Exam 4: M10-12

Question 1

The tricyclic antidepressants should be prescribed cautiously in patients with:
1. Eczema
2. Asthma
3. Diabetes
4. Heart disease

Answer 1

4. Heart disease

Question 2

Jamison has been prescribed citalopram (Celexa) to treat his depression. Education regardinghow quickly selective serotonin reuptake inhibitor (SSRI) antidepressants work would be:
1.Appetite and concentration improve in the first 1 to 2 weeks.
2.Sleep should improve almost immediately upon starting citalopram.
3.Full response to the SSRI may take 2 to 4 months after he reaches the fulltherapeutic dose.
4.His dysphoric mood will improve in 1 to 2 weeks.

Answer 2

1.Appetite and concentration improve in the first 1 to 2 weeks.

Question 3

Why is the consistency of taking paroxetine (Paxil) and never running out of medication more important than with most other selective serotonin reuptake inhibitors (SSRIs)?
1. It has a shorter half-life and withdrawal syndrome has a faster onset without taper.
2. It has the longest half-life and the withdrawal syndrome has a faster onset.
3. It is quasi-addictive in the dopaminergic reward system.
4. It is the most activating of SSRI medications and will cause the person to have
sudden deep sadness.

Answer 3

1. It has a shorter half-life and withdrawal syndrome has a faster onset without taper.

Question 4

Suzanne is started on paroxetine (Paxil), a selective serotonin reuptake inhibitor (SSRI), for depression. Education regarding her antidepressant includes:
1. SSRIs may take 2 to 6 weeks before she will have maximum drug effects.
2. Red-green color blindness may occur and should be reported.
3. If she experiences dry mouth or heart rates greater than 80, she should stop taking the drug immediately.
4. She should eat lots of food high in fiber to prevent constipation.

Answer 4

1. SSRIs may take 2 to 6 weeks before she will have maximum drug effects.

Question 5

A patient with anxiety and depression may respond to:
1. Duloxetine (Cymbalta)
2. Fluoxetine (Prozac)
3. Oxazepam (Serax)
4. Buspirone (Buspar) and an SSRI combined

Answer 5

4. Buspirone (Buspar) and an SSRI combined

Question 6

Jaycee has been on escitalopram (Lexapro) for a year and is willing to try tapering off of the selective serotonin reuptake inhibitor. What is the initial dosage adjustment when starting a taper off antidepressants?
1. Change dose to every other day dosing for a week
2. Reduce dose by 50% for 3 to 4 days
3. Reduce dose by 50% every other day
4. Escitalopram (Lexapro) can be stopped abruptly due to its long half-life

Answer 6

2. Reduce dose by 50% for 3 to 4 days

Question 7

An appropriate first-line drug for the treatment of depression with fatigue and low energy would be:
1. Venlafaxine (Effexor)
2. Escitalopram (Lexapro)
3. Buspirone (Buspar)
4. Amitriptyline (Elavil)

Answer 7

1. Venlafaxine (Effexor)

Question 8

The laboratory monitoring required when a patient is on a selective serotonin reuptake inhibitor is:
1. Complete blood count every 3 to 4 months
2. Therapeutic blood levels every 6 months after a steady state is achieved
3. Blood glucose every 3 to 4 months
4. There is no laboratory monitoring required

Answer 8

4. There is no laboratory monitoring required

Question 9

Patients who are prescribed olanzapine (Zyprexa) should be monitored for:
1. Insomnia
2. Weight gain
3. Hypertension
4. Galactorrhea

Answer 9

1. Insomnia

Question 10

A 19-year-old male was started on risperidone. Monitoring for risperidone includes observing for common side effects, including:
1. Bradykinesia, akathisia, and agitation
2. Excessive weight gain
3. Hypertension
4. Potentially fatal agranulocytosis

Answer 10

1. Bradykinesia, akathisia, and agitation

Question 11

Cecilia presents with depression associated with complaints of fatigue, sleeping all the time, and lack of motivation. An appropriate initial antidepressant for her would be:
1. Fluoxetine (Prozac)
2. Paroxetine (Paxil)
3. Amitriptyline (Elavil)
4. Duloxetine (Cymbalta)

Answer 11

4. Duloxetine (Cymbalta)

Question 12

Common mistakes practitioners make in treating anxiety disorders include:
1.Switching medications after an 8- to 12-week trial
2.Maximizing dosing of antianxiety medications
3.Encouraging exercise and relaxation therapy before starting medication
4.Thinking a partial response to medication is acceptable

Answer 12

4.Thinking a partial response to medication is acceptable

Question 13

An appropriate first-line drug to try for mild to moderate generalized anxiety disorder would be:
1.Alprazolam (Xanax)
2.Diazepam (Valium)
3.Buspirone (Buspar)
4.Amitriptyline (Elavil)

Answer 13

3.Buspirone (Buspar)

Question 14

If interventions to resolve the cause of pain (e.g., rest, ice, compression, and elevation) are insufficient, pain medications are given based on the severity of pain. Drugs are given in which order of use?
1. NSAIDs, opiates, corticosteroids
2. Low-dose opiates, salicylates, increased dose of opiates
3. Opiates, non-opiates, increased dose of non-opiate
4. Non-opiate, increased dose of non-opiate, opiate

Answer 14

4. Non-opiate, increased dose of non-opiate, opiate

Question 15

Patients need to be questioned about all pain sites because:
1.Patients tend to report the most severe or important in their perception.
2.Pain tolerance generally decreases with repeated exposure.
3.The reported pain site is usually the most important to treat.
4.Pain may be referred from a different site to the one reported.

Answer 15

1.Patients tend to report the most severe or important in their perception.

Question 16

Which of the following statements is true about acute pain?
1.Somatic pain comes from body surfaces and is only sharp and well-localized.
2.Visceral pain comes from the internal organs and is most responsive to acetaminophen and opiates.
3.Referred pain is present in a distant site for the pain source and is based on activating the same spinal segment as the actual pain site.
4.Acute neuropathic pain is caused by a lack of blood supply to the nerves in a given area.

Answer 16

3.Referred pain is present in a distant site for the pain source and is based on activating the same spinal segment as the actual pain site.

Question 17

All nonsteroidal anti-inflammatory drugs (NSAIDS) have an FDA Black Box Warning regarding:
1. Potential for causing life-threatening GI bleeds
2. Increased risk of developing systemic arthritis with prolonged use
3. Risk of life-threatening rashes, including Stevens-Johnson
4. Potential for transient changes in serum glucose

Answer 17

1. Potential for causing life-threatening GI bleeds

Question 18

One of the main drug classes used to treat acute pain is NSAIDs. They are used because:
1.They have less risk for liver damage than acetaminophen.
2. Inflammation is a common cause of acute pain.
3. They have minimal GI irritation.
4. Regulation of blood flow to the kidney is not affected by these drugs.

Answer 18

2. Inflammation is a common cause of acute pain.

Question 19

Which of the following statements is true about age and pain?
1. Use of drugs that depend heavily on the renal system for excretion may require dosage adjustments in very young children.
2. Among the NSAIDs, indomethacin is the preferred drug because of lower adverse effects profiles than other NSAIDs.
3. Older adults who have dementia probably do not experience much pain due to loss of pain receptors in the brain.
4. Acetaminophen is especially useful in both children and adults because it has no effect on platelets and has fewer adverse effects than NSAIDs.

Answer 19

4. Acetaminophen is especially useful in both children and adults because it has no effect on platelets and has fewer adverse effects than NSAIDs.

Question 20

Patients with rheumatoid arthritis who are on chronic low-dose prednisone will need co-treatment with which medications to prevent further adverse effects?
1. A bisphosphonate
2. Calcium supplementation
3. Vitamin D
4. All of the above

Answer 20

4. All of the above

Question 21

An appropriate first-line drug to try for mild to moderate generalized anxiety disorder would be:
1.Alprazolam (Xanax)
2.Diazepam (Valium)
3.Buspirone (Buspar)
4.Amitriptyline (Elavil)

Answer 21

3.Buspirone (Buspar)

Question 22

Phenobarbital overdose- antidote

Answer 22

There is no direct antidote but you can use intravenous lipid emulsion; other tx activated charcoal enhances the elimination of the drug from the body. Activated charcoal can be administered multiple times to shorten the elimination half-life of phenobarbital and reduce the duration of coma in cases of overdose

Question 23

An appropriate drug to initially treat panic disorder is:
1.Alprazolam (Xanax)
2.Diazepam (Valium)
3.Buspirone (Buspar)
4.Amitriptyline (Elavil)

Answer 23

2.Diazepam (Valium)

Very fast onset-longer 1/2 life; buspar is contraindicated w/ panic d/o. TCA-3rd line med; Xanax higher abuse potnential

Question 24

What does the nurse understand must occur in order to produce withdrawal syndrome?
1.Addiction
2.Craving
3.Drug tolerance
4.Physical dependence

Answer 24

4.Physical dependence

Question 25

The nurse is caring for a patient who is being treated for chronic alcohol intoxication. The nurse notes that the patients serum alcohol level is 0.40 mg%. The patient is awake and talkative even though this is a potentially lethal dose. The nurse recognizes this as alcohol
1.addiction.
2.dependence.
3.misuse.
4.tolerance.

Answer 25

4.tolerance.

Question 26

The nurse is teaching a group in the community about drug abuse. Which statement by the nurse is correct?
1.Cue-induced cravings eventually disappear after long periods of abstinence by the person addicted todrugs.
2.Drug abuse and drug addiction are synonymous terms, describing dependence on drugs.
3.Drug addiction is characterized by emotional, mental, and sometimes physical dependence.
4.Drug addiction occurs when physical dependence is present.

Answer 26

3.Drug addiction is characterized by emotional, mental, and sometimes physical dependence.

Question 27

A patient is brought to the emergency department by a family member. The patient reports seeing colored lights and describes feeling bugs crawling under the skin. The nurse suspects that this patient is abusing which drug?
1. Alcohol
2. Cocaine
3. LSD
4. Methamphetamine

Answer 27

2. Cocaine

Question 28

The nurse is teaching a patient who has completed detoxification for alcohol abuse who will be discharged home with a prescription for disulfiram (Antabuse). Which statement by the patient indicates understanding of the teaching?
1. Even topical products containing alcohol can have serious adverse effects while I am taking this drug.
2. If I experience drowsiness or skin rash, I should discontinue this drug immediately.
3. It is safe to take a product containing alcohol one week after the last dose of disulfiram.
4. This drug acts by blocking the pleasurable effects of alcohol.

Answer 28

1. Even topical products containing alcohol can have serious adverse effects while I am taking this drug.

Question 29

A patient who has a long history of alcohol abuse is admitted to the hospital for detoxification. In addition to medications needed to treat withdrawal symptoms, the nurse will anticipate giving intravenous
1. dopamine to restore blood pressure.
2. fluid boluses to treat dehydration.
3. glucose to prevent hypoglycemia.
4. thiamine to treat nutritional deficiency.

Answer 29

4. thiamine to treat nutritional deficiency.

Question 30

A patient arrives in the emergency department in an acute state of alcohol intoxication and reports chronic consumption of several six packs of beer every day for the past year. The nurse anticipates administering which medication or treatment?
1. Chlordiazepoxide (Librium)
2. Disulfiram (Antabuse)
3. Gastric lavage
4. Vasoconstrictors

Answer 30

1. Chlordiazepoxide (Librium)

Question 31

A patient who is unconscious arrives in the emergency department with clammy skin and constricted pupils. The nurse assesses a respiratory rate of 8 to 10 breaths per minute. The paramedics report obvious signs of drug abuse in the patient’s home. The nurse suspects that this patient has had an overdose of which substance?
1. Alcohol
2. LSD
3. An opioid
4. Methamphetamine

Answer 31

3. An opioid

Question 32

A patient is brought to the emergency department after ingesting an overdose of lorazepam (Ativan) several hours prior. The patient has a respiratory rate of 6 to 10 breaths per minute and is unconscious. The nurse will prepare to perform which action?
1. Administer activated charcoal.
2. Give flumazenil (Romazicon).
3. Give naloxone (Narcan).
4. Perform gastric lavage.

Answer 32

2. Give flumazenil (Romazicon).

Question 33

A patient with a history of opioid abuse will be discharged home with buprenorphine to help prevent relapse. Which product will the nurse anticipate the provider to order?
1. Buprenex
2. Suboxone
3. Subutex
4.Vivitrol

Answer 33

1. Buprenex-less abuse potential

Question 34

The tricyclic antidepressants should be prescribed cautiously in patients with:
1. Eczema
2. Asthma
3. Diabetes
4. Heart disease

Answer 34

4. Heart disease

Question 35

A 66-year-old male was prescribed phenelzine (Nardil) while in an acute psychiatric unit for recalcitrant depression. The NP managing his primary health care needs to understand the following regarding phenelzine and other monoamine oxidase inhibitors (MAOIs):
1. He should not be prescribed any serotonergic drug such as sumatriptan (Imitrex)
2. MAOIs interact with many common foods, including yogurt, sour cream, and soy sauce
3. Symptoms of hypertensive crisis (headache, tachycardia, sweating) require immediate treatment
4. All of the above

Answer 35

4. All of the above

Question 36

Taylor is a 10-year-old child diagnosed with major depression. The appropriate first-line antidepressant for children is:
1. Fluoxetine
2. Fluvoxamine
3. Sertraline
4. Escitalopram

Answer 36

1. Fluoxetine

Question 37

Jake, a 45-year-old patient with schizophrenia, was recently hospitalized for acute psychosis due to medication noncompliance. He was treated with IM long-acting haloperidol. Besides monitoring his schizophrenia symptoms, the patient should be assessed by his primary care provider:
1. For excessive weight loss
2. With the Abnormal Involuntary Movement Scale (AIMS) for extrapyramidal symptoms (EPS)
3. Monthly for tolerance to the haloperidol
4. Only by the mental health provider, as most NPs in primary care do not care for mentally ill patients

Answer 37

2. With the Abnormal Involuntary Movement Scale (AIMS) for extrapyramidal symptoms (EPS)

Question 38

Anticholinergic agents, such as benztropine (Cogentin), may be given with a phenothiazine to:
1. Reduce the chance of tardive dyskinesia
2. Potentiate the effects of the drug
3. Reduce the tolerance that tends to occur
4. Increase central nervous system (CNS) depression

Answer 38

2. Potentiate the effects of the drug

Question 39

The nurse is caring for a 7-year-old child who has difficulty concentrating and completing tasks and who cannot seem to sit still. Which diagnostic test may be ordered to assist with a diagnosis of attention deficit/hyperactivity disorder (ADHD) in this child?
1.Computerized tomography (CT) of the head
2.Electrocardiogram (ECG)
3.Electroencephalogram (EEG)
4.Magnetic resonance imaging (MRI) ofthe brain

Answer 39

3.Electroencephalogram (EEG)

Question 40

The nurse is teaching a child and a parent about taking methylphenidate (Ritalin) to treat attention deficit/hyperactivity disorder (ADHD). Which statement by the parent indicates an understanding of the teaching?
1.I should give this drug to my child at bedtime.
2.My child should avoid products containing caffeine.
3.The drug should be stopped immediately if my child develops aggression.
4.We should monitor my child’s weight since weight gain is common.

Answer 40

2.My child should avoid products containing caffeine.

Question 41

The parent of a child who is taking amphetamine (Adderall) to treat attention deficit/hyperactivity disorder (ADHD) asks the provider to recommend an over-the-counter medication to treat a cold. What will the nurse tell the parent?
1.Avoid any products containing pseudoephedrine or caffeine.
2.Never give over-the-counter medications with Adderall.
3.Sudafed is a safe and effective decongestant.
4.Use any over-the-counter medication from the local pharmacy.

Answer 41

1.Avoid any products containing pseudoephedrine or caffeine.

Question 42

The nurse is checking an 8-year-old child who has attention-deficit/hyperactivity disorder (ADHD) into a clinic for an annual well-child visit. The child takes methylphenidate HCl (Ritalin). Which assessments are especially important for this child?
1.Heart rate, respiratory rate, and oxygen saturation
2.Height, weight, and blood pressure
3.Measures of fine- and gross-motor development
4.Nausea, vomiting, and gastrointestinal upset

Answer 42

2.Height, weight, and blood pressure

Question 43

The parent of an adolescent who has taken methylphenidate 20 mg/day for 6 months for attention deficit/hyperactivity disorder (ADHD) brings the child to clinic for evaluation of a recent onset of nausea, vomiting, and headaches. The parent expresses concern that the child seems less focused and more hyperactive than before. What will the nurse do next?
1. Ask the child whether the drug is being taken as prescribed.
2. Contact the provider to discuss increasing the dose to 30 mg/day.
3. Recommend taking the drug with meals to reduce gastrointestinal side effects.
4. Report signs of drug toxicity to the patient’s provider.

Answer 43

1. Ask the child whether the drug is being taken as prescribed.

Question 44

The nurse is teaching a parent about methylphenidate (Ritalin) to treat attention deficit/hyperactivity disorder (ADHD). Which statement by the parent indicates understanding of the teaching?
1. I should consult a pharmacist when giving my child OTC medications.
2. I will only give my child diet soft drinks while administering this medication.
3. Medication therapy means that behavioral therapy will not be necessary.
4. Weight gain is a common side effect of this medication.

Answer 44

1. I should consult a pharmacist when giving my child OTC medications.

Question 45

The parents of a 6-year-old child diagnosed with ADHD will most typically describe their child’s behavior as:
1. a learning disorder and muscle paralysis.
2. nervousness and sleeplessness.
3. hyperactivity and decreased attention span
4. hyperactivity and nervousness.

Answer 45

3. hyperactivity and decreased attention span

Question 46

A pediatric nurse admits a child who has a history of ADHD. The nurse is aware that ADHD may display as:
1. poor coordination and abnormal electroencephalogram (EEG).
2. abnormal EEG and decrease in intelligence.
3. minimal brain dysfunction and a marked decrease in intelligence.
4. developmental delay and poor coordination.

Answer 46

1. poor coordination and abnormal electroencephalogram (EEG).

Question 47

A nurse is teaching the family of a child with ADHD about her diet and medications. The child is prescribed methylphenidate (Ritalin) every day. In teaching about the client’s diet, it is most important that the nurse encourage the child to avoid which foods and/or drinks?
1. High-sodium foods
2. High-sugar foods and drinks
3. High-fat foods
4. Caffeinated foods and drinks

Answer 47

4. Caffeinated foods and drinks

Question 48

A client with ADHD is prescribed methylphenidate (Ritalin). Based on the half-life of the drug, how often should the nurse administer the drug?
1. Daily
2. Twice a day
3. Every 8 hours
4. Every 12 hours

Answer 48

2. Twice a day

Question 49

The nurse is teaching a patient who will be discharged home with naltrexone (ReVia) after treatment for opioid addiction. What information will the nurse include in the teaching for this patient?
1. This drug will help control cravings.
2.You may take this drug once weekly.
3. ReVia blocks the pleasurable effects of opioids.
4. If you discontinue this drug abruptly, you will have withdrawal symptoms.

Answer 49

3. ReVia blocks the pleasurable effects of opioids.

Question 50

Jack, age 8, has attention deficit disorder (ADD) and is prescribed methylphenidate (Ritalin). He and his parents should be educated about the side effects of methylphenidate, which are:
1. Slurred speech and insomnia
2. Bradycardia and confusion
3. Dizziness and orthostatic hypotension
4. Insomnia and decreased appetite

Answer 50

4. Insomnia and decreased appetite

Question 51

Monitoring for a child on methylphenidate for attention deficit hyperactivity disorder (ADHD) includes:
1. ADHD symptoms
2. Routine height and weight checks
3. Amount of methylphenidate being used
4. All of the above

Answer 51

4. All of the above

Question 52

4. Clonidine has several off-label uses, including:
   a. Alcohol and nicotine withdrawal
   b. Post-herpetic neuralgia
   c. Both 1 and 2
   d. Neither 1 nor 2

Answer 52

3 Both 1 and 2

Question 53

Cholinergic blockers are used to:
1. Counteract the extrapyramidal symptoms (EPS) effects of phenothiazines
2. Control tremors and relax smooth muscle in Parkinson’s disease
3. Inhibit the muscarinic action of ACh on bladder muscle
4. All of the above

Answer 53

Counteract the extrapyramidal symptoms (EPS) effects of phenothiazines
Control tremors and relax smooth muscle in Parkinson’s disease
Inhibit the muscarinic action of ACh on bladder muscle
4. All of the above

Question 54

Juanita presents to the clinic with a complaint of headaches off and on for months. She reports they feel like someone is “squeezing” her head. She occasionally takes Tylenol for the pain, but usually just “toughs it out.” Initial treatment for tension headache includes asking her to keep a headache diary and a prescription for:
1. Sumatriptan (Imitrex)
2. Naproxen (Aleve)
3. Ergotamine (Ergostat)
4. Tylenol with codeine (Tylenol #3)

Answer 54

2. Naproxen (Aleve)

Question 55

Nonpharmacologic therapy for tension headaches includes:
1. Biofeedback
2. Stress management
3. Massage therapy
4. All of the above

Answer 55

4. All of the above

Question 56

Patients who are on chronic long-term corticosteroid therapy need education regarding:
1. Receiving all vaccinations, especially the live flu vaccine
2. Reporting black tarry stools or abdominal pain
3. Eating a high carbohydrate diet with plenty of fluids
4. Small amounts of alcohol are generally tolerated.

Answer 56

2. Reporting black tarry stools or abdominal pain

Question 57

When prescribing ergotamine suppositories (Wigraine) to treat acute migraine, patient education would include:
1.Ergotamine will briefly make the migraine worse before the migraine resolves.
2.The patient may experience bradycardia and dizziness.
3.They may need premedication with an antinausea medication.
4.Ergotamine works best if the patient starts off with a full suppository to get the full effect.

Answer 57

3.They may need premedication with an antinausea medication.

Question 58

Amber is a 24-year-old patient who has had migraines for 10 years. She reports a migraine on average of once a month. The migraines are effectively aborted with naratriptan (Amerge). When refilling Amber’s naratriptan, education would include:
1. Naratriptan will interact with antidepressants, including selective serotonin reuptake inhibitors (SSRIs) and St John’s wort, and she should inform any providers she sees that she has migraines.
2. Continue to monitor her headaches, if the migraine is consistently happening around her menses there is preventive therapy available.
3. Pregnancy is contraindicated when taking a triptan.
4. All of the above

Answer 58

4. All of the above

Question 59

When prescribing for migraines, patient education includes:
1. Triptans are safe to be used as often as needed as long as the patient is healthy.
2. Use triptan before trying OTC meds such as acetaminophen or naproxen.
3. Stress reduction and regular sleep are integral to migraine treatment.
4. If migraines worsen, they are to increase their medication.

Answer 59

3. Stress reduction and regular sleep are integral to migraine treatment.

Question 60

James has been diagnosed with cluster headaches. Appropriate acute therapy would be:
1. Butalbital and aspirin (Fiorinal)
2. Meperidine IM (Demerol)
3. Oxygen 100% for 15 to 30 minutes
4. Indomethacin (Indocin)

Answer 60

3. Oxygen 100% for 15 to 30 minutes

Question 61

Preventative therapy for cluster headaches includes:
1. Massage or relaxation therapy
2. Ergotamine nightly before bed
3. Intranasal lidocaine four times a day during “clusters” of headaches
4. Propranolol (Inderal) daily

Answer 61

2. Ergotamine nightly before bed

Question 62

Kelly is a 14-year-old patient who presents to the clinic with a classic migraine. She says she is having a headache two to three times a month. The initial plan would be:
1. Prescribe NSAIDs as abortive therapy and have her keep a headache diary to identify her triggers.
2. Prescribe zolmitriptan (Zomig) as abortive therapy and recommend relaxation therapy to reduce her stress.
3. Prescribe acetaminophen with codeine (Tylenol #3) for her to take at the first onset of her migraine.
4. Prescribe sumatriptan (Imitrex) nasal spray and arrange for her to receive the first dose in the clinic.

Answer 62

1. Prescribe NSAIDs as abortive therapy and have her keep a headache diary to identify her triggers.

Question 63

Migraines in pregnancy may be safely treated with:
1.Acetaminophen with codeine (Tylenol #3)
2.Sumatriptan (Imitrex)
3.Ergotamine tablets (Ergostat)
4.Dihydroergotamine (DHE)

Answer 63

1.Acetaminophen with codeine (Tylenol #3)

Question 64

What happens to cells when hypotonic fluids are administered?

Answer 64

Cells swell

Hypotonic fluids, such as D5 water, increase intracellular volume.

Question 65

What happens to cells when hypotonic fluids are administered?

Answer 65

Cells swell

Hypotonic fluids, such as D5 water, increase intracellular volume.

Question 66

What is the role of sodium in the extracellular fluid?

Answer 66

Sodium is the primary determinant of fluid volume and osmotic pressure in the extracellular compartment.

Normal sodium levels range from 135 to 145 mEq/L.

Question 68

What is the effect of isotonic solutions on cells?

Answer 68

No change in cell volume

Isotonic solutions, like normal saline, do not cause fluid movement into or out of cells.

Question 69

What defines isotonic fluids?

Answer 69

Fluids that have the same osmotic concentration as plasma, typically in the range of 250 to 375 mOsm/L.

Isotonic fluids do not shift fluid between intracellular and extracellular compartments.

Question 70

What are isotonic IV fluids used for?

Answer 70

To replace normal fluid losses

Common isotonic fluids include normal saline and lactated Ringer’s solution.

Question 71

How should fluids be calculated for a patient with a fluid deficit?

Answer 71

Replace the deficit with isotonic fluids and add maintenance requirements

Example: For a 1L deficit, give 500 mL in the first hour, then 250 mL over the next two hours.

Question 72

What happens to 5% dextrose in water (D5W) as it metabolizes?

Answer 72

It becomes free water, which is hypotonic.

Avoid in cerebral head injuries.

Question 73

What is the osmolarity of D5 in half normal saline?

Answer 73

406 mOsm/L

This hypertonic solution becomes half normal saline upon metabolism.

Question 74

What is the osmolarity of hypertonic saline (3%)?

Answer 74

Around 360 milliosmoles

Hypertonic saline can dehydrate cells, making it useful in cases of brain injury.

Question 75

What are the common synthetic colloids mentioned?

Answer 75

Dextran, hydroxyethyl starch (HES), and albumin.

Each has different volumes of fluid they can pull into the plasma.

Question 76

What are the primary uses of 3% normal saline?

Answer 76

• Treatment of cerebral edema
• Severe symptomatic hyponatremia

Caution is required to avoid hypernatremia and hyperchloremia.

Question 77

What is the osmolarity of half normal saline (0.4%)?

Answer 77

154 mOsm/L

This hypotonic solution shifts fluid into cells.

Question 78

What do colloids do in IV fluid therapy?

Answer 78

They act as volume or plasma expanders and have high oncotic pressure.

Colloids stay within blood vessels longer than crystalloids.

Question 79

What is the risk associated with using colloids in patients with sepsis?

Answer 79

Colloids can leak into interstitial spaces and pull more fluid out of the vascular space.

This can worsen edema.

Question 80

In hypovolemic hypotonic hyponatremia, what indicates greater sodium loss than water loss?

Answer 80

Sodium loss greater than water loss

This condition often presents with decreased skin turgor and orthostatic changes.

Question 81

What are the classifications of hypotonic hyponatremia based on extracellular volume status?

Answer 81

• Euvolemic
• Hypovolemic
• Hypervolemic

Question 82

When replacing blood loss with crystalloid, what is the replacement ratio?

Answer 82

2 mL of crystalloid for every 1 mL of blood loss.

In shock and trauma, the ratio may be 3:1.

Question 83

What characterizes hyperkalemia?

Answer 83

Potassium levels greater than 5.0 mEq/L

It can lead to serious cardiac arrhythmias and may require emergent treatment.

Question 84

What are common treatments for hyperkalemia?

Answer 84

• Calcium gluconate
• Insulin with glucose
• Beta agonists
• Diuretics
• Dialysis

Question 85

What is considered hypokalemia?

Answer 85

Potassium levels less than 3.5 mEq/L

This can lead to arrhythmias and specific EKG changes.

Question 86

What EKG changes are associated with hypokalemia?

Answer 86

• Flat T-wave
• ST depression
• U-wave

Question 87

What is the treatment for hypokalemia?

Answer 87

IV potassium replacement

Administer slowly and monitor levels to avoid complications.

Question 88

The Centers for Disease Control recommends all newborn infants receive prophylactic administration within 1 hour of birth.
1. Gentamicin ophthalmic ointment
2. Ciprofloxacin ophthalmic drops
3. Erythromycin oral suspension
4. Erythromycin ophthalmic ointment

Answer 88

4. Erythromycin ophthalmic ointment

Question 89

Twenty-year-old Annie comes to the clinic complaining of copious yellow-green eye discharge.Gram stain indicates she most likely has gonococcal conjunctivitis. While awaiting the culture results, the plan of care should be:
1.None, wait for the culture results to determine the course of treatment
2. Ciprofloxacin (Ciloxan) ophthalmic drops
3.IM ceftriaxone
4.High-dose oral amoxicillin

Answer 89

3.IM ceftriaxone`

Question 90

Sadie was prescribed betaxolol ophthalmic drops by her ophthalmologist to treat her glaucoma. Oral beta blockers should be avoided in patients who use ophthalmic beta blockers because:
1.There may be an antagonistic reaction between the two.
2.The additive effects may include bradycardia.
3.They may potentiate each other and cause respiratory depression.
4.The additive effects may cause metabolic acidosis.

Answer 90

2.The additive effects may include bradycardia.

Question 91

Ciprofloxacin otic drops are contraindicated in:
1.Children
2. Patients with acute otitis externa
3. Patients with a perforated tympanic membrane
4. Swimmer’s ear

Answer 91

3. Patients with a perforated tympanic membrane

Question 92

Patient education regarding the use of ciprofloxacin-hydrocortisone (Cipro HC otic) ear drops includes:
1. Fill the canal with the drops with each dose.
2. Some redness and itching around the ear canal is normal.
3. Warm the bottle of ear drops in his or her hand before administering.
4. Cipro HC otic may cause ototoxicity.

Answer 92

3. Warm the bottle of ear drops in his or her hand before administering.

Question 93

First-line therapy for hyperlipidemia is:
1.Statins
2.Niacin
3.Lifestyle changes
4.Bile acid-binding resins

Answer 93

3.Lifestyle changes

Question 94

What is the primary function of statin drugs?

Answer 94

Decrease LDL and total cholesterol

Statins lower the risk of heart failure, myocardial infarction (MI), and sudden death.

Question 95

What additional benefits do statins provide beyond lowering cholesterol?

Answer 95

Promote plaque stability, decrease inflammation, improve endothelial function

They also decrease the risk of atrial fibrillation and thrombosis.

Question 96

What are some indications for statin use?

Answer 96

Previous MI, AFib, hypertension, diabetes

Expanded uses include primary prevention even with normal LDL levels.

Question 97

What are the risks associated with statin use?

Answer 97

Myopathy, rhabdomyolysis, liver injury, diabetes

Myopathy occurs in about 5-10% of statin users.