurse
take?
Prepare to administer an IV dose of
epinephrine to mitigate the effects of
acetylcholine.
Contact the physician as the patient may be
experiencing a cholinergic crisis.
Insert a Foley catheter as the patient may have
to a spinal tumor has been taking bethanechol.
The patient has illuminated his call light, and
19. the nurse has found him anxious, diaphoretic,
and visibly flushed. Following a safety
assessment, what action should the nurse
take?
Prepare to administer an IV dose of
epinephrine to mitigate the effects of
acetylcholine.
Contact the physician as the patient may be
experiencing a cholinergic crisis.
Insert a Foley catheter as the patient may have
excessive urine in his bladder.
Assess the volume of the patient's bladder
contents using a bladder ultrasound.
B
Feedback:
The presence of sweating and skin flushing in
a patient taking bethanechol is suggestive of a
cholinergic crisis. This is a medical
emergency that warrants prompt intervention
by the care team. This problem is not treated
with epinephrine. Assessing the patient's
bladder or inserting a Foley catheter is not
sufficient.
A)
B)
C)
D)
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B)
C)
D)
Ans:
A military nurse is part of a team reviewing
the appropriate response to chemical weapons
attacks, including sarin, tabun, and soman.
20.
When reviewing the physiology of a response
to such drugs, the nurse should identify what
goal of treatment?
Restore anticholinesterase function.
Restore GABA function.
Restore dopamine function.
Increase serotonin reuptake.
A
Feedback:
These drugs are irreversible anticholinesterase
agents. The goal of treatment, such as
atropine administration, is to restore normal
function of anticholinesterase and rid
synapses of excessive acetylcholine.
Chapter 48 Drug Therapy for Parkinson's Disease, Urinary Spasticity, and
Disorders Requiring Anticholinergic Drug Therapy
A 60-year-old male patient has developed a
tremor of the right hand with a pill-rolling
motion. Upon interviewing the patient, he
1. states he sustained several head injuries
playing football. Based on this information,
what do you suspect the patient is suffering
from?
Seizure disorder
Degenerative joint disease
Amyotrophic lateral sclerosis
Parkinson's disease
D
Feedback:
Parkinson's disease is a chronic, progressive,
degenerative disorder of the central nervous
system characterized by resting tremor,
bradykinesia, rigidity, and postural instability.
The patient is not experiencing degenerative
joint disease. The patient is not showing signs
of symptoms of a seizure disorder. The patient
has rigidity with tremors, not the signs of
muscle weakness that are found in
amyotrophic lateral sclerosis.
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B)
C)
D)
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B)
C)
D)
Ans:
A patient has developed symptoms of rigidity
and bradykinesia. Which of the following
2.
medications has been linked to secondary
parkinsonism?
Haloperidol
Furosemide (Lasix)
Psyllium hydrophilic mucilloid (Metamucil)
Valproic acid (Valproate)
A
Feedback:
Drugs that deplete dopamine stores or block
dopamine receptors, including the older
antipsychotic drugs (phenothiazines and
haloperidol), reserpine, and metoclopramide,
can produce movement disorders such as
secondary parkinsonism. Furosemide does not
deplete dopamine stores. Psyllium does not
deplete dopamine stores. Valproic acid does
not deplete dopamine stores.
A patient is being treated for Parkinson's
disease and has been prescribed both
3. levodopa (L-dopa) and carbidopa (Lodosyn).
Why is this course of combination treatment
most effective?
Levodopa restores dopamine and carbidopa
decreases peripheral breakdown of levodopa.
Levodopa decreases the toxic effects of
carbidopa to reduce the extrapyramidal
reaction.
Carbidopa increases the peripheral breakdown
of levodopa to hasten its onset and peak.
Levodopa and carbidopa, when combined,
enhance voluntary movement to improve gait.
A
Feedback:
Levodopa restores dopamine levels and, in
combination with carbidopa, decreases the
peripheral breakdown of levodopa and allows
more to reach the brain. Levodopa does not
decrease the toxic effects of carbidopa to
reduce the extrapyramidal reaction. Carbidopa
does not increase the peripheral breakdown of
levodopa to increase its effectiveness.
Levodopa and carbidopa combined do not
exacerbate abnormal voluntary movement to
increase gait.
A)
B)
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C)
D)
A)
B)
C)
D)
Ans:
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Ans:
A patient who suffers from Parkinson's
disease is being treated with levodopa/
4. carbidopa. Which of the following disorders
will result in the discontinuation of this drug
based on a disease-related contraindication?
Human immune deficiency virus
Human papillomavirus
Transient ischemic attacks
Narrow-angle glaucoma
D
Feedback:
Since levodopa can dilate pupils and raise
intraocular pressure, it is contraindicated in
narrow-angle glaucoma. Levodopa is not
contraindicated in patients with human
immune deficiency virus. Levodopa is not
contraindicated in patients with human
papillomavirus. Levodopa is not listed as a
contraindication with TIAs.
Human papillomavirus
Transient ischemic attacks
Narrow-angle glaucoma
D
Feedback:
Since levodopa can dilate pupils and raise
intraocular pressure, it is contraindicated in
narrow-angle glaucoma. Levodopa is not
contraindicated in patients with human
immune deficiency virus. Levodopa is not
contraindicated in patients with human
papillomavirus. Levodopa is not listed as a
contraindication with TIAs.
A patient with long-standing Parkinson's
disease has been prescribed entacapone
(Comtan). The patient asks the nurse to
5.
describe exactly how this medication works.
Which of the following responses is most
appropriate?
“Entacapone is best given parenterally to
relieve symptoms.”
“Entacapone inhibits COMT so that dopamine
is active for a longer time.”
“It increases the metabolism of levodopa in
the bloodstream.”
“It increases the amount of dopamine that
your brain creates.”
B
Feedback:
Entacapone is a COMT inhibitor. COMT
plays a role in brain metabolism of dopamine.
Entacapone is administered orally, not
parenterally. Entacapone does not increase the
metabolism of dopamine in the bloodstream.
It inhibits the metabolism of levodopa in the
blood stream. Entacapone is 90% excreted in
the biliary tract and feces and 10% in the
urine.
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B)
C)
D)
Ans:
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B)
C)
D)
Ans:
A patient with Parkinson's disease is being
treated with rasagiline (Azilect). This
medication inhibits the metabolism of
6.
dopamine by monoamine oxidase. Which of
the following foods should the patient be
instructed to avoid?
Cheddar cheese and Polish sausage
Ham and rye bread
Roast beef and horseradish
Dairy products
A
Feedback:
Cheddar cheese and Polish sausage are high
in tyramine, which produces a life-threatening
the following foods should the patient be
instructed to avoid?
Cheddar cheese and Polish sausage
Ham and rye bread
Roast beef and horseradish
Dairy products
A
Feedback:
Cheddar cheese and Polish sausage are high
in tyramine, which produces a life-threatening
reaction of hypertension when combined with
rasagiline. The other listed foods are not high
in tyramine.
A patient with Parkinson's disease has been
prescribed rasagiline. When educating this
7. patient on this medication, which herbal
supplement has the potential to produce
hyperpyrexia and death with rasagiline?
Ginger
Dextromethorphan
Garlic
St. John's wort
D
Feedback:
Rasagiline administered with the herbal
supplement St. John's wort will enhance the
stimulation of serotonergic receptors to cause
hyperpyrexia and death. Dextromethorphan
can produce the same reaction but is not an
herbal supplement. Ginger and garlic are
herbal supplements but will not produce
hyperpyrexia and death.
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A)
B)
C)
D)
Ans:
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A)
B)
C)
D)
Ans:
A)
B)
C)
D)
Ans:
An 80-year-old patient has been prescribed an
anticholinergic agent for treatment of
8.
Parkinson-related symptoms. What patient
education should be provided?
“Avoid high environmental temperatures.”
“Anticholinergics increase mental alertness.”
“It is safe to take Sudafed for a cold.”
“You may experience urinary incontinence.”
A
Feedback:
Anticholinergic drugs decrease sweating and
may cause heat stroke. The patient should be
instructed to avoid high environmental
temperatures. Anticholinergic agents will
decrease mental alertness. Sudafed will
produce anticholinergic effects and should not
be administered. Anticholinergic agents
produce urinary retention, not incontinence.
“Anticholinergics increase mental alertness.”
“It is safe to take Sudafed for a cold.”
“You may experience urinary incontinence.”
A
Feedback:
Anticholinergic drugs decrease sweating and
may cause heat stroke. The patient should be
instructed to avoid high environmental
temperatures. Anticholinergic agents will
decrease mental alertness. Sudafed will
produce anticholinergic effects and should not
be administered. Anticholinergic agents
produce urinary retention, not incontinence.
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A 77-year-old male patient with Parkinson's
disease will soon begin treatment with
9. levodopa, carbidopa, and entacapone
(Stalevo). Prior to starting this course of
treatment, the nurse must ensure that
the patient has committed to having weekly
blood work drawn for the next 2 months.
the patient has completed an anticholinergic
challenge in a clinical setting.
the patient's existing dose of levodopa has
been reduced.
the patient has a prognosis for complete
recovery from Parkinson's disease.
B
Feedback:
Patients whose medication regime is being
changed to Stalevo should be administered
levodopa and the adjunctive entacapone. The
levodopa dose should be adjusted prior to the
conversion to Stalevo therapy. Weekly blood
work and the completion of an anticholinergic
challenge are not necessary. Complete
recovery from Parkinson's disease is not a
realistic goal.
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D)
Ans:
The nurse is teaching a woman who has
Parkinson's disease about the dietary
10. implications of her upcoming treatment with
levodopa/carbidopa. What should the nurse
teach this patient?
“It's important to take this medication on a
full stomach so that it doesn't make you
nauseous.”
“Most people find that it's best to take this
medication at bedtime, provided you haven't
snacked in the evening.”
“If possible, try to eat extra protein when
you're taking this medication.”
“Dairy products will make this medication
ineffective, so make sure you don't take them
levodopa/carbidopa. What should the nurse
teach this patient?
“It's important to take this medication on a
full stomach so that it doesn't make you
nauseous.”
“Most people find that it's best to take this
medication at bedtime, provided you haven't
snacked in the evening.”
“If possible, try to eat extra protein when
you're taking this medication.”
“Dairy products will make this medication
ineffective, so make sure you don't take them
at the same time.”
A
Feedback:
Levodopa/carbidopa is administered with or
just after food or following a meal to reduce
nausea and vomiting. Levodopa/carbidopa is
not administered with a high-protein diet.
Dairy products do not interfere with
pharmacokinetics.
A)
B)
C)
D)
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A woman is admitted to the emergency
department with a diagnosis of sinus
11. bradycardia. The patient has been prescribed
atropine 0.5 mg IV. How often can atropine
be administered?
Every 24 hours
Every 6 hours
Every 30 minutes
Every 3 to 5 minutes
D
Feedback:
Atropine 0.5 mg should be administered IV
every 3 to 5 minutes and may be repeated up
to 3 mg. Atropine can be administered every
24 hours, but this administration is not the
recommended therapy for bradycardia.
Atropine can be administered every 6 hours,
but this administration is not the
recommended therapy for bradycardia.
Atropine can be given in 30 minutes, but this
administration is not the recommended
therapy for bradycardia.
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12.
A)
B)
C)
A patient is administered atropine to increase
the heart rate. What is the action of atropine?
It blocks the parasympathetic vagal
stimulation.
It exacerbates the parasympathetic vagal
stimulation.
It provides long-acting antihistamine
blockage.
It blocks cell wall synthesis of gram-negative
12.
A)
B)
C)
D)
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A patient is administered atropine to increase
the heart rate. What is the action of atropine?
It blocks the parasympathetic vagal
stimulation.
It exacerbates the parasympathetic vagal
stimulation.
It provides long-acting antihistamine
blockage.
It blocks cell wall synthesis of gram-negative
bacilli.
A
Feedback:
Moderate to large doses of atropine increase
the heart rate by blocking parasympathetic
vagal stimulation. The exacerbation of the
parasympathetic vagal stimulation is opposite
the effect of atropine. The blockage of
histamine is seen with the antihistamine
medications, not anticholinergic agents.
Atropine does not block cell wall synthesis.
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A patient has been administered atropine for
sinus bradycardia. Which of the following
13.
symptoms is noted with large doses of
atropine?
Pallor
Flushing
Edema
Incontinence
B
Feedback:
Large doses of atropine cause facial flushing
because of dilation of blood vessels in the
neck. Pallor, edema, and incontinence are not
caused by dilation of blood vessels in the
neck.
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A patient is scheduled for a
hemithyroidectomy. She has been prescribed
an anticholinergic agent prior to surgery. Why
14.
is it important to administer the
anticholinergic agent in the preoperative
phase?
It will prevent tachycardia.
It will decrease respiratory secretions.
It will decrease gastric motility.
It relaxes the detrusor muscle.
B
Feedback:
In preoperative patients, the nurse assesses for
diminished secretions, particularly when an
anticholinergic is administered for head and
neck surgery. The administration of an
phase?
It will prevent tachycardia.
It will decrease respiratory secretions.
It will decrease gastric motility.
It relaxes the detrusor muscle.
B
Feedback:
In preoperative patients, the nurse assesses for
diminished secretions, particularly when an
anticholinergic is administered for head and
neck surgery. The administration of an
anticholinergic agent will not prevent
tachycardia. Anticholinergic agents do
decrease gastric motility, but this rationale is
not a reason for administration in the
preoperative phase. The anticholinergic
agents cause relaxation of the detrusor
muscle, but this rationale is not the reason for
administration of the medication in the
preoperative phase.
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The physician orders benztropine mesylate
(Cogentin). What disease process would
15.
contraindicate the administration of this
anticholinergic medication?
Diabetes mellitus
Myocardial infarction
Narrow-angle glaucoma
Hyperparathyroidism
C
Feedback:
Narrow-angle glaucoma will result in
increased intraocular pressure, and the patient
should not receive the anticholinergic agent.
Patients who suffer from diabetes mellitus,
myocardial infarction, or hyperparathyroidism
can normally be administered anticholinergic
agents.
The physician has ordered scopolamine
transdermally for motion sickness. Which of
16. the following statements by the patient
indicates an understanding of the medication's
administration guideline?
“I will place it on my chest each morning.”
“I will use it when I am sick to my stomach.”
“I will change the patch every 4 hours.”
“I will change the patch every 3 days.”
D
Feedback:
Scopolamine is used for motion sickness. The
disk (Transderm-V) protects against motion
sickness for 72 hours. The scopolamine patch
is applied behind the ear, not to the chest. The
administration guideline?
“I will place it on my chest each morning.”
“I will use it when I am sick to my stomach.”
“I will change the patch every 4 hours.”
“I will change the patch every 3 days.”
D
Feedback:
Scopolamine is used for motion sickness. The
disk (Transderm-V) protects against motion
sickness for 72 hours. The scopolamine patch
is applied behind the ear, not to the chest. The
patch is used prior to the patient experiencing
nausea. The patch is not changed every 4
hours.
A patient with myasthenia gravis is
experiencing rhinorrhea. Which of the
17.
following medications should not be
administered to the patient?
Azelastine hydrochloride (Astelin)
Ipratropium (Atrovent)
Fexofenadine (Allegra)
Nedocromil sodium (Tilade)
B
Feedback:
Ipratropium (Atrovent) is administered for
rhinorrhea, but is contraindicated in patients
who have been diagnosed with myasthenia
gravis because of its anticholinergic effects.
Azelastine hydrochloride (Astelin),
fexofenadine (Allegra), and nedocromil
sodium (Tilade) are not contraindicated for
patients with myasthenia gravis.
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B)
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A patient is suffering from urinary urgency
and frequency. Which of the following
18.
medications will assist in treating the patient's
symptoms of urinary frequency?
Belladonna tincture
Homatropine hydrobromide
Hyoscyamine (Anaspaz)
Ipratropium (Atrovent)
C
Feedback:
Hyoscyamine (Anaspaz) is a belladonna
alkaloid used in genitourinary disorders
characterized by spasm, increased secretion,
and increased motility. Belladonna tincture is
used for GI disorders because of its
antispasmodic effect. Homatropine
hydrobromide is used as an eyedrop to
produce mydriasis and cycloplegia.
Ipratropium (Atrovent) is used to treat
rhinorrhea.
Homatropine hydrobromide
Hyoscyamine (Anaspaz)
Ipratropium (Atrovent)
C
Feedback:
Hyoscyamine (Anaspaz) is a belladonna
alkaloid used in genitourinary disorders
characterized by spasm, increased secretion,
and increased motility. Belladonna tincture is
used for GI disorders because of its
antispasmodic effect. Homatropine
hydrobromide is used as an eyedrop to
produce mydriasis and cycloplegia.
Ipratropium (Atrovent) is used to treat
rhinorrhea.
A patient has been diagnosed with chronic
obstructive pulmonary disease. The patient is
to be administered tiotropium bromide
19.
(Spiriva HandiHaler). The patient's creatinine
level is 25. What is the patient at risk for
developing?
Drug toxicity
Pneumonia
Hepatotoxicity
Central nervous system depression
A
Feedback:
The patient has an elevated creatinine level.
Tiotropium bromide is eliminated by the renal
system, and patients with moderate to severe
renal dysfunction should be carefully
monitored for drug toxicity.
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A patient has been administered
chlorpromazine (Thorazine) for many years to
treat his psychotic disorder. He has recently
developed extrapyramidal symptoms related
20.
to long-term administration of this drug.
Which of the following medications can be
administered to assist in relieving these
symptoms?
Diazepam (Valium)
Darifenacin (Enablex)
Trihexyphenidyl (Trihexy)
Trospium chloride (Sanctura)
C
Feedback:
Trihexyphenidyl (Trihexy) is used in the
treatment of parkinsonism and extrapyramidal
reactions caused by antipsychotic drugs.
Valium is a benzodiazepine and is not used
for this purpose. Darifenacin is used for the
treatment of overactive bladder. Trospium
B)
C)
D)
Ans:
Darifenacin (Enablex)
Trihexyphenidyl (Trihexy)
Trospium chloride (Sanctura)
C
Feedback:
Trihexyphenidyl (Trihexy) is used in the
treatment of parkinsonism and extrapyramidal
reactions caused by antipsychotic drugs.
Valium is a benzodiazepine and is not used
for this purpose. Darifenacin is used for the
treatment of overactive bladder. Trospium
chloride (Sanctura) reduces the tone of the
smooth muscle in the bladder.
Chapter 49 Drug Therapy With Opioids
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A surgical patient has highly elevated AST
and ALT levels. Standard orders specify that
1. she is to receive morphine sulfate 10 mg
postoperatively. What action should the nurse
take prior to administering the medication?
Draw up half of the medication for
administration.
Notify the physician for a reduced dosage.
Assess the patient's respiratory status.
Assess the patient's pain tolerance.
B
Feedback:
Morphine and meperidine form
pharmacologically active metabolites. Thus,
liver impairment can interfere with
metabolism, and kidney impairment can
interfere with excretion. Drug accumulation
and increased adverse effects may occur if
dosage is not reduced. The nurse cannot
administer half of the medication without a
physician's order. It is important to assess the
patient's respiratory status before
administration, but this action is not the
primary intervention in this case. Narcotics
prior to surgery are administered to increase
pain tolerance during the surgical procedure,
not during the preoperative phase.
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An outpatient has been prescribed
hydrocodone for back pain related to a
2. compression fracture. Which of the following
interventions should the patient be taught
regarding the medication administration?
Consume a diet high in fiber.
Decrease activity due to pain.
Elevate the lower extremities.
Take aspirin with the medication.
A
An outpatient has been prescribed
hydrocodone for back pain related to a
2. compression fracture. Which of the following
interventions should the patient be taught
regarding the medication administration?
Consume a diet high in fiber.
Decrease activity due to pain.
Elevate the lower extremities.
Take aspirin with the medication.
A
Feedback:
Hydrocodone is an opioid, which, in the
gastrointestinal tract, slows motility. To
prevent constipation, the patient should
consume a diet high in fiber. A decrease in
activity due to pain will increase constipation.
Elevating the lower extremities will not
increase or decrease pain. Hydrocodone
should not be routinely combined with aspirin
unless prescribed by the physician.
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A hospice patient has been ordered morphine
(Roxanol) 5 mg sub-Q every 2 hours.
3.
Roxanol contains 10 mg/mL. How many
milliliters will be administered?
0.25 mL
0.5 mL
1 mL
2 mL
B
Feedback:
5 mg/X = 10 mg/mL. The calculation results
in 0.5 mL. The administration of 0.25, 1, or 2
mL is incorrect.
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A patient who suffers from cancer pain is
receiving morphine every 2 hours. For which
4.
of the following should the family be taught
to assess while the patient is on morphine?
Diarrhea
Respiratory depression
Lung sounds
Urinary incontinence
B
Feedback:
The administration of morphine can result in
respiratory depression. The family should be
taught to assess the patient for respiratory
depression. Morphine sulfate can be
administered to treat severe diarrhea. The
patient's lung sounds are important to assess,
but only after the nurse assesses for
respiratory depression. Morphine does not
cause urinary incontinence.
Respiratory depression
Lung sounds
Urinary incontinence
B
Feedback:
The administration of morphine can result in
respiratory depression. The family should be
taught to assess the patient for respiratory
depression. Morphine sulfate can be
administered to treat severe diarrhea. The
patient's lung sounds are important to assess,
but only after the nurse assesses for
respiratory depression. Morphine does not
cause urinary incontinence.
A patient is admitted to the surgical division
after a mastectomy. The patient has a PCA
pump and states to you that she is fearful she
5.
will overdose on morphine. Which of the
following interventions is most appropriate to
teach the patient?
“The pump will administer all of the doses, so
you don't have to worry.”
“If you follow the instructions, that won't
happen to you.”
“The device is preset, so you cannot receive
more than you need.”
“The device will give you a placebo when
you press it often.”
C
Feedback:
PCA pumps deliver a basic amount of
analgesic by continuous infusion, with the
patient injecting additional doses when
needed. The amount of the drug is preset and
limited. The pump will administer a basal
rate, but the patient can administer the
medication at preset intervals. Telling the
patient not to worry is not effective teaching
or use of therapeutic communication. Telling
the patient to follow the instructions is not
effective teaching or use of therapeutic
communication. Instructing the patient on a
placebo is not effective teaching or use of
therapeutic communication.
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A patient has been given MS Contin. You
enter the room and the patient is
6. unresponsive. His respirations are 6 breaths
per minute. What medication will be ordered
for the patient?
Naloxone (Narcan)
Capsaicin (Zostrix)
Butorphanol (Stadol)
Nalbuphine (Nubain)
A
Feedback:
Naloxone (Narcan) has long been the drug of
choice to treat respiratory depression caused
by an opioid. Capsaicin is made from cayenne
pepper and applied topically for pain relief.
Butorphanol (Stadol) is a synthetic, Schedule
IV agonist similar to morphine in analgesic
effects and ability to cause respiratory
depression. Nalbuphine (Nubain) is a
synthetic analgesic used for moderate to
severe pain.
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A patient has been administered an opioid.
7. For which of the following effects should the
patient be assessed?
Oliguria
Decreased level of consciousness
Edema
Tachycardia
B
Feedback:
Opioids will produce decreased LOC.
Oliguria is not a result of the administration
of an opioid. Edema is not a result of the
administration of an opioid. Tachycardia is
not a result of the administration of an opioid.
A nurse is teaching a patient about her
prescription for Tylenol #3 that she will take
8.
at home. This medication consists of
acetaminophen and what other drug?
Codeine
Acetylsalicylic acid (aspirin)
Methadone (Dolophine)
Tramadol (Ultram)
A
Feedback:
Tylenol #3 is acetaminophen (Tylenol) and
8.
A patient is near the end of life and has
developed increased respiratory secretions
9. and labored breathing. The physician is likely
to order which of the following medications
to decrease these symptoms?
Meclizine (Antivert)
Ampicillin
Naloxone (Narcan)
Morphine sulfate
D
Feedback:
Morphine is used for the treatment of acute
pulmonary edema. Meclizine (Antivert) is
given for dizziness. Ampicillin is used to treat
infection. Naloxone (Narcan) is the opioid
antidote.
