Study guide questions for each chapter

Question 1

True or False for Chapter 1 Study Guide

Question 2

A concept that influences patient care focuses on a disease-centered model of health care.

Answer 2

False. “Concept” focuses on the patient-centered model of care instead of a disease-centered model.

Question 3

Concepts are related to patient’s problems, the medications, or topic of care listed within the medical diagnosis.

Answer 3

False. Concepts are related to patient’s problems, the medications, or topic of care listed within the nursing process.

Question 4

The Nursing Alliance for Quality Care (NAQC) that supports quality patient-centered health care is partnered with the American Medical Association.

Answer 4

False. The Nursing Alliance for Quality Care (NAQC) that supports quality patient-centered health care is partnered with the American Nurses Association.

Question 5

The Nursing Alliance for Quality Care (NAQC) believes that it is everyone’s role to cultivate successful patient and family engagement.

Answer 5

False. NAQC believes that it is nurse’s role to cultivate successful patient and family engagement.

Question 6

The purpose of the nursing process is to diagnose and provide care.

Answer 6

False. The purpose of the nursing process is to identify a patient’s problem and provide care. Nurses do not diagnose.

Question 7

Arrange the following actions of the nursing process in correct order. This Is Chapter one

Question 8

a. Implementation b. Planning c. Evaluation d. Assessment

e. Patient problem

Answer 8

d, e, b, a, c

Question 9

Match the phrases in Column I to the step of the nursing process in Column II. The nursing process in Column II will be used more than once.

This is for Study Guide chapter one

Question 10

Column I
\_\_\_\_\_\_\_\_ 7.  Decreased adherence 
\_\_\_\_\_\_\_\_ 8. Current health history
\_\_\_\_\_\_\_\_ 9.  Goal/outcome setting
\_\_\_\_\_\_\_\_ 10. Patient’s environment 
\_\_\_\_\_\_\_\_ 11. Action to accomplish goals 
\_\_\_\_\_\_\_\_ 12. Drug allergies and reactions
\_\_\_\_\_\_\_\_ 13. Referral
\_\_\_\_\_\_\_\_ 14. Patient/significant other teaching 
 \_\_\_\_\_\_\_\_ 15. Use of teaching drug cards
 \_\_\_\_\_\_\_\_ 16. Laboratory test results
\_\_\_\_\_\_\_\_ 17. Effectiveness of health teaching and drug therapy

Column II

a. Assessment
b. Patient problem
c. Planning
d. Implementation/intervention
e. Evaluation

Answer 10

7. b 8. a 9. c

10. a 11. d 12. a 13. d or e 14. d 15. d 16. a 17. e

Question 11

Match the clinical manifestations in Column I with the data type in Column II. The data type in Column II will be used more than once. Still Chapter one!!

Question 12

\_\_\_\_\_\_\_\_ 18. Productive cough
\_\_\_\_\_\_\_\_ 19. Pain in left ear
 \_\_\_\_\_\_\_\_ 20.Lab values 
 \_\_\_\_\_\_\_\_ 21.Nausea
 \_\_\_\_\_\_\_\_ 22.Heart rate
\_\_\_\_\_\_\_\_ 23. Patient perception of drug’s effectiveness \_\_\_\_\_\_\_\_ 24 Reported Allergies

Column II

a. Subjective
b. Objective

Answer 12

18. b 19. a 20. b 21. a 22. b 23. a 24. a

Question 13

REVIEW QUESTIONS Select the best response.

Chapter One Study Guide

Question 14

Possible injury would be included in which phase of the nursing process for a patient who is taking a sedative-hypnotic?

Answer 14

(d.) A patient problem is based on analysis of subjective and objective data so that patient-centered care is provided.

Question 15

The patient has congestive heart failure and has been prescribed a diuretic. Obtain patient’s weight to be used for future comparison is included in which phase of the nursing process?

Answer 15

a. Data is gathered during an assessment of subjective and objective data to provide patient-centered care.

Question 16

The patient will receive adequate nutritional sup-port through enteral feedings is included in which phase of the nursing process?

Answer 16

c. Goals are set during the planning phase after analyzing all the data that was gathered during the assessment phase. Usually, a goal statement starts with “The patient will.. . ”

Question 17

The patient will maintain a diastolic blood pressure between 60 to 80 is included in which phase of the nursing process? a. Assessment b. Evaluation c. Planning d. Patient problem

Answer 17

c. Goals are set during the planning phase after analyzing all the data that was gathered during the assessment phase. Usually, a goal statement starts with “The patient will.. . ”

Question 18

The patient has been diagnosed with angina and hypertension and has been started on a drug. In-struct patient to avoid caffeine-containing beverages is included in which phase of the nursing process? a. Evaluation
b. Implementation c. Patient problem d. Planning

Answer 18

b. Nurses provide education, drug administration, patient care, and other interventions during the implementation phase.

Question 19

Revision of goals is included in which phase of the nursing process? a. Assessment b. Evaluation c. Implementation
d. Planning

Answer 19

b. After implementing part of the plan, the nurse must evaluate to determine whether the goals and teaching objectives have been met during the evaluation phase. Patient-centered care is an ongoing assessment data gathering, planning, implementing, and evaluating.

Question 20

The patient has been prescribed a diuretic to treat hypertension. Disturbed sleep is included in which phase of the nursing process? a. Assessment b. Evaluation
c. Implementation d. Patient problem

Answer 20

d. A patient problem is based on analysis of subjective and objective data so that patient-centered care is provided. Knowing the patient is receiving a di-uretic is objective data.

Question 21

The pediatric patient has been started on antibiotics for strep throat. Advise the child’s parents to report adverse reactions such as nausea and vomiting to the health care provider is included in which phase of the nursing process? a. Assessment b. Implementation c. Planning d. Potential Patient problem

Answer 21

b. Nurses provide education, drug administration, patient care, and other interventions during the implementation phase.

Question 22

The patient has been prescribed an opioid pain drug after hip surgery. Psychological disturbance is included in which phase of the nursing process? a. Implementation b. Evaluation c. Patient problem d. Planning

Answer 22

c. A patient problem is based on analysis of subjec-tive and objective data so that patient-centered care is provided. Knowing the patient is receiving a di-uretic is an objective data.

Question 23

Instruct patient not to discontinue drugs abruptly is included in which part of the nursing process for a patient with epilepsy who is taking phenytoin? a. Assessment
b. Evaluation c. Implementation d. Planning

Answer 23

c. Nurses provide education, drug administration, patient care, and other interventions during the implementation phase.

Question 24

Chapter 2 Study Guide Matching

Question 25

Column I a. Determines which drugs can be sold with or with-out a prescription b. Attempts to control the abuse of depressants, stimulants, and hallucinogens c. Tightened controls on drug safety and testing d. Mandated physicians and pharmacists in keeping records of prescribed narcotics e. Promotes the development of drugs used to treat rare illnesses f. Tried to remedy the escalating problem of drug abuse g. Empowered the FDA to monitor and regulate the manufacturing and marketing of drugs Column II ________ 1. Kefauver-Harris Amendment ________ 2. Federal Food, Drug, and Cosmetic Act ________ 3.The Orphan Drug Act ________ 4. Durham-Humphrey Amendment ________ 5. Harrison Narcotic Act ________ 6. Drug Abuse Control Amendments ________ 7. Comprehensive Drug Abuse Prevention and Control Act

Answer 25

1. b 2. g 3. e 4. a 5. d 6. b 7.f

Question 26

Fill in the Blank for Chapter 2 Study Guide

Question 27

The ________________ name, also known as the proprietary name, is usually a registered trademark

Answer 27

trade or brand

Question 28

Schedule ________________ drugs are not approved for medical use.

Answer 28

I

Question 29

The Health Insurance Portability and Accountability Act (HIPAA) allows patients more control over their ________________ ________________.

Answer 29

health information

Question 30

The Food and Drug Administration Safety and Innovation Act (FDASIA) strengthens the ________________ to safeguard and advance public ________________ by expediting development of ________________, ________________, and ________________ products.

Answer 30

FDA; health; innovative; safe; effective

Question 31

Practicing nurses should be knowledgeable about the ________________ ________________ ________________ to safely administer drugs

Answer 31

nurse practice act

Question 32

True/False Chapter 2

Question 33

Substance examples of Schedule II drugs include peyote, heroin, and Cannabis.

Answer 33

False. Schedule II drugs include cocaine, methadone, meperidine, and oxycodone

Question 34

Examples of Schedule IV substances include the category of benzodiazepines.

Answer 34

True

Question 35

All drugs become less effective over time.

Answer 35

True

Question 36

A nurse advances the health care profession through research and scholarly inquiry.

Answer 36

True

Question 37

A nurse will not be prosecuted for omitting a drug dose.

Answer 37

False. A nurse will be prosecuted for omitting a drug dose, giving the wrong drug, or giving the drug by the wrong route.

Question 38

Choose the Best answer choice | Chapter 2

Question 39

Which ethical principle is being observed when a nurse explains to a research participant the risk versus the benefits of participating in the research? a. Justice b. Beneficence c. Autonomy d. Respect for persons

Answer 39

b. Beneficence is the duty to protect research participants from harm. It clearly defines the research and ensures the benefits outweigh the risks. Justice involves the selection process of research participants is fair. Autonomy is the right to self determination and the nurse must allow the research participant to make decisions. Respect for persons mean that all clients, including research participants, are treated as an independent persons who are capable of making decisions in their own best interests.

Question 40

Before administering controlled drugs to a client, a nurse would perform which action? a. verify orders before drug administration b. not document all wasted drugs c. keep controlled drugs accessible for patient’s convenience d. have a witness for wastage of only Scheduled III drugs

Answer 40

a. Prior to administering any drugs, a nurse should verify orders. When administering any controlled substances, a nurse must document all wasted amount, keep all controlled drugs in a secure, locked area; and have a witness for any controlled drug wastages.

Question 41

Which resource provides the basis for standards in drug strength and composition throughout the world? a. United States Pharmacopeia/National Formulary b. American Hospital Formulary Service (AHFS) Drug Information c. MedlinePlus d. International Pharmacopeia

Answer 41

d. the International Pharmacopeia provides a basis for standards in strength and composition of drugs for use throughout the world. The United States Pharmacopeia/ National Formulary sets the drug standards used in the United States. The American Hospital Formulary Service Drug Information provides complete drug in-formation for both the health care provider and the consumer for drugs marketed in the United States. The Medline Plus provides extensive drug information and is available on the world wide web.

Question 42

Which primary purpose of federal legislation is related to drug standards? a. Provide consistency b. Establish cost controls c. Ensure safety d. Promote competition

Answer 42

c. Federal legislation’s primary purpose is to ensure safety and protect the public from drugs that are impure, toxic, ineffective, or not tested.

Question 43

The Kefauver-Harris Amendment was passed to improve safety by requiring which information to be included in the drug’s literature? a. Recommended dose b. Pregnancy category c. Side effects and contraindications d. Adverse reactions and contraindications

Answer 43

d. The Kefauver-Harris Amendment requires ad-verse reactions and contraindications to be included in the drug’s literature.

Question 44

The client presents to the emergency department with hallucinations. The client’s friend states the client has been using lysergic acid diethylamide (LSD) and mescaline. To which schedule do these drugs belong? a. Schedule IV b. Schedule III c. Schedule II d. Schedule I

Answer 44

d. LSD and mescaline are schedule I drugs. Schedule IV drugs include alprazolam and zolpidem. Schedule III drugs include ketamine and products containing less than 90 milligrams of codeine. Schedule II drugs include products with less than 15 milligrams of hydrocodone, cocaine, meperidine, and fentanyl.

Question 45

In which schedule would the nurse find codeine, an ingredient found in many cough syrup formulations? a. II b. III c. IV d. V

Answer 45

d. Schedule V drugs include cough preparation containing not more than 200 mg of codeine. Schedule II drugs include products with less than 15 milligrams of hydrocodone, cocaine, meperidine, and fentanyl. Schedule III drugs include ketamine and products containing less than 90 milli-grams of codeine. Schedule IV drugs include alprazolam and zolpidem.

Question 46

Where must controlled substances be stored in an institution/agency? a. In a double-wrapped and labeled container b. In the patient’s drug bin c. Near the nurse’s station d. In a locked, secured area

Answer 46

d. All controlled substances must be stored in a locked, secured area.

Question 47

A client with advanced pancreatic cancer agrees to participate in a clinical research for a new chemotherapy regimen and asks the nurse which group will be assigned. The nurse answers, knowing that: a. he will receive information about the study through the mail. b. the nurse has the role in explaining the study to the patient. c. the patient must be alert and comprehend the information being provided. d. information should be vague because the patient does not need to know the study protocol.

Answer 47

All participants in a research study has the right to be informed. It is the responsibility of the health care provider, not the nurse, to explain the study. In order for the participant provide an informed consent, the person must be alert and able to comprehend the information.

Question 48

The nurse must be alert for counterfeit prescription drugs. Which clues help identify counterfeit products? (Select all that apply). a. Different color b. Different dose c. Different taste d. Different labeling e. Different shape

Answer 48

a, c, d, e. Differences in appearance, either in the drug or in the packaging, can be an indication of a counterfeit drug. However, it is important to re-member that pharmacies may change their pharmaceutical supplier, so the drug may appear as a different color or shape to the patient. This is an opportunity for the nurse and the pharmacist to work together to provide client education

Question 49

Chapter 3 Study Guide Fill in the blank

Question 50

1. The pharmacokinetic phase is composed of ________________, ________________, ________________, and ________________.

Answer 50

absorption, distribution, metabolism, and excretion

Question 51

The t1/2 or the ________________ is when 50% of the drug concentration is eliminated.

Answer 51

half-life

Question 52

________________ is the effect of drug action on cells.

Answer 52

Pharmacodynamics

Question 53

Drug absorption is the movement of the drug into the ________________ after ________________.

Answer 53

bloodstream; administration

Question 54

Drugs that are ________________ block responses

Answer 54

antagonists

Question 55

Cell membranes contain ________________ that enhance drug actions.

Answer 55

receptors

Question 56

Match the terms in Column I with their descriptions in Column II. For Chapter two

Question 57

``` Column I ________ 7. Dissolution ________ 8. Hepatic first pass ________ 9. Nonselective receptors ________ 10. Passive absorption ________ 11.Protein-bound drug ________ 12. Unbound drug ________ 13. Facilitated diffusion ``` a. Drug absorbed by diffusion b. Causes inactive drug action/response c. Drugs that affect various receptors d. Free active drug causing a pharmacologic response e. Proceeds directly from intestine to the liver f. Breakdown of a drug into smaller particles g. Drug requiring a carrier for absorption

Answer 57

7. f 8. e 9. c 10. a 11. b 12. d 13. g

Question 58

``` Column I ________ 14.Duration of action ________ 15. Onset ________ 16.Peak action ________ 17. Therapeutic index ``` Column II a. Length of time a drug has a pharmacologic effect b. The margin of safety of a drug c. Occurs when a drug has reached its highest plasma concentration d. Time it takes a drug to reach minimum effective concentration

Answer 58

14. a 15. d 16. c 17. b

Question 59

Pick the best Answer Choice Chap 3

Question 60

Which drug form is most rapidly absorbed from the gastrointestinal (GI) tract? a. Capsule b. Sublingual c. Liquid d. Tablet

Answer 60

c. Since liquid drugs do not need to dissolute and dissolve like tablets and capsules, they are absorbed more rapidly. Absorption of drugs is the movement of the drug from the gastrointestinal (GI) tract into the bloodstream after administration. Sublingual drugs enter the blood stream without having to be absorbed by the GI tract.

Question 61

Disintegration of enteric-coated tablets occurs in the: | a. colon. b. liver. c. small intestine. d. stomach.

Answer 61

c. Disintegration of enteric-coated (EC) tablets occur in an alkaline environment of the small intestine. Drugs that are EC resist disintegration in the stomach by the gastric acid.

Question 62

Usually food _______________________ dissolution and absorption of drug. a. increases b. decreases c. has no effect on d. prevents

Answer 62

b. Food usually decrease dissolution and absorption of drugs. However, there are some drugs that are irritating to the gastric mucosa. Food can decrease the irritating effects.

Question 63

Which statement places the four processes of pharmacokinetics in the correct sequence? a. Absorption, metabolism, distribution, excretion b. Distribution, absorption, metabolism, excretion c. Distribution, metabolism, absorption, excretion d. Absorption, distribution, metabolism, excretion

Answer 63

d. Absorption, distribution, metabolism, and excretion are the correct sequence of pharmacokinetic phase. The drug must be absorbed from the GI tract into the bloodstream; drug must be distributed to the tissues; drug must be metabolized into an excretable form; the drug must be excreted.

Question 64

Which type of drug passes rapidly through the gastrointestinal (GI) membrane? a. Lipid-soluble and ionized b. Lipid-soluble and nonionized c. Water-soluble and ionized d. Water-soluble and nonionized

Answer 64

b. Drugs that are lipid-soluble and nonionized can readily pass through the GI membrane. The mucous membrane lining the GI tract is composed of lipids and protein which allows lipid-soluble drugs to pass through. On the other hand, water-soluble drug needs a carrier.

Question 65

Which factor(s) most commonly affect(s) a drug’s absorption? (Select all that apply.) a. Body mass index b. Hypotension c. Pain d. Sleep e. Stress

Answer 65

b, c, e. The gastrointestinal tract is not considered vital to a patient in shock and hypotensive, so blood is shunted away, and drug absorption is slowed. Blood flow is also slowed because of pain and stress, resulting in a prolonged emptying time of the stomach.

Question 66

Two days after starting diazepam for anxiety, the client is started on ampicillin with sulbactam for an infection. Which action will happen to the diazepam in the client’s body? a. The diazepam remains highly protein bound. b. The diazepam is deactivated. c. Most of the diazepam is released, and it be-comes more active. d. The diazepam is excreted in the urine un-changed.

Answer 66

c. Both drugs are highly protein-bound. When two or more highly protein-bound drugs are taken at the same time, they compete for the protein-binding sites. The more highly bound drug could displace the weakly bound drug; ampicillin/sulbactam could displace diazepam, which results in increase activity of diazepam.

