L2-1530-E4 Flashcards
Contained in this deck is ___________________
Content: Comfort, Mobility, Inflammation drugs, Anti-infective, Antineoplastic agents
Concepts: Comfort, Mobility, Inflammation
Chapters 24 Neurologic and Neuromuscular Agents
Chapters 25, 26 Anti-inflammatories, Analgesics
Chapters 29, 30, 31 Antibacterial and Anti-infective Agents
Chapters 32, 33, 34 Additional Anti-infective Agents
Chapters 37, 38, 39 Antineoplastic Agents
- The nurse is preparing to care for a patient who has myasthenia gravis. The nurse will be alert to symptoms affecting which body system in this patient?
a. Cardiovascular system and postural muscles
b. Central nervous system (CNS), memory, and cognition
c. Gastrointestinal system (GI) and lower extremity muscles
d. Respiratory system and facial muscles
ANS: D
d. Respiratory system and facial muscles
Myasthenia gravis causes fatigue and muscular weakness of the respiratory system, facial muscles, and extremities. It does not directly affect the cardiovascular system, CNS, or GI systems.
- A 40-year-old woman is diagnosed with myasthenia gravis, and her provider recommends removal of her thymus gland. She asks the nurse why this would be helpful. The nurse will explain that removal of the thymus gland may
a. increase binding of acetylcholine (ACh) molecules to ACh receptors.
b. increase the amount of ACh available at neuromuscular junction sites.
c. reduce the number of acetylcholine receptor sites.
d. reduce the autoimmune destruction of ACh receptor sites.
ANS: D
d. reduce the autoimmune destruction of ACh receptor sites.
Myasthenia gravis is an autoimmune disorder involving an antibody response against a subunit of the ACh receptor site. Since the thymus is involved in systemic immunity, it is thought that removing the thymus can inhibit this process. It does not increase binding of ACh molecules to receptors or increase the amount of ACh or reduce the number of ACh receptor sites.
- The nurse assumes care of a patient who has myasthenia gravis and notes that a dose of neostigmine (Prostigmin) due 1 hour prior was not given. The nurse will anticipate the patient to exhibit which symptoms?
a. Excessive salivation
b. Muscle spasms
c. Muscle weakness
d. Respiratory paralysis
ANS: C
c. Muscle weakness
Neostigmine must be given on time to prevent myasthenic crisis, which is characterized by generalized, severe muscle weakness. The other symptoms are characteristic of cholinergic crisis, caused by too much medication.
- The nurse is caring for a patient who has myasthenia gravis (MG) and takes pyridostigmine bromide (Mestinon) 60 mg every 4 hours. The patient’s last dose was 45 minutes prior. The nurse notes severe muscle weakness, excess salivation, fasciculations of facial muscles, and pupil constriction. The nurse will perform which action?
a. Assess the patient for signs of ptosis.
b. Notify the provider to discuss an order for intravenous immune globulin (IVIG).
c. Obtain an order for atropine sulfate.
d. Request an order for an extra dose of pyridostigmine.
ANS: C
c. Obtain an order for atropine sulfate.
Severe muscle weakness, excess salivation, fasciculations of facial muscles, and pupil constriction are the major signs of cholinergic crisis, caused by excess pyridostigmine. The antidote is atropine, so the nurse should obtain an order to give this. Ptosis is sign of myasthenic crisis. IVIG is given to treat symptoms of MG and not used for cholinergic crisis. Giving extra pyridostigmine would increase the symptoms.
- The nurse is caring for a patient who has myasthenia gravis (MG) and is receiving pyridostigmine bromide (Mestinon). The nurse notes ptosis of both eyelids and observes that the patient has difficulty swallowing. What action will the nurse perform next?
a. Contact the provider to request an order for atropine sulfate.
b. Contact the provider to request an order for edrophonium chloride (Tensilon).
c. Report signs of cholinergic crisis to the provider.
d. Report signs of myasthenic crisis to the provider.
ANS: B
b. Contact the provider to request an order for edrophonium chloride (Tensilon).
Overdosing and underdoing of AChE inhibitors have similar symptoms: muscle weakness, dyspnea, and dysphagia. Edrophonium may be used to diagnose MG or to distinguish between myasthenic crisis and cholinergic crisis since it is a very short-acting AChE inhibitor. When given, if the symptoms are alleviated, the cause is myasthenic crisis; if symptoms worsen, it is cholinergic crisis. Since patients can have similar symptoms, the nurse cannot report one or the other to the provider without more information.
- A patient experiences severe muscle weakness, and the provider orders edrophonium bromide (Tensilon). The patient begins to show improved muscle strength within a few minutes after administration of this drug. The nurse anticipates the provider will order which drug?
a. Atropine sulfate
b. Edrophonium bromide (Tensilon)
c. Intravenous immune globulin (IVIG)
d. Pyridostigmine HCl (Mestinon)
ANS: D
d. Pyridostigmine HCl (Mestinon)
In this case, edrophonium is used to diagnose myasthenia gravis. Since symptoms improved with the AChE inhibitor, the patient will benefit from a longer-acting AChE inhibitor such as pyridostigmine. Atropine is given for AChE inhibitor overdose. Edrophonium is very short-acting, so it will not be used for treatment. IVIG is used when other AChE inhibitors fail.
- A patient exhibits ptosis of both eyes, and the provider orders edrophonium (Tensilon). The nurse notes immediate improvement of the ptosis. The nurse understands that this patient most likely has which disorder?
a. Cerebral palsy
b. Multiple sclerosis
c. Muscle spasms
d. Myasthenia gravis
ANS: D
d. Myasthenia gravis
Improvement of symptoms after administration of edrophonium is diagnostic for myasthenia gravis.
- The charge nurse observes a nurse administer undiluted intravenous pyridostigmine bromide (Mestinon) at a rate of 0.8 mg/min. The charge nurse will stop the infusion and perform which action?
a. Administer atropine sulfate to prevent cholinergic crisis.
b. Monitor the patient closely for respiratory distress.
c. Suggest that the nurse dilute the medication with colloidal fluids.
d. Tell the nurse to slow the rate of infusion of the pyridostigmine.
ANS: D
d. Tell the nurse to slow the rate of infusion of the pyridostigmine.
When given, IV pyridostigmine should be administered undiluted at a rate of 0.5 mg/min and should not be added to IV fluids. It is not necessary to administer atropine, since the patient is not symptomatic of cholinergic crisis.