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A)
B)
C)
D)
Ans:
prescription for Tylenol #3 that she will take
at home. This medication consists of
acetaminophen and what other drug?
Codeine
Acetylsalicylic acid (aspirin)
Methadone (Dolophine)
Tramadol (Ultram)
A
Feedback:
Tylenol #3 is acetaminophen (Tylenol) and
codeine. Acetylsalicylic acid (aspirin) is not
combined with acetaminophen (Tylenol).
Methadone (Dolophine) is not combined with
Tylenol. Tramadol (Ultram) is not combined
with Tylenol.
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A patient has been receiving morphine sulfate
5 mg IV every 4 hours for the past several
10. days. She states that the pain is not being
relieved as well as it was in the past. What is
the reason for this development?
She has developed a dependency on the
morphine.
She has metastatic cancer and is dying.
She has greater pain with inactivity.
She has developed tolerance to morphine.
D
Feedback:
Larger-than-usual doses of morphine are
required to treat pain in opiate-tolerant
people. The patient has not developed a
dependence on morphine. A patient with
metastatic cancer will require increasing pain
management, but this feature is not the
rationale for the patient's statement. The
increased pain is not related to inactivity.
She has metastatic cancer and is dying.
She has greater pain with inactivity.
She has developed tolerance to morphine.
D
Feedback:
Larger-than-usual doses of morphine are
required to treat pain in opiate-tolerant
people. The patient has not developed a
dependence on morphine. A patient with
metastatic cancer will require increasing pain
management, but this feature is not the
rationale for the patient's statement. The
increased pain is not related to inactivity.
In which of the following patients should the
11. nurse question the physician's order for IV
morphine?
An 88-year-old female with failure to thrive
A 45-year-old female, 1-day postoperative
mastectomy
An 8-year-old male with a fractured femur
A 17-year-old female, 1-day postoperative
appendectomy
A
Feedback:
Opioid analgesics should be used cautiously
in older adults, especially if they are
debilitated. Treatment with morphine 1 day
after mastectomy is appropriate for pain
management. The treatment of pain with
morphine is appropriate for a patient with a
fractured femur. The treatment of pain with
morphine is appropriate for a patient who is
1-day postoperative for an appendectomy.
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B)
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A 30-year-old male patient has been ordered
Demerol 75 mg IM every 4 hours after a
12.
fractured femur. What action should the nurse
take?
Give the medication as ordered.
Administer half the dose.
Call the physician for a smaller dose.
Give the dose by mouth.
A
Feedback:
The patient should be administered the full
dose of medication, which is within dosing
recommendations. A male patient with a
fractured femur who has adequate hepatic and
renal function should not receive a lower dose
of Demerol and should not receive the
medication by mouth.
B)
C)
D)
Ans:
Administer half the dose.
Call the physician for a smaller dose.
Give the dose by mouth.
A
Feedback:
The patient should be administered the full
dose of medication, which is within dosing
recommendations. A male patient with a
fractured femur who has adequate hepatic and
renal function should not receive a lower dose
of Demerol and should not receive the
medication by mouth.
A nurse is instructing a patient on the
13. administration of an opioid medication. What
medication effect will most likely develop?
Lower extremity paresthesia
Drowsiness
Occipital headache
Polyuria
B
Feedback:
Drowsiness and sedation are results of central
nervous system depression. The patient will
not develop lower extremity paresthesia,
occipital headache, or polyuria. If these
effects develop, they are not related to the
opioid medication.
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A patient has been ordered a fentanyl patch
known as Duragesic for chronic pain. What
14.
patient teaching should be provided to the
patient and family?
Remove the patch every 3 days.
Apply it to the chest only.
Apply it for breakthrough pain.
Remove it daily and clean skin.
A
Feedback:
Duragesic has a slow onset of action, but lasts
about 72 hours. Duragesic can be applied to
other areas of the skin, not solely on the chest.
Duragesic is not applied for breakthrough
pain. Duragesic is not removed daily.
What is the most effective way to evaluate the
15. patient's pain response after administering an
opioid analgesic?
Observe the patient when he/she is not aware
you are assessing him/her.
Ask another nurse to assess the patient's
response to the medication.
Using a pain scale, ask the patient to describe
the pain.
Ask the family to determine the patient's
response to the pain.
C
Feedback:
Asking the patient to describe the pain using a
pain scale is the most effective assessment of
pain response. Observing the patient when he/
she is unaware is an objective assessment and
does not represent a true pain experience.
Asking another nurse to assess the patient's
response will not provide accurate data.
Asking the family to determine the patient's
response will not provide accurate data.
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C)
D)
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Nonopioid analgesics may sometimes be
16. added to a narcotic analgesic. What action
will result?
Antagonism
Additive effect
Interference
Increased excretion
B
Feedback:
Aspirin and Tylenol are added to narcotic
analgesics for additive effects of pain relief
without the addition of narcotic adverse
effects. Aspirin and Tylenol do not provide an
antagonistic effect. Aspirin and Tylenol do not
cause an interference of action. Aspirin and
Tylenol will not increase excretion.
A 16-year-old has been brought to the
emergency department by his football coach
17. after twisting his ankle during a practice drill.
Diagnostic testing reveals a fracture. This
patient is experiencing what type of pain?
Acute somatic pain
Acute cutaneous pain
Visceral pain
Neuropathic pain
A
Feedback:
Sprains and other traumatic injuries are
examples of acute somatic pain. Somatic pain
results from stimulation of nociceptors in
skin, bone, muscle, and soft tissue. Visceral
pain, which is diffuse and not well localized,
results when nociceptors are stimulated in
abdominal or thoracic organs and their
surrounding tissues. Neuropathic pain is
caused by lesions or physiologic changes that
injure peripheral pain receptors, nerves, or the
central nervous system. Cutaneous pain is not
a recognized category.
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A)
B)
C)
D)
Ans:
A patient with traumatic injuries describes his
current pain as being “unbearable.” The
18.
pathophysiology of pain begins with a signal
from
myelin sheaths.
nociceptors.
baroceptors.
synapses.
B
Feedback:
For a person to feel pain, the signal from
nociceptors in peripheral tissues must be
transmitted to the spinal cord, then to the
hypothalamus and cerebral cortex in the brain.
Myelin sheaths, synapses, and baroceptors are
not directly involved in pain transmission.
A 54-year-old woman is being admitted to the
postsurgical unit following a transverse rectus
abdominis myocutaneous (TRAM) flap. The
19.
patient's care plan specifies the use of
preemptive analgesia. This approach to pain
control will involve
frequent administration of high-dose opioids.
simultaneous use of analgesics from different
drug classes.
alternating administration of opioid
antagonists with opioid agonists.
patient-controlled analgesia.
B
Feedback:
Preemptive analgesia is used to reduce
postsurgical pain by simultaneously
administering medications from different drug
classes to suppress pain by blocking multiple
pain pathways. It is not synonymous with
PCA and does not require alternation between
opioid agonists and antagonists.
A)
B)
C)
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D)
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Following the administration of pentazocine
(Talwin) to a patient with moderate pain, the
20.
nurse should assess for what change in the
patient's vital signs?
Increased blood pressure
Decreased oxygen saturation
Increased temperature
Increased respiratory rate
A
Feedback:
Talwin may cause increased blood pressure. It
does not typically cause deoxygenation, fever,
or tachypnea.
Chapter 50 Drug Therapy With Local Anesthetics
A patient has suffered a severe laceration to
his thumb and index finger during a
workplace accident, and local anesthetic is to
1.
be utilized to facilitate suturing. Which of the
patient's following statements should prompt
the nurse to provide further health education?
“I have to admit I'm relieved that they'll be
freezing my hand before they stitch it up.”
“I'm feeling pretty queasy about getting
stitches, so I'm glad they'll be knocking me
out.”
“They told me that it will take a few hours
before I can feel my hand again.”
“If I understand correctly, I won't be able to
move my hand normally for a while after
getting the anesthesia.”
B
Feedback:
Local anesthesia is differentiated from general
anesthesia in that there is no loss of
consciousness. “Freezing” is an accurate
description. Normal motor control and
sensation return after a period of time.
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B)
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Spinal anesthesia will be used to perform a
patient's scheduled bunionectomy. What
2.
should the nurse teach the patient about the
administration of this form of anesthesia?
It will cause a significant, but temporary,
decrease in level of consciousness.
It will be injected at the level of C7 to T2.
It will be injected between T8 and T9.
It will be injected into the cerebrospinal fluid.
D
Feedback:
Spinal anesthesia involves injecting the
anesthetic agent into the cerebrospinal fluid,
usually in the lumbar spine. It does not cause
a significant decrease in level of
consciousness.
Resetting of a patient's fracture will take place
under local anesthetic. These anesthetics
reduce movement and sensation by decreasing
3.
the permeability of the nerve cell membrane
to ions. What is the most important ion that
participates in this process?
Calcium
Magnesium
Sodium
Potassium
C
Feedback:
Local anesthetics decrease the permeability of
the nerve cell membrane to ions, especially
sodium.
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B)
C)
D)
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A patient who suffered a laceration while
doing woodwork in his garage will have his
wound treated under local anesthesia achieved
4. using lidocaine and epinephrine. The nurse
who will assist with the procedure should
recognize that epinephrine performs what
function in this situation?
Promoting vasodilation
Prolonging the effects of lidocaine
Preventing adverse effects of lidocaine
Blocking the afferent nerve pathways
B
Feedback:
Lidocaine has a rapid effect, and, when
combined with epinephrine, this effect is
prolonged. Epinephrine can promote
vasoconstriction, not vasodilation, and it
neither prevents adverse effects nor blocks
afferent nerve pathways.
A)
B)
C)
D)
Ans:
A patient's chronic venous ulcer on the lower
lateral surface of his leg requires incision and
5. debridement (I & D). The nurse should
anticipate that lidocaine will be administered
by which of the following routes?
Intravenous
Topical
Injection
Nebulized
C
Feedback:
Injectable lidocaine is used for infiltration of
5. debridement (I & D). The nurse should
anticipate that lidocaine will be administered
by which of the following routes?
Intravenous
Topical
Injection
Nebulized
C
Feedback:
Injectable lidocaine is used for infiltration of
the skin or subcutaneous administration prior
to minor surgical procedures, such as I & D.
Nebulized administration of lidocaine is
reserved for lung procedures. Topical
administration would be insufficient, and IV
administration is not warranted.
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B)
C)
D)
Ans:
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A patient with hand trauma following a
gunshot wound currently has bier block
anesthesia with lidocaine. What assessment
6.
finding should signal the nurse to the
possibility that the patient has local anesthetic
systemic toxicity (LAST)?
The patient has become intensely anxious and
agitated.
The patient has complained of nausea and had
an episode of blood-tinged emesis.
The patient's heart rate has become
bradycardic and irregular.
The patient states that he still has sensation in
his hand.
A
Feedback:
Initial symptoms of LAST may include
analgesia, circumoral numbness, metallic
taste, tinnitus or auditory changes, and
agitation. Nausea, dysrhythmias, and
continued sensory nerve function do not
suggest LAST.
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B)
C)
D)
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An older adult patient has sought care for the
treatment of hemorrhoids, and the care
provider has prescribed topical lidocaine. The
7.
nurse should teach the patient that full pain
relief will normally be achieved how long
after application of lidocaine?
5 to 10 minutes
15 to 30 minutes
20 to 60 minutes
90 minutes to 2 hours
C
Feedback:
Following topical administration of lidocaine,
the area becomes numb in 20 to 60 minutes.
7.
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B)
C)
D)
Ans:
A patient undergoing chemotherapy for the
treatment of lung cancer has developed
stomatitis. Oral lidocaine viscous has
8. consequently prescribed by the primary
caregiver. To minimize the patient's chance of
aspiration, the nurse should encourage the
patient to
take small bites of food and small sips of fluid
after administration.
adopt a minced and pureed diet for the
duration of treatment.
remain in a high Fowler's position for 90
minutes following the use of lidocaine
viscous.
avoid eating or drinking for 1 hour following
the use of lidocaine viscous.
D
Feedback:
Patients should not drink fluids or eat after
gargling with viscous lidocaine for at least 60
minutes due to risk of aspiration. Upright
positioning will not mitigate this risk. A
textured diet is unnecessary.
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A)
B)
C)
D)
Ans:
nurse should teach the patient that full pain
relief will normally be achieved how long
after application of lidocaine?
5 to 10 minutes
15 to 30 minutes
20 to 60 minutes
90 minutes to 2 hours
C
Feedback:
Following topical administration of lidocaine,
the area becomes numb in 20 to 60 minutes.
A patient has been administered lidocaine in
anticipation of a bronchoscopy and lung
9. biopsy. What change in status would the nurse
recognize as a potential hypersensitivity to
lidocaine?
Audible wheeze
Pleural pain
Audible S3
Hemoptysis
A
Feedback:
It is necessary to assess the respiratory status
and lung sounds for signs of bronchospasm
related to hypersensitivity after lidocaine
administration. An audible wheeze is
suggestive of bronchospasm. Pleural pain,
audible S3, and hemoptysis are less likely to
B)
C)
D)
Ans:
Pleural pain
Audible S3
Hemoptysis
A
Feedback:
It is necessary to assess the respiratory status
and lung sounds for signs of bronchospasm
related to hypersensitivity after lidocaine
administration. An audible wheeze is
suggestive of bronchospasm. Pleural pain,
audible S3, and hemoptysis are less likely to
be a direct result of hypersensitivity.
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A woman who is in her second trimester of
pregnancy has suffered burns to her forearm
10. from a steaming kettle. What amide local
anesthetic can the nurse safely administer by
the topical route during pregnancy?
Lidocaine
Mepivacaine (Carbocaine, Polocaine)
Bupivacaine (Marcaine, Sensorcaine)
Dibucaine (Nupercainal)
D
Feedback:
Dibucaine (Nupercainal) is local anesthetic
administered topically to the affected area to
induce pain relief. It is not absorbed
systemically; therefore, it is considered safe
during pregnancy. The other amides are not
approved for use during pregnancy.
A)
B)
C)
D)
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A)
B)
C)
D)
Ans:
A hospital patient's medication administration
record specifies the parenteral administration
11. of lidocaine before a tissue biopsy to be
performed later in the day. What action should
the nurse take in response to this order?
Obtain an order for epinephrine in order to
potentiate the action of lidocaine.
Contact the prescriber because administration
should be performed by a physician or nurse
anesthetist.
Administer a 500 mL bolus of normal saline
to ensure adequate vascular volume.
Assess the patient's need for an antihistamine
to be on hold during administration of the
lidocaine.
B
Feedback:
A physician or nurse anesthetist administers
the injectable form of lidocaine. A fluid bolus,
an antihistamine, and epinephrine are not
necessarily indicated.
Assess the patient's need for an antihistamine
to be on hold during administration of the
lidocaine.
B
Feedback:
A physician or nurse anesthetist administers
the injectable form of lidocaine. A fluid bolus,
an antihistamine, and epinephrine are not
necessarily indicated.
D)
Ans:
Spinal anesthesia using procaine has been
ordered for a patient prior to revision of the
12.
patient's ankle hardware. This drug achieves
anesthesia by
preventing the influx of sodium into nerve
cells.
increasing the action of anticholinesterase in
nerve synapses.
antagonizing nociceptors.
agonizing opioid receptors in the CNS.
A
Feedback:
Procaine decreases the influx of sodium into
the nerve cell and depresses depolarization to
prevent conduction of the nerve impulse. It
does not alter the function of nociceptors,
opioid receptors, or anticholinesterase.
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B)
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D)
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The nurse is assessing a patient who was
recently administered procaine for local
13. anesthesia. Which of the following
assessment findings would suggest the
possibility of adverse effects?
Increased temperature
Increased heart rate
Decreased blood pressure
Lethargy
B
Feedback:
Following administration of procaine, the
nurse assesses the CNS for excitability and
the cardiovascular status for tachycardia and
hypertension, leading to cardiovascular
collapse. Lethargy, hypotension, and fever are
not typical adverse effects.
A nurse is planning the care of a patient
whose laceration requires the use of local
14. anesthesia. The nurse recognizes that there is
a risk to the patient who has local anesthesia
due to what nursing diagnosis?
Disturbed sensory perception
Autonomic dysreflexia
Self-care deficit
Latex allergy response
A
Feedback:
The absence of sensory perception means that
patients are at risk for injuring the
anesthetized body part without their
knowledge. Autonomic dysreflexia and latex
allergy response are not plausible risks. The
brief action of local anesthetics means that
self-care deficit is rarely an issue.
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B)
C)
D)
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A woman's prolonged epistaxis (nosebleed)
following a basketball injury has created a
need for anesthesia and vasoconstriction of
15.
the nasal mucous membranes. These
therapeutic effects can best be achieved with
what drug?
Prilocaine
Procaine hydrochloride
Bupivacaine
Cocaine hydrochloride
D
Feedback:
Topical cocaine is an anesthetic administered
to the ear, nose, or throat to produce adequate
anesthesia and vasoconstriction of the mucous
membranes. The other listed anesthetics are
not typically used for this purpose.
Chapter 51 Drug Therapy With General Anesthetics
A)
B)
C)
D)
Prior to her elective hip replacement surgery,
the nurse is explaining the basic
characteristics of general anesthesia to the
1.
patient. The nurse should perform this
education in the understanding that general
anesthesia is best understood as
a nonreversible, temporary state of
unresponsiveness.
a state of reversible unconsciousness.
stage N2 non–rapid eye movement sleep.
stage N3 non–rapid eye movement sleep.
Prior to her elective hip replacement surgery,
the nurse is explaining the basic
characteristics of general anesthesia to the
1.
patient. The nurse should perform this
education in the understanding that general
anesthesia is best understood as
a nonreversible, temporary state of
unresponsiveness.
a state of reversible unconsciousness.
stage N2 non–rapid eye movement sleep.
stage N3 non–rapid eye movement sleep.
B
Feedback:
General anesthesia is defined as a medicationinduced reversible unconsciousness with loss
of protective reflexes. There is the
misconception that general anesthesia is a
deep sleep.
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C)
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A perioperative nurse is explaining the
process of general anesthesia in anticipation
of the adult patient's imminent bowel
2.
resection. When describing the phase of
induction, the nurse should explain that this is
usually achieved by what means?
Intramuscular injection of anesthetics and
benzodiazepines
Intravenous administration of opioid
analgesics
Subcutaneous injection of a rapid-acting
anesthetic
Intravenous administration of anesthetics
D
Feedback:
The administration of a general anesthetic can
be divided into three phases. The first phase is
induction, which is rendering the patient
unconscious by using inhalation anesthetics,
intravenous anesthetics, or both. Adult
patients usually receive a rapid-acting
intravenous anesthetic medication. IM
medications, sub-Q medications, and opioids
are not used.
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B)
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B)
C)
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An adult patient who is currently undergoing
rhinoplasty has developed the characteristic
3. signs and symptoms of malignant
hyperthermia. The operating room nurse
should anticipate what intervention?
Hemodialysis
Tracheal intubation
IV administration of naloxone (Narcan)
IV administration of dantrolene sodium
(Dantrium)
D
An adult patient who is currently undergoing
rhinoplasty has developed the characteristic
3. signs and symptoms of malignant
hyperthermia. The operating room nurse
should anticipate what intervention?
Hemodialysis
Tracheal intubation
IV administration of naloxone (Narcan)
IV administration of dantrolene sodium
(Dantrium)
D
Feedback:
The treatment for malignant hyperthermia
consists of intravenous dantrolene sodium
(Dantrium), oxygenation and
hyperventilation, hydration, and body cooling.
The patient will already be intubated. Narcan
and dialysis are not indicated.
A)
B)
C)
D)
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The operating room nurse is reading the
anesthesiologist's consult of a 30-year-old
female patient who will undergo surgical
4. repair of a meniscus tear later that day. The
nurse reads that total intravenous anesthesia
(TIVA) is indicated. What is the most likely
rationale for this intervention?
The patient has a diagnosis of chronic
obstructive pulmonary disease (COPD).
The patient's insurer does not reimburse for
inhaled anesthesia.
The patient has previously experienced severe
postoperative nausea and vomiting.
The patient is in the first trimester of
pregnancy.
C
Feedback:
In patients who have history of severe
postoperative nausea and vomiting, the
anesthetist may substitute the inhalation
anesthetic with a technique called total
intravenous anesthesia (TIVA). TIVA is not
necessarily indicated in patients who are
pregnant or who have COPD. Insurance
considerations would not normally be an
absolute indication for the use of TIVA.
A)
B)
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A certified registered nurse anesthetist is
describing the minimum alveolar
5. concentration (MAC) of isoflurane. How will
the addition of nitrous oxide or IV anesthetics
affect the MAC of isoflurane?
The MAC will remain the same.
The MAC will decrease.
The MAC of isoflurane will not be relevant.
The MAC will be more difficult to calculate.
B
Feedback:
With the addition of other medications such
as opioids, intravenous anesthetics, or nitrous
oxide, the MAC values decrease.
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B)
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A patient is scheduled to undergo craniofacial
surgery, a procedure that will necessitate the
use of propofol. The operating use nurse
6.
should be aware that alternative medications
will be absolutely necessary in order to
produce what effect in the patient?
Amnesia
Euphoria
Analgesia
Hypnosis
C
Feedback:
Propofol produces amnesia, euphoria, and
hypnosis. It therefore blocks the perception of
pain. It does not, however, provide analgesia.
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B)
C)
D)
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A)
B)
C)
D)
Ans:
The anesthesiologist has specified that
ketamine will be included in a surgical
patient's balanced anesthesia. When in
7.
postanesthetic recovery, the nurse should
assess for what adverse effect of this
medication?
Labile blood pressure
Increased intracranial pressure
Hyperventilation and respiratory alkalosis
Delirium and agitation
D
Feedback:
Ketamine can produce emergence delirium,
hallucinations, and unpleasant dreams.
Symptoms of this effect may include
confusion, agitation, and nystagmus. The drug
preserves blood pressure and does not cause
B)
C)
D)
Ans:
Increased intracranial pressure
Hyperventilation and respiratory alkalosis
Delirium and agitation
D
Feedback:
Ketamine can produce emergence delirium,
hallucinations, and unpleasant dreams.
Symptoms of this effect may include
confusion, agitation, and nystagmus. The drug
preserves blood pressure and does not cause
hyperventilation or increased ICP.
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A)
Vecuronium will be administered to a surgical
patient to facilitate intubation and achieve
8.
balanced anesthesia. This medication induces
paralysis by
antagonizing acetylcholine receptors at
neuromuscular junctions.
potentiating the effects of acetylcholinesterase
in synapses.
crossing the blood–brain barrier and
agonizing cerebellar function.
binding with serotonin and inhibiting its
neuromuscular effects.
A
Feedback:
Because vecuronium is structurally similar to
ACh, it binds to the receptors on the muscle
and prevents normal function of ACh,
producing skeletal muscle paralysis. The drug
does not influence the physiology of
serotonin, the cerebellum, or
acetylcholinesterase.
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C)
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B)
C)
D)
Ans:
A 39-year-old patient has been diagnosed
with thyroid cancer and will have a
thyroidectomy performed. During surgery in
9. this nerve-rich and highly vascular region of
the body, the patient may require vecuronium.
What will be the primary purpose of this
medication?
To ensure that the patient does not move
during surgery
To prevent intraoperative vomiting
To protect the patient's airway during surgery
To induce hypnosis and amnesia
A
Feedback:
Delicate repairs, such as neck surgery and
neurosurgery, may require the use of
neuromuscular agents to prevent movement
and subsequent damage. Vecuronium is not
used to prevent nausea and vomiting, to
protect the patient's airway, or to induce
To prevent intraoperative vomiting
To protect the patient's airway during surgery
To induce hypnosis and amnesia
A
Feedback:
Delicate repairs, such as neck surgery and
neurosurgery, may require the use of
neuromuscular agents to prevent movement
and subsequent damage. Vecuronium is not
used to prevent nausea and vomiting, to
protect the patient's airway, or to induce
hypnosis and amnesia.
