Midterm Exam view questions From book Flashcards
(295 cards)
1
Q
The nurse is developing a human needs statement for a patient who has a new diagnosis of heart failure. Identification of human
needs statements occur with which of these activities?
a. Collection of patient data
b. Administering interventions
c. Deciding on patient outcomes
d. Documenting the patient’s behavior
A
a. Collection of patient data
2
Q
The patient is to receive oral guaifenesin (Mucinex) twice a day. Today, the nurse was busy and gave the medication 2 hours after
the scheduled dose was due. What type of problem does this represent?
a. “Right time”
b. “Right dose”
c. “Right route”
d. “Right medication”
A
“Right time”
3
Q
The nurse has been monitoring the patient’s progress on a new drug regimen since the first dose and documenting the patient’s
therapeutic response to the medication. Which phase of the nursing process do these actions illustrate?
a. Human needs statement
b. Planning
c. Implementation
d. Evaluation
A
d. Evaluation
4
Q
The nurse is assigned to a patient who is newly diagnosed with type 1 diabetes mellitus. Which statement best illustrates an
outcome criterion for this patient?
a. The patient will follow instructions.
b. The patient will not experience complications.
c. The patient will adhere to the new insulin treatment regimen.
d. The patient will demonstrate correct blood glucose testing technique.
A
d. The patient will demonstrate correct blood glucose testing technique.
5
Q
Which activity best reflects the implementation phase of the nursing process for the patient who is newly diagnosed with
hypertension?
a. Providing education on keeping a journal of blood pressure readings
b. Setting goals and outcome criteria with the patient’s input
c. Recording a drug history regarding over-the-counter medications used at home
d. Formulating human needs statements regarding insufficient knowledge related to
the new treatment regimen
A
a. Providing education on keeping a journal of blood pressure readings
6
Q
The medication order reads, “Give ondansetron (Zofran) 4 mg, 30 minutes before beginning chemotherapy to prevent nausea.” The
nurse notes that the route is missing from the order. What is the nurse’s best action?
a. Give the medication intravenously because the patient might vomit.
b. Give the medication orally because the tablets are available in 4-mg doses.
c. Contact the prescriber to clarify the route of the medication ordered.
d. Hold the medication until the prescriber returns to make rounds.
A
c. Contact the prescriber to clarify the route of the medication ordered.
7
Q
When the nurse considers the timing of a drug dose, which factor is appropriate to consider when deciding when to give a drug?
a. The patient’s ability to swallow
b. The patient’s height
c. The patient’s last meal
d. The patient’s allergies
A
c. The patient’s last meal
8
Q
The nurse is performing an assessment of a newly admitted patient. Which is an example of subjective data?
a. Blood pressure 158/96 mm Hg
b. Weight 255 pounds
c. The patient reports that he uses the herbal product ginkgo.
d. The patient’s complete blood count results.
A
c. The patient reports that he uses the herbal product ginkgo.
9
Q
When giving medications, the nurse will follow the rights of medication administration. The rights include the right documentation,
the right reason, the right response, and the patient’s right to refuse. Which of these are additional rights? (Select all that apply.)
a. Right drug
b. Right route
c. Right dose
d. Right diagnosis
e. Right time
f. Right patient
A
a. Right drug
b. Right route
c. Right dose
e. Right time
f. Right patient
10
Q
Place the phases of the nursing process in the correct order, with 1 as the first phase and 5 as the last phase. (Select all that apply.)
a. Planning
b. Evaluation
c. Assessment
d. Implementation
e. Human needs statement
A
a. Planning
b. Evaluation
c. Assessment
d. Implementation
e. Human needs statement
11
Q
The patient is receiving two different drugs. At current dosages and dosage forms, both drugs have the same concentration of the
active ingredient. Which term is used to identify this principle?
a. Bioequivalent
b. Synergistic
c. Prodrugs
d. Steady state
A
a. Bioequivalent
12
Q
When given an intravenous medication, the patient says to the nurse, “I usually take pills. Why does this medication have to be
given in the arm?” What is the nurse’s best answer?
a. “The medication will cause fewer adverse effects when given intravenously.”
b. “The intravenous medication will have delayed absorption into the body’s
tissues.”
c. “The action of the medication will begin sooner when given intravenously.”
d. “There is a lower chance of allergic reactions when drugs are given
intravenously.”
A
c. “The action of the medication will begin sooner when given intravenously.”
13
Q
The nurse is administering parenteral drugs. Which statement is true regarding parenteral drugs?
a. Parenteral drugs bypass the first-pass effect.
b. Absorption of parenteral drugs is affected by reduced blood flow to the stomach.
c. Absorption of parenteral drugs is faster when the stomach is empty.
d. Parenteral drugs exert their effects while circulating in the bloodstream.
A
a. Parenteral drugs bypass the first-pass effect.
14
Q
When monitoring the patient receiving an intravenous infusion to reduce blood pressure, the nurse notes that the patient’s blood
pressure is extremely low, and the patient is lethargic and difficult to awaken. This would be classified as which type of adverse
drug reaction?
a. Adverse effect
b. Allergic reaction
c. Idiosyncratic reaction
d. Pharmacologic reaction
A
d. Pharmacologic reaction
15
Q
The nurse is reviewing pharmacology terms for a group of newly graduated nurses. Which sentence defines a drug’s half-life?
a. The time it takes for the drug to cause half of its therapeutic response
b. The time it takes for one half of the original amount of a drug to reach the target
cells
c. The time it takes for one half of the original amount of a drug to be removed from
the body
d. The time it takes for one half of the original amount of a drug to be absorbed into
the circulation
A
c. The time it takes for one half of the original amount of a drug to be removed from
the body
16
Q
When administering drugs, the nurse remembers that the duration of action of a drug is defined as which of these?
a. The time it takes for a drug to elicit a therapeutic response
b. The amount of time needed to remove a drug from circulation
c. The time it takes for a drug to achieve its maximum therapeutic response
d. The time period at which a drug’s concentration is sufficient to cause a
therapeutic response
A
d. The time period at which a drug’s concentration is sufficient to cause a
therapeutic response
17
Q
When reviewing the mechanism of action of a specific drug, the nurse reads that the drug works by selective enzyme interaction.
Which of these processes describes selective enzyme interaction?
a. The drug alters cell membrane permeability.
b. The drug’s effectiveness within the cell walls of the target tissue is enhanced.
c. The drug is attracted to a receptor on the cell wall, preventing an enzyme from
binding to that receptor.
d. The drug binds to an enzyme molecule and inhibits or enhances the enzyme’s
action with the normal target cell.
A
d. The drug binds to an enzyme molecule and inhibits or enhances the enzyme’s
action with the normal target cell.
18
Q
When administering a new medication to a patient, the nurse reads that it is highly protein bound. Assuming that the patient’s
albumin levels are normal, the nurse would expect which result, as compared to a medication, that is not highly protein bound?
a. Renal excretion will be faster.
b. The drug will be metabolized quickly.
c. The duration of action of the medication will be shorter.
d. The duration of action of the medication will be longer.
A
d. The duration of action of the medication will be longer.
19
Q
The patient is experiencing chest pain and needs to take a sublingual form of nitroglycerin. Where does the nurse instruct the
patient to place the tablet?
a. Under the tongue
b. On top of the tongue
c. At the back of the throat
d. In the space between the cheek and the gum
A
a. Under the tongue
20
Q
The nurse is administering medications to the patient who is in renal failure resulting from end-stage renal disease. The nurse is
aware that patients with kidney failure would most likely have problems with which pharmacokinetic phase?
a. Absorption
b. Distribution
c. Metabolism
d. Excretion
A
d. Excretion
21
Q
A patient who has advanced cancer is receiving opioid medications around the clock to keep him comfortable as he nears the end of
his life. Which term best describes this type of therapy?
a. Palliative therapy
b. Maintenance therapy
c. Empiric therapy
d. Supplemental therapy
A
a. Palliative therapy
22
Q
The patient is stating that he has a headache and asks the nurse which over-the-counter medication form would work the fastest to
help reduce the pain. Which medication form will the nurse suggest?
a. A capsule
b. A tablet
c. An enteric-coated tablet
d. A powder
A
d. A powder
23
Q
The nurse will be injecting a drug into the superficial skin layers immediately underneath the epidermal layer of skin. Which route
does this describe?
a. Intradermal
b. Subcutaneous
c. Intramuscular
d. Transdermal
A
a. Intradermal
24
Q
Which drugs would be affected by the first-pass effect when administered? (Select all that apply.)
a. Morphine given by IV push injection
b. Sublingual nitroglycerin tablets
c. Diphenhydramine (Benadryl) elixirs
d. Levothyroxine (Synthroid) tablets
e. Transdermal nicotine patches
f. Esomeprazole (Nexium) capsules
g. Penicillin given by IV piggyback infusion
A
c. Diphenhydramine (Benadryl) elixirs
d. Levothyroxine (Synthroid) tablets
f. Esomeprazole (Nexium) capsules
25
1. A drug dose that delivers 800 mg has a half-life of 5 hours. Identify how much drug will remain in the body after one half-life.
400mg
26
Drug transfer to the fetus is more likely during the last trimester of pregnancy for which reason?
a. Decreased fetal surface area
b. Increased placental surface area
c. Enhanced blood flow to the fetus
d. Increased amount of protein-bound drug in maternal circulation
c. Enhanced blood flow to the fetus
27
The nurse is monitoring a patient who is in the 26th week of pregnancy and has developed gestational diabetes and pneumonia. She
is given medications that pose a possible fetal risk, but the potential benefits may warrant the use of the medications in her
situation. The nurse recognizes that these medications are in which U.S. Food and Drug Administration pregnancy safety category?
a. Category X
b. Category B
c. Category C
d. Category D
d. Category D
28
When discussing dosage calculation for pediatric patients with a clinical pharmacist, the nurse notes that which type of dosage
calculation is used most commonly in pediatric calculations?
a. West nomogram
b. Clark rule
c. Height-to-weight ratio
d. Milligram per kilogram of body weight formula
d. Milligram per kilogram of body weight formula
29
The nurse is assessing a newly admitted 83-year-old patient and determines that the patient is experiencing polypharmacy. Which
statement most accurately illustrates polypharmacy?
a. The patient is experiencing multiple illnesses.
b. The patient uses one medication for an illness several times per day.
c. The patient uses over-the-counter drugs for an illness.
d. The patient uses multiple medications simultaneously.
d. The patient uses multiple medications simultaneously.
30
The nurse is aware that confusion, forgetfulness, and increased risk for falls are common responses in an elderly patient who is
taking which type of drug?
a. Laxatives
b. Anticoagulants
c. Sedatives
d. Antidepressants
c. Sedatives
31
For accurate medication administration to pediatric patients, the nurse must take into account which criteria?
a. Organ maturity
b. Renal output
c. Body temperature
d. Height
a. Organ maturity
32
The nurse recognizes that an elderly patient may experience a reduction in the stomach’s ability to produce hydrochloric acid. This
change may result in which effect?
a. Delayed gastric emptying
b. Increased gastric acidity
c. Decreased intestinal absorption of medications
d. Altered absorption of some drugs
d. Altered absorption of some drugs
33
The nurse is administering drugs to neonates and will consider which factor may contribute the most to drug toxicity?
a. The lungs are immature.
b. The kidneys are small.
c. The liver is not fully developed.
d. Excretion of the drug occurs quickly.
c. The liver is not fully developed.
34
An 83-year-old woman has been given a thiazide diuretic to treat heart failure. She and her daughter should be told to watch for
which problems?
a. Constipation and anorexia
b. Fatigue, leg cramps, and dehydration
c. Daytime sedation and lethargy
d. Edema, nausea, and blurred vision
b. Fatigue, leg cramps, and dehydration
35
An elderly patient with a new diagnosis of hypertension will be receiving a new prescription for an antihypertensive drug. The
nurse expects which type of dosing to occur with this drug therapy?
a. Drug therapy will be based on the patient’s weight.
b. Drug therapy will be based on the patient’s age.
c. The patient will receive the maximum dose that is expected to reduce the blood
pressure.
d. The patient will receive the lowest possible dose at first, and then the dose will be
increased as needed.
d. The patient will receive the lowest possible dose at first, and then the dose will be
increased as needed.
36
The nurse is trying to give a liquid medication to a 2 1
2 -year-old child and notes that the medication has a strong taste. Which
technique is the best way for the nurse to give the medication to this child?
a. Give the medication with a spoonful of ice cream.
b. Add the medication to the child’s bottle.
c. Tell the child you have candy for him.
d. Add the medication to a cup of milk.
a. Give the medication with a spoonful of ice cream.
37
The nurse is preparing to give an injection to a 4-year-old child. Which intervention is age appropriate for this child?
a. Give the injection without any advanced preparation.
b. Give the injection, and then explain the reason for the procedure afterward.
c. Offer a brief, concrete explanation of the procedure at the patient’s level and with
the parent or caregiver present.
d. Prepare the child in advance with details about the procedure without the parent
or caregiver present.
c. Offer a brief, concrete explanation of the procedure at the patient’s level and with
the parent or caregiver present.
38
Which statements are true regarding pediatric patients and pharmacokinetics? (Select all that apply.)
a. The levels of microsomal enzymes are decreased.
b. Perfusion to the kidneys may be decreased and may result in reduced renal
function.
c. First-pass elimination is increased because of higher portal circulation.
d. First-pass elimination is reduced because of the immaturity of the liver.
e. Total body water content is much less than in adults.
f. Gastric emptying is slowed because of slow or irregular peristalsis.
g. Gastric emptying is more rapid because of increased peristaltic activity.
a. The levels of microsomal enzymes are decreased.
b. Perfusion to the kidneys may be decreased and may result in reduced renal
function.
d. First-pass elimination is reduced because of the immaturity of the liver.
f. Gastric emptying is slowed because of slow or irregular peristalsis.
39
Which statements are true regarding the elderly and pharmacokinetics? (Select all that apply.)
a. The levels of microsomal enzymes are decreased.
b. Fat content is increased because of decreased lean body mass.
c. Fat content is decreased because of increased lean body mass.
d. The number of intact nephrons is increased.
e. The number of intact nephrons is decreased.
f. Gastric pH is less acidic.
g. Gastric pH is more acidic.
a. The levels of microsomal enzymes are decreased.
b. Fat content is increased because of decreased lean body mass.
e. The number of intact nephrons is decreased.
f. Gastric pH is less acidic.
40
A 7-year-old child will be receiving amoxicillin (Amoxil) 50 mg/kg/day in two divided doses. The child weighs 55 pounds. The
medication, once reconstituted, is available as an oral suspension of 125 mg/5 mL. Identify how many milliliters will the child
receive per dose. _______
25 mL per dose
Convert pounds to kilograms: 55 pounds = 25 kg.
25 kg × 50 mg/kg/day = 1250 mg/day
To get the amount per dose, divide 1250 by 2, which equals 625 mg/dose.
To calculate the milliliters:
125 mg:5 mL :: 625 mg:x mL
(125 × x) = (5 × 625); 125x = 3125; x = 25 mL/dose
41
The nurse is reviewing medication errors. Which situation is an example of a medication error?
a. A patient refuses her morning medications.
b. A patient receives a double dose of a medication because the nurse did not cut the
pill in half.
c. A patient develops hives after having started an IV antibiotic 24 hours earlier.
d. A patient complains of severe pain still present 60 minutes after a pain medication
was given.
b. A patient receives a double dose of a medication because the nurse did not cut the
pill in half.
42
The nurse is reviewing a list of verbal medication orders. Which is the proper notation of the dose of the drug ordered?
a. Levothyroxine.75 mg
b. Levothyroxine.750 mg
c. Levothyroxine 0.75 mg
d. Levothyroxine 0.750 mg
c. Levothyroxine 0.75 mg
43
When given a scheduled morning medication, the patient states, “I haven’t seen that pill before. Are you sure it’s correct?” The
nurse checks the medication administration record and verifies that it is listed. Which is the nurse’s best response?
a. “It’s listed here on the medication sheet, so you should take it.”
b. “Go ahead and take it, and then I’ll check with your doctor about it.”
c. “It wouldn’t be listed here if it were not ordered for you!”
d. “Let me check on the order first before you take it.”
d. “Let me check on the order first before you take it.”
44
During a period of time when the computerized medication order system was down, the prescriber wrote admission orders, and the
nurse is transcribing them. The nurse is having difficulty transcribing one order because of the prescriber’s handwriting. Which is
the best action for the nurse to take at this time?
a. Ask a colleague what the order says.
b. Contact the prescriber to clarify the order.
c. Wait until the prescriber makes rounds again to clarify the order.
d. Ask the patient what medications he takes at home.
b. Contact the prescriber to clarify the order.
45
When taking a telephone order for a medication, which action by the nurse is most appropriate?
a. Verify the order with the charge nurse.
b. Call back the prescriber to review the order.
c. Repeat the order to the prescriber before hanging up the telephone.
d. Ask the pharmacist to double-check the order.
c. Repeat the order to the prescriber before hanging up the telephone.
46
During morning medication administration, the nurse discovered an error on the electronic MAR before the medication was given.
Which action by the nurse is appropriate for this “near-miss?”
a. Correct the MAR error but say nothing because nothing happened.
b. Notify the pharmacy about the error they almost caused.
c. Report the near-miss using the facility’s recommended protocol, and correct the
error on the MAR.
d. Report the near-miss to the next shift before the next dose is due.
c. Report the near-miss using the facility’s recommended protocol, and correct the
error on the MAR
47
When reviewing pediatric medication administration, the nurse recognizes that which type of medication error is most common
with children?
a. Oral medication administration errors
b. Wrong route errors
c. Incorrect dosage form errors
d. Dosing errors
d. Dosing errors
48
The nurse can prevent medication errors by following which principles? (Select all that apply.)
a. Assess for allergies after giving medications.
b. Use two patient identifiers before giving medications.
c. Always following the rights of medication administration.
d. Minimize the use of verbal and telephone orders.
e. Use trade names instead of generic names to avoid confusion.
b. Use two patient identifiers before giving medications.
c. Always following the rights of medication administration.
d. Minimize the use of verbal and telephone orders.
49
Levothyroxine is available in 75-mcg tablet form. Convert this dose to milligram strength. (do not round) _______
0.075 mg
One mg equals 1000 mcg. To convert 75 mcg to mg, divide 75 by 1000 to equal 0.075 mg, or move the decimal point to the left
three spaces. Do not forget to include the leading zero in front of the decimal point.
50
Digoxin is available in 0.125-mg tablet form. Convert this dose to microgram strength. (do not round) _______
ANS:
125 mcg
One mg equals 1000 mcg. To convert 0.125 mg to mcg, multiply by 1000 to equal 125 mcg, or move the decimal point to the right
three spaces.
51
The nurse is reviewing the teaching plan for a clinic patient who was seen for a sinus infection. Which of these outcomes reflect the
affective domain of learning?
a. The patient will take the prescribed antibiotic for the full 14 days of the
prescription.
b. The patient will demonstrate correct nasal spray self-administration.
c. The patient will list signs and symptoms that need to be reported immediately if
they occur.
d. The patient will list measures to take to reduce allergy triggers at home.
a. The patient will take the prescribed antibiotic for the full 14 days of the
prescription.
52
The nurse is developing a care plan for a patient who will be self-administering a metered-dose inhaler. Which statement reflects a
measurable outcome?
a. The patient will know about self-administration of a metered-dose inhaler.
b. The patient will understand the principles of self-administration of a metered-dose
inhaler.
c. The patient will demonstrate the proper technique of self-administering a
metered-dose inhaler.
d. The patient will comprehend the proper technique of self-administering a
metered-dose inhaler.
c. The patient will demonstrate the proper technique of self-administering a
metered-dose inhaler.
53
During a nursing assessment, which question by the nurse allows for greater clarification and additional discussion with the
patient?
a. “Are you allergic to penicillin?”
b. “What medications do you take?”
c. “Have you had a reaction to this drug?”
d. “Are you taking this medication with meals?”
b. “What medications do you take?”
54
The nurse is setting up a teaching session with an 85-year-old patient who will be going home on anticoagulant therapy. Which
educational strategy would reflect consideration of the age-related changes that may exist with this patient?
a. Show a video about anticoagulation therapy.
b. Present all the information in one session just before discharge.
c. Give the patient pamphlets about the medications to read at home.
d. Develop large-print handouts that reflect the verbal information presented.
d. Develop large-print handouts that reflect the verbal information presented.
55
When the nurse teaches a skill such as self-injection of insulin to the patient, what is the best way to set up the teaching/learning
session?
a. Provide written pamphlets for instruction.
b. Show a video, and allow the patient to practice as needed on his own.
c. Verbally explain the procedure, and provide written handouts for reinforcement.
d. After demonstrating the procedure, allow the patient to do several return
demonstrations.
d. After demonstrating the procedure, allow the patient to do several return
demonstrations.
56
A patient with a new prescription for a diuretic has just reviewed with the nurse how to include more potassium in her diet. This
reflects learning in which domain?
a. Cognitive
b. Affective
c. Physical
d. Psychomotor
a. Cognitive
57
During an admission assessment, the nurse discovers that the patient does not speak English. Which is considered the ideal resource
for translation?
a. A family member of the patient
b. A close family friend of the patient
c. A translator who does not know the patient
d. Prewritten note cards with both English and the patient’s language
c. A translator who does not know the patient
58
A 60-year-old patient is on several new medications and expresses worry that she will forget to take her pills. Which action by the
nurse would be most helpful in this situation?
a. Teaching effective coping strategies
b. Asking the patient’s prescriber to reduce the number of drugs prescribed
c. Assuring the patient that she will not forget once she is accustomed to the routine
d. Assisting the patient with obtaining and learning to use a calendar or pill
container
d. Assisting the patient with obtaining and learning to use a calendar or pill
container
59
Which are appropriate considerations when the nurse is assessing the learning needs of a patient? (Select all that apply.)
a. Cultural background
b. Family history
c. Level of education
d. Readiness to learn
e. Health beliefs
a. Cultural background
c. Level of education
d. Readiness to learn
e. Health beliefs
60
The nurse is teaching an older patient about the use of an incentive spirometer after surgery. Which of these age-related changes are
appropriate for the nurse to consider when teaching older patients? (Select all that apply.)
a. Decreased sense of touch
b. Increased conduction of sound
c. Decreased cognitive function
d. Decreased short-term memory
e. Increased ability to concentrate
a. Decreased sense of touch
c. Decreased cognitive function
d. Decreased short-term memory
61
A patient is to receive prednisone 7.5 mg PO daily. The tablets are available in a 2.5-mg strength. Identify how many tablets will
the patient receive. _______
ANS:
3 tablets
1 tablet:2.5 mg :: x tablet:7.5 mg.
(1 × 7.5) = (2.5 × x); 7.5 = 2.5x; x = 3; therefore 7.5 mg = 3 tablets.
62
A 25-year-old woman is visiting the prenatal clinic and shares with the nurse her desire to go “natural” with her pregnancy. She
shows the nurse a list of herbal remedies that she wants to buy so that she can “avoid taking any drugs.” Which statement by the
nurse is correct?
a. “Most herbal remedies are not harmful and are safe for use during pregnancy.”
b. “Please read each label carefully before use to check for cautionary warnings.”
c. “Keep in mind that products from different manufacturers are required to contain
consistent amounts of the herbal products.”
d. “It’s important to remember that herbal remedies do not have proven safety
ratings for pregnant women.”
d. “It’s important to remember that herbal remedies do not have proven safety
ratings for pregnant women.”
63
The nurse is giving a lecture about current U.S. laws and regulations of herbal products. According to the Dietary Supplement and
Health Education Act of 1994, which statement is true?
a. Medicinal herbs are viewed as dietary supplements.
b. Herbal remedies are held to the same standards as drugs.
c. Producers of herbal products must prove therapeutic efficacy.
d. Herbal remedies are protected by patent laws.
a. Medicinal herbs are viewed as dietary supplements.
64
The patient wants to take the herbal product kava to help him rest at night. The nurse would be concerned about potential
interactions if he is taking a medication from which class of drugs?
a. Digitalis
b. Anticoagulants
c. Sedatives
d. Immunosuppressants
c. Sedatives
65
The patient has been taking an over-the-counter (OTC) acid-reducing drug because he has had “stomach problems” for several
months. He tells the nurse that the medicine helps as long as he takes it, but once he stops it, the symptoms return. Which statement
by the nurse is the best advice for this patient?
a. “The over-the-counter drug has helped you, so you should continue to take it.”
b. “The over-the-counter dosage may not be strong enough. You should be taking
prescription-strength for best effects.”
c. “For best results, you need to watch what you eat in addition to taking this drug.”
d. “Using this drug may relieve your symptoms, but it does not address the cause.
Please make an appointment with your health care provider.”
d. “Using this drug may relieve your symptoms, but it does not address the cause.
Please make an appointment with your health care provider.”
66
During an assessment, the patient tells the nurse that he eats large amounts of garlic for its cardiovascular benefits. Which drug or
drug class, if taken, would have a potential interaction with the garlic?
a. Acetaminophen (Tylenol)
b. Insulin
c. Antilipemic drugs
d. Sedatives
b. Insulin
67
A patient calls the clinic to ask about taking cranberry dietary supplement capsules because a friend recommended them. The nurse
will discuss which possible concern when a patient is taking cranberry supplements?
a. It may increase the risk for bleeding if the patient is taking anticoagulants.
b. It may increase the risk of toxicity of some psychotherapeutic drugs.
c. It may reduce elimination of drugs that are excreted by the kidneys.
d. Cranberry may increase the intensity and duration of effects of caffeine.
c. It may reduce elimination of drugs that are excreted by the kidneys.
68
A patient wants to take the herb gingko to help his memory. The nurse reviews his current medication list and would be concerned
about potential interactions if he is taking a medication from which class of drugs?
a. Digitalis
b. Antiplatelet drugs
c. Sedatives
d. Immunosuppressants
b. Antiplatelet drugs
69
The nurse is conducting a class for senior citizens about the use of over-the-counter (OTC) drugs. Which statements are true
regarding the use of OTC drugs? (Select all that apply.)
a. Use of OTC drugs may delay treatment of serious ailments.
b. Drug interactions with OTC medications are rare.
c. OTC drugs may relieve symptoms without addressing the cause of the problem.
d. OTC drugs are indicated for long-term treatment of conditions.
e. Patients may misunderstand product labels and use the drugs improperly.
a. Use of OTC drugs may delay treatment of serious ailments.
c. OTC drugs may relieve symptoms without addressing the cause of the problem.
e. Patients may misunderstand product labels and use the drugs improperly.
70
The nurse is reviewing the criteria for over-the-counter drugs. Which criteria for over-the-counter status in the United States are
accurate? (Select all that apply.)
a. The drug must be easy to use.
b. The drug must have a low therapeutic index.
c. The consumer must be able to monitor the drug’s effectiveness.
d. The drug must have a low potential for abuse.
e. The drug must not have any interactions with other drugs.
a. The drug must be easy to use.
c. The consumer must be able to monitor the drug’s effectiveness.
e. The drug must not have any interactions with other drugs.
71
A patient with a PEG tube is to receive ferrous sulfate, 65 mg per the tube, daily. The medication is available as an elixir, 220 mg/5
mL. How many milliliters will the patient receive per dose? Record your answer using one decimal place.
ANS:
1.5 mL
220 mg:5 mL :: 65 mg:x mL
(220 × x) = (5 × 65); 220x = 325; x = 1.477 which rounds to 1.5 mL/dose
72
Before administering any medication, what is the nurse’s priority action regarding patient safety?
a. Verifying orders with another nurse
b. Documenting the medications given
c. Counting medications in the medication cart drawers
d. Checking the patient’s identification using two identifiers
d. Checking the patient’s identification using two identifiers
73
A patient is to receive a penicillin intramuscular (IM) injection in the ventrogluteal site. The nurse will use which angle for the
needle insertion?
a. 15 degrees
b. 45 degrees
c. 60 degrees
d. 90 degrees
d. 90 degrees
74
When administering medication by IV bolus (push), the nurse will occlude the IV line by which method?
a. Not pinching the IV tubing at all
b. Pinching the tubing just above the injection port
c. Pinching the tubing just below the injection port
d. Pinching the tubing just above the drip chamber of the infusion set
b. Pinching the tubing just above the injection port
75
The nurse has an order to administer an intramuscular (IM) immunization to a 2-month-old child. Which site is considered the best
choice for this injection?
a. Deltoid
b. Dorsogluteal
c. Ventrogluteal
d. Vastus lateralis
d. Vastus lateralis
76
The nurse needs to administer insulin subcutaneously to an obese patient. Which is the proper technique for this injection?
a. Using the Z-track method
b. Inserting the needle at a 5- to 15-degree angle until resistance is felt
c. Pinching the skin at the injection site, and then inserting the needle to below the
tissue fold at a 90-degree angle
d. Spreading the skin tightly over the injection site, inserting the needle, and then
releasing the skin
c. Pinching the skin at the injection site, and then inserting the needle to below the
tissue fold at a 90-degree angle
77
The nurse will plan to use the Z-track method of intramuscular (IM) injections for which situation?
a. The medication is known to be irritating to tissues.
b. The patient is emaciated and has very little muscle mass.
c. The medication must be absorbed quickly into the tissues.
d. The patient is obese and has a deep fat layer below the muscle mass.
a. The medication is known to be irritating to tissues.
78
After administering an intradermal (ID) injection for a skin test, the nurse notices a small bleb at the injection site. Which of these
is the best action for the nurse to take at this time?
a. Apply heat.
b. Massage the area.
c. Do nothing.
d. Report the bleb to the physician.
c. Do nothing.
79
The nurse is administering an IV push medication through an IV lock. After injecting the medication, which action will be taken
next?
a. Flushing the lock
b. Regulating the IV flow
c. Clamping the tubing for 10 minutes
d. Holding the patient’s arm up to improve blood flow
a. Flushing the lock
80
When adding medications to a bag of intravenous (IV) fluid, the nurse will use which method to mix the solution?
a. Shaking the bag or bottle vigorously
b. Turning the bag or bottle gently from side to side
c. Inverting the bag or bottle one time after injecting the medication
d. Allowing the IV solution to stand for 10 minutes to enhance even distribution of
medication
b. Turning the bag or bottle gently from side to side
81
The nurse is measuring 4 mL of a liquid cough elixir for a child. Which method is most appropriate?
a. Using a teaspoon to measure and administer
b. Holding the medication cup at eye level and filling it to the desired level
c. Withdrawing the elixir from the container using a syringe without a needle
attached
d. Withdrawing the elixir from the container using a calibrated oral syringe
d. Withdrawing the elixir from the container using a calibrated oral syringe
82
While the nurse is assisting a patient in taking his medications, the medication cup falls to the floor, spilling the tablets. What is the
nurse’s best action at this time?
a. Discarding the medications and repeating preparation
b. Asking the patient if he will take the medications
c. Waiting until the next dose time, and then giving the medications
d. Retrieving the medications and administering them to avoid waste
a. Discarding the medications and repeating preparation
83
When giving a buccal medication to a patient, which action by the nurse is appropriate?
a. Encouraging the patient to swallow, if necessary
b. Administering water after the medication has been given
c. Placing the medication between the upper or lower molar teeth and the cheek
d. Placing the tablet under the patient’s tongue and allowing it to dissolve
completely
c. Placing the medication between the upper or lower molar teeth and the cheek
84
The nurse is giving liquid medications through a percutaneous endoscopic gastrostomy (PEG) tube. Which technique is correct?
a. Administering the medications using a 3-mL medication syringe
b. Applying firm pressure on the syringe’s piston to infuse the medication
c. Flushing the tubing with 30 mL of saline after the medication has been given
d. Using the barrel of the syringe, allowing the medication to flow via gravity into
the tube
d. Using the barrel of the syringe, allowing the medication to flow via gravity into
the tube
85
The nurse is about to give a rectal suppository to a patient. Which technique would facilitate the administration and absorption of
the rectal suppository?
a. Having the patient lie on his or her right side, unless contraindicated
b. Having the patient hold his or her breath during insertion of the medication
c. Lubricating the suppository with a small amount of petroleum-based lubricant
before insertion
d. Encouraging the patient to lie on his or her left side for 15 to 20 minutes after
insertion
d. Encouraging the patient to lie on his or her left side for 15 to 20 minutes after
insertion
86
A patient is receiving eyedrops that contain a beta-blocker medication. The nurse will use what method to reduce systemic effects
after administering the eyedrops?
a. Wiping off excess liquid immediately after instilling the drops
b. Having the patient close the eye tightly after the drops are instilled
c. Having the patient try to keep the eye open for 30 seconds after the drops are
instilled
d. Applying gentle pressure to the patient’s nasolacrimal duct for 30 to 60 seconds
after instilling the drops
d. Applying gentle pressure to the patient’s nasolacrimal duct for 30 to 60 seconds
after instilling the drops
87
A 2-year-old child is to receive eardrops. The nurse is teaching the parent about giving the eardrops. Which statement reflects the
proper technique for administering eardrops to this child?
a. Administer the drops without pulling on the ear lobe.
b. Straighten the ear canal by pulling the lobe upward and back.
c. Straighten the ear canal by pulling the pinna down and back.
d. Straighten the ear canal by pulling the pinna upward and outward.
c. Straighten the ear canal by pulling the pinna down and back.
88
A patient with asthma is to begin medication therapy using a metered-dose inhaler. What is an important reminder to include during
teaching sessions with the patient?
a. Repeat subsequent puffs, if ordered, after 5 minutes.
b. Inhale slowly while pressing down to release the medication.
c. Inhale quickly while pressing down to release the medication.
d. Administer the inhaler while holding it 3 to 4 inches away from the mouth.
b. Inhale slowly while pressing down to release the medication.
89
When giving medications, the nurse will use Standard Precautions, which include what action?
a. Bending the needle to prevent reuse
b. Recapping needles to prevent needle sticks
c. Discarding all syringes and needles in the trash can
d. Discarding all syringes and needles in a puncture-resistant container
d. Discarding all syringes and needles in a puncture-resistant container
90
A patient says he prefers to chew rather than swallow his pills. One of the pills has the abbreviation SR behind the name of the
medication. The nurse needs to remember which correct instruction regarding how to give this medication?
a. Break the tablet into halves or quarters.
b. Dissolve the tablet in a small amount of water before giving it.
c. Do not crush or break the tablet before administration.
d. Crush the tablet as needed to ease administration.
c. Do not crush or break the tablet before administration.
91
When administering nasal spray, which instruction by the nurse is appropriate?
a. “You will need to blow your nose before I give this medication.”
b. “You will need to blow your nose after I give this medication.”
c. “When I give this medication, you will need to hold your breath.”
d. “You need to sit up for 5 minutes after you receive the nasal spray.”
a. “You will need to blow your nose before I give this medication.”
92
The nurse is preparing to give an aqueous intramuscular (IM) injection to an average-sized adult. Which actions are appropriate?
(Select all that apply.)
a. Choose a 26- or 27-gauge, 1/4- to 1/2-inch needle.
b. Choose a 20- to 25-gauge, 1- to 1 1/2-inch needle.
c. Choose the dorsogluteal site, the preferred site for IM injections for adults.
d. Insert the needle at a 45-degree angle.
e. Insert the needle at a 90-degree angle.
f. Before injecting the medication, withdraw the plunger to check for blood return.
b. Choose a 20- to 25-gauge, 1- to 1 1/2-inch needle.
e. Insert the needle at a 90-degree angle.
f. Before injecting the medication, withdraw the plunger to check for blood return.
93
A patient is to receive hydromorphone (Dilaudid) 1.5 mg IV push now. The medication comes in a prefilled syringe, 2 mg/mL.
Identify how many milliliters the nurse will administer for this dose. _______
ANS:
0.75 mL
2 mg:1 mL :: 1.5 mg:x mL
(2 × x) = (1 × 1.5); 2x = 1.5; x = 0.75; administer 0.75 mL
94
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?
a. Acute pain
b. Chronic pain
c. Somatic pain
d. Neuropathic pain
b. Chronic pain
95
A 16-year-old field hockey player fell and twisted her ankle during a game. The nurse will expect to administer which type of
analgesic?
a. Synthetic opioid, such as meperidine (Demerol)
b. Opium alkaloid, such as morphine sulfate
c. Opioid antagonist, such as naloxone HCL (Narcan)
d. Nonopioid analgesics, such as indomethacin (Indocin)
d. Nonopioid analgesics, such as indomethacin (Indocin)
96
A patient had abdominal surgery this morning. The patient is groggy but complaining of severe pain around the incision. What is
the most important assessment data to consider before the nurse administers a dose of morphine sulfate to the patient?
a. The patient’s pulse rate
b. The patient’s respiratory rate
c. The appearance of the incision
d. The date of the patient’s last bowel movement
b. The patient’s respiratory rate
97
A 78-year-old patient is in the recovery room after having a lengthy surgery on his hip. As he is gradually awakening, he requests
pain medication. Within 10 minutes after receiving a dose of morphine sulfate, he is very lethargic and his respirations are shallow,
with a rate of 7 breaths/minute. The nurse prepares for which priority action at this time?
a. Assessment of the patient’s pain level
b. Immediate intubation and artificial ventilation
c. Administration of naloxone (Narcan)
d. Close observation of signs of opioid tolerance
c. Administration of naloxone (Narcan)
98
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?
a. How to prevent dehydration due to diarrhea
b. The importance of taking the drug only when the pain becomes severe
c. How to prevent constipation
d. The importance of taking the drug on an empty stomach
c. How to prevent constipation
99
A patient has been treated for lung cancer for 3 years. Over the past few months, the patient has noticed that the opioid analgesic is
not helping as much as it had previously and more medication is needed for the same pain relief. The nurse is aware that this patient
is experiencing which of these?
a. Opioid addiction
b. Opioid tolerance
c. Opioid toxicity
d. Opioid abstinence syndrome
b. Opioid tolerance
100
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?
a. Tachycardia
b. Central nervous system depression
c. Hepatic necrosis
d. Nephropathy
c. Hepatic necrosis
101
A 57-year-old woman being treated for end-stage breast cancer has been using a transdermal opioid analgesic as part of the
management of pain. Lately, she has been experiencing breakthrough pain. The nurse expects this type of pain to be managed by
which of these interventions?
a. Administering NSAIDs
b. Administering an immediate-release opioid
c. Changing the opioid route to the rectal route
d. Making no changes to the current therapy
b. Administering an immediate-release opioid
102
The nurse is reviewing herbal therapies. Which is a common use of the herb feverfew?
a. Muscle aches
b. Menstrual cramps
c. Joint pain
d. Incision pain after surgery
b. Menstrual cramps
103
A patient is to receive acetylcysteine (Mucomyst) as part of the treatment for an acetaminophen (Tylenol) overdose. Which action
by the nurse is appropriate when giving this medication?
a. Giving the medication undiluted for full effect
b. Avoiding the use of a straw when giving this medication
c. Disguising the flavor with soda or flavored water
d. Preparing to give this medication via a nebulizer
c. Disguising the flavor with soda or flavored water
104
A patient is receiving gabapentin (Neurontin), an anticonvulsant, but has no history of seizures. The nurse expects that the patient is
receiving this drug for which condition?
a. Inflammation pain
b. Pain associated with peripheral neuropathy
c. Depression associated with chronic pain
d. Prevention of seizures
b. Pain associated with peripheral neuropathy
105
The nurse is assessing a patient who has been admitted to the emergency department for a possible opioid overdose. Which
assessment finding is characteristic of an opioid drug overdose?
a. Dilated pupils
b. Restlessness
c. Respiration rate of 6 breaths/min
d. Heart rate of 55 beats/min
c. Respiration rate of 6 breaths/min
106
The drug nalbuphine (Nubain) is an agonist-antagonist (partial agonist). The nurse understands that which is a characteristic of
partial agonists?
a. They have anti-inflammatory effects.
b. They are given to reverse the effects of opiates.
c. They have a higher potency than agonists.
d. They have a lower dependency potential than agonists.
d. They have a lower dependency potential than agonists.
107
The nurse is assessing a patient for contraindications to drug therapy with acetaminophen (Tylenol). Which patient should not
receive acetaminophen?
a. A patient with a fever of 101° F (38.3° C)
b. A patient who is complaining of a mild headache
c. A patient with a history of liver disease
d. A patient with a history of peptic ulcer disease
c. A patient with a history of liver disease
108
A patient arrives at the urgent care center complaining of leg pain after a fall when rock climbing. The radiographs show no broken
bones, but he has a large bruise on his thigh. The patient says he drives a truck and does not want to take anything strong because
he needs to stay awake. Which statement by the nurse is most appropriate?
a. “It would be best for you not to take anything if you are planning to drive your
truck.”
b. “We will discuss with your doctor about taking an opioid because that would
work best for your pain.”
c. “You can take acetaminophen, also known as Tylenol, for pain, but no more than
1000 mg per day.”
d. “You can take acetaminophen, also known as Tylenol, for pain, but no more than
3000 mg/day.”
d. “You can take acetaminophen, also known as Tylenol, for pain, but no more than
3000 mg/day.”
109
A patient is suffering from tendonitis of the knee. The nurse is reviewing the patient’s medication administration record and
recognizes that which adjuvant medication is most appropriate for this type of pain?
a. Antidepressant
b. Anticonvulsant
c. Corticosteroid
d. Local anesthesia
c. Corticosteroid
110
The opioid 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.)
a. Diarrhea
b. Constipation
c. Lightheadedness
d. Nervousness
e. Urinary retention
f. Itching
b. Constipation
c. Lightheadedness
e. Urinary retention
f. Itching
111
A patient is to receive methadone (Dolophine) 2.5 mg intramuscularly (IM) now. The medication is available in a concentration of
10 mg/mL. Identify how many milliliters of methadone will be drawn up for this dose. ______
ANS:
0.25 mL
10 mg: 1 mL:: 2.5 mg: 1 mL
(10 × x) = (2.5 × 1); 10x = 2.5; x = 0.25 mg
112
During a fishing trip, a patient pierced his finger with a large fishhook. He is now in the emergency department to have it removed.
The nurse anticipates that which type of anesthesia will be used for this procedure?
a. No anesthesia
b. Topical benzocaine spray on the area
c. Topical prilocaine/lidocaine (EMLA) cream around the site
d. Infiltration of the puncture wound with lidocaine
d. Infiltration of the puncture wound with lidocaine
113
While monitoring a patient who had surgery under general anesthesia 2 hours ago, the nurse notes a sudden elevation in body
temperature. This finding may be an indication of which problem?
a. Tachyphylaxis
b. Postoperative infection
c. Malignant hypertension
d. Malignant hyperthermia
d. Malignant hyperthermia
114
When assessing patients in the preoperative area, the nurse knows that which patient is at a higher risk for an altered response to
anesthesia?
a. The 21-year-old patient who has never had surgery before
b. The 35-year-old patient who stopped smoking 8 years ago
c. The 40-year-old patient who is to have a kidney stone removed
d. The 82-year-old patient who is to have gallbladder removal
d. The 82-year-old patient who is to have gallbladder removal
115
The nurse is caring for a patient who is on a ventilator for respiratory arrest. Which parenteral anesthetic is also used for sedation
during mechanical ventilation in ICU settings?
a. Ketamine
b. Midazolam (Versed)
c. Propofol (Diprivan)
d. Sevoflurane (Ultane)
c. Propofol (Diprivan)
116
When administering a neuromuscular blocking drug, the nurse needs to remember which principle?
a. It is used instead of general anesthesia during surgery.
b. Only skeletal muscles are paralyzed; respiratory muscles remain functional.
c. It causes sedation and pain relief while allowing for lower doses of anesthetics.
d. Artificial mechanical ventilation is required because of paralyzed respiratory
muscles.
d. Artificial mechanical ventilation is required because of paralyzed respiratory
muscles.
117
A patient is being prepared for an oral endoscopy, and the nurse anesthetist reminds him that he will be awake during the procedure
but probably will not remember it. What type of anesthetic technique is used in this situation?
a. Local anesthesia
b. Moderate sedation
c. Topical anesthesia
d. Spinal anesthesia
b. Moderate sedation
118
During the immediate postoperative period, the Post Anesthesia Care Unit nurse is assessing a patient who had hip surgery. The
patient is experiencing tachycardia, tachypnea, and muscle rigidity, and his temperature is 103° F (39.4° C). The nurse will prepare
for what immediate treatment?
a. Naltrexone hydrochloride (Narcan) injection, an opioid reversal drug
b. Dantrolene (Dantrium) injection, a skeletal muscle relaxant
c. An anticholinesterase drug, such as neostigmine
d. Cardiopulmonary resuscitation (CPR) and intubation
b. Dantrolene (Dantrium) injection, a skeletal muscle relaxant
119
The nurse is preparing to administer dexmedetomidine (Precedex) to a patient. Which is an appropriate indication for
dexmedetomidine? (Select all that apply.)
a. Procedural sedation
b. Surgeries of short duration
c. Surgeries of long duration
d. Postoperative anxiety
e. Sedation of mechanically ventilated patients
a. Procedural sedation
b. Surgeries of short duration
e. Sedation of mechanically ventilated patients
120
The nurse is reviewing the effects of inhaled and intravenous general anesthesia, which includes which of these? (Select all that
apply.)
a. Increased intracranial pressure
b. Increased glomerular filtration
c. CNS depression
d. Hypotension
e. Decreased hepatic clearance
a. Increased intracranial pressure
c. CNS depression
d. Hypotension
e. Decreased hepatic clearance
121
A patient is to receive midazolam (Versed) 2 mg IV push over 2 minutes just before an endoscopy procedure. The medication is
available in a strength of 1 mg/mL. Identify how many milliliters of medication will the nurse draw up into the syringe for this
dose. _______
ANS:
2 mL
1 mg:1 mL :: 2 mg:x mL
(1 × x) = (1 × 2); 1x = 2; x = 2
122
A patient who has received some traumatic news is panicking and asks for some medication to help settle down. The nurse
anticipates giving which drug that is most appropriate for this situation?
a. Diazepam (Valium)
b. Zolpidem (Ambien)
c. Phenobarbital
d. Cyclobenzaprine (Flexeril)
a. Diazepam (Valium)
123
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?
a. These are adverse effects that usually subside after a few weeks.
b. The drug must be stopped immediately because of possible adverse effects.
c. This drug causes the rapid eye movement (REM) sleep period to increase,
resulting in nightmares and restlessness.
d. This drug causes deprivation of REM sleep and may cause the inability to deal
with normal stress.
d. This drug causes deprivation of REM sleep and may cause the inability to deal
with normal stress.
124
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?
a. He took a multivitamin.
b. He drank a glass of wine.
c. He took a dose of aspirin.
d. He developed an allergy to the drug.
b. He drank a glass of wine.
125
A patient has been taking temazepam (Restoril) for intermittent insomnia. She calls the nurse to say that when she takes it, she
sleeps well, but the next day she feels “so tired.” Which explanation by the nurse is correct?
a. “Long-term use of this drug results in a sedative effect.”
b. “If you take the drug every night, this hangover effect will be reduced.”
c. “These drugs affect the sleep cycle, resulting in daytime sleepiness.”
d. “These drugs increase the activity of the central nervous system, making you tired
the next day.”
c. “These drugs affect the sleep cycle, resulting in daytime sleepiness.”
126
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?
a. Providing a quiet environment
b. Exercising before bedtime to become tired
c. Consuming heavy meals in the evening to promote sleepiness
d. Drinking hot tea or coffee just before bedtime
a. Providing a quiet environment
127
A patient is brought to the emergency department for treatment of a suspected overdose. The patient was found with an empty
prescription bottle of a barbiturate by his bedside. He is lethargic and barely breathing. The nurse would expect which immediate
intervention?
a. Starting an intravenous infusion of diluted bicarbonate solution
b. Administering medications to increase blood pressure
c. Implementing measures to maintain the airway and support respirations
d. Administrating naloxone (Narcan) as an antagonist
c. Implementing measures to maintain the airway and support respirations
128
Ramelteon (Rozerem) is prescribed for a patient with insomnia. The nurse checks the patient’s medical history, knowing that this
medication is contraindicated in which disorder?
a. Coronary artery disease
b. Renal insufficiency
c. Liver disease
d. Anemia
c. Liver disease
129
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. A musculoskeletal injury
b. Insomnia
c. Epilepsy
d. Agitation
a. A musculoskeletal injury
130
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?
a. Secobarbital (Seconal), a barbiturate
b. Diazepam (Valium), a benzodiazepine
c. Midazolam (Versed), a benzodiazepine
d. Eszopiclone (Lunesta), a nonbenzodiazepine sleep aid
d. Eszopiclone (Lunesta), a nonbenzodiazepine sleep aid
131
A patient tells the nurse that he likes to drink kava herbal tea to help him relax. Which statement by the patient indicates that
additional teaching about this herbal product is needed?
a. “I will not drink wine with the kava tea.”
b. “If I notice my skin turning yellow, I will stop taking the tea.”
c. “I will not take sleeping pills if I have this tea in the evening.”
d. “I will be able to drive my car after drinking this tea.”
d. “I will be able to drive my car after drinking this tea.”
132
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.)
a. Gout
b. Pregnancy
c. Epilepsy
d. Severe chronic obstructive pulmonary disease
e. Severe liver disease
f. Diabetes mellitus
b. Pregnancy
d. Severe chronic obstructive pulmonary disease
e. Severe liver disease
133
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.)
a. Antihistamines
b. Opioids
c. Diuretics
d. Anticoagulants
e. Oral contraceptives
f. Insulin
a. Antihistamines
b. Opioids
d. Anticoagulants
e. Oral contraceptives
134
A patient is about to receive pentobarbital (Nembutal) 100 mg IV as preoperative sedation. The medication is available in a
concentration of 50 mg/mL. How many milliliters will the patient receive for this dose?
ANS:
2 mL
50 mg:1 mL :: 100 mg:x mL
(50 × x) = (1 × 100); 50x = 100; x = 2 mL
135
A patient is receiving instructions regarding the use of caffeine. The nurse shares that caffeine should be used with caution if which
of these conditions is present?
a. A history of peptic ulcers
b. Migraine headaches
c. Asthma
d. A history of kidney stones
a. A history of peptic ulcers
136
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?
a. These are expected adverse effects that will eventually diminish.
b. The patient will need to stop this drug immediately if these adverse effects are
occurring.
c. The patient will need to increase her fat intake to prevent these adverse effects.
d. The patient will need to restrict fat intake to less than 30% of total calories to help
reduce these adverse effects.
d. The patient will need to restrict fat intake to less than 30% of total calories to help
reduce these adverse effects.
137
A 6-year-old boy has been started on an extended-release form of methylphenidate hydrochloride (Ritalin) for the treatment of
attention deficit hyperactivity disorder (ADHD). During a follow-up visit, his mother tells the nurse that she has been giving the
medication at bedtime so that it will be “in his system” when he goes to school the next morning. What is the nurse’s appropriate
evaluation of the mother’s actions?
a. She is giving him the medication dosage appropriately.
b. The medication should not be taken until he is at school.
c. The medication should be taken with meals for optimal absorption.
d. The medication should be given 4 to 6 hours before bedtime to diminish
insomnia.
d. The medication should be given 4 to 6 hours before bedtime to diminish
insomnia.
138
A 22-year-old nursing student has been taking NoDoz (caffeine) tablets for the past few weeks to “make it through” the end of the
semester and exam week. She is in the university clinic today because she is “exhausted.” What human needs statement may be
appropriate for her?
a. Altered oxygenation need
b. Altered physical activity
c. Altered need for sleep
d. Altered food intake
c. Altered need for sleep
139
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?
a. Eye examination
b. Height and weight
c. Liver function studies
d. Hearing test
b. Height and weight
140
When evaluating a patient who is taking orlistat (Xenical), which is an intended therapeutic effect?
a. Increased wakefulness
b. Increased appetite
c. Decreased weight
d. Decreased hyperactivity
c. Decreased weight
141
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?
a. “I will take this medication regularly to prevent a migraine headache from
occurring.”
b. “I will take this medication when I feel a migraine headache starting.”
c. “This medication will not reduce the number of migraines I will have.”
d. “I will keep a journal to record the headaches I have and how the injections are
working.”
a. “I will take this medication regularly to prevent a migraine headache from
occurring.”
142
The nurse is reviewing the use of central nervous system stimulants. Which of these are indications for this class of drugs? (Select
all that apply.)
a. Narcolepsy
b. Depression
c. Panic attacks
d. Neonatal apnea
e. Attention deficit hyperactivity disorder (ADHD)
f. Appetite suppression
a. Narcolepsy
d. Neonatal apnea
e. Attention deficit hyperactivity disorder (ADHD)
f. Appetite suppression
143
A patient has a new prescription for phentermine (Ionamin) as part of the treatment for weight loss. Which information will the
nurse include when teaching this patient about a stimulant such as phentermine? (Select all that apply.)
a. Take this medication after meals.
b. Take this medication in the morning.
c. This drug is taken along with supervised exercise and suitable diet.
d. Use mouth rinses, sugarless gum, or hard candies to minimize dry mouth.
e. Avoid foods that contain caffeine, such as coffee, tea, and colas.
b. Take this medication in the morning.
c. This drug is taken along with supervised exercise and suitable diet.
d. Use mouth rinses, sugarless gum, or hard candies to minimize dry mouth.
e. Avoid foods that contain caffeine, such as coffee, tea, and colas.
144
The order reads, “Give atomoxetine (Strattera) 0.5 mg/kg/day once daily in the morning before school.” The child weighs 88
pounds. Identify how many milligrams will be administered per dose. _______
ANS:
20 mg
88 pounds ÷ 2.2 = 40 kg
0.5 mg/kg/day × 40 kg = 20 mg/day
145
The nurse is reviewing the dosage schedule for several different antiepileptic drugs (AEDs). Which antiepileptic drug allows for
once-a-day dosing?
a. Levetiracetam (Keppra)
b. Phenobarbital
c. Valproic acid (Depakote)
d. Gabapentin (Neurontin)
b. Phenobarbital
146
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?
a. “I will need to take extra care of my teeth and gums while on this medication.”
b. “I can go out for a beer while on this medication.”
c. “I can skip doses if the side effects bother me.”
d. “I will be able to stop taking this drug once the seizures stop.”
a. “I will need to take extra care of my teeth and gums while on this medication.”
147
When teaching a patient about taking a newly prescribed antiepileptic drug (AED) at home, the nurse will include which
instruction?
a. “Driving is allowed after 2 weeks of therapy.”
b. “If seizures recur, take a double dose of the medication.”
c. “Antacids can be taken with the AED to reduce gastrointestinal adverse effects.”
d. “Take the drug at the same time every day.”
d. “Take the drug at the same time every day.”
148
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?
a. Give the same dose intravenously.
b. Give the morning dose with a small sip of water.
c. Contact the prescriber for another dosage form of the medication.
d. Notify the operating room that the medication has been withheld.
c. Contact the prescriber for another dosage form of the medication.
149
The nurse is monitoring a patient who has been taking carbamazepine (Tegretol) for 2 months. Which effects would indicate that
autoinduction has started to occur?
a. The drug levels for carbamazepine are higher than expected.
b. The drug levels for carbamazepine are lower than expected.
c. The patient is experiencing fewer seizures.
d. The patient is experiencing toxic effects from the drug.
b. The drug levels for carbamazepine are lower than expected.
150
The nurse is giving an intravenous dose of phenytoin (Dilantin). Which action is correct when administering this drug?
a. Give the dose as a fast intravenous (IV) bolus.
b. Mix the drug with normal saline, and give it as a slow IV push.
c. Mix the drug with dextrose (D5W), and give it as a slow IV push.
d. Mix the drug with any available solution as long as the administration rate is
correct.
b. Mix the drug with normal saline, and give it as a slow IV push.
151
The U.S. Food and Drug Administration has issued a warning for users of antiepileptic drugs. Based on this report, the nurse will
monitor for which potential problems with this class of drugs?
a. Increased risk of suicidal thoughts and behaviors
b. Signs of bone marrow depression
c. Indications of drug addiction and dependency
d. Increased risk of cardiovascular events, such as strokes
a. Increased risk of suicidal thoughts and behaviors
152
A patient is experiencing status epilepticus. The nurse prepares to give which drug of choice for the treatment of this condition?
a. Diazepam (Valium)
b. Midazolam (Versed)
c. Valproic acid (Depakote)
d. Carbamazepine (Tegretol)
a. Diazepam (Valium)
153
Phenytoin (Dilantin) has a narrow therapeutic index. The nurse recognizes that this characteristic indicates which of these?
a. The safe and the toxic plasma levels of the drug are very close to each other.
b. The phenytoin has a low chance of being effective.
c. There is no difference between safe and toxic plasma levels.
d. A very small dosage can result in the desired therapeutic effect.
a. The safe and the toxic plasma levels of the drug are very close to each other.
154
A patient has been taking an AED for several years as part of his treatment for focal seizures. His wife has called because he ran
out of medication this morning and wonders if he can go without it for a few days until she has a chance to go to the drugstore.
What is the nurse’s best response?
a. “He is taking another antiepileptic drug, so he can go without the medication for a
week.”
b. “Stopping this medication abruptly may cause withdrawal seizures. A refill is
needed right away.”
c. “He can temporarily increase the dosage of his other antiseizure medications until
you get the refill.”
d. “He can stop all medications because he has been treated for several years now.”
b. “Stopping this medication abruptly may cause withdrawal seizures. A refill is
needed right away.”
155
During a routine appointment, a patient with a history of seizures is found to have a phenytoin (Dilantin) level of 23 mcg/mL. What
concern will the nurse have, if any?
a. The patient is at risk for seizures because the drug level is not at a therapeutic
level.
b. The patient’s seizures should be under control because this is a therapeutic drug
level.
c. The patient’s seizures should be under control if she is also taking a second
antiepileptic drug.
d. The drug level is at a toxic level, and the dosage needs to be reduced.
d. The drug level is at a toxic level, and the dosage needs to be reduced.
156
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?
a. The medication is used for the treatment of neuropathic pain.
b. The medication is helpful for the treatment of multiple sclerosis.
c. The medication is used to reduce the symptoms of Parkinson’s disease.
d. The medical record is missing the correct information about the patient’s history
of seizures.
a. The medication is used for the treatment of neuropathic pain.
157
The nurse is reviewing antiepileptic drug (AED) therapy. Which statements about AED therapy are accurate? (Select all that
apply.)
a. AED therapy can be stopped when seizures are stopped.
b. AED therapy is usually lifelong.
c. Consistent dosing is the key to controlling seizures.
d. A dose may be skipped if the patient is experiencing adverse effects.
e. Abruptly stopping AEDs may cause rebound seizure activity.
b. AED therapy is usually lifelong.
c. Consistent dosing is the key to controlling seizures.
d. A dose may be skipped if the patient is experiencing adverse effects.
158
A 9-year-old child will be receiving carbamazepine (Tegretol) suspension, 200 mg twice daily. The medication is available in a
strength of 100 mg/5 mL. Identify how many milliliters the nurse will give to the patient for each dose. _______
ANS:
10 mL
100 mg:5 mL :: 200 mg:x mL
(100 × x) = (5 × 200); 100x = 1000; x = 10 mL
159
A patient has been taking selegiline (Eldepryl) for a few months, and recently the prescriber increased his dose to 20 mg/day.
Today, during his office visit, he tells the nurse that he forgot and had a beer with dinner last evening, and “felt awful.” What did
the patient most likely experience?
a. Hypotension
b. Hypertension
c. Urinary discomfort
d. Gastrointestinal upset
b. Hypertension
160
A patient has been given a prescription for levodopa-carbidopa (Sinemet) for a new diagnosis of Parkinson’s disease. The patient
asks the nurse, “Why are there two drugs in this pill?” The nurse’s best response reflects which fact?
a. Carbidopa allows for larger doses of levodopa to be given.
b. Carbidopa prevents the breakdown of levodopa in the periphery.
c. There are concerns about drug–food interactions with levodopa therapy that do
not exist with the combination therapy.
d. Carbidopa is the biologic precursor of dopamine and can penetrate into the central
nervous system.
b. Carbidopa prevents the breakdown of levodopa in the periphery.
161
When a patient is taking an anticholinergic such as benztropine (Cogentin) as part of the treatment for Parkinson’s disease, the
nurse should include which information in the teaching plan?
a. Minimize the amount of fluid taken while on this drug.
b. Discontinue the medication if adverse effects occur.
c. Take the medication on an empty stomach to enhance absorption.
d. Use artificial saliva, sugarless gum, or hard candy to counteract dry mouth.
d. Use artificial saliva, sugarless gum, or hard candy to counteract dry mouth.
162
A patient has been treated with antiparkinson medications for 3 months. What therapeutic responses should the nurse look for when
assessing this patient?
a. Decreased appetite
b. Gradual development of cogwheel rigidity
c. Newly developed dyskinesias
d. Improved ability to perform activities of daily living
d. Improved ability to perform activities of daily living
163
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?
a. Drowsiness, headache, weight loss
b. Dizziness, insomnia, nausea
c. Peripheral edema, fatigue, syncope
d. Heart palpitations, hypotension, urinary retention
d. Heart palpitations, hypotension, urinary retention
164
The nurse is assessing the medication history of a patient with a new diagnosis of Parkinson’s disease. Which condition is a
contraindication for the patient, who will be taking entacapone (Comtan)?
a. Glaucoma
b. Seizure disorder
c. Liver failure
d. Benign prostatic hyperplasia
c. Liver failure
165
The nurse is developing a care plan for a patient who is taking an anticholinergic drug. Which human needs statement would be
appropriate for this patient?
a. Altered gastrointestinal elimination (diarrhea)
b. Altered urinary elimination
c. Altered safety needs, risk for infection
d. Altered sleep needs
b. Altered urinary elimination
166
A patient who has been on levodopa therapy for a year has a new order for a catechol ortho-methyltransferase (COMT) inhibitor as
part of treatment for Parkinson’s disease. The nurse recognizes that which of these is an advantage of this drug class?
a. It has a shorter duration of action.
b. It causes less gastrointestinal distress.
c. It has a slower onset than traditional Parkinson’s disease drugs.
d. It reduces the wearing-off phenomenon.
d. It reduces the wearing-off phenomenon.
167
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?
a. This is a harmless effect of the drug.
b. The patient has taken this drug along with red wine or cheese.
c. The patient is having an allergic reaction to the drug.
d. The ordered dose is too high for this patient.
a. This is a harmless effect of the drug.
168
While a patient is receiving drug therapy for Parkinson’s disease, the nurse monitors for dyskinesia, which is manifested by which
finding?
a. Rigid, tense muscles
b. Difficulty in performing voluntary movements
c. Limp extremities with weak muscle tone
d. Confusion and altered mental status
b. Difficulty in performing voluntary movements
169
When treating patients with medications for Parkinson’s disease, the nurse knows that the wearing-off phenomenon occurs for
which reason?
a. There are rapid swings in the patient’s response to levodopa.
b. The patient cannot tolerate the medications at times.
c. The medications begin to lose effectiveness against Parkinson’s disease.
d. The patient’s liver is no longer able to metabolize the drug.
c. The medications begin to lose effectiveness against Parkinson’s disease.
170
When assessing the medication history of a patient with a new diagnosis of Parkinson’s disease, which conditions are
contraindications for the patient who will be taking carbidopa-levodopa? (Select all that apply.)
a. Angle-closure glaucoma
b. History of malignant melanoma
c. Hypertension
d. Benign prostatic hyperplasia
e. Concurrent use of monoamine oxidase inhibitors (MAOIs)
a. Angle-closure glaucoma
b. History of malignant melanoma
e. Concurrent use of monoamine oxidase inhibitors (MAOIs)
171
The prescriber writes this order, “Give amantadine (Symmetrel) 100 mg per PEG tube twice a day.” The medication is available in
a liquid form with a concentration 50 mg/5 mL. Identify how many milliliters the nurse will give with each dose. _______
ANS:
10 mL
50 mg:5 mL :: 100 mg:x mL
(50 × x) = (5 × 100); 50x = 500; x = 10 mL
172
The nurse reads in the patient’s medication history that the patient is taking buspirone (BuSpar). The nurse interprets that the
patient may have which disorder?
a. Anxiety disorder
b. Depression
c. Schizophrenia
d. Bipolar disorder
a. Anxiety disorder
173
Before beginning a patient’s therapy with selective serotonin reuptake inhibitor (SSRI) antidepressants, the nurse will assess for
concurrent use of which medications or medication class?
a. Aspirin
b. Anticoagulants
c. Diuretics
d. Nonsteroidal anti-inflammatory drugs
b. Anticoagulants
174
When a patient is receiving a second-generation antipsychotic drug, such as risperidone (Risperdal), the nurse will monitor for
which therapeutic effect?
a. Fewer panic attacks
b. Decreased paranoia and delusions
c. Decreased feeling of hopelessness
d. Improved tardive dyskinesia
b. Decreased paranoia and delusions
175
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?
a. Increased paranoia
b. Drowsiness and dizziness
c. Abnormal muscle movements
d. Dry mouth and constipation
c. Abnormal muscle movements
176
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?
a. “You can drink beer as long as you have a designated driver.”
b. “Now that you’ve been on the drug for 6 months, there will be no further dietary
restrictions.”
c. “If you begin to experience a throbbing headache, rapid pulse, or nausea, you’ll
need to stop drinking.”
d. “You need to avoid all foods that contain tyramine, including beer, while taking
this medication.”
d. “You need to avoid all foods that contain tyramine, including beer, while taking
this medication.”
177
A patient has been taking lithium for 1 year, and the most recent lithium level is 0.9 mEq/L. Which statement about the laboratory
result is correct?
a. The lithium level is therapeutic.
b. The lithium level is too low.
c. The lithium level is too high.
d. Lithium is not usually monitored with blood levels.
a. The lithium level is therapeutic.
178
A patient with the diagnosis of schizophrenia is hospitalized and is taking a phenothiazine drug. Which statement by this patient
indicates that he is experiencing a common adverse effect of phenothiazines?
a. “I can’t sleep at night.”
b. “I feel hungry all the time.”
c. “Look at how red my hands are.”
d. “My mouth has been so dry lately.”
d. “My mouth has been so dry lately.”
179
A patient has been taking the selective serotonin reuptake inhibitor (SSRI) sertraline (Zoloft) for about 6 months. At a recent visit,
she tells the nurse that she has been interested in herbal therapies and wants to start taking St. John’s wort. Which response by the
nurse is appropriate?
a. “That should be no problem.”
b. “Good idea! Hopefully you’ll be able to stop taking the Zoloft.”
c. “Be sure to stop taking the herb if you notice a change in side effects.”
d. “Taking St. John’s wort with Zoloft may cause severe interactions and is not
recommended.”
d. “Taking St. John’s wort with Zoloft may cause severe interactions and is not
recommended.”
180
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?
a. Hypertensive crisis
b. Self-injury or suicidal tendencies
c. Extrapyramidal symptoms
d. Loss of appetite
b. Self-injury or suicidal tendencies
181
A patient has been admitted to the emergency department with a suspected overdose of a tricyclic antidepressant. The nurse will
prepare for what immediate concern?
a. Hypertension
b. Renal failure
c. Cardiac dysrhythmias
d. Gastrointestinal bleeding
c. Cardiac dysrhythmias
182
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! The medicine is not working!” What is the nurse’s best response?
a. “The medication may not be effective for him. He may need to try another type.”
b. “It may take up to 6 weeks to notice any therapeutic effects. Let’s wait a little
longer to see how he does.”
c. “It sounds like the dose is not high enough. I’ll check about increasing the
dosage.”
d. “Some patients never recover from depression. He may not respond to this
therapy.”
b. “It may take up to 6 weeks to notice any therapeutic effects. Let’s wait a little
longer to see how he does.”
183
Clozapine (Clozaril), an atypical antipsychotic, is prescribed for a patient. The nurse will monitor for which adverse effect during
this drug therapy?
a. Edema
b. Photosensitivity
c. Hypotension
d. Severe neutropenia
d. Severe neutropenia
184
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?
a. Grapefruit juice
b. Fried eggs over-easy
c. Pepperoni pizza
d. Pancakes and maple syrup
c. Pepperoni pizza
185
A patient wants to take a ginseng dietary supplement. The nurse instructs the patient to look for which potential adverse effect?
a. Drowsiness
b. Palpitations and anxiety
c. Dry mouth
d. Constipation
b. Palpitations and anxiety
186
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?
a. SSRIs have fewer sexual side effects.
b. Unlike tricyclic antidepressants, SSRIs do not have drug–food interactions.
c. Tricyclic antidepressants cause serious cardiac dysrhythmias if an overdose
occurs.
d. SSRIs cause a therapeutic response faster than tricyclic antidepressants.
c. Tricyclic antidepressants cause serious cardiac dysrhythmias if an overdose
occurs.
187
A patient who has been taking a selective serotonin reuptake inhibitor (SSRI) states that he “felt awful” when he started taking an
over-the-counter St. John’s wort herbal product at home. The nurse suspects that he is experiencing serotonin syndrome. Which of
these are symptoms of serotonin syndrome? (Select all that apply.)
a. Agitation
b. Drowsiness
c. Tremors
d. Bradycardia
e. Sweating
a. Agitation
c. Tremors
e. Sweating
188
Which statements are true regarding the selective serotonin reuptake inhibitors (SSRIs)? (Select all that apply.)
a. Avoid foods and beverages that contain tyramine.
b. Monitor the patient for extrapyramidal symptoms.
c. Therapeutic effects may not be seen for about 4 to 6 weeks after the medication is
started.
d. If the patient has been on an MAOI, a 2- to 5-week or longer time span is required
before beginning an SSRI medication.
e. These drugs have anticholinergic effects, including constipation, urinary
retention, dry mouth, and blurred vision.
f. Cogentin is often also prescribed to reduce the adverse effects that may occur.
c. Therapeutic effects may not be seen for about 4 to 6 weeks after the medication is started.
d. If the patient has been on an MAOI, a 2- to 5-week or longer time span is required before beginning an SSRI medication.
189
A patient is to receive an intravenous dose of lorazepam (Ativan). The order reads, “Give lorazepam, 1 mg, IV push, now.” Identify
how many milliliters the nurse will administer for this dose. The medication vial contains 2 mg/mL. _______
ANS:
1 mL
2 mg:1 mL :: 2 mg:x mL
(2 × x) = 1 × 2); 2x = 2; x = 1 mL
190
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?
a. “It’s possible that these cravings will never stop.”
b. “These cravings may persist for several months.”
c. “The cravings tell us that you are still using nicotine.”
d. “The cravings show that you are about to experience nicotine withdrawal.”
b. “These cravings may persist for several months.”
191
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?
a. Diazepam (Valium)
b. Methadone
c. Disulfiram (Antabuse)
d. Bupropion (Zyban)
b. Methadone
192
A patient has been taking naltrexone (ReVia) as part of the treatment for addiction to heroin. The nurse expects that the naltrexone
will have which therapeutic effect for this patient?
a. Naltrexone prevents the cravings for opioid drugs.
b. Naltrexone works as a safer substitute for the heroin until the patient completes
withdrawal.
c. The patient will experience flushing, sweating, and severe nausea if he takes
heroin while on naltrexone.
d. If opioid drugs are used while taking naltrexone, euphoria is not produced; thus,
the opioid’s desired effects are lost.
d. If opioid drugs are used while taking naltrexone, euphoria is not produced; thus,
the opioid’s desired effects are lost.
193
The nurse is presenting a substance-abuse lecture for teenage girls and is asked about “roofies.” The nurse recognizes that this is
the slang term for which substance?
a. Cocaine
b. Flunitrazepam
c. Secobarbital
d. Methamphetamine
b. Flunitrazepam
194
A 29-year-old patient is admitted to the intensive care unit with the following symptoms: restlessness, hyperactive reflexes,
talkativeness, confusion and periods of panic, and tachycardia. The nurse suspects that he may be experiencing the effects of taking
which substance?
a. Opioids
b. Alcohol
c. Stimulants
d. Depressants
c. Stimulants
195
When admitting a patient with a suspected diagnosis of chronic alcohol use, the nurse will keep in mind that chronic use of alcohol
might result in which condition?
a. Renal failure
b. Cerebrovascular accident
c. Korsakoff’s psychosis
d. Alzheimer’s disease
c. Korsakoff’s psychosis
196
A patient is being treated for ethanol alcohol abuse in a rehabilitation center. The nurse will include which information when
teaching him about disulfiram (Antabuse) therapy?
a. He should not smoke cigarettes while on this drug.
b. He needs to know about the common over-the-counter substances that contain
alcohol.
c. This drug will cause the same effects as the alcohol did, without the euphoric
effects.
d. Mouthwashes and cough medicines that contain alcohol are safe because they are
used in small amounts.
b. He needs to know about the common over-the-counter substances that contain
alcohol.
197
The nurse is conducting a smoking-cessation program. Which statement regarding drugs used in cigarette-smoking-cessation
programs is true?
a. Rapid chewing of the nicotine gum releases an immediate dose of nicotine.
b. Quick relief from withdrawal symptoms is most easily achieved by using a
transdermal patch.
c. Compliance with treatment is higher with use of the gum rather than the
transdermal patch.
d. The nicotine gum can be used only up to six times per day.
a. Rapid chewing of the nicotine gum releases an immediate dose of nicotine.
198
A nurse is providing teaching for a patient who will be taking varenicline (Chantix) as part of a smoking-cessation program. Which
teaching points are appropriate for a patient taking this medication? (Select all that apply.)
a. This drug is available as a chewing gum that can be taken to reduce cravings.
b. Use caution when driving because drowsiness may be a problem.
c. There have been very few adverse effects reported for this drug.
d. Notify the prescriber immediately if feelings of sadness or thoughts of suicide
occur.
e. Avoid caffeine while on this drug.
b. Use caution when driving because drowsiness may be a problem.
d. Notify the prescriber immediately if feelings of sadness or thoughts of suicide
occur.
199
A patient has been taking disulfiram (Antabuse) as part of his rehabilitation therapy. However, this evening, he attended a party and
drank half a beer. As a result, he became ill and his friends took him to the emergency department. The nurse will look for which
adverse effects associated with acetaldehyde syndrome? (Select all that apply.)
a. Euphoria
b. Severe vomiting
c. Diarrhea
d. Pulsating headache
e. Difficulty breathing
f. Sweating
b. Severe vomiting
d. Pulsating headache
e. Difficulty breathing
f. Sweating
200
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.)
a. Agitation
b. Drowsiness
c. Tremors
d. Systolic blood pressure higher than 200 mm Hg
e. Temperature over 100° F (37.7° C)
f. Pulse rate 150 beats/min
a. Agitation
c. Tremors
d. Systolic blood pressure higher than 200 mm Hg
f. Pulse rate 150 beats/min
201
The nurse is aware that adrenergic drugs produce effects similar to which of these nervous systems?
a. Central nervous system
b. Somatic nervous system
c. Sympathetic nervous system
d. Parasympathetic nervous system
c. Sympathetic nervous system
202
When an adrenergic drug stimulates beta1-adrenergic receptors, the result is an increased force of contraction, which is known as
what type of effect?
a. Positive inotropic
b. Antiadrenergic
c. Negative chronotropic
d. Positive dromotropic
a. Positive inotropic
203
When a patient is taking an adrenergic agonist drug, the nurse expects to observe which effect?
a. Increased heart rate
b. Bronchial constriction
c. Constricted pupils
d. Increased intestinal peristalsis
a. Increased heart rate
204
An adrenergic agonist is ordered for a patient in shock. The nurse will note that this drug has had its primary intended effect if
which expected outcome occurs?
a. Volume restoration
b. Increased cardiac output
c. Decreased urine output
d. Reduced anxiety
b. Increased cardiac output
205
The nurse is administering a stat dose of epinephrine. Epinephrine is appropriate for which situation?
a. Severe hypertension
b. Angina
c. Cardiac arrest
d. Tachycardia
c. Cardiac arrest
206
A patient is on a low-dose dobutamine drip for heart failure. She had been feeling better but now has a sense of tightness in her
chest, palpitations, and a bit of anxiety. Her heart rate is up to 110 beats/min, and her blood pressure is 150/98 mm Hg (increased
from previous readings of 86 beats/min and 120/80 mm Hg). What is the nurse’s immediate concern for this patient?
a. She is experiencing normal adverse effects of dobutamine therapy.
b. She may be experiencing an allergic reaction to the dobutamine.
c. The medication may be causing a worsening of a preexisting cardiac disorder.
d. The dosage of the dobutamine needs to be increased to control the symptoms
better.
c. The medication may be causing a worsening of a preexisting cardiac disorder.
207
A 14-year-old patient has been treated for asthma for almost 4 months. Two weeks ago, she was given salmeterol as part of her
medication regimen. However, her mother has called the clinic to report that it does not seem to work when her daughter is having
an asthma attack. Which response by the nurse is appropriate?
a. “It takes time for a therapeutic response to develop.”
b. “She is too young for this particular medication; it will be changed.”
c. “She needs to take up to two puffs every 4 hours to ensure adequate blood levels.”
d. “This medication is indicated for prevention of bronchospasms, not for relief of
acute symptoms.”
d. “This medication is indicated for prevention of bronchospasms, not for relief of
acute symptoms.”
208
A hospitalized patient is experiencing a severe anaphylactic reaction to a dose of intravenous penicillin. Which drug will the nurse
expect to use to treat this condition?
a. Ephedra
b. Epinephrine
c. Phenylephrine
d. Pseudoephedrine
b. Epinephrine
209
The nurse recognizes that adrenergic drugs cause relaxation of the bronchi and bronchodilation by stimulating which type of
receptors?
a. Dopaminergic
b. Beta1 adrenergic
c. Beta2 adrenergic
d. Alpha1 adrenergic
c. Beta2 adrenergic
210
The nurse is preparing to administer dopamine. Which is the correct technique for administering dopamine?
a. Orally
b. Intravenous (IV) push injection
c. Intermittent IV infusions (IV piggyback)
d. Continuous IV infusion with an infusion pump
d. Continuous IV infusion with an infusion pump
211
The nurse is presenting information to a class of students about adrenergic drugs. Which are the effects of drugs that stimulate the
sympathetic nervous system? (Select all that apply.)
a. Dilation of bronchioles
b. Constriction of bronchioles
c. Decreased heart rate
d. Increased heart rate
e. Dilated pupils
f. Constricted pupils
g. Glycogenolysis
a. Dilation of bronchioles
d. Increased heart rate
e. Dilated pupils
g. Glycogenolysis
212
The nurse is to administer epinephrine 0.3 mg subcutaneously. The ampule contains 1 mL of medication and is labeled 1 mg/mL.
Identify how many milliliters of epinephrine the nurse will give. _______
ANS:
0.3 mL
1 mg:1 mL :: 0.3 mg:x mL
(1 × x) = (1 × 0.3); 1x = 0.3; x = 0.3; give 0.3 mL.
213
During therapy with a beta blocker, the patient notices that she has swollen feet, has gained 3 pounds within 2 days, feels short of
breath even when walking around the house, and has been dizzy. The nurse suspects that which of these is occurring?
a. The patient is experiencing an allergic reaction.
b. The patient may be developing heart failure.
c. More time is needed for the patient to see a therapeutic response to the drug.
d. The patient is experiencing expected adverse effects of the drug.
b. The patient may be developing heart failure.
214
A patient is going home with a new prescription for the beta-blocker atenolol (Tenormin). The nurse will include which content
when teaching the patient about this drug?
a. Never stop taking this medication abruptly.
b. The medication will be stopped once symptoms subside.
c. If adverse effects occur, stop taking the drug for 24 hours, and then resume.
d. Be watchful for first-dose hypotension.
a. Never stop taking this medication abruptly.
215
During rounds, the nurse notes that a dobutamine infusion has extravasated into the forearm of a patient. After stopping the
infusion, the nurse follows standing orders and immediately injects phentolamine (Regitine) subcutaneously in a circular fashion
around the extravasation site. What is the mechanism of action of the phentolamine in this situation?
a. It neutralizes the extravasated dobutamine immediately.
b. It causes arterial vasoconstriction and reduces pain and swelling at the site.
c. It increases peripheral vascular resistance and reduces arterial pressure at the site.
d. It increases blood flow to the ischemic site by vasodilation to prevent tissue
damage.
d. It increases blood flow to the ischemic site by vasodilation to prevent tissue
damage.
216
A 58-year-old man has had a myocardial infarction (MI), has begun rehabilitation, and is ready for discharge. He is given a
prescription for metoprolol (Lopressor) and becomes upset after reading the patient education pamphlet. “I don’t have high blood
pressure—why did my doctor give me this medicine?” Which explanation by the nurse is correct?
a. “This medication will prevent blood clots that may lead to another heart attack.”
b. “Beta blockers will improve blood flow to the kidneys.”
c. “This drug is prescribed to prevent the high blood pressure that often occurs after
a heart attack.”
d. “Studies have shown that this medication has greatly increased survival rates in
patients who have had a heart attack.”
d. “Studies have shown that this medication has greatly increased survival rates in
patients who have had a heart attack.”
217
The teaching for a patient who is taking tamsulosin (Flomax) to reduce urinary obstruction due to benign prostatic hyperplasia will
include which of these?
a. Fluids need to be restricted while on this medication.
b. Take the medication with breakfast to promote the maximum effects of the drug.
c. Get up slowly from a sitting or lying position.
d. Blood pressure must be monitored because the medication may cause
hypertension.
c. Get up slowly from a sitting or lying position.
218
The nurse is screening a patient who will be taking a nonspecific/nonselective beta blocker. Which condition, if present, may cause
serious problems if the patient takes this medication?
a. Angina
b. Hypertension
c. Glaucoma
d. Asthma
d. Asthma
219
A patient is experiencing Class II heart failure. The nurse expects which beta blocker to be ordered for this patient?
a. Atenolol (Tenormin)
b. Carvedilol (Coreg)
c. Labetalol (Normodyne)
d. Esmolol (Brevibloc)
b. Carvedilol (Coreg)
220
During a teaching session about self-monitoring while taking a beta blocker at home, the nurse has taught the patient to take his
apical pulse daily for 1 minute. If the pulse rate decreases to less than 60 beats/min, the nurse will instruct the patient to do which
of these?
a. Notify his prescriber.
b. Reduce the dose of his beta blocker by half.
c. Continue the medication because this is an expected effect.
d. Skip the medication dose that day, and check his pulse again the next day.
a. Notify his prescriber.
221
A 49-year-old patient is in the clinic for a follow-up visit 3 months after starting a beta blocker for treatment of hypertension.
During this visit, his blood pressure is 169/98 mm Hg, and he eventually confesses that he stopped taking this medicine 2 months
ago because of an “embarrassing problem.” What problem did the patient most likely experience with this medication that caused
him to stop taking it?
a. Urge incontinence
b. Dizziness when standing up
c. Excessive flatus
d. Impotence
d. Impotence
222
A patient has a new prescription for tamsulosin (Flomax) as treatment for benign prostatic hyperplasia. The nurse is checking his
current medication list and will contact the prescriber regarding a potential interaction if the patient is also taking which drug?
a. Levothyroxine (Synthroid) for hypothyroidism
b. Sildenafil (Viagra), an erectile dysfunction medication
c. Omeprazole (Prilosec), a proton pump inhibitor
d. Low-dose aspirin for stroke prevention
b. Sildenafil (Viagra), an erectile dysfunction medication
223
A patient is taking an alpha blocker as treatment for benign prostatic hyperplasia. The nurse will monitor for which potential drug
effect?
a. Orthostatic hypotension
b. Increased blood pressure
c. Decreased urine flow
d. Discolored urine
a. Orthostatic hypotension
224
A beta blocker is prescribed for a patient with angina. The nurse reviews the orders for other drugs that may interact with the beta
blocker. Which drugs or drug classes are known to have an interaction with a beta blocker? (Select all that apply.)
a. Diuretics
b. Anticholinergics
c. Penicillins
d. Oral hypoglycemics
e. Alcohol
f. Anticoagulants
a. Diuretics
b. Anticholinergics
d. Oral hypoglycemics
e. Alcohol
225
A patient has an order for carvedilol (Coreg) 9.375 mg twice a day PO. The tablets are 3.125 mg each. Identify how many tablets
will the nurse administer per dose. _______
ANS:
3 tablets
3.125 mg:1 tablet :: 9.375 mg: x tablets
(3.125 × x) = (1 × 9.375); 3.125x = 9.375 x = 3 tablets
226
When monitoring a patient who is taking a cholinergic drug, the nurse will watch for which cardiovascular effect?
a. Bradycardia
b. Tachycardia
c. Vasoconstriction
d. Palpitations
a. Bradycardia
227
The nurse notes in a patient’s medication history that the patient is taking pilocarpine (Pilocar). Based on this finding, the nurse
interprets that the patient has which disorder?
a. Anticholinergic poisoning
b. Glaucoma
c. Bladder atony
d. Myasthenia gravis
b. Glaucoma
228
A patient has had an overdose of an intravenous cholinergic drug. The nurse expects to administer which drug as an antidote?
a. Atenolol (Tenormin)
b. Bethanechol (Urecholine)
c. Dobutamine
d. Atropine sulfate
d. Atropine sulfate
229
A patient who has had abdominal surgery has been discharged on a cholinergic drug to assist in increasing gastrointestinal
peristalsis. The nurse will teach this patient to look for which therapeutic effect?
a. Decreased pulse rate
b. Abdominal cramping
c. Passage of flatus
d. Decreased urge to void
c. Passage of flatus
230
A cholinergic drug is prescribed for a patient with a new diagnosis of myasthenia gravis, and the nurse provides instructions to the
patient about the medication. What is important to include in the teaching?
a. Give daytime doses close together for maximal therapeutic effect.
b. Take the medication with meals to avoid gastrointestinal distress.
c. Take the medication 30 minutes before eating to improve swallowing and chewing.
d. Take the medication only if difficulty swallowing occurs during a meal.
c. Take the medication 30 minutes before eating to improve swallowing and chewing.
231
A factory worker has been admitted to the emergency department after an industrial accident involving organophosphate
insecticides. The nurse will prepare to administer which drug?
a. Pilocarpine (Salagen)
b. Bethanechol (Urecholine)
c. Physostigmine (Antilirium)
d. Tacrine (Cognex)
c. Physostigmine (Antilirium)
232
The nurse is providing teaching regarding drug therapy to the husband of a woman with Alzheimer’s disease. She was diagnosed 3
months ago, has mild memory loss, and will be receiving donepezil (Aricept). What is the drug’s expected action?
a. Prevents memory loss in later stages
b. Reverses the course of Alzheimer’s disease
c. Provides sedation to prevent agitation and restlessness
d. May help to improve the mood and decrease confusion
d. May help to improve the mood and decrease confusion
233
A patient has been taking donepezil (Aricept) for 2 weeks as part of the treatment for early stages of Alzheimer’s disease. Her
daughter calls the prescriber’s office and is upset because “Mother has not improved one bit!” Which response by the nurse is
appropriate?
a. “Increase the dosage to twice daily.”
b. “It takes time for the cure to take effect.”
c. “It may take up to 6 weeks to see an improvement.”
d. “Take the medication on an empty stomach for improved absorption.”
c. “It may take up to 6 weeks to see an improvement.”
234
A patient who has been diagnosed with Sjögren’s syndrome will be given cevimeline (Evoxac) for the treatment of xerostomia. The
nurse will monitor for what therapeutic effect?
a. Reduction of salivation
b. Stimulation of salivation
c. Reduction of gastrointestinal peristalsis
d. Improvement of fine-motor control
b. Stimulation of salivation
235
The nurse is reviewing the mechanism of action of cholinergic drugs. The undesired effects of cholinergic drugs come from the
stimulation of which receptors?
a. Muscarinic
b. Nicotinic
c. Cholinergic
d. Ganglionic
b. Nicotinic
236
A patient calls the clinic to speak to the nurse about taking an herbal product that contains ginkgo (Ginkgo biloba) to “help my
memory.” He states that he has read much information about the herbal product. Which statement by the patient indicates a need
for further education?
a. “I know the FDA has not approved this herbal product, but I’d like to try it to see
if it helps my memory.”
b. “I need to watch for possible side effects, such as headaches, or stomach or
intestinal upset.”
c. “I will take aspirin or ibuprofen (Motrin) if I have a headache.”
d. “Ginkgo may cause increased bleeding, so I’ll have to be careful when doing yard
work.”
c. “I will take aspirin or ibuprofen (Motrin) if I have a headache.”
237
A patient is receiving a dose of edrophonium (Tensilon). The nurse recognizes that this drug is given to determine the diagnosis of
which disease?
a. Parkinson’s disease
b. Multiple sclerosis
c. Myasthenia gravis
d. Alzheimer’s disease
c. Myasthenia gravis
238
A cholinergic drug is prescribed for a patient. The nurse checks the patient’s medical history, knowing that this drug is
contraindicated in which disorders? (Select all that apply.)
a. Bladder atony
b. Gastrointestinal obstruction
c. Bradycardia
d. Alzheimer’s disease
e. Hypotension
f. Chronic obstructive pulmonary disease
b. Gastrointestinal obstruction
c. Bradycardia
e. Hypotension
f. Chronic obstructive pulmonary disease
239
A patient is receiving memantine (Namenda) 10 mg PO daily. The patient is unable to swallow pills, so an oral solution that contains 2 mg/mL is ordered. Identify how much will the patient receive per dose. _______
ANS:
5 mL
2 mg:1 mL :: 10 mg:x mL
(2 × x) = (1 × 10); 2x = 10; x = 5 mL.
240
The nurse is about to administer a stat dose of intravenous atropine sulfate to a patient who is experiencing a symptomatic cardiac
dysrhythmia. During administration of this drug, the nurse will monitor the patient closely for which adverse effect?
a. Tachycardia
b. Bradycardia
c. Ectopic beats
d. Cardiac standstill
a. Tachycardia
241
A patient has a prescription for oxybutynin (Ditropan), an anticholinergic drug. When reviewing the patient’s medical history,
which condition, if present, would be considered a contraindication to therapy with this drug?
a. Diarrhea
b. Hypertension
c. Neurogenic bladder
d. Uncontrolled angle-closure glaucoma
d. Uncontrolled angle-closure glaucoma
242
The nurse is reviewing the use of anticholinergic drugs. Anticholinergic drugs block the effects of which nervous system?
a. Central nervous system
b. Somatic nervous system
c. Sympathetic nervous system
d. Parasympathetic nervous system
d. Parasympathetic nervous system
243
A patient has received an accidental overdose of intravenous atropine. Which drug will the nurse prepare to administer?
a. Atenolol (Tenormin)
b. Bethanechol (Urecholine)
c. Dicyclomine (Bentyl)
d. Physostigmine (Antilirium)
d. Physostigmine (Antilirium)
244
A 72-year-old man has a new prescription for an anticholinergic drug. He is an active man and enjoys outdoor activities, such as
golfing and doing his own yard work. What will the nurse emphasize to him during the teaching session about his drug therapy?
a. Drowsiness may interfere with his outdoor activities.
b. Increased salivation may occur during exercise and outside activities.
c. Fluid loss may occur as a result of an increased incidence of diarrhea.
d. He will need to take measures to reduce the occurrence of heat stroke during his
activities.
d. He will need to take measures to reduce the occurrence of heat stroke during his
activities.
245
The nurse will monitor for which adverse effect when administering an anticholinergic drug?
a. Excessive urination
b. Diaphoresis
c. Dry mouth
d. Pupillary constriction
c. Dry mouth
246
The nurse is reviewing a patient’s medication history and notes that the patient is taking the cholinergic blocker tolterodine
(Detrol). Which is an indication for this medication?
a. Irritable bowel disease
b. Induction of mydriasis
c. Urge incontinence
d. Reduction of secretions preoperatively
c. Urge incontinence
247
A patient has been taking tolterodine (Detrol), but today her prescriber changed her to a newer drug, darifenacin (Enablex). What
advantage does darifenacin have over the tolterodine?
a. The newer cholinergic-blocker drugs are more effective.
b. It helps reduce urinary retention.
c. It can be used in patients with narrow-angle glaucoma.
d. The incidence of dry mouth is much lower with darifenacin.
d. The incidence of dry mouth is much lower with darifenacin.
248
The nurse working in a preoperative admitting unit administers an anticholinergic medication to a patient before surgery. What is
the purpose of this drug in the preoperative setting?
a. Reduce pain
b. Relax the patient
c. Reduce urinary frequency
d. Reduce oral and gastrointestinal secretions
d. Reduce oral and gastrointestinal secretions
249
In preparation for eye surgery, the nurse monitors for which desired drug effect in a patient who is receiving a cholinergic-blocking
eyedrop medication?
a. Miosis
b. Mydriasis
c. Increased intraocular fluid production
d. Enhanced tear production
b. Mydriasis
250
A patient has a new prescription for the transdermal form of scopolamine. The nurse knows that this form of scopolamine is used
for which condition?
a. Angina
b. Chronic pain
c. Hypertension
d. Motion sickness
d. Motion sickness
251
The nurse is reviewing the indications for atropine sulfate. Atropine is appropriate for which of these patients? (Select all that
apply.)
a. A patient who has suddenly developed symptomatic bradycardia with a heart rate
of 32 beats/min
b. A patient who has suddenly developed symptomatic tachycardia with a heart rate
of 180 beats/min
c. A patient with severe narrow-angle glaucoma
d. A patient who is about to have surgery
e. A patient newly diagnosed with myasthenia gravis
f. A patient with anticholinesterase inhibitor poisoning
a. A patient who has suddenly developed symptomatic bradycardia with a heart rate
of 32 beats/min
d. A patient who is about to have surgery
f. A patient with anticholinesterase inhibitor poisoning
252
A patient has a new order for the adrenergic drug doxazosin (Cardura). When providing education about this drug, the nurse will
include which instructions?
a. “Weigh yourself daily, and report any weight loss to your prescriber.”
b. “Increase your potassium intake by eating more bananas and apricots.”
c. “The impaired taste associated with this medication usually goes away in 2 to 3
weeks.”
d. “Be sure to lie down after taking the first dose, because first-dose hypotension
may make you dizzy.”
d. “Be sure to lie down after taking the first dose, because first-dose hypotension
may make you dizzy.”
253
A patient with severe liver disease is receiving the angiotensin-converting enzyme (ACE) inhibitor, captopril (Capoten). The nurse is aware that the advantage of this drug for this patient is which characteristic?
a. Captopril rarely causes first-dose hypotensive effects.
b. Captopril has little effect on electrolyte levels.
c. Captopril is a prodrug and is metabolized by the liver before becoming active.
d. Captopril does not need to be metabolized by the liver before becoming active because it is not a prodrug.
d. Captopril does not need to be metabolized by the liver before becoming active because it is not a prodrug.
254
During a follow-up visit, the health care provider examines the fundus of the patient’s eye. Afterward, the patient asks the nurse,
“Why is he looking at my eyes when I have high blood pressure? It does not make sense to me!” What is the best response by the
nurse?
a. “We need to monitor for drug toxicity.”
b. “We must watch for increased intraocular pressure.”
c. “The provider is assessing for visual changes that may occur with drug therapy.”
d. “The provider is making sure the treatment is effective over the long term.”
d. “The provider is making sure the treatment is effective over the long term.”
255
The nurse is preparing for a community education program on hypertension. Which of these parameters determine the regulation of
arterial blood pressure?
a. Cardiac output and systemic vascular resistance
b. Heart rate and peripheral resistance
c. Blood volume and renal blood flow
d. Myocardial contractility and arteriolar constriction
a. Cardiac output and systemic vascular resistance
256
When counseling a male patient about the possible adverse effects of antihypertensive drugs, the nurse will discuss which potential
problem?
a. Impotence
b. Bradycardia
c. Increased libido
d. Weight gain
a. Impotence
257
The nurse is reviewing drug therapy for hypertension. According to the JNC-8 guidelines, antihypertensive drug therapy for a
newly diagnosed hypertensive African-American patient would most likely include which drug or drug classes?
a. Vasodilators alone
b. ACE inhibitors alone
c. Calcium channel blockers with thiazide diuretics
d. Beta blockers with thiazide diuretics
c. Calcium channel blockers with thiazide diuretics
258
The nurse is creating a plan of care for a patient with a new diagnosis of hypertension. Which is a potential human needs statement
for the patient taking antihypertensive medications?
a. Altered GI elimination (diarrhea)
b. Altered sexual function
c. Altered urinary elimination (urge incontinence)
d. Need for effective perception
b. Altered sexual function
259
A patient’s blood pressure elevates to 270/150 mm Hg, and a hypertensive emergency is obvious. He is transferred to the intensive care unit and started on a sodium nitroprusside (Nipride) drip to be titrated per his response. With this medication, the nurse knows that the maximum dose of this drug should be infused for how long?
a. 10 minutes
b. 30 minutes
c. 1 hour
d. 24 hours
a. 10 minutes
260
A patient with primary hypertension is prescribed drug therapy for the first time. The patient asks how long drug therapy will be needed. Which answer by the nurse is the correct response?
a. “This therapy will take about 3 months.”
b. “This therapy will take about a year.”
c. “This therapy will go on until your symptoms disappear.”
d. “Therapy for high blood pressure is usually lifelong.”
d. “Therapy for high blood pressure is usually lifelong.”
261
A patient who has been taking antihypertensive drugs for a few months states that a new, persistent dry cough is very bothersome. The nurse knows that this cough is an adverse effect of which class of antihypertensive drugs?
a. Beta blockers
b. Angiotensin-converting enzyme (ACE) inhibitors
c. Angiotensin II receptor blockers (ARBs)
d. Calcium channel blockers
b. Angiotensin-converting enzyme (ACE) inhibitors
262
A pregnant woman is experiencing hypertension. The nurse knows that which drug is used for a pregnant patient who is
experiencing hypertension?
a. Mannitol (Osmitrol)
b. Enalapril (Vasotec)
c. Hydrochlorothiazide (HydroDIURIL)
d. Methyldopa (Aldomet)
d. Methyldopa (Aldomet)
263
A patient with type 2 diabetes mellitus has been found to have trace proteinuria. The prescriber writes an order for an angiotensin-converting enzyme (ACE) inhibitor. What is the main reason for prescribing this class of drug for this patient?
a. Cardioprotective effects
b. Renal protective effects
c. Reduces blood pressure
d. Promotes fluid output
b. Renal protective effects
264
The nurse is reviewing the orders for a patient and notes a new order for an angiotensin-converting enzyme (ACE) inhibitor. The nurse checks the current medication orders, knowing that this drug class may have a serious interaction with what other drug class?
a. Calcium channel blockers
b. Diuretics
c. Nonsteroidal anti-inflammatory drugs
d. Nitrates
c. Nonsteroidal anti-inflammatory drugs
265
An older adult patient will be taking a vasodilator for hypertension. Which adverse effect is of most concern for the older adult
patient taking this class of drug?
a. Dry mouth
b. Restlessness
c. Constipation
d. Hypotension
d. Hypotension
266
When teaching a patient about antihypertensive drug therapy, which statements by the nurse are correct? (Select all that apply.)
a. “You need to have your blood pressure checked once a week and keep track of
the readings.”
b. “If you notice that the symptoms have gone away, you should be able to stop taking the drug.”
c. “An exercise program may be helpful in treating hypertension, but let’s check with your doctor first.”
d. “If you experience severe side effects, stop the medicine and let us know at your next office visit.”
e. “Most over-the-counter decongestants are compatible with antihypertensive drugs.”
f. “Please continue taking the medication, even if you are feeling better.”
a. “You need to have your blood pressure checked once a week and keep track of the readings.”
c. “An exercise program may be helpful in treating hypertension, but let’s check with your doctor first.”
f. “Please continue taking the medication, even if you are feeling better.”
267
A patient is to receive enalapril (Vasotec) 5 mg IV every 6 hours. Each dose is given over 5 minutes. The medication is available in an injectable form, 1.25 mg/mL. Identify how many milliliters of medication will the nurse draw up for each dose. _______
ANS:
4 mL
1.25mg:1 mL :: 5 mg:x mL.
(1.25 × x) = (1 × 5); 1.25x = 5; x = 4.
268
A patient with elevated lipid levels has a new prescription for nicotinic acid (niacin). The nurse informs the patient that which adverse effects may occur with this medication?
a. Pruritus, cutaneous flushing
b. Tinnitus, urine with a burnt odor
c. Myalgia, fatigue
d. Blurred vision, headaches
a. Pruritus, cutaneous flushing
269
A patient reports having adverse effects with nicotinic acid (niacin). The prescriber has recommended which action to minimize
these undesirable effects?
a. Take the drug on an empty stomach.
b. Take the medication every other day until the effects subside.
c. Take an aspirin tablet 30 minutes before taking the drug.
d. Take the drug with large amounts of fiber.
c. Take an aspirin tablet 30 minutes before taking the drug.
270
A patient calls the clinic office saying that the cholestyramine (Questran) powder he started yesterday clumps and sticks to the
glass when he tries to mix it. The nurse will suggest what method for mixing this medication for administration?
a. Mix the powder in a carbonated soda drink to dissolve it faster.
b. Add the powder to any liquid, and stir vigorously to dissolve it quickly.
c. Mix the powder with food or fruit, or at least 4 to 6 ounces of fluid.
d. Sprinkle the powder into a spoon and take it dry, followed by a glass of water.
c. Mix the powder with food or fruit, or at least 4 to 6 ounces of fluid.
271
A patient is concerned about the adverse effects of the fibric acid derivative she is taking to lower her cholesterol level. Which is an
adverse effect of this class of medication?
a. Constipation
b. Diarrhea
c. Joint pain
d. Dry mouth
b. Diarrhea
272
While a patient is receiving antilipemic therapy, the nurse knows to monitor the patient closely for the development of which
problem?
a. Neutropenia
b. Pulmonary problems
c. Vitamin C deficiency
d. Liver dysfunction
d. Liver dysfunction
273
A patient tells the nurse that he likes to eat large amounts of garlic “to help lower his cholesterol levels naturally.” The nurse
reviews his medication history and notes that which drug has a potential interaction with the garlic?
a. Acetaminophen (Tylenol)
b. Warfarin (Coumadin)
c. Digoxin (Lanoxin)
d. Phenytoin (Dilantin)
b. Warfarin (Coumadin)
274
A patient with coronary artery disease asks the nurse about the “good cholesterol” laboratory values. The nurse knows that “good
cholesterol” refers to which lipids?
a. Triglycerides
b. Low-density lipoproteins (LDLs)
c. Very–low-density lipoproteins (VLDLs)
d. High-density lipoproteins (HDLs)
d. High-density lipoproteins (HDLs)
275
A patient who has recently started therapy on a statin drug asks the nurse how long it will take until he sees an effect on his serum
cholesterol. Which statement would be the nurse’s best response?
a. “Blood levels return to normal within a week of beginning therapy.”
b. “It takes 6 to 8 weeks to see a change in cholesterol levels.”
c. “It takes at least 6 months to see a change in cholesterol levels.”
d. “You will need to take this medication for almost a year to see significant
results.”
b. “It takes 6 to 8 weeks to see a change in cholesterol levels.”
276
The nurse will monitor for myopathy (muscle pain) when a patient is taking which class of antilipemic drugs?
a. Niacin
b. HMG–CoA reductase inhibitors
c. Fibric acid derivatives
d. Bile acid sequestrants
b. HMG–CoA reductase inhibitors
277
When teaching a patient who is beginning antilipemic therapy about possible drug–food interactions, the nurse will discuss which
food?
a. Bran muffins
b. Grapefruit juice
c. Licorice
d. Dairy products
b. Grapefruit juice
278
The nurse is conducting a class about antilipemic drugs. The antilipemic drug ezetimibe (Zetia) works by which mechanism?
a. Inhibiting HMG–CoA reductase
b. Preventing resorption of bile acids from the small intestines
c. Activating lipase, which breaks down cholesterol
d. Inhibiting cholesterol absorption in the small intestine
d. Inhibiting cholesterol absorption in the small intestine
279
Antilipemic drug therapy is prescribed for a patient, and the nurse is providing instructions to the patient about the medication.
Which instructions will the nurse include? (Select all that apply.)
a. Limit fluid intake to prevent fluid overload.
b. Eat extra servings of raw vegetables and fruit.
c. Report abnormal or unusual bleeding or yellow discoloration of the skin.
d. Report the occurrence of muscle pain immediately.
e. Drug interactions are rare with antilipemics.
f. Take the drug 1 hour before or 2 hours after meals to maximize absorption.
b. Eat extra servings of raw vegetables and fruit.
c. Report abnormal or unusual bleeding or yellow discoloration of the skin.
d. Report the occurrence of muscle pain immediately.
280
The medication order reads, “Give simvastatin (Zocor) 30 mg daily at bedtime, PO.” The medication is available in 20-mg tablets.
Identify how many tablets the nurse will administer to the patient. _______
ANS:
1.5 tablets
20 mg:1 tablet :: 30 mg:x tablets.
(20 × x) = (1 × 30); 20x = 30; x = 1.5 tablets.
281
When monitoring a patient who has diabetes and is receiving a carbonic anhydrase inhibitor for edema, the nurse will monitor for
which possible adverse effect?
a. Metabolic alkalosis
b. Elevated blood glucose
c. Hyperkalemia
d. Mental alertness
b. Elevated blood glucose
282
The nurse will monitor a patient for signs and symptoms of hyperkalemia if the patient is taking which of these diuretics?
a. Hydrochlorothiazide (HydroDIURIL)
b. Furosemide (Lasix)
c. Acetazolamide (Diamox)
d. Spironolactone (Aldactone)
d. Spironolactone (Aldactone)
283
Mannitol (Osmitrol) has been ordered for a patient with acute renal failure. The nurse will administer this drug using which
procedure?
a. Intravenously, through a filter
b. By rapid intravenous bolus
c. By mouth in a single morning dose
d. Through a gravity intravenous drip with standard tubing
a. Intravenously, through a filter
284
Furosemide (Lasix) is prescribed for a patient who is about to be discharged, and the nurse provides instructions to the patient
about the medication. Which statement by the nurse is correct?
a. “Take this medication in the evening.”
b. “Avoid foods high in potassium, such as bananas, oranges, fresh vegetables, and
dates.”
c. “If you experience weight gain, such as 5 pounds or more per week, be sure to tell
your physician during your next routine visit.”
d. “Be sure to change positions slowly and rise slowly after sitting or lying so as to
prevent dizziness and possible fainting because of blood pressure changes.”
d. “Be sure to change positions slowly and rise slowly after sitting or lying so as to
prevent dizziness and possible fainting because of blood pressure changes.”
285
When reviewing the mechanisms of action of diuretics, the nurse knows that which statement is true about loop diuretics?
a. They work by inhibiting aldosterone.
b. They are very potent, having a diuretic effect that lasts at least 6 hours.
c. They have a rapid onset of action and cause rapid diuresis.
d. They are not effective when the creatinine clearance decreases below 25 mL/min.
c. They have a rapid onset of action and cause rapid diuresis.
286
When monitoring a patient who is taking hydrochlorothiazide (HydroDIURIL), the nurse notes that which drug is most likely to
cause a severe interaction with the diuretic?
a. Digitalis
b. Penicillin
c. Potassium supplements
d. Aspirin
a. Digitalis
287
When a patient is receiving diuretic therapy, which of these assessment measures would best reflect the patient’s fluid volume
status?
a. Blood pressure and pulse
b. Serum potassium and sodium levels
c. Intake, output, and daily weight
d. Measurements of abdominal girth and calf circumference
c. Intake, output, and daily weight
288
A patient is being discharged to home on a single daily dose of a diuretic. The nurse instructs the patient to take the dose at which
time so it will be least disruptive to the patient’s daily routine?
a. In the morning
b. At noon
c. With supper
d. At bedtime
a. In the morning
289
A patient is started on a diuretic for antihypertensive therapy. The nurse expects that a drug in which class is likely to be used
initially?
a. Loop diuretics
b. Osmotic diuretics
c. Thiazide diuretics
d. Potassium-sparing diuretics
c. Thiazide diuretics
290
A patient in the neurologic intensive care unit is being treated for cerebral edema. Which class of diuretic is used to reduce
intracranial pressure?
a. Loop diuretics
b. Osmotic diuretics
c. Thiazide diuretics
d. Vasodilators
b. Osmotic diuretics
291
A 79-year-old patient is taking a diuretic for treatment of hypertension. This patient is very independent and wants to continue to
live at home. The nurse will know that which teaching point is important for this patient?
a. He should take the diuretic with his evening meal.
b. He should skip the diuretic dose if he plans to leave the house.
c. If he feels dizzy while on this medication, he needs to stop taking it and take
potassium supplements instead.
d. He needs to take extra precautions when standing up because of possible
orthostatic hypotension and resulting injury from falls.
d. He needs to take extra precautions when standing up because of possible
orthostatic hypotension and resulting injury from falls.
292
The nurse is monitoring a patient who is taking a potassium-sparing diuretic. Which of the drugs or drug classes may have an
interaction with this type of diuretic? (Select all that apply.)
a. Lithium
b. Vancomycin
c. Potassium supplements
d. NSAIDs
e. Antidiabetic drugs
f. ACE inhibitors
a. Lithium
c. Potassium supplements
d. NSAIDs
f. ACE inhibitors
293
When assessing a patient who is receiving a loop diuretic, the nurse looks for the manifestations of potassium deficiency, which
would include what symptoms? (Select all that apply.)
a. Dyspnea
b. Constipation
c. Tinnitus
d. Muscle weakness
e. Anorexia
f. Lethargy
d. Muscle weakness
e. Anorexia
f. Lethargy
294
A patient is to receive furosemide (Lasix) via a percutaneous endoscopic gastrostomy (PEG) tube. The order reads, “Give furosemide, 80 mg, per PEG tube once daily.” The medication is available in a liquid form, 40 mg/5 mL. Identify how many
milliliters the nurse will administer for each dose. _______
ANS:
10 mL
40 mg:5 mL :: 80 mg:x mg
(40 × x) = (5 × 80); 40x = 400; x = 10 mL
295
The order for a child reads, “Give furosemide (Lasix) 2 mg/kg IV STAT.” The child weighs 33 pounds. Identify how many milligrams the child will receive for this dose. _______
ANS:
30 mg
First, convert 33 pounds to kilograms: 33 pounds ÷ 2.2 = 15 kg. Next, calculate mg/kg: 2 mg/kg × 15 kg = 30 mg.