- A patient reports weakness of the extremities and diplopia. The nurse knows that these symptoms are characteristic of which condition?
a. Cerebral palsy (CP)
b. Multiple sclerosis (MS)
c. Myasthenia gravis (MG)
d. Parkinson’s disease (PD)
ANS: B
b. Multiple sclerosis (MS)
Diplopia and weakness of the extremities are two symptoms of MS. CP is characterized by muscle spasticity. MG involves generalized weakness, especially of facial muscles and respiratory muscles. PD manifests as tremors and difficulty moving and walking.
- A patient has symptoms that are characteristic of multiple sclerosis (MS). Which diagnostic tests are likely to be ordered to aid in the diagnosis of this patient?
a. Cerebrospinal fluid (CSF) immunoglobulin G and magnetic resonance imaging (MRI)
b. CSF proteins and an angiography
c. Serum albumin and a computed tomography (CT) scan
d. Serum anti-acetylcholine antibodies and x-rays
ANS: A
a. Cerebrospinal fluid (CSF) immunoglobulin G and magnetic resonance imaging (MRI)
Laboratory tests that may suggest MS include CSF IgG and MRI.
- The nurse is caring for a patient who has recurrent muscle spasms. The provider has ordered metaxalone (Skelaxin) to treat the spasms. The nurse learns that the patient has a history of drug and alcohol abuse. The nurse will contact the provider to discuss switching this patient to which medication?
a. Carisoprodol (Soma)
b. Chlorzoxazone (Parafon forte DSC)
c. Cyclobenzaprine (Flexeril)
d. Methocarbamol (Robaxin)
ANS: C
c. Cyclobenzaprine (Flexeril)
Cyclobenzaprine is a muscle relaxant that does not cause drug dependence. The other muscle relaxants can cause drug dependence.
- The nurse provides teaching to a patient who will begin taking cyclobenzaprine (Flexeril) to treat muscle spasms. Which statement by the patient indicates a need for further teaching?
a. “I may experience dizziness and drowsiness when I take this drug.”
b. “I should not consume alcohol while taking this medication.”
c. “I should take this medication with food to decrease stomach upset.”
d. “I will take this medication for three weeks and then stop taking it.”
ANS: D
d. “I will take this medication for three weeks and then stop taking it.”
This medication should not be stopped abruptly. Patients may experience dizziness and drowsiness. Alcohol will compound the central nervous system sedative effects. To decrease gastrointestinal upset, the nurse should counsel the patient to take it with food.
- The nurse is performing an admission assessment on a patient who has been taking carisoprodol (Soma) for 3 weeks to treat muscle spasms. The patient reports that the muscle spasms have resolved. The nurse will contact the provider to discuss
a. changing to cyclobenzaprine (Flexeril).
b. continuing the carisoprodol for 1 more week.
c. discontinuing the carisoprodol now.
d. ordering a taper of the carisoprodol.
ANS: D
d. ordering a taper of the carisoprodol.
Muscle relaxants can cause drug dependence and should not be withdrawn abruptly. The nurse should discuss a drug taper.
- The nurse is teaching a group of nursing students about multiple sclerosis (MS). Which statement by the nurse is correct
a. “MS is characterized by degeneration of neurons and nerves in the brain and spinal cord.”
b. “MS is characterized by lesions or plaques on myelin sheaths of nerves.”
c. “MS is characterized by neuritic plaques and neurofibrillary tangles in the CNS.”
d. “MS is characterized by weak muscles and decreased nerve impulses caused by decreased ACh.”
ANS: B
b. “MS is characterized by lesions or plaques on myelin sheaths of nerves.”
MS is characterized by lesions on myelin sheaths of nerves.
- The nurse is caring for a patient who has multiple sclerosis. The patient is experiencing an acute attack. Which drug does the nurse anticipate the provider will order?
a. Adrenocorticotropic hormone (ACTH)
b. Cyclophosphamide (Cytoxan)
c. Glatiramer acetate (Copaxone)
d. Interferon-B (IFN-B)
ANS: A
a. Adrenocorticotropic hormone (ACTH)
ACTH is given to treat an acute attack of MS. Glatiramer acetate and interferon are used for remission-exacerbation states. Cyclophosphamide is given for chronic, progressive symptoms.
- The nurse is performing a health history on a patient who has multiple sclerosis. The patient reports episodes of muscle spasticity and recurrence of muscle weakness and diplopia. The nurse will expect this patient to be taking which medication?
a. Adrenocorticotropic hormone (ACTH)
b. Cyclophosphamide (Cytoxan)
c. Cyclobenzaprine (Flexeril)
d. Interferon-B (IFN-B)
ANS: D
d. Interferon-B (IFN-B)
This patient is showing signs of remission and exacerbation of MS symptoms. Interferon is used to treat this phase. ACTH is used for acute attacks. Cyclophosphamide is used for chronic, progressive symptoms. Cyclobenzaprine is a centrally acting muscle relaxant that is used for muscle spasms to decrease pain and increase range of motion.
- The nurse is preparing to care for a patient who has multiple sclerosis (MS). The nurse learns that the patient receives cyclophosphamide (Cytoxan). The nurse knows that this patient is in which stage of MS?
a. Acute attack phase
b. Chronic, progressive phase
c. End-stage phase
d. Remission-exacerbation phase
ANS: B
b. Chronic, progressive phase
Cyclophosphamide is used to treat MS patients who are in the chronic, progressive phase.
- Which muscle relaxant is used in surgery as a skeletal muscle relaxant?
a. Baclofen (Lioresal)
b. Chlorzoxazone (Parafon forte)
c. Pancuronium bromide (Pavulon)
d. Methocarbamol (Robaxin)
ANS: C
c. Pancuronium bromide (Pavulon)
Pancuronium bromide is used as a depolarizing muscle relaxant during anesthesia.
- The nurse is preparing to administer methocarbamol (Robaxin) to a patient who is experiencing acute muscle spasms. The nurse notes that the patient’s urine has turned black. What will the nurse do?
a. Administer the next dose of methocarbamol since this is a harmless side effect.
b. Contact the provider to discuss changing to cyclobenzaprine (Flexeril).
c. Obtain an order for a complete blood count to evaluate blood loss.
d. Request an order for liver function tests since this indicates hepatotoxicity.
ANS: A
a. Administer the next dose of methocarbamol since this is a harmless side effect.