A surgical patient's balanced anesthesia
includes the use of vecuronium. What nursing
10.
action should the operating room nurses
prioritize?
Monitoring the patient for signs of increased
level of consciousness
Assessing and protecting the patient's airway
Protecting the patient's skin integrity
Monitoring the patient's deep tendon reflexes
B
Feedback:
The maintenance of the patient's airway and
respiratory function following the
administration of neuromuscular blocking
agents such as vecuronium is the most
important nursing implication. The
importance of airway protection supersedes
that of DTR assessment, assessing LOC, and
maintaining skin integrity, though each of
these is a valid consideration.
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C)
D)
Ans:
A)
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B)
C)
D)
Ans:
A)
B)
C)
D)
Ans:
A patient will undergo an endoscopy with
conscious sedation using midazolam (Versed).
11. The nurse who is participating in this
procedure should monitor the patient closely
for signs of
increased intracranial pressure.
respiratory depression.
hemorrhage.
rhabdomyolysis.
B
Feedback:
Following administration of midazolam,
continuous monitoring for respiratory
depression is required, and if necessary, agespecific resuscitative measures should be
implemented. Increased ICP, rhabdomyolysis,
and hemorrhage are less likely than
respiratory depression.
B)
C)
D)
Ans:
respiratory depression.
hemorrhage.
rhabdomyolysis.
B
Feedback:
Following administration of midazolam,
continuous monitoring for respiratory
depression is required, and if necessary, agespecific resuscitative measures should be
implemented. Increased ICP, rhabdomyolysis,
and hemorrhage are less likely than
respiratory depression.
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A 55-year-old woman will have a partial
mastectomy performed as treatment for breast
cancer. The anesthesiologist has informed the
12.
operating room nurse that opioids will be used
to supplement anesthesia. What opioid is most
likely to be utilized?
Codeine
Oxycodone
Fentanyl
Meperidine
C
Feedback:
A synthetic opioid that is about 100 times
more potent than morphine sulfate, fentanyl
can be used to supplement sedation, regional
techniques, and general anesthesia. Codeine,
meperidine, and oxycodone do not have
intraoperative applications.
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B)
C)
D)
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Chapter 52 Drug Therapy for Migraines and Other Headaches
A)
B)
C)
D)
Ans:
A patient has been diagnosed with migraines
after experiencing headaches of increasing
1. severity. When providing health education to
this patient about her new diagnosis, what
should the nurse convey?
The etiology of migraines is thought to have a
genetic component.
Migraines are typically the result of
prolonged psychosocial stress.
Migraines can be a precursor to transient
ischemic attacks (TIAs) or stroke.
The pathophysiology of migraine headaches
involves a disruption in the limbic system.
A
Feedback:
Migraines demonstrate a familial pattern, and
authorities believe that they are inherited as
autosomal dominant traits with incomplete
penetrance. Stress may precipitate a migraine,
but this is not an aspect of the etiology. They
Migraines can be a precursor to transient
ischemic attacks (TIAs) or stroke.
The pathophysiology of migraine headaches
involves a disruption in the limbic system.
A
Feedback:
Migraines demonstrate a familial pattern, and
authorities believe that they are inherited as
autosomal dominant traits with incomplete
penetrance. Stress may precipitate a migraine,
but this is not an aspect of the etiology. They
are not a precursor to TIAs or stroke, and they
do not involve disruption of the limbic
system.
C)
D)
A middle-aged patient describes her
headaches as “utterly debilitating” and tells
the nurse, “It's hard to explain, but I just know
2.
when one is coming, and I'm never wrong.”
This patient's statement suggests that she has
what diagnosis?
Migraines
Cluster headaches
Tension headaches
Ischemic headaches
A
Feedback:
The severity of her headaches coupled with
the fact that she experiences a prodrome
suggests that she experiences migraines. This
clinical presentation is not typical of cluster
headaches or tension headaches. Ischemic
headache is not a recognized subtype.
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B)
C)
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B)
C)
D)
Ans:
A young man has been diagnosed with
migraines, and the nurse is teaching him
3.
about abortive therapy. The primary goal of
this form of therapy will be to
permanently correct the patient's brain
physiology.
ensure that the patient experiences fewer
migraine headaches.
relieve the symptoms of the patient's
migraines.
foster coping skills that will allow the patient
to live with his migraines.
C
Feedback:
Abortive therapy is the administration of
medications to treat the symptoms of
migraine headache. These medications do not
provide a permanent correction of
pathophysiological neurological function, and
they are not preventative. Coping skills are
C)
migraines.
foster coping skills that will allow the patient
to live with his migraines.
C
Feedback:
Abortive therapy is the administration of
medications to treat the symptoms of
migraine headache. These medications do not
provide a permanent correction of
pathophysiological neurological function, and
they are not preventative. Coping skills are
not provided through medications.
D)
Ans:
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A patient who lives with migraines has been
prescribed naproxen. The nurse should
4.
recognize that this drug achieves a therapeutic
effect through which of the following means?
Demyelinizing pain fibers in the CNS
Selectively antagonizing opioid receptors in
the CNS
Inhibiting the synthesis of COX-1 and COX-2
Slowing the reuptake of serotonin and
acetylcholine in brain synapses
C
Feedback:
Naproxen is a nonselective inhibitor of
cyclooxygenase resulting in the inhibition of
prostaglandin synthesis of COX-1 and
COX-2. It does not involve serotonin,
acetylcholine, or opioid receptors.
A)
B)
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B)
C)
D)
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A nurse has administered a scheduled dose of
naproxen to a hospital patient who has been
taking the drug for several weeks. What
5.
assessment finding should cause the nurse to
suspect that the patient is experiencing
adverse effects of this drug treatment?
There is an increase in the patient's
neutrophils but no increase in temperature.
The patient's stool tests positive for occult
blood.
The patient complains of itchy, dry skin.
The patient has peripheral edema and there is
a steady increase in the patient's weight.
B
Feedback:
GI bleeding is a significant adverse effect of
naproxen. This drug does not typically cause
leukocytosis, dry skin, or fluid imbalances.
C)
The patient complains of itchy, dry skin.
The patient has peripheral edema and there is
a steady increase in the patient's weight.
B
Feedback:
GI bleeding is a significant adverse effect of
naproxen. This drug does not typically cause
leukocytosis, dry skin, or fluid imbalances.
D)
Ans:
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The nurse at a long-term care facility is
assessing a new resident's current medication
regimen, and the resident states that she often
takes an OTC remedy when she experiences a
6. migraine. She has brought the bottle with her,
and the nurse notes it to be Anacin Advanced
Headache Formula. The nurse should
document that the patient takes which drugs?
Select all that apply.
Codeine
Acetaminophen
Aspirin
Caffeine
Naproxen
B, C, D
Feedback:
Anacin Advanced Headache Formula and
other similar OTC formulations include
acetaminophen, aspirin, and caffeine.
A)
B)
C)
D)
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B)
C)
D)
E)
Ans:
A patient who is well-known to the clinic
asked if it would safe for him to take Excedrin
Extra Strength for the treatment of a severe
7. headache. The nurse is well aware of this
patient's medical history and should advise
against using this medication based on what
aspect of his current health status?
The patient has not adhered to previous
treatment regimens.
The patient has a chronic venous ulcer on his
lower leg.
The patient has a diagnosis of liver cirrhosis.
The patient is a smoker.
C
Feedback:
People with hepatic impairment should not
receive this combination agent on an ongoing
basis. They may not metabolize
acetaminophen in this combined medication
effectively, leading to hepatotoxicity. Lack of
previous adherence, cigarette smoking, and
the presence of skin ulcers do not necessarily
contraindicate the use of this drug.
B)
lower leg.
The patient has a diagnosis of liver cirrhosis.
The patient is a smoker.
C
Feedback:
People with hepatic impairment should not
receive this combination agent on an ongoing
basis. They may not metabolize
acetaminophen in this combined medication
effectively, leading to hepatotoxicity. Lack of
previous adherence, cigarette smoking, and
the presence of skin ulcers do not necessarily
contraindicate the use of this drug.
A young woman who is 14 weeks pregnant
has sought care because she has been
experiencing migraine headaches with
increasing severity and frequency in recent
months. She states, “My headaches used to be
8. something I could live with, but now they're
affecting every other part of my life.” The
patient has conducted online research and
requested a prescription for ergotamine. How
will this patient's current health status affect
the clinician's response to this request?
The patient can safely use ergotamine but
must be monitored for blood dyscrasias.
The patient must use a reduced dose of
ergotamine until she has given birth.
The patient must wait until she has given birth
before taking ergotamine.
The patient cannot safely take ergotamine
until she has weaned her infant.
D
Feedback:
Pregnancy and lactation are contraindications
to the use of ergotamine.
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C)
D)
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B)
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A)
B)
C)
D)
Ans:
A patient has been treated for migraines on an
ongoing basis and the care provider has just
9. prescribed sumatriptan. Which of the
following is the priority intervention for
patient education?
“You might get dizzy and lightheaded after
you take sumatriptan, but this is normal.”
“It's important that you never take Tylenol
within 12 hours of sumatriptan.”
“Make sure that you stop taking ergotamine
before you get this prescription filled.”
“You will likely experience a brief worsening
of your migraine before this drug relieves the
pain.”
C
Feedback:
A)
you take sumatriptan, but this is normal.”
“It's important that you never take Tylenol
within 12 hours of sumatriptan.”
“Make sure that you stop taking ergotamine
before you get this prescription filled.”
“You will likely experience a brief worsening
of your migraine before this drug relieves the
pain.”
C
Feedback:
It is important to ask the patient about recent
administration ergot alkaloids. The ergot
alkaloids should not be given within 24 hours
of the administration of triptans. Signs of low
blood pressure should be reported promptly,
and there is no particular reason to avoid
acetaminophen. Triptans do not make
symptoms worse before they provide relief.
B)
C)
D)
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A nurse is teaching a patient how to take
Imitrex in the home setting in order to
10. maximize therapeutic benefit while reducing
the risk of adverse effects. The nurse should
teach the patient to take Imitrex
before breakfast each day.
on days when migraines may be anticipated.
as soon as the earliest symptoms of migraine
are sensed.
when the pain of a migraine becomes too
much to bear.
C
Feedback:
It is important to administer sumatriptan at the
onset of migraine symptoms. The drug is not
taken on a daily, scheduled basis and is not
used as a preventative treatment.
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B)
C)
D)
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B)
C)
D)
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A middle-aged patient has not achieved
adequate symptom relief of migraines with
first-line therapies, and the clinician is
11. considering the use of frovatriptan (Frova).
The patient's concurrent use of what
medication would contraindicate the safe use
of frovatriptan?
Albuterol (Ventolin)
Metformin
Atorvastatin (Lipitor)
Fluoxetine (Prozac)
D
Feedback:
Frovatriptan (Frova) interacts unfavorably
with selective serotonin reuptake inhibitors
and may lead to serotonin syndrome.
Ventolin, metformin, and Lipitor do not
of frovatriptan?
Albuterol (Ventolin)
Metformin
Atorvastatin (Lipitor)
Fluoxetine (Prozac)
D
Feedback:
Frovatriptan (Frova) interacts unfavorably
with selective serotonin reuptake inhibitors
and may lead to serotonin syndrome.
Ventolin, metformin, and Lipitor do not
present a risk for interactions.
A)
B)
C)
D)
Ans:
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A woman in her 40s has been living with
migraines for many years, and these have
12. only just been identified as being linked to her
menstrual cycles. Estradiol has been
prescribed, which the nurse will administer
intravenously.
transcutaneously.
intramuscularly.
sublingually.
B
Feedback:
Estradiol for the treatment of migraines is
administered by the transcutaneous route.
A)
B)
C)
D)
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A)
B)
C)
D)
Ans:
A nurse in surgical daycare is completing a
preoperative assessment of a woman who will
undergo hip arthroplasty. The nurse has
questioned the woman about her daily use of
13.
gabapentin (Neurontin), and the woman has
stated that she takes this drug to treat her
migraines. What role does this drug play in
migraine treatment?
It reduces the intensity of menstrual
migraines.
It prevents migraines from occurring.
It relieves acute migraine pain.
It lengthens the aura that precedes a migraine.
B
Feedback:
Studies have shown that gabapentin is
effective in reducing the frequency of
migraines. Gabapentin is not an abortive
treatment.
A patient experiences debilitating migraines
on a frequent basis and has had oral
prochlorperazine (Compazine) added as an
14. adjuvant medication to abortive therapy.
When teaching the patient to take this drug
safely in the home setting, the nurse should
emphasize what teaching point?
The importance of taking the pill whole and
not crushing or splitting it
The importance of having a bimonthly
complete blood count (CBC) drawn
The need to avoid taking the drug after eating
fatty food
The need to be aware of the potential for
hypotension
A
Feedback:
When taking prochlorperazine orally, it is
important to swallow it whole and not chew
or crush the tablets. Blood work is not
warranted, and there is no need to avoid fatty
food prior to taking the drug. Compazine is
not noted to cause hypotension.
A)
B)
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C)
D)
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A)
B)
C)
D)
Ans:
Mrs. Gonzaga is a 60-year-old woman who
first began having headaches during the onset
of menopause and who has subsequently been
diagnosed with migraines. She tearfully
explains to the nurse how her husband
downplays her health condition and tells her
15. that she needs to “just push through a
headache.” She describes how her migraines
have limited her ability to provide childcare
for her young grandchildren and explains that
she is unable to keep up her garden. The nurse
should identify what nursing diagnosis when
planning Mrs. Gonzaga's care?
Ineffective health maintenance related to
migraine headaches
Ineffective role performance related to
migraine headaches
Situational low self-esteem related to
migraine headaches
Spiritual distress related to migraine
headaches
B
Feedback:
Many nursing diagnoses likely apply to this
patient's situation, but there is evidence that
she grieves her inability to perform a
caregiving role for her grandchildren. There is
Situational low self-esteem related to
migraine headaches
Spiritual distress related to migraine
headaches
B
Feedback:
Many nursing diagnoses likely apply to this
patient's situation, but there is evidence that
she grieves her inability to perform a
caregiving role for her grandchildren. There is
no evidence that the patient's health
maintenance is inadequate or that she has low
self-esteem. Spiritual distress is also not in
evidence.
C)
D)
Ans:
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Chapter 53 Drug Therapy for Seizure Disorders and Spasticity
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B)
C)
D)
Ans:
A)
B)
C)
D)
Ans:
A patient has a left temporal brain tumor. He
smells an odor of ammonia prior to
1. experiencing rapid rhythmic jerking
movements. What is the odor of ammonia
classified as?
Chemical agent evoked by the tumor
An aura prior to the seizure activity
The metastatic process of tumor growth
The inhibition of serotonin and acetylcholine
B
Feedback:
The smell of ammonia is an aura, which is a
warning prior to seizure activity. The tumor
will not evoke a chemical agent prior to the
seizure. The metastatic process will not evoke
a chemical smell. The chemical smell is not
related to the inhibition of serotonin and
acetylcholine.
A patient has been taking phenytoin (Dilantin)
for a seizure disorder. He has recently run out
2.
of his medication and has not obtained a refill.
What is the patient at risk for developing?
Hypotension
Migraine headaches
Status epilepticus
Depression
C
Feedback:
In a person taking medications for a
diagnosed seizure disorder, the most common
cause of status epilepticus is abruptly
stopping AEDs. Abruptly stopping phenytoin
will not cause hypotension. Abruptly stopping
phenytoin will not cause migraine headaches.
Abruptly stopping phenytoin will not cause
depression.
B)
C)
D)
Ans:
Migraine headaches
Status epilepticus
Depression
C
Feedback:
In a person taking medications for a
diagnosed seizure disorder, the most common
cause of status epilepticus is abruptly
stopping AEDs. Abruptly stopping phenytoin
will not cause hypotension. Abruptly stopping
phenytoin will not cause migraine headaches.
Abruptly stopping phenytoin will not cause
depression.
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A patient is admitted to the emergency room
in status epilepticus. What medication may be
3.
administered intravenously to assist in
reducing seizure activity?
Diazepam (Valium)
Hydromorphone (Dilaudid)
Insulin
Meperidine (Demerol)
A
Feedback:
IV diazepam is an adjunctive skeletal muscle
relaxant administered for the treatment of
severe recurrent convulsive seizures and
status epilepticus. Ethosuximide (Zarontin) is
not administered for status epilepticus.
Meperidine (Demerol) and insulin are not
administered for status epilepticus.
A)
B)
C)
D)
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A)
B)
C)
D)
Ans:
An 80-year-old patient has severe pain after a
case of shingles. The pain is noted along the
4. shoulder and back. He states the pain is so
severe he cannot sleep. What is the primary
medication that will relieve this pain?
Meperidine (Demerol)
Morphine sulfate (MS Contin)
Naproxen sodium (Naprosyn)
Gabapentin (Neurontin)
D
Feedback:
Gabapentin is the first oral medication
approved by the FDA for the management of
postherpetic neuralgia. Meperidine will
provide pain relief but is not effective in
postherpetic neuralgia. Morphine sulfate will
provide pain relief but is not effective in
postherpetic neuralgia. Naproxen sodium will
decrease inflammation but is not effective for
postherpetic neuralgia.
B)
C)
D)
Ans:
Morphine sulfate (MS Contin)
Naproxen sodium (Naprosyn)
Gabapentin (Neurontin)
D
Feedback:
Gabapentin is the first oral medication
approved by the FDA for the management of
postherpetic neuralgia. Meperidine will
provide pain relief but is not effective in
postherpetic neuralgia. Morphine sulfate will
provide pain relief but is not effective in
postherpetic neuralgia. Naproxen sodium will
decrease inflammation but is not effective for
postherpetic neuralgia.
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A patient who has been taking valproic acid
(sodium valproate) for a seizure disorder is
5. asking the nurse about getting pregnant. Why
is pregnancy discouraged in women who are
being treated for seizure disorders?
Seizure disorders are genetic.
Seizure disorders are familial.
Antiepilepsy drugs decrease fertility.
Antiepilepsy drugs are teratogenic.
D
Feedback:
Antiepileptic drugs such as valproic acid must
be used cautiously during pregnancy because
they are teratogenic. Seizure disorders are not
normally genetic or familial. Antiepilepsy
medications do not decrease fertility.
A)
B)
C)
D)
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A)
B)
C)
D)
Ans:
A patient is being treated for a seizure
disorder with phenytoin (Dilantin). He is
6. admitted to the emergency room with sinus
bradycardia. What action will occur regarding
his antiepileptic agent?
Phenytoin (Dilantin) dose will be reduced.
Phenytoin (Dilantin) will be discontinued.
Phenytoin (Dilantin) will be given every other
day.
Phenytoin (Dilantin) dose will be increased.
B
Feedback:
Phenytoin should be discontinued
immediately because it is contraindicated in
patients with sinus bradycardia. Reducing the
frequency of administration would likely be
insufficient.
Phenytoin (Dilantin) will be given every other
day.
Phenytoin (Dilantin) dose will be increased.
B
Feedback:
Phenytoin should be discontinued
immediately because it is contraindicated in
patients with sinus bradycardia. Reducing the
frequency of administration would likely be
insufficient.
C)
D)
Ans:
A patient is admitted to the hospital with
severe dehydration and also has decreased
7. albumin levels. What effect will the patient's
current status have if a prescribed dose of
phenytoin (Dilantin) is administered?
Potentially toxic serum level
Reduced serum level
Increased seizure activity
Thromboembolism
A
Feedback:
Phenytoin is highly bound to plasma proteins
and only a fraction is not bound to albumin;
hypoalbuminemia will result in toxic serum
levels of phenytoin. A reduced serum level of
phenytoin will not be seen with
hypoalbuminemia. The patient will not suffer
from increased seizure activity. The patient
will not suffer from thromboembolism.
A)
B)
C)
D)
Ans:
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A)
B)
C)
D)
Ans:
The nurse has been educating the patient on
the self-administration of phenytoin
8. (Dilantin). Which of the following statements
by the patient demonstrates an understanding
of the medication?
“I'll only take the drug when I feel an
impending seizure.”
“I'll reduce my dose if I remain seizure free.”
“I'll make sure to take the drug with food.”
“I'll stop taking the drug if I don't have a
seizure for 8 weeks.”
C
Feedback:
Phenytoin should be taken with food to
reduce the chance of stomach upset. It should
be taken on a regular basis, and not only when
a seizure occurs. The patient should not
arbitrarily reduce his or her dose of
phenytoin. Abrupt cessation can cause
seizures.
C)
“I'll make sure to take the drug with food.”
“I'll stop taking the drug if I don't have a
seizure for 8 weeks.”
C
Feedback:
Phenytoin should be taken with food to
reduce the chance of stomach upset. It should
be taken on a regular basis, and not only when
a seizure occurs. The patient should not
arbitrarily reduce his or her dose of
phenytoin. Abrupt cessation can cause
seizures.
D)
Ans:
A patient suffers from trigeminal neuralgia.
9. What antiepileptic agent may be used to treat
this disorder?
Phenytoin (Dilantin)
Carbamazepine (Tegretol)
Fosphenytoin (Cerebyx)
Ethosuximide (Zarontin)
B
Feedback:
Carbamazepine (Tegretol) is prescribed to
treat trigeminal neuralgia. Phenytoin is not
administered for trigeminal neuralgia.
Fosphenytoin is not administered for
trigeminal neuralgia. Ethosuximide is not
administered for trigeminal neuralgia.
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B)
C)
D)
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A)
B)
C)
D)
Ans:
A child suffers from absence seizures and has
been prescribed acetazolamide (Diamox). The
nurse should know that this medication is an
10.
adjuvant medication useful in the treatment of
seizures. What is the therapeutic action of
Diamox?
It slows the action potential of neurons.
It slows the reuptake of acetylcholine.
It suppresses the limbic and reticular systems.
It controls fluid secretion in the CNS.
D
Feedback:
The sulfonamide diuretic acetazolamide
(Diamox) controls fluid secretion in the CNS;
it is thought to inhibit CNS carbonic
anhydrase to decrease neuronal excitability.
A patient has been diagnosed with a brain
tumor, which has caused partial seizure
activity. The patient is being treated with
11. gabapentin (Neurontin). After administering
the medication, the nurse should assess the
patient because of the potential for what
adverse effect?
Tetany
Hypersensitivity
Paradoxical seizures
CNS depression
D
Feedback:
The most common adverse effects of
gabapentin are associated with CNS
depression and include dizziness,
somnolence, insomnia, and ataxia. The drug
has not been noted to cause tetany,
hypersensitivity reactions, or paradoxical
seizures.
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A)
B)
C)
D)
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B)
C)
D)
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A patient with impaired liver function is
suffering from a seizure disorder that most
12. often results in partial seizures. Which of the
following AEDs may be administered to a
patient with impaired liver function?
Oxcarbazepine (Trileptal)
Fosphenytoin (Cerebyx)
Carbamazepine (Tegretol)
Levetiracetam (Keppra)
D
Feedback:
Levetiracetam (Keppra) is not primarily
metabolized in the liver. Oxcarbazepine
(Trileptal) is metabolized in the liver.
Fosphenytoin (Cerebyx) is metabolized in the
liver. Carbamazepine (Tegretol) is
metabolized in the liver.
A)
B)
C)
D)
Ans:
A patient is admitted to the hospital for severe
back spasms and pain. Which of the following
13.
skeletal muscle relaxants will act peripherally
on the muscle itself?
Cyclobenzaprine (Flexeril)
Carisoprodol (Soma)
Methocarbamol (Robaxin)
Dantrolene sodium (Dantrium)
D
Feedback:
Dantrolene is the only skeletal muscle
13.
A)
B)
C)
D)
Ans:
back spasms and pain. Which of the following
skeletal muscle relaxants will act peripherally
on the muscle itself?
