Exam 2

Question 1

The nurse teaches the client relaxation techniques and guided imagery as an adjunct to medication for treatment of pain. What is the main rationale for the use of these techniques as an adjunct to analgesic medication?

1. They are less costly techniques.
2. They may allow lower doses of drugs with fewer adverse effects.
3. They can be used at home.
4. They do not require self-injection.

Answer 1

2. They may allow lower doses of drugs with fewer adverse effects.

Question 2

The emergency department nurse is caring for a client with a migraine headache. Which drug would the nurse anticipate administering to abort the client’s migraine attack?

1. Morphine
2. Propranolol (Inderal)
3. Ibuprofen (Motrin)
4. Sumatriptan (Imitrex)

Answer 2

4. Sumatriptan (Imitrex)

Question 3

A client admitted with hepatitis B is prescribed hydrocodone with acetaminophen (Vicodin) 2 tablets for pain. What is the most appropriate action for the nurse to take?

1. Administer the drug as ordered.
2. Administer 1 tablet only.
3. Recheck the order with the health care provider.
4. Hold the drug until the health care provider arrives.

Answer 3

3. Recheck the order with the health care provider.

Question 4

The nurse administers morphine sulfate 4 mg IV to a client for treatment of severe pain. Which of the following assessments require immediate nursing interventions? (Select all that apply.)

1. The client’s blood pressure is 110/70 mmHg.
2. The client is drowsy.
3. The client’s pain is unrelieved in 15 minutes.
4. The client’s respiratory rate is 10 breaths per minute.
5. The client becomes unresponsive.

Answer 4

3. The client’s pain is unrelieved in 15 minutes.
4. The client’s respiratory rate is 10 breaths per minute.
5. The client becomes unresponsive.

Question 5

Planning teaching needs for a client who is to be discharged postoperatively with a prescription for oxycodone with acetaminophen (Percocet) should include which of the following?

1. Refer the client to a drug treatment center if addiction occurs.
2. Encourage increased fluids and fiber in the diet.
3. Monitor for GI bleeding.
4. Teach the client to self-assess blood pressure.

Answer 5

2. Encourage increased fluids and fiber in the diet.

Question 6

What is the most appropriate method to ensure adequate pain relief in the immediate postoperative period from an opioid drug?

1. Give the drug only when the family members report that the client is complaining of pain.
2. Give the drug every time the client complains of acute pain.
3. Give the drug as consistently as possible for the first 24 to 48 hours.
4. Give the drug only when the nurse observes signs and symptoms of pain.

Answer 6

3. Give the drug as consistently as possible for the first 24 to 48 hours.

Question 7

The client received lidocaine viscous before a gastroscopy was performed. Which of the following would be a priority for the nurse to assess during the postprocedure period?

1. Return of gag reflex
2. Ability to urinate
3. Leg pain
4. Ability to stand

Answer 7

1. Return of gag reflex

Question 8

A young client requires suturing of a laceration to the right forearm and the provider will use lidocaine (Xylocaine) with epinephrine as the local anesthetic prior to the procedure. Why is epinephrine included in the lidocaine for this client?

1. It will increase vasodilation at the site of the laceration.
2. It will prevent hypotension.
3. It will ensure that infection risk is minimized postsuturing.
4. It will prolong anesthetic action at the site.

Answer 8

4. It will prolong anesthetic action at the site.

Question 9

The client who is scheduled to have a minor in-office surgical procedure will receive nitrous oxide and expresses concern to the nurse that the procedure will hurt. Which of the following would be the nurse’s best response?

1. “You may feel pain during the procedure but you won’t remember any of it.”
2. “You will be unconscious the entire time and won’t feel any pain.”
3. “You will not feel any pain during the procedure because the drug blocks the pain signals.”
4. “You will feel pain but you won’t perceive it the same way; that’s why it’s called ‘laughing gas.’ ”

Answer 9

3. “You will not feel any pain during the procedure because the drug blocks the pain signals.”

