Chapter 20: Pharmacology

Question 1

The nurse is caring for a patient newly diagnosed with hypertension. Blood pressure readings over the past 8 hours have been:08:00: 164/93 mm Hg12:00: 158/90 mm Hg16:00: 166/94 mm HgThe health care provider prescribes a no added salt diet and plans to start the patient on hydrochlorothiazide 25 mg. Which action is most important for the nurse to do before administering this drug?

1. Check the patient’s serum potassium level.
2. Review the patient’s urine output for the past 24 hours.
3. Instruct the unlicensed assistive personnel to check the patient’s blood pressure.
4. Check whether the patient is having abnormal heart rhythms.

Answer 1

Ans: 1
Hydrochlorothiazide is a thiazide diuretic often used to treat hypertension. An adverse effect of these diuretics is that when Na+ reabsorption is blocked by thiazide diuretics, this increases Na+ delivery to the cortical collecting duct and increases Na+ reabsorption in this segment of the nephron. Because Na+ reabsorption is coupled to K+ secretion in the cortical collecting duct, these drugs can lead to excessive K+ secretion and hypokalemia ([K+] in extracellular fluid is too low). The same is true of loop diuretics (e.g., furosemide). Thiazide and loop diuretics may be combined with potassium-sparing diuretics (e.g., spironolactone) to counteract this possibility. The other actions are also appropriate for this patient but are not as urgent. Focus: Prioritization.

Question 2

A patient is prescribed meloxicam for rheumatoid arthritis. This drug has a long half-life of 51 hours. Which prescription would the nurse be sure to clarify with the health care provider before giving the medication?

1. Meloxicam 7.5 to 15 mg/day
2. Meloxicam 15 mg/day before breakfast
3. Meloxicam 7.5 mg every 4 hours as needed for pain
4. Meloxicam 7.5 mg/day as needed

Answer 2

Ans: 3
A drug’s plasma half-life depends on how quickly the drug is eliminated from the plasma. The half-life of a given medication is how long it takes for the body to get rid of half of the dose. If a drug with a long half-life is given too often or at short intervals, its level can become so high that it is toxic. Focus: Prioritization.

Question 3

The RN is a team leader working with an LPN/LVN and two unlicensed assistive personnel (UAP) to provide care for eight medical patients. Which action would be appropriate for the RN take with regard to nursing care provided by the LPN/LVN?

1. Delegate the performance of an abdominal dressing change to the LPN/LVN.
2. Supervise and document the patient assessments completed by the LPN/LVN.
3. Assign the LPN/LVN the administration of insulin to a patient with type 1 diabetes.
4. Delegate checking and recording vital signs on all eight patients to the LPN/LVN.

Answer 3

Ans: 3
LPN/LVNs are licensed and therefore responsible for their own practice. Their scope of practice includes administration of medications. The RN team leader is responsible for supervision as well as making assignments for LPN/LVNs (team leaders also make assignments for other RNs on the team). Delegation of checking and recording vital signs is appropriate for the UAPs. The LPN/LVN could perform the dressing change, but the RN would assign, not delegate, the task. Focus: Assignment.

Question 4

A 14-year-old child was recently diagnosed with type 1 diabetes. The patient is prescribed 10 units of regular insulin and 15 units of NPH insulin each morning. How should the nurse instruct this patient to give herself the prescribed doses of insulin?

1. “First draw up and administer the NPH insulin. Wait at least 15 minutes; then draw up and administer the regular insulin.”
2. “First draw up and administer the regular insulin; then draw up and administer the NPH insulin.”
3. “First draw up the NPH insulin; then draw up the regular insulin in the same syringe.”
4. “First draw up the regular insulin; then draw up the NPH insulin in the same syringe.”

Answer 4

Ans: 4
When mixing two different type of insulin in the same syringe, inject both bottles with the amount of air equal to the dose of that insulin. Then draw up the short-acting insulin first. Regular insulin is short acting. NPH insulin is an intermediate-acting insulin. Take care not to inject any regular insulin into the NPH bottle. Focus: Prioritization.