Cyclobenzaprine (Flexeril)
Carisoprodol (Soma)
Methocarbamol (Robaxin)
Dantrolene sodium (Dantrium)
D
Feedback:
Dantrolene is the only skeletal muscle
relaxant that acts peripherally on the muscle
itself; it inhibits the release of calcium in
skeletal muscle cells, thereby decreasing the
strength of muscle contraction. The other
listed drugs act centrally.
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A patient is recovering from a stroke and has
developed severe muscle contractions. Which
14.
of the following medications will inhibit the
release of calcium in skeletal muscle cells?
Dantrolene sodium (Dantrium)
Baclofen (Lioresal)
Carisoprodol (Soma)
Cyclobenzaprine (Flexeril)
A
Feedback:
Dantrium relieves spasticity by inhibiting the
release of calcium in skeletal muscle cells.
Lioresal, Soma, and Flexeril act centrally.
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B)
C)
D)
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A)
B)
C)
D)
Ans:
A patient with multiple sclerosis is admitted
to the medical division for treatment of severe
15.
spasticity. What medication is used to treat
spasticity and is administered intrathecally?
Baclofen (Lioresal)
Carisoprodol (Soma)
Diazepam (Valium)
Dantrolene (Dantrium)
A
Feedback:
Baclofen is used to treat spasticity in MS and
spinal cord injuries. It can be administered
intrathecally. Carisoprodol is used to relieve
discomfort from acute, painful
musculoskeletal disorders. Diazepam is used
to relieve muscle spasms but not used
intrathecally. Dantrolene is used to treat
malignant hyperthermia but not multiple
sclerosis.
Carisoprodol (Soma)
Diazepam (Valium)
Dantrolene (Dantrium)
A
Feedback:
Baclofen is used to treat spasticity in MS and
spinal cord injuries. It can be administered
intrathecally. Carisoprodol is used to relieve
discomfort from acute, painful
musculoskeletal disorders. Diazepam is used
to relieve muscle spasms but not used
intrathecally. Dantrolene is used to treat
malignant hyperthermia but not multiple
sclerosis.
A patient is admitted with acute, painful
muscle spasms and suffers from intermittent
porphyria, an inherited enzyme deficiency.
16.
Which of the following muscle relaxants is
contraindicated due to the patient's history of
porphyria?
Baclofen (Lioresal)
Carisoprodol (Soma)
Diazepam (Valium)
Dantrolene (Dantrium)
B
Feedback:
Carisoprodol is used to relieve discomfort
from acute, painful musculoskeletal disorders.
It is contraindicated in patients with
intermittent porphyria. Baclofen is not known
to be contraindicated with porphyria.
Diazepam is not known to be contraindicated
with porphyria. Dantrolene is not known to be
contraindicated with porphyria.
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B)
C)
D)
Ans:
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B)
C)
D)
Ans:
A)
B)
C)
D)
Ans:
A patient with muscle spasms is administered
cyclobenzaprine (Flexeril). Which adverse
17.
effect should the nurse assess for with this
medication?
Muscle spasms
Insomnia
Drowsiness
Urinary incontinence
C
Feedback:
A common adverse effect with
cyclobenzaprine (Flexeril) is drowsiness. The
patient will not experience muscle spasms,
insomnia, or urinary incontinence.
B)
C)
D)
Ans:
Insomnia
Drowsiness
Urinary incontinence
C
Feedback:
A common adverse effect with
cyclobenzaprine (Flexeril) is drowsiness. The
patient will not experience muscle spasms,
insomnia, or urinary incontinence.
A patient has been started on dantrolene
(Dantrium). What is the most serious adverse
18.
effect about which the patient should be
instructed?
Metabolic acidosis
Hypercarbia
Renal calculi
Hepatitis
D
Feedback:
The most serious adverse effect of oral
dantrolene is fatal hepatitis. Metabolic
acidosis, hypercarbia, and renal calculi are not
adverse effects of oral dantrolene.
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B)
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Ans:
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B)
C)
D)
Ans:
A)
B)
C)
D)
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A patient has been started on cyclobenzaprine
19. (Flexeril). For the duration of treatment, the
nurse should teach the patient to avoid
OTC vitamin supplements.
alcohol.
stool softeners.
fatty foods.
B
Feedback:
Increased CNS depression occurs when
cyclobenzaprine is combined with alcohol or
other CNS depressants. There is no particular
need for the patient to avoid fatty foods, stool
softeners, or vitamin supplements.
A patient is taking tizanidine (Zanaflex) to
treat spasticity from multiple sclerosis. Which
20. of the following adverse effects of muscle
relaxants is most pronounced with this
medication?
Hypotension
Dark black urine
Excessive salivation
Eczema
A
Feedback:
Hypotension is the most significant adverse
20. of the following adverse effects of muscle
relaxants is most pronounced with this
medication?
Hypotension
Dark black urine
Excessive salivation
Eczema
A
Feedback:
Hypotension is the most significant adverse
effect of tizanidine. Dark black urine,
excessive salivation, and eczema are not
adverse effects of tizanidine.
A)
B)
C)
D)
Ans:
Chapter 54 Drug Therapy for Anxiety and Insomnia
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A patient is having seizure activity, and the
physician has ordered diazepam (Valium) to
1. be given parenterally. If this medication is
administered intravenously, when will its
onset of action be observed?
1 to 5 minutes
7 to 10 minutes
More than 10 minutes
Less than 1 minute
A
Feedback:
Intravenous diazepam (Valium) is
administered intravenously to decrease
seizure activity and has a 1- to 5-minute onset
of action. Diazepam (Valium) decreases
seizure activity in less than 7 to 10 minutes.
Diazepam (Valium) should decrease seizure
activity in less than 10 minutes. Diazepam
(Valium) will take more than 1 minute to
begin working.
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B)
C)
D)
Ans:
A)
B)
C)
D)
Ans:
A patient suffers from insomnia and is
prescribed flurazepam. This medication has a
2. longer half-life than 24 hours. Which of the
following contributes to the long half-life of
this medication and other benzodiazepines?
Metabolism by cytochrome P450
Presence of active metabolites
Excretion by the renal system
Movement of calcium in the cell
B
Feedback:
Benzodiazepines differ mainly in their plasma
half-lives, production of active metabolites,
and clinical uses. Drugs with half-lives longer
than 24 hours form active metabolites that
also have long half-lives and tend to
Presence of active metabolites
Excretion by the renal system
Movement of calcium in the cell
B
Feedback:
Benzodiazepines differ mainly in their plasma
half-lives, production of active metabolites,
and clinical uses. Drugs with half-lives longer
than 24 hours form active metabolites that
also have long half-lives and tend to
accumulate, especially in older adults and
people with impaired liver function.
Flurazepam is not metabolized by cytochrome
P450. Flurazepam is excreted in the renal
system but does not contribute to the effect on
the half-life. Flurazepam does not contribute
to movement of calcium in the cell.
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B)
C)
D)
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A patient is given midazolam (Versed) in
combination with an opioid in the
preoperative phase before a laparoscopic
3.
cholecystectomy. What does the
administration of midazolam (Versed) assist
in minimizing?
Oral secretions
Anxiety
Hypotension
Muscle tone
B
Feedback:
Midazolam (Versed) provides preoperative
sedation and mechanical ventilation. It does
not reduce secretions, increase blood pressure,
or reduce muscle tone.
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B)
C)
D)
Ans:
A)
B)
C)
D)
Ans:
A patient's medication regimen for treatment
of anxiety has been changed from a
benzodiazepine. The patient asks the nurse
4.
what likely prompted his care provider to
change his medication. What is the nurse's
best response?
“Your doctor may have been concerned about
causing depression.”
“Your doctor may have been worried about
the possibility of convulsions.”
“Long-term use of benzodiazepines can result
in dependency.”
“Long-term use of benzodiazepines can cause
insomnia.”
C
Feedback:
Although benzodiazepines are effective
anxiolytics, long-term use is associated with
concerns over tolerance, dependency,
B)
the possibility of convulsions.”
“Long-term use of benzodiazepines can result
in dependency.”
“Long-term use of benzodiazepines can cause
insomnia.”
C
Feedback:
Although benzodiazepines are effective
anxiolytics, long-term use is associated with
concerns over tolerance, dependency,
withdrawal, lack of efficacy for treating the
depression that often accompanies anxiety
disorders, and the need for multiple daily
dosing with some agents. They do not cause
insomnia, convulsions, or depression.
C)
D)
A patient has developed excessive sedation
and respiratory depression. The patient has
been taking a benzodiazepine and has
5. diminished liver function. Which of the
following medications will reduce the effects
of sedation and respiratory depression in this
patient?
Olmesartan medoxomil (Benicar)
Pancrelipase (Pancrease)
Pamidronate disodium (Aredia)
Flumazenil (Romazicon)
D
Feedback:
Toxic effects of benzodiazepines include
excessive sedation, respiratory depression,
and coma. Flumazenil (Romazicon) is a
specific antidote that competes with
benzodiazepines for benzodiazepine receptors
and reverses toxicity. Olmesartan medoxomil
(Benicar) is an angiotensin II receptor
antagonist that is used to treat hypertension.
Pancrelipase (Pancrease) is used for enzyme
replacement therapy. Pamidronate disodium is
used as a bone metabolism regulator.
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B)
C)
D)
Ans:
A)
B)
C)
D)
Ans:
A patient is being observed for acute
benzodiazepine withdrawal symptoms. Which
6.
of the following symptoms is characteristic of
this problem?
Bradycardia
Agitation
Lethargy
Diaphoresis
B
Feedback:
Common signs and symptoms of withdrawal
include increased anxiety, psychomotor
agitation, insomnia, irritability, headache,
this problem?
Bradycardia
Agitation
Lethargy
Diaphoresis
B
Feedback:
Common signs and symptoms of withdrawal
include increased anxiety, psychomotor
agitation, insomnia, irritability, headache,
tremor, and palpitations. Bradycardia,
lethargy, and diaphoresis are uncharacteristic.
A)
B)
C)
D)
Ans:
A patient is administered a benzodiazepine for
7. anxiety. Which of the following will place the
patient at risk for benzodiazepine toxicity?
Decreased albumin
Increased calcium
Decreased potassium
Low bicarbonate
A
Feedback:
Patients with liver disease are at risk for
adverse effects with drugs that are highly
bound to plasma proteins. Increased calcium
will not contribute to benzodiazepine toxicity.
Decreased potassium will not have a direct
impact on benzodiazepine toxicity. The
normal bicarbonate will not contribute to
benzodiazepine toxicity.
A)
B)
C)
D)
Ans:
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B)
C)
D)
Ans:
An older adult patient suffers from
generalized anxiety disorder. The use of
8.
benzodiazepines in this patient population
creates a risk for what adverse effect?
Seizures
Falls
Dysrhythmias
Sexual dysfunction
B
Feedback:
Adverse effects of benzodiazepines may
contribute to falls and other injuries unless
patients are carefully monitored and
safeguarded. Seizures, dysrhythmias, and
sexual dysfunction are not characteristic
adverse effects.
A 77-year-old patient is suffering from
insomnia. Which of the following
9.
medications can be most safely administered
to this patient to induce sleep?
Alprazolam (Xanax)
Clonazepam (Klonopin)
Diazepam (Valium)
Temazepam (Restoril)
D
Feedback:
Temazepam (Restoril) is eliminated by
conjugation with glucuronide. Thus,
temazepam (Restoril) is the drug of choice for
patients who are elderly, have liver disease, or
are taking drugs that interfere with hepatic
drug–metabolizing enzymes. Alprazolam
(Xanax) is not administered for insomnia.
Clonazepam (Klonopin) is not administered
for insomnia. Diazepam (Valium) is not
administered for insomnia.
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B)
C)
D)
Ans:
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A)
Ans:
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B)
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A child with night terrors is administered a
10. benzodiazepine agent. Why must the nurse
follow the child's health status closely?
The child is more likely to develop insomnia.
The child is more likely to develop
dependence.
The child is more vulnerable to adverse
effects.
The child is more vulnerable to
hepatotoxicity.
C
Feedback:
Children may be more sensitive to its effects
of this drug, namely mood and/or mental
changes. Hepatotoxicity, insomnia, and
dependence are not among the most common
adverse effect.
When administering benzodiazepines, which
11. of the following medications should be
considered the drug of first choice?
Lorazepam (Ativan)
Estazolam (Prosom)
Temazepam (Restoril)
Triazolam (Halcion)
A
Feedback:
When administering benzodiazepines, which
11. of the following medications should be
considered the drug of first choice?
Lorazepam (Ativan)
Estazolam (Prosom)
Temazepam (Restoril)
Triazolam (Halcion)
A
Feedback:
Lorazepam (Ativan) is probably the
benzodiazepine of first choice. The drug
provides rapid tranquilization of patients
experiencing agitation. Administered
intravenously, it reduces nausea and vomiting
as well as anxiety and induces procedural
amnesia. Lorazepam has a slow onset of
action (5 to 20 minutes) because of delayed
brain penetration but an intermediate to
prolonged duration.
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A)
B)
C)
D)
Ans:
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A patient is admitted to the intensive care unit
with a diagnosis of septicemia. In addition to
12. relieving agitation and anxiety, what is a
rationale for using benzodiazepines in the
treatment of a critically ill patient?
Increased diffusion and perfusion
Decreased cardiac workload
Increased level of consciousness
Decreased blood pH
B
Feedback:
Antianxiety and sedative–hypnotic drugs are
often useful in critically ill patients to relieve
stress, anxiety, and agitation. Their calming
effects decrease cardiac workload (e.g., heart
rate, blood pressure, force of myocardial
contraction, myocardial oxygen consumption)
and respiratory effort. They do not decrease
blood pH, increase diffusion and perfusion, or
increase LOC.
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A)
B)
C)
D)
Ans:
A)
B)
C)
D)
Ans:
A patient is scheduled to undergo a
bronchoscopy for the investigation of a
13. bronchial mass. What benzodiazepine should
the clinic nurse anticipate administering for
conscious sedation?
Triazolam (Halcion)
Midazolam (Versed)
Oxazepam (Serax)
Chlordiazepoxide (Librium)
B
Feedback:
A patient is scheduled to undergo a
bronchoscopy for the investigation of a
13. bronchial mass. What benzodiazepine should
the clinic nurse anticipate administering for
conscious sedation?
Triazolam (Halcion)
Midazolam (Versed)
Oxazepam (Serax)
Chlordiazepoxide (Librium)
B
Feedback:
Midazolam (Versed) is frequently used for
conscious sedation during invasive
procedures. Halcion, Serax, and Librium are
not typically used for this purpose.
A middle-aged woman has become
increasingly debilitated by anxiety, to the
extent that she has sought medical help. After
14. a thorough assessment, her care provider has
diagnosed her with an anxiety disorder. The
etiology of anxiety involves which of the
following physiological processes?
Stimulation of the parasympathetic nervous
system
Stimulating effects of somatotropin
Increased activation of the autonomic nervous
system
Adrenocortical suppression
C
Feedback:
Clinical manifestations of anxiety include
overactivity of the autonomic nervous system,
such as dyspnea, palpitations, tachycardia,
sweating, dry mouth, dizziness, nausea, and
diarrhea. Somatotropin is not directly
involved, and the adrenal cortex is not
suppressed during times of anxiety. The
parasympathetic nervous system is not
stimulated during times of anxiety.
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B)
C)
D)
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B)
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Ans:
A patient's current medical status includes
multiple comorbidities. In recent months, the
patient has been complaining of insomnia that
15.
has begun to have a significant impact on his
quality of life. What aspect of this patient's
health is most likely to cause insomnia?
The patient has hypothyroidism.
The patient is morbidly obese.
The patient has chronic pain.
The patient has type 2 diabetes.
C
Feedback:
Chronic pain is commonly associated with
15.
In the 18 months following the death of his
wife, a middle-aged man has been taking
benzodiazepines on a daily basis. He has
expressed to the nurse his desire to stop
16.
taking these medications. In order to
minimize the chances of withdrawal
symptoms, the nurse knows that the patient
will likely be advised to
taper down his dose of benzodiazepines over
a prolonged period of time.
replace the benzodiazepine with a herbal
supplement in anticipation of stopping the
medication.
replace the immediate-acting form of the drug
with a long-acting form.
replace the benzodiazepine with an
anticonvulsant.
A
Feedback:
To avoid withdrawal symptoms, it is
necessary to taper benzodiazepines gradually
before discontinuing them completely. Longacting benzodiazepines, anticonvulsants, and
herbal remedies are not recommended in the
effort to prevent withdrawal.
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A)
B)
C)
D)
Ans:
patient has been complaining of insomnia that
has begun to have a significant impact on his
quality of life. What aspect of this patient's
health is most likely to cause insomnia?
The patient has hypothyroidism.
The patient is morbidly obese.
The patient has chronic pain.
The patient has type 2 diabetes.
C
Feedback:
Chronic pain is commonly associated with
insomnia. Diabetes, obesity, and
hypothyroidism are not normally associated
with insomnia.
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A patient with a history of alcoholism is being
treated in the intensive care unit for multiple
trauma following a motor vehicle accident.
The patient is currently being treated with
17. lorazepam (Ativan) to treat signs of alcohol
withdrawal as well as hydromorphone
(Dilaudid) for the pain of injuries. The
intensive care nurse should prioritize what
assessments?
Arterial blood gases
Respiratory rate and oxygen saturation
Deep tendon reflexes and pupillary response
Cardiac rate and rhythm
B
Feedback:
The combination of opioids and
benzodiazepines creates a significant risk for
CNS depression; respiratory function is
consequently an important focus of
assessment. It would likely supersede other
assessments, even though each may be
warranted.
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A)
B)
C)
D)
Ans:
A)
B)
C)
D)
Ans:
A 77-year-old woman who experiences
significant anxiety has been taking diazepam
for several months. She was brought to the
clinical earlier this week by her daughter, who
stated that her mother had been behaving in
an uncharacteristically confused manner. The
18.
clinician discontinued the patient's diazepam.
Three days later, the daughter states that her
mother has still been having problems with
impaired memory and confusion. The nurse
should consider what possible explanation for
the patient's current status?
Benzodiazepines can occasionally cause
permanent alterations in personality and level
of consciousness.
The patient may have decreased liver
function.
The patient may have been experiencing a
hypersensitivity to the drug, rather than an
adverse effect.
The adverse effects of benzodiazepines can
persist for several days after stopping the
drug.
D
Feedback:
Both therapeutic effects and adverse effects of
diazepam are more likely to occur after 2 or 3
The patient may have decreased liver
function.
The patient may have been experiencing a
hypersensitivity to the drug, rather than an
adverse effect.
The adverse effects of benzodiazepines can
persist for several days after stopping the
drug.
D
Feedback:
Both therapeutic effects and adverse effects of
diazepam are more likely to occur after 2 or 3
days of therapy than initially. Such effects
accumulate with chronic usage and persist for
several days after the drug is discontinued.
Hypersensitivity and decreased liver function
are unlikely. Benzodiazepines do not cause
permanent changes in cognition.
B)
C)
D)
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A patient's severe family tragedy 1 year ago
resulted in depression and insomnia. Which of
19.
the following hypnotics may be safely taken
for longer-term treatment of insomnia?
Lorazepam (Ativan)
Eszopiclone (Lunesta)
Chloral hydrate
Oxazepam (Serax)
B
Feedback:
Eszopiclone (Lunesta) is the first oral
nonbenzodiazepine hypnotic to receive FDA
approval for long-term use (≤12 months).
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B)
C)
D)
Ans:
A)
B)
C)
D)
Ans:
A nurse has noted that a newly admitted
patient has been taking ramelteon (Rozerem)
for the past several weeks. The nurse is
20.
justified in suspecting that this patient was
experiencing what problem prior to starting
this drug?
Somnambulism (sleepwalking)
Difficulty falling asleep at night
Early morning waking
Frequent nighttime awakenings
B
Feedback:
Ramelteon (Rozerem), the newest oral
nonbenzodiazepine hypnotic, has received
FDA approval for the long-term treatment of
insomnia characterized by difficulty with
sleep onset.
B)
C)
D)
Ans:
Difficulty falling asleep at night
Early morning waking
Frequent nighttime awakenings
B
Feedback:
Ramelteon (Rozerem), the newest oral
nonbenzodiazepine hypnotic, has received
FDA approval for the long-term treatment of
insomnia characterized by difficulty with
sleep onset.
Chapter 55 Drug Therapy for Depression and Mood Stabilization
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A woman has a history of long periods of
depression interspersed with hypomanic
1.
episodes. What mood disorder is the patient
most likely suffering from?
Bipolar disorder type I
Bipolar disorder type II
Situational depression
Coping disorder
B
Feedback:
Bipolar disorder type II is characterized by
episodes of major depression plus hypomanic
episodes and occurs more frequently in
women. Bipolar disorder type I is
characterized by episodes of major depression
plus mania and occurs equally in men and
women. Situation depression lasts a shorter
amount of time and is related to life events. A
coping disorder is not related to hypomania.
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A)
B)
C)
D)
Ans:
A)
B)
C)
D)
Ans:
A patient is admitted for assessment because
of his history of inappropriately flamboyant
and extroverted behavior coupled with risk2. taking behaviors. The wife states he has also
had periods of major depression but refuses to
seek help. From what mood disorder is the
patient most likely suffering?
Schizophrenia
Depression
Bipolar disorder type I
Bipolar disorder type II
C
Feedback:
Bipolar disorder type I is characterized by
episodes of major depression plus mania and
occurs equally in men and women.
Schizophrenia results from abnormal brain
synapses and includes a wide variety of
diseases. Depression is a mood disorder, but
does not exhibit periods of mania. Bipolar
disorder type II is characterized by episodes
Depression
Bipolar disorder type I
Bipolar disorder type II
C
Feedback:
Bipolar disorder type I is characterized by
episodes of major depression plus mania and
occurs equally in men and women.
Schizophrenia results from abnormal brain
synapses and includes a wide variety of
diseases. Depression is a mood disorder, but
does not exhibit periods of mania. Bipolar
disorder type II is characterized by episodes
of major depression plus hypomanic episodes
and occurs more frequently in women.
A patient suffers from depression and states
feelings of gloom and inability to perform the
3. activities of daily living. The normal function
of which neurotransmitter is most likely
impaired?
Acetylcholine
Epinephrine
Insulin
Serotonin
D
Feedback:
Serotonin helps regulate several behaviors
that are disturbed in depression. Acetylcholine
is a neurotransmitter with action in the cardiac
and skeletal muscle. Acetylcholine has a
limited impact in depression. Epinephrine is
not associated with depression, though
norepinephrine is implicated. Insulin is
released by the pancreas to regulate blood
sugar.
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B)
C)
D)
Ans:
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B)
C)
D)
Ans:
A)
B)
C)
D)
Ans:
A patient has been taking a selective serotonin
reuptake inhibitor for the treatment of
4.
depression. Which of the following represents
the action of the medication?
Selective serotonin reuptake inhibitors block
GABA.
Selective serotonin reuptake inhibitors
prevent serotonin from being reabsorbed.
Selective serotonin reuptake inhibitors
increase serotonin synthesis.
Selective serotonin reuptake inhibitors
increase the number of serotonin binding
sites.
B
Feedback:
Fluoxetine and the other SSRIs block the
reabsorption of the neurotransmitter serotonin
A)
GABA.
Selective serotonin reuptake inhibitors
prevent serotonin from being reabsorbed.
Selective serotonin reuptake inhibitors
increase serotonin synthesis.
Selective serotonin reuptake inhibitors
increase the number of serotonin binding
sites.
B
Feedback:
Fluoxetine and the other SSRIs block the
reabsorption of the neurotransmitter serotonin
in the brain. This helps elevate mood. SSRIs
do not increase serotonin synthesis or the
number of binding sites. They do not
influence the role of GABA.
B)
C)
D)
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An 8-year-old child is being seen in the clinic.
The mother states he suffers from bed-wetting
5.
at least four times per week. What medication
is effective in treating enuresis in children?