Question 67

Which body organ is the major site of drug metabolism? a. Kidney b. Liver c. Lung d. Skin

Answer 67

b. The liver is the major site of drug metabolism. Kidneys excrete the drug.

Question 68

Which route of drug absorption has the greatest bioavailability? a. Intramuscular b. Intravenous c. Oral d. Subcutaneous

Answer 68

b. The percentage of drug (bioavailability) for therapeutic activity is greatest after intravenous administration. Factors that affect bioavailability of drugs include drug form, route of administration, gastric mucosa and motility, food or other drugs, and liver function.

Question 69

Which is the best description of a drug’s serum half-life? a. The time required for half of a drug dose to be absorbed b. The time required after absorption for half of the drug to be eliminated c. The time required for a drug to be totally effective d. The time required for half of the drug dose to be completely distributed

Answer 69

b. The best description is the time required for half of the drug to be eliminated. Other factors affecting drug’s half-life are amount administered, amount of drug remaining from previous dose, and metabolism.

Question 70

A client is taking a drug that has a half-life of 24 to 30 hours. In preparing discharge teaching, which dosing schedule would the nurse anticipate will be prescribed for this drug? a. Daily b. Every other day c. Twice per day d. Three times per day

Answer 70

a. A drug that has a half-life of 24 to 30 hours will be taken once daily to maintain a steady state.

Question 71

Which type of drug metabolite can be eliminated through the kidneys? a. Enteric-coated b. Lipid-soluble c. Protein-bound d. Water-soluble

Answer 71

d. Kidneys excrete drugs that are water-soluble, drugs that are not bound, and drugs that are un-changed.

Question 72

An older adult client with a glomerular filtration rate (GFR) of less than 30 has been prescribed trimethoprim for a urinary tract infection. If the nor-mal dose is 200 mg per day, which dosing would the nurse anticipate will occur with this client’s dosing regimen? a. The dose will double. b. The dose will decrease by one-half. c. The dose will stay the same. d. The dose will increase to three times per day

Answer 72

b. A decreased eGFR indicates renal dysfunction. Decreased eGFR is expected in older adults be-cause of their decreased muscle mass. Many drugs, including trimethoprim, are eliminated through the kidneys. To prevent toxicity, the dose would need to be decreased.

Question 73

Which statement provides the best determinant of the biologic activity of a drug? a. The fit of the drug at the receptor site b. The misfit of the drug at the receptor site c. The inability of the drug to bind to a specific receptor d. The ability of the drug to be rapidly excreted

Answer 73

a. Drug is more active if it is able to “fit” at the receptor site. The drug-receptor interactions are similar to the fit of the right key in a lock.

Question 74

Which type of drug prevents or inhibits a cellular response? a. Agonist b. Antagonist c. Cholinergic d. Nonspecific drug

Answer 74

b. An antagonist prevents (inhibits) and/or blocks a response. An agonist activates receptors and/or produces a desired response. A cholinergic is a type of a receptor. Nonspecific drug can either be an antagonist or agonist; depends on the type of receptors the drug affects.

Question 75

A drug effect on receptors located in different parts of the body may initiate a variety of responses de-pending on the anatomic site. Which type of drug responds in this manner? a. Ligand-gated b. Nonselective c. Nonspecific d. Placebo

Answer 75

c. A nonspecific drug affects same type of receptors located throughout the body, producing both antagonist and agonist effects. On the other hand, a nonselective drug affects more than one type of receptors.

Question 76

Which term measures the margin of safety of a drug. a. Therapeutic range b. Therapeutic index c. Duration of action d. Biologic half-life

Answer 76

b. Therapeutic index describes the relationship between the therapeutic dose and the toxic dose.

Question 77

Which measurement checks for the highest plasma/ serum concentration of the drug? a. Peak level b. Minimal effective concentration c. Half-life d. Trough level

Answer 77

a. Measurements that check a drug’s concentration include peak and trough levels; peak level measures the highest serum concentration and the trough level measures the lowest serum concentration of the drug.

Question 78

Which data would be important for the nurse to check in a drug reference book or pamphlet before administering a drug?(Select all that apply.) a. Contraindications b. Half-life c. Maximum effective concentration d. Protein-binding effect e. Therapeutic range

Answer 78

a, b, d, e. The nurse must be completely familiar with any drug being administered, such as contraindications, half-life, protein-binding effect, and therapeutic range. Information needs to be obtained not only on the drug but also on the specific patient’s history. Drug reference books, drug pamphlets/inserts, or a pharmacist may be consulted with questions.

Question 79

Which types of physiologic effects are predictable or associated with the use of a specific drug? a. Severe adverse reactions b. Side effects c. Synergistic effects d. Toxic effects

Answer 79

b. Side effects are secondary effects of all drugs and are often predictable. They may be desirable or undesirable. Adverse reactions, either mild or severe, are unintentional, unexpected reactions that occur at normal dosages. Synergistic effects occur when two or more drugs given together have a combined effect greater than the sum of their separate effects. Toxic effects are undesirable drug effects, often times life-threatening.

Question 80

Which term is illustrated when the nurse gives a large initial dose of a drug to rapidly achieve mini-mum effective concentration in the plasma? a. Therapeutic dose b. Toxic dose c. Loading dose d. Peak dose

Answer 80

c. Loading dose is a larger than usual dose to obtain a therapeutic effect while waiting for the steady state to be achieved.

Question 81

A time-response curve evaluates parameters of a drug’s action. Which parameter(s) is/are part of the time-response curve? (Select all that apply.) a. Duration of action b. Onset of action c. Peak action d. Therapeutic range e. Minimum effective concentration

Answer 81

a, b, c. A time-response curve shows the dose-relationship of the drug’s pharmacodynamics, which include onset, peak, and the duration of the drug’s action.

Question 82

Which intervention(s) regarding drug therapy would the nurse implement? (Select all that apply.) a. Assess for side effects, with a focus on undesirable side effects. b. Check reference books or drug inserts before administering the medication. c. Teach the patient to wait 1 week after the appearance of side effects to see if they disappear. d. Check the patient’s serum therapeutic range of drugs that have a narrow therapeutic range. e. Evaluate peak and trough levels before administering drugs with a narrow therapeutic range.

Answer 82

a, b, d, e. The nurse should assess the client for side effects (both desirable and undesirable) when administering drugs. This is especially important for drugs that have nonselective actions. The nurse must be familiar with the drug, including its dose range, desired effects, side effects, and ad-verse effects, before administration. This information can be obtained from a variety of sources including current reference books, drug inserts, and pharmacists. If the drug has a narrow therapeutic range or requires peak/trough levels, these should be evaluated before and after administration. Side effects may occur immediately or up to several days after a dose. There is no set time to wait and see if side effects disappear. The health care provider should be notified as soon as possible after the appearance of side effects, especially if they are undesirable.

Question 83

Chapter Five Study Guide Matching

Question 84

Column I ________ 1.Therapeutic value of plants ________ 2.Clarified marketing regulations for dietary supplements ________ 3. Assures manufacturing quality controls ________ 4. Reviews global literature on herbal studies by clinicians and researchers ________ 5. Supports study of alternative therapies Column II a. Current Good Manufacturing Practices b. Dietary Supplement Health and Education Act of 1994 c. National Center for Complementary and Integrative Health d. Natural Standard Research Collaboration e. Phytomedicine

Answer 84

1. e 2.b 3.a 4. d 5.c

Question 85

Fill in the blank for Chapter five

Question 86

Pouring boiling water over ________________ is called ________________.

Answer 86

plants; infusion

Question 87

A(n) ________________ is derived from soaking fresh or dried herbs in a solvent.

Answer 87

tincture

Question 88

________________ of a plant added to a solvent and applied topically is called a(n) ________________.

Answer 88

Extract; liniment

Question 89

Tea made from boiling plants, such as bark, rhizomes, and roots, is called a(n)________________.

Answer 89

decoction

Question 90

Aromatic ________________ oils from plants are called _______________ _______________ _______________.

Answer 90

volatile; herb-infused oils

Question 91

Matching section for chapter five

Question 92

``` Column I ________ 11. Ginkgo biloba ________ 12. Peppermint oil ________ 13. Dong quai ________ 14. Garlic ________ 15.Cinnamon ________ 16.Chamomile ________ 17. Hawthorn ________ 18.Echinacea ________19.Ginger ________ 20.St. John’s wort ``` Column II a. May be used to treat bronchitis and diabetes b. May be used to treat kidney disease c. Immune enhancer d. May be helpful in intermittent claudication and Alzheimer disease e. Relief from stiffness and pain of osteoarthritis and rheumatoid arthritis f. May be used to induce sleep g. May be effective treatment for tension headache h. May interfere with anticoagulants i. “Herbal Prozac” j. May help lower cholesterol and prevent stomach cancer

Answer 92

11. d, h 12. g 13. h 14. j 15. a, h 16. f 17. b 18. c 19. e, h 20. i

Question 93

Which herb would the nurse recognize as one that provides relief of digestive and gastrointestinal distress? a. Chamomile b. Milk thistle c. Echinacea d. St. John’s wort

Answer 93

a. Chamomile is used for stomach or intestinal distress. It is also used for sleeplessness, and anxiety. Milk thistle is used for liver and gallbladder disorders. Echinacea is commonly used for virus related symptoms. St. John’s wort is used to treat mental disorders and nerve pain.

Question 94

The daughter of a parent with Alzheimer disease asks about a complementary therapy that can improve memory. The nurse provides information knowing that which substance has been used in clients with Alzheimer disease. a. echinacea b. ginger c. Ginkgo biloba d. peppermint

Answer 94

c. Gingko biloba is used to improve memory, pre-vent Alzheimer disease and other dementias. It is also used for pulmonary distress, fatigue, and tinnitus. Echinacea is mostly used for virus related symptoms. Ginger is mostly used for nausea and diarrhea. Peppermint is good for nausea, indigestion, headaches, and nerve pain.

Question 95

Health teaching for a client who was prescribed warfarin would include information on which herbal product(s)? (Select all that apply.) a. Bilberry b. Garlic c. Ginseng d. Licorice e. Turmeric

Answer 95

a, b, c, d. Bilberry, garlic, ginseng, and licorice can interfere with anticoagulants, such as warfarin

Question 96

The nurse noticed a client has been taking ginseng. Which interventions would be appropriate by the nurse? (Select all that apply.) a. Discuss with the client the potential interactions of ginseng with anticoagulants. b. Tell the patient to stop taking the anticoagulant. c. Advise the client to continue taking the same brand of herbal therapy. d. Advise the client to report signs and symptoms of bleeding. e. Discuss with the client foods to avoid.

Answer 96

a, d, e. The nurse should intervene by discussing with the patient that ginseng can interfere with the anticoagulants and increase the chance of bleeding; therefore, the patient should report any signs or symptoms of bleeding, such as bleeding of gums, black and tarry stools, and blood in the urine. Although educating the patient about the potential food-drug interactions while taking an anticoagulant, it is not appropriate in this specific scenario

Question 97

Which statement(s) by the client reflect(s) prudent use of herbs? (Select all that apply.) a. “Herbs are fine to use when breastfeeding.” b. “Do not take a large quantity of any one herbal product.” c. “Give the herb time to work for a persistent symptom before seeking care from a health care provider.” d. “Do not give herbs to infants or young children.” e. “Brands of herbal products are interchange-able.”

Answer 97

b, d. Large quantities of any one herbal product can lead to an “overdosage” of that product. Because specific doses and quantities are not regulated in this country, it is difficult to determine the correct amount. More is not necessarily better. Infants and children should not receive herbal preparations because of the lack of standardization and testing in a pediatric population.

Question 98

The nurse is caring for a client who takes a variety of herbal products and is starting a prescription antidiabetic drug. The nurse teaches the client knowing that the effects of an antidiabetic drug are altered with which herbal products? (Select all that apply.) a. Astragalus b. Echinacea c. Ginseng d. Milk thistle e. Peppermint

Answer 98

c, d. Ginseng and milk thistle can have an additive effect when used with antidiabetic drugs causing hypoglycemia.

Question 99

Which drug(s) has/have negative interactions with St. John’s wort? (Select all that apply.) a. Anticoagulants b. Anticonvulsants c. Antidepressants d. Birth control drugs e. Paralytic drugs

Answer 99

a, b, c, d. St. John’s wort interacts with multiple drugs including anticoagulants and antiplatelets, anticonvulsants, antidepressants, and drugs for birth control. St. John’s wort can increase bleeding time; it can cause decreased drug levels of anticonvulsants and oral contraceptives; it can increase serotonin levels, leading to serotonin syndrome.

Question 100

A client with a history of hypertension, atrial fibrillation, chronic obstructive pulmonary disease, and insomnia tells the nurse, “I really love the taste of licorice.” What drug-herb interactions should the nurse inform the client can occur when given in combination with licorice? (Select all that apply.) a. Antihypertensive drug effects are decreased. b. Corticosteroid effects are increased. c. CNS depressant drug effects are decreased. d. Digoxin effects are increased. e. Rifampin effects are decreased.

Answer 100

a, b, d. The effects of antihypertensive medications may be decreased. Because licorice may have similar effects to aldosterone and corticosteroids, the effects of corticosteroid drugs may be in-creased. Taking licorice with digitalis may increase the effects of digitalis and lead to digitalis toxicity.

Question 101

Chapter 6 Fill in the Blank/Multiple choice

Question 102

Infants have __________________________ protein sites than adults, resulting in __________________________ risk of toxicity.

Answer 102

fewer; increased

Question 103

The degree and rate of absorption of drugs in a pediatric patient are based on ________________________, __________________________, __________________________, and ________________________.

Answer 103

age; health status; weight; route of administration

Question 104

Gastric pH does not reach adult acidity until around ______________________ to ______________________ year(s) of age.

Answer 104

2; 3

Question 105

Distribution of a drug throughout the body is affected by ________________________________, ________________________, ________________________, and effectiveness of various barriers to drug trans-port.

Answer 105

body fluid composition; tissue composition; protein-binding capability

Question 106

Until about the age of ______________________, the pediatric patient requires a(n) ______________________ dose of water-soluble drugs to achieve therapeutic levels.

Answer 106

2 years; higher

Question 107

``` ________ 6. Infant ________ 7. Toddler ________ 8. Preschool ________ 9.School-age ________ 10. Adolescent ``` Column II a. Allow some choice b. Involve in administration process c. Collaborate regarding plan of care d. Provide simple explanation e. Use minimum restraint necessary

Answer 107

6. e 7. d 8. a 9. b | 10. c

Question 108

The nurse is administering an oral drug with a low pH to a 2-week-old infant. Which action describes the impact of the infant’s age on the absorption of this drug? (Select all that apply.) a. Absorption may be slower in this infant. b. Absorption may be quicker in this infant. c. This drug will be absorbed at the same rate as an older client. d. Oral drugs should not be administered to this age group.

Answer 108

a, b. Absorption depends on the drug formulation (basic [alkalotic] or acidic). A low pH environment favors acidic drug absorption, whereas a high pH favors basic drug formulations.

Question 109

The 18-month-old child has been prescribed an oral drug that is water-soluble. Based on the nurse’s knowledge of drug distribution, how may the dosage need to be modified for the child to reach therapeutic level? a. Alternate route b. Decreased c. Increased d. No change

Answer 109

c. The dosage for a water-soluble medication may need to be increased in this age group because their bodies are about 70% water up until age 2 years. Therefore, there is more water in which the drug will be distributed

Question 110

Since the blood-brain barrier in infants is immature, which drug outcome is more likely? a. Increased effect of drug b. More side effects from drug c. Quicker results of drug d. Higher toxicity risk

Answer 110

d. Immature blood-brain barrier allows drugs to pass easily into the central nervous system tissue (brain), increasing the risk of toxicity. As a child matures, the blood-brain barrier becomes more impervious to drugs.

Question 111

Which drug action does the nurse know about the rate of absorption for topical drugs to a 3-year-old child? a. The drug will absorb faster. b. The drug will absorb slower. c. There will be no difference. d. It depends on the sex of the child.

Answer 111

a. The drug will absorb faster. One of the factors in which the degree and rate of drug absorption is age. The skin of infants and young children is thinner than that of adults. Furthermore, the ratio of body surface area to body mass is proportionately higher than for adults. Topical drugs are readily absorbed and toxicity can result. Sex of a child does not in-fluence drug absorption.

Question 112

Which components are related to pharmacokinetics? (Select all that apply.) a. Absorption b. Distribution c. Excretion d. Metabolism e. Onset

Answer 112

a, b, c, d. Pharmacokinetics include drug absorption, distribution, metabolism, and excretion.

Question 113

A child has been admitted for nausea, vomiting, and diarrhea, and the health care provider has pre-scribed several drugs. Which concern(s) are appropriate for the nurse to have regarding drug administration? (Select all that apply.) a. Renal tubular function is decreased. b. Dehydration may lead to toxicity. c. The drugs should not be administered by the oral route. d. Rectal administration will promote quick ab-sorption. e. Developmental levels must be considered.

Answer 113

a, b, c, e. In early adolescence, renal tubular function decreases, which may lead to impaired excretion and a higher risk for toxicity. Dehydration can also decrease renal function and may lead to toxicity. Because the client is nauseated and vomiting, drugs should not be administered orally. When providing care to any client, developmental levels should be considered.

Question 114

The nurse is teaching a group of parents how to administer drugs to their children. Which element(s) of drug administration will be included in the teaching? (Select all that apply.) a. Allow the child to determine the time of drug administration. b. Lightly restrain the child as needed. c. Praise the child after successful administration. d. Never threaten the child into taking the drug. e. Never tell the child what to expect; just give the drug. f. Herbal preparations should not, in general, be given to children.

Answer 114

b, c, d, f. If necessary, a child may be lightly restrained but should not be forcibly held down. The child should be praised for taking the drug. At no time should a child be threatened, forced, or made to view the medication as punishment. Depending on the developmental level of the child, explanations should be given to the child about what to expect, but the child should not be given the option of debating whether to take the drug. Herbal preparations are not usually given to children; however, cultural traditions should be respected as much as possible.

Question 115

Age-related factors among older adults influence drug ________________, ________________, ________________, and excretion.

Answer 115

absorption, distribution, metabolism

Question 116

Drugs for older adults are prescribed at ________________ dosages and ________________ increase in dosage based on therapeutic ________________.