Question 5

A patient with type 2 diabetes has a prescription for a change in oral antidiabetic agents from glyburide to acarbose. The patient asks the nurse why there is no need to be worried about the new drug causing hypoglycemia. What is the nurse’s best answer?

1. “Because your pancreatic function is improving, it does not need as much stimulation, so acarbose is not as powerful as glyburide.”
2. “Glyburide stimulates your pancreas to secrete insulin, increasing your risk for hypoglycemia. Acarbose does not stimulate insulin secretion; rather, it reduces your intestinal uptake of sugar.”
3. “Acarbose increases the cells’ uptake of glucose without the need for insulin, so you cannot become hypoglycemic even if you miss a meal on this medication.”
4. “Glyburide is actually an oral form of insulin, and too much could make your blood sugar drop quickly. Acarbose reduces blood sugar by suppressing pancreatic release of glucagon.”

Answer 5

Ans: 2 
Glyburide is a sulfonylurea antidiabetic drug. Its action is to lower blood glucose levels by triggering the beta cells of the pancreas to release the small amount of preformed insulin present in the beta cells. Acarbose is an alpha-glucosidase inhibiting drug. Its action is to slow the digestion of dietary starches and other carbohydrates by inhibiting an enzyme that breaks them down into glucose. The result of this action is that blood glucose does not rise as far or as fast after a meal. Drugs from this class do not cause hypoglycemia when taken as the only therapy for diabetes. Focus: Prioritization.

Question 6

An adult patient with type 2 diabetes is prescribed miglitol 25 mg three times a day with meals. What specific priority instruction about this drug does the RN provide the LPN/LVN assigned to care for this patient?

1. “Make certain the patient’s meal is actually on the unit before administering the drug and give the drug with the first bite of the meal.”
2. “Check the patient’s blood glucose level to determine whether the drug therapy is having an effect on the diabetes.”
3. “Check the patient’s daily urine output and current lab work, especially the blood urea nitrogen (BUN) and serum creatinine levels, because kidney problems increase the effects of the drug.”
4. “Make sure that the patient is able to eat and will do so within 30 minutes of taking the drug.”

Answer 6

Ans: 1
Miglitol is an alpha-glucosidase inhibiting drug. Make certain the patient’s meal is actually on the unit before giving the drug. Give the drug with the first bite of the meal. The action of the drug is quick and brief. If the drug is taken too long before the meal is eaten, it will not prevent the carbohydrates from being absorbed, and the patient’s blood glucose level will rise. The other teaching is also appropriate for diabetics but not specific to the effectiveness of miglitol. Focus: Prioritization.

Question 7

An older adult patient with type 1 diabetes is legally blind and is prescribed daily morning doses of regular and NPH insulin. The patient’s daughter provides in-home care and will be preparing insulin syringes on a weekly basis. What does the nurse teach the patient’s daughter about storing the prefilled insulin syringes?

1. “Keep the syringes stored flat and do not attach the needles until you are ready to use a syringe.”
2. “Keep the syringes in the upright position with the needle pointing toward the ceiling.”
3. “Keep them in the upright position with the needle pointing toward the floor.”
4. “Storage position is unimportant as long as the syringes are kept in the refrigerator.”

Answer 7

Ans: 2
Prefilled insulin syringes, cartridges, and pens should be stored upright rather than lying flat. The needle must point upward. Focus: Prioritization.

Question 8

A female patient with type 2 diabetes who is breast-feeding her newborn infant has a prescription for glipizide. What is the nurse’s best action?

1. Administer the drug as ordered with meals.
2. Hold the drug and clarify the order with the health care provider.
3. Assign the LVN/LPN to administer the drug before breakfast.
4. Instruct the unlicensed assistive personnel to check the patient’s fingerstick glucose; then give the drug.