Amitriptyline (Elavil)
Duloxetine (Cymbalta)
Imipramine (Tofranil)
Venlafaxine (Effexor)
C
Feedback:
Imipramine (Tofranil) is approved for treating
childhood enuresis in children older than 6
years. Amitriptyline (Elavil) is a tricyclic
antidepressant but is not used for childhood
enuresis. Duloxetine (Cymbalta) is a
serotonin–norepinephrine reuptake inhibitor
that is used for depression. Venlafaxine
(Effexor) is a serotonin–norepinephrine
reuptake inhibitor that is used for depression.
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A)
B)
C)
D)
Ans:
A)
B)
C)
D)
Ans:
An elderly patient is admitted to the medical
unit after a fall. At home he is taking
6. amitriptyline (Elavil) 20 mg three times per
day. What adverse effect could be related to
the patient's fall?
Urinary frequency
Urinary retention
Visual disturbances
Orthostatic hypotension
D
Feedback:
Orthostatic hypotension is an adverse effect
related to amitriptyline (Elavil). Urinary
retention (not frequency) is an adverse effect
of amitriptyline but is not related to the falls.
Visual disturbances are not a common adverse
effect.
Urinary retention
Visual disturbances
Orthostatic hypotension
D
Feedback:
Orthostatic hypotension is an adverse effect
related to amitriptyline (Elavil). Urinary
retention (not frequency) is an adverse effect
of amitriptyline but is not related to the falls.
Visual disturbances are not a common adverse
effect.
A 40-year-old man has been prescribed
fluoxetine (Prozac). The patient states he has
not continued the prescribed therapy even
7.
though his depression improved. What
assessment is most important for the nurse to
make?
Assess for sexual dysfunction.
Assess for hypotension.
Assess for pain and discomfort.
Assess for cardiac dysrhythmia.
A
Feedback:
Fluoxetine (Prozac) produces adverse effects,
such as sexual dysfunction. It is imperative
that the nurse assess for sexual dysfunction,
which is a major reason for noncompliance in
men. The assessment of hypotension is not
accurate without symptoms of hypotension.
The assessment of pain or discomfort is not
accurate in this patient. The assessment of
cardiac dysrhythmia is not accurate in this
patient.
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B)
C)
D)
Ans:
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B)
C)
D)
Ans:
A)
B)
C)
D)
Ans:
A patient is to be switched from fluoxetine
(Prozac) to isocarboxazid (Marplan). What
8.
patient education is most important when
changing from fluoxetine (Prozac)?
Wait 5 days before starting isocarboxazid
(Marplan).
Wait 1 week before starting isocarboxazid
(Marplan).
Wait 2 weeks before starting isocarboxazid
(Marplan).
Wait 5 weeks before starting isocarboxazid
(Marplan).
D
Feedback:
If a patient is taking fluoxetine (Prozac) and is
being switched to isocarboxazid (Marplan),
the fluoxetine should be discontinued at least
5 weeks before starting the MAO inhibitor.
Waiting less time than this before starting the
C)
(Marplan).
Wait 5 weeks before starting isocarboxazid
(Marplan).
D
Feedback:
If a patient is taking fluoxetine (Prozac) and is
being switched to isocarboxazid (Marplan),
the fluoxetine should be discontinued at least
5 weeks before starting the MAO inhibitor.
Waiting less time than this before starting the
isocarboxazid (Marplan) will place the patient
at risk for serotonin syndrome.
D)
Duloxetine (Cymbalta) is being considered in
the treatment of a patient's depression. Which
9. of the following laboratory values would
prevent the patient from being treated with
this medication?
Decreased hemoglobin level
Decreased potassium level
Increased ALT
Increased erythrocyte sedimentation rate
C
Feedback:
Duloxetine (Cymbalta) is highly protein
bound, extensively metabolized by CYP2D6
and CYP1A2 enzymes in the liver, and
excreted by the kidneys. It is not
recommended for use in patients with severe
renal or any degree of liver impairment. Low
hemoglobin, elevated potassium, and
increased ESR do not necessarily preclude the
use of Cymbalta.
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B)
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A)
B)
C)
D)
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A patient has been prescribed phenelzine
sulfate (Nardil), which is an MAO inhibitor.
10.
Which of the following foods should the
patient avoid eating?
Mashed potatoes and roast beef
Aged Swiss cheese and bratwurst
Tortellini in cream sauce
Anise cookies and milk
B
Feedback:
When taking an MAO inhibitor, the following
foods should be avoided: aged cheeses and
meats, concentrated yeast extracts, sauerkraut,
and fava beans. None of the other listed foods
is problematic.
B)
C)
D)
Ans:
Aged Swiss cheese and bratwurst
Tortellini in cream sauce
Anise cookies and milk
B
Feedback:
When taking an MAO inhibitor, the following
foods should be avoided: aged cheeses and
meats, concentrated yeast extracts, sauerkraut,
and fava beans. None of the other listed foods
is problematic.
A patient has been prescribed mirtazapine
11. (Remeron). How will it decrease migraine
headaches and depression?
It increases concentration of endogenous
epinephrine.
It blocks the presynaptic alpha2-adrenergic
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A)
B)
receptors.
It acts on the dopamine only receptors in the
brain.
It inhibits norepinephrine and serotonin
reuptake.
B
Feedback:
Mirtazapine blocks presynaptic alpha2-
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adrenergic receptors (which increase the
release of norepinephrine), serotonin
receptors, and histamine H1 receptors.
A)
B)
C)
D)
Ans:
Consequently, the drug decreases anxiety,
agitation, insomnia, and migraine headaches
as well as depression.
A patient suffers from insomnia secondary to
temporomandibular joint pain. Which of the
12. following selective serotonin reuptake
inhibitors is most effective for treating
insomnia?
Fluoxetine (Prozac)
Olanzapine (Zyprexa)
Citalopram hydrobromide (Celexa)
Trazodone (Desyrel)
D
Feedback:
Trazodone (Desyrel) is administered more
often for sedation and sleep than depression.
Fluoxetine (Prozac) is not administered for
sleep. Olanzapine (Zyprexa) is not
administered for sleep. Citalopram
hydrobromide is not administered for sleep.
Olanzapine (Zyprexa)
Citalopram hydrobromide (Celexa)
Trazodone (Desyrel)
D
Feedback:
Trazodone (Desyrel) is administered more
often for sedation and sleep than depression.
Fluoxetine (Prozac) is not administered for
sleep. Olanzapine (Zyprexa) is not
administered for sleep. Citalopram
hydrobromide is not administered for sleep.
A patient is being treated for bipolar disorder
with lithium carbonate (Eskalith). He also
suffers from congestive heart failure and
hypertension. The patient has an increased
13.
fluid volume and has recently had difficulty
breathing. What laboratory value will most
affect the action of the patient's lithium
carbonate?
Increased hematocrit
Increased sodium level
Increased potassium level
Increased white blood cell count
B
Feedback:
A sodium excess causes more lithium to be
excreted and may lower lithium levels to
nontherapeutic ranges. An increased lithium
level would not be noted with a patient who
has fluid volume excess and hypertension. An
increased potassium level is unlikely with
fluid volume excess. An increased white
blood cell count is indicative of infection,
from which the patient does not suffer.
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C)
D)
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B)
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B)
C)
D)
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A patient with a diagnosis of depression states
to the nurse that she has started taking St.
John's wort to help her feel better and tolerate
14. the demands of parenting. The patient has
been taking an SSRI for the past several
months. The nurse should teach that patient
that this combination may result in
worsened symptoms of depression.
blood dyscrasias.
dangerous drug interactions.
hemostatic instability.
C
Feedback:
Combining St. John's wort with
antidepressants can cause serious adverse
effects. These effects do not typically include
worsened depression, alterations in
coagulation, or dyscrasias.
B)
C)
D)
Ans:
blood dyscrasias.
dangerous drug interactions.
hemostatic instability.
C
Feedback:
Combining St. John's wort with
antidepressants can cause serious adverse
effects. These effects do not typically include
worsened depression, alterations in
coagulation, or dyscrasias.
A patient has been taking lithium carbonate
(Eskalith) for many years to treat bipolar
15. disorder. Which of the following diets will
require the dose of lithium carbonate
(Eskalith) be reduced?
Low calorie
Low carbohydrate
Low sodium
Low residue
C
Feedback:
A low-salt (sodium) diet will impair lithium
secretion, so the dose of lithium should be
reduced. The administration of a low-calorie
diet will not affect the dose of lithium. The
administration of a low-carbohydrate diet will
not affect the dose of lithium. The
administration of a low-residue diet will not
affect the dose of lithium.
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A patient treated for bipolar disorder with
lithium carbonate (Eskalith) is scheduled for a
16.
lithium blood level. What is the therapeutic
serum lithium level?
0.5 to 1.2 mEq/L
1.5 to 2.0 mEq/L
2.7 to 2.9 mEq/L
2.75 to 3.25 mEq/L
A
Feedback:
The therapeutic serum lithium level is 0.5 to
1.2 mEq/L. A serum lithium level of 2.7 to 2.9
mEq/L is toxic. A serum lithium level of 1.5
to 2.0 mEq/L is toxic. A serum lithium level
of 2.75 to 3.25 mEq/L is toxic.
A)
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A 34-year-old man was diagnosed with
depression several weeks ago and began
taking citalopram (Celexa) 10 days ago. He
has now scheduled an appointment at the
17. clinic and has told the nurse that he intends to
stop taking the drug, stating, “I don't feel any
less depressed than I did before I started
taking these pills.” How should the nurse best
respond to the patient's statement?
“I'll pass that information along to your care
provider; a different drug might be more
appropriate for you.”
“I'd encourage you to continue with the drug;
it can take several weeks before it improves
your mood.”
“People who take this drug often think they
don't feel better because the changes in mood
are incremental and subtle.”
“It could be that one of the other medications
or supplements you're taking is negating the
effects of Celexa.”
B
Feedback:
Steady-state blood levels of SSRIs are
achieved slowly, over several weeks. This
aspect of pharmacokinetics is more likely
than a possible drug interaction. The patient
should expect to sense an eventual
improvement in mood, and it would be
premature to change medications.
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B)
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A high school–aged girl has been suffering
from major depression for several months,
and she has begun treatment with an SSRI. In
18.
light of the black box warning accompanying
SSRIs, the nurse should prioritize which of
the following assessments?
Assessment for venous thromboembolism
(VTE)
Assessment of cardiac rate and rhythm
Assessment for hypomanic state
Assessment for suicidal ideation
D
Feedback:
The FDA has issued a black box warning
alerting health care providers to the increased
risk of suicidal ideation in children,
adolescents, and young adults 18 to 24 years
of age when taking antidepressant
medications. VTE, arrhythmias, and
hypomania are not likely adverse effects.
Assessment of cardiac rate and rhythm
Assessment for hypomanic state
Assessment for suicidal ideation
D
Feedback:
The FDA has issued a black box warning
alerting health care providers to the increased
risk of suicidal ideation in children,
adolescents, and young adults 18 to 24 years
of age when taking antidepressant
medications. VTE, arrhythmias, and
hypomania are not likely adverse effects.
A patient with a diagnosis of major depression
has failed to respond to treatment with SSRIs,
and the use of venlafaxine is being
19. considered. The psychiatric nurse would
recognize that this drug may have a
therapeutic effect by which of the following
means?
Slowing the reuptake of endorphins in the
CNS
Increasing levels of serotonin and
norepinephrine
Stimulating synthesis and potentiating the
action of dopamine
Slowing the reuptake of acetylcholine in brain
synapses
B
Feedback:
Venlafaxine increases the levels of serotonin
and norepinephrine in the brain by preventing
the reuptake of these neurotransmitters known
to play an important part in mood. It does not
directly affect endorphins or acetylcholine.
The drug weakly inhibits dopamine reuptake.
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An elderly woman tells the nurse that she was
successfully treated with phenelzine (Nardil)
during a bout of severe depression in the
1970s. Her mood has been worsening in
recent years as she has dealt with the death of
20.
her husband and functional declines. As a
result, she has asked the nurse if her care
provider is likely to prescribe this same drug.
What fact should underlie the nurse's response
to the patient?
Cognitive behavioral therapy has been found
to be more effective than MAO inhibitors, so
they are rarely prescribed.
In most situations, MAO inhibitors have been
largely superseded by tricyclic
antidepressants.
The risks of serious drug interactions and
20.
A)
B)
C)
D)
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recent years as she has dealt with the death of
her husband and functional declines. As a
result, she has asked the nurse if her care
provider is likely to prescribe this same drug.
What fact should underlie the nurse's response
to the patient?
Cognitive behavioral therapy has been found
to be more effective than MAO inhibitors, so
they are rarely prescribed.
In most situations, MAO inhibitors have been
largely superseded by tricyclic
antidepressants.
The risks of serious drug interactions and
food interactions mean that MAO inhibitors
are rarely used.
MAO inhibitors are rarely used because
serum levels must be monitored with blood
work every 2 weeks.
C
Feedback:
MAO inhibitors are rarely used in clinical
practice today, mainly because they may
interact with some foods and drugs to produce
severe hypertension and possible heart attack
or stroke. Serum levels do not need to be
monitored. The potential benefits of cognitive
behavioral therapy do not affect prescribers'
decisions to use MAO inhibitors. SSRIs have
become the first line of treatment for
depression, replacing tricyclic
antidepressants.
A)
B)
C)
D)
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Chapter 56 Drug Therapy for Psychotic Disorders
A person is seen wandering the streets and
talking in an animated way to people who are
1.
not there. From what disorder do you suspect
the person is suffering?
Confusion
Delusions
Psychosis
Depression
C
Feedback:
The patient is suffering from psychosis, which
is a severe mental disorder characterized by
disordered thought processes. Delusions are
false beliefs that persist in the absence of
reason or evidence and are also a symptom of
a psychosis. Depression is a disorder and
symptom that is not as severe as a psychotic
disorder. Confusion is a more generic term
that denotes a lack of clear thinking.
Delusions
Psychosis
Depression
C
Feedback:
The patient is suffering from psychosis, which
is a severe mental disorder characterized by
disordered thought processes. Delusions are
false beliefs that persist in the absence of
reason or evidence and are also a symptom of
a psychosis. Depression is a disorder and
symptom that is not as severe as a psychotic
disorder. Confusion is a more generic term
that denotes a lack of clear thinking.
A patient is admitted to the hospital for
cardiac surgery and has just come up to the
postsurgical unit from the recovery room. He
2. develops unprecedented confusion and states,
“I see bugs up and down the walls. They are
going to get me.” The nurse suspects the
patient is suffering from what symptom?
Depression
Delusions
Delirium
Schizophrenia
C
Feedback:
The patient is suffering from delirium as a
postoperative complication. Delusions are
false beliefs that persist in the absence of
reason or evidence. Schizophrenia is a variety
of disorders and not a single symptom.
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A teenage boy has begun to exhibit the
characteristic signs and symptoms of
3. schizophrenia. During his mother's pregnancy,
during what time in development could she
have experienced an intrauterine insult?
Conception
First trimester
Second trimester
Third trimester
C
Feedback:
The neurodevelopmental model proposes that
schizophrenia results when abnormal brain
synapses are formed in response to an
intrauterine insult during the second trimester
of pregnancy, when neuronal migration is
normally taking place. At conception, no
implantation in the uterus has occurred. The
first trimester is prior to neuronal migration.
The third trimester is after neuronal
First trimester
Second trimester
Third trimester
C
Feedback:
The neurodevelopmental model proposes that
schizophrenia results when abnormal brain
synapses are formed in response to an
intrauterine insult during the second trimester
of pregnancy, when neuronal migration is
normally taking place. At conception, no
implantation in the uterus has occurred. The
first trimester is prior to neuronal migration.
The third trimester is after neuronal
migration.
A patient is experiencing an episode of
psychosis. He is belligerent, loud, and abusive
4. when you enter the room. What is the best
response by the nurse during future
interactions?
Respond to him in an assertive tone.
Use a calm, soft voice.
Delegate care to the technician.
Place him in the quiet room.
B
Feedback:
The most therapeutic communication
technique for this patient is to use a calm, soft
voice. To respond to the patient in a loud tone
will increase his agitation. Delegating care to
the patient care technician can increase the
patient's agitation based on the fact that the
unlicensed caretaker may not possess strong
therapeutic communication skills. Placing the
patient in a quiet room will not affect any
changes in his behavior and may increase his
hallucinations.
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C)
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B)
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A patient who has a diagnosis of
5. schizophrenia is likely to have which of the
following pathophysiologic effects?
Increased dopamine
Increased serum potassium
Decreased numbers of glutamate receptors
Decreased interaction with GABA
A
Feedback:
The patient suffering from schizophrenia has
increased dopamine activity in the brain. The
amount of potassium would cause other
physiological symptoms, but not affect
schizophrenic symptoms. The patient with
schizophrenia will have widespread glutamate
Increased serum potassium
Decreased numbers of glutamate receptors
Decreased interaction with GABA
A
Feedback:
The patient suffering from schizophrenia has
increased dopamine activity in the brain. The
amount of potassium would cause other
physiological symptoms, but not affect
schizophrenic symptoms. The patient with
schizophrenia will have widespread glutamate
receptors, not decreased glutamate receptors.
In addition, the glutamatergic system interacts
with the dopaminergic and gammaaminobutyric acid systems and possibly other
neurotransmission systems.
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C)
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A patient has been prescribed an antipsychotic
6. agent to relieve psychotic symptoms. Which
of the following goals of care is the priority?
The patient will demonstrate independent
health maintenance.
The patient will interact therapeutically with
peers.
The patient will participate in activities of
daily living.
The patient will remain safe.
D
Feedback:
Safety is a priority over other goals. Goals
such as participation in ADLs, health
maintenance, and participation in
relationships are valid, but safety is a priority.
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A patient in her 60s has been living with
schizophrenia since she was a young woman
and was treated with chlorpromazine for
many years. The nurse who is meeting the
7. patient for the first time observes that the
patient continually smacks her lips and
appears to be chewing. The nurse should
recognize that this patient is likely
experiencing what problem?
Tardive dyskinesia
Akathisia
Dystonias
Neuroleptic malignant syndrome
A
Feedback:
Tardive dyskinesia occurs as the result of
long-term use of chlorpromazine. Patients
may experience lip smacking, tongue
protrusion, and facial grimaces and may have
choreic movements of trunk and limbs.
Akathisia
Dystonias
Neuroleptic malignant syndrome
A
Feedback:
Tardive dyskinesia occurs as the result of
long-term use of chlorpromazine. Patients
may experience lip smacking, tongue
protrusion, and facial grimaces and may have
choreic movements of trunk and limbs.
Akathisia is a form of restlessness, and
dystonias are uncoordinated movements.
Neuroleptic malignant syndrome is an acute
complication.
An elderly patient with a long-standing
history of schizophrenia has been admitted to
the hospital for treatment of hyponatremia.
The nurse reviews the patient's medical chart
8.
and reads that the patient was previously
treated with phenothiazine antipsychotics.
What medication may this patient have been
treated with?
Aminophylline (Theophylline)
Acetylsalicylic acid (aspirin)
Chlorpromazine (Thorazine)
Dantrolene sodium (Dantrium)
C
Feedback:
Chlorpromazine (Thorazine) is the prototype
phenothiazine. Aminophylline (Theophylline)
is a xanthine agent administered to increase
bronchioles. Acetylsalicylic acid (aspirin) and
dantrolene sodium (Dantrium) are not
phenothiazines.
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B)
C)
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A patient who was diagnosed with
schizophrenia in 1962 was prescribed
chlorpromazine (Thorazine). The patient has
9.
been taking the medication for more than 40
years. What adverse effect will the patient
most likely experience?
Hypertension
Extrapyramidal effects
Central nervous system agitation
Urinary frequency
B
Feedback:
A patient who has taken chlorpromazine
(Thorazine) on a long-term basis will be at
risk for late extrapyramidal effects.
Hypertension is not an adverse effect of
chlorpromazine, but hypotension is an
adverse effect. Central nervous system
Extrapyramidal effects
Central nervous system agitation
Urinary frequency
B
Feedback:
A patient who has taken chlorpromazine
(Thorazine) on a long-term basis will be at
risk for late extrapyramidal effects.
Hypertension is not an adverse effect of
chlorpromazine, but hypotension is an
adverse effect. Central nervous system
agitation is not an adverse effect of
chlorpromazine, but central nervous system
depression is an adverse effect. Urinary
frequency is not an adverse effect of
chlorpromazine, but urinary retention is an
adverse effect.
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C)
D)
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A child suffers from tics and verbal outbursts
in the classroom and while he is awake. The
10. patient is prescribed haloperidol (Haldol).
What disease process is haloperidol (Haldol)
used to treat?
Muscular dystrophy
Early-onset dementia
Tourette's syndrome
Myasthenia gravis
C
Feedback:
Haloperidol (Haldol) is used in treating
Tourette's syndrome, which is a disorder
characterized by involuntary movements and
vocalizations. Muscular dystrophy is not
treated with atypical antipsychotics.
Alzheimer's disease is not normally treated
with atypical antipsychotics. Myasthenia
gravis is not treated with atypical
antipsychotics.
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B)
C)
D)
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B)
C)
D)
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A patient is prescribed clozapine (Clozaril).
The patient and family should be instructed
11. on the adverse effects of this medication.
What laboratory test is most important in the
first months of the medication regime?
Weekly liver enzymes
Daily INR
Monthly creatinine levels
Regular complete blood counts
D
Feedback:
Clozapine (Clozaril) is associated with lifethreatening decrease in white blood cells
(agranulocytosis). It is essential to monitor the
complete blood count due to this risk. Weekly
Weekly liver enzymes
Daily INR
Monthly creatinine levels
Regular complete blood counts
D
Feedback:
Clozapine (Clozaril) is associated with lifethreatening decrease in white blood cells
(agranulocytosis). It is essential to monitor the
complete blood count due to this risk. Weekly
liver enzymes are not recommended when
administering clozapine. Monthly creatinine
levels and INR monitoring are not
recommended with clozapine therapy.
A patient is prescribed olanzapine (Zyprexa)
for the treatment of schizophrenia. The patient
tells the nurse he is voiding three times each
12. night and is always thirsty. Based on the
adverse effects of this medication, what
should the nurse suspect the patient has
developed?
Urinary tract infection
Diabetes mellitus
Renal calculi
Hyperthyroidism
B
Feedback:
The development of polyuria and polydipsia
is indicative of diabetes mellitus. Olanzapine
has been associated with weight gain,
hyperglycemia, and initiation or aggravation
of diabetes mellitus. Urinary tract infection is
not considered an adverse effect with
olanzapine. Renal calculus is not an adverse
effect of olanzapine. Hyperthyroidism is not
an adverse effect of olanzapine.
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A patient diagnosed with schizophrenia is
being seen by the home care nurse. What is
13.
the most important aspect of patient teaching
with this patient?
Maintain the medication regimen.
Report signs of neuralgia.
Stop medications if weight gain occurs.
Limit alcohol intake to two drinks per day.
A
Feedback:
The patient should be instructed to maintain
the medication regime to control symptoms of
schizophrenia. Reporting signs of neuralgia is
not taught because the medication does not
have this effect. The medications will cause
weight gain and should not be stopped in the
Report signs of neuralgia.
Stop medications if weight gain occurs.
Limit alcohol intake to two drinks per day.
A
Feedback:
The patient should be instructed to maintain
the medication regime to control symptoms of
schizophrenia. Reporting signs of neuralgia is
not taught because the medication does not
have this effect. The medications will cause
weight gain and should not be stopped in the
event that weight gain develops. The use of
alcohol is strictly prohibited with
antipsychotic agents.
A patient with schizophrenia has been taking
haloperidol for several years. The care team
and the patient have collaborated and chosen
to transition the patient to an atypical
antipsychotic in an effort to reduce adverse
14.
effects and maximize therapeutic effects. In
order to reduce the patient's risk of
extrapyramidal effects during this transition,
the care team should do which of the
following?
Gradually taper the dose of haloperidol.
Have a 2- to 3-week “drug holiday” between
stopping the haloperidol and starting the
atypical antipsychotic.
Administer haloperidol and the atypical
antipsychotic drug concurrently for 6 to 8
weeks.