Answer 116

low; gradually; response

Question 117

Some of the characteristics in older adults that increase the risk for problems related to drugs include ________________ and ________________ changes associated with ________________.

Answer 117

sensory; physical; aging

Question 118

Pharmacodynamic responses to drugs are altered with aging as a result of changes in the number of ________________ sites, which affects the ________________ of certain drugs.

Answer 118

receptor; affinity

Question 119

Identify at least five drugs that nurses should avoid administering to older adults with stage 4 or 5 chronic kidney disease.

Answer 119

sotalol, all NSAIDs, meperidine, glyburide, metformin, exenatide, nitrofurantoin, potassium-sparing diuretics, thiazide diuretics, olmesartan, and new anticoagulants

Question 120

Column I a. Altered by the decline in renal function b. Altered by a decline in muscle mass and an increase in fat c. Altered by decreased small-bowel surface area, decreased gastric emptying, and reduced gastric blood flow d. Altered by the decline in hepatic circulation, liver atrophy, and a reduction in hepatic enzyme activity Column II 6. Absorption 7. Distribution 8. Metabolism 9. Excretion

Answer 120

6. c 7. b 8. d 9. a

Question 121

Identify the drug class for each group of drugs. Lisinopril, benazepril, enalapril, quinapril

Answer 121

Angiotensin converting enzyme inhibitor (ACE-I)

Question 122

Acebutolol, atenolol, sotalol

Answer 122

Beta blockers

Question 123

Lithium, gabapentin, duloxetine, bupropion, venlafaxine, pregabalin

Answer 123

Psychotropics

Question 124

Irbesartan, losartan, valsartan

Answer 124

Angiotensin II-receptor blockers (ARBs)

Question 125

Answer the following questions as true or false. If false, rewrite the statement into a true statement. Risk factors associated with polypharmacy do not include advanced age.

Answer 125

False. Risk factors associated with polypharmacy includes advanced age in addition to female gen-der, having multiple health care providers, use of herbal therapies, use of over-the-counter (OTC) drugs, multiple chronic disorders, and frequency of hospitalizations and care transitions.

Question 126

Risk factors associated with polypharmacy include being female.

Answer 126

True

Question 127

Risk factors associated with polypharmacy include having more than one health care provider.

Answer 127

True

Question 128

Risk factors associated with polypharmacy do not include the use of OTC drugs.

Answer 128

False. Risk factors associated with polypharmacy include over-the-counter (OTC) drugs, in addition to female gender, having multiple health care providers, use of herbal therapies, advanced age, multiple chronic disorders, and frequency of hospitalizations and care transitions.

Question 129

Beers criteria is a document that lists drugs that has negative interactions in older adults when they drink alcohol.

Answer 129

False. Beers criteria is a document developed by the American Geriatric Society listing drugs to avoid among older adults and information on renal dosing and drug-drug interactions.

Question 130

Risk factors associated with polypharmacy include the use of vitamin and mineral supplements.

Answer 130

True

Question 131

Polypharmacy increases the risk of falls among older adults.

Answer 131

True

Question 132

Which lab result is an indicator of normal glomerular filtration rate for an adult? a. Creatinine clearance: 100–125 mL/min b. Aspartate aminotransferase: 4–12 mL/min c. Troponin: 80–120 mL/min d. Urea: 1.2–4.5

Answer 132

a. Creatinine clearance is determined by the glo-merular filtration rate (GFR). Normal working kid-neys will have a GFR of 100 to 125 mL/min. Aspar-tate aminotransferase (AST) measures the liver function. Troponin is a type of protein found in skeletal and heart muscles. Urea is a waste product.

Question 133

The safest antihypertensive drugs for older adults have a low incidence of which side effect? a. Constipation b. Electrolyte imbalance c. Loss of appetite d. Vision disturbances

Answer 133

b. Renal function is decreased in older adults, which can cause electrolyte imbalance. Also, decreased renal function can lead to prolonged half-life and elevated drug levels. Certain antihypertensives like ACE-I, potassium-sparing diuretics, and thiazide diuretics can worsen electrolyte imbalance.

Question 134

An older adult client recently started on diphen-hydramine for runny nose, headache, sneezing, and scratchy eyes. List of drugs taken on a daily basis in-cludes digoxin, fluoxetine, and a multivitamin on a daily basis. a. “I cannot work outside anymore because of the digoxin.” b. “I think I need to find a different allergy drug to take.” c. “I take fluoxetine because I have depression.” d. “I should not take my wife’s headache drug.”

Answer 134

a. There is no reason that the client cannot work outside while taking digoxin, and the client’s symptoms are not related to the digoxin. Diphenhydramine can be very sedating among older

Question 135

Which drug would have fewer adverse and toxic effects while maintaining its therapeutic effect? a. Half-life of 50 hours b. 90% protein bound c. Half-life of 4 hours d. Fat-soluble

Answer 135

c. Drugs with a shorter half-life will be eliminated from the body faster than drugs with longer half-life without interfering with its therapeutic effect. Quicker elimination will decrease the risk of ad-verse/toxic drug effects. More protein binding the drug has, the less active drug is available to exert its therapeutic effect. Fat-soluble drugs have greater volume of distribution and a prolonged period of action. This can also increase the risk for toxicity.

Question 136

Which lab value(s) will the nurse monitor in an older adult client to assess kidney function? (Select all that apply.) a. BUN b. Creatinine clearance c. CBC d. Lipase e. Triglycerides

Answer 136

a, b. BUN (blood urea nitrogen) and creatinine clearance are assessed to determine renal function. The ability for the kidneys to excrete drugs de-crease with age. CBC (complete blood count) is a test that evaluates red blood cells, white blood cells, and platelets. Lipase is a pancreatic enzyme. Triglycerides are a type of fat.

Question 137

An older adult client reports feeling dizzy every morning when getting out of bed. Which physio-logical effect does the nurse recognize the client is most likely experiencing? a. Bradycardia b. Intermittent claudication c. Hyperventilation d. Orthostatic hypotension

Answer 137

d. Dizziness when going from a supine to a standing position is referred to as orthostatic hypotension. Although bradycardia may cause dizziness, this is not the most likely cause.

Question 138

Which actions would the nurse recommend to a client who experiences dizziness when arising from bed? a. Change positions slowly. b. Move a chair close to the bed. c. Take deep breaths. d. Measure pulse before standing.

Answer 138

a. Changing positions slowly should assist in de-creasing the dizziness associated with hypotension related to changes in position. Taking a deep breath and checking heart rate will not affect dizziness. Having a chair close to the bed may be beneficial if the client feels dizzy but may also pose a safety risk; the client may strike the chair with fainting.

Question 139

Following hospitalization, the older adult client re-ceives a home visit from the nurse. The client asks if the drugs taken before hospitalization should continue. Which response would be appropriate by the nurse? a. “Yes, you should continue to take the drugs that you took before going to the hospital.” b. “You should take one-half the dosage of each drug that you took prior to hospitalization.” c. “You should take only the drugs that have been prescribed on discharge and not drugs that you took prior to hospitalization unless otherwise indicated.” d. “You should continue to take those drugs that have been helpful to you.”

Answer 139

c. When a person has been hospitalized, a drug reconciliation has been completed. Depending on the client’s response, drugs may be added to or subtracted from the regimen and dose adjustments may be made. The client should take only those drugs that have been prescribed at discharge.

Question 140

The older adult client has difficulties opening the bottle of celecoxib. Which response is appropriate by the nurse? a. “Please ask your pharmacist to place your drug in a bottle with a non-childproof cap.” b. “You can keep your drug in a glass cup in the medicine cabinet.” c. “You could place your drug in an envelope.” d. “A family member could help you with your daily drug regimen.”

Answer 140

a. Although a family member could assist with the daily drug regimen, the client will be able to maintain more independence using a non-childproof cap. Us-ing a non-childproof cap should make the container easier for the older adult client to grasp and open.

Question 141

An older adult client is to take newly prescribed drugs at different times. Which suggestion by the nurse would be appropriate so that the client can adhere with the drug regimen? a. “Line up the bottles of medications on a table and take them in that order.” b. “Obtain a weekly pill container with multiple time slots from the drugstore and fill the container the day or week before with the drugs.” c. “Ask a neighbor to give the daily drugs.” d. “Write down the drugs that you have taken each day.”

Answer 141

b. Maintaining independence for as long as possible is crucial for an older adult client. A client who has visual challenges can, with assistance, fill a drug-dispensing container for the upcoming week. The client must have assistance in the setup to assure that the correct drugs are in each separate compartment. Leaving the drug bottles on the counter could lead to a mix-up if they are dis-placed. Writing down which drugs need to be taken is not beneficial if the patient has visual challenges.

Question 142

In older adults, drug dosages are adjusted based on which factor(s)? (Select all that apply.) a. Amount of adipose tissue b. Height c. Nutritional status d. Laboratory results e. Response to drug

Answer 142

a, c, d, e. Of the listed factors, only height does not have a role in dosage adjustment. Older adults have more adipose tissue, so a greater amount of lipid-soluble drug would be absorbed. Protein is required for binding of some drugs, so if a patient is malnourished, there would be less protein avail-able, leading to more free drug; this can lead to drug toxicity. Laboratory results, specifically those that assess renal and hepatic function, are important to trend, as well as those drug levels (digoxin, INR) needed to measure toxicity. As with any population, it is important to evaluate the client for responsiveness to the drug.

Question 143

Before administering drugs to the older adult, which drug information(s) would the nurse know beforehand? (Select all that apply.) a. Whether the drug is highly protein bound b. Half-life of the drug c. Patient’s last bowel movement d. Serum levels of drugs with a narrow therapeutic range e. Baseline vital signs

Answer 143

a, b, d, e. Older adults have less protein available for binding, so it is important to know if a drug is highly protein bound. Drugs with a short half-life are less likely to cause problems for the client. Certain drugs (some antibiotics, digoxin, warfarin) have very narrow therapeutic ranges, so they must be monitored closely. Vital signs may vary as a client ages; therefore, it is important to obtain baseline vital signs to know the client’s norm.

Question 144

Chapter 8 Match/Multiple choice/ fill in the blank

Question 145

Column I ________ 1.Cognitive behavioral therapy ________ 2.Motivational enhancement therapy ________ 3.Contingency management Column II a. Based on frequent behavior monitoring and removal of rewards for substance use b. Recognize and stop negative patterns and enhance self-control c. Develop motivation internally to commit to specific plan

Answer 145

1. b 2. c 3. a

Question 146

Misused drugs typically increase ________________ and other ________________ in the limbic system of the brain.

Answer 146

dopamine, neurotransmitters

Question 147

The ________________ ________________ is a structure within the brain that regulates the body’s ability to feel pleasure.

Answer 147

reward circuit

Question 148

The study of environmental influences on genetics is called ________________.

Answer 148

epigenetics

Question 149

Disulfiram ________________ the enzyme involved in metabolizing alcohol.

Answer 149

inhibits

Question 150

Heroin addiction may be treated with ________________.

Answer 150

methadone or buprenorphine, or naltrexone

Question 151

Benzodiazepines are FDA approved to treat addiction to ________________.

Answer 151

GHB (gamma-hydroxybutyrate)

Question 152

Opioids provide a sense of ________________ and ________________; methadone ________________ these feelings.

Answer 152

euphoria, tranquility, blocks

Question 153

________________ questionnaire can be used to screen for alcohol misuse.

Answer 153

CAGE

Question 154

Substance use disorder among nurses can be recognized by changes in ________________, ________________, ________________, and ________________.

Answer 154

personality, behavior, job performance, job attendance

Question 155

Answer the following questions as true or false. If false, rewrite the statement into a true statement. Electronic cigarettes are safer than tobacco products.

Answer 155

False. Electronic cigarettes are not safer than tobacco products.

Question 156

Dehydroepiandrosterone (DHEA) is found in many dietary supplements and is approved to slow aging.

Answer 156

False. DHEA is found in many dietary supplements, and there is no evidence that DHEA slows aging, increases energy levels, or increases muscle strength.

Question 157

Discrepancies in controlled-drug handling and records among health care professionals may indicate drug diversion.

Answer 157

True

Question 158

``` Column I ________ 16.Craving ________ 17. Impaired control ________ 18. Tolerance ________ 19. Withdrawal syndrome ``` Column II a. Diminished ability to control the use of a drug in terms of onset, level, or termination b. A strong desire for the drug effects c. A group of signs and symptoms of physiologic disturbance upon cessation or reduction of a drug d. Requiring a significantly increased amount of a drug to achieve the desired effect

Answer 158

16. b 17. a 18. d 19. c

Question 159

A client is seen in the emergency department for reportedly swallowing a small balloon full of cocaine. Which clinical manifestations would the nurse expect to see if the balloon ruptured? a. Dilated pupils and restlessness b. Hypotension and tachycardia c. Insomnia and fine tremors d. Respiratory depression and pinpoint pupils

Answer 159

a. Cocaine can cause dilated pupils (not pinpoint pupils) and restlessness. It can also cause hypertension (not hypotension), tachycardia, insomnia, erratic behaviors (not fine tremors), and tachypnea (not respiratory depression).

Question 160

Which drug can be given to aid a client with opioid withdrawal? a. Disulfiram b. Lorazepam c. Methadone d. Naloxone

Answer 160

c. Methadone is a long-acting opioid that is effec-tive in treating persons addicted to opioids by blocking the sensation of euphoria and tranquility produced by opioids, and it prevents opioid with-drawal and craving. Dronabinol is a synthetic can-nabis, lorazepam is a benzodiazepine to decrease anxiety, and naloxone is a reversal agent for opi-oid-induced respiratory depression.

Question 161

The client has decided to quit smoking. Which key point(s) must the nurse include in the teaching plan? (Select all that apply.) a. Assess that the client is motivated to quit. b. Assist in setting a quit date of 1 month. c. Help the client identify what increases the de-sire to smoke. d. Advise the client to use chewing tobacco as a substitute. e. Provide the client with a list of smoking cessation aids.

Answer 161

a, c, e. A client must be ready and motivated to quit any addictive substance, or the likelihood of success is decreased. This is a difficult process that will re-quire the client’s commitment. Certain triggers, like places where a person smokes or times that trigger the craving for a cigarette, should be identified and alternatives determined. There are a variety of aids, both pharmacologic and nonpharmacologic, that can be utilized to help a client quit smoking. Ideally, a quit date of 1 to 2 weeks should be set so the client stays motivated. Tobacco in any form is still addictive, so chewing tobacco or smoking tobacco in a pipe instead of a cigarette is still abusing tobacco. Although it is difficult, some clients prefer to quit smoking “cold turkey” or without the use of aids.

Question 162

Which percentage of nurses abuse drugs and demonstrate impaired practice attributable to that abuse? a. 1–2% b. 3–6% c. 7–10% d. 10–15%

Answer 162

d. It is estimated that 10–15% of nurses have a substance use disorder, including cannabis, cocaine, narcotics, opiates, alcohol, and nicotine.

Question 163

“Bath salts” are classified as which type of drug? a. Amphetamine b. Benzodiazepine c. Hallucinogenic d. Synthetic cathinone

Answer 163

d. Bath salts are synthetic cathinone's that have amphetamine-like stimulant effects.

Question 164

Chapter 9 Study guide fill in the blank/matching/multiple choice

Question 165

Minimizing risk to clients. ____________________________________________

Answer 165

Safety

Question 166

Respecting the client’s rights. ________________________

Answer 166

Client-family-centered care

Question 167

Working collaboratively with inter-professional teams. _____

Answer 167

Collaboration and teamwork

Question 168

Improving client’s delivery of care. __________

Answer 168

Quality improvement

Question 169

Using technology to improve care. ______

Answer 169

Informatics

Question 170

Delivering safe care based on current research. _____________

Answer 170

Evidence-based care

Question 171

``` Column I ________ 7. Right route ________ 8. Right patient ________ 9. Right time ________ 10.Right documentation ________ 11. Right assessment ________ 12. Right drug ________ 13. Right dose ________ 14. Right education ________ 15. Right to refuse ________ 16.Right to evaluation ``` Column II a. Measurement of a client’s apical pulse b. Amount of drug given as prescribed c. Drug given intramuscularly (IM) as prescribed d. Teaching a client about possible side effects of the drug e. The client refuses to take drug f. Verification of client identification (ID) g. Nurse charts client’s pain was decreased after drug administration h. Client receives the prescribed drug i. Nurse checks blood pressure following blood pressure drug administration j. Drug given at the time prescribed

Answer 171

7. c 8.f 9.j 10. g 11. a 12. h 13. b 14. d 15. e 16. i

Question 172

Column I ________ 17. Drugs poured by others ________ 18. Client states the drug is different than usual ________ 19. Bad-tasting drugs first, then pleasant-tasting drugs ________ 20. Drugs in an unlabeled container ________ 21. An opened multidose vial with date and time it was opened and initialed ________ 22. Drugs left with visitors Column II a. Do not administer b. Do administer

Answer 172

17. a 18. a 19. b 20. a 21. b 22. a

Question 173

A client tells the nurse the unused opioids were flushed down the toilet. Which response is best by the nurse? a. “Flushing unused drugs is okay.” b. “Be sure to crush the drugs before flushing them.” c. “Crush the drugs and throw them in the trash.” d. “Throw them in the trash after mixing the drugs with unpalatable nonfood substance.”

Answer 173

d. Unused drugs should not be disposed in a manner that is connected to the sewage. Instead, it is best to dispose of them by taking the drug to a facility that has a “take-back” program. If this is not available, then drugs should be mixed whole in an unpalatable nonfood substance, such as kitty litter or dirt prior to placing them in the regular trash. It should not be crushed prior to mixing it.

Question 174

Chapter 10 Study Guide multiple choice, fill in the blank, matching

Question 175

______________________ and ______________________ drugs must be swallowed whole

Answer 175

Enteric-coated; timed-release

Question 176

Handheld nebulizers deliver a very ____________________ ____________________ in a spray of drug.

Answer 176

fine particle

Question 177

When giving a client a drug via a handheld nebulizer, the client should be placed in __________________ position.

Answer 177

semi-Fowler’s or high Fowler’s

Question 178

A nasogastric tube should be flushed with ______ mL of water (or the prescribed amount) following drug administration.

Answer 178

30

Question 179

Following insertion of a rectal suppository, the patient should remain in a side-lying position for at least _______ minutes.

Answer 179

30

Question 180

What is correct length of needle? | Subcutaneous

Answer 180

3/8 to 5/8 inch in length

Question 181

What is the correct length of needle | Intradermal (ID)

Answer 181

1/4 to 1/2 inch in length

Question 182

What is the correct length of the needle? | Intramuscular (IM)

Answer 182

5/8-1 1/2 inch in length

Question 183

The injection site that is away from major nerves and is a preferred site for Z-track injections is the

Answer 183

ventrogluteal

Question 184

The preferred site for immunizations for infants and children who are not ambulating alone is the

Answer 184

vastus lateralis

Question 185

The site that is easily accessible but is suitable for only small-volume doses is the

Answer 185

deltoid

Question 186

The preferred site for intramuscular injections in infants and children of any age is the

Answer 186

ventrogluteal

Question 187

A client is vomiting and has been prescribed an antiemetic. Which route does the nurse know is contraindicated for this client? a. Intradermal b. Intravenous c. Oral d. Rectal suppository

Answer 187

c. The oral route is contraindicated in a client who is vomiting. Parenteral routes are preferred.

Question 188

The 2-year-old child has been prescribed antibiotic eardrops. The nurse is providing education to the parents. Which instruction is correct in which to pull the auricle? a. Down and back b. Forward and back c. Forward and up d. Up and back

Answer 188

a. In children younger than 3 years old, straighten the external ear canal by pulling the auricle down and back. In older children and adults, straighten the canal by pulling the auricle upward and out-ward.

Question 189

A client has been prescribed an intramuscular (IM) injection. The drug is thick and must be administered deep IM. Which does site would the nurse choose for the injection? a. Deltoid b. Dorsolateral c. Vastus lateralis d. Ventrogluteal

Answer 189

d. The ventrogluteal muscle is the preferred site for many IM injections because it is a deep mus-cle, situated away from major nerves and blood vessels.

Question 190

Which site is preferred for an immunization injection in an 8-week-old infant? a. Deltoid b. Dorsogluteal c. Vastus lateralis d. Ventrogluteal

Answer 190

c. Vastus lateralis is the preferred site because of easy access; however, ventrogluteal can also be used. Dorsogluteal muscle is no longer used. Deltoid muscle is not developed.

Question 191

A client is being discharged on new drugs. Which statement made by the client would indicate that more teaching is required? a. “I can take any over-the-counter drug or herbal preparation that I think would be helpful.” b. “I need to make sure I keep appointments with my health care provider.” c. “I need to report any side effects to my health care provider.” d. “I will contact my pharmacy if I am going out of town to ensure that I have enough drug.”

Answer 191

a. Over-the-counter drugs and herbal preparations may interact with prescription drugs. Clients must be encouraged to discuss the use of these preparations with their pharmacist or health care provider.

Question 192

The client has been started on a new oral drug. Which information will the nurse include in the teaching? (Select all that apply.) a. Desired effect of the drug b. Dietary considerations c. Storage of all drugs in the refrigerator d. Research testing and development e. Written instructions on how to administer the drug

Answer 192

a, b, e. Nurses have the responsibility of teaching clients about their drugs. Teaching includes expected therapeutic effects, dietary considerations, and instructions should be written. Other aspects of teaching include possible side and adverse drug effects, possible laboratory tests that may be required, and ensuring continuous supply of the drug, among others. c is incorrect because not all drugs are stored in the refrigerator. d is incorrect because clients do not need to know how the drug was tested and developed.

Question 193

The client has been prescribed a steroid metered-dose inhaler (MDI) for asthma. Which statement by the client indicates understanding of how to use the MDI? a. “I can use it as often as I need it.” b. “I need to rinse out my mouth after I use it.” c. “I should put my mouth tightly over the end.” d. “I can administer multiple puffs at one time.”

Answer 193

b. The client should rinse out the mouth after administering a dose from a metered-dose inhaler. This will help prevent secondary infection and irritation. a is incorrect because the MDI must be used as prescribed. Overuse can increase side effects and tolerance can result. c is incorrect because the mouth is not placed tightly over the end. It is closed around the MDI with the opening toward the back of the throat or it can be positioned 1-2 inches from the mouth if a spacer is not used. d is incorrect; subsequent doses should be spaced 1-2 minutes apart.

Question 194

Chapter 11 is Dosage Calculation so Practice!!

Question 195

``` Column I ________ 1. Alpha1 blocker ________ 2. Beta blocker ________ 3. Selectivity ________ 4. Sympathomimetic ________ 5. Sympatholytic ``` Column II a. Blocks action of sympathetic nervous system b. Has a greater affinity for certain receptors c. Causes vasodilation d. Causes decreased heart rate e. Similar in action to stimulation of the sympathetic nervous system

Answer 195

1. c. Alpha1 blocker causes vasodilation. Alpha2 blocker causes vasoconstriction. 2. d. Beta blockers can decrease heart rate. Beta1 affects the heart; whereas, Beta2 affects bronchioles, uterus and glycogenolysis. 3. b. Has greater affinity for certain receptors 4. e. The sympathomimetic mimics the sympathetic nervous system. 5. a. Blocks action of sympathetic nervous system

Question 196

Adrenergic receptors are located on the ________________ cells of smooth muscles.

Answer 196

effector

Question 197

Bladder relaxation and urinary sphincter constriction resulting in urinary retention may occur with high doses of _____________________________ agonists.

Answer 197

adrenergic

Question 198

Sympathomimetics (do/do not) pass into the breast milk. (Circle correct answer.)

Answer 198

do

Question 199

Adrenergic blockers are also called ___________

Answer 199

sympatholytics

Question 200

The antidote for infiltration intravenously (IV) of alpha-and beta-adrenergic drugs such as norepinephrine and dopamine is ____

Answer 200

phentolamine mesylate

Question 201

A beta-adrenergic blocker that can be given for migraine or hypertension is ________________________

Answer 201

propranolol

Question 202

Mood changes such as depression and suicidal tendencies are possible when taking which type of adrenergic blocker? ______________

Answer 202

Beta blocker; many drugs can cause depression. Beta blockers should not be abruptly discontinued.

Question 203

Carvedilol, penbutolol, and pindolol are examples of selective/nonselective beta blockers. (Circle correct answer.)

Answer 203

nonselective

Question 204

Nonselective beta blockers, such as propranolol, are contraindicated in patients with _______________________ and ________________

Answer 204

asthma; chronic obstructive pulmonary disease (COPD)

Question 205

What is most likely to occur if a patient is taking an adrenergic agonist with an adrenergic blocker? __________________________

Answer 205

The adrenergic blocker will be an antagonist which would negate the therapeutic actions of the adrenergic agonist.

Question 206

Study Alpha 1-2, and beta 1-2

Question 207

A client with asthma asks the nurse how albuterol inhaler will work to help breathe better. Which response by the nurse best explains the action of the drug? a. “Albuterol will increase your heart rate so you will feel like you are able to breathe better.” b. “Albuterol causes the airways to open up more in the lungs, improving function.” c. “Albuterol will cause an increase in urinary output to remove extra fluid from the lungs.” d. “Albuterol causes bronchial smooth muscle contraction that forces air into the lungs.”

Answer 207

a, c, d. Complications associated with TPN include air embolism, hyperglycemia, and pneumothorax. Air embolism can occur when air enters the central line catheter. TPN consists of hypertonic dextrose solution which can increase serum glucose. Pneumothorax is air or gas in the pleural space causing the lungs to collapse. This can occur due to punctured lung during the procedure in inserting the central line. Aspiration can occur with enteral tube feeding, not because of TPN.

Question 208

A client presents to the clinic with a swollen face and tongue, difficulty breathing, and audible wheezes after eating a peanut butter sandwich for lunch. Which action would the nurse first take? a. Ensure a patent airway. b. Obtain an electrocardiogram (ECG). c. Administer 1 mg of 1:1000 epinephrine subcutaneously. d. Start an intravenous (IV) normal saline.

Answer 208

. Ensuring a patent airway is the first step in providing care to any client. There is no indication currently for an electrocardiogram. Although epinephrine is beneficial in allergic reactions, 1 mg of 1:1000 exceeds the subcutaneous dosage. Establishing an IV would not be the first action to take.

Question 209

A client calls the home health agency to tell the nurse about shaking and trembling after using the albuterol inhaler. Which question would the nurse first ask the client? a. “Are you having any other symptoms?” b. “How long ago did this start?” c. “When was the last time you used your inhaler?” d. “How many puffs on the inhaler did you take?”

Answer 209

d. Although all pieces of information are important, the nurse should ask the client how many puffs of the inhaler were taken to determine that the client did not overdose on the drug. Other side effects of albuterol, besides shaking and trembling, include sweating, nausea, headaches, blurred vision, and flushing.

Question 210

Which drug(s) is/are classified as beta blockers? (Select all that apply.) a. Albuterol b. Atenolol c. Propranolol d. Amphetamine e. Acebutolol

Answer 210

b, c, e. Albuterol is a beta agonist and amphetamine is a sympathomimetic.

Question 211

The nurse discovers an intravenous (IV) site has infiltrated on a client receiving intravenous (IV) dopamine. The nurse prepares to administer which drug as an antidote. a. dobutamine b. epinephrine c. phentolamine d. reserpine

Answer 211

c. Dopamine is a vasopressor (adrenergic agonist) that acts on alpha1-and beta1-receptor sites. Dopamine can cause tissue necrosis. Phentolamine mesylate is an adrenergic antagonist and is an antidote to stop further tissue necrosis. Dobutamine and epinephrine are also adrenergic agonists that can cause tissue necrosis. Although reserpine is an adrenergic neuron antagonist, it is used to treat hypertension.

Question 212

When completing the client health history, the nurse finds a history of narrow-angle glaucoma. When performing the drug reconciliation, which drug would concern the nurse? (Select all that apply.) a. Pseudoephedrine b. Midodrine c. Albuterol d. Carvedilol

Answer 212

a, b, c. Carvedilol is an adrenergic blocker. The other three drugs are adrenergic agonists. Adrenergic agonists are contraindicated in narrow-angle glaucoma.

Question 213

Some over-the-counter (OTC) drugs for cold symptoms contain substances that have sympathetic properties. These drugs are contraindicated in clients with which disease process? a. Allergic rhinitis b. Hypertension c. Orthostatic hypotension d. Chronic bronchitis

Answer 213

b. Many OTC drugs, such as nasal decongestion, contain pseudoephedrine, which is a sympathomimetic; they can worsen hypertension.

Question 214

Which adrenergic drug used in emergency settings does not decrease renal function? a. Norepinephrine b. Dopamine c. Phenylephrine d. Dobutamine

Answer 214

b. Dopamine acts primarily on dopaminergic receptors and are located in renal, mesenteric, coronary, and cerebral arteries. These dopaminergic receptors can only be activated by dopamine. When these receptors are stimulated, vasodilation and increased blood flow occur, which can increase renal flow.

Question 215

Beta1 receptors are located in which area of the body? (Select all that apply.) a. Gastrointestinal tract b. Lungs c. Kidneys d. Brain e. Heart

Answer 215

c, e. Beta1 receptors are primarily located in the heart and in the kidney.

Question 216

A client tells the nurse during the admitting history that alternative and complementary therapies are used to help manage medical conditions. Which drug would raise a concern in a client taking St. John’s wort? a. Reserpine b. Albuterol c. Propranolol d. Pseudoephedrine

Answer 216

a. St John’s wort can decrease the hypotensive effects of reserpine.

Question 217

A nurse received an order for timolol 100 mg b.i.d. Which action is most appropriate by the nurse? a. Give the client the drug after proper identification. b. Hold the drug, and contact the health care provider regarding the dosage. c. Give the drug now, and request a new order during patient rounds. d. Assess the client’s vital signs, and give the drug.

Answer 217

b. The proper dosage for timolol is initially 10 mg b.i.d., with a maximum dose of 60 mg/day. The above-ordered dose is 10 times the initial starting dose.

Question 218

Catecholamine can be best defined by which statement? a. A substance that can produce a sympathomimetic response b. Another name for a beta blocker c. A type of decongestant d. A receptor site in the lungs

Answer 218

a. Catecholamines are substances that can produce a sympathomimetic response. Endogenous catecholamines include epinephrine, norepinephrine, and dopamine. Exogenous catecholamines are isoproterenol and dobutamine.

Question 219

Chapter 16 Study guide multiple choice/ fill in the blank/ matching

Question 220

``` Column I ________ 1. Acetylcholine (ACh) ________ 2. Anticholinergic ________ 3. Anticholinesterase ________ 4. Anticholinesterase ________ 5. Cholinesterase ________ 6. Muscarinic receptor ________ 7. Nicotinic receptor ________ 8.Direct-acting parasympathomimetic ``` Column II a. Stimulates smooth muscle and slows heart rate b. Impacts skeletal muscles c. Stimulates muscarinic and nicotinic receptors d. Stimulate the parasympathetic system e. Blocks the action of acetylcholine f. Mimics cholinergic actions g. Blocks the breakdown of acetylcholine h. Causes the breakdown of acetylcholine

Answer 220

1. c 2. e 3. g. Also known as acetylcholinesterase inhibitors 4. d 5. h 6. a 7. b 8. f. Direct-acting acts like cholinergic agonists. Indi-rect-acting acts like cholinesterase inhibitors.

Question 221

Which drug would the nurse anticipate administering to a client who ingested an organophosphate poison? a. Bethanechol b. Edrophonium chloride c. Metoclopramide d. Pralidoxime chloride

Answer 221

d. Pralidoxime chloride is an anticholinergic that inhibits the actions of acetylcholine. It is given for cholinesterase inhibitor toxicity and organophosphate pesticide toxicity. Bethanechol is a direct-acting cholinergic agonist and is used to treat urinary retention. Metoclopramide, a direct-acting cholinergic agonist, is used to treat gastrointestinal (GI) symptoms.

Question 222

The pediatric client has urinary retention. Which cholinergic drug does the nurse anticipate will be prescribed to increase urination? a. Bethanechol b. Edrophonium chloride c. Metoclopramide d. Neostigmine bromide

Answer 222

a. Bethanechol, a direct-acting cholinergic agonist, is used to treat urinary retention. Metoclopramide, a direct-acting cholinergic agonist, is used to treat gastrointestinal (GI) symptoms. Neostigmine bromide is used to treat myasthenia gravis.

Question 223

Anticholinergic eyedrops are used for which purpose? a. Constrict the pupils b. Dilate the pupils c. Decrease the intraocular pressure d. Detect astigmatism

Answer 223

b. Anticholinergics inhibit the acetylcholine receptors and include muscarinic and nicotinic receptors. Anticholinergic eyedrops causes dilated pupils (mydriasis). Cholinergic agonists will constrict pupils. Direct-acting cholinergic agonists will de-crease intraocular pressure.

Question 224

A client with narrow-angle glaucoma is prescribed an anticholinergic drug. Which action would be a priority by the nurse? a. Administer the medication as ordered after verifying the patient’s identity. b. Give only one-half of the prescribed dose. c. Hold the dose and contact the health care provider. d. Wait until after the patient has taken glaucoma medication and then give the drug.

Answer 224

c. Anticholinergic drugs are contraindicated in a client with glaucoma because they increase the intraocular pressure. Therefore, the nurse should hold the drug and contact the prescriber.

Question 225

Which type of medication is Bethanechol? a. Anticholinergic b. Cholinergic agonist c. Cholinesterase inhibitor d. Sympatholytic

Answer 225

b. Bethanechol is a direct-acting cholinergic agonist. Agonists promote tissue response.

Question 226

Which statement describes the mechanism of action for Bethanechol? a. Inhibits muscarinic receptors b. Inhibits nicotinic receptors c. Stimulates muscarinic receptors d. Stimulates nicotinic receptors

Answer 226

c. Bethanechol, a direct-acting cholinergic agonist, works on the muscarinic receptor. Nicotinic receptors work on skeletal muscles. Anticholinergics inhibits muscarinic and nicotinic receptor.

Question 227

The client who was prescribed Bethanechol asks the nurse how it works. Which response would be most appropriate by the nurse? a. “This drug decreases bladder tone.” b. “This drug inhibits bladder contraction.” c. “This drug promotes contraction of the bladder.” d. “This drug stimulates urine production.

Answer 227

c. Bethanechol, a direct-acting cholinergic agonists stimulates the muscarinic receptors to contract bladder which increases urination.

Question 228

Which outcome to the body would occur from receiving large doses of cholinergic drugs? (Select all that apply.) a. Decreased blood pressure b. Decreased salivation c. Increased bronchial secretions d. Mydriasis e. Urinary retention

Answer 228

a, c. Cholinergic drugs are parasympathomimetic in that they mimic the parasympathetic responses. One response is the dilation of blood vessels, which decreases blood pressure. Other responses include pupillary constriction (miosis), bronchoconstriction and increased bronchial secretions, decreased heart rate, increased gastrointestinal peristalsis and secretions, bladder contraction, and increased salivation.

Question 229

The client has been prescribed Bethanechol and is experiencing decreased urinary output. Which action would be a priority by the nurse? a. Catheterize the client to drain the bladder and measure output. b. Encourage the client to increase fluid intake to increase urinary output. c. Encourage the client to relax when urinating. d. Notify the health care provider with current in-take and output values.

Answer 229

d. Bethanechol is used to treat urinary retention but will not be effective and should not be used in the case of a mechanical obstruction. If this client was prescribed Bethanechol for urinary retention and the urine output is decreasing, the health care provider should be notified to investigate another cause

Question 230

The client has been taking Bethanechol and is experiencing flushing, sweating, nausea, and abdominal cramps. Which action would be best for the nurse to take? a. Document the client’s manifestations. b. Give the client a laxative. c. Increase the client’s fluid intake. d. Obtain an order to administer atropine.

Answer 230

d. Bethanechol is a cholinergic agonist. The client is experiencing an adverse response, and the treatment of choice is atropine. The nurse should obtain an order to administer atropine, the antidote for cholinergic overdose. The nurse should document the client’s experiences, but it is not the best action by the nurse. Abdominal cramps is due the action on the muscarinic receptors, not due to constipation. Increasing fluid intake will not relieve the side effects of Bethanechol.

Question 231

Which drug treats myasthenia gravis by increasing muscle strength? a. Bethanechol b. Edrophonium chloride c. Neostigmine bromide d. Pilocarpine

Answer 231

c. Neostigmine bromide is used to treat myasthenia gravis (MG). Bethanechol is used to treat urinary retention. Pilocarpine is used to treat glaucoma.

Question 232

The nurse is taking care of five clients in the emergency department. Which client(s) would be candidate(s) to receive atropine? (Select all that apply.) a. A client having surgery for appendicitis b. A client with a heart rate of 38 beats/minute and dizziness c. A client with paralytic ileus d. A client with urinary retention e. A client with gastric ulcers

Answer 232

a, b. Atropine would be beneficial as a preoperative drug to help control oral secretions. It is also used for clients who are symptomatic with a heart rate less than 50 beats per minute and is symptomatic of decreased cardiac output. Bethanechol is for urinary retention. Benztropine is for paralytic ileus. Propantheline bromide is used for gastric ulcers.

Question 233

The nurse would question an order for atropine for which client? a. A client with a peptic ulcer b. A client with parkinsonism c. A client with cirrhosis d. A client with narrow-angle glaucoma

Answer 233

d. Atropine-like drugs should not be administered to clients with narrow-angle glaucoma because they will increase the intraocular pressure.

Question 234

The client with new diagnosis of peptic ulcers was prescribed propantheline. Which substance would the nurse teach that is a priority point for nutrition? a. Calcium b. Fat c. Fiber d. Protein

Answer 234

c. Because of the decrease in gastrointestinal motility that can be associated with propantheline, the client should be encouraged to eat foods that are high in fiber and drink adequate amounts of liquid to prevent constipation.

Question 235

Which teaching point(s) will the nurse include for a client taking hyoscyamine for irritable bowel syndrome? (Select all that apply.) a. Ensure adequate fluid intake. b. Do not drive until you are aware of how this drug will affect your vision. c. Sucking on hard candy may help with dry mouth. d. Increased sweating is a common side effect. e. Report a rapid heart rate to your health care provider.

Answer 235

a, b, c, e. Hyoscyamine is an anticholinergic drug that will have similar side effects to the prototype drug atropine. Adequate fluid intake will help pre-vent constipation. Vision may be blurry, and the client should be advised not to drive until the effects of the drug on the vision are known. Sucking on hard candy or sugar-free ice pops, as well as increased fluid intake, may help with dry mouth. The client should be educated as to baseline heart rate and advised to report tachycardia (rates above 100 beats/minute) to the health care provider. In-creased sweating is not a common side effect.

Question 236

Anticholinergic drugs are contraindicated in clients with which disease processes? (Select all that apply.) a. Coronary artery disease b. Diabetes mellitus c. Gastrointestinal obstruction d. Supraventricular tachycardia

Answer 236

a, c, d. Anticholinergic drugs block the normal parasympathetic responses of the pupils, lungs, heart, blood vessels, gastrointestinal tract, bladder, and salivary glands. Therefore, anticholinergic drugs are contraindicated in clients with any heart disease and diabetes mellitus.

Question 237

A specific group of anticholinergics may be pre-scribed in the early treatment of which neuromuscular disorder? a. Multiple sclerosis b. Muscular dystrophy c. Myasthenia gravis d. Parkinsonism

Answer 237

d. Anticholinergics, such as biperiden and benztropine, are used to treat early Parkinson. Anticholinesterase, not anticholinergics, are used to treat myasthenia gravis.

Question 238

The older adult client is taking benztropine for symptoms associated with parkinsonism. The nurse will instruct the client to report which clinical manifestation(s) to the health care provider? (Select all that apply.) a. Diarrhea b. Dizziness c. Hallucinations d. Hyperthermia e. Palpitations

Answer 238

b, c, d, e. Common side effects of anticholinergic drugs, like benztropine, may include dry mouth, constipation, and urinary retention. Dizziness and hallucinations should be reported to the health care provider because these may become dangerous to the client. Because there is a decreased ability to perspire, life-threatening hyperthermia may develop. Palpitations may be due to tachycardia.

Question 239

Chapter 17 Stimulants Study guide

Question 240

The central nervous system involves the _________ and the _____ _____.

Answer 240

brain; spinal cord

Question 241

Attention-deficit/hyperactivity disorder can be caused by a _____________ of neurotransmitters.

Answer 241

dysregulation

Question 242

Amphetamines stimulate the release of neurotransmitters ________ and _______, and can lead to cardiovascular problems.

Answer 242

norepinephrine; dopamine

Question 243

Anorexiants have a/an _______ effect on the brain to _______ ________.

Answer 243

stimulant; suppress appetite

Question 244

Central nervous system stimulants, also referred to as _______, stimulate respiration.

Answer 244

analeptics

Question 245

Which medical condition(s) is/are central nervous system (CNS) stimulants approved to treat? (Select all that apply.) a. Attention-deficit/hyperactivity disorder (ADHD) b. Anorexia c. Narcolepsy d. Obesity e. Posttraumatic stress disorder (PTSD)

Answer 245

a, c, d. CNS stimulants, such as amphetamines, analeptics, and anorexiants, are approved to treat ADHD, narcolepsy, and PTSD.

Question 246

An adult client has been prescribed methylphenidate for the treatment of narcolepsy. The client presents to the clinic with hand tremors and feelings of nervousness. Which priority teaching consideration(s) should be included for this client? (Select all that apply.) a. Avoid operating hazardous equipment. b. Caffeine should be avoided. c. Nervousness and tremors may occur. d. Take the medication before meals. e. Report any weight gain.

Answer 246

a, b, c, d. Methylphenidate is a stimulant to treat ADHD and narcolepsy. Clients taking methylphenidate should not operate hazardous equipment when they experience tremors, nervousness, or in-creased heart rate; avoid other stimulants, such as caffeine; and that nervousness or tremors can occur. The drug should be taken before meals. Weight loss can occur, not weight gain.

Question 247

Which drug group acts on the brainstem and medulla to stimulate respiration? a. Amphetamine b. Analeptic c. Anorexiant d. Triptan

Answer 247

b. Analeptics stimulate the brainstem and medulla to stimulate respiration. Anorexiants stimulate the satiety center in the hypothalamic and limbic areas of the brain. Amphetamines stimulate the cerebral cortex.

Question 248

An adolescent client is being treated with methylphenidate for attention-deficit/hyperactivity disorder (ADHD). What common effects should the client and family be informed might occur? (Select all that apply.) a. Euphoria b. Headache c. Hypertension d. Irritability e. Hypotension f. Vomiting

Answer 248

a, b, c, d, f. Methylphenidate can cause euphoria, headache, hypertension, irritability, and vomiting. Hypotension is an adverse effect, not a common side effect.

Question 249

To maintain the half-life of immediate-release methylphenidate, how often should this drug be taken? a. Daily b. 2 to 3 times a day c. 4 times a day d. Every other day

Answer 249

b. An immediate-release drug can be taken in 2 or 3 divided doses. An extended-release drug should be taken once daily.

Question 250

The client has been prescribed phentermine hydrochloride for obesity. The client also has Parkinson disease and takes selegiline. Which nursing action would the nurse do before the client starts the new drug? a. Contact the client’s primary health care provider to verify the prescription. b. Have baseline lab work drawn to assess liver function. c. Tell the client to immediately stop taking the selegiline. d. Tell the client to increase fluid intake with the next meal

Answer 250

a. Phentermine hydrochloride should not be taken within 14 days of monoamine oxidase inhibitors (MAOIs) such as selegiline. Combinations of the two drugs intensify the stimulation and vasopressor effects of phentermine that can cause severe cardiovascular and cerebrovascular responses. There-fore, the nurse should contact the health care provider to verify the prescription.

Question 251

An overweight client has a history of migraines, depression, and hypertension and has been started on phentermine-topiramate. For which condition is phentermine-topiramate used? a. Attention-deficit/hyperactivity disorder (ADHD) b. Asthma c. Narcolepsy d. Short-term weight management

Answer 251

d. Phentermine-topiramate is used for short-term weight management.

Question 252

The pediatric client has been started on methylphenidate for attention-deficit/hyperactivity disorder (ADHD). Which information should the nurse include in the health teaching? a. Constipation is a common side effect. b. Counseling should be combined with drug. c. This drug will only be used for a few weeks. d. Weight gain is to be expected.

Answer 252

b. The nurse should include that counseling should be obtained while on methylphenidate. Diarrhea, not constipation, is a common side effect. Methylphenidate is usually prescribed long term and should not be stopped abruptly. Weight loss, not gain, can occur.

Question 253

Which statement(s) is/are true of methylphenidate? (Select all that apply.) a. If taken with monoamine oxidase inhibitors (MAOIs), it may increase a hypertensive crisis. b. The effects of anticoagulants may increase. c. Hyperglycemia may occur. d. Insulin will be more effective. e. There may be increased effects if taken with caffeinated beverages.

Answer 253

a, b, e. Methylphenidate and MAOIs taken together can increase hypertensive crisis. Methylphenidate can increase the effects of anticoagulants. The effects of methylphenidate can be increased by caffeine.

Question 254

An 18-year-old client is brought to the emergency department by the roommates. Blood pressure is 220/136 mm Hg, heart rate 142 beats/minute, and respiratory rate 20 breaths/minute. the client is responsive only to deep pain. Client’s roommates report the client was trying to lose weight and has been taking “these pills obtained over the Internet.” Which medical condition would the nurse consider as the most likely cause for this client’s symptoms? a. Cardiac arrest b. Food poisoning c. Hemorrhagic stroke d. Pregnancy-induced hypertension

Answer 254

c. Hemorrhagic stroke is the most likely diagnosis of those listed. There is a high risk for hemorrhagic stroke attributable to hypertensive crisis in clients taking appetite suppressants or anorexiants. Pregnancy-induced hypertension is a possibility, but the client has been trying to lose weight, not become pregnant. However, a pregnancy test should be obtained; anorexiants are contraindicated in pregnancy.

Question 255

Central nervous system (CNS) stimulants are absolutely contraindicated for clients with a history of which condition(s)? (Select all that apply.) a. Coronary artery disease b. Diabetes c. Hypothyroidism d. Hypertension e. Glaucoma

Answer 255

a, d, e. CNS stimulants are absolutely contraindicated in clients with coronary artery disease, hyper-tension, and liver failure. Cautious use is recommended for clients with any amount of liver disease.

Question 256

A neonate born at 28 weeks’ gestation is scheduled to receive caffeine citrate 20 mg/kg intravenously shortly after birth. The neonate’s mother asks, “Why are you giving my baby stuff that is in coffee?” Which statement made by the nurse is most appropriate? a. “Caffeine can help your baby breathe better.” b. “It will help your baby gain weight faster.” c. “The baby’s temperature will be warmer with caffeine.” d. “This isn’t the same substance that is in coffee.”

Answer 256

a. Caffeine can stimulate the respiratory system to help the neonate breathe better. It will not cause the baby to gain weight and increase body’s temperature

Question 257

Chapter 18 Depressants

Question 258

Identify the induction time for the following anesthetics—slow or rapid: 1. Halothane _______________ 2. Enflurane _______________ 3. Methoxyflurane _______________ 4. Midazolam _______________ 5. Propofol _______________ 6. Nitrous oxide _______________

Answer 258

1. rapid 2. rapid 3. slow 4. rapid 5. rapid 6. rapid

Question 259

The broad classification of CNS depressants includes the following seven groups: _______________, _________________, _________________, _________________, _________________, _________________, and _______________.

Answer 259

sedative-hypnotics; general anesthetics; analgesics; opioid and nonopioid analgesics; anticonvulsants; antipsychotics; antidepressants

Question 260

The two phases of sleep are _______________ and _______________.

Answer 260

rapid eye movement; nonrapid eye movement

Question 261

The mildest form of CNS depression is _______________.

Answer 261

sedation

Question 262

Anesthesia (may/may not) be achieved with high doses of sedative-hypnotics. (Circle correct answer.)

Answer 262

may

Question 263

procaine hydrochloride is used in local anesthesia as a short/moderate/long-acting anesthetic (Circle correct answer.)

Answer 263

short

Question 264

General anesthesia depresses the _______________ system, alleviates _______________, and causes a loss of _______________.

Answer 264

central nervous; pain; consciousness

Question 265

Surgery is performed during the _______________ stage of anesthesia. The other three stages are _______________, _______________, and _______________.

Answer 265

surgical; analgesia; excitement or delirium; medullary paralysis

Question 266

Bupivacaine and tetracaine are drugs commonly used for _______________ anesthesia

Answer 266

spinal

Question 267

A major potential adverse effect of spinal anesthesia is ______________

Answer 267

respiratory distress or failure

Question 268

A type of spinal anesthesia used for patients in labor is a(n) ____

Answer 268

saddle block

Question 269

Muscle relaxants (are/are not) part of balanced anesthesia. (Circle correct answer.)

Answer 269

are

Question 270

Drugs used to induce sleep in those who have difficulty getting to sleep are _______________-acting barbiturates.

Answer 270

short

Question 271

One example of a nonbenzodiazepine drug for the treatment of insomnia is _______________. (Answers may vary.).

Answer 271

zolpidem tartrate (also eszopiclone, zaleplon, and ramelteon)

Question 272

The drug of choice for the management of benzodiazepine overdose is _____________

Answer 272

Flumazenil

Question 273

Local anesthetics are divided into two groups: _______________ and ____________

Answer 273

esters; amides

Question 274

``` ________ 22. Hangover ________ 23. REM rebound ________ 24.Dependence ________ 25. Tolerance ________ 26. Respiratory Depression ________ 27. Hypersensitivity ``` Column II a. Need to increase dosage to get desired effect b. Suppression of respiratory center in the medulla c. Skin rashes d. Residual drowsiness e. Results in withdrawal symptoms f. Vivid dreams and nightmares

Answer 274

22. d 23. f 24. e 25. a 26. b 27. c

Question 275

Which class of drug is the most commonly pre-scribed drug to assist patients with sleep disorders? a. Analeptic b. Anesthetic c. Sedative-hypnotic d. Triptan

Answer 275

c. Sedative-hypnotics are commonly prescribed to treat sleep disorders. Analeptics are CNS stimulants. Anesthetics are CNS depressants and are not prescribed for sleep. Triptans help with migraines.

Question 276

Which drugs may be prescribed to control seizures? a. Intermediate-acting barbiturates b. Long-acting barbiturates c. Short-acting barbiturates d. Ultra–short-acting barbiturates

Answer 276

b. Long-acting barbiturates, such as phenobarbital, are used to control seizures. Intermediate-acting barbiturates, such as butobarbital, use useful to sustain sleep. Short-acting, such as secobarbital, may be used for sedation. Ultra-short-acting barbiturates, such as methohexital sodium, are used for anesthesia induction.

Question 277

A client returns to the unit after having surgery with spinal anesthesia. Which action(s) would be best for the nurse to take to decrease the possibility of spinal headache? (Select all that apply.) a. Administer morphine 1 to 2 mg intravenously (IV). b. Ambulate the client as soon as she regains sensation. c. Encourage the client to stay flat in bed. d. Increase fluid intake. e. Position the patient in high-Fowler’s position.

Answer 277

c, d. Postdural-puncture headache can occur because of a decrease in pressure due to fluid leakage from the cerebrospinal space. Maintaining the client flat in bed for 24 to 48 hours and encouraging adequate oral fluid intake as tolerated may help prevent a spinal headache. The client may also re-quire IV fluids to supplement oral intake.

Question 278

The client who will be receiving spinal anesthesia for surgery is positioned with the back arched. The client asks “Why do I have to sit a certain way? Why can’t I just be comfortable?” Which statement would be best for the nurse to provide to the client? a. “It is easier for the anesthesiologist if you sit this way.” b. “Because of your age, you have to sit straight up.” c. “The anesthesia is injected in a specific area so it distributes evenly.” d. “You can sit however you like.”

Answer 278

c. By explaining the reason for positioning (either seated with an arched back or fetal position), the client will feel more control. The nurse can reassure the client that assistance in her maintaining the proper position will be provided.

Question 279

The client is postoperative day 3 from major orthopedic surgery and is unable to sleep. If nonpharmacologic measures have not been effective, what drug does the nurse anticipate may be ordered? a. Flumazenil b. Phenobarbital c. Triazolam d. Zolpidem

Answer 279

d. Zolpidem may be ordered. It is a nonbenzodiazepine for short-term treatment of insomnia. Flumazenil is an antidote for benzodiazepine overdose. Phenobarbital, a long-acting barbiturate, is used to treat seizures. Triazolam is a benzodiazepine. While this class of drug can help with insomnia, a nonbenzodiazepine is a better choice.

Question 280

Which type(s) of anesthesia is/are administered using lidocaine? (Select all that apply.) a. General b. Inhaled c. Intravenous d. Local e. Spinal

Answer 280

d, e. Lidocaine is used for local and spinal anesthesia that has a rapid onset with its effects long-lasting.

Question 281

The client works 12-hour night shifts one week and 12-hour day shifts the next week. the client tells the nurse that “some kind of sleeping pill from the drugstore” is used to help with sleep. What does the nurse suspect is the most likely main ingredient in the over-the-counter sleep drug? a. Antihistamines b. Barbiturates c. Benzodiazepines d. Opioid agonists

Answer 281

a. Antihistamines, such as diphenhydramine, are the primary ingredient in over-the-counter sleep aids.

Question 282

The 71-year-old client presents to the health care provider with complaints of inability to go to sleep and inability to stay asleep. Which question(s) will the nurse ask to further evaluate the complaint? (Select all that apply.) a. “What are your bedtime routine?” b. “How many caffeinated beverages do you drink per day?” c. “Do you take naps?” d. “Do you sleep with the windows open?” e. “Are you taking diuretics?”

Answer 282

a, b, c, e. Older clients may have more problems with Stage 3 and Stage 4 nonrapid eye movement (NREM) sleep and awaken frequently. Establishing a bedtime routine, maintaining a schedule of going to bed and arising in the morning, and avoiding caffeine and alcohol at bedtime may help. Al-though it sounds intuitive to take naps, they may hinder a client from obtaining a good night’s sleep if the naps last longer than 20–30 minutes. Diuretics should be taken in the morning and fluids should be limited at bedtime to prevent frequent trips to the bathroom, which may interrupt sleep.

Question 283

Chapter 19 Study guide

Question 284

``` ________ 1.Absence seizure ________ 2. Partial seizure ________ 3. Generalized seizure ________ 4. Myoclonic seizure ________ 5.Simple seizure ``` a. Involves one hemisphere of the brain with no loss of consciousness b. Can be focal or massive with jerky movements lasting 10 seconds or less c. No loss of consciousness and can have a motor, sensory, autonomic, or psychic form d. Loss of consciousness usually lasts less than 10 seconds; also called petit mal seizures e. A seizure that involves both hemispheres of the brain with loss of consciousness

Answer 284

1. d 2. a 3. e 4. b 5. c

Question 285

To diagnose epilepsy, results of a(n) ______________ are useful.

Answer 285

electroencephalogram (EEG)

Question 286

Seventy-five percent of all epilepsy is primary or ______________

Answer 286

idiopathic

Question 287

The International Classification of Seizures describes the two categories of seizures as ______________ and ______________.

Answer 287

generalized; partial

Question 288

Antiseizure drugs suppress abnormal electrical impulses, thus ______________ the seizure, but they (do/do not) eliminate the cause. (Circle correct answer.)

Answer 288

preventing; do not

Question 289

Antiseizure drugs (are/are not) used for all types of seizures. (Circle correct answer.)

Answer 289

are not

Question 290

The first anticonvulsant used to treat seizures was ______________, discovered in 1938, and today is the most commonly used drug for seizures.

Answer 290

phenytoin

Question 291

It is strongly recommended that the patient check with the health care provider before taking ______________ products

Answer 291

over-the-counter

Question 292

Administration of phenytoin via the (oral/intramuscular/intravenous) route is not recommended because of its erratic absorption rate. (Circle correct answer.)

Answer 292

intramuscular

Question 293

The client with a history of bipolar disorder recently experienced tonic-clonic seizures. Which drug would the nurse expect to be prescribed for this client? (Select all that apply.) a. Carbamazepine b. Diazepam c. Ethosuximide d. Acetazolamide

Answer 293

a, b. Carbamazepine and diazepam are given for tonic-clonic seizures. Ethosuximide and acetazolamide are indicated for absence seizures.

Question 294

The client has a seizure disorder and has just dis-covered that she is pregnant. At her first prenatal visit, she tells the nurse, “I quit taking all of my drugs because I don’t want anything to be wrong with my baby.” What is the nurse’s best response? a. “You can’t do that. You have to take your medications.” b. “What drugs have been prescribed for you?” c. “How long have you had seizures?” d. “When was your last seizure?”

Answer 294

b. Although it is important to know the client’s medical history regarding seizures, the best response is asking about the drugs that have been prescribed. Most Antiseizure drugs have terato-genic properties. Women with seizure history are at increased risk for seizures during pregnancy. The risk versus the benefits need to be discussed. Abruptly stopping Antiseizure drugs can also in-crease the risk of seizures.

Question 295

Which anticonvulsant(s) is/are appropriate for status epilepticus? (Select all that apply.) a. Fosphenytoin b. Carbamazepine c. Phenobarbital d. Diazepam e. Topiramate

Answer 295

a, c, d. Hydantoins, such as Fosphenytoin, barbiturates, such as phenobarbital, and benzodiazepines, such as diazepam or lorazepam are used for status epilepticus. Diazepam is the drug of choice. Carbamazepine and topiramate are indicated for tonic-clonic and partial seizures.

Question 296

The client has just been diagnosed with epilepsy and will be starting phenytoin. The client’s spouse asks how this drug works in the body. What is the nurse’s best response? a. “It inhibits the enzyme that destroys one of the neurotransmitters.” b. “It helps stop the entry of sodium into the cell.” c. “It has not been determined exactly how it prevents seizures.” d. “It increases the amount of calcium that enters the cell.”

Answer 296

b. Phenytoin prevents sodium from entering the cells. This reduces the activities of cells. Antiseizure drugs inhibit neurotransmitters; they do not destroy them. Antiseizure drugs suppress entry of calcium; they do not increase the influx.

Question 297

The client has just been diagnosed with a seizure disorder and has been started on valproic acid. What statement(s) by the client indicate(s) to the nurse more instruction regarding the drug is needed? (Select all that apply.) a. “I just have to remember to take it once a day.” b. “I do not have to worry about labs.” c. “I need to take it at the same times every day.” d. “This drug will cure my seizures.”

Answer 297

a, b, d. Valproic acid is taken in divided doses. Doses start at 10–15 mg/kg/day and increase to a maximum of 60/mg/kg/day until seizures are controlled. Frequent labs are needed to monitor serum levels and liver functions. Antiseizure drugs control the frequency and severity of seizures, it does not cure.

Question 298

The nurse has received an order to administer an initial dose of intravenous (IV) phenytoin to a client with new-onset seizures. What will the nurse check before administering the first dose? (Select all that apply.) a. Hourly urine output b. Blood glucose levels c. Cardiac rhythm d. Blood pressure measurements

Answer 298

b, c, d. An absolute contraindication is heart block and bradycardia. Cautious use is recommended for clients with hypoglycemia and hypotension. Dilantin is excreted in small amounts in the urine. Urine output should be monitored afterward, but not hourly.

Question 299

The client receiving intravenous (IV) phenytoin for grand mal seizures complains of burning at the IV site. What is the nurse’s best action? a. Call the health care provider immediately to change the drug to oral. b. Continue the infusion and reassure the patient. c. Flush the line with 10 mL of normal saline and continue the infusion. d. Discontinue the IV and restart the IV infusion at a different site.

Answer 299

d. Intravenous phenytoin is irritating to the tissue, and the nurse should discontinue the IV and restart the infusion at a different site. It is recommended that a central line or peripherally inserted central catheter (PICC) line be utilized when possible. The health care provider does not need to be notified immediately to change the medication to oral form. Continuing the infusion, even with a saline flush, may cause sloughing of the tissue.

Question 300

A client was started on an Antiseizure drug for a seizure disorder of unknown cause and asks how long the drug will need to be taken. Which response is appropriate by the nurse? a. “You will need to take an anticonvulsant of some type for your lifetime.” b. “This drug should be taken until you haven’t had a seizure for a month.” c. “Seizures are unpredictable and so is the duration of the treatment.” d. “You will only need to take it for a short period of time because antiseizures will cure the seizure disorder.”

Answer 300

a. Although a variety of antiseizures may be utilized over a client’s lifetime, at this time, there is no cure for seizure disorders. The client will most likely need to take an Antiseizure for one’s lifetime.

Question 301

Which result is within the therapeutic range for phenytoin? a. 8 mcg/mL of bound phenytoin b. 18 mcg/mL of bound phenytoin c. 28 mcg/mL of unbound phenytoin d. 38 mcg/mL of unbound phenytoin

Answer 301

b. 18 mcg/mL is within the therapeutic range of 10 to 20 mcg/mL for bound phenytoin and 1 to 2 mcg/ mL for unbound/free drugs. 8 mcg/mL is below the therapeutic range and the client may be at risk for seizure. 28 and 38 mcg/mL are too high, drug toxicity can occur.

Question 302

Which information would the nurse document after witnessing a client having seizure?? (Select all that apply.) a. Types of movements b. Duration of movements c. Ability to stop movements d. Progression of movements e. Preceding events

Answer 302

a, b, d, e. Documenting the types of movements (tonic/clonic), the duration of seizure activity, and the locations where the movements started and progressed are important pieces of gathering the history of the seizure event. It is important to know, if possible, what the client had been doing before the event and if the client reported any warning before the seizure. The client is unable to stop true seizure activity voluntarily.

Question 303

The nurse is preparing discharge teaching for a client who has been started on phenytoin for a seizure disorder. Which information about the side effects of this drug will the nurse provide to the client and family member? a. “There may be a green discoloration of the patient’s urine.” b. “It is best to use a hard-bristle toothbrush for dental care.” c. “Nosebleeds and sore throats should be reported to the health care provider.” d. “The patient should get up slowly to prevent fainting.”

Answer 303

c. Nosebleeds and sore throats may be a sign of blood dyscrasias and should be reported to the health care provider. A reddish pink discoloration of the urine may be expected. To prevent injury to the gums, a soft toothbrush should be utilized. Orthostatic hypotension is not associated with phenytoin use.

Question 304

Which effect would the nurse expect to see if the client is experiencing a common side effect of phenytoin? a. Gingival hyperplasia b. Excessive thirst c. Weight gain d. Muscle tremors

Answer 304

a. Gingival hyperplasia is a common side effect of phenytoin. Excessive thirst and weight gain are not common with phenytoin.

Question 305

A client presents to the emergency department in status epilepticus. Which drug would the nurse anticipate being ordered first? a. Diazepam b. Midazolam c. Propofol d. Phenobarbital

Answer 305

a. The first-line drug of choice for status epilepticus is diazepam. Midazolam, Propofol, and high-dose phenobarbital are administered for continued seizures

Question 306

Which statement(s) is/are true about seizures and Antiseizure uses in pregnancy? (Select all that apply.) a. Seizures may increase up to 33% in women with history of seizures. b. Many Antiseizure drugs have teratogenic properties. c. Antiseizure drug use increases the loss of folic acid. d. Antiseizure drugs increase the effects of vitamin K. e. Valproic acid causes malformation in 40% to 80% of fetuses.

Answer 306

a, b, c. Up to 33% of women with history of seizures can have increased seizure activity during pregnancy. Many Antiseizure drugs have teratogenic properties. Antiseizure drugs increase the excretion of folic acid; therefore, pregnant individuals should take daily folate supplement. Anti-seizure drugs inhibit vitamin K, contributing to bleeding.

Question 307

Which Antiseizure drug may also be used as prophylaxis for migraine headaches? a. Diazepam b. Phenytoin c. Valproic acid d. Clorazepate

Answer 307

c. Valproic acid and topiramate are indicated for migraine. Diazepam can be used additionally to those with spasms, anxiety, and alcohol withdrawal. Clorazepate can be used for anxiety and alcohol withdrawal.

Question 308

Chapter 20 Study Guide

Question 309

Match the description in Column I with the letter of the reference in Column II. Column I ``` _______ 1. Acetylcholinesterase (AChE) inhibitor ________ 2. Dopamine agonist ________ 3. Dystonic movement ________ 4. Bradykinesia ________ 5. Pseudo parkinsonism ``` Column II a. Stimulates dopamine receptors b. Drug-induced parkinsonism c. Allows more acetylcholine in the neuron receptors d. Involuntary abnormal movements e. Slowed movements

Answer 309

1. c 2. a 3. d 4. e 5. b

Question 310

The two neurotransmitters within the neurons of the striatum of the brain that have opposing effects are ______________ and ______________.

Answer 310

dopamine; acetylcholine

Question 311

Which of the neurotransmitters is deficient in Parkinson disease? _________

Answer 311

dopamine

Question 312

A drug used in a combination therapy to treat Parkinson disease by replacing the neurotransmitter is ____________.

Answer 312

levodopa

Question 313

The substance that inhibits the enzyme dopa decarboxylase and allows more levodopa to reach the brain is ______________.

Answer 313

carbidopa

Question 314

An example of an acetylcholinesterase inhibitor is ______

Answer 314

donepezil or rivastigmine

Question 315

Acetylcholinesterase inhibitors ___________ transmission at the cholinergic synapses.

Answer 315

enhance

Question 316

The drug ____________ prolongs action of levodopa and can decrease “on-off” fluctuations in patients with parkinsonism

Answer 316

selegiline

Question 317

The drugs that are a combination of dopaminergic and a catechol-O-methyltransferase (COMT) inhibitor that provides the greatest dosing flexibility include ______________, ______________, and _______________.

Answer 317

carbidopa, levodopa, entacapone

Question 318

An example of a Food and Drug Administration (FDA)–approved anticholinergic drug used for Parkinson disease is __________________.

Answer 318

trihexyphenidyl (also benztropine)

Question 319

A client taking carbidopa-levodopa tablets for parkinsonism is complaining of dizziness, diarrhea, anxiety, and nasal stuffiness. Which complaints would the nurse recognize as a possible side effect of carbidopa-levodopa? a. Dizziness b. Diarrhea c. Anxiety d. Nasal stuffiness

Answer 319

a. Dizziness is a common side effect of carbidopa-levodopa. Constipation is a side effect, not diarrhea. Anxiety and nasal stuffiness are not a side effect of carbidopa-levodopa

Question 320

The nurse is teaching a client with parkinsonism about extended-release carbidopa-levodopa. Which statement(s) by the client indicate(s) the need for further teaching? (Select all that apply.) a. “This drug may make my movements smoother.” b. “My skin may turn yellow if I miss too many doses.” c. “If I have trouble swallowing, I can crush my drug and mix it with applesauce.” d. “I must take this medicine on an empty stomach.” e. “I need to check my blood sugar regularly while taking this drug.”

Answer 320

b, c, d, e. Carbidopa-levodopa may make the client’s movements smoother, although at high doses, dyskinesia may be noted. Jaundice will not result from missing doses. Extended release drugs should not be crushed or cut; if the client is unable to swallow tablets, then other preparations, such as liquid or oral disintegrating tablets, are available. Nausea and vomiting are side effects, so taking the drug with meals may be beneficial. There is no indication that carbidopa-levodopa affects glucose levels.

Question 321

The nurse is helping a family prepare for a grocery shopping trip for a client who has been prescribed selegiline for Parkinson disease. Which food(s) should be avoided? (Select all that apply.) a. Aged cheeses b. Chocolate c. Peanut butter d. Wheat bread e. Yogurt

Answer 321

a, b, e. Tyramine rich foods should be avoided, such as, aged cheeses, chocolate, and yogurt. These foods should be avoided when taking selegiline to prevent a hypertensive crisis from occurring. Peanut butter and wheat bread are not high in tyramine.

Question 322

A client with Alzheimer disease is taking rivastigmine and has also been started on a drug for de-pression. Which order will the nurse question be-fore administering the new drug? a. Atypical antidepressant b. Monoamine oxidase inhibitor (MAOI) antidepressant c. Selective serotonin reuptake inhibitor (SSRI) antidepressant d. Tricyclic antidepressant

Answer 322

d. An order for tricyclic antidepressant should be questioned. Tricyclic antidepressants decrease the effect of rivastigmine.

Question 323

A client with parkinsonism currently takes carbidopa-levodopa, and the client’s health care provider adds entacapone to the drug regimen. Which change in the dosing of carbidopa-levodopa would the nurse expect to occur? a. There should be no change in the drug dosage. b. Both carbidopa and levodopa dosages should be decreased. c. Only the levodopa dosage should decrease. d. Only the carbidopa dosage should decrease.

Answer 323

c. The nurse understand that levodopa only will be decreased. When taken with levodopa, COMT inhibitors like entacapone will increase the levodopa combination in the brain.

Question 324

Anticholinergics are contraindicated for which client? a. A client with glaucoma b. A client with shingles c. A client with urinary frequency d. A client with diabetes e. A client with angina

Answer 324

a. Anticholinergic drugs are contraindicated in persons with glaucoma. Extreme caution is warranted for persons with heart problems and those with urinary retention, not urinary frequency. Shingles and diabetes are not contraindications.

Question 325

A client with a history of Parkinson disease is brought into the emergency department after the family reports the client is talking to “rabbits coming out of the walls” at home. Which drug does the nurse suspect may have caused this symptom? (Select all that apply.) a. Bromocriptine mesylate b. Selegiline hydrochloride c. Pramipexole dihydrochloride d. Tolcapone

Answer 325

a, c. Even though most drugs for Parkinson disease can cause hallucinations, they are more common with bromocriptine and pramipexole.

Question 326

A client’s wandering and hostility levels have increased per family reports. Which dosing information would concern the nurse in this client who is taking memantine 10 mg/day? a. The dose is too high a daily dose to maintain mental status. b. The client has taken an overdose of the drug. c. The client is not taking enough of the drug. d. A combination of memantine and amantadine may be needed.

Answer 326

c. Memantine is prescribed for the treatment of mild to severe Alzheimer disease. Increased wandering and hostility can indicate that the disease is progressing and an increase in the dose may be beneficial. The maximum dose for memantine is 20 mg per day.

Question 327

Which statement by the client indicates an under-standing of how to relieve some of the side effects associated with the use of benztropine mesylate? a. “I can suck on hard candy or chew sugarless gum to prevent dry mouth.” b. “I need to take my drug every 6 hours so I don’t get constipated.” c. “I should decrease the doses of all of my other drugs so I don’t get dizzy.” d. “I should urinate after meals so I do not retain urine.”

Answer 327

a. Sucking on hard candy or chewing sugarless gum may help with dry mouth associated with anticholinergic drugs such as benztropine mesylate. This drug is initially taken at bedtime and twice per day in divided doses as a maintenance dose. The nurse should remind the client that all drug adjustments need to be made by the health care provider. Urinary retention is a side effect of anticholinergic drugs; however, the nurse should encourage the client to urinate when the urge is felt and not on a set schedule.

Question 328

Chapter 21 Study Guide

Question 329

Match the classifications of multiple sclerosis (MS) in Column I with the definition in Column II. ``` Column I ________ 1. Relapsing remitting MS ________ 2. Primary progressive MS ________ 3. Secondary progressive MS ________ 4. Progressive relapsing MS ``` Column II a. May have relapses, remissions, and plateaus b. Relapse with full recovery and residual deficit c. Clear acute relapses with or without full recovery d. Will have slowly worsening symptoms with no re-lapses or remissions

Answer 329

1. b 2. d 3. a 4. c

Question 330

Muscle spasms can result from ________________ injuries and spasticity from chronic ___________ ___________.

Answer 330

traumatic; debilitating disorders

Question 331

Muscle relaxants suppress the ________________ reflex and are prescribed for muscle spasms that do not respond to ________________ drugs or other forms of therapy.

Answer 331

hyperactive; anti-inflammatory

Question 332

Baclofen, dantrolene, and tizanidine are some drugs to ________________ pain and ________________ mobility for hyperexcitable, spastic muscles.

Answer 332

decrease; increase

Question 333

Identify the affected neuromuscular site(s) for each of the autoimmune neuromuscular disorders and the drugs to treat the disorders. Myasthenia gravis

Answer 333

Myasthenia gravis is an autoimmune disorder that involves an antibody response against acetylcholine receptor (AChR) sites, eventually destroying the receptor sites for acetylcholine (Ach). Drugs used to treat myasthenia gravis (MG) are the acetylcholinesterase (AChE) inhibitors (cholinesterase inhibitors and anticholinesterase), such as neostigmine or pyridostigmine. They inhibit the action of AChE, which allows more activation of the cholinergic receptors.

Question 334

Multiple sclerosis

Answer 334

Multiple sclerosis (MS) is an autoimmune disorder that attacks the myelin sheath of the nerve fibers of the central nervous system, resulting in plaques. Drugs used to treat MS include corticosteroids and immunomodulators, such as teriflunomide, alemtuzumab, and glatiramer acetate.

Question 335

``` The nurse is assessing a client who is receiving treatment for myasthenia gravis with pyridostigmine. Which clinical manifestations would be noted if the drug is working? a. Increased salivation b. Maintenance of muscle strength c. Miosis d. Tachycardia ```

Answer 335

b. Pyridostigmine increases muscle strength in clients with myasthenia gravis. Increased salivation and miosis are signs and symptoms of overdose. Bradycardia, not tachycardia can be an adverse drug effect.

Question 336

The client is receiving treatment for myasthenia gravis with an acetylcholinesterase (AChE) inhibitor. The nurse observes that the client is diaphoretic, drooling, and eyes are tearing. What will concern The nurse would be most concerned about the client exhibiting these clinical manifestations in which medical condition? a. Client is having an anaphylactic reaction. b. Client is having a cholinergic crisis. c. Client is in the early stages of myasthenic crisis. d. Client is having a vascular spasm.

Answer 336

b. Drooling, excessive tearing, sweating, and miosis are signs of a cholinergic crisis, an overdose of AChE inhibitors.

Question 337

Which emergency drug will be administered to a client exhibiting signs of cholinergic crisis? a. Atropine b. Diazepam c. Neostigmine d. Pyridostigmine

Answer 337

a. Atropine is the antidote for AChE inhibitor.

Question 338

Antipsychotic drugs were developed to improve the ________________ _______________, ________________, and ________________ of patients with psychotic symptoms resulting from an imbalance of ________________, a neurotransmitter.

Answer 338

thought processes; behaviors; dopamine

Question 339

Typical antipsychotics are subdivided into phenothiazines and nonphenothiazines. Nonphenothiazines are divided into four classes: ________________, ________________, ________________, and ______________

Answer 339

dihydroindolones; thioxanthene's; butyrophenones; dibenzoxazepines

Question 340

The most common side effect of all antipsychotics is ___________

Answer 340

drowsiness

Question 341

Antipsychotics may lead to dermatologic side effects early in drug therapy that include ________________ and ________________.

Answer 341

Pruritis,photosentivity

Question 342

Phenothiazines (increase/decrease) the seizure threshold; adjustment of anticonvulsants may be required. (Circle correct answer.)

Answer 342

decrease

Question 343

Anxiolytics (are/are not) usually given for secondary anxiety. (Circle correct answer.)

Answer 343

are not

Question 344

Long-term use of anxiolytics is not recommended because ________________ may develop within weeks or months.

Answer 344

tolerance

Question 345

The action of anxiolytics resembles that of ________________, not antipsychotics.

Answer 345

sedative-hypnotics

Question 346

Neuroleptic drugs are useful in the management of which type of medical condition? a. Anxiety disorders b. Depressive disorders c. Psychotic disorders d. Psychosomatic disorders

Answer 346

c. Neuroleptics are considered antipsychotics that modify psychotic behaviors and exert antipsychotic effects. Anxiolytics treat anxiety and insomnia. Antidepressives treat depressive disorders; anti-psychotics worsen depression.

Question 347

A client who was started on antipsychotic drugs asks the nurse when the drug will take effect. Which response is best by the nurse? a. “It may take up to one week to start to feel the full effects.” b. “Responses vary, but it may be about 6 weeks.” c. “You will only feel better when you start psychotherapy, too.” d. “You should start to feel better within 30-60 minutes.”

Answer 347

b. The nurse should inform the client that antipsychotic drugs can take 3 to 6 weeks before full therapeutic effects occur. While psychotherapy may help, it is not required for antipsychotics to have therapeutic effects. While the onset may be minutes to hours, its full therapeutic effect does occur until weeks later.

Question 348

The client has been started on chlorpromazine hydrochloride for treatment of intractable hiccups. Which information will the nurse include in client education about this class of drug? a. “A therapeutic response to this drug will be immediate.” b. “Change positions slowly from sitting to standing to prevent orthostatic hypotension.” c. “It is all right to have alcohol when taking this drug.” d. “This drug may be stopped abruptly as soon as your pain stops.”

Answer 348

b. Orthostatic hypotension may occur with phenothiazines and nonphenothiazines drugs within this class. The client should be encouraged to change positions slowly to prevent orthostatic hypotension. Clients should abstain from alcohol while on antipsychotics, it can worsen drowsiness, dizziness, and hypotension. Any antipsychotics should not be abruptly stopped.

Question 349

Typical antipsychotics may cause extrapyramidal symptoms (EPS) or pseudo parkinsonism. Which symptom is considered an extrapyramidal symptom? a. Downward eye movement b. Intentional tremors c. Loss of hearing d. Shuffling gait

Answer 349

d. Pseudoparkinsonism, major side effect of typical antipsychotics, are symptoms similar to Parkinson disease. Shuffling gait is one example of EPS. Other EPS include masklike facies, rigidity, tremors at rest (not intentional tremors), pill-rolling, motions of the hands, and bradykinesia.

Question 350

Which drug would the nurse expect to give to decrease extrapyramidal symptoms (EPS)? a. Benztropine b. Bethanechol c. Buspirone hydrochloride d. Doxepin

Answer 350

a. Benztropine, an anticholinergic antiparkinsonian drug. Bethanechol is an antispasmodic for urinary retention. Buspirone is an anxiolytic. Doxepin is an antidepressant.

Question 351

Phenothiazines are grouped into three categories based on their side effects. In which group is fluphenazine? a. Aliphatic b. Piperazine c. Piperidine d. Thioxanthene

Answer 351

b. Fluphenazine belongs to the piperazine subclass of phenothiazines. Chlorpromazine is an aliphatic phenothiazine. Thioridazine is a piperidine. Thioxanthene is a nonphenothiazine.

Question 352

Chapter 23 Study Guide

Question 353

Clinical response of tricyclic antidepressants (TCAs) occurs after ________________ of drug therapy.

Answer 353

2 to 4 weeks

Question 354

TCAs ________________ mood, ________________ interest in daily living, and ________________ insomnia.

Answer 354

increase; increase; decrease

Question 355

Herbal supplements that can be used to treat mild depression include ______________

Answer 355

St. John’s wort

Question 356

Atypical antidepressants or ________________ ________________ affect one or two of the three neurotransmitters: ________________, ________________, and ________________.

Answer 356

second-generation antidepressants; dopamine, nor-epinephrine, serotonin

Question 357

Any drugs that ________________ the ________________ can cause a hypertensive crisis when taken with an MAOI.

Answer 357

stimulate; central nervous system

Question 358

________________ was the first drug used to treat ________________ ________________ disorder.

Answer 358

Lithium; bipolar affective

Question 359

Lithium’s therapeutic index has a ________________ range from ________________.

Answer 359

narrow; 0.8 to 1 mEq/L

Question 360

Nonsteroidal anti-inflammatory drugs (NSAIDs) can ________________ lithium level whereas ________________ and ________________ diuretics can ________________ lithium levels.

Answer 360

increase; caffeine; loop; decrease

Question 361

SNRIs are used for major depression, ________________, and ________________.

Answer 361

generalized anxiety disorder, and social anxiety disorder

Question 362

Many antidepressants interact with ________________ ________________ that can lead to ________________

Answer 362

grapefruit juice; toxicity

Question 363

Which drug would the nurse expect to administer to a young client with enuresis? a. Citalopram b. Fluvoxamine c. Imipramine d. Sertraline

Answer 363

c. Imipramine, a tricyclic antidepressant (TCA) is also indicated for enuresis, involuntary urination while sleeping.

Question 364

The client has been taking phenelzine for several months for depression, which has not improved. Which dose is the maximum daily dose for this drug? a. 15 mg/day b. 45 mg/day c. 60 mg/day d. 90 mg/day

Answer 364

d. The maximum daily dose of phenelzine is 90 mg. The initial dose is 15 mg/day in three divided doses.

Question 365

The client has been prescribed amitriptyline as an adjunct to therapy for depression. Which information will the nurse include in the health teaching regarding this drug? a. “Check your heart rate daily. It may become very slow.” b. “Stand up slowly because your blood pressure can drop suddenly.” c. “You should start to feel less depressed within 12 hours.” d. “Take your drug in the morning because it will make you alert.”

Answer 365

b. Orthostatic hypotension is a frequent side effect of tricyclic antidepressants (TCAs). The client should be encouraged to change positions slowly to avoid this side effect. Amitriptyline can cause tachycardia, not bradycardia. The onset of amitriptyline is 1-3 weeks, not 12 hours. Since amitriptyline has an anticholinergic action, it should be taken at night, not during the day.

Question 366

Which food(s) or beverage(s) is/are contraindicated in a client that is prescribed isocarboxazid? (Select all that apply.) a. Bananas b. Chocolate c. Chicken d. Milk e. Wine

Answer 366

a, b, e. Foods high in tyramine, such as bananas, chocolate, and wine are contraindicated in a client who is taking a monoamine oxidase inhibitor (MAOI), such as isocarboxazid. Other foods that are high in tyramine include aged cheeses, processed meats, and soybeans or soy products. These foods have sympathomimetic-like effects and can cause hypertensive crisis.

Question 367

A client who has been taking fluoxetine and “some herb” for depression is complaining of a severe headache. The client is diaphoretic and restless. Which herb does the nurse suspect the client has been taking? a. Ephedra b. Ginseng c. Garlic d. St. John’s wort

Answer 367

d. St. John’s wort is a common herbal remedy for depression. St. John’s wort, when taken in com-bination with selective serotonin reuptake inhibitor (SSRI) drugs, such as fluoxetine, can precipitate serotonin syndrome, which presents as headache, sweating, and agitation. Ephedra and ginseng can cause palpitations, heart attack, and hypertensive crisis when taken with MAOIs, not SSRIs.

Question 368

Which effect is an advantage of taking selective serotonin reuptake inhibitors (SSRIs) over tricyclic antidepressants (TCAs)? a. Fewer sexual side effects b. Increased appetite c. Less sedation d. Less tachycardia

Answer 368

c. SSRIs has less sedative effect. They also do not cause hypotension, anticholinergic effects, or cardiotoxicity. However, SSRIs can cause sexual dysfunction.

Question 369

Which nursing intervention is most important for a client taking lithium? a. Advising the client that the drug can be stopped when not in a manic phase b. Emphasizing the importance of client-adjusted dosage c. Monitoring for excessive thirst, weight gain, and increased urination d. Teaching the client to limit fluid intake to prevent weight gain

Answer 369

c. Monitoring the client is one of the most important roles of the nurse. Trending vital signs, weight, and lab work will be important to the client’s ongoing care. The client needs to maintain a fluid intake of 2–3 L of fluid/day initially and must be especially vigilant to maintain an adequate intake in hot weather. Clients during manic phase frequently stop taking their drug when they feel better. They must be advised to continue taking the drug even if they feel better.

Question 370

The client is currently taking lithium for bipolar disorder, manic phase. Which laboratory value would the nurse monitor? a. BUN b. Blood glucose c. INR d. Platelet count

Answer 370

a. Monitoring hepatic and renal function in a client taking lithium should be completed with weekly blood work, which includes BUN and creatinine level measurements.

Question 371

The client has been taking lithium 1800 mg/day in three divided doses for 10 days. The client remains agitated and hyperactive, with a lithium level of 0.7 mEq/L. Which client condition would the nurse suspect is occurring? a. The patient is experiencing lithium toxicity. b. The patient’s lithium level is subtherapeutic. c. The patient’s lithium level is therapeutic. d. The patient is allergic to lithium.

Answer 371

b. The client’s lithium level is still subtherapeutic, and he remains in a manic phase. Therapeutic range for lithium is 0.8 to 1.2 mEq/L.

Question 372

The nurse is teaching the client about lithium. Which statement by the client indicates a need for more education? a. “I can stop my drug if I have not been manic for 2 weeks.” b. “I should avoid caffeine products that may aggravate the manic phase.” c. “I should take my drug with food.” d. “It is important that I wear or carry ID indicating that I am taking lithium.”

Answer 372

a. The client needs further education requiring the purpose of the drug. Lithium may be used in bipolar disorder as a mood stabilizer, but its effect is on the manic phase. The drug should be taken with food. Tyramine rich foods, such as caffeine should be avoided.

Question 373

The client has been prescribed venlafaxine for generalized anxiety disorder. Which statement by the client indicates the need for further health teaching? a. “I need to take my drug even if I am not feeling anxious.” b. “I need to wear sunscreen when I am outdoors.” c. “If I have any issues with my sexual performance, I can ask my health care provider.” d. “It is OK if I keep taking my herbal drugs for my depression and anxiety.”

Answer 373

d. Venlafaxine is a serotonin-norepinephrine reup-take inhibitor (SNRI). Side effects of venlafaxine may include drowsiness, insomnia, photosensitivity, and ejaculatory dysfunction, among others. Taking St. John’s wort while taking venlafaxine increases the risk of serotonin syndrome or neuroleptic malignant syndrome.

Question 374

The client with a history of bipolar disorder and is taking lithium is considering pregnancy. Which teratogenic effects can occur when taking lithium while pregnant? (Select all that apply.) a. Congenital anomaly b. Excessive weight gain c. Hyperemesis gravidarum d. Heart defects e. Multiple gestation

Answer 374

a, d. Some studies have linked lithium to a congenital anomaly involving the tricuspid valve of the heart if taken during the first trimester of pregnancy.

Question 375

Inflammation is a response to tissue ________________ and ________________.

Answer 375

injury; infection

Question 376

The five cardinal signs of inflammation are ________________, ________________, ________________, ________________, and ________________.

Answer 376

redness (erythema); swelling (edema); heat; pain; loss of function

Question 377

Leukocyte infiltration of the inflamed tissue occurs during the ________________ phase of inflammation.

Answer 377

delayed

Question 378

The half-life of each NSAID (does/does not) differ greatly. (Circle correct answer.)

Answer 378

does

Question 379

When using NSAIDs for inflammation, the dosage is generally ________________ than that for pain relief

Answer 379

higher (or increased)

Question 380

Corticosteroids are indicated to control __________ flareups.

Answer 380

arthritic

Question 381

Which body response occurs during the vascular phase of inflammation? a. Leukocyte and protein infiltration into inflamed tissue b. Vasoconstriction with leukocyte infiltration into inflamed tissue c. Vasoconstriction and fluid influx into the interstitial space d. Vasodilation with increased capillary permeability

Answer 381

d. The vascular phase of the inflammation is associated with vasodilation and increased vascular permeability. This allows leukocyte and other sub-stances to filter into the inflamed tissue.

Question 382

A client who is taking nonsteroidal anti-inflammatory drugs (NSAIDs) for arthritis complains of persistent heartburn. What further question(s) should the nurse ask the client about the heartburn? (Select all that apply.) a. “Do you take your drug with food?” b. “Have you been drinking an increased amount of water?” c. “Have you noticed a change in the color of your bowel movements?” d. “What dosage of the NSAID are you taking?” e. “Where is the heartburn located?”

Answer 382

a, c, d, e. Heartburn can be a side effect of NSAIDs. Taking NSAIDs with food may help decrease heartburn. Dark, tarry, or bloody bowel movements are an indication of GI bleeding, which is an adverse effect of NSAID use. The dosage range for NSAIDs varies from drug to drug, but large doses may cause erosive esophagitis, which would cause indigestion-type pain. There are many types of heartburn, including those associated with acute myocardial infarction. Not all heartburn is of GI origin attributable to a drug effect.

Question 383

When preparing discharge teaching for a client who has been prescribed ibuprofen for arthritis, Which statement would the nurse provide to the client on the mechanism of action? a. “Ibuprofen is a COX-2 inhibitor, so it blocks prostaglandin synthesis.” b. “Ibuprofen inhibits prostaglandin synthesis.” c. “Ibuprofen binds with opiate receptor sites.” d. “Ibuprofen promotes vasodilation to increase blood flow.”

Answer 383

b. NSAIDs inhibit the production of prostaglandin, thereby, decreasing inflammation and pain. Ibuprofen is not a COX-2 inhibitor. Ibuprofen does not bind to opiate receptor sites and it does not pro-mote vasodilation.

Question 384

A client with a complicated medical history including hypertension, atrial fibrillation, and arthritis calls the health care provider’s office to speak with a nurse about “all of these bruises I have all of a sudden.” Which potential drug interaction should concern the nurse with these symptoms? a. Aspirin and warfarin b. Sulfasalazine and acetaminophen c. Tolmetin and propranolol d. Meloxicam and amlodipine

Answer 384

a. Warfarin is an anticoagulant that may be taken by clients with atrial fibrillation. Aspirin displaces warfarin from its protein-binding site. This increases the anticoagulant effect and may lead to excessive bleeding, which may initially be indicated by bruising. Although the other drugs may have drug-drug interactions, they do not cause in-creased anticoagulant effects, as evidenced by the bruising.

Question 385

A 4-year-old child was brought to the emergency room for continued fever despite taking aspirin. Which statement is correct about a 4-year-old receiving aspirin? a. Aspirin has the potential to cause gastrointestinal (GI) bleeding in children. b. Aspirin has the potential to cause ringing in the ears in children. c. Aspirin has the potential to cause hyperglycemia in children. d. Aspirin has the potential to cause Reye syndrome in children.

Answer 385

d. Aspirin should not be given to young children due to the risk of Reye syndrome, which can be fatal. Hypersensitivity reactions, such as ringing in the ears can occur in any person, but it is not the most concerning. Side effects, such as GI distress can occur in anyone taking NSAIDs, but it is not the most concerning.

Question 386

A client with a history of asthma has been pre-scribed sulfasalazine, a salicylate derivative, for arthritis. Which effects can salicylic acid and salicylate derivatives cause that would concern the nurse? a. Tachycardia b. Increased secretions c. Bronchospasm d. Fluid retention

Answer 386

c. Sulfasalazine, a salicylate derivative, can cause bronchospasms in a client with asthma; therefore, its use is contraindicated to those with known sensitivity.

Question 387

Which statement is correct about the positive aspect of ibuprofen in relation to other nonsteroidal anti-inflammatory drugs (NSAIDs)? a. It tends to cause less gastrointestinal (GI) irritation. b. It may be taken between meals. c. It has a long half-life of 20–30 hours. d. It has no drug-drug interactions.

Answer 387

a. Ibuprofen is a propionic acid derivative, which has a decreased risk of GI disturbances. Ibuprofen should be taken with food. It has a short half-life and is highly protein bound. There are many drug-drug interactions. Ibuprofen can increase bleed time when taken with warfarin. When taken with aspirin, the effects of the ibuprofen are decreased.

Question 388

A client has been prescribed ibuprofen 400 mg three times a day (tid) for arthritis. Which statement by the client would indicate a need for further education? a. “This drug may cause gastrointestinal (GI) upset.” b. “Now I won’t have to drink so much water.” c. “I know this drug might cause some diarrhea.” d. “I will need to stop taking this drug if I get pregnant.”

Answer 388

b. Since ibuprofen is excreted in the urine, adequate fluid intake and urine output should be maintained. Ibuprofen can have negative consequences during early pregnancy and is contraindicated during third trimester. It can cause GI upset and diarrhea.

Question 389

What advantage does piroxicam have over other nonsteroidal anti-inflammatory drugs (NSAIDs)? a. Piroxicam does not cause any GI irritation b. Piroxicam has fewer drug-drug interactions c. Piroxicam has a long half-life d. Piroxicam has a rapid onset

Answer 389

c. Piroxicam has a long half-life (50 hours). Be-cause of its long half-life, it is taken once daily. Like other NSAIDs, it can cause GI irritation. It has many drug-drug interactions, and its onset is delayed.

Question 390

By which action does colchicine relieve the symptoms of gout? a. Colchicine inhibits the migration of leukocytes to the inflamed area. b. Colchicine blocks reabsorption of uric acid. c. Colchicine blocks prostaglandin release. d. Colchicine inhibits uric acid synthesis.

Answer 390

a. Colchicine inhibits the migration of leukocytes to the inflamed area; thereby decreasing inflammation. Colchicine does not inhibit the synthesis of uric acid nor does it block the reabsorption or re-move uric acid. Colchicine does not block the re-lease of prostaglandins.

Question 391

Which mechanism of action is primary for probenecid in the treatment of gout? a. Probenecid is used for the retention of urate crystals in the body b. Probenecid is used for the inhibition of the reabsorption of uric acid c. Probenecid is used for the promotion of uric acid removal in the ureters d. Probenecid is used for the increasing the release of uric acid

Answer 391

b. Probenecid is used for the inhibition of the reabsorption of uric acid in the kidneys; thereby, increasing the excretion. Its primary action is not the retention of urate crystals. Ureters are tubes for the pathway of urine; it is not the primary action of probenecid.

Question 392

Which describes the mechanism of action for etanercept for the treatment of severe rheumatoid arthritis? a. Etanercept neutralizes tumor necrosis factor (TNF), thereby altering the inflammatory response. b. Etanercept inhibits IL-1 from binding to interleukin receptor sites in cartilage and bone. c. Etanercept blocks COX-2 receptors, which are needed for biosynthesis of prostaglandins. d. Etanercept promotes uric acid reabsorption

Answer 392

a. Etanercept neutralizes tumor necrosis factor (TNF). This neutralizing alters the inflammatory process. Anakinra, not etanercept, inhibits IL-1 from binding to interleukin receptors found in bones and cartilages. Celecoxib inhibits COX-2 receptors to alter the inflammatory process. Uricosurics, such as probenecid, blocks the reabsorption of uric acid.

Question 393

When discontinuing steroid therapy, which time frame would the dosage be tapered? a. No tapering is necessary b. 1–4 days c. 5–10 days d. More than 10 days

Answer 393

c. Steroids should be tapered over 5-10 days.

Question 394

A client has started taking corticosteroids for an arthritic condition. Which information should the nurse include in a health teaching plan? (Select all that apply.) a. Corticosteroids are used to control arthritic flare-ups in severe cases. b. Corticosteroids have a short half-life. c. Corticosteroids are usually administered once a day. d. Corticosteroids are tapered over the course of 5–10 days. e. Corticosteroids may not be taken with prostaglandin inhibitors.

Answer 394

a, c, d. Corticosteroids may be used for a variety of disease processes including flare-ups of arthritic conditions. They have a long half-life and are usually taken once a day in a large prescribed dose and then the dose is tapered for 5–10 days. Lengthy corticosteroid therapy is never stopped abruptly. They may be given in combination with other drugs including prostaglandin inhibitors.

Question 395

Which information should the nurse include when teaching about antigout drug? (Select all that apply.) a. Include large doses of vitamin C supplements. b. Increase fluid intake. c. Avoid alcoholic beverages. d. Avoid foods high in purine. e. Take the drug with food. f. Avoid direct sunlight.

Answer 395

b, c, d, e. Fluid intake should be increased to pro-mote uric acid excretion. Avoiding alcohol is important because alcohol causes an overproduction, as well as an underexcretion, of uric acid. Purine is required to synthesize uric acid. Taking the drug with food will help avoid GI upset. Some studies have shown that vitamin C may help increase uric acid elimination; however, large doses of supple-mental vitamin C are not recommended, and since vitamin C is an acid, there is a higher risk of kidney stone formation.

Question 396

A client who has been prescribed infliximab for severe rheumatoid arthritis has developed temperature of 101.9° F, chills, nausea, vomiting, and dizziness. Which advise would the nurse provide for the client to do? a. The nurse does not need to advise anything. These are common side effects of infliximab. b. Instruct the client take a cool bath. c. The client should wait 24 hours and, if symptoms continue, call the clinic back. d. The client should contact the health care provider for further evaluation.

Answer 396

d. Although side effects of infliximab may include headache, dizziness, cough, nausea, and vomiting, an adverse reaction to the drug is severe infection attributable to immunosuppression. A fever of 101.9° F in an adult who is taking infliximab needs to be evaluated.

Question 397

Chapter 37 Study guide

Question 398

Heart failure occurs when the myocardium (strengthens/weakens) and (shrinks/enlarges), which causes the heart to lose its ability to pump blood through the heart and circulatory system. (Circle correct answers.)

Answer 398

weakens; enlarges

Question 399

With heart failure there is a(n) (increase/decrease) in preload and afterload. (Circle correct answer.)

Answer 399

increase

Question 400

Cardiac glycosides are also called ________________ ________________ which ________________ the sodium-potassium pump.

Answer 400

digitalis glycosides; inhibit

Question 401

The action of antianginal drugs is to increase blood flow and to (increase/decrease) oxygen supply or to (increase/ decrease) oxygen demand by the myocardium. (Circle correct answers.)

Answer 401

increase; decrease

Question 402

Name three of the four effects digitalis preparations have on the heart muscle (myocardium): ________________, ________________, and ________________.

Answer 402

positive inotropic action (increases heart contraction); negative chronotropic action (decreases heart rate); negative dromotropic action (decreases conduction of the heart cells); and increased stroke volume

Question 403

Beta blockers and calcium channel blockers (decrease/increase) the workload of the heart. (Circle correct answer.)

Answer 403

decrease

Question 404

To prevent thromboembolus in patients with atrial dysrhythmias, ________________ is prescribed concurrently with antidysrhythmics

Answer 404

warfarin (or other anticoagulants)

Question 405

Electrolyte imbalances such as ________________, ________________, and ________________ can increase digitalis toxicity.

Answer 405

hypokalemia, hypomagnesemia, hypercalcemia

Question 406

Angiotensin converting enzyme (ACE) inhibitors help patients with heart failure by ________________ venules and ________________, which improves ________________ blood flow and ________________ blood fluid volume.

Answer 406

dilating; arterioles; renal; decreases

Question 407

Short-acting nitroglycerin (NTG) is not swallowed because it undergoes ________________, thereby decreasing its effectiveness.

Answer 407

extensive first-pass metabolism by the liver

Question 408

NTG acts directly on the ________________, causing relaxation and dilation.

Answer 408

smooth muscle of blood vessels

Question 409

NTG sublingually acts within ________________ minutes. Administration may be repeated ________________ times

Answer 409

1–3; 3

Question 410

The most common side effect of NTG is _____________

Answer 410

headache

Question 411

The two drug groups that may be used as an antianginal, antidysrhythmic, and antihypertensive ________________ ________________ and ________________ ________________ ________________.

Answer 411

beta blockers and calcium channel blockers

Question 412

Calcium channel blockers that are effective in the long-term treatment of angina, dysrhythmia, and hypertension and have the side effect of bradycardia are ________________ and ________________.

Answer 412

verapamil; diltiazem

Question 413

Beta blockers and calcium channel blockers should not be discontinued without health care provider approval. Withdrawal symptoms may include ________________ ________________ and ________________.

Answer 413

reflex tachycardia; pain

Question 414

Classic angina occurs when the patient is _______________

Answer 414

stressed (or exerted)

Question 415

Unstable angina (preinfarction) has the following pattern of occurrence: Occurs ________________, is ________________, and manifests with ____________ severity

Answer 415

frequently, unpredictable, and progressive

Question 416

Variant angina (Prinzmetal’s angina) occurs when the patient __________

Answer 416

is at rest

Question 417

Prinzmetal’s angina is due to ________________ of the vessels.

Answer 417

spasm

Question 418

The major systemic effect of nitrates is ____________

Answer 418

reduction of venous tone or coronary vasodilation

Question 419

Cardiac dysrhythmias can result from (hypoxia/hyperoxia) and (hypocapnia/hypercapnia). (Circle correct answers.)

Answer 419

hypoxia; hypercapnia

Question 420

Examples of antidysrhythmics include ________________, ________________, and ________________.

Answer 420

fast sodium channel blockers; beta blockers; calcium channel blockers; also drugs that prolong repolarization

Question 421

Patients with heart failure should avoid ________________ and ________________.

Answer 421

alcohol; cigarettes

Question 422

Phosphodiesterase inhibitors promote which actions in treating heart failure? a. Increase serum sodium and potassium levels b. Promote negative inotropic action c. Promote positive inotropic action d. Promote vasoconstriction

Answer 422

c. Phosphodiesterase inhibitors, such as milrinone, promote positive inotropic response and vasodilation, not vasoconstriction. Phosphodiesterase inhibitors do not increase serum sodium and potassium levels. Increasing serum sodium can promote water retention, which will worsen heart failure.

Question 423

A client with a history of atrial flutter is prescribed quinidine. What is the nurse’s best response when answering a patient who asks how the drug helps the heart? a. “It will help your heart pump stronger.” b. “It will prevent you from having chest pain.” c. “It will decrease myocardial oxygen consumption.” d. “It will slow down the speed of your heart so that it will work more effectively.”

Answer 423

d. Quinidine is a fast sodium channel blocker that decreases sodium influx into cardiac cells. The response is slowed conduction speed, suppressed automaticity, and increased repolarization time.

Question 424

Which is more effective when other drugs are ineffective in treating ventricular fibrillation. a. Amiodarone b. Atropine c. Acebutolol HCl d. Propafenone HCl

Answer 424

a. Amiodarone prolongs repolarization and is given intravenously in emergency treatment for ventricular dysrhythmias when other antidysrhythmics are not effective. Atropine is for symptomatic brady-cardia; acebutolol is for premature ventricular con-tractions and is given orally.

Question 425

What is lidocaine primarily used to treat? a. Atrial fibrillation b. Bradycardia c. Complete heart block d. Ventricular dysrhythmias

Answer 425

d. Lidocaine is used to treat ventricular dysrhythmias. Atrial fibrillation, bradycardia, and complete heart block are atrial dysrhythmias.

Question 426

A client with angina has been prescribed verapamil. Which priority teaching point(s) will the nurse include regarding this drug? (Select all that apply.) a. “Eat lots of fiber to avoid constipation.” b. “High blood pressure can be caused by verapamil.” c. “This drug is taken three times per day.” d. “Wear sunscreen due to photosensitivity.” e. “You should not take this drug if you are diabetic.

Answer 426

a, c. Constipation is a side effect of verapamil, which is taken three times per day. Verapamil may cause hypotension, not hypertension.

Question 427

A client has been prescribed amlodipine to help control hypertension. Which laboratory values must be monitored carefully when on amlodipine? a. Arterial blood gasses b. Blood glucose c. Complete blood count d. Liver enzymes

Answer 427

d. Calcium channel blockers can affect kidney and liver function, so baseline liver enzymes and renal function should be obtained and trended.

Question 428

Abnormal levels of atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) indicate which disease process? a. Aneurysm b. Cerebrovascular accident c. Heart failure d. Myocardial infarction

Answer 428

c. ANP and BNP are elevated in persons with HF. Both are secreted from the atrial cells of the heart.

Question 429

A client taking digoxin daily along with several other drugs has a brain natriuretic peptide (BNP) level of 630 pg/mL. What concerns the nurse about this level? a. It is below the normal/reference range for her age. b. Nothing. It is within the normal range. c. It is slightly elevated. d. It is markedly elevated.

Answer 429

d. Normal values are less than 100 pg/mL. Greater than 100 pg/mL is considered elevated. Older women tend to have higher normal BNP levels than older men; however, a level of 630 pg/mL is markedly elevated and is of concern for heart failure.

Question 430

The nurse knows that digitalis is usually prescribed for which abnormal rhythm? a. Atrial fibrillation b. Paroxysmal atrial tachycardia c. Second-degree heart block d. Ventricular tachycardia

Answer 430

a. Digitalis drugs, such as digoxin, can be used for heart failure or atrial fibrillation. Atrial fibrillation is a cardiac dysrhythmia of the atria.

Question 431

What is the usual maintenance dose of digoxin? a. 0.125-5 mg/d b. 0.025-1 mg/d c. 0.05-1.75 mg/d d. 6–10 mg/d

Answer 431

a. The usual maintenance dose of digoxin is 0.125-0.5 mg/d. Answers b and c are too low and answer d is too high of a dose. The therapeutic serum level for digoxin is 0.8 to 2 ng/mL.

Question 432

A client, who has been on digoxin, presents to the clinic complaining of nausea, malaise, and “just not feeling well.” The nurse suspects digoxin toxicity. What is a therapeutic digitalis level? a. 0.15–0.5 ng/mL b. 0.8–2 ng/mL c. 2–3.5 ng/mL d. 3.5–4 ng/mL

Answer 432

b. Digoxin has a long half of 30-40 hours and has low protein-binding power of 20-30%. Because of these, drug accumulation can occur causing digoxin toxicity. Serum digoxin levels are drawn to assess for possible toxicity. The therapeutic serum level when taken for dysrhythmias is 0.8 to 2 ng/ mL. When it is taken for heart failure, the therapeutic level is 0.5 to 1 ng/mL.

Question 433

What is the antidote for digitalis toxicity? a. Cardizem b. Digoxin immune Fab c. Gamma globulin d. Protamine

Answer 433

b. Digoxin-immune Fab can be given to treat severe digitalis toxicity. This drug binds with digoxin so that it can be excreted in the urine.

Question 434

The nurse is reviewing the patient’s medication administration record (MAR). Which drug(s) on the MAR will concern the nurse, given that the patient is taking digitalis? (Select all that apply.) a. Cortisone b. Furosemide c. Hydrochlorothiazide d. Nitroglycerin e. Potassium supplement

Answer 434

a, b, c. Cortisone, furosemide, and hydrochlorothiazide all promote loss of potassium, which increases the effect of digitalis and can lead to digitalis toxicity. A person taking a potassium-wasting diuretic or cortisol should avoid hypokalemia by eating potassium-rich foods or taking potassium supplements.

Question 435

The nurse is providing health teaching to a client prescribed digoxin for heart failure. Which food(s) will the nurse tell the client to avoid? (Select all that apply.) a. Apples b. Celery c. Hot dogs d. Lettuce e. Potatoes

Answer 435

c. There are no specific drug-food contraindications for digoxin. The client should be encouraged to eat foods high in potassium such as fruits and vegetables (including potatoes). A client with heart failure should avoid hot dogs because of their high sodium content.

Question 436

What is the duration of action of a nitroglycerin transdermal patch? a. 6–8 hours b. 10–12 hours c. 18–24 hours d. 36–48 hours

Answer 436

c. The duration of action for NTG patch is 18-24 hours. However, clients should be instructed to remove the patch nightly to allow for an 8-12 hours nitrate-free interval to avoid building tolerance.

Question 437

Chapter 38

Question 438

Which group(s) of diuretics is/are frequently pre-scribed to treat hypertension and congestive heart failure? (Select all that apply.) a. Carbonic anhydrase inhibitors b. Loop diuretics c. Osmotic diuretics d. Potassium-sparing diuretics e. Thiazide diuretics

Answer 438

b, d, e. Diuretics are classified according to their mechanisms of action. Loop diuretics promote the loss of potassium and sodium; potassium-sparing diuretics promote the loss of sodium while retaining potassium; and thiazide diuretics promote the loss of sodium and some potassium. All diuretics promote the loss of water. While osmotic diuretics promote the loss of water and sodium, they are not used to treat hypertension and congestive heart failure; instead, they are used to decrease edema, especially cerebral edema. Carbonic anhydrase inhibitors also promote water and bicarbonate loss with minimal influence on electrolytes. Their use is to decrease intraocular pressure, not hypertension and heart failure.

Question 439

What is the pharmacologic action of spironolactone? a. Increase potassium and sodium excretion b. Promote potassium retention c. Promote potassium and calcium retention d. Promote potassium excretion and sodium retention

Answer 439

b. Spironolactone is a potassium-sparing diuretic. It promotes potassium retention in the renal tubules.

Question 440

What is the classification of furosemide? a. Loop diuretic b. Osmotic diuretic c