Answer 8

Ans: 2
Glipizide is a second-generation sulfonylurea antidiabetic drug. These drugs are contraindicated for breast-feeding mothers because they enter the milk and increase the infant’s risk for hypoglycemia. Focus: Prioritization.

Question 9

A patient is to receive metoprolol tartrate 5 mg IV to control high blood pressure. IV metoprolol tartrate is administered over 2 minutes. Based on the label for the medication, the nurse will administer _______________ mL/min.

Answer 9

Ans: 2.5 mg/min
5 mg in 5 mL = 5 mL / 2 min = 2.5 mL/min. Focus: Prioritization.INSERT PIC

Question 10

Which of the following should the nurse be sure to assess before and after giving amlodipine to treat high blood pressure? Select all that apply.

1. Swelling in ankles or feet 2. Heart rate
2. Oral temperature
3. Blood pressure
4. Lung sounds
5. Weight
6. Respiratory rate

Answer 10

Ans: 1, 2, 4, 5, 6
Amlodipine is a calcium channel blocker with side effects that include peripheral and pulmonary edema, weight gain, decreased heart rate (bradycardia), and decreased blood pressure (hypotension). The nurse would be sure to get a baseline for each of these parameters and then be sure to assess for each regularly after administering the drug. Although respirations and body temperature are parts of vital sign assessment, they are not as high a priority because they are not usually affected by antihypertensive drugs. Focus: Prioritization.

Question 11

A patient diagnosed with hypertension has received the first dose of lisinopril. Which interventions will the RN delegate to the unlicensed assistive personnel (UAP)? Select all that apply.

1. Restrict the patient to bed rest for at least 12 hours.
2. Recheck the patient’s vital signs every 4 to 8 hours.
3. Ensure that the patient’s call light is within easy reach.
4. Keep the patient’s bed in a supine position with all side rails up.
5. Remind the patient to rise slowly from the bed and sit before standing.
6. Assist the patient to get out of bed and use the bathroom.
7. Assess the patient for signs of dizziness.

Answer 11

Ans: 2, 3, 5, 6
After the first dose of most antihypertensive drugs, dizziness is a common side effect. The patient should call for help when getting out of bed, and the call light should be within easy reach. The patient should rise slowly, sitting on the side of the bed before standing, and then can be assisted to the bathroom. The UAP’s scope of practice includes these actions. Patients are not restricted to bed rest or kept in a supine (flat) position, and side rails are not all kept up for safety of the patient. Assessment is not within the scope of practice for a UAP. However, the RN could instruct the UAP to ask the patient about dizziness before and during ambulation and then report any dizziness immediately to the RN. Focus: Delegation; Test Taking Tip: The nurse must be aware of the scope of practice for a UAP to understand which patient care tasks may be delegated. Remember that the nurse may not delegate tasks such as assessment, teaching, evaluating, or administering drugs to a UAP.

Question 12

An older patient with chronic obstructive pulmonary disease (COPD) is to be discharged with prescriptions for albuterol, a short-acting beta agonist (SABA), and salmeterol, a long-acting beta agonist (LABA) bronchodilator. Which statement by the patient indicates to the nurse that the patient requires additional teaching?

1. “I will insert my inhaler into the spacer and shake the whole unit three or four times before taking my dose of the drug.”
2. “I will use my salmeterol whenever I become suddenly short of breath.”
3. “I will wait at least 1 minute between the first and second puff of my inhaler.”
4. “I will check my pulse before and after using my bronchodilator inhaler.”

Answer 12

Ans: 2
Salmeterol is a LABA and is used to prevent episodes of shortness of breath. When a patient becomes suddenly short of breath, the drug of choice would be a SABA such as albuterol. Statements 1, 3, and 4 all demonstrate correct understanding of how to use an aerosol inhaler. An older adult may be more sensitive to cardiac effects of these drugs and should check the heart rate before and after each dose. Focus: Prioritization; Test Taking Tip: The nurse must know the differences between SABA and LABA drugs, including how they work and why they are prescribed, to be able to assess the patient’s understanding of these drugs and determine if additional teaching is required.