Arrange for weekly electroconvulsive therapy
during the time of transition.
A
Feedback:
When discontinuing haloperidol, it is essential
to taper the dosage to prevent extrapyramidal
symptoms. If the medication is abruptly
discontinued, the patient is at risk for this
condition. A drug holiday would exacerbate
symptoms, and ECT is not indicated.
Concurrent administration of two drugs has
the potential to exacerbate adverse effects.
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A psychiatric nurse is discussing the
advantages of atypical antipsychotics with the
parents of a teenage girl who has been
15. diagnosed with schizophrenia. When
comparing these drugs with the older, typical
antipsychotics, what advantage should the
nurse cite?
Lower cost
The possibility of oral administration
Reduced adverse effects
Absence of black box warnings
C
Feedback:
Atypical antipsychotics may be more
effective in relieving some symptoms than
typical antipsychotics, and they usually
produce milder adverse effects. A major
drawback is the high cost of these drugs. All
antipsychotics are available for the oral route.
There are several black box warnings relating
to atypical antipsychotics.
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B)
C)
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B)
C)
D)
Ans:
A 22-year-old man's increasingly bizarre
behavior has culminated in a diagnosis of
schizophrenia. In light of current treatment
16.
modalities for schizophrenia, the nurse should
anticipate that the patient is most likely to be
prescribed what drug?
Chlorpromazine (Thorazine)
Olanzapine (Zyprexa)
Haloperidol (Haldol)
Prochlorperazine (Compazine)
B
Feedback:
The "atypical" antipsychotics, such as
olanzapine, are the drugs of choice, especially
for patients who are newly diagnosed with
schizophrenia.
A psychiatric nurse is providing care for a
female patient with schizophrenia whose
medication regimen includes oral
17.
chlorpromazine. When administering this
medication, the nurse should do which of the
following?
Have the patient hold the drug under her
tongue for at least 30 seconds.
Administer the drug 1 to 2 hours before
bedtime.
Administer the drug on alternating days.
Instruct the patient to avoid dairy products for
1 hour before and 2 hours after
administration.
B
Feedback:
For oral administration of chlorpromazine, the
nurse should give doses 1 to 2 hours before
bedtime; peak sedation occurs in about 2
hours. The drug is not given on alternating
days, and there is no need to avoid dairy
products. It is unnecessary for the patient to
hold the drug under her tongue.
A)
B)
C)
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A)
B)
C)
D)
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A patient has been achieving an acceptable
reduction in his positive and negative signs of
schizophrenia after several weeks of treatment
18. with clozapine. The patient has asked the
nurse if it is acceptable for him to have “a few
drinks from time to time.” How should the
nurse best respond to the patient's inquiry?
“If you notice that your symptoms are
worsening when you drink, you should stop
doing it.”
“That shouldn't present a problem, provided
you make sure that you're safe when you do
it.”
“That's okay in most cases, but it's advisable
to limit it to beer and wine and to avoid
spirits.”
“When you're taking clozapine, it's best to
avoid drinking alcohol altogether.”
D
Feedback:
Alcohol increases central nervous system
depression in patients taking clozapine;
patients should ideally abstain from drinking
alcohol.
spirits.”
“When you're taking clozapine, it's best to
avoid drinking alcohol altogether.”
D
Feedback:
Alcohol increases central nervous system
depression in patients taking clozapine;
patients should ideally abstain from drinking
alcohol.
D)
Ans:
A patient's medication administration record
orders the IM administration of
19.
chlorpromazine. When administering this
drug, the nurse should
observe the patient while he or she selfadministers the drug.
administer the drug into the deltoid muscle
with a 1 1/2-inch needle.
have the patient massage the injection site for
1 to 2 minutes after the injection.
have the patient lie down for 30 to 60 minutes
after the injection.
D
Feedback:
For IM administration of chlorpromazine, the
nurse should have the patient lie down for 30
to 60 minutes after the injection to prevent
orthostatic hypotension. Massage is
unnecessary, and the ventrogluteal site is
used. Self-administration is not the norm.
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Parenteral haloperidol has been ordered for a
patient who is experiencing an acute
20.
psychotic episode. The nurse should
recognize what primary goal of treatment?
Increased insight into delusional thinking
Increased sophistication of thinking
Decreased agitation and combativeness
Decreased CNS stimulation
C
Feedback:
When haloperidol is given for acute psychotic
episodes, the nurse observes for sedation,
decreased agitation, combativeness, and
psychomotor activity. Insight, clarity of
thinking, and decreased CNS stimulation are
not short-term priorities during an acute
psychotic episode.
Chapter 57 Drug Therapy for Attention Deficit Hyperactivity Disorder and
Narcolepsy
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A 4-year-old child is brought to the pediatric
clinic by his mother. She states, “I don't know
what to do with him. He is in constant motion.
He won't sit for more than a few seconds and
he is doing something else. He often throws
1. his toys and yells loudly, even compared with
other kids his age.” The child is diagnosed
with attention deficit hyperactivity disorder.
Which of the following medications will most
likely be administered in conjunction with
treatment?
ACE inhibitors
SSRIs
Central nervous system stimulants
MAO inhibitors
C
Feedback:
ADHD is characterized by persistent
hyperactivity, short attention span, difficulty
completing tasks, restlessness, and
impulsivity. The diagnosis has increased in
recent years, with a concomitant increase in
the use of prescribed CNS stimulants for its
treatment. SSRIs, ACE inhibitors, and MAOIs
are not typically used.
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A)
B)
C)
D)
Ans:
A)
B)
C)
D)
Ans:
A patient visits the occupational health office
of the factory in which he works. He has
fallen asleep on the line and has a history of
2. muscle weakness. This instance is not the first
time he has fallen asleep on the line. From
what disease process does the occupational
health nurse suspect the patient is suffering?
Sleep apnea
Insomnia
Narcolepsy
Substance abuse
C
Feedback:
Narcolepsy is characterized by daytime sleep
attacks in which the person goes to sleep at
any place or at any time. Sleep apnea is
episodes of apnea during sleep. Insomnia is
the inability to sleep. This patient is not
exhibiting signs and symptoms of substance
B)
C)
D)
Ans:
Insomnia
Narcolepsy
Substance abuse
C
Feedback:
Narcolepsy is characterized by daytime sleep
attacks in which the person goes to sleep at
any place or at any time. Sleep apnea is
episodes of apnea during sleep. Insomnia is
the inability to sleep. This patient is not
exhibiting signs and symptoms of substance
abuse.
A patient suffers from narcolepsy. Which of
3. the following aspects of patient teaching
should be provided?
Take 250 mg of caffeine daily.
Avoid working shifts.
Take a lengthy nap every afternoon.
Increase the Ritalin dose as needed.
B
Feedback:
The patient who is diagnosed with sleep
apnea should avoid shift work. Caffeine use
may or may not be indicated. The patient
should ideally not take naps. The patient
should not increase the Ritalin dose without
the input of the primary health provider.
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B)
C)
D)
Ans:
A child is prescribed an amphetamine for
attention deficit hyperactivity disorder. Which
4.
of the following effects provide evidence that
the medications are working?
Improved grades
Increased sleep quality
Lethargy
Polyphagia
A
Feedback:
Amphetamines used with ADHD improve
academic performance. Amphetamines often
decrease sleep. Amphetamines will not result
in lethargy. Amphetamines decrease appetite
and do not cause polyphagia.
A patient is taking dextroamphetamine for
ADHD. He has developed constipation since
5.
beginning therapy. Which of the following
should the patient be taught?
Take an OTC laxative daily.
Increase fiber intake.
Take diphenoxylate hydrochloride (Lomotil).
Take metronidazole (Flagyl).
B
Feedback:
A patient who is experiencing constipation
should be instructed to increase fiber in his
diet. The patient should not take a laxative.
The patient should not be instructed to take
diphenoxylate hydrochloride (Lomotil)
because it is an antidiarrheal agent. The
patient should not be given metronidazole
(Flagyl).
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B)
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A neonate is suffering from apnea. Which of
6. the following medications may be
administered as a respiratory stimulant?
Caffeine and methylphenidate
Caffeine and Mefoxitin
Caffeine and sodium benzoate
Caffeine and sodium bicarbonate
C
Feedback:
The combination of caffeine and sodium
benzoate is occasionally used as a respiratory
stimulant in neonates. Caffeine is not mixed
with methylphenidate. Caffeine is not mixed
with Mefoxitin. Caffeine is not mixed with
sodium bicarbonate for this indication.
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A)
B)
C)
D)
Ans:
A)
B)
C)
D)
Ans:
A patient has been treated with
dextroamphetamine for ADHD. At the age of
7. 16 years, she is diagnosed with
hyperthyroidism. What intervention should be
implemented with this patient?
Discontinue the high-calorie diet.
Assess the patient for pulmonary edema.
Discontinue the amphetamines.
Administer a proton pump inhibitor.
C
Feedback:
Amphetamines are contraindicated upon the
development of hyperthyroidism. The patient
hyperthyroidism. What intervention should be
implemented with this patient?
Discontinue the high-calorie diet.
Assess the patient for pulmonary edema.
Discontinue the amphetamines.
Administer a proton pump inhibitor.
C
Feedback:
Amphetamines are contraindicated upon the
development of hyperthyroidism. The patient
will require a higher calorie count, not a
discontinuation of a high-calorie count. The
patient will not require an assessment for
pulmonary edema. The patient will only
require a proton pump inhibitor if gastric
hyperacidity occurs.
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B)
C)
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B)
C)
D)
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B)
C)
D)
Ans:
A teenage boy is on amphetamine therapy for
attention deficit hyperactivity disorder. The
8. care provider has suggested a “drug holiday”
for July and August. What is the purpose of
this drug holiday?
To minimize weight loss
To prevent hyperthyroidism
To allow electrolyte imbalances to resolve
To slow bone resorption
A
Feedback:
Dextroamphetamine often causes loss of
appetite, and the health care provider may
stop the medication during the months when
the child is not in school. A drug holiday, as
this is called, helps decrease weight loss and
growth suppression. It does not address
potential electrolyte imbalances, thyroid
imbalances, or the process of bone
remodeling.
A patient is seen in the ambulatory care clinic
with a complaint of insomnia. What should
9.
the nurse assess in regard to the complaint of
insomnia?
Daily intake of caffeine-containing products
The amount of exercise in which the patient
engages
The family history of insomnia and sleep
Possible use of amphetamines
A
Feedback:
The daily intake of caffeine should be
assessed to determine if the intake is sufficient
to disturb sleep. The amount of exercise the
patient engages in is important but not as
critical as caffeine consumption. The family
The amount of exercise in which the patient
engages
The family history of insomnia and sleep
Possible use of amphetamines
A
Feedback:
The daily intake of caffeine should be
assessed to determine if the intake is sufficient
to disturb sleep. The amount of exercise the
patient engages in is important but not as
critical as caffeine consumption. The family
history of insomnia and sleep is not critical to
assess. Amphetamines also have the potential
to disrupt sleep, but caffeine use is far more
prevalent.
B)
A female patient asks the nurse how much
caffeine is safe to consume per day. What is
10.
the recommended amount of caffeine for a
nonpregnant woman?
125 mg of caffeine
250 mg of caffeine
500 mg of caffeine
1 g of caffeine
B
Feedback:
Some authorities recommend that normal,
healthy, nonpregnant adults consume not
more than 250 mg of caffeine daily. 125 mg
of caffeine is lower than the recommended
safe amount of consumption. 500 mg to 1 g is
more than the recommended daily
consumption of caffeine.
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D)
Ans:
A)
B)
C)
D)
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B)
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A patient who suffers from asthma is given
11. theophylline. Theophylline will have an
increased effect if taken with
Ritalin.
atomoxetine (Strattera).
modafinil (Provigil).
caffeine.
D
Feedback:
Caffeine increases the effects of theophylline.
Ritalin, Provigil, and Strattera are noted to
have this effect.
A patient is being prescribed
dextroamphetamine for the treatment of
12. ADHD. During health education, the nurse
should make the patient aware of the black
box warning relating to
the risks of kidney failure.
the potential for abuse.
the risk of stroke with excessive doses.
the potential for unstable blood glucose
levels.
B
Feedback:
A black box warning makes users of
dextroamphetamine aware of the drug's high
abuse potential. Black box warnings do not
address the potential for renal failure, stroke,
or unstable blood sugars.
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B)
C)
D)
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A 13-year-old child is started on atomoxetine
(Strattera) for ADHD. The patient and his
family should be taught about the peak
13.
plasma levels of the medication. He takes his
medication at 07:00 AM. When will this
medication reach its peak plasma level?
08:00 to 09:00 AM
09:45 to 10:30 AM
10:30 to 11:45 AM
13:00 to 14:00 PM
A
Feedback:
Atomoxetine is rapidly absorbed with peak
plasma levels in 1 to 2 hours. If he takes the
medication at 07:00 AM, it will peak at 08:00
to 09:00 AM.
A)
B)
C)
D)
Ans:
A patient with narcolepsy is placed on a
central nervous system stimulant. What is the
14.
central nervous system stimulant of choice to
treat narcolepsy?
Atomoxetine (Strattera)
Guarana
Caffeine
Modafinil (Provigil)
D
Feedback:
Modafinil (Provigil) is used to treat
narcolepsy. Atomoxetine is administered for
ADHD. Guarana is the main ingredient in
caffeine and is not administered for
Atomoxetine (Strattera)
Guarana
Caffeine
Modafinil (Provigil)
D
Feedback:
Modafinil (Provigil) is used to treat
narcolepsy. Atomoxetine is administered for
ADHD. Guarana is the main ingredient in
caffeine and is not administered for
narcolepsy. Caffeine is not administered for
narcolepsy.
A boy has been diagnosed with ADHD and
has been prescribed Ritalin. The boy's mother
tells the nurse that she does not understand
why a stimulant would help him, stating, “If
15.
anything, he's completely overstimulated, not
understimulated!” What should the nurse
explain to the mother about the therapeutic
use of Ritalin?
Ritalin helps with the symptoms of ADHD,
but the reasons for this are not well
understood.
Ritalin stimulates the parasympathetic
nervous system, resulting in increased control
of behavior.
Ritalin stimulates the limbic system, which
regulates control over behavior and affect.
Ritalin enhances the function of dopamine,
which regulates cognition.
A
Feedback:
The efficacy of Ritalin in ADHD is
paradoxical and not well understood. It does
not significantly affect dopamine levels or the
function of the limbic system and
parasympathetic nervous system.
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B)
C)
After experiencing two workplace accidents
in which he fell asleep, a 30-year-old
construction worker has been diagnosed with
narcolepsy. The patient admits that he is
16.
embarrassed to receive this diagnosis and is
adamant that no one find out about it. The
nurse should respond to the patient by
explaining what aspect of the etiology?
“This is the result of neurological factors over
which you have no direct control.”
“In a lot of cases, making improvements to
your sleep habits can resolve narcolepsy.”
“This is something that runs in certain
families, and it's not your fault that this has
happened.”
adamant that no one find out about it. The
nurse should respond to the patient by
explaining what aspect of the etiology?
“This is the result of neurological factors over
which you have no direct control.”
“In a lot of cases, making improvements to
your sleep habits can resolve narcolepsy.”
“This is something that runs in certain
families, and it's not your fault that this has
happened.”
“This usually stems from suppressed
emotions, so counseling usually helps
greatly.”
A
Feedback:
Narcolepsy is a neurological sleep disorder,
not the result of mental illness or
psychological problems. It is most likely due
to a number of genetic abnormalities, but
family history is not noted to be highly
significant.
A)
B)
C)
D)
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A 13-year-old boy has been taking
dextroamphetamine for the treatment of
ADHD since he was 10, achieving significant
17. improvements in behavior and mood. When
assessing the boy during a scheduled followup appointment, the nurse should prioritize
what physical assessment?
Abdominal girth and assessment for
peripheral edema
Measurement of height and body weight
Visual acuity and hearing ability
Assessment of deep tendon reflexes and
peripheral pulses
B
Feedback:
Suppression of weight and height may occur
in children taking amphetamines, and the
nurse ensures that growth is monitored during
drug therapy. Assessments for edema,
diminished reflexes, and sensory deficits are
not normally warranted.
A)
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A high school boy has been brought to the
emergency department (ED) by his friends
who state that he has taken a “whole handful
18. of Dex” and is now lapsing in and out of
consciousness. The ED nurse should prioritize
what assessment related to
dextroamphetamine overdose?
Blood glucose monitoring
Cognitive assessment
Lung function testing
Cardiac monitoring
D
Feedback:
Dextroamphetamine misuse may cause
sudden death or serious cardiovascular events.
It is essential to obtain a baseline
electrocardiogram (ECG) and blood pressure
reading. These assessments are priorities over
blood glucose monitoring, respiratory
assessment, and cognitive assessment.
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B)
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A 12-year-old girl has undergone an extensive
diagnostic workup that has resulted in a
diagnosis of ADHD. The prescriber has
reviewed the benefits and risks of
19.
dextroamphetamine therapy, and the nurse is
now reviewing the correct schedule for taking
the drug. The child should most likely take
her dextroamphetamine at what times?
07:00 and 11:30
07:30, 11:30, 16:30, and 20:00
08:00 and 20:00
09:00, 14:00, and 19:00
A
Feedback:
People should take the first dose of
dextroamphetamine on awakening or early in
the day and the last dose at least 6 hours
before bedtime. Twice-daily dosing is most
common.
Methylphenidate will be used to treat a 9year-old boy's ADHD. In light of this drug's
20. most common adverse effects, the nurse who
is working with the family should implement
what strategy?
A strategy to ensure that the boy maintains
normal bladder function
A plan to address the boy's loss of appetite
A plan to enhance the boy's self-esteem
A strategy to regularly monitor the boy's
blood glucose levels
B
Feedback:
Like dextroamphetamine, methylphenidate
often causes loss of appetite. Plans to address
this should be in place at the beginning of
therapy. Frequent blood glucose monitoring
and actions to maintain bladder function are
not likely necessary. Self-esteem should likely
be addressed during treatment, but reduced
self-esteem is not an adverse effect of
methylphenidate.
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B)
C)
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Chapter 58 Drug Therapy for Substance Abuse Disorders
A patient has a long history of heavy alcohol
use and has been admitted to the hospital for
traumatic injuries after a motor vehicle
1.
accident. How should the nurse best assess
the patient for physical dependence on
alcohol?
Assess the patient's perceptions of his coping
strategies.
Assess whether the patient ever feels guilty
about his drinking.
Assess the patient for signs and symptoms of
alcohol withdrawal.
Assess the patient's typical alcohol intake.
C
Feedback:
Physical dependence involves physiologic
adaptation to chronic use of a drug so that
withdrawal, or unpleasant symptoms, occurs
when the drug is stopped, when its action is
antagonized by another drug, or when its
dosage is decreased. Assessment of coping
strategies, alcohol intake, and the patient's
feelings about his drinking are relevant, but
none directly addresses the possibility of
physical dependence.
Assess the patient for signs and symptoms of
alcohol withdrawal.
Assess the patient's typical alcohol intake.
C
Feedback:
Physical dependence involves physiologic
adaptation to chronic use of a drug so that
withdrawal, or unpleasant symptoms, occurs
when the drug is stopped, when its action is
antagonized by another drug, or when its
dosage is decreased. Assessment of coping
strategies, alcohol intake, and the patient's
feelings about his drinking are relevant, but
none directly addresses the possibility of
physical dependence.
C)
A patient is admitted to the hospital for
treatment of a stasis ulcer of the right leg. The
patient's history indicates he has abused
2. alcohol in the past, and he typically consumes
at least eight alcoholic beverages daily. What
symptoms should the nurse assess the patient
for?
Confusion, hallucination, agitation, tremors
Denial, manipulation, combativeness
Depression, remorse, withdrawal from reality
Suspicion, mania, stubbornness, fear
A
Feedback:
Delirium tremens, the most serious form of
alcohol withdrawal, is characterized by
confusion, disorientation, delusions, visual
hallucinations, and other signs of acute
psychosis. Denial, manipulation,
combativeness, depression, remorse,
withdrawal from reality, suspicion, mania,
stubbornness, and fear are not symptoms of
alcohol withdrawal.
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B)
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A)
B)
C)
D)
Ans:
A patient was admitted to the emergency
room with acute alcohol intoxication and has
been diagnosed with alcohol abuse after
3.
subsequent assessment and treatment. What
are the goals of long-term treatment of this
patient's substance abuse disorder?
Detoxification, abstinence, and prevention of
relapse
Withdrawal, reeducation, and compliance
Withdrawal, abstinence, and accountability
Assessment, planning, and intervention
A
Feedback:
The major goals of treatment for substance
abuse are detoxification, initiation of
patient's substance abuse disorder?
Detoxification, abstinence, and prevention of
relapse
Withdrawal, reeducation, and compliance
Withdrawal, abstinence, and accountability
Assessment, planning, and intervention
A
Feedback:
The major goals of treatment for substance
abuse are detoxification, initiation of
abstinence, and prevention of relapse.
Withdrawal may occur, but this is not a goal
of treatment. The nursing process may be
utilized, but the steps of the process are not
the goals of treatment.
A)
A patient is admitted to the inpatient alcohol
rehabilitation program. What medication will
4.
the patient most likely be prescribed to treat
alcohol withdrawal syndromes?
Clonidine (Catapres)
Methyldopa (Aldomet)
Chlordiazepoxide (Librium)
Atenolol (Tenormin)
C
Feedback:
Benzodiazepines antianxiety agents are the
drugs of choice for treating alcohol
withdrawal syndromes. Chlordiazepoxide is
administered to patients for acute withdrawal
syndrome. Clonidine is not a benzodiazepine
and is not prescribed for acute alcohol
syndrome. Methyldopa is not a
benzodiazepine and is not prescribed for acute
alcohol syndrome. Atenolol is not a
benzodiazepine and is not prescribed for acute
alcohol syndrome.
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C)
D)
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B)
C)
D)
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A)
B)
C)
D)
Ans:
A 77-year-old patient is admitted for the
treatment of a fracture, and the nurse has
identified that the patient has a history of
5.
heavy alcohol use. At what point should the
care team administer pharmacologic
treatments for alcohol withdrawal?
After skeletal muscle relaxants have taken
effect
As soon as the patient shows signs of
withdrawal
After cognitive behavioral therapy has begun
After treatment for the patient's acute injuries
has been completed
B
Feedback:
Treatment with chlordiazepoxide for alcohol
After skeletal muscle relaxants have taken
effect
As soon as the patient shows signs of
withdrawal
After cognitive behavioral therapy has begun
After treatment for the patient's acute injuries
has been completed
B
Feedback:
Treatment with chlordiazepoxide for alcohol
withdrawal should begin as soon as the
clinician identifies that the patient needs it. It
is unsafe to delay treatment of withdrawal.
Muscle relaxants are not indicated in the
treatment of alcohol withdrawal.
A)
B)
C)
D)
A patient is admitted to the emergency room
suffering from symptoms of alcohol
6. withdrawal. The nurse should plan care with
the goal of preventing which of the
following?
Bradycardia
Hypotension
Seizures
Gastrointestinal bleeding
C
Feedback:
In acute alcohol withdrawal, a goal of
treatment is to prevent seizures. Bradycardia
is not the primary symptom of acute alcohol
withdrawal. Hypotension is not the primary
symptom of acute alcohol withdrawal.
Gastrointestinal bleeding results from heavy
alcohol use but is not the primary symptom of
acute alcohol withdrawal.
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B)
C)
D)
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A patient who suffers from alcoholism is
prescribed disulfiram (Antabuse). How does
7.
this medication assist the patient in refraining
from ingestion of alcohol?
Allows the accumulation of acetaldehyde
Increases the level of serotonin
Increases the level of acetylcholine
Decreases stimulation of the CNS
A
Feedback:
Disulfiram interferes with hepatic metabolism
of alcohol and allows accumulation of
acetaldehyde. Disulfiram does not increase
the level of serotonin. Disulfiram does not
increase the level of acetylcholine. Disulfiram
does not decrease the stimulation of the
central nervous system.