Question 10

The client returns to the postanesthesia recovery unit for observation and recovery following surgery with a general anesthetic. Which of the following assessment findings may the nurse expect to find during this recovery period? (Select all that apply.)

1. Bradycardia
2. Severe headache
3. Hypertension
4. Respiratory depression
5. Urinary frequency

Answer 10

1. Bradycardia

4. Respiratory depression

Question 11

A client is admitted to the postanesthesia recovery unit (PACU) after receiving ketamine (Ketalar) after his minor orthopedic surgery. What is the most appropriate nursing action in the recovery period for this client?

1. Frequently orient the client to time, place, and person.
2. Keep the client in a bright environment so there is less drowsiness.
3. Frequently assess the client for sensory deprivation.
4. Place the client in a quiet area of the unit with low lights and away from excessive noise.

Answer 11

4. Place the client in a quiet area of the unit with low lights and away from excessive noise.

Question 12

A client has received succinylcholine (Anectine) along with the general anesthetic in surgery. Which of the following abnormal findings in the recovery period should be reported immediately to the provider?

1. Temperature 38.9°C (102°F)
2. Heart rate 56
3. Blood pressure 92/58
4. Respiratory rate 15

Answer 12

1. Temperature 38.9°C (102°F)

Question 13

A client with a history of hypertension is to start drug therapy for rheumatoid arthritis. Which of the following drugs would be contraindicated, or used cautiously, for this client? (Select all that apply.)

1. Aspirin
2. Ibuprofen (Advil, Motrin)
3. Acetaminophen (Tylenol)
4. Naproxen (Aleve)
5. Methylprednisolone (Medrol)

Answer 13

1. Ibuprofen (Advil, Motrin)
2. Naproxen (Aleve)
3. Methylprednisolone (Medrol)

Question 14

The client has been taking aspirin for several days for headache. During the assessment, the nurse discovers that the client is experiencing ringing in the ears and dizziness. What is the most appropriate action by the nurse?

1. Question the client about history of sinus infections.
2. Determine whether the client has mixed the aspirin with other medications.
3. Tell the client not to take any more aspirin.
4. Tell the client to take the aspirin with food or milk.

Answer 14

3. Tell the client not to take any more aspirin.

Question 15

While educating the client about hydrocortisone (Cortef), the nurse would instruct the client to contact the health care provider immediately if which of the following occurs?

1. There is a decrease of 2 lb in weight.
2. There is an increase in appetite.
3. There is tearing of the eyes.
4. There is any difficulty breathing.

Answer 15

4. There is any difficulty breathing.

Question 16

The nurse is admitting a client with rheumatoid arthritis. The client has been taking prednisone (Aristospan) for an extended time. During the assessment, the nurse observes that the client has a very round moon-shaped face, bruising, and an abnormal contour of the shoulders. What does the nurse conclude based on these findings?

1. These are normal reactions with the illness.
2. These are probably birth defects.
3. These are symptoms of myasthenia gravis.
4. These are symptoms of adverse drug effects from the prednisone.

Answer 16

4. These are symptoms of adverse drug effects from the prednisone.

Question 17

A 24-year-old client reports taking acetaminophen (Tylenol) fairly regularly for headaches. The nurse knows that a client who consumes excess acetaminophen per day or regularly consumes alcoholic beverages should be observed for what adverse effect?

1. Hepatic toxicity
2. Renal damage
3. Thrombotic effects
4. Pulmonary damage

Answer 17

1. Hepatic toxicity

Question 18

The nurse is counseling a mother regarding antipyretic choices for her 8-year-old daughter. When asked why aspirin is not a good drug to use, what should the nurse tell the mother?

1. It is not as good an antipyretic as is acetaminophen.
2. It may increase fever in children under age 10.
3. It may produce nausea and vomiting.
4. It increases the risk of Reye’s syndrome in children under 18 with viral infections.

Answer 18

4. It increases the risk of Reye’s syndrome in children under 18 with viral infections.

Question 19

Following administration of phenylephrine (Neo-Synephrine), the nurse would assess for which of the following adverse drug effects?

1. Insomnia, nervousness, and hypertension
2. Nausea, vomiting, and hypotension
3. Dry mouth, drowsiness, and dyspnea
4. Increased bronchial secretions, hypotension, and bradycardia

Answer 19

1. Insomnia, nervousness, and hypertension

Question 20

Anticholinergics may be ordered for which of the following conditions? (Select all that apply.)

1. Peptic ulcer disease
2. Bradycardia
3. Decreased sexual function
4. Irritable bowel syndrome
5. Urine retention

Answer 20

1. Peptic ulcer disease
2. Bradycardia
3. Irritable bowel syndrome

Question 21

Propranolol (Inderal) has been ordered for a client with hypertension. Because of adverse effects related to this drug, the nurse would carefully monitor for which adverse effect?

1. Bronchodilation
2. Tachycardia
3. Edema
4. Bradycardia

Answer 21

4. Bradycardia

Question 22

Older adult clients taking bethanechol (Urecholine) need to be assessed more frequently because of which of the following adverse effects?

1. Tachycardia
2. Hypertension
3. Dizziness
4. Urinary retention

Answer 22

3. Dizziness

Question 23

The client taking benztropine (Cogentin) should be provided education on methods to manage which common adverse effect?

1. Heartburn
2. Constipation
3. Hypothermia
4. Increased gastric motility

Answer 23

2. Constipation

Question 24

The client or family of a client taking tacrine (Cognex) should be taught to be observant for which of the following adverse effects that may signal that a possible overdose has occurred?

1. Excessive sweating, salivation, and drooling
2. Extreme constipation
3. Hypertension and tachycardia
4. Excessively dry eyes and reddened sclera

Answer 24

1. Excessive sweating, salivation, and drooling

Question 25

An 8-year-old boy is evaluated and diagnosed with absence seizures. He is started on ethosuximide (Zarontin). Which information should the nurse provide the parents? 1. After-school sports activities will need to be stopped because they will increase the risk of seizures. 2. Monitor height and weight to assess that growth is progressing normally. 3. Fractures may occur, so increase the amount of vitamin D and calcium-rich foods in the diet. 4. Avoid dehydration with activities and increase fluid intake.

Answer 25

2. Monitor height and weight to assess that growth is progressing normally.

Question 26

The nurse is providing education for a 12-year-old client with partial seizures currently prescribed valproic acid (Depakene). The nurse will teach the client and the parents to immediately report which symptom? 1. Increasing or severe abdominal pain 2. Decreased or foul taste in the mouth 3. Pruritus and dry skin 4. Bone and joint pain

Answer 26

1. Increasing or severe abdominal pain

Question 27

The nurse is caring for a 72-year-old client taking gabapentin (Neurontin) for a seizure disorder. Because of this client’s age, the nurse would establish which nursing diagnosis related to the drug’s common adverse effects? 1. Risk for Deficient Fluid Volume 2. Risk for Impaired Verbal Communication 3. Risk for Constipation 4. Risk for Falls

Answer 27

4. Risk for Falls

Question 28

A client has been taking phenytoin (Dilantin) for control of generalized seizures, tonic–clonic type. The client is admitted to the medical unit with symptoms of nystagmus, confusion, and ataxia. What change in the phenytoin dosage does the nurse anticipate will be made based on these symptoms? 1. The dosage will be increased. 2. The dosage will be decreased. 3. The dosage will remain unchanged; these are symptoms unrelated to the phenytoin. 4. The dosage will remain unchanged but an additional antiseizure medication may be added.

Answer 28

2. The dosage will be decreased.

Question 29

Teaching for a client receiving carbamazepine (Tegretol) should include instructions that the client should immediately report which symptom? 1. Leg cramping 2. Blurred vision 3. Lethargy 4. Blister-like rash

Answer 29

4. Blister-like rash

Question 30

Which of the following medications may be used to treat partial seizures? (Select all that apply.) 1. Phenytoin (Dilantin) 2. Valproic acid (Depakene) 3. Diazepam (Valium) 4. Carbamazepine (Tegretol) 5. Ethosuximide (Zarontin)

Answer 30

1. Phenytoin (Dilantin) 2. Valproic acid (Depakene) 3. Carbamazepine (Tegretol)

Question 31

Which of the following client statements indicates that the levodopa/carbidopa (Sinemet) is effective? 1. “I’m sleeping a lot more, especially during the day.” 2. “My appetite has improved.” 3. “I’m able to shower by myself.” 4. “My skin doesn’t itch anymore.”

Answer 31

3. “I’m able to shower by myself.”

Question 32

The client asks what can be expected from the levodopa/carbidopa (Sinemet) he is taking for treatment of parkinsonism. What is the best response by the nurse? 1. “A cure can be expected within 6 months.” 2. “Symptoms can be reduced and the ability to perform ADLs can be improved.” 3. “Disease progression will be stopped.” 4. “EPS will be prevented.”

Answer 32

2. “Symptoms can be reduced and the ability to perform ADLs can be improved.”

Question 33

The nurse discusses the disease process of multiple sclerosis with the client and caregiver. The client will begin taking glatiramer acetate (Copaxone), and the nurse is teaching the client about the drug. Which of the following points should be included? 1. Drink extra fluids while this drug is given. 2. Local injection site irritation is a common effect. 3. Take the drug with plenty of water and remain in an upright position for at least 30 minutes. 4. The drug causes a loss of vitamin C so include extra citrus and foods containing vitamin C in the diet.

Answer 33

2. Local injection site irritation is a common effect.

Question 34

A client who has not responded well to other drug therapy for Alzheimer’s disease is placed on tacrine (Cognex). Which of the following are major disadvantages to the use of tacrine? (Select all that apply.) 1. It must be administered four times per day. 2. It causes weight gain. 3. It may cause vision difficulties. 4. It may cause serious hepatic damage. 5. It may be purchased over the counter.

Answer 34

It must be administered four times per day. | 1. It may cause serious hepatic damage.

Question 35

An early sign(s) of levodopa toxicity is (are) which of the following? 1. Orthostatic hypotension 2. Drooling 3. Spasmodic eye winking and muscle twitching 4. Nausea, vomiting, and diarrhea

Answer 35

3. Spasmodic eye winking and muscle twitching

Question 36

Cyclobenzaprine (Amrix, Flexeril) is prescribed for a client with muscle spasms of the lower back. Appropriate nursing intervention would include which of the following? (Select all that apply.) 1. Assessing the heart rate for tachycardia 2. Assessing the home environment for client safety concerns 3. Encouraging frequent ambulation 4. Providing oral suction for excessive oral secretions 5. Providing assistance with ADLs such as reading

Answer 36

1. Assessing the heart rate for tachycardia 2. Assessing the home environment for client safety concerns 3. Providing assistance with ADLs such as reading

Question 37

The client is scheduled to receive rimabotulinumtoxinB (Myobloc) for treatment of muscle spasticity. Which of the following will the nurse teach the client to report immediately? 1. Fever, aches, or chills 2. Difficulty swallowing, ptosis, blurred vision 3. Continuous spasms and pain on the affected side 4. Moderate levels of muscle weakness on the affected side

Answer 37

2. Difficulty swallowing, ptosis, blurred vision

Question 38

A client has purchased capsaicin OTC cream to use for muscle aches and pains. What education is most important to give this client? 1. Apply with a gloved hand only to the site of pain. 2. Apply the medication liberally above and below the site of pain. 3. Apply to areas of redness and irritation only. 4. Apply liberally with a bare hand to the affected limb.

Answer 38

1. Apply with a gloved hand only to the site of pain.

Question 39

A client has been prescribed clonazepam (Klonopin) for muscle spasms and stiffness secondary to an automobile accident. While the client is taking this drug, what is the nurse’s primary concern? 1. Monitoring hepatic laboratory work 2. Encouraging fluid intake to prevent dehydration 3. Assessing for drowsiness and implementing safety measures 4. Providing social services referral for client concerns about the cost of the drug

Answer 39

3. Assessing for drowsiness and implementing safety measures

Question 40

A female client is prescribed dantrolene sodium (Dantrium) for painful muscle spasms associated with multiple sclerosis. The nurse is writing the discharge plan for the client and will include which of the following teaching points? (Select all that apply.) 1. If muscle spasms are severe, supplement the medication with hot baths or showers three times per day. 2. Inform the health care provider if she is taking estrogen products. 3. Sip water, ice, or hard candy to relieve dry mouth. 4. Return periodically for required laboratory work. 5. Obtain at least 20 minutes of sun exposure per day to boost vitamin D levels

Answer 40

2. Inform the health care provider if she is taking estrogen products. 3. Sip water, ice, or hard candy to relieve dry mouth. 4. Return periodically for required laboratory work.

Question 41

A client who has been prescribed baclofen (Lioresal) returns to the health care provider after a week of drug therapy, complaining of continued muscle spasms of the lower back. What further assessment data will the nurse gather? 1. Whether the client has been taking the medication consistently or only when the pain is severe 2. Whether the client has been consuming alcohol during this time 3. Whether the client has increased the dosage without consulting the health care provider 4. Whether the client’s log of symptoms indicates that the client is telling the truth

Answer 41

1. Whether the client has been taking the medication consistently or only when the pain is severe

Question 42

The nurse should assess a client who is taking lorazepam (Ativan) for the development of which of these adverse effects? 1. Tachypnea 2. Astigmatism 3. Ataxia 4. Euphoria

Answer 42

3. Ataxia

Question 43

A client is receiving temazepam (Restoril). Which of these responses should a nurse expect the client to have if the medication is achieving the desired effect? 1. The client sleeps in 3-hour intervals, awakens for a short time, and then falls back to sleep. 2. The client reports feeling less anxiety during activities of daily living. 3. The client reports having fewer episodes of panic attacks when stressed. 4. The client reports sleeping 7 hours without awakening.

Answer 43

4. The client reports sleeping 7 hours without awakening.

Question 44

A 32-year-old female client has been taking lorazepam (Ativan) for her anxiety and is brought into the emergency department after taking 30 days’ worth at one time. What antagonist for benzodiazepines may be used in this case? 1. Epinephrine 2. Atropine 3. Flumazenil 4. Naloxone

Answer 44

3. Flumazenil

Question 45

A 17-year-old client has been prescribed escitalopram (Lexapro) for increasing anxiety uncontrolled by other treatment measures. Because of this client’s age, the nurse will ensure that the client and parents are taught what important information? 1. Cigarette smoking will counteract the effects of the drug. 2. Signs of increasing depression or thoughts of suicide should be reported immediately. 3. The drug causes dizziness and alternative schooling arrangements may be needed for the first two months of use. 4. Anxiety and excitability may increase during the first two weeks of use but then will have significant improvement.

Answer 45

2. Signs of increasing depression or thoughts of suicide should be reported immediately.

Question 46

Zolpidem (Ambien) has been ordered for a client for the treatment of insomnia. What information will the nurse provide for this client? (Select all that apply.) 1. Be cautious when performing morning activities because it may cause a significant “hangover” effect with drowsiness and dizziness. 2. Take the drug with food; this enhances the absorption for quicker effects. 3. Take the drug immediately before going to bed; it has a quick onset of action. 4. If the insomnia is long-lasting, this drug may safely be used for up to one year. 5. Alcohol and other drugs that cause CNS depression (e.g., antihistamines) should be avoided while taking this drug.

Answer 46

1. Take the drug immediately before going to bed; it has a quick onset of action. 2. Alcohol and other drugs that cause CNS depression (e.g., antihistamines) should be avoided while taking this drug.

Question 47

Education given to clients about the use of all drugs to treat insomnia should include an emphasis on what important issue? 1. They will be required long-term to achieve lasting effects. 2. They require frequent blood counts to avoid adverse effects. 3. They are among the safest drugs available and have few adverse effects. 4. Long-term use may increase the risk of adverse effects, create a “sleep debt,” and cause rebound insomnia when stopped.

Answer 47

4. Long-term use may increase the risk of adverse effects, create a “sleep debt,” and cause rebound insomnia when stopped.

Question 48

The nurse is monitoring the client for early signs of lithium (Eskalith) toxicity. Which symptoms, if present, may indicate that toxicity is developing? (Select all that apply.) 1. Persistent GI upset (e.g., nausea, vomiting) 2. Confusion 3. Increased urination 4. Convulsions 5. Ataxia

Answer 48

1. Persistent GI upset (e.g., nausea, vomiting) 2. Confusion 3. Increased urination

Question 49

The parents of a young client receiving methylphenidate (Ritalin) express concern that the health care provider has suggested the child have a “holiday” from the drug. What is the purpose of a drug-free period? 1. To reduce or eliminate the risk of drug toxicity 2. To allow the child’s “normal” behavior to return 3. To decrease drug dependence and assess the client’s status 4. To prevent the occurrence of a hypertensive crisis

Answer 49

3. To decrease drug dependence and assess the client’s status

Question 50

A 16-year-old client has taken an overdosage of citalopram (Celexa) and is brought to the emergency department. What symptoms would the nurse expect to be present? 1. Seizures, hypertension, tachycardia, extreme anxiety 2. Hypotension, bradycardia, hypothermia, sedation 3. Miosis, respiratory depression, absent bowel sounds, hypoactive reflexes 4. Manic behavior, paranoia, delusions, tremors

Answer 50

1. Seizures, hypertension, tachycardia, extreme anxiety

Question 51

A 77-year-old female client is diagnosed with depression with anxiety and is started on imipramine. Because of this client’s age, the nurse will take precautions for care related to which adverse effects? 1. Dry mouth and photosensitivity 2. Anxiety, headaches, insomnia 3. Drowsiness and sedation 4. Urinary frequency

Answer 51

3. Drowsiness and sedation

Question 52

Which of the following would be a priority component of the teaching plan for a client prescribed phenelzine (Nardil) for treatment of depression? 1. Headaches may occur. OTC medications will usually be effective. 2. Hyperglycemia may occur and any unusual thirst, hunger, or urination should be reported. 3. Read labels of food and over-the-counter drugs to avoid those with substances that should be avoided as directed. 4. Monitor blood pressure for hypotension and report any BP below 90/60.

Answer 52

3. Read labels of food and over-the-counter drugs to avoid those with substances that should be avoided as directed.

Question 53

The nurse determines that the teaching plan for a client prescribed sertraline (Zoloft) has been effective when the client makes which statement? 1. “I should not decrease my sodium or water intake.” 2. “The drug can be taken concurrently with the phenelzine (Nardil) that I’m taking.” 3. “It may take up to a month for the drug to reach full therapeutic effects and I’m feeling better.” 4. “There are no other drugs I need to worry about; Zoloft doesn’t react with them.”

Answer 53

3. “It may take up to a month for the drug to reach full therapeutic effects and I’m feeling better.”

Question 54

The client states that he has not taken his antipsychotic drug for the past 2 weeks because it was causing sexual dysfunction. What is the nurse’s primary concern at this time? 1. A hypertensive crisis may occur with such abrupt withdrawal of the drug. 2. Significant muscle twitching may occur, increasing fall risk. 3. EPS symptoms such as pseudoparkinsonism are likely to occur. 4. Symptoms of psychosis are likely to return.

Answer 54

4. Symptoms of psychosis are likely to return.

Question 55

Prior to discharge, the nurse plans for client teaching related to side effects of phenothiazines to the client, family, or caregiver. Which of the following should be included? 1. The client may experience withdrawal and slowed activity. 2. Severe muscle spasms may occur early in therapy. 3. Tardive dyskinesia is likely early in therapy. 4. Medications should be taken as prescribed to prevent adverse effects.

Answer 55

2. Severe muscle spasms may occur early in therapy.

Question 56

A 20-year-old man is admitted to the psychiatric unit for treatment of acute schizophrenia and is started on risperidone (Risperdal). Which client effects should the nurse assess for to determine whether the drug is having therapeutic effects? 1. Restful sleep, elevated mood, and coping abilities 2. Decreased delusional thinking and lessened auditory/visual hallucinations 3. Orthostatic hypotension, reflex tachycardia, and sedation 4. Relief of anxiety and improved sleep and dietary habits.

Answer 56

2. Decreased delusional thinking and lessened auditory/visual hallucinations

Question 57

Nursing implications of the administration of haloperidol (Haldol) to a client exhibiting psychotic behavior include which of the following? (Select all that apply.) 1. Take 1 hour before or 2 hours after antacids. 2. The incidence of EPS is high. 3. It is therapeutic if ordered on an as-needed (PRN) basis. 4. Haldol is contraindicated in Parkinson’s disease, seizure disorders, alcoholism, and severe mental depression. 5. Crush the sustained-release form for easier swallowing.

Answer 57

1. Take 1 hour before or 2 hours after antacids. 2. The incidence of EPS is high. 3. Haldol is contraindicated in Parkinson’s disease, seizure disorders, alcoholism, and severe mental depression.

Question 58

A client is treated for psychosis with fluphenazine. What drug will the nurse anticipate may be given to prevent the development of acute dystonia? 1. Benztropine (Cogentin) 2. Diazepam (Valium) 3. Haloperidol (Haldol) 4. Lorazepam (Ativan)

Answer 58

1. Benztropine (Cogentin)

Question 59

The nurse should immediately report the development of which of the following symptoms in a client taking antipsychotic medication? 1. Fever, tachycardia, confusion, incontinence 2. Pacing, squirming, or difficulty with gait such as bradykinesia 3. Severe spasms of the muscles of the tongue, face, neck, or back 4. Sexual dysfunction or gynecomastia

Answer 59

1. Fever, tachycardia, confusion, incontinence

Question 60

The client has been prescribed oxymetazoline (Afrin) nasal spray for seasonal rhinitis. The nurse will provide which of the following instructions? 1. Limit use of this spray to 5 days or less. 2. The drug may be sedating so be cautious with activities requiring alertness. 3. This drug should not be used in conjunction with antihistamines. 4. This is an OTC drug and may be used as needed for congestion.

Answer 60

1. Limit use of this spray to 5 days or less.

Question 61

A client has a prescription for fluticasone (Flonase). Place the instructions that follow in the order in which the nurse will instruct the client to use the drug. 1. Instill one spray directed high into the nasal cavity. 2. Clear the nose by blowing. 3. Prime the inhaler prior to first use. 4. Spit out any excess liquid that drains into the mouth

Answer 61

1. Instill one spray directed high into the nasal cavity. THIRD 2. Clear the nose by blowing. SECOND 3. Prime the inhaler prior to first use. FIRST 4. Spit out any excess liquid that drains into the mouth. FOURTH

Question 62

A male, age 67, reports taking diphenhydramine (Benadryl) for “hay fever.” Considering this client’s age, the nurse assesses for which of the following findings? 1. A history of prostate or urinary conditions 2. Any recent weight gain 3. A history of allergic reactions 4. A history of peptic ulcer disease

Answer 62

1. A history of prostate or urinary conditions

Question 63

The nurse is teaching a client about the use of dextromethorphan with guaifenesin (Robitussin-DM) syrup for a cough accompanied by thick mucus. Which instruction should be included in the client’s teaching? 1. “Lie supine for 30 minutes after taking the liquid.” 2. “Drink minimal fluids to avoid stimulating the cough reflex.” 3. “Take the drug with food for best results.” 4. “Avoid drinking fluids immediately after the syrup but increase overall fluid intake throughout the day.”

Answer 63

4. “Avoid drinking fluids immediately after the syrup but increase overall fluid intake throughout the day.”

Question 64

A client has been prescribed fluticasone (Flonase) to use with oxymetazoline (Afrin). How should the client be taught to use these drugs? 1. Use the fluticasone first, then the oxymetazoline after waiting 5 minutes. 2. Use the oxymetazoline first, then the fluticasone after waiting 5 minutes. 3. The drugs may be used in either order. 4. The fluticasone should be used only if the oxymetazoline fails to relieve the nasal congestion.

Answer 64

2. Use the oxymetazoline first, then the fluticasone after waiting 5 minutes.

Question 65

Which of the following is the best advice that the nurse can give a client with viral rhinitis who intends to purchase an OTC combination cold remedy? 1. “Dosages in these remedies provide precise dosing for each symptom that you are experiencing.” 2. “These drugs are best used in conjunction with an antibiotic.” 3. “It is safer to use a single-drug preparation if you are experiencing only one symptom.” 4. “Since these drugs are available over the counter, it is safe to use any of them as long as needed.”

Answer 65

3. “It is safer to use a single-drug preparation if you are experiencing only one symptom.”

Question 66

A client is receiving treatment for asthma with albuterol (Proventil, VoSpire). The nurse teaches the client that while serious adverse effects are uncommon, the following may occur. (Select all that apply.) 1. Tachycardia 2. Sedation 3. Temporary dyspnea 4. Nervousness 5. Headache

Answer 66

1. Tachycardia 2. Nervousness 3. Headache

Question 67

A client with asthma has a prescription for two inhalers, albuterol (Proventil, VoSpire) and beclomethasone (Qvar). How should the nurse instruct this client on the proper use of the inhalers? 1. Use the albuterol inhaler, and use the beclomethasone only if symptoms are not relieved. 2. Use the beclomethasone inhaler, and use the albuterol only if symptoms are not relieved. 3. Use the albuterol inhaler, wait 5–10 minutes, then use the beclomethasone inhaler. 4. Use the beclomethasone inhaler, wait 5–10 minutes, then use the albuterol inhaler.

Answer 67

3. Use the albuterol inhaler, wait 5–10 minutes, then use the beclomethasone inhaler.

Question 68

A client has been using a fluticasone (Flovent) inhaler as a component of his asthma therapy. He returns to his health care provider’s office complaining of a sore mouth. On inspection, the nurse notices white patches in the client’s mouth. What is a possible explanation for these findings? 1. The client has been consuming hot beverages after the use of the inhaler. 2. The client has limited his fluid intake, resulting in dry mouth. 3. The residue of the inhaler propellant is coating the inside of the mouth. 4. The client has developed thrush as a result of the fluticasone.

Answer 68

4. The client has developed thrush as a result of the fluticasone.

Question 69

A 65-year-old client is prescribed ipratropium (Atrovent) for the treatment of asthma. Which of the following conditions should be reported to the health care provider before giving this client the ipratropium? 1. A reported allergy to peanuts 2. A history of intolerance to albuterol (Proventil, VoSpire) 3. A history of bronchospasms 4. A reported allergy to chocolate

Answer 69

1. A reported allergy to peanuts

Question 70

A client who received a prescription for zafirlukast (Accolate) returns to his provider’s office after three days, complaining that “the drug is not working.” She reports mild but continued dyspnea and has had to maintain consistent use of her bronchodilator inhaler, pirbuterol (Maxair). What does the nurse suspect is the cause of the failure of the zafirlukast? 1. The client is not taking the drug correctly. 2. The client is not responding to the drug and will need to be switched to another formulation. 3. The drug has not had sufficient time of use to have full effects. 4. The pirbuterol inhaler is interacting with the zafirlukast.

Answer 70

3. The drug has not had sufficient time of use to have full effects.

Question 71

Which of the following drugs is most immediately helpful in treating a severe acute asthma attack? 1. Beclomethasone (Qvar) 2. Zileuton (Zyflo CR) 3. Albuterol (Proventil, Ventolin) 4. Salmeterol (Serevent)

Answer 71

3. Albuterol (Proventil, Ventolin)