Question 13

Which patient care action could the nurse delegate to unlicensed assistive personnel (UAP) after administering an inhaled anti-inflammatory drug to a patient with chronic obstructive pulmonary disease (COPD)?

1. Assess the patient’s mouth for white-colored patches.
2. Teach the patient how to clean the inhaler and spacer.
3. Assist the patient to rinse the mouth with water or mouthwash.
4. Auscultate the patient’s lungs for any changes in breath sounds.

Answer 13

Ans: 3
Side effects of inhaled anti-inflammatory drugs include leaving a bad taste in the mouth after use and increased risk for oral candidiasis (thrush). Rinsing with water or mouthwash helps remove the drug from the mouth and reduce the bad taste and oral infection risk. 1, 2, and 4 are all actions that are within the scope of practice for the RN. Assisting the patient to rinse the mouth after administration of these drugs is within the scope of practice for a UAP. Focus: Delegation.

Question 14

A patient with familial hypercholesterolemia is prescribed atorvastatin 10 mg once a day. Which finding will the nurse immediately report to the health care provider?

1. Stomach upset
2. Constipation
3. Bloating
4. Muscle soreness

Answer 14

Ans: 4
Patients who are prescribed statin drugs such as atorvastatin can develop the adverse effect of rhabdomyolysis. Signs and symptoms include general muscle soreness, muscle pain, weakness, vomiting, stomach pain, and brown urine. When a patient develops these signs and symptoms, the drug needs to be discontinued and another type of antilipidemic drug prescribed. Upset stomach and constipation are common side effect of statin drugs but are not adverse effects. Bloating is a more common side effect of the bile acid sequestrant type of antilipidemic drug. Focus: Prioritization.

Question 15

What key instruction must the nurse give to the unlicensed assistive personnel (UAP) who is assisting with morning care for an older patient prescribed apixaban, 2.5 mg orally twice a day, for chronic atrial fibrillation?

1. “Be sure to tell me if you notice any bleeding from the gums when the patient brushes his or her teeth.”
2. “Instruct the patient to avoid using aspirin-containing drugs or nonsteroidal anti-inflammatory drugs.”
3. “Teach the patient to expect some bruising to occur because this is a side effect of the drug.”
4. “Remind the patient that each morning a laboratory technician will stop by early to draw clotting studies.”

Answer 15

Ans: 1
Apixaban is a direct thrombin inhibitor. Bleeding from the gums is a side effect of these drugs. The nurse should be notified of any bleeding so that she or he can assess this effect. Instructing and teaching are not within the scope of practice for a UAP, but the UAP can remind patients about what the RN has taught. Apixaban does not require laboratory monitoring. Focus: Supervision.

Question 16

The RN team leader has assigned the LPN/LVN to administer clopidogrel 75 mg orally to a patient with a diagnosis of myocardial infarction. The patient also has an antacid prescribed for a diagnosis of gastric reflux. What must the LPN/LVN remember when administering these drugs? Select all that apply.

1. Clopidogrel can interfere with absorption of the antacid.
2. The antacid can interfere with absorption of clopidogrel.
3. Clopidogrel can be given with a meal to prevent nausea or upset stomach.
4. Clopidogrel should be given 1 hour after giving the antacid.
5. Clopidogrel and the antacid are compatible and can be given together.
6. Clopidogrel can be given one hour before the antacid.

Answer 16

Ans: 2, 3, 6
Antacids can interfere with absorption of clopidogrel (an antiplatelet drug) and many other drugs. Clopidogrel does not interfere with absorption of antacids. Side effects of antiplatelet drugs include nausea and upset stomach, which can be minimized by given the drug with or just after a meal. Antiplatelet drugs should be given 2 hours after or 1 hour before an antacid. Focus: Assignment.

Question 17

Which drug prescription would the nurse be sure to question for a patient diagnosed with heart failure?

1. Carvedilol 3.125 mg orally twice a day
2. Lisinopril 5 mg orally once a day
3. Digoxin 1.25 mg orally once a day
4. Isosorbide dinitrate 20 mg orally twice a day

Answer 17

Ans: 3
Digoxin maintenance doses are very low (0.1 to 0.375 mg per day orally). This dosage is 10 times what a maintenance dose should be and could cause adverse, even life-threatening, effects. Options 1, 2, and 4 all include dosages within the normal limits. Focus: Prioritization

Question 18

The RN is supervising a student nurse caring for a patient with hypertension. The health care provider prescribed enalapril 2.5 mg orally twice a day. The student tells the nurse that the patient has swelling around the eyes and lips. What does the nurse tell the student is the first best action?

1. Assess the patient’s ability to speak and breathe.
2. Have the student apply ice to the patient’s eyes and lips.
3. Check the patient’s white blood cell count.
4. Instruct the student to check the patient’s vital signs.

Answer 18

Ans: 1
Enalapril is an angiotensin-converting enzyme (ACE) inhibitor. Swelling of the eyes, mouth, and tongue may indicate angioedema, which is an adverse effect of ACE inhibitors. This can lead to swelling of the trachea, which interferes with breathing and can be life threatening. After the nurse assesses the patient’s breathing, the health care provider should be notified. Ice may help reduce swelling but is not a priority at this time. Checking the white blood cell count, especially neutrophils, is important if neutropenia is suspected. Checking vital signs is a good idea but not the highest priority in this situation. Focus: Prioritization, Supervision.

Question 19

A patient with hypertension is prescribed atenolol 25 mg orally once a day. Which change would be most important for the nurse report to the health care provider (HCP) after the patient begins taking this drug?

1. Heart rate of 58 beats/min
2. Cold hands and feet
3. Patient report of depression
4. Patient report of tiredness

Answer 19

ns: 3
Atenolol is a beta-blocker. Depression is a side effect of beta-blockers. These drugs may cause first-time depression or may cause existing depression to worsen. Decreased heart rate and blood pressure are expected responses to beta-blockers. Bradycardia, cold hands and feet, and tiredness are expected side effects of beta-blockers and should be monitored but are not as urgent and often do not require changes in the treatment plan. Focus: Prioritization.

Question 20

The unlicensed assistive personnel reports to the nurse that a patient with hypertension is experiencing a drop in blood pressure when sitting up after receiving his morning medications. The patient received furosemide 20 mg, a multivitamin, and quinapril 10 mg orally. What side effect does the nurse recognize?

1. Hypokalemia
2. Hyponatremia
3. Photosensitivity
4. Postural hypotension

Answer 20

Ans: 4
Furosemide is a loop diuretic, and quinapril is an angiotensin- converting enzyme inhibitor. Both lower blood pressure, and patients may experience a drop in blood pressure when sitting or standing, which is a classical sign of postural hypotension. Signs of low potassium include dry mouth, muscle cramps, and irregular heartbeat, and signs of low sodium include confusion, seizures, decreased mental activity, and weakness or fatigue. Photosensitivity is a side effect of furosemide, but it is increased sensitivity to sunlight. Focus: Prioritization, Supervision.

Question 21

The nurse is providing patient teaching for an older adult about spironolactone. Which key points would the nurse include? Select all that apply.

1. Avoid the use of salt substitutes.
2. Do not consume excessive amounts of foods that are high in potassium.
3. Be prepared for a decrease in your urine output.
4. This drug works by conserving sodium and excreting potassium.
5. Older adults may be more sensitive to the action of this drug.
6. As an older adult, you are more likely to experience side effects of this drug.

Answer 21

Ans: 1, 2, 5, 6
Spironolactone is a potassium-sparing diuretic, so patients should avoid excessive intake of foods high in potassium such as bananas, broccoli, and spinach. Salt substitutes should also be avoided because the sodium is replaced with potassium. Urine output should increase, not decrease. The drug works by increasing excretion of water and sodium, but not potassium, in urine. Older adults are more sensitive to the action of this drug and are also more likely to experience side effects. Focus: Prioritization.

Question 22

The RN is preparing to administer drugs to a group of patients. Which drug is most important for the nurse to discuss with the health care provider before administration?

1. Albuterol for a patient with chronic obstructive pulmonary disease
2. Hydrochlorothiazide for a patient with hypertension
3. Ibuprofen for a patient with osteoarthritis
4. Methimazole for a patient with hypothyroidism

Answer 22

Ans: 4
Methimazole is a thyroid-suppressing drug, which would make hypothyroidism worse. An appropriate drug for hypothyroidism would be a thyroid replacement drug such as levothyroxine. Options 1, 2, and 3 include appropriate drugs for the conditions listed. Focus: Prioritization.

Question 23

A patient has been taking prednisone 20 mg orally each day for 10 days for a severe allergic skin reaction. The patient tells the nurse that she no longer needs to take the prednisone because she is feeling better and the reaction has cleared up. What is the nurse’s best response?

1. “After taking this drug for over 1 week, it must be slowly decreased to allow the adrenal glands to begin making cortisol.”
2. “When the health care provider (HCP) visits, I will ask if he will write an order prescribing that this drug be discontinued.”
3. “You may need to continue taking the prednisone for another week or two to be sure that the skin allergic reaction is under control.”
4. “Because you have taken prednisone for 10 days, it will be necessary for the HCP to order a topical form of the drug for use as needed.”

Answer 23

Ans: 1
Prednisone is a corticosteroid drug that is similar to natural cortisol secreted by the adrenal glands. The amount of cortisol made each day is influenced by the amount circulating in the blood. When a patient takes this drug, the adrenal glands reduce production of cortisol. After taking the drug for more than 1 week, it is necessary to taper the drug before stopping it to give the adrenal glands time to produce more cortisol. The HCP would not suddenly discontinue the drug or continue it at the same level when it is no longer needed. A topical form of the drug would not be needed. Focus: Prioritization.

Question 24

A child with an ear infection is prescribed liquid amoxicillin 20 mg/kg every 8 hours. The child weighs 12 kg (26.5 lb). How many milligrams of amoxicillin will the nurse give with each dose?
__________mg

Answer 24

Ans: 240 mg
20 mg/kg × 12 kg = 240 mg. Focus: Prioritization.

Question 25

A patient visits the urgent care clinic with a bacterial respiratory infection. The nurse will anticipate the need for patient teaching about which medication?

1. Azithromycin
2. Amantadine
3. Fluconazole
4. Ethambutol

Answer 25

Ans: 1
Azithromycin is an antibacterial drug. Amantadine is antiviral,
fluconazole antifungal, and ethambutol antitubercular. Focus: Prioritization

Question 26

A patient diagnosed with overactive bladder is prescribed oxybutynin 5 mg orally twice a day. The nurse is providing patient teaching about side effects of this drug. Which side effects would be included? Select all that apply.

1. Diarrhea
2. Dry mouth
3. Dizziness
4. Headache
5. Rash
6. Constipation

Answer 26

Ans: 2, 3, 4, 6
Oxybutynin is an anticholinergic drug used to treat overactive bladder. It inhibits the neurotransmitter acetylcholine which results in decreased secretions and can cause the side effects of dry mouth and eyes, headaches, dizziness, and constipation. Diarrhea and rash are not common side effects of this drug. Focus: Prioritization.

Question 27

A patient is prescribed 3000 units of heparin subcutaneously. The drug is available in vial of 5000 units/1 mL. How many milliliters will the nurse administer?
__________mL

Answer 27

Ans: 0.6 mL
Need 3000 units/X mL: Have 5000 units/1 mL = 3/5 = 6/10 = 0.6 mL. Focus: Prioritization.

Question 28

The nurse is providing care for a patient with chronic kidney disease who receives hemodialysis 3 days a week. As the nurse prepares to administer the patient’s dose of epoetin alfa subcutaneously, the patient asks why the shot is necessary. What is the nurse’s best response?

1. “It will help stimulate production of white blood cells to protect you from infection.”
2. “It will help stimulate production of platelets to improve your ability to form clots.”
3. “It will help stimulate production of phagocytes to engulf and kill bacteria.”
4. “It will help stimulate production of red blood cells to increase your red blood cell count.”

Answer 28

Ans: 4
Epoetin alfa is a colony-stimulating factor, an erythropoiesis- stimulating agent that helps stimulate production of red blood cells, often used for patients who have chronic kidney disease, anemia from chemotherapy, or need to increase the RBC count before surgery. Another type of colony-stimulating factor is oprelvekin, a thrombopoiesis-stimulating agent that helps increase platelet counts. Both types of colony-stimulating factors are used to decrease the need for transfusion of blood and blood products. Focus: Prioritization.

Question 29

The patient is experiencing nausea due to Ménière disease. For which drug is the nurse most likely to plan patient teaching?

1. Promethazine
2. Prochlorperazine
3. Meclizine
4. Granisetron

Answer 29

Ans: 3
Meclizine is an antihistamine antiemetic drug that is prescribed for
labyrinth disorders, including motion sickness and Ménière disease.
Promethazine and prochlorperazine are phenothiazine antiemetic drugs with
sedating effects that help to control sensations of nausea. Granisetron is a
5HT -receptor antagonist antiemetic drug commonly used to manage nausea 3
and vomiting associated with cancer chemotherapy. Focus: Prioritization.

Question 30

The patient is experiencing nausea and vomiting for which the health care provider has prescribed promethazine 12.5 mg orally four times a day as needed. Which patient care task would the nurse appropriately delegate to the unlicensed assistive personnel (UAP) before giving this drug?

1. Check the patient’s temperature, blood pressure, and heart rate.
2. Auscultate the patient’s abdomen for active bowel sounds.
3. Examine the patient’s abdomen for any distention.
4. Ask the patient about constipation or difficulty swallowing

Answer 30

Ans: 1
Checking and recording vital signs for patients falls within the scope of practice for a UAP. Auscultating, examining, and asking questions about patient history remain within the scope of practice for a nurse and should not be delegated to UAP. Focus: Delegation.

Question 31

The nurse assigns an LPN/LVN to administer prochlorperazine 10 mg orally to an older adult patient experiencing nausea. Which specific instruction would the nurse give the LPN/LVN regarding monitoring this patient after the drug has been given?

1. “You should expect the patient’s bowel sounds to decrease after he takes this drug.”
2. “Be sure to monitor his level of consciousness and watch for sedation.”
3. “Apply oxygen by nasal cannula in case his respiratory rate decreases.”
4. “The patient should be able to ambulate on his own to the bathroom.”

Answer 31

Ans: 2
Prochlorperazine is a phenothiazine antiemetic drug. These drugs commonly have sedation as a side effect, and the sedation (especially in older adults) is what helps control the sensation of nausea when they are given to a patient. Bowel sounds should not change after this drug. Although the nurse should monitor for respiratory depression, oxygen is not necessary unless the patient experiences respiratory difficulties. Because of the sedation effects of this drug, a patient should be instructed to call for help and be assisted to ambulate to the bathroom at least until the effects of the drug on a patient are known. Focus: Assignment, Supervision.

Question 32

The health care provider (HCP) prescribes a bisacodyl 10 mg suppository rectally for an older adult who has not had a bowel movement for over 5 days. Which actions are accurate when the nurse administers this drug rectally? Select all that apply.

1. Explain the procedure and include how long the drug must be held in the rectum.
2. Bring the drug, some lubricant, and a pair of disposable gloves to the bedside.
3. Place the patient in prone position.
4. Provide privacy by closing doors or pulling curtains.
5. Remove the suppository wrapping and coat the blunt end with lubricant.
6. Have the patient take a deep breath and push the suppository 1 inch (2.5 cm) into the rectum.

Answer 32

Ans: 1, 2, 4, 6
Statements 1, 2, 4, and 6 are accurate with regard to administering a rectal suppository. The best position to place a patient in for administering a suppository is left Sims. Only a small amount of lubricant should be used to coat the pointed end of the suppository, and a small amount of lubricant should also be used to coat the end of the finger that the nurse will use to insert the suppository. Focus: Prioritization.

Question 33

A patient with diarrhea has been prescribed loperamide 2 mg orally after each unformed stool. Which laboratory value will be most important for the nurse to monitor for this patient?

1. Serum sodium
2. Serum potassium
3. Urine protein
4. Urine nitrogen

Answer 33

Ans: 2
Patients with diarrhea have increased water in bowel movements as well as increased volume and frequency of stools. A common side effect of diarrhea is electrolyte imbalance, especially low potassium (hypokalemia), so the nurse must monitor this laboratory value. Even small changes in potassium level may cause potentially life-threatening problems such as dysrhythmias. Focus: Prioritization.

Question 34

The RN is preparing to administer drugs to a group of patients with gastrointestinal disorders. Which drug is most important to discuss with the health care provider before administration?

1. Omeprazole for patient with peptic ulcer disease (PUD)
2. Ranitidine for patient with gastroesophageal reflux disease (GERD)
3. Diphenoxylate with atropine for patient with constipation
4. Ondansetron for patient with nausea due to chemotherapy

Answer 34

Ans: 3
Diphenoxylate with atropine is an antimotility drug commonly used to treat diarrhea. The actions of this drug would not relieve a patient’s constipation but would likely make it much worse. Omeprazole is a proton pump inhibitor often used to treat PUD and GERD, ranitidine is a histamine2 blocker used to treat GERD and PUD, and ondansetron is a 5H3-receptor antagonist used to treat nausea caused by chemotherapy. Appropriate drugs to treat constipation include emollient stool softeners (e.g., docusate), stimulants (e.g., bisacodyl), and osmotic laxatives (e.g., lactulose). Focus: Prioritization.

Question 35

The RN is caring for a patient in the emergency department with severe chest pain for which the health care provider has prescribed morphine 2 mg IV push. Morphine is available in prefilled syringes with 4 mg/mL. How many milliliters does the nurse administer?
__________ mL

Answer 35

Ans: 0.5 mL
Need 2 mg/X mL: Have 4 mg/1 mL = 2/4 = 1/2 = 0.5 mL. Focus: Prioritization.

Question 36

During a check-up at the health care provider’s (HCP’s) office, a male patient tells the nurse that he is having difficulty getting and keeping an erection. The HCP diagnoses the patient with erectile dysfunction (ED) and prescribes sildenafil 50 mg orally once daily 30 minutes to 1 hour before sexual activity. Which are key teaching points about this drug? Select all that apply.

1. The drug will have no effect without sexual stimulation.
2. Notify the HCP if the patient experiences an erection lasting longer than 2 hours.
3. If a prolonged and painful erection occurs, be sure to notify the HCP.
4. The action of sildenafil last up to 36 hours.
5. The patient should not take sildenafil while taking nitrate drugs.
6. Consuming high-fat meals may delay maximum effectiveness of this drug.

Answer 36

Ans: 1, 3, 5, 6
Sildenafil requires sexual stimulation to work. The HCP should be notified for erections lasting longer than 4 hours as well as painful prolonged erections (priapism). The action of sildenafil lasts about 4 hours (vardenafil’s action can last up to 36 hours). Use of nitrate drugs along with sildenafil can lead to severe hypotension, and consuming high-fat meals can cause a delay in the maximum effect of this drug. Focus: Prioritization.

Question 37

A patient with pulmonary edema is prescribed furosemide 60 mg IV push. The drug comes in a 10-mL vial with a concentration of 10 mg/mL. How many milliliters will the nurse administer?
__________ mL

Answer 37

Ans: 6 mL
Need 60 mg/X mL: Have 10 mg/1 mL = 6/1 = 6 mL. Focus: Prioritization.