NCLEX - Week 4 Flashcards
A nurse is caring for a patient who is taking warfarin (Coumadin). The patient’s INR is 4.5. Which of the following foods should the nurse instruct the patient to avoid?
A. Broccoli
B. Spinach
C. Bananas
D. Oranges
B. Spinach
Rationale:
Foods high in Vitamin K can decrease the effects of Warfarin.
Warfarin is a Vitamin K antagonist, meaning that it works by blocking the effects of Vitamin K, which is needed for blood clotting.
When a patient eats foods high in Vitamin K, it can reduce the effectiveness of warfarin and increase the risk of blood clots.
Spinach is high in vitamin K
A patient is prescribed tetracycline for an infection. What education should the nurse provide regarding drug-food interactions?
A. “Take this medication with milk to prevent gastrointestinal upset.”
B. “Avoid taking this medication with iron supplements.”
C. “Take this medication 1 hour before or 2 hours after meals.”
D. “Limit your intake of dairy products while on this medication.”
D. “Limit your intake of dairy products while on this medication.”
Rationale:
Calcium containing foods given with tetracycline antibiotics can reduce drug absorption and can lower antibacterial effects.
A nurse is admitting a patient who reports taking several herbal supplements. What is the nurse’s priority action?
A. Document the names and dosages of the supplements in the patient’s chart.
B. Advise the patient to discontinue all herbal supplements while in the hospital. C. Notify the healthcare provider of the supplements and obtain further orders.
D. Educate the patient on the potential risks and interactions of herbal supplements.
C. Notify the healthcare provider of the supplements and obtain further orders.
Rationale:
It is crucial to inform the provider about all medications a patient is taking, including herbal supplements, as they can interact with prescribed medications.
The provider will determine if any adjustments to the treatment plan are needed.
A patient is receiving a new medication and develops itching and a rash. The nurse suspects an allergic reaction. What is the priority nursing action?
A. Administer an antihistamine.
B. Discontinue the medication immediately.
C. Notify the healthcare provider.
D. Document the reaction in the patient’s chart.
B. Discontinue the medication immediately.
Rationale:
When a patient shows signs of a potential allergic reaction, immediate discontinuation of the medication is paramount to prevent the reaction from escalating.
An allergic reaction, even if mild, could worsen with continued exposure to the allergen.
A nurse is administering two medications to a patient via IV push. What is the most important safety check to prevent a direct chemical or physical interaction?
A. Verify the patient’s allergies before administration.
B. Ensure both medications are compatible before combining.
C. Check the patient’s identification twice before administering.
D. Flush the IV line with saline between each medication.
B. Ensure both medications are compatible before combining.
Rationale:
Compatibility ensures the medications, when mixed, won’t undergo any chemical changes that could be harmful to the patient.
Precipitates (visible particles) are a tell-tale sign of incompatibility.
A patient with a history of chronic kidney disease (CKD) is prescribed a new medication. The nurse anticipates which adjustment to the dosage?
A. An increased dosage is likely needed to achieve therapeutic levels.
B. The dosage will likely remain the same as for patients with healthy kidneys.
C. A decreased dosage is likely needed to prevent drug accumulation and toxicity.
D. The dosage will be determined after obtaining blood levels of the medication.
**Answer: C. A decreased dosage is likely needed to prevent drug accumulation and toxicity. **
Rationale:
CKD affects drug excretion.
Patients with CKD are at risk for drug accumulation and potential toxicity as their kidneys cannot effectively clear medications from the body.
The nurse is teaching a patient about the “grapefruit juice effect.” Which statement by the patient indicates understanding of this teaching?
A. “Grapefruit juice can reduce the effectiveness of some medications.”
B. “Grapefruit juice should be taken with all medications to improve absorption.”
C. “Grapefruit juice can increase the levels of some medications in my body.”
D. “Grapefruit juice has no effect on medications and can be consumed freely.”
**Answer: C. “Grapefruit juice can increase the levels of some medications in my body.” **
Rationale:
Grapefruit juice inhibits intestinal metabolism of certain medications, leading to higher drug levels in the body and increasing the risk of adverse effects or toxicity.
A patient is taking digoxin for heart failure. Which food should the nurse advise the patient to avoid?
A. Bran cereal
B. Chicken breast
C. White rice
D. Green beans
Answer: A. Bran cereal
Rationale:
Foods high in fiber can decrease the absorption of medications, and digoxin has a narrow therapeutic index, making careful monitoring of food interactions essential to prevent therapeutic failure
A patient is prescribed a medication that has a narrow therapeutic range. What is the most important nursing implication?
A. Monitor the patient’s vital signs frequently.
B. Administer the medication with food to decrease absorption.
C. Teach the patient about common side effects of the medication.
D. Closely monitor the patient for signs of toxicity and therapeutic effects.
D. Closely monitor the patient for signs of toxicity and therapeutic effects.
Rationale:
Medications with a narrow therapeutic range have a fine line between a therapeutic dose and a toxic dose.
Close monitoring is critical to ensure the medication is effective but not causing harm.
A patient with liver disease is prescribed a medication. What is the nurse’s primary concern?
A. Increased risk of allergic reactions.
B. Decreased metabolism of the medication.
C. Enhanced absorption of the medication. D. Altered distribution of the medication
B. Decreased metabolism of the medication.
Rationale:
The liver plays a key role in drug metabolism.
Liver dysfunction can lead to a reduced ability to metabolize drugs, potentially leading to a build-up of the medication in the body and increasing the risk of adverse effects.
A patient is prescribed a medication known to prolong the QT interval. Which of the following factors would further increase the patient’s risk for developing a dysrhythmia?
A. Being male
B. Hypokalemia
C. Hypernatremia
D. Taking antacids
B. Hypokalemia
Rationale:
QT interval drugs, when combined with existing risk factors like hypokalemia (low potassium), can significantly increase the risk of serious, even fatal, dysrhythmias.
A nurse is reviewing a patient’s medication list and notices that two of the drugs have overlapping toxicity. What is the nurse’s best action?
A. Administer the medications as prescribed, monitoring the patient for signs of toxicity.
B. Contact the prescriber to discuss the potential for combined toxicity and alternative options.
C. Hold both medications and notify the pharmacist for clarification.
D. Consult a drug reference guide to determine the level of risk associated with combined toxicity.
B. Contact the prescriber to discuss the potential for combined toxicity and alternative options.
Rationale:
While there are situations where medications with overlapping toxicities might be necessary, it’s crucial for the nurse to flag this potential issue to the prescriber.
The prescriber can then make an informed decision, considering the benefits and risks.
A patient is prescribed a medication that can cause hepatotoxicity. Which laboratory tests will the nurse monitor to assess liver function?
A. Blood urea nitrogen (BUN) and creatinine
B. Complete blood count (CBC)
C. Aspartate aminotransferase (AST) and alanine aminotransferase (ALT)
D. International normalized ratio (INR) and prothrombin time (PT)
C. Aspartate aminotransferase (AST) and alanine aminotransferase (ALT)
Rationale:
AST and ALT are liver enzymes. Elevated levels of these enzymes in the blood can indicate liver damage or injury, including damage caused by medications.
A patient tells the nurse, “I stopped taking my medication because it wasn’t working.” What is the nurse’s best initial response?
A. “You should never stop taking a medication without talking to your doctor.” B. “Why do you think the medication wasn’t working?”
C. “Let me notify the doctor so they can prescribe a different medication for you.” D. “It’s important to give medications time to work, sometimes it takes a few weeks.”
B. “Why do you think the medication wasn’t working?”
Rationale:
Open-ended questions allow for patient elaboration and can uncover the reasons for non-compliance.
This approach promotes dialogue and helps the nurse understand the patient’s perspective.
A patient receiving a medication known to cause orthostatic hypotension is preparing for discharge. What is the most important instruction the nurse should provide to this patient?
A. “Take this medication with a full glass of water.”
B. “Avoid consuming alcohol while taking this medication.”
C. “Change positions slowly when getting up from a sitting or lying position.”
D. “Monitor your blood pressure at home twice a day.”
C. “Change positions slowly when getting up from a sitting or lying position.”
Rationale:
Orthostatic hypotension is a drop in blood pressure upon standing, leading to dizziness and potential falls.
Changing positions slowly can help prevent this effect
A nurse is caring for a patient who is on multiple medications, including one that is known to be a cytochrome P450 (CYP) enzyme inhibitor. What is the nurse’s understanding of this medication’s potential effect on other drugs the patient is taking?
A. The inhibitor may decrease the metabolism of other drugs, leading to increased drug levels.
B. The inhibitor may increase the metabolism of other drugs, leading to decreased drug levels.
C. The inhibitor will have no effect on the metabolism of other drugs.
D. The inhibitor will enhance the therapeutic effects of other drugs.
A. The inhibitor may decrease the metabolism of other drugs, leading to increased drug levels.
Rationale:
CYP enzymes are crucial for drug metabolism in the liver.
An inhibitor will slow down the metabolism of certain drugs, leading to their accumulation in the body and potentially increasing the risk of side effects or toxicity.
A nurse is educating a patient about a newly prescribed medication. Which statement by the patient indicates a need for further teaching about adverse drug reactions (ADRs)?
A. “ADRs are unintended and undesirable responses to medications.”
B. “All ADRs are caused by an allergic reaction to the medication.”
C. “ADRs can range from mild side effects to life-threatening complications.”
D. “It’s important to report any unusual symptoms to my healthcare provider.”
“All ADRs are caused by an allergic reaction to the medication.”
Rationale:
ADRs encompass a wide range of responses, from predictable side effects to severe, unexpected reactions.
While allergic reactions are one type of ADR, they are not the sole cause of all adverse reactions
A patient is receiving gentamicin (an aminoglycoside antibiotic) and develops tinnitus. What type of adverse drug reaction does the nurse suspect?
A. Hepatotoxicity
B. Ototoxicity
C. Nephrotoxicity
D. Cardiotoxicity
B. Ototoxicity
Rationale:
Aminoglycosides like gentamicin are known to be ototoxic, meaning they can damage the inner ear, potentially causing hearing loss or tinnitus.
A patient is taking furosemide (Lasix), a loop diuretic, and digoxin. Which electrolyte imbalance would increase the risk of digoxin toxicity?
A. Hyperkalemia
B. Hyponatremia
C. Hypokalemia
D. Hypercalcemia
C. Hypokalemia
Rationale:
Loop diuretics can cause potassium loss. Hypokalemia (low potassium) can potentiate the effects of digoxin, leading to an increased risk of digoxin toxicity
What is the most important nursing consideration when administering a medication that can cause iatrogenic effects?
A. Monitor the patient closely for the intended therapeutic effects of the medication.
B. Be aware that iatrogenic effects are unpredictable and cannot be prevented.
C. Assess the patient for signs and symptoms that mimic the iatrogenic condition.
D. Educate the patient about the potential for long-term disability from iatrogenic effects.
C. Assess the patient for signs and symptoms that mimic the iatrogenic condition.
Rationale:
Iatrogenic effects are conditions caused by medical treatment.
Recognizing early signs of these effects is essential for prompt intervention and prevention of further complications.
A patient asks the nurse, “What is a placebo effect?” What is the nurse’s best response?
A. “It’s when a person feels better after taking a sugar pill.”
B. “It’s a psychological response that can occur with or without active medication.” C. “It means the medication isn’t working and you need a higher dose.”
D. “It’s when the medication causes side effects even though it’s not supposed to.”
B. “It’s a psychological response that can occur with or without active medication.”
Rationale:
The placebo effect highlights the powerful influence of the mind on the body and can contribute to a patient’s perceived improvement even when receiving an inactive substance.
Which factor is a major cause of variability in drug absorption?
A. Patient’s age
B. Route of administration C. Differences in drug formulations
D. Time of day the drug is administered
C. Differences in drug formulations
Rationale:
Variations in how a medication is formulated (e.g., tablets, capsules, liquids, sustained-release) can affect its dissolution and absorption rate, leading to differences in bioavailability.
What is the primary mechanism of pharmacodynamic tolerance?
A. Increased drug metabolism
B. Decreased drug excretion
C. Adaptive changes in receptor sensitivity D. Enhanced drug absorption
C. Adaptive changes in receptor sensitivity
Rationale:
With chronic exposure to a drug, receptors in the body can become less responsive to its effects, requiring higher doses to achieve the same response.
This is a key characteristic of pharmacodynamic tolerance.
The nurse is teaching a patient about the importance of medication adherence. Which statement by the patient indicates a need for further teaching?
A. “I should take my medications as prescribed, even if I feel better.”
B. “It’s okay to stop taking my medication once the symptoms are gone.”
C. “I should tell my doctor about all the medications and supplements I take.”
D. “I can ask my pharmacist if I have any questions about my medications.”
B. “It’s okay to stop taking my medication once the symptoms are gone.”
Rationale:
Abruptly stopping certain medications can lead to withdrawal symptoms or a resurgence of the condition.
It’s crucial to emphasize completing the prescribed course of treatment unless directed otherwise by the healthcare provider.
A nurse suspects that a patient is experiencing an idiosyncratic drug reaction. What does this mean?
A. The reaction is a common and expected side effect of the drug.
B. The reaction is an immune-mediated response to the drug.
C. The reaction is a result of excessive dosing of the drug.
D. The reaction is an unusual or unexpected response due to genetic predisposition.
D. The reaction is an unusual or unexpected response due to genetic predisposition.
Rationale:
Idiosyncratic reactions are not predictable based on the drug’s known actions.
They are often linked to genetic variations that affect drug metabolism or response.