Urine may turn green, brown, or black in patients taking methocarbamol, and this is a harmless side effect. There is no need to change medications or order lab tests.
- A client with myasthenia gravis is experiencing a cholinergic crisis. Which symptoms are associated with this condition? (Select all that apply.)
a. Bradycardia
b. Rash
c. Vomiting
d. Fever
e. Drooling
f. Weakness
ANS: A, C, E, F
a. Bradycardia
c. Vomiting
e. Drooling
f. Weakness
Bradycardia, drooling, and weakness can all occur with cholinergic crisis.
- A nursing student asks the nurse to explain the role of cyclooxygenase-2 (COX-2) and its role in inflammation. The nurse will explain that COX-2
a. converts arachidonic acid into a chemical mediator for inflammation.
b. directly causes vasodilation and increased capillary permeability.
c. irritates the gastric mucosa to cause gastrointestinal upset.
d. releases prostaglandins, which cause inflammation and pain in tissues.
ANS: A
a. converts arachidonic acid into a chemical mediator for inflammation
COX-2 is an enzyme that converts arachidonic acid into prostaglandins and their products, and this synthesis causes pain and inflammation. They do not act directly to cause inflammation. COX-1 irritates the gastric mucosa. COX-2 synthesizes but does not release prostaglandins.
- A nursing student asks how nonsteroidal antiinflammatory drugs (NSAIDs) work to suppress inflammation and reduce pain. The nurse will explain that NSAIDs
a. exert direct actions to cause relaxation of smooth muscle.
b. inhibit cyclooxygenase that is necessary for prostaglandin synthesis.
c. interfere with neuronal pathways associated with prostaglandin action.
d. suppress prostaglandin activity by blocking tissue receptor sites.
ANS: B
b. inhibit cyclooxygenase that is necessary for prostaglandin synthesis.
NSAIDs act by inhibiting COX-1 and COX-2 to help block prostaglandin synthesis. They do not have direct action on tissues, nor do they interfere with chemical receptor sites or neuronal pathways.
- A patient is taking ibuprofen 400 mg every 4 hours to treat moderate arthritis pain and reports that it is less effective than before. What action will the nurse take?
a. Counsel the patient to discuss a prescription NSAID with the provider.
b. Recommend adding aspirin to increase the antiinflammatory effect.
c. Suggest asking the provider about a short course of corticosteroids.
d. Tell the patient to increase the dose to 800 mg every 4 hours.
ANS: A
a. Counsel the patient to discuss a prescription NSAID with the provider.
The patient should discuss another NSAID with the provider if tolerance has developed to the over-the-counter NSAID. Patients should not take aspirin with NSAIDs because of the increased risk of bleeding and gastrointestinal upset. Steroids are not the drugs of choice for arthritis because of their side effects and are not used unless inflammation is severe. A prescription NSAID would be used prior to starting corticosteroids. Increasing the dose will increase side effects but may not increase desired effects. The maximum dose per day is 2400 mg, which would most likely be exceeded when increasing the dose to 800 mg every 4 hours.
- A patient who is taking aspirin for arthritis pain asks the nurse why it also causes gastrointestinal upset. The nurse understands that this is because aspirin
a. increases gastrointestinal secretions.
b. increases hypersensitivity reactions.
c. inhibits both COX-1 and COX-2.
d. is an acidic compound.
ANS: C
c. inhibits both COX-1 and COX-2.
Aspirin is a COX-1 and COX-2 inhibitor. COX-1 protects the stomach lining, so when it is inhibited, gastric upset occurs. Aspirin does not increase gastrointestinal secretions or hypersensitivity reactions. It is a weak acid.
- A patient is taking aspirin to help prevent myocardial infarction and is experiencing moderate gastrointestinal upset. The nurse will contact the patient’s provider to discuss changing from aspirin to which drug?
a. A COX-2 inhibitor
b. Celecoxib (Celebrex)
c. Enteric-coated aspirin
d. Nabumetone (Relafen)
ANS: C
c. Enteric-coated aspirin
Aspirin is used to inhibit platelet aggregation to prevent cardiovascular accident and myocardial infarction. Patients taking aspirin for this purpose would not benefit from COX-2 inhibitors, since the COX-1 enzyme is responsible for inhibiting platelet aggregation. The patient should take enteric-coated aspirin to lessen the gastrointestinal distress. Celecoxib and nabumetone are both COX-2 inhibitors.
- A patient who is 7 months pregnant and who has arthritis asks the nurse if she can take aspirin for pain. The nurse will tell her not to take aspirin for which reason?
a. It can result in adverse effects on her fetus.
b. It causes an increased risk of Reye’s syndrome.
c. It increases hemorrhage risk.
d. It will cause increased gastrointestinal distress.
ANS: A
a. It can result in adverse effects on her fetus.
Patients should not take aspirin during the third trimester of pregnancy because it can cause premature closure of the ductus arteriosus in the fetus. It does not increase her risk of Reye’s syndrome. Aspirin taken within a week of delivery will increase the risk of bleeding. It can cause gastrointestinal distress, but this is not the reason for caution.
- The nurse is performing a health history on a patient who has arthritis. The patient reports tinnitus. Suspecting a drug adverse effect, the nurse will ask the patient about which medication?
a. Aspirin (Bayer)
b. Acetaminophen (Tylenol)
c. Anakinra (Kineret)
d. Prednisone (Deltasone)
ANS: A
a. Aspirin (Bayer)
Aspirin causes tinnitus at low toxicity levels. The nurse should question the patient about this medication. The other medications do not have this side effect.
- The nurse is teaching a patient about using high-dose aspirin to treat arthritis. What information will the nurse include when teaching this patient?
a. “A normal serum aspirin level is between 30 and 40 mg/dL.”
b. “You may need to stop taking this drug a week prior to surgery.”
c. “You will need to monitor aspirin levels if you are also taking warfarin.”
d. “Your stools may become dark, but this is a harmless side effect.”
ANS: B
b. “You may need to stop taking this drug a week prior to surgery.”
Aspirin should be discontinued prior to surgery to avoid prolonged bleeding time. A normal serum level is 15 to 30 mg/dL. Patients taking warfarin and aspirin will have increased amounts of warfarin, so the INR will need to be monitored. Tarry stools are a symptom of gastrointestinal bleeding and should be reported.
- A patient who takes high-dose aspirin to treat rheumatoid arthritis has a serum salicylate level of 35 mg/dL. The nurse will perform which action?
a. Assess the patient for tinnitus.
b. Monitor the patient for signs of Reye’s syndrome.
c. Notify the provider of severe aspirin toxicity.
d. Request an order for an increased aspirin dose.
ANS: A
a. Assess the patient for tinnitus.
Mild toxicity occurs at levels above 30 mg/dL, so the nurse should assess for signs of toxicity, such as tinnitus. This level will not increase the risk for Reye’s syndrome. Severe toxicity occurs at levels greater than 50 mg/dL. The dose should not be increased.
- The nurse provides teaching for a patient who will begin taking indomethacin (Indocin) to treat rheumatoid arthritis. Which statement by the patient indicates a need for further teaching?
a. “I should limit sodium intake while taking this drug.”
b. “I should take indomethacin on an empty stomach.”
c. “I will need to check my blood pressure frequently.”
d. “I will take the medication twice daily.”
ANS: B
b. “I should take indomethacin on an empty stomach.”
Indomethacin is very irritating to the stomach and should be taken with food. It can cause sodium retention and elevated blood pressure, so patients should limit sodium intake. The medication is taken twice daily.
- The nurse is caring for a postpartum woman who is refusing opioid analgesics but is rating her pain as a 7 or 8 on a 10-point pain scale. The nurse will contact the provider to request an order for which analgesic medication?
a. Diclofenac sodium (Voltaren)
b. Ketoprofen (Orudis)
c. Ketorolac (Toradol)
d. Naproxyn (Naprosyn)
ANS: C
c. Ketorolac (Toradol)
Ketorolac is the first injectable NSAID and has shown analgesic efficacy equal or superior to that of opioid analgesics. The other NSAIDs listed are not used for postoperative pain.
- A patient who has osteoarthritis with mild to moderate pain asks the nurse about taking over-the-counter ibuprofen (Motrin). What will the nurse tell this patient?
a. “It may take several weeks to achieve therapeutic effects.”
b. “Unlike aspirin, there is no increased risk of bleeding with ibuprofen.”
c. “Take ibuprofen twice daily for maximum analgesic benefit.”
d. “Combine ibuprofen with acetaminophen for best effect.”
ANS: A
a. “It may take several weeks to achieve therapeutic effects.”
OTC NSAIDs can be effective for mild to moderate arthritis pain, but the effects may not appear for several weeks. NSAIDs carry a risk for bleeding. Ibuprofen is taken every 4 hours or QID. Ibuprofen should not be combined with aspirin or acetaminophen.
- The nurse is caring for a patient who has been taking an NSAID for 4 weeks for osteoarthritis. The patient reports decreased pain, but the nurse notes continued swelling of the affected joints. The nurse will perform which action?
a. Assess the patient for drug-seeking behaviors.
b. Notify the provider that the drug is not effective.
c. Reassure the patient that swelling will decrease eventually.
d. Remind the patient that this drug is given for pain only.
ANS: B
b. Notify the provider that the drug is not effective.
This medication is effective for both pain and swelling. After 4 weeks, there should be some decrease in swelling, so the nurse should report that this medication is ineffective. There is no indication that this patient is seeking an opioid analgesic. The drug should be effective within several weeks. NSAIDs are given for pain and swelling.
- The nurse is discussing celecoxib (Celebrex) with a patient who will use the drug to treat dysmenorrhea. What information will the nurse include in teaching?
a. “Do not take the medication during the first 2 days of your period.”
b. “The initial dose will be twice the amount of subsequent doses.”
c. “Take this medication with food to minimize gastrointestinal upset.”
d. “Take the drug on a regular basis to prevent dysmenorrhea.”
ANS: B
b. “The initial dose will be twice the amount of subsequent doses.”
The initial dose of Celebrex is twice that of subsequent doses. The medication should not be taken just before a period. It does not need to be taken with food. It is taken as needed.
- The nurse is caring for a patient who has rheumatoid arthritis and who is receiving infliximab (Remicade) IV every 8 weeks. Which laboratory test will the nurse anticipate that this patient will need?
a. Calcium level
b. Complete blood count
c. Electrolytes
d. Potassium
ANS: B
b. Complete blood count
Infliximab is an immunomodulator and can cause agranulocytosis, so patients should have regular CBC evaluation.
- The nurse is teaching a patient about taking colchicine to treat gout. What information will the nurse include when teaching this patient about this drug?
a. Avoid all alcohol except beer.
b. Include salmon in the diet.
c. Increase fluid intake.
d. Take on an empty stomach
ANS: C
c. Increase fluid intake.
The patient who is taking colchicine should increase fluid intake to promote uric acid excretion and prevent renal calculi. Foods rich in purine should be avoided, including beer, and some sea foods, such as salmon. Gastric irritation is a common problem, so colchicine should be taken with food.
- Which antigout medication is used to treat chronic tophaceous gout?
a. Allopurinol (Zyloprim)
b. Colchicine
c. Probenecid (Benemid)
d. Sulfinpyrazone (Anturane)
ANS: A
a. Allopurinol (Zyloprim)
Allopurinol inhibits the biosynthesis of uric acid and is used long-term to manage chronic gout. Colchicine does not inhibit uric acid synthesis or promote uric acid secretion and is not used for chronic gout. Probenecid can be used for chronic gout but is not the first choice. Sulfinpyrazone has many serious side effects.
- The nurse is assessing a patient who has gout who will begin taking allopurinol (Zyloprim). The nurse reviews the patient’s medical record and will be concerned about which laboratory result?
a. Elevated BUN and creatinine
b. Increased serum uric acid
c. Slight increase in the white blood count
d. Increased serum glucose
ANS: A
a. Elevated BUN and creatinine
Antigout drugs are excreted via the kidneys, so patients should have adequate renal function.
- The nurse provides teaching for a patient who will begin taking allopurinol. Which statement by the patient indicates understanding of the teaching?
a. “I should increase my vitamin C intake.”
b. “I will get yearly eye exams.”
c. “I will increase my protein intake.”
d. “I will limit fluids to prevent edema.”
ANS: B
b. “I will get yearly eye exams.”
Patients taking allopurinol can have visual changes with prolonged use and should have yearly eye exams. It is not necessary to increase vitamin C. Protein can increase purine intake, which is not recommended. Patients should consume extra fluids.
- Which are characteristic signs of inflammation? (Select all that apply.)
a. Edema
b. Erythema
c. Heat
d. Numbness
e. Pallor
f. Paresthesia
ANS: A, B, C
a. Edema
b. Erythema
c. Heat
Edema, erythema, and heat are signs of inflammation. The other three are signs of neurocirculatory compromise
- The nurse is teaching a female patient who will begin taking 2 tablets of 325 mg acetaminophen every 4 to 6 hours as needed for pain. Which statement by the patient indicates understanding of the teaching?
a. “I may take acetaminophen up to 6 times daily if needed.”
b. “I should increase the dose of acetaminophen if I drink caffeinated coffee.”
c. “If I take oral contraceptive pills, I should use back-up contraception.”
d. “It is safe to take acetaminophen with any over-the-counter medications.”
ANS: A
a. “I may take acetaminophen up to 6 times daily if needed.”
The maximum daily dose of acetaminophen is 4000 mg. If this patient takes 650 mg/dose 6 times daily, this amount is safe. Taking acetaminophen with caffeine increases the effect of the acetaminophen. Taking acetaminophen with OCPs decreases the effect of the acetaminophen but does not diminish the effect of the OCP. Many over-the-counter medications contain acetaminophen, so patients should be advised to read labels carefully to avoid overdose.
- The parent of a 5-year-old child asks the nurse to recommend an over-the-counter pain medication for the child. Which analgesic will the nurse recommend?
a. Acetaminophen (Tylenol)
b. Aspirin (Ecotrin)
c. Diflunisal (Dolobid)
d. Ibuprofen (Motrin)
ANS: A
a. Acetaminophen (Tylenol)
Acetaminophen is safe to give children and does not cause gastrointestinal upset or interfere with platelet aggregation. Aspirin carries an increased risk of Reye’s syndrome in children. Diflunisal (Dolobid) is not available over the counter.
- The nurse is performing an admission assessment on an adolescent who reports taking extra-strength acetaminophen (Tylenol) regularly to treat daily headaches. The nurse will notify the patient’s provider and discuss an order for
a. a selective serotonin receptor agonist (SSRA).
b. hydrocodone with acetaminophen for headache pain.
c. liver enzyme tests.
d. serum glucose testing.
ANS: C
c. liver enzyme tests.
Large doses or overdoses of acetaminophen can be toxic to hepatic cells, so when large doses are administered over a long period, liver function should be assessed. Daily headaches are not typical of migraine headaches, so SSRA medication is not indicated. Hydrocodone with acetaminophen is not indicated without further evaluation of headaches. Serum glucose is not indicated.
- The nurse is caring for a postoperative older patient who received PO hydrocodone with acetaminophen (Lortab) 45 minutes prior after reporting a pain level of 8 on a scale of 1 to 10. The patient reports a pain level of 4, and the nurse notes a respiratory rate of 20 breaths per minute, a heart rate of 92 beats per minute, and a blood pressure of 170/95 mm Hg. Which action will the nurse take?
a. Contact the provider and request an order for a more potent opioid analgesic.
b. Reassess the patient in 30 minutes.
c. Request an order for ibuprofen to augment the opioid analgesic.
d. Suggest that the patient use nonpharmacologic measures to relieve pain.
ANS: A
a. Contact the provider and request an order for a more potent opioid analgesic.
Even though the patient reports decreased pain, the patient’s vital signs indicate continued discomfort. The nurse should contact the provider to request a stronger analgesic. The pain medication should have been effective within 30 minutes. Ibuprofen is used for musculoskeletal pain. Nonpharmacologic measures may be useful, but the patient still needs a stronger analgesic.
- The nurse is providing teaching to a patient who will begin taking aspirin to treat arthritis pain. Which statement by the patient indicates a need for further teaching?
a. “I should increase fiber and fluids while taking aspirin.”
b. “I will call my provider if I have abdominal pain.”
c. “I will drink a full glass of water with each dose.”
d. “I will notify my provider of ringing in my ears.”
ANS: A
a. “I should increase fiber and fluids while taking aspirin.”
Aspirin is not constipating, so patients do not need to be counseled to consume extra fluids and fiber. Abdominal pain can occur with gastrointestinal bleeding, and tinnitus (ringing in the ears) can be an early sign of toxicity, so patients should be taught to contact their provider if these occur. Taking a full glass of water with each dose helps minimize gastrointestinal side effects.
- An adolescent female has dysmenorrhea associated with heavy menstrual periods. The patient’s provider has recommended ibuprofen (Motrin). When teaching this patient about this drug, the nurse will tell her that ibuprofen
a. may decrease the effectiveness of oral contraceptive pills.
b. may increase bleeding during her period.
c. should be taken on an empty stomach to increase absorption.
d. will decrease the duration of her periods.
ANS: B
b. may increase bleeding during her period.
When nonsteroidal antiinflammatory drugs (NSAIDs) are used to treat dysmenorrhea, excess bleeding may occur during the first 2 days of a period. NSAIDs do not decrease the effect of OCPs. NSAIDs are irritating to the stomach, so patients should take with food or a full glass of water. NSAIDs will not decrease the duration of periods.
- The emergency department nurse is caring for a patient who has received morphine sulfate for severe pain following an injury. The nurse performs a drug history and learns that the patient takes St. John’s wort for symptoms of depression. The nurse will observe this patient closely for an increase in which opioid adverse effect?
a. Constipation
b. Pruritis
c. Respiratory depression
d. Sedation
ANS: D
d. Sedation
St. John’s wort can increase the sedative effects of opioids. It does not enhance other side effects.
- The nurse is performing an admission assessment on a stable patient admitted after a motor vehicle accident. The patient reports having “bad pain.” What will the nurse do first?
a. Administer acetaminophen (Tylenol).
b. Ask the patient to rate the pain on a 1 to 10 scale.
c. Attempt to determine what type of pain the patient has.
d. Request an order for an intravenous opioid analgesic.
ANS: B
b. Ask the patient to rate the pain on a 1 to 10 scale.
To ascertain severity of pain, the nurse should ask the patient to rate the pain on a scale of 1 to 10. Further assessments include location and type of pain. Pain medication should be given after the severity of pain is assessed so that an appropriate analgesic may be given.
- The nurse assumes care of a patient in the post-anesthesia care unit (PACU). The patient had abdominal surgery and is receiving intravenous morphine sulfate for pain. The patient is asleep and has not voided since prior to surgery. The nurse assesses a respiratory rate of 10 breaths per minute and notes hypoactive bowel sounds. The nurse will contact the surgeon to report which condition?
a. Paralytic ileus
b. Respiratory depression
c. Somnolence
d. Urinary retention
ANS: B
b. Respiratory depression
The patient’s respiratory rate of 10 breaths per minute is lower than normal and is a sign of respiratory depression, which is a common adverse effect of opioid analgesics. The other effects may occur with opioids but are also not expected this soon after abdominal surgery.
- One hour after receiving intravenous morphine sulfate, a patient reports generalized itching. The nurse assesses the patient and notes clear breath sounds, no rash, respirations of 14 breaths per minute, a heart rate of 68 beats per minute, and a blood pressure of 110/70 mm Hg. Which action will the nurse take?
a. Administer naloxone to reverse opiate overdose.
b. Have resuscitation equipment available at the bedside.
c. Prepare an epinephrine injection in case of an anaphylactic reaction.
d. Reassure the patient that this is a common side effect of this drug.
ANS: D
d. Reassure the patient that this is a common side effect of this drug.
Pruritis is a common opioid side effect and can be managed with diphenhydramine. Patients developing anaphylaxis will have urticaria and hypotension, and these patients will need epinephrine and resuscitation. Respiratory depression is a sign of morphine overdose, which will require naloxone.
- The nurse administers nalbuphine (Nubain) to a patient who is experiencing severe pain. Which statement by the patient indicates a need for further teaching about this drug?
a. “I may experience unusual dreams while taking this medication.”
b. “I may need to use a laxative when taking this drug.”
c. “I should ask for assistance when I get out of bed.”
d. “I should expect to have more frequent urination.”
ANS: D
d. “I should expect to have more frequent urination.”
A common side effect of opioid agents is urinary retention. Patients should notify the nurse if they cannot void. Side effects may include unusual dreams, constipation, and dizziness.
- The nurse is caring for a patient who was admitted with a fractured leg and for observation of a closed head injury after a motor vehicle accident. The patient reports having pain at a level of 3 on a 1 to 10 pain scale. The nurse will expect the provider to order which analgesic medication for this patient?
a. Acetaminophen (Tylenol) PO
b. Hydromorphone HCl (Dilaudid) IM
c. Morphine sulfate PCA
d. Transdermal fentanyl (Duragesic)
ANS: A
a. Acetaminophen (Tylenol) PO
Use of opioid analgesics is contraindicated for patients with head injuries because of the risk of increased intracranial pressure. If opioids are necessary because of severe pain, they must be given in reduced doses. This patient is experiencing mild pain, so acetaminophen is an appropriate analgesic.
- Which patient may require a higher than expected dose of an opioid analgesic?
a. A patient with cancer
b. A patient with a concussion
c. A patient with hypotension
d. A patient 3 days after surgery
ANS: A
a. A patient with cancer
Opioids are titrated for oncology patients until pain relief is achieved or the side effects become intolerable, and extremely high doses may be required. Patient with closed head injuries should receive reduced doses of opioids if at all to reduce the risk of increased intracranial pressure. Patients with hypotension should receive reduced doses to prevent further decrease in blood pressure. Patients who are 3 days post-operation should not be experiencing severe pain.
- The nurse assesses an older patient 60 minutes after administering 4 mg of intravenous morphine sulfate (MS) for postoperative pain. The patient’s analgesia order is for 2 to 5 mg of MS IV every 2 hours. The nurse notes that the patient is lying very still. The patient’s heart rate is 96 beats per minute, respiratory rate is 14 breaths per minute, and blood pressure is 140/90 mm Hg. When asked to rate the level of pain, the patient replies “just a 5.” The nurse will perform which action?
a. Give 3 mg of MS at the next dose.
b. Give 5 mg of MS at the next dose.
c. Request an order for an oral opioid to give now.
d. Request an order for acetaminophen to give now.
ANS: B
b. Give 5 mg of MS at the next dose.
Older patients often minimize pain when asked, so the nurse should evaluate nonverbal cues to pain such as elevated heart rate and blood pressure and the fact that the patient is lying very still. The nurse should increase the dose the next time the pain medication is given.
- A postoperative patient has a history of opioid abuse. Which analgesic medication will the nurse expect the provider to order for this patient?
a. Buprenorphine (Buprenex)
b. Butorphanol tartrate (Stadol)
c. Naloxone (Narcan)
d. Pentazocine (Talwin)
ANS: A
a. Buprenorphine (Buprenex)
Buprenorphine is an opioid agonist-antagonist analgesic and was developed to help decrease opioid abuse. Butophanol and pentazocine are also in this class, but reports say that they cause dependence. Naloxone is an opioid antagonist and is given to reverse the effects of opioids if toxicity occurs.
- The nurse checks on a patient who has received sumatriptan (Imitrex) for treatment of a migraine headache. The patient reports moderate improvement in headache pain and reports feeling dizzy. The nurse notes a blood pressure of 160/85 mm Hg. Which action by the nurse is correct?
a. Notify the provider of the dizziness.
b. Notify the provider of the increased blood pressure.
c. Plan to administer a second dose in 1 hour.
d. Request an order for intranasal sumatriptan.
ANS: B
b. Notify the provider of the increased blood pressure.
Triptans can cause increased blood pressure, which is an adverse drug reaction and should be reported to the provider. Dizziness is a common side effect but not potentially life-threatening. The second dose should not be given if the patient is experiencing elevated blood pressure. Intranasal sumatriptan has the same adverse effects.
- The nurse is caring for a 6-year-old child who had surgery that morning. The child is awake and lying very still in bed and won’t respond when the nurse asks about pain. The nurse will perform which action?
a. Ask the child to rate the pain on a scale of 1 to 10.
b. Encourage the child to request pain medication when needed.
c. Evaluate the child’s pain using an “ouch” scale.
d. Plan to administer pain medication if the child begins to cry.
ANS: C
c. Evaluate the child’s pain using an “ouch” scale.
Some children will not verbalize discomfort even when they have severe pain because they fear injections. Nurses may use an “ouch” scale or a faces scale to evaluate pain if the child won’t respond. Waiting for severe pain is not appropriate
- The nurse is caring for a patient who is receiving an intravenous antibiotic. The nurse notes that the provider has ordered serum drug peak and trough levels. The nurse understands that these tests are necessary for which type of drugs?
a. Drugs with a broad spectrum
b. Drugs with a narrow spectrum
c. Drugs with a broad therapeutic index
d. Drugs with a narrow therapeutic index
ANS: D
d. Drugs with a narrow therapeutic index
Medications with a narrow therapeutic index have a limited range between the therapeutic dose and a toxic dose. It is important to monitor these medications closely by evaluating regular serum peak and trough levels.
- The nurse is caring for a patient who is receiving an intravenous antibiotic. The patient has a serum drug trough of 1.5 mcg/mL. The normal trough for this drug is 1.7 mcg/mL to 2.2 mcg/mL. What will the nurse expect the patient to experience?
a. Inadequate drug effects
b. Increased risk for superinfection
c. Minimal adverse effects
d. Slowed onset of action
ANS: A
a. Inadequate drug effects
Low peak levels may indicate that the medication is below the therapeutic level. They do not indicate altered risk for superinfection, a decrease in adverse effects, or a slowed onset of action.
- The nurse is teaching a nursing student about the minimal effective concentration (MEC) of antibiotics. Which statement by the nursing student indicates understanding of this concept?
a. “A serum drug level greater than the MEC ensures that the drug is bacteriostatic.”
b. “A serum drug level greater than the MEC broadens the spectrum of the drug.”
c. “A serum drug level greater than the MEC helps eradicate bacterial infections.”
d. “A serum drug level greater than the MEC increases the therapeutic index.”
ANS: C
c. “A serum drug level greater than the MEC helps eradicate bacterial infections.”
The MEC is the minimum amount of drug needed to halt the growth of a microorganism. A level greater than the MEC helps eradicate infections. Drugs at or above the MEC are usually bactericidal, not bacteriostatic. Raising the drug level does not usually broaden the spectrum or increase the therapeutic index of a drug.
- The nurse is caring for a patient who has recurrent urinary tract infections. The patient’s current infection is not responding to an antibiotic that has been used successfully several times in the past. The nurse understands that this is most likely due to
a. acquired bacterial resistance.
b. cross-resistance.
c. inherent bacterial resistance.
d. transferred resistance.
ANS: A
a. acquired bacterial resistance.
Acquired resistance occurs when an organism has been exposed to the antibacterial drug. Cross-resistance occurs when an organism that is resistant to one drug is also resistant to another. Inherent resistance occurs without previous exposure to the drug. Transferred resistance occurs when the resistant genes of one organism are passed to another organism.
- The nurse is preparing to administer amoxicillin (Amoxil) to a patient and learns that the patient previously experienced a rash when taking penicillin. Which action will the nurse take?
a. Administer the amoxicillin and have epinephrine available.
b. Ask the provider to order an antihistamine.
c. Contact the provider to discuss using a different antibiotic.
d. Request an order for a beta-lactamase resistant drug.
ANS: C
c. Contact the provider to discuss using a different antibiotic.
Patients who have previously experienced manifestations of allergy to a penicillin should not use penicillins again unless necessary. The nurse should contact the provider to discuss using another antibiotic from a different class. Epinephrine and antihistamines are useful when patients are experiencing allergic reactions, depending on severity.
- The nurse is preparing to administer an antibiotic to a patient who has been receiving the antibiotic for 2 days after a culture was obtained. The nurse notes increased erythema and swelling, and the patient has a persistent high fever of 39° C. What is the nurse’s next action?
a. Administer the antibiotic as ordered.
b. Contact the provider to request another culture.
c. Discuss the need to add a second antibiotic with the provider.
d. Review the sensitivity results from the patient’s culture.
ANS: D
d. Review the sensitivity results from the patient’s culture.
The sensitivity results from the patient’s culture will reveal whether the organism is sensitive or resistant to a particular antibiotic. The patient is not responding to the antibiotic being given, so the antibiotic should be held and the provider notified. Another culture is not indicated. Antibiotics should be added only when indicated by the sensitivity.
- The nurse is preparing to administer the first dose of an antibiotic to a patient admitted for a urinary tract infection. Which action is most important prior to administering the antibiotic?
a. Administering a small test dose to determine whether hypersensitivity exists
b. Having epinephrine available in the event of a severe hypersensitivity reaction
c. Monitoring baseline vital signs, including temperature and blood pressure
d. Obtaining a specimen for culture and sensitivity
ANS: D
d. Obtaining a specimen for culture and sensitivity
To obtain the most accurate culture, the specimen should be obtained before antibiotic therapy begins. It is important to obtain cultures when possible in order to correctly identify the organism and help determine which antibiotic will be most effective. Administering test doses to determine hypersensitivity is sometimes done when there is a strong suspicion of allergy when a particular antibiotic is needed. Epinephrine is kept close at hand when there is a strong suspicion of allergy.
- A patient is admitted to the hospital for treatment of pneumonia after complaining of high fever and shortness of breath. The patient was not able to produce sputum for a culture. The nurse will expect the patient’s provider to order
a. a broad-spectrum antibiotic.
b. a narrow-spectrum antibiotic.
c. multiple antibiotics.
d. the pneumococcal vaccine.
ANS: A
a. a broad-spectrum antibiotic.
Broad-spectrum antibiotics are frequently used to treat infections when the offending organism has not been identified by culture and sensitivity (C&S). Narrow-spectrum antibiotics are usually effective against one type of organism and are used when the C&S indicates sensitivity to that antibiotic. The use of multiple antibiotics, unless indicated by C&S, can increase resistance. The pneumococcal vaccine is used to prevent, not treat, an infection.
- The nurse is teaching a patient who will be discharged home from the hospital to take amoxicillin (Amoxil) twice daily for 10 days. Which statement by the nurse is correct?
a. “Discontinue the antibiotic when your temperature returns to normal and your symptoms have improved.”
b. “If diarrhea occurs, stop taking the drug immediately and contact your provider.”
c. “Stop taking the drug and notify your provider if you develop a rash while taking this drug.”
d. “You may save any unused antibiotic to use if your symptoms recur.”
ANS: C
c. “Stop taking the drug and notify your provider if you develop a rash while taking this drug.”
Patients who develop signs of allergy, such as rash, should notify their provider before continuing medication therapy. Patients should be counseled to continue taking their antibiotics until completion of the prescribed regimen even when they feel well. Diarrhea is an adverse effect but does not warrant cessation of the drug. Before deciding to stop taking a medication due to a side effect, encourage the patient to contact the provider first. Patients should discard any unused antibiotic.
- The nurse is preparing to administer the first dose of intravenous ceftriaxone (Rocephin) to a patient. When reviewing the patient’s chart, the nurse notes that the patient previously experienced a rash when taking amoxicillin. What is the nurse’s next action?
a. Administer the drug and observe closely for hypersensitivity reactions.
b. Ask the provider whether a cephalosporin from a different generation may be used.
c. Contact the provider to report drug hypersensitivity.
d. Notify the provider and suggest an oral cephalosporin.
ANS: A
a. Administer the drug and observe closely for hypersensitivity reactions.
A small percentage of patients who are allergic to penicillin could also be allergic to a cephalosporin product. Patients should be monitored closely after receiving a cephalosporin if they are allergic to penicillin. There is no difference in hypersensitivity potential between different generations or method of delivery of cephalosporins.
- The nurse is preparing to give a dose of a cephalosporin medication to a patient who has been receiving the antibiotic for 2 weeks. The nurse notes ulcers on the patient’s tongue and buccal mucosa. Which action will the nurse take?
a. Hold the drug and notify the provider.
b. Obtain an order to culture the oral lesions.
c. Gather emergency equipment to prepare for anaphylaxis.
d. Report a possible superinfection side effect of the cephalosporin.
ANS: D
d. Report a possible superinfection side effect of the cephalosporin.
The patient’s symptoms may indicate a superinfection and should be reported to the physician so it can be treated; however, the drug does not need to be held. It is not necessary to culture the lesions. The symptoms do not indicate impending anaphylaxis.
- The nurse is providing teaching to a patient who will begin taking a cephalosporin to treat an infection. Which statement by the patient indicates a need for further teaching?
a. “I may stop taking the medication if my symptoms clear up.”
b. “I should eat yogurt while taking this medication.”
c. “I should stop taking the drug and call my provider if I develop a rash.”
d. “I will not consume alcohol while taking this medication.”
ANS: A
a. “I may stop taking the medication if my symptoms clear up.”
Patients should take all of an antibiotic regimen even after symptoms clear to ensure complete treatment of the infection. Patients are often advised to eat yogurt or drink buttermilk to prevent superinfection. A rash is a sign of hypersensitivity, and patients should be counseled to stop taking the drug and notify the provider if this occurs. Alcohol consumption may cause adverse effects and should be avoided by patients while they are taking cephalosporins.
- The nurse is caring for a patient who takes low-dose erythromycin as a prophylactic medication. The patient will begin taking cefaclor for treatment of an acute infection. The nurse should discuss this with the provider because taking both of these medications simultaneously can cause which effect?
a. Decreased effectiveness of cefaclor.
b. Increased effectiveness of cefaclor.
c. Decreased effectiveness of erythromycin.
d. Increased effectiveness of erythromycin.
ANS: A
a. Decreased effectiveness of cefaclor.
The interaction of cefaclor and erythromycin will produce a decrease in the action of the cefaclor.
- A patient is receiving high doses of a cephalosporin. Which laboratory values will this patient’s nurse monitor closely?
a. Blood urea nitrogen (BUN), serum creatinine, and liver function tests
b. Complete blood count and electrolytes
c. Serum calcium and magnesium
d. Serum glucose and lipids
ANS: A
a. Blood urea nitrogen (BUN), serum creatinine, and liver function tests
Cefazolin will produce an increase in the patient’s BUN, creatinine, AST, ALT, ALP, LDH, and bilirubin.
- A patient will begin taking amoxicillin. The nurse should instruct the patient to avoid which foods?
a. Green leafy vegetables
b. Beef and other red meat
c. Coffee, tea, and colas
d. Acidic fruits and juices
ANS: D
d. Acidic fruits and juices
Acidic fruits and juices should be avoided while the client is being treated with amoxicillin because amoxicillin can be irritating to the stomach. Stomach irritation will be increased with the ingestion of citrus and acidic foods. Amoxicillin may also be less effective when taken with acidic fruit or juice.
- The patient will begin taking penicillin G procaine (Wycillin).The nurse notes that the solution is milky in color. What action will the nurse take?
a. Call the pharmacist and report the milky color.
b. Add normal saline to dilute the medication.
c. Call the physician and report the milky appearance.
d. Administer the medication as ordered by the physician.
ANS: D
d. Administer the medication as ordered by the physician.
Penicillin G procaine (Wycillin) has a milky appearance; therefore, the appearance should not concern the nurse.
- Which actions can contribute to bacterial resistance to antibiotics? (Select all that apply.)
a. Frequent use of antibiotics
b. Giving large doses of antibiotics
c. Skipping doses
d. Taking a full course of antibiotics
e. Treating viral infections with antibiotics
ANS: A, C, E
a. Frequent use of antibiotics
c. Skipping doses
e. Treating viral infections with antibiotics
Frequent use of antibiotics increases the exposure of bacteria to an antibiotic and results in acquired resistance. Skipping doses of an antibiotic can lead to incomplete treatment of an infection, and the remaining bacteria may develop acquired resistance. Treating viral infections with antibiotics is unnecessary and may cause acquired resistance to develop from unneeded exposure to a drug. Infections adequately treated with an antibiotic do not result in resistance.
- The nurse caring for a patient who will receive penicillin to treat an infection asks the patient about previous drug reactions. The patient reports having had a rash when taking amoxicillin (Amoxil). The nurse will contact the provider to
a. discuss giving a smaller dose of penicillin.
b. discuss using erythromycin (E-mycin) instead of penicillin.
c. request an order for diphenhydramine (Benadryl).
d. suggest that the patient receive cefuroxime (Ceftin).
ANS: B
b. discuss using erythromycin (E-mycin) instead of penicillin.
Erythromycin is the drug of choice when penicillin is not an option. Giving smaller doses of penicillin does not prevent hypersensitivity reactions. Benadryl is useful when a hypersensitivity reaction has occurred. A small percentage of patients allergic to penicillins may be hypersensitive to cephalosporins.
- A patient is diagnosed with mycoplasma pneumonia. Which antibiotic will the nurse expect the provider to order to treat this infection?
a. Azithromycin (Zithromax)
b. Clarithromycin (Biaxin)
c. Erythromycin (E-Mycin)
d. Fidaxomicin (Dificid)
ANS: C
c. Erythromycin (E-Mycin)
Erythromycin is the drug of choice for treating mycoplasma pneumonia.