Increases the level of serotonin
Increases the level of acetylcholine
Decreases stimulation of the CNS
A
Feedback:
Disulfiram interferes with hepatic metabolism
of alcohol and allows accumulation of
acetaldehyde. Disulfiram does not increase
the level of serotonin. Disulfiram does not
increase the level of acetylcholine. Disulfiram
does not decrease the stimulation of the
central nervous system.
A patient who has long abused alcohol is
being treated with disulfiram (Antabuse). The
patient currently takes phenytoin (Dilantin)
8. for an underlying seizure disorder. Based on
the interaction of these two medications, what
will need to be adjusted in the medication
administration?
The patient will require more frequent
administration of disulfiram (Antabuse).
The patient will require a larger dose of
disulfiram (Antabuse).
The patient will require a reduced dose of
phenytoin (Dilantin).
The patient will require phenytoin (Dilantin)
to be administered twice daily.
C
Feedback:
The patient will require a reduced dose of
phenytoin (Dilantin) because disulfiram
interferes with the metabolism of phenytoin.
The patient will not require more frequent
administration of disulfiram. The patient will
not require a larger dose of disulfiram. The
patient will not require increased
administration of phenytoin.
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B)
C)
D)
Ans:
A)
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D)
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Ans:
A)
B)
C)
D)
Ans:
A patient is taking disulfiram (Antabuse) and
later consumes several shots of vodka. What
9.
effect will be produced from the combination
of alcohol and disulfiram?
Hypertension
Vomiting
Hyperalertness
Oral bleeding
B
Feedback:
Disulfiram interferes with hepatic metabolism
of alcohol and allows the accumulation of
acetaldehyde. If alcohol is ingested during
disulfiram therapy, acetaldehyde causes
headaches, confusion, seizures, chest pain,
Vomiting
Hyperalertness
Oral bleeding
B
Feedback:
Disulfiram interferes with hepatic metabolism
of alcohol and allows the accumulation of
acetaldehyde. If alcohol is ingested during
disulfiram therapy, acetaldehyde causes
headaches, confusion, seizures, chest pain,
flushing, palpitations, hypotension, sweating,
blurred vision, nausea, vomiting, and a garliclike aftertaste. Disulfiram will not cause
hypertension, increased alertness, or bleeding.
A 22-year-old male is brought to the
emergency room due to an overdose of
10. diazepam (Valium). What drug will be
administered in the emergency room to treat
the overdose?
Disulfiram (Antabuse)
Flumazenil (Romazicon)
Methadone (Dolophine)
Naloxone (Narcan)
B
Feedback:
Flumazenil (Romazicon) is a specific antidote
that can reverse benzodiazepine-induced
sedation, coma, and respiratory depression.
Disulfiram is not administered to reverse
benzodiazepine overdose. Methadone is not
administered to reverse benzodiazepine
overdose. Naloxone is not administered for
benzodiazepine overdose.
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B)
C)
D)
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A)
B)
C)
D)
Ans:
A)
B)
C)
D)
Ans:
A patient is being treated for opioid abuse
after many years of cocaine and heroin use.
11.
The nurse should anticipate that this patient
will be treated with what drug?
Disulfiram (Antabuse)
Flumazenil (Romazicon)
Methadone (Dolophine)
Naloxone (Narcan)
C
Feedback:
Opioid withdrawal symptoms are treated with
methadone. Naloxone is used to treat acute
opioid intoxication or overdose, but it is not
used to treat opioid abuse.
B)
C)
D)
Ans:
Flumazenil (Romazicon)
Methadone (Dolophine)
Naloxone (Narcan)
C
Feedback:
Opioid withdrawal symptoms are treated with
methadone. Naloxone is used to treat acute
opioid intoxication or overdose, but it is not
used to treat opioid abuse.
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A)
A nurse is providing health education for the
family of a patient who has a substance use
12.
disorder. How should the nurse best explain
the etiology of this disorder?
“Substance abuse is multifactorial and
involves genetics, personality, and culture.”
“Substance abuse is considered to be
primarily a cultural concept, since definitions
vary widely across time and place.”
“Many different factors contribute to
substance abuse, but the primary ones are lack
of willpower and impaired coping.”
“Substance abuse is a complex phenomenon,
and science has not yet begun to truly
understand the phenomenon.”
A
Feedback:
Researchers have identified a number of
factors in the predisposition to substance
abuse and dependence. These factors include
genetics, personality, and culture. The
disorder is not, however, solely rooted in
culture or wholly misunderstood. It is
simplistic to understand the disorder as
resulting from impaired coping and lack of
willpower.
B)
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C)
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Ans:
A)
B)
C)
D)
Ans:
A patient with a diagnosis of endocarditis has
been admitted, and the care team is aware that
IV opioid use is the origin of the patient's
13. infection. The patient is open to the idea of
treatment for her substance abuse disorder.
When planning this aspect of the patient's
care, what goal should the nurse first address?
Compliance with treatment
Safe detoxification
Taking ownership of the problem
Adequate stimulation of the CNS
B
Feedback:
The major goals of treatment for substance
abuse are detoxification, initiation of
abstinence, and prevention of relapse.
Ensuring the patient's safety during
Compliance with treatment
Safe detoxification
Taking ownership of the problem
Adequate stimulation of the CNS
B
Feedback:
The major goals of treatment for substance
abuse are detoxification, initiation of
abstinence, and prevention of relapse.
Ensuring the patient's safety during
detoxification is a priority over compliance
with treatment. Taking ownership and
providing CNS stimulation are not priority
goals.
A man has asked the care team to consider the
use of benzodiazepines to treat his wife's
14. severe alcoholism. The use of
benzodiazepines for this purpose may be
contraindicated in what circumstances?
The patient is acutely intoxicated.
The patient denies the severity of her
addiction.
The patient has previously been treated with
benzodiazepines.
The patient is also addicted to nicotine.
A
Feedback:
If the patient's vital signs are depressed during
acute intoxication, the use of benzodiazepines
is contraindicated. Denial, previous treatment
with benzodiazepines, and nicotine addiction
do not contraindicate this treatment.
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A)
B)
C)
D)
Ans:
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Ans:
A)
B)
C)
D)
Ans:
A 33-year-old patient with a diagnosis of
alcoholism is to be treated with
15. chlordiazepoxide on an inpatient basis. When
a nurse is administering this medication, he or
she should do which of the following actions?
Monitor the patient's vital signs closely during
IV administration
Administer the oral form of the medication if
the patient is combative
Assess the patient's cardiac status prior to
administering each dose
Promptly stop administering the medication
once status improvements are noted
A
Feedback:
The nurse should take the patient's vital signs
regularly when giving the IV form of this
drug, as well as observe and document
subjective and objective reports by the
patient. Combative patients usually require a
Assess the patient's cardiac status prior to
administering each dose
Promptly stop administering the medication
once status improvements are noted
A
Feedback:
The nurse should take the patient's vital signs
regularly when giving the IV form of this
drug, as well as observe and document
subjective and objective reports by the
patient. Combative patients usually require a
parenteral route of administration, and it is
unnecessary to perform a full cardiac
assessment before each dose. Usage should be
tapered, and not stopped abruptly, in order to
prevent rebound CNS stimulation.
C)
D)
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A patient was admitted with a diagnosis of a
gastrointestinal bleed, the latest of several
hospital admissions that have been attributed
16.
to his alcohol abuse. The addictions medicine
specialist has prescribed disulfiram, which
will
prevent the patient from experiencing
euphoria if he drinks alcohol.
produce unpleasant reactions if the patient
drinks alcohol.
intensify the patient's CNS depression if he
drinks alcohol.
result in a depressed mood if he drinks
alcohol.
B
Feedback:
Disulfiram inhibits the enzyme aldehyde
dehydrogenase to block the oxidation of
alcohol. The resulting accumulation of
acetaldehyde produces an unpleasant reaction
when disulfiram is consumed with alcohol.
The effects do not include prevention of
euphoria, increased CNS depression, or
depressed mood, however.
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A)
B)
A patient with a well-known history of heroin
use has begun addiction treatment. The nurse
had administered the patient's daily dose of
17.
methadone. The nurses should know that this
medication aids in treating opioid addiction
because it does which of the following?
Acts as an agonist at opioid receptors and
prevents withdrawal symptoms
Acts as an opioid antagonist and causes
unpleasant symptoms if the patient uses
opioids
Acts on the limbic system and the reticular
A patient with a well-known history of heroin
use has begun addiction treatment. The nurse
had administered the patient's daily dose of
17.
methadone. The nurses should know that this
medication aids in treating opioid addiction
because it does which of the following?
Acts as an agonist at opioid receptors and
prevents withdrawal symptoms
Acts as an opioid antagonist and causes
unpleasant symptoms if the patient uses
opioids
Acts on the limbic system and the reticular
system to suppress brain activity associated
with addiction
Depresses the CNS to a similar degree as
opioids, aiding in detoxification
A
Feedback:
Methadone is an agonist at specific opioid
receptors in the CNS. Its action allows it to
prevent symptoms of withdrawal. It does not
cause unpleasant effects if the patient uses
opioids and does not act directly on the limbic
system or reticular system.
A)
B)
C)
D)
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Ans:
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A)
B)
C)
D)
Ans:
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A patient has been brought to the emergency
department by paramedics. The patient's
known history and highly agitated state are
18. suggestive of cocaine-induced psychosis.
What assessment should the nurse prioritize
prior to administering pharmacologic
treatments?
Assessment of blood glucose levels
Assessment of cranial nerve function
Lung auscultation
Cardiovascular assessment
D
Feedback:
Cocaine intoxication carries a high risk for
cardiac dysrhythmias. Consequently,
cardiovascular assessment would be a priority
over lung auscultation, assessment of cranial
nerve function, or assessment of blood
glucose levels.
A 15-year-old boy with a complex
psychosocial history is being treated for
inhalant abuse. When providing health
19.
education to this boy, the nurse should cite
which of the following risks associated with
inhalant abuse?
Hyperactivity
Psychological dependence
Physiological dependence
Organ damage
D
Feedback:
Inhalants can harm the brain, liver, heart,
kidneys, and lungs, and abuse of any drug
during adolescence may interfere with brain
development. Dependence has not been
definitively demonstrated, and hyperactivity is
not a risk.
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B)
C)
D)
Ans:
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A patient is being treated for addiction to
cocaine and heroin and will begin treatment
20. with naltrexone (ReVia). If the patient uses an
opioid after taking this drug, the nurse should
expect what effect?
The patient will experience a decline in
neurological function.
The patient will experience visual
disturbances and unpleasant hallucinations.
The patient will not experience the usual
physiological effects of opioids.
The patient will experience a sudden onset of
nausea and vomiting.
C
Feedback:
Naltrexone (ReVia) is a pure opioid
antagonist that blocks opioids from occupying
receptor sites, thereby preventing their
physiologic effects. It will not cause
neurological deficits, GI upset, or
hallucinations.
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Chapter 59 Drug Therapy for Disorders of the Eye
A patient is diagnosed with a fungal infection
of the eye. What of the following medications
1.
is the most likely the cause of the fungal
infection of the eye?
Ophthalmic corticosteroid
Systemic antibiotic agent
Mydriatic
Saline ophthalmic drops
A
Feedback:
Fungal infections commonly occur and may
often be attributed to frequent use of
ophthalmic antibiotics and corticosteroids.
Systemic antibiotic agents are not the cause of
fungal infections of the eye. Mydriatics are
not the cause of fungal infections of the eye.
Saline ophthalmic drops are not the cause of
fungal infections of the eye.
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B)
C)
D)
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B)
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A patient states that his eyes are “watering”
excessively, and he claims that he has a gritty
2.
feeling of the eye. What common eye disorder
is suspected?
Hordeolum
Blepharitis
Conjunctivitis
Glaucoma
C
Feedback:
Conjunctivitis is a common eye disorder with
redness, tearing, itching, edema, and gritty
sensations of the eye. Hordeolum is a sty.
Blepharitis is a chronic infection of glands
and lash follicles on the margins of the
eyelids. Glaucoma is a disease with an
increased intraocular pressure.
A)
B)
C)
D)
Ans:
A patient has a foreign body in the right eye.
What medication will most likely be
3.
administered before removal of the foreign
body?
Cortisporin ointment
Proparacaine eye drops
Cephalosporin orally
Atropine eye drops
B
Feedback:
Proparacaine is a commonly used agent to
3.
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A)
B)
C)
D)
Ans:
What medication will most likely be
administered before removal of the foreign
body?
Cortisporin ointment
Proparacaine eye drops
Cephalosporin orally
Atropine eye drops
B
Feedback:
Proparacaine is a commonly used agent to
provide anesthetic. One drop is instilled in the
affected eye prior to removing the foreign
body. Cortisporin ointment would not
routinely be administered before foreign body
removal. Cephalosporin is not administered.
Atropine eye drops are not administered for
this purpose.
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A patient is scheduled for cataract surgery.
4. What anesthetic agent should the nurse
prepare to administer?
Acetazolamide (Diamox)
Pilocarpine (Pilocar)
Dipivefrin (Propine)
Lidocaine
D
Feedback:
Injectable local anesthetics are administered
by ophthalmologists, usually for eye surgery.
Lidocaine is commonly used; it has a rapid
onset and lasts 1 to 2 hours. Acetazolamide
(Diamox) is not used as an anesthetic agent.
Pilocarpine (Pilocar) is not used as an
anesthetic agent. Dipivefrin (Propine) is not
used as an anesthetic agent.
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A)
B)
C)
D)
Ans:
A)
B)
C)
D)
Ans:
A patient is prescribed ophthalmic
corticosteroids. What eye disorder may result
5.
from long-term use of ophthalmic
corticosteroids?
Conjunctivitis
Hordeolum
Glaucoma
Blepharitis
C
Feedback:
Long-term use of corticosteroid ophthalmic
agents may result increased IOP, optic nerve
damage, defects in visual acuity, and fields of
vision, cataracts, and secondary ocular
infections.
B)
C)
D)
Ans:
Hordeolum
Glaucoma
Blepharitis
C
Feedback:
Long-term use of corticosteroid ophthalmic
agents may result increased IOP, optic nerve
damage, defects in visual acuity, and fields of
vision, cataracts, and secondary ocular
infections.
A patient is predicted to benefit from
dexamethasone eye drops. The presence of
6.
what eye disorder would contraindicate the
use of this drug?
Fungal infection
Nearsightedness
Cataracts
Bacterial conjunctivitis
A
Feedback:
Contraindications to dexamethasone include
corneal or conjunctival viral disease caused
by herpes simplex, vaccina, or varicella. Also,
other contraindications are mycobacterial and
fungal infection of the eye as well as
advanced glaucoma and hypersensitivity to
corticosteroids.
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B)
C)
D)
Ans:
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A)
B)
C)
D)
Ans:
A patient is scheduled for an ophthalmic
7. examination. Which of the following
medications will be administered?
Pseudoephedrine hydrochloride
Epoetin alfa (Epogen)
Phenylephrine
Pilocarpine (Pilocar)
C
Feedback:
Phenylephrine is used to dilate the pupil
before ophthalmic examinations.
Pseudoephedrine hydrochloride is used to
relieve nasal congestion. Epoetin alfa is used
to treat bone marrow depression. Pilocarpine
reduces intraocular pressure.
A patient is being administered phenylephrine
in an outpatient clinic. Which of the following
8.
conditions requires that phenylephrine be
administered cautiously?
Cataracts
Hypothyroidism
Diabetes mellitus
Hypertension
D
Feedback:
Adrenergic mydriatics should be used
cautiously in patients with hypertension,
cardiac dysrhythmias, arteriosclerotic heart
disease, and hyperthyroidism. Patients with
cataracts, hypothyroidism, and diabetes
mellitus can safely be administered
phenylephrine.
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A)
B)
C)
D)
Ans:
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A patient's medication administration record
include daily timolol maleate eye drops. The
9.
nurse should identify what goal of therapy
when planning this patient's care?
Decrease intraocular pressure.
Constrict pupils.
Promote lacrimation.
Improve visual acuity.
A
Feedback:
The purpose of the administration of betablocking drugs such as timolol is to decrease
the IOP. Beta-blockers are not used to
promote lacrimation, improve vision, or
constrict the pupils.
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A)
B)
C)
D)
Ans:
A)
B)
C)
D)
Ans:
A nurse is administering eye drops of two
different drugs to a patient. How long should
10.
the nurse wait between the instillation of the
first medication and the second medication?
At least 1 minute
At least 5 minutes
At least 15 minutes
At least 20 minutes
B
Feedback:
When multiple eye drops are required, there
should be an interval of 5 to 10 minutes
between drops. The drops should not be as
close as 1 minute. The drops will not need to
A)
B)
C)
D)
Ans:
At least 1 minute
At least 5 minutes
At least 15 minutes
At least 20 minutes
B
Feedback:
When multiple eye drops are required, there
should be an interval of 5 to 10 minutes
between drops. The drops should not be as
close as 1 minute. The drops will not need to
be separated by 15 to 20 minutes.
A patient is administering eye drops. What
11. should the patient be taught in order to
decrease systemic absorption of eye drops?
Lie supine for 1 minute after instillation.
Apply pressure for 2 minutes over the tear
duct.
Apply pressure for 5 minutes over the tear
duct.
Remain still for 10 minutes after instillation
C
Feedback:
Systemic absorption of eye drops can be
decreased by closing the eye and applying
pressure over the tear duct for 3 to 5 minutes
after instillation. Pressure should not be
applied to the tear duct for less than 3 minutes
or greater than 5 minutes. It is unnecessary to
remain still or supine after instillation.
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A)
B)
C)
A)
B)
C)
D)
Ans:
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D)
Ans:
A child with glaucoma is being treated with
short-acting mydriatics. Which cycloplegic
12.
will be administered with the mydriatic
agent?
Tropicamide
Cortisporin
Phenylephrine
Acetazolamide (Diamox)
A
Feedback:
Children with glaucoma are treated with
mydriatics and cycloplegics, such as
tropicamide. The child with glaucoma is not
treated with cortisporin, phenylephrine, or
acetazolamide.
A nurse is providing health education about
the way the normal intraocular pressure (IOP)
13. is maintained. The nurse should explain that
normal IOP results from which of the
following?
Consistent production and resorption of tears
Consistent feedback from baroreceptors
located throughout the retina
A balance between production and drainage
of aqueous humor
Two-way interaction between the medulla
oblongata and the eye
C
Feedback:
Normally, production and drainage of
aqueous humor are approximately equal, and
the intraocular pressure (IOP) is normal. IOP
is not dependent of tear production,
baroreceptors in the eye, or stimulation from
the medulla.
A)
B)
C)
D)
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Ans:
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A)
B)
C)
D)
Ans:
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A resident of a long-term care facility was
referred to an outpatient ophthalmology clinic
for assessment, and the nurse has received the
14. clinical report. The nurse reads that the
resident's intraocular pressure was elevated
above clinical norms. The nurse should
recognize that the resident is at risk of
cataracts.
glaucoma.
myopia.
conjunctivitis.
B
Feedback:
Glaucoma is characterized by increased IOP,
possibly damaging the optic nerve, which
transmits images to the brain. If damage to the
optic nerve from high IOP continues,
glaucoma leads to loss of vision. Cataracts,
myopia, and conjunctivitis are not the results
of increased IOP.
A nurse who provides care in an
ophthalmology clinic has an order to instill
atropine eye drops to a patient prior to the
15.
patient's clinical examination. What health
education should the nurse provide prior to
this intervention?
“These drops might sting a little bit, and they
will make you temporarily sensitive to light.”
“These eye drops will make it more difficult
to close your eyes, but this will pass in a few
hours.”
“These drops will make your pupil
temporarily constrict so that your eye can be
examined more closely.”
“These drops will make your eyes very
bloodshot and sensitive, but this is only
temporary.”
A
Feedback:
The nurse instructs patients about the effects
of atropine such as photophobia and stinging
on administration. Atropine does not make it
difficult to close the eyes, and it causes pupil
dilation, not constriction.
A)
B)
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B)
C)
D)
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Ans:
The nurse has administered a scheduled dose
of phenylephrine to a patient. The nurse
16. would recognize that a therapeutic effect has
been achieved by which of the following
assessment findings?
The cornea can be manipulated without
causing the patient to blink.
The patient acknowledges an improvement in
visual acuity.
The patient's pupils neither dilate nor constrict
in response to light.
The inner aspect of the patient's eye can be
visualized.
D
Feedback:
Uses of phenylephrine (ophthalmic) include
mydriasis prior to ophthalmic procedures.
Consequently, the nurse assesses whether the
inner aspect of the eye can be visualized 15
minutes after administration. Phenylephrine
does not inhibit blinking, improve vision, or
eliminate light accommodation.
C)
in response to light.
The inner aspect of the patient's eye can be
visualized.
D
Feedback:
Uses of phenylephrine (ophthalmic) include
mydriasis prior to ophthalmic procedures.
Consequently, the nurse assesses whether the
inner aspect of the eye can be visualized 15
minutes after administration. Phenylephrine
does not inhibit blinking, improve vision, or
eliminate light accommodation.
D)
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A)
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B)
C)
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D)
Ans:
A)
B)
C)
D)
Ans:
A patient's sudden increase in IOP has
necessitated the oral administration of
glycerin (Osmoglyn). When assessing the
17.
patient for adverse effects related to this
intervention, the nurse should prioritize which
of the following?
Assessment for signs and symptoms of acid–
base imbalances
Assessment for signs and symptoms of fluid
volume deficit
Monitoring of serum potassium and sodium
levels
Monitoring of aPTT and INR
B
Feedback:
Adverse effects of glycerin relate to decreased
fluid volume. The most serious of these
conditions is hyperosmolar nonketotic coma.
Consequently, the nurse should prioritize
assessments that are focused on the signs and
symptoms of fluid volume deficit.
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Ans:
A nurse is providing care for a patient who is
on the third day of her prescribed course of
18. ciprofloxacin eye drops. The nurse should
conclude that this patient most likely has a
diagnosis of what health problem?
Astigmatism
Cataracts
Conjunctivitis
Increased IOP
C
Feedback:
Uses of ciprofloxacin include the treatment of
corneal ulcer and bacterial conjunctivitis. This
drug is not used to treat cataracts, increased
IOP, or astigmatism.
B)
C)
D)
Ans:
Cataracts
Conjunctivitis
Increased IOP
C
Feedback:
Uses of ciprofloxacin include the treatment of
corneal ulcer and bacterial conjunctivitis. This
drug is not used to treat cataracts, increased
IOP, or astigmatism.
Chapter 60 Drug Therapy for Disorders of the Ear
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A)
B)
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Ans:
A)
B)
C)
D)
Ans:
A young boy has just returned home from his
family's tropical vacation and is now
complaining of worsening tenderness in his
1.
right ear. He is subsequently diagnosed with
otitis externa. What causative factor of this
infection should the nurse suspect?
Immunocompromised state resulting from
sleep deprivation while on vacation
The potential for foodborne pathogens
ingested while on vacation
Frequent swimming and water sports while
the boy was on vacation
Ear trauma related to pressurization and
depressurization while flying
C
Feedback:
People whose ears are frequently exposed to
moisture are more prone to the development
of otitis externa. Swimming is a more likely
cause of infection than pressure changes,
foodborne pathogens, or impaired immunity.
A pediatric nurse practitioner has diagnosed a
4-year-old girl with otitis media. The nurse
2. should understand that infectious
microorganisms likely entered the girl's
middle ear by what means?
Through an alteration in the eustachian tube
Through the external ear
From within the cochlea or vestibule
From the interstitial spaces in the middle ear
A
Feedback:
The causative pathogens implicated in otitis
media include Haemophilus influenzae,
Streptococcus pneumoniae, and Moraxella
catarrhalis. They enter the middle ear as a
result of an alteration in the eustachian tube,
not from the inner ear, external ear, or
interstitial spaces.
B)
C)
D)
Ans:
Through the external ear
From within the cochlea or vestibule
From the interstitial spaces in the middle ear
A
Feedback:
The causative pathogens implicated in otitis
media include Haemophilus influenzae,
Streptococcus pneumoniae, and Moraxella
catarrhalis. They enter the middle ear as a
result of an alteration in the eustachian tube,
not from the inner ear, external ear, or
interstitial spaces.
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A patient has responded appreciably to firstline treatments for necrotizing otitis externa,
and the care team is concerned about the
3.
possible progression of the disease. The nurse
should be aware that this infection has the
potential to progress to
meningitis.
osteomyelitis.
necrotizing fasciitis.
epiglottitis.
B
Feedback:
The advancement of necrotizing otitis externa
results in osteomyelitis of the skull and
temporomandibular joint. It does not cause
meningitis, necrotizing fasciitis, or
epiglottitis.
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A)
B)
C)
D)
Ans:
A)
B)
C)
D)
Ans:
A 12-year-old boy has been diagnosed with
acute otitis externa. The patient's mother has
asked if oral medications might be more
4. effective than ear drops. The nurse should
respond in the knowledge that systemic
medications for the treatment of otitis externa
are only indicated in what circumstances?
The infection is accompanied by ear
discharge.
The patient is allergic to penicillins.
The patient is unable to self-administer ear
drops.
A deep tissue infection develops.
D
Feedback:
For acute otitis externa, use of topical agents,
as opposed to systemic agents, is more
common. Systemic medications are indicated
only if a deep tissue infection develops
outside the external canal or if
immunocompromised status is an issue.
Allergy status, ability to self-administer, and
the presence or discharge are not indications
The patient is unable to self-administer ear
drops.
A deep tissue infection develops.
D
Feedback:
For acute otitis externa, use of topical agents,
as opposed to systemic agents, is more
common. Systemic medications are indicated
only if a deep tissue infection develops
outside the external canal or if
immunocompromised status is an issue.
Allergy status, ability to self-administer, and
the presence or discharge are not indications
for systemic antibiotics.
C)
The nurse is providing health education for
the parents of a child whose otitis media has
warranted treatment with Cortisporin Otic.
5.
The nurse should explain that this medication
contains which of the following components?
Select all that apply.
An analgesic
A topical anesthetic
An antibiotic
A steroid
An immunomodulator
C, D
Feedback:
Health care providers use the combination
drug Cortisporin Otic (neomycin–polymyxin
B–hydrocortisone) for the treatment of acute
external otitis media. Neomycin and
polymyxin B are antibiotics, which combat
bacterial infections. Hydrocortisone is a
steroid, which reduces the actions of
chemicals in the body that cause
inflammation, redness, and swelling. This
medication does not contain analgesics,
anesthetics, or immunomodulators.
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A)
B)
C)
D)
E)
Ans:
A)
B)
C)
D)
A child's primary health care provider has
prescribed Cortisporin Otic for a child who
6. has otitis media in her right ear. What
administration instructions should the nurse
provide to the parents of the child?
“Put one drop into her right ear each
morning.”
“Place two drops in her right ear each
morning and then again before bedtime.”
“Put one to two drops in her right ear
whenever you notice discharge or she
complains of pain.”
“Place three drops into her ear four times a
day.”
provide to the parents of the child?
“Put one drop into her right ear each
morning.”
“Place two drops in her right ear each
morning and then again before bedtime.”
“Put one to two drops in her right ear
whenever you notice discharge or she
complains of pain.”
“Place three drops into her ear four times a
day.”
D
Feedback:
For children 6 months and older, 3 drops of
Cortisoprin Otic are instilled into the affected
ear three to four times daily. Dosage is not
matched to acute symptoms.
A)
B)
C)
D)
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B)
A nurse is demonstrating the correct
technique for instilling antibiotic ear drops
7. into a child's ear canal. The nurse should
teach the child's caregivers to do which of the
following?
Have the child lie supine during instillation of
the ear drops.
Have the child lie still for 30 to 45 minutes
after instilling the ear drops.
Place a cotton ball in the ear canal after
instilling the ear drops.
Rinse the child's ear canal with normal saline
prior to instilling the ear drops.
C
Feedback:
The proper administration of ear drops
requires tilting the head toward the opposite
shoulder, pulling the superior aspect of the
auricle upward, and instilling the ear drops
into the ear canal. The patient should then lie
on the side opposite the side of administration
for 20 minutes. To maximize medication
absorption, the patient should have a cotton
ball placed in the ear canal. Supine
positioning is not used, and the ear canal does
not need to be rinsed prior to drug
administration.
The nurse is providing care for a teenager
with otitis media. When assessing the patient
8.
for potentially adverse effects of Cortisporin
Otic, what question should the nurse ask?
“Have you developed a fever since you
started to use the ear drops?”
“Have you been getting any headaches since
you started taking the drops?”
“Has there been any blood that you've noticed
The nurse is providing care for a teenager
with otitis media. When assessing the patient
8.
for potentially adverse effects of Cortisporin
Otic, what question should the nurse ask?
“Have you developed a fever since you
started to use the ear drops?”
“Have you been getting any headaches since
you started taking the drops?”
“Has there been any blood that you've noticed
in your outer ear?”
“Have you noticed any loss of hearing since
you started taking the drops?”
D
Feedback:
It is also necessary to assess the patient taking
Cortisporin Otic for signs of hearing loss due
to ototoxicity. Fever, bleeding, and headaches
are not typical adverse effects.
A)
B)
C)
D)
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An adult patient has been assessed in the
emergency department and diagnosed with
necrotizing otitis externa. The primary care
9.
provider has prescribed ciprofloxacin. In
preparation for administering this medication,
what action should the nurse perform?
Establish intravenous access.
Remove as much cerumen as possible from
the patient's ear canal.
Flush the affected ear with warmed sterile
water.
Establish a sterile field around the perimeter
of the ear.
A
Feedback:
Ciprofloxacin (Cipro) is the drug of choice for
necrotizing otitis externa. Initially,
administration is intravenous, until symptoms
decrease; then it is oral. Consequently, IV
access is necessary for the initiation of
treatment. This is a priority over rinsing the
ear or removing cerumen. It is unnecessary to
create a sterile field.
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D)
A pediatric nurse is providing inpatient care
for a child who was diagnosed with
necrotizing otitis externa. The child is
10.
currently being treated with ciprofloxacin.
What microorganism is the most likely cause
of this child's infection?
Aspergillus
Candida albicans
Pseudomonas aeruginosa
Escherichia coli
C
Feedback:
Health care providers use ciprofloxacin for
the treatment of Pseudomonas aeruginosa in
patients with necrotizing otitis externa. If the
causative agent is Aspergillus, amphotericin B
is the drug of choice. E. coli and Candida are
not typically implicated in cases of
necrotizing otitis externa.
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A)
B)
C)
D)
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B)
C)
D)
Ans:
A woman was diagnosed with necrotizing
otitis externa and will soon begin a course of
11. oral ciprofloxacin. When providing health
education to this patient, the nurse should
emphasize the need to temporarily avoid
calcium antacids.
fatty foods.
grapefruit juice.
foods containing purines.
A
Feedback:
Patients should not take oral ciprofloxacin
within 2 hours of eating dairy products,
calcium-fortified juices, antacids, zinc, or
iron. There is no specific need to avoid fatty
foods, grapefruit juice, or high-purine foods.
A 4-year-old boy was diagnosed with acute
otitis media and began a course of oral
amoxicillin. The boy's mother has contacted
the clinic and states that there has been no
12. significant improvement in her son's ear
infection since beginning the antibiotics 3
days ago. The nurse should consider which of
the following explanations for this
phenomenon?
The boy has not been receiving the
medication consistently.
The boy's ear infection has a viral etiology.
The boy's ear infection is caused by an
antibiotic-resistant microorganism.
The medication should have been prescribed
parenterally.
B
Feedback:
Many people with acute otitis media do not
benefit from antibiotics because the cause of
their illness is viral, not bacterial. This
possibility is more likely than incorrect
administration or antibiotic resistance.
Parenteral administration would be no more
effective in this case.
A)
B)
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C)
D)
A)
B)
C)
D)
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Ans:
A patient has been taking oral amoxicillin to
treat otitis media for the past 6 days and has
told the nurse that his ear is now “back to
13.
normal.” He asks the nurse if he can now stop
taking his antibiotics. How should the nurse
respond?
“That's excellent that you're feeling better, but
it's important to keep taking the antibiotics
until they're all finished.”
“Try reducing your dose by half. If your ear
infection gets worse, resume the dose you've
been taking until now.”
“You should stop taking the antibiotics
because if you don't, it could cause antibiotic
resistance.”
“You can likely stop taking the antibiotics, but
keep them on hand in case your infection
returns.”
A
Feedback:
The patient should take the full course of
antibiotics and not discontinue them, even if
the otitis media seems to be improving.
Stopping prematurely can cause antibiotic
resistance.”
“You can likely stop taking the antibiotics, but
keep them on hand in case your infection
returns.”
A
Feedback:
The patient should take the full course of
antibiotics and not discontinue them, even if
the otitis media seems to be improving.
Stopping prematurely can cause antibiotic
resistance.
D)
A child's otitis media has resulted in pain and
fever. The child's mother has asked the nurse
to recommend OTC remedies to address these
14.
problems. Which of the following
recommendations is most likely to be safe and
effective?
Concurrent use of ASA and ibuprofen for 3
days
Alternating doses of acetaminophen and
ibuprofen
Monotherapy with ASA until symptoms
improve
Use of an OTC antihistamine and
acetaminophen
B
Feedback:
Alternating acetaminophen and ibuprofen
every 4 hours over a 3-day period to control
fever in young children (ages 6–36 months)
has been shown to be more effective than
monotherapy with either agent. ASA is
contraindicated in children, and an
antihistamine is unnecessary.
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B)
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B)
C)
D)
Ans:
A young adult has been diagnosed with otitis
media. When planning this patient's care,
15.
what nursing diagnosis is the most likely
priority?
Hyperthermia related to infectious process
Infection related to presence of
microorganisms
Disturbed auditory sensory perception related
to otitis media
Chronic pain related to otitis media
B
Feedback:
Infection is the essence of otitis media, and
would be a priority over other diagnoses such
as hyperthermia or temporary hearing loss.
The pain associated with this disorder would
be acute, not chronic.
Disturbed auditory sensory perception related
to otitis media
Chronic pain related to otitis media
B
Feedback:
Infection is the essence of otitis media, and
would be a priority over other diagnoses such
as hyperthermia or temporary hearing loss.
The pain associated with this disorder would
be acute, not chronic.
C)
D)
Ans:
Chapter 61 Drug Therapy for Disorders of the Skin
A teenager is using a tanning bed two times
1. per week. Which cells within the skin change
color in response to the tanning bed's lights?
Melanocytes
Stratum corneum
Merkel cells
Dermis
A
Feedback:
Melanocytes are pigment-producing cells
located at the junction of the epidermis and
the dermis. The stratum corneum, Merkel
cells, and dermis do not perform this role.
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B)
C)
D)
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A)
B)
C)
D)
Ans:
A teenager is being treated for acne vulgaris.
2. Which oral antibiotics may be prescribed to
treat acne?
Neomycin and vancomycin
Gentamicin and Rocephin
Tetracycline and erythromycin
Bacitracin and polymyxin B
C
Feedback:
Commonly used oral antibiotics for acne
treatment include tetracycline, doxycycline,
minocycline, and erythromycin. Neomycin
and vancomycin are not used to treat acne.
Gentamicin and Rocephin are not used to treat
acne. Bacitracin and polymyxin B are not
used to treat acne.
A young mother is seen in the clinic with her
young children. It is May, and the family is
3. planning to go to the beach for vacation.
Which of the following aspects of patient
teaching is most important?
“Try to stay indoors as much as possible.”
“Apply SPF 30 sunscreen to the children
before sun exposure.”
“Be sure that each child wears a hat at the
beach.”
“Apply Neosporin to any skin abrasions your
children get.”
B
Feedback:
Dermatologists recommend sunscreen
preparations that block both UVA and UVB
and have a sun protective factor of SPF value
30 or higher. It is unnecessary to avoid all
outdoor locations. The mother should apply a
hat, but this advice is not the most important
health promotion intervention; this does not
prevent sun damage to most skin surfaces.
The mother should be cautious with the
application of Neosporin.
A)
B)
C)
D)
B)
C)
D)
Ans:
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A 17-year-old woman is prescribed
isotretinoin (Accutane) for severe acne
4. vulgaris. Which of the following is the most
important intervention related to the
administration of this medication?
Effective contraception must accompany this
medication.
Administer the medication on an empty
stomach to decrease discomfort.
The tablets should be crushed if they are too
large to swallow.
Administer a vitamin A supplement daily to
enhance effectiveness.
A
Feedback:
The administration of retinoids requires
adequate contraceptive practices in women.
Retinoids should be given with food, not on
an empty stomach. The tablets should not be
crushed. The patient should not take vitamin
A or a multivitamin because of the retinoid
toxicity.
C)
large to swallow.
Administer a vitamin A supplement daily to
enhance effectiveness.
A
Feedback:
The administration of retinoids requires
adequate contraceptive practices in women.
Retinoids should be given with food, not on
an empty stomach. The tablets should not be
crushed. The patient should not take vitamin
A or a multivitamin because of the retinoid
toxicity.
D)
Ans:
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A college sophomore has sought care because
of her worsening acne. Before beginning a
5. medical regime that includes a retinoid, which
of the following laboratory tests must be
negative?
Throat culture
Skin culture
Stool for occult blood
Pregnancy test
D
Feedback:
The female patient should have a negative
pregnancy test before beginning retinoid
therapy. It is not necessary to have a negative
throat culture or skin culture. If the patient has
a positive stool for occult blood, the cause
should be determined but is not affected by
retinoid therapy.
A)
B)
C)
D)
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A)
B)
C)
D)
Ans:
A teenage male patient is administered
isotretinoin (Accutane) for severe acne. When
6. teaching the teen and his parents about the
medication, which of the following
assessments should be routinely made?
Assess blood pressure.
Assess blood lipid levels.
Assess for euphoria.
Assess for increased weight.
B
Feedback:
The administration of isotretinoin is linked
with increased blood lipid levels. The parents
and teen should be taught that lipid levels
should be periodically assessed. The
assessment of blood pressure is not
imperative. The patient should be assessed for
depression, not euphoria. The patient will not
need his weight assessed.
Assess blood lipid levels.
Assess for euphoria.
Assess for increased weight.
B
Feedback:
The administration of isotretinoin is linked
with increased blood lipid levels. The parents
and teen should be taught that lipid levels
should be periodically assessed. The
assessment of blood pressure is not
imperative. The patient should be assessed for
depression, not euphoria. The patient will not
need his weight assessed.
The physician orders tretinoin (Retin-A) for
7. the treatment of acne. Which of the following
instructions should be provided?
“You will see positive results in 1 week”
“Apply the medication two to three times a
day.”
“Apply the topical medication one time per
day.”
“Apply the medication for 1 hour and remove
it.”
C
Feedback:
Tretinoin is applied one time per day. Positive
results from the medication will be noted in
12 weeks, not 1 week. The medication should
not be applied two to three times per day. The
medication should not be applied for 1 hour
and then removed.
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B)
C)
D)
Ans:
A)
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B)
C)
D)
Ans:
A teenager has acne that requires treatment.
The physician does not want to use retinoids
8. because of the adverse effects. Which of the
following medication regimens will likely be
most effective?
Topical azelaic acid
Topical benzoyl peroxide
Topical clindamycin
Topical clindamycin with benzoyl peroxide
D
Feedback:
Combination products of topical clindamycin
or erythromycin and benzoyl peroxide are
more effective than antibiotics alone. Azelaic
acid and benzoyl peroxide are effective but
not as effective as combination medications.
Topical clindamycin is effective, but
combination medications may be more
effective.
B)
C)
D)
Ans:
Topical benzoyl peroxide
Topical clindamycin
Topical clindamycin with benzoyl peroxide
D
Feedback:
Combination products of topical clindamycin
or erythromycin and benzoyl peroxide are
more effective than antibiotics alone. Azelaic
acid and benzoyl peroxide are effective but
not as effective as combination medications.
Topical clindamycin is effective, but
combination medications may be more
effective.
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A patient has a severe reaction to poison ivy.
9. Which of the following medications will be
most effective?
Topical antihistamines
Corticosteroids
Emollients
Analgesics
B
Feedback:
Corticosteroids are used to treat the
inflammation present in many dermatologic
conditions. They are most often applied
topically but also may be given orally or
parenterally. Emollients and analgesics would
be ineffective. Antihistamines are not
administered topically.
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B)
C)
D)
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A)
B)
C)
D)
Ans:
A patient has psoriasis and has been
10. prescribed coal tar (Balnetar). How will this
prescription be administered?
Topically
Orally in divided daily doses
Orally in the morning
Parenterally at bedtime
A
Feedback:
Coal tar is administered topically.
A child who has not received the chickenpox
vaccine has developed the chickenpox virus.
The child has itching related to the
11.
chickenpox pustules. Which of the following
herbal preparations would be helpful to
decrease itching?
Coal tar (Balnetar)
Colloidal oatmeal (Aveeno)
Clindamycin
Bacitracin (Bacillin)
B
Feedback:
Oat preparations, such as Aveeno, are used
topically to treat minor skin irritation. Coal tar
is not used for this child; it is primarily
administered for psoriasis and dermatitis.
Clindamycin is not administered to treat
minor skin irritation. Bacitracin is not
administered to relieve itching related to
chickenpox.
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A)
B)
C)
D)
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B)
C)
D)
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A patient has rosacea. Which of the following
12. medications is most effective in treating
rosacea?
Topical metronidazole (Flagyl)
Oral nystatin (Mycostatin)
Oral prednisone
Topical hydrocortisone
A
Feedback:
Topical metronidazole is commonly used for
rosacea. Oral Mycostatin is not used for
rosacea. Oral prednisone is not used for
rosacea. Topical hydrocortisone is not used
for rosacea.
13.
A)
B)
C)
D)
Ans:
A patient has a bacterial skin infection. Which
medication can be applied to the lesion?
Bacitracin
Benzoyl peroxide
Butenafine (Mentax)
Clotrimazole (Lotrimin)
A
Feedback:
Bacitracin is used to treat a bacterial skin
infection. Butenafine is an antifungal agent.
Clotrimazole is used to treat tinea infections.
Benzoyl peroxide is used to treat acne.
A)
B)
C)
D)
Ans:
Bacitracin
Benzoyl peroxide
Butenafine (Mentax)
Clotrimazole (Lotrimin)
A
Feedback:
Bacitracin is used to treat a bacterial skin
infection. Butenafine is an antifungal agent.
Clotrimazole is used to treat tinea infections.
Benzoyl peroxide is used to treat acne.
A patient has developed urticaria following
the administration of an oral antibiotic. What
14. substance most commonly mediates the
formation of the wheals that characterize
urticaria?
Cytokines
CD4+ lymphocytes
Histamine
Interleukin
C
Feedback:
Histamine is the most common mediator of
urticaria; it causes vasodilation, increased
vascular permeability, and pruritus.
Cytokines, including interleukin, and CD4+
lymphocytes do not usually mediate the
development of urticaria.
A)
B)
C)
D)
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A)
B)
C)
D)
Ans:
An older adult who resides in a long-term
care facility has been diagnosed with oral
candidiasis (thrush). When considering
15.
factors that may have contributed to this
health problem, the nurse should prioritize
which of the following?
The resident recently completed a course of
broad-spectrum antibiotics.
The resident takes metformin for the
treatment of type 2 diabetes.
The resident has been using OTC skin
emollients several times a day.
The resident was immunized against the
influenza virus 1 week ago.
A
Feedback:
Oral candidiasis (thrush) involves mucous
membranes of the mouth. It often occurs as a
superinfection after the use of broad-spectrum
systemic antibiotics. Oral antihyperglycemics,
skin emollients, and vaccinations do not
contribute to thrush.
C)
emollients several times a day.
The resident was immunized against the
influenza virus 1 week ago.
A
Feedback:
Oral candidiasis (thrush) involves mucous
membranes of the mouth. It often occurs as a
superinfection after the use of broad-spectrum
systemic antibiotics. Oral antihyperglycemics,
skin emollients, and vaccinations do not
contribute to thrush.
D)
A)
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A)
B)
C)
D)
Ans:
A topical corticosteroid has been prescribed
for short-term use on an infant's skin. When
16. planning the use of a topical medication for
an infant, what principle should guide the
nurse's actions?
Topical medications on infants' skin must be
covered with an impermeable barrier.
Infants' skin is more permeable to medication
than older patients'.
Infants have more subcutaneous fat than older
patients, so higher concentrations of topical
medications are often necessary.
Systemic drugs are preferable to topical
medications in the care of infants.
B
Feedback:
With topical medications, cautious use is
recommended with infants and young
children due to the fact they have more
permeable skin and are more likely to absorb
the topical drugs. Infants have significant
subcutaneous fat, but this does not necessitate
higher concentrations of drugs. Topical drugs
do not necessarily have to be covered with a
barrier following administration.
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Ans:
A patient has been diagnosed with severe
atopic dermatitis and treatment with
tacrolimus (Protopic) ointment has been
17.
deemed necessary. When planning this
patient's care, the nurse should ensure that the
patient has been informed of what risk?
Risk of chemical burn injury
Increased risk of developing psoriasis or type
IV hypersensitivity
Risk of opportunistic fungal infection that
may become systemic
Increased risks of skin cancer and lymphoma
D
Feedback:
Tacrolimus has a black box warning about a
possible increased risk of skin cancer and
A)
Risk of chemical burn injury
Increased risk of developing psoriasis or type
IV hypersensitivity
Risk of opportunistic fungal infection that
may become systemic
Increased risks of skin cancer and lymphoma
D
Feedback:
Tacrolimus has a black box warning about a
possible increased risk of skin cancer and
lymphoma. It is not noted to cause fungal
infections, psoriasis, or chemical burn
injuries.
B)
C)
D)
Ans:
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om
A 15-year-old boy has begun acne treatment
using a combination ointment of clindamycin
18. and benzoyl peroxide. The nurse should teach
the boy to expect maximum results in how
long?
5 to 7 days
1 to 2 weeks
3 to 5 weeks
8 to 12 weeks
D
Feedback:
Best results of combination acne treatments
require 8 to 12 weeks of therapy, and
maintenance therapy is usually required.
A)
B)
C)
D)
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A)
B)
C)
D)
Ans:
A young adult began acne treatment several
weeks ago using a combination ointment and
has presented for a follow-up appointment at
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the clinic. When assessing the patient for
adverse effects of treatment, what question
should the nurse prioritize?
“Have you found that the ointment makes
your skin a lighter color?”
“Do you find that the ointment makes your
pimples bleed more easily?”
“Do your eyes burn when you apply the
ointment to your face?”
“Is the skin on your face uncomfortably dry
since you began using the ointment?”
D
Feedback:
Adverse effects of topical antibiotics include
erythema, peeling, dryness, and burning as
well as development of resistant strains of P.
acnes. Such ointments are not expected to
produce eye irritation, bleeding, or changes in
skin tone.
C)
ointment to your face?”
“Is the skin on your face uncomfortably dry
since you began using the ointment?”
D
Feedback:
Adverse effects of topical antibiotics include
erythema, peeling, dryness, and burning as
well as development of resistant strains of P.
acnes. Such ointments are not expected to
produce eye irritation, bleeding, or changes in
skin tone.
D)
Ans:
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om
A nurse practitioner has discussed the
possible risks and benefits of isotretinoin
treatment with a patient who has acne
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vulgaris. The nurse should be aware that this
medication achieves a reduction in the signs
and symptoms of acne by what method?
Stimulating phagocytosis in the epidermis and
dermis
Suppressing the production of sebum
Enhancing humoral immunity
Inhibiting the function of sudoriferous glands
B
Feedback:
The antiacne effects of isotretinoin include
suppression of sebum production, inhibition
of comedone formation, and inhibition of
inflammation. The drug does not stimulate
immune function or reduce the function of
sweat glands.
A)
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B)
C)
D)
Ans: