exam 2 questions Flashcards
The nurse is monitoring a patient who is experiencing severe ethanol withdrawal. Which are signs and symptoms of severe ethanol withdrawal (Select all that apply.)
Agitation Drowsiness Tremors Systolic blood pressure higher than 200 mm Hg Temperature over 100° F (37.7° C) Pulse rate 110 beats/min
Agitation
Tremors
Systolic blood pressure higher than 200 mm Hg
Signs and symptoms of severe ethanol withdrawal (delirium tremens) include systolic blood pressure higher than 200 mm Hg, diastolic blood pressure higher than 140 mm Hg, pulse rate higher than 140 beats/min, temperature above 101° F (38.3° C), tremors, insomnia, and agitation. See Box 17-6 for all signs and symptoms of ethanol withdrawal.
The nurse is monitoring drug levels for a patient who is receiving theophylline. The most recent theophylline level was 22 mcg/mL, and the nurse evaluates this level to be:
below the therapeutic level.
at a therapeutic level.
above the therapeutic level.
at a toxic level.
above the therapeutic level.
Although the optimal level may vary from patient to patient, most standard references have suggested that the therapeutic range for theophylline blood level is 10 to 20 mcg/mL. However, most clinicians now advise levels between 5 and 15 mcg/mL.
A patient with end-stage renal failure has been admitted to the hospital for severe anemia. She is refusing blood transfusions. The nurse anticipates drug therapy with which drug to stimulate the production of red blood cells
Folic acid
Cyanocobalamin (vitamin B12)
Epoetin alfa (Epogen)
Filgrastim (Neupogen)
Epoetin alfa (Epogen)
Epoetin alfa is a colony-stimulating factor that is responsible for erythropoiesis, or formation of red blood cells. The other options are incorrect.
A patient tells the nurse that she wants to start taking the herbal product goldenseal to improve her health. The nurse will assess for which potential cautions or contraindications to goldenseal (Select all that apply.)
Taking a proton-pump inhibitor Nasal congestion Hypothyroidism Hypertension Sinus infections Pregnancy
Taking a proton-pump inhibitor
Hypertension
Pregnancy
Goldenseal is contraindicated in patients with acute or chronic gastrointestinal disorders and during pregnancy (because it has uterine stimulant properties). It should be used with caution by those with cardiovascular disorders. Potential drug interactions may occur with gastric acid suppressors such as antacids, histamine H2 blockers (e.g., ranitidine), and proton pump inhibitors (e.g., omeprazole), theoretically because of their reduced effectiveness resulting from the acid-promoting effect of the herb, and with antihypertensive drugs (because of the vasoconstrictive activity of the herb). Goldenseal is potentially useful for sinus infections and chronic nasal allergies.
When educating a patient recently placed on inhaled corticosteroids, the nurse will discuss which potential adverse effects
Fatigue and depression
Anxiety and palpitations
Headache and rapid heart rate
Oral candidiasis and dry mouth
Oral candidiasis and dry mouth
Oral candidiasis and dry mouth are two possible adverse effects of inhaled corticosteroids. The other responses are incorrect.
The nurse is teaching a patient with iron-deficiency anemia about foods to increase iron intake. Which food may enhance the absorption of oral iron forms
Milk Yogurt Antacids Orange juice .
Orange juice
Orange juice contains ascorbic acid, which enhances the absorption of oral iron forms; antacids, milk, and yogurt may interfere with absorption
A patient has received an overdose of intravenous heparin, and is showing signs of excessive bleeding. Which substance is the antidote for heparin overdose
Vitamin E
Vitamin K
Protamine sulfate
Potassium chloride
Protamine sulfate
Protamine sulfate is a specific heparin antidote and forms a complex with heparin, completely reversing its anticoagulant properties. Vitamin K is the antidote for warfarin (Coumadin) overdose. The other options are incorrect.
A patient has been taking an AED for several years as part of his treatment for partial seizures. His wife has called because he ran out of medication this morning and wonders if he can go without it for a week until she has a chance to go to the drugstore. What is the nurse’s best response
“He is taking another antiepileptic drug, so he can go without the medication for a week.”
“Stopping this medication abruptly may cause withdrawal seizures. A refill is needed right away.”
“He can temporarily increase the dosage of his other antiseizure medications until you get the refill.”
“He can stop all medications because he has been treated for several years now.”
Stopping this medication abruptly may cause withdrawal seizures. A refill is needed right away.”
Abrupt discontinuation of antiepileptic drugs can lead to withdrawal seizures. The other options are incorrect. The nurse cannot change the dose or stop the medication without a prescriber’s order.
A patient has been taking phenobarbital for 2 weeks as part of his therapy for epilepsy. He tells the nurse that he feels tense and that “the least little thing” bothers him now. Which is the correct explanation for this problem
These are adverse effects that usually subside after a few weeks.
The drug must be stopped immediately because of possible adverse effects.
This drug causes the rapid eye movement (REM) sleep period to increase, resulting in nightmares and restlessness.
This drug causes deprivation of REM sleep and may cause the inability to deal with normal stress.
This drug causes deprivation of REM sleep and may cause the inability to deal with normal stress.
Barbiturates such as phenobarbital deprive people of REM sleep, which can result in agitation and the inability to deal with normal stress. A rebound phenomenon occurs when the drug is stopped (not during therapy), and the proportion of REM sleep increases, sometimes resulting in nightmares. The other options are incorrect.
The nurse has given medication instructions to a patient receiving phenytoin (Dilantin). Which statement by the patient indicates that the patient has an adequate understanding of the instructions
“I will need to take extra care of my teeth and gums while on this medication.”
“I can go out for a beer while on this medication.”
“I can skip doses if the side effects bother me.”
“I will be able to stop taking this drug once the seizures stop.”
“I will need to take extra care of my teeth and gums while on this medication.”
Scrupulous dental care is necessary to prevent gingival hypertrophy during therapy with phenytoin. Alcohol and other central nervous system depressants may cause severe sedation. Consistent dosing is important to maintain therapeutic drug levels. Therapy with AEDs usually must continue for life and must not be stopped once seizures stop.
A patient is taking intravenous aminophylline for a severe exacerbation of chronic obstructive pulmonary disease. The nurse will assess for which therapeutic response
Increased sputum production
Increased heart rate
Increased respiratory rate
Increased ease of breathing
Increased ease of breathing
The therapeutic effects of bronchodilating drugs such as xanthine derivatives include increased ease of breathing. The other responses are incorrect.
The nurse notes in a patient’s medication history that the patient is taking allopurinol (Zyloprim). Based on this finding, the nurse interprets that the patient has which disorder
Rheumatoid arthritis
Gout
Osteoarthritis
Systemic lupus erythematosus
Gout
Allopurinol is indicated for the treatment of gout but is not indicated for the other disorders listed.
A patient has a 9-year history of a seizure disorder that has been managed well with oral phenytoin (Dilantin) therapy. He is to be NPO (consume nothing by mouth) for surgery in the morning. What will the nurse do about his morning dose of phenytoin
Give the same dose intravenously.
Give the morning dose with a small sip of water.
Contact the prescriber for another dosage form of the medication.
Notify the operating room that the medication has been withheld.
Contact the prescriber for another dosage form of the medication.
If there are any questions about the medication order or the medication prescribed, contact the prescriber immediately for clarification and for an order of the appropriate dose form of the medication. Do not change the route without the prescriber’s order. There is an increased risk of seizure activity if one or more doses of the AED are missed.
A patient has experienced insomnia for months, and the physician has prescribed a medication to help with this problem. The nurse expects which drug to be used for long-term treatment of insomnia
Secobarbital (Seconal), a barbiturate
Diazepam (Valium), a benzodiazepine
Midazolam (Versed), a benzodiazepine
Eszopiclone (Lunesta), a nonbenzodiazepine sleep aid
Eszopiclone (Lunesta), a nonbenzodiazepine sleep aid
Eszopiclone (Lunesta) is one of the newest prescription hypnotics to be approved for long-term use in treatment of insomnia. Barbiturates and benzodiazepines are not appropriate for long-term treatment of insomnia; midazolam is used for procedural (moderate) sedation.
When giving dextromethorphan, the nurse understands that this drug suppresses the cough reflex by which mechanism of action
Causing depression of the central nervous system
Anesthetizing the stretch receptors
Having direct action on the cough center
Decreasing the viscosity of the bronchial secretions
Having direct action on the cough center
Dextromethorphan suppresses the cough reflex through a direct action on the cough center. The other options are incorrect.
The nurse notes in the patient’s medication orders that the patient will be starting anticoagulant therapy. What is the primary goal of anticoagulant therapy
Stabilizing an existing thrombus
Dissolving an existing thrombus
Preventing thrombus formation
Dilating the vessel around a clot
Preventing thrombus formation
Anticoagulants prevent thrombus formation but do not dissolve or stabilize an existing thrombus, nor do they dilate vessels around a clot.
A patient taking entacapone (Comtan) for the first time calls the clinic to report a dark discoloration of his urine. After listening to the patient, the nurse realizes that what is happening in this situation
This is a harmless effect of the drug
.
The patient has taken this drug along with red wine or cheese.
The patient is having an allergic reaction to the drug.
The ordered dose is too high for this patient.
This is a harmless effect of the drug
.
COMT inhibitors, including entacapone, may darken a patient’s urine and sweat.
The nurse is reviewing new medication orders for a patient who has an epidural catheter for pain relief. One of the orders is for enoxaparin (Lovenox), a low–molecular-weight heparin (LMWH). What is the nurse’s priority action
Give the LMWH as ordered.
Double-check the LMWH order with another nurse, and then administer as ordered.
Stop the epidural pain medication, and then administer the LMWH.
Contact the prescriber because the LMWH cannot be given if the patient has an epidural catheter.
Contact the prescriber because the LMWH cannot be given if the patient has an epidural catheter
LMWHs are contraindicated in patients with an indwelling epidural catheter; they can be given 2 hours after the epidural is removed. This is very important to remember, because giving an LMWH with an epidural has been associated with epidural hematoma.
The nurse is reviewing herbal therapies. Which is a common use of the herb feverfew
Muscle aches
Migraine headaches
Leg cramps
Incision pain after surgery
Migraine headaches
Feverfew is commonly used for migraine headaches, menstrual problems, arthritis, and fever. Possible adverse effects include muscle stiffness and muscle and joint pain.
While monitoring a depressed patient who has just started SSRI antidepressant therapy, the nurse will observe for which problem during the early time frame of this therapy
Hypertensive crisis
Self-injury or suicidal tendencies
Extrapyramidal symptoms
Loss of appetite
Self-injury or suicidal tendencies
In 2005, the U.S. Food and Drug Administration (FDA) issued special black-box warnings regarding the use of all classes of antidepressants in both adult and pediatric patient populations. Data from the FDA indicated a higher risk for suicide in patients receiving these medications. As a result, current recommendations for all patients receiving antidepressants include regular monitoring for signs of worsening depressive symptoms, especially when the medication is started or the dosage is changed. The other options are incorrect.
A patient was diagnosed with pancreatic cancer last month, and has complained of a dull ache in the abdomen for the past 4 months. This pain has been gradually increasing, and the pain relievers taken at home are no longer effective. What type of pain is the patient experiencing
Acute pain
Chronic pain
Somatic pain
Neuropathic pain
Chronic pain
Chronic pain is associated with cancer and is characterized by slow onset, long duration, and dull, persistent aching. The patient’s symptoms are not characteristics of acute pain, somatic pain, or neuropathic pain.
A patient is taking flurazepam (Dalmane) three to four nights a week for sleeplessness. She is concerned that she cannot get to sleep without taking the medication. What nonpharmacologic measures should the nurse suggest to promote sleep for this patient
Providing a quiet environment
Exercising before bedtime to become tired
Consuming heavy meals in the evening to promote sleepiness
Drinking hot tea or coffee just before bedtime
Providing a quiet environment
Nonpharmacologic approaches to induce sleep include providing a quiet environment, avoiding heavy exercise before bedtime, avoiding heavy meals late in the evening, and drinking warm decaffeinated drinks, such as warm milk, before bedtime.
A 38-year-old male patient stopped smoking 6 months ago. He tells the nurse that he still feels strong cigarette cravings and wonders if he is ever going to feel “normal” again. Which statement by the nurse is correct
“It’s possible that these cravings will never stop.”
“These cravings may persist for several months.”
“The cravings tell us that you are still using nicotine.”
“The cravings show that you are about to experience nicotine withdrawal.”
These cravings may persist for several months.”
Cigarette cravings may persist for months after nicotine withdrawal. The other statements are false.
Carbidopa-levodopa (Sinemet) is prescribed for a patient with Parkinson’s disease. The nurse informs the patient that which common adverse effects can occur with this medication
Drowsiness, headache, weight loss
Dizziness, insomnia, nausea
Peripheral edema, fatigue, syncope
Heart palpitations, hypotension, urinary retention
Heart palpitations, hypotension, urinary retention
Common adverse reactions associated with carbidopa-levodopa include palpitations, hypotension, urinary retention, dyskinesia, and depression. The other effects may occur with other antiparkinson drugs.
A patient who started taking orlistat (Xenical) 1 month ago calls the clinic to report some “embarrassing” adverse effects. She tells the nurse that she has had episodes of “not being able to control my bowel movements.” Which statement is true about this situation
These are expected adverse effects that will eventually diminish.
The patient will need to stop this drug immediately if these adverse effects are occurring.
The patient will need to increase her fat intake to prevent these adverse effects.
The patient will need to restrict fat intake to less than 30% to help reduce these adverse effects.
The patient will need to restrict fat intake to less than 30% to help reduce these adverse effects.
Restricting dietary intake of fat to less than 30% of total calories can help reduce some of the GI adverse effects, which include oily spotting, flatulence, and fecal incontinence. The other options are incorrect.
A patient in a rehabilitation center is beginning to experience opioid withdrawal symptoms. The nurse expects to administer which drug as part of the treatment
Diazepam (Valium)
Methadone
Disulfiram (Antabuse)
Bupropion (Zyban)
Methadone
Opioid withdrawal can be managed with either methadone or clonidine (Catapres). Diazepam and disulfiram are used for treatment of alcoholism, and bupropion is used to assist with smoking cessation.
The nurse is preparing to administer a barbiturate. Which conditions or disorders would be a contraindication to the use of these drugs (Select all that apply.)
Gout Pregnancy Epilepsy Severe chronic obstructive pulmonary disease Severe liver disease Diabetes mellitus
Pregnancy
Severe chronic obstructive pulmonary disease
Severe liver disease
Contraindications to barbiturates include pregnancy, significant respiratory difficulties, and severe liver disease. The other disorders are not contraindications.
The barbiturate phenobarbital is prescribed for a patient with epilepsy. While assessing the patient’s current medications, the nurse recognizes that interactions may occur with which drugs (Select all that apply.)
Antihistamines Opioids Diuretics Anticoagulants Oral contraceptives Insulin
Antihistamines
Opioids
Anticoagulants
Oral contraceptives
The co-administration of barbiturates and alcohol, antihistamines, benzodiazepines, opioids, and tranquilizers may result in additive CNS depression. Co-administration of anticoagulants and barbiturates can result in decreased anticoagulation response and possible clot formation. Co-administration of barbiturates and oral contraceptives can result in accelerated metabolism of the contraceptive drug and possible unintended pregnancy. There are no interactions with diuretics and insulin.
A patient is taking guaifenesin (Humibid) as part of treatment for a sinus infection. Which instruction will the nurse include during patient teaching
Force fluids to help loosen and liquefy secretions.
Report clear-colored sputum to the prescriber.
Avoid driving a car or operating heavy machinery because of the sedating effects.
Report symptoms that last longer than 2 days.
Force fluids to help loosen and liquefy secretions
Forcing fluids helps to loosen and liquefy secretions. The patient must be fully aware that any fever, chest tightness, change in sputum from clear to colored, difficult or noisy breathing, activity intolerance, or weakness needs to be reported. The patient must also report to the prescriber a fever of higher than 100.4° F (38° C) or symptoms that last longer than 3 to 4 days. Decongestants do not cause sedation, and therefore the patient does not need to avoid driving a car or operating heavy machinery.
The nurse is administering intravenous iron dextran for the first time to a patient with anemia. After giving a test dose, how long will the nurse wait before administering the remaining portion of the dose
30 minutes
1 hour
6 hours
24 hours
1 hour
Although anaphylactic reactions usually occur within a few moments after the test dose, it is recommended that a period of at least 1 hour elapse before the remaining portion of the initial dose is given. The other options are incorrect.
The nurse is teaching a patient who is taking colchicine for the treatment of gout. Which instruction will the nurse include during the teaching session
“Fluids should be restricted while on colchicine therapy.”
“Take colchicine with meals.”
“The drug will be discontinued when symptoms are reduced.”
“Call your doctor if you have increased pain or blood in the urine.”
“Call your doctor if you have increased pain or blood in the urine.”
Colchicine may cause renal effects; therefore, these symptoms must be reported immediately. The drug is taken on an empty stomach for better absorption, and fluids should be increased unless contraindicated. Successful treatment depends upon continuing the medication as ordered.
A nurse is giving instructions to a patient who will be receiving oral iron supplements. Which instructions will be included in the teaching plan
Take the iron tablets with milk or antacids.
Crush the pills as needed to help with swallowing.
Take the iron tablets with meals if gastrointestinal distress occurs.
If black tarry stools occur, report it to the doctor immediately.
Take the iron tablets with meals if gastrointestinal distress occurs.
Although taking iron tablets with food may decrease absorption, doing so helps to reduce gastrointestinal distress. Antacids and milk may cause decreased iron absorption; iron tablets must be taken whole and not crushed. Black, tarry stools are expected adverse effects of oral iron supplements.
A patient has been taking the monoamine oxidase inhibitor (MAOI) phenelzine (Nardil) for 6 months. The patient wants to go to a party and asks the nurse, “Will just one beer be a problem” Which advice from the nurse is correct
“You can drink beer as long as you have a designated driver.”
“Now that you’ve had the last dose of that medication, there will be no further dietary restrictions.”
“If you begin to experience a throbbing headache, rapid pulse, or nausea, you’ll need to stop drinking.”
“You need to avoid all foods that contain tyramine, including beer, while taking this medication.”
“You need to avoid all foods that contain tyramine, including beer, while taking this medication.”
Foods containing tyramine, such as beer and aged cheeses, should be avoided while a patient is taking an MAOI. Drinking beer while taking an MAOI may precipitate a dangerous hypertensive crisis. The other options are incorrect.
The nurse is teaching a patient how to self-administer triptan injections for migraine headaches. Which statement by the patient indicates that he needs further teaching
“I will take this medication regularly to prevent a migraine headache from occurring.”
“I will take this medication when I feel a migraine headache starting.”
“This medication does not reduce the number of migraines I will have.”
“I will keep a journal to record the headaches I have and how the injections are working.”
“I will take this medication regularly to prevent a migraine headache from occurring.”
Although they may be taken during aura symptoms by patients who have auras with their headaches, these drugs are not indicated for preventive migraine therapy. The medication is intended to relieve the migraine and not to prevent it or to reduce the number of attacks. The triptans do not reduce the number of migraines a person will have. Journal recordings of headaches and the patient’s responses to the medication are helpful.
A patient calls the clinic to ask about taking a glucosamine-chondroitin supplement for arthritis. The nurse reviews the medication history and notes that there will be a concern for drug interactions if the patient is also taking medications for which disorder
Type 2 diabetes mellitus
Hypothyroidism
Hypertension
Angina
Type 2 diabetes mellitus
The glucosamine in glucosamine-chondroitin supplements may cause an increase in insulin resistance, necessitating the need for higher doses of oral hypoglycemics or insulin.
After receiving a nebulizer treatment with a beta agonist, the patient complains of feeling slightly nervous and wonders if her asthma is getting worse. What is the nurse’s best response
“This is an expected adverse effect. Let me take your pulse.”
“The next scheduled nebulizer treatment will be skipped.”
“I will notify the physician about this adverse effect.”
“We will hold the treatment for 24 hours.”
“This is an expected adverse effect. Let me take your pulse.”
Nervousness, tremors, and cardiac stimulation are possible and expected adverse effects of beta agonists. The other options are incorrect responses.
The nurse will teach a patient who is receiving oral iron supplements to watch for which expected adverse effects
Palpitations
Drowsiness and dizziness
Black, tarry stools
Orange-red discoloration of the urine
Black, tarry stools
Black, tarry stools and other gastrointestinal disturbances may occur with the administration of iron preparations. The other options are incorrect.
A patient has been treated with antiparkinson medications for 3 months. What therapeutic responses should the nurse look for when assessing this patient
Decreased appetite
Gradual development of cogwheel rigidity
Newly developed dyskinesias
Improved ability to perform activities of daily living
Improved ability to perform activities of daily living
Therapeutic responses to antiparkinson agents include an improved sense of well-being, improved mental status, increased appetite, increased ability to perform activities of daily living and to concentrate and think clearly, and less intense parkinsonian manifestations.
The nurse is reviewing medications used for depression. Which of these statements is a reason that selective serotonin reuptake inhibitors (SSRIs) are more widely prescribed today than tricyclic antidepressants
SSRIs have fewer sexual side effects.
Unlike tricyclic antidepressants, SSRIs do not have drug-food interactions.
Tricyclic antidepressants cause serious cardiac dysrhythmias if an overdose occurs.
SSRIs cause a therapeutic response faster than tricyclic antidepressants.
Tricyclic antidepressants cause serious cardiac dysrhythmias if an overdose occurs.
Death from overdose of tricyclic antidepressants usually results from either seizures or dysrhythmias. SSRIs are associated with significantly fewer and less severe systemic adverse effects, especially anticholinergic and cardiovascular adverse effects. The other options are incorrect.
The nurse notes in the patient’s medication history that the patient is taking cyclobenzaprine (Flexeril). Based on this finding, the nurse interprets that the patient has which disorder
A musculoskeletal injury
Insomnia
Epilepsy
Agitation
A musculoskeletal injury
Cyclobenzaprine (Flexeril) is the muscle relaxant most commonly used to reduce spasms following musculoskeletal injuries. It is not appropriate for insomnia, epilepsy, or agitation.
A patient has been taking haloperidol (Haldol) for 3 months for a psychotic disorder, and the nurse is concerned about the development of extrapyramidal symptoms. The nurse will monitor the patient closely for which effects
Increased paranoia
Drowsiness and dizziness
Tremors and muscle twitching
Dry mouth and constipation
Tremors and muscle twitching
Extrapyramidal symptoms are manifested by tremors and muscle twitching, and the incidence of such symptoms is high during haloperidol therapy. The other options are incorrect.
The nurse is conducting a smoking-cessation program. Which statement regarding drugs used in cigarette-smoking–cessation programs is true
Rapid chewing of the nicotine gum releases an immediate dose of nicotine.
Quick relief from withdrawal symptoms is most easily achieved by using a transdermal patch.
Compliance with treatment is higher with use of the gum rather than the transdermal patch.
The nicotine gum can be used only up to six times per day.
Rapid chewing of the nicotine gum releases an immediate dose of nicotine.
Quick or acute relief from withdrawal symptoms is most easily achieved with the use of the gum because rapid chewing of the gum produces an immediate dose of nicotine. However, treatment compliance is higher with the use of the transdermal patch system. Nicotine gum can be used whenever the patient has a strong urge to smoke.
The nurse is reviewing the food choices of a patient who is taking a monoamine oxidase inhibitor ( MAOI). Which food choice would indicate the need for additional teaching
Orange juice
Fried eggs over-easy
Salami and Swiss cheese sandwich
Biscuits and honey
Salami and Swiss cheese sandwich
Aged cheeses, such a Swiss or cheddar cheese, and Salami contain tyramine. Patients who are taking MAOIs need to avoid tyramine-containing foods because of a severe hypertensive reaction that may occur. Orange juice, eggs, biscuits, and honey do not contain tyramine.
Vicodin (acetaminophen/hydrocodone) is prescribed for a patient who has had surgery. The nurse informs the patient that which common adverse effects can occur with this medication (Select all that apply.)
Diarrhea Constipation Lightheadedness Nervousness Urinary retention Itching
Constipation
Lightheadedness
Urinary retention
Itching
Constipation (not diarrhea), lightheadedness (not nervousness), urinary retention, and itching are some of the common adverse effects that the patient may experience while taking Vicodin.
A patient who has a history of coronary artery disease has been instructed to take one 81-mg aspirin tablet a day. The patient asks about the purpose of this aspirin. Which response by the nurse is correct
“Aspirin is given reduce anxiety.”
“It helps to reduce inflammation.”
“Aspirin is given to relieve pain.”
“It will help to prevent clot formation.”
“It will help to prevent clot formation.”
Aspirin can reduce platelet aggregation; low doses of aspirin (81 to 325 mg once daily) are used for thromboprevention. Higher doses are required for pain relief, reduction of inflammation, and reduction of fever. The other options are incorrect.
A 6-year-old child who has chickenpox also has a fever of 102.9° F (39.4° C). The child’s mother asks the nurse if she should use aspirin to reduce the fever. What is the best response by the nurse
“It’s best to wait to see if the fever gets worse.”
“You can use the aspirin, but watch for worsening symptoms.”
“Acetaminophen (Tylenol) should be used to reduce his fever, not aspirin.”
“You can use aspirin, but be sure to follow the instructions on the bottle.”
“Acetaminophen (Tylenol) should be used to reduce his fever, not aspirin.”
Aspirin is contraindicated in children with flu-like symptoms because the use of this drug has been strongly associated with Reye’s syndrome. This is an acute and potentially life-threatening condition involving progressive neurologic deficits that can lead to coma and may also involve liver damage. Acetaminophen is appropriate for this patient. The other responses are incorrect.
A patient will be discharged with a 1-week supply of an opioid analgesic for pain management after abdominal surgery. The nurse will include which information in the teaching plan
How to prevent dehydration due to diarrhea
The importance of taking the drug only when the pain becomes severe
How to prevent constipation
The importance of taking the drug on an empty stomach
How to prevent constipation
Gastrointestinal (GI) adverse effects, such as nausea, vomiting, and constipation, are the most common adverse effects associated with opioid analgesics. Physical dependence usually occurs in patients undergoing long-term treatment. Diarrhea is not an effect of opioid analgesics. Taking the dose with food may help minimize GI upset.
A mother brings her toddler into the emergency department and tells the nurse that she thinks the toddler has eaten an entire bottle of chewable aspirin tablets. The nurse will assess for which most common signs of salicylate intoxication in children
Photosensitivity and nervousness
Tinnitus and hearing loss
Acute gastrointestinal bleeding
Hyperventilation and drowsiness
Hyperventilation and drowsiness
The most common manifestations of chronic salicylate intoxication in adults are tinnitus and hearing loss. Those in children are hyperventilation and CNS effects, such as dizziness, drowsiness, and behavioral changes.
An 18-year-old basketball player fell and twisted his ankle during a game. The nurse will expect to administer which type of analgesic
Synthetic opioid, such as meperidine (Demerol)
Opium alkaloid, such as morphine sulfate
Opioid antagonist, such as naloxone HCL (Narcan)
Nonopioid analgesic, such as indomethacin (Indocin)
Nonopioid analgesic, such as indomethacin (Indocin)
Somatic pain, which originates from skeletal muscles, ligaments, and joints, usually responds to nonopioid analgesics such as nonsteroidal anti-inflammatory drugs (NSAIDs). The other options are not the best choices for somatic pain.
The wife of a patient who has been diagnosed with depression calls the office and says, “It’s been an entire week since he started that new medicine for his depression, and there’s no change! What’s wrong with him” What is the nurse’s best response
“The medication may not be effective for him. He may need to try another type.”
“It may take up to 6 weeks to notice any therapeutic effects. Let’s wait a little longer to see how he does.”
“It sounds like the dose is not high enough. I’ll check about increasing the dosage.”
“Some patients never recover from depression. He may not respond to this therapy.”
.
“It may take up to 6 weeks to notice any therapeutic effects. Let’s wait a little longer to see how he does.”
Patients and family members need to be told that antidepressant drugs commonly require several weeks before full therapeutic effects are noted. The other answers are incorrect
A 50-year-old man who has been taking phenobarbital for 1 week is found very lethargic and unable to walk after eating out for dinner. His wife states that he has no other prescriptions and that he did not take an overdose—the correct number of pills is in the bottle. The nurse suspects that which of these may have happened
He took a multivitamin.
He drank a glass of wine.
He took a dose of aspirin.
He developed an allergy to the drug.
He drank a glass of wine.
Alcohol has an additive effect when combined with barbiturates and causes central nervous system (CNS) depression. Multivitamins and aspirin do not interact with barbiturates, and this situation does not illustrate an allergic reaction.
A 38-year-old man has come into the urgent care center with severe hip pain after falling from a ladder at work. He says he has taken several pain pills over the past few hours but cannot remember how many he has taken. He hands the nurse an empty bottle of acetaminophen (Tylenol). The nurse is aware that the most serious toxic effect of acute acetaminophen overdose is which condition
Tachycardia
Central nervous system depression
Hepatic necrosis
Nephropathy
Hepatic necrosis
Hepatic necrosis is the most serious acute toxic effect of an acute overdose of acetaminophen. The other options are incorrect.
The drug nalbuphine (Nubain) is an agonist-antagonist (partial agonist). The nurse understands that which is a characteristic of partial agonists
They have anti-inflammatory effects.
They are given to reverse the effects of opiates.
They have a higher potency than agonists.
They have a lower dependency potential than agonists.
They have a lower dependency potential than agonists.
Partial agonists such as nalbuphine are similar to the opioid agonists in terms of their therapeutic indications; however, they have a lower risk of misuse and addiction. They do not have anti-inflammatory effects, nor are they given to reverse the effects of opiates. They do not have a higher potency than agonists.
During a routine checkup, a patient states that she is unable to take the prescribed antihistamine because of one of its most common adverse effects. The nurse suspects that which adverse effect has been bothering this patient
Constipation
Abdominal cramps
Drowsiness
Decreased libido
Drowsiness
Drowsiness is usually the chief complaint of people who take antihistamines.
Chlorpromazine (Thorazine) is prescribed for a patient, and the nurse provides instructions to the patient about the medication. The nurse includes which information
The patient needs to avoid caffeine while on this drug.
The patient needs to wear sunscreen while outside because of photosensitivity.
Long-term therapy may result in nervousness and excitability.
The medication may be taken with an antacid to reduce gastrointestinal upset.
The patient needs to wear sunscreen while outside because of photosensitivity.
Sun exposure and tanning booths need to be avoided with conventional antipsychotics because of the adverse effect of photosensitivity. Instruct the patient to apply sunscreen liberally and to wear sun-protective clothing and hats.
A patient has used enteric aspirin for several years as treatment for osteoarthritis. However, the symptoms are now worse and she is given a prescription for a nonsteroidal anti-inflammatory drug and misoprostol (Cytotec). The patient asks the nurse, “Why am I now taking two pills for arthritis” What is the nurse’s best response
“Cytotec will also reduce the symptoms of your arthritis.”
“Cytotec helps the action of the NSAID so that it will work better.”
“Cytotec reduces the mucous secretions in the stomach, which reduces gastric irritation.”
“Cytotec may help to prevent gastric ulcers that may occur in patients taking NSAIDs.”
Cytotec may help to prevent gastric ulcers that may occur in patients taking NSAIDs.”
Cytotec inhibits gastric acid secretions and stimulates mucous secretions; it has proved successful in preventing the gastric ulcers that may occur in patients taking NSAIDs.
A patient has been taking iron supplements for anemia for 2 months. During a follow-up assessment, the nurse will observe for which therapeutic response
Decreased weight
Increased activity tolerance
Decreased palpitations
Increased appetite
Increased activity tolerance
Absence of fatigue, increased activity tolerance and well-being, and improved nutrition status are therapeutic responses to iron supplementation. The other options are incorrect.
The nurse is reviewing the therapeutic effects of nonsteroidal anti-inflammatory drugs (NSAIDs), which include which effect
Anxiolytic
Sedative
Antipyretic
Antimicrobial
Antipyretic
NSAIDs have antipyretic effects but not the other effects listed.
A 10-year-old patient will be started on methylphenidate hydrochloride (Ritalin) therapy. The nurse will perform which essential baseline assessment before this drug is started
Eye examination
Height and weight
Liver function studies
Hearing test
Height and weight
Assessment of baseline height and weight is important before beginning Ritalin therapy because it may cause a temporary slowing of growth in prepubertal children. The other studies are not as essential at this time.
A 29-year-old male patient is admitted to the intensive care unit with the following symptoms: restlessness, hyperactive reflexes, talkativeness, confusion and periods of panic and euphoria, tachycardia, and fever. The nurse suspects that he may be experiencing the effects of taking which substance
Opioids
Alcohol
Stimulants
Depressants
Stimulants
The adverse effects listed may occur with use of stimulants and are commonly an extension of their therapeutic effects. Opioids, alcohol, and depressants do not have these effects.
A patient is receiving thrombolytic therapy, and the nurse monitors the patient for adverse effects. What is the most common undesirable effect of thrombolytic therapy
Dysrhythmias
Nausea and vomiting
Anaphylactic reactions
Internal and superficial bleeding
Internal and superficial bleeding
Bleeding, both internal and superficial, as well as intracranial, is the most common undesirable effect of thrombolytic therapy. The other options list possible adverse effects of thrombolytic drugs, but they are not the most common effects.
A patient is taking gabapentin (Neurontin), and the nurse notes that there is no history of seizures on his medical record. What is the best possible rationale for this medication order
The medication is used for the treatment of neuropathic pain.
The medication is helpful for the treatment of multiple sclerosis.
The medication is used to reduce the symptoms of Parkinson’s disease.
The medical record is missing the correct information about the patient’s history of seizures.
The medication is used for the treatment of neuropathic pain
Gabapentin (Neurontin) is commonly used to treat neuropathic pain. The other options are incorrect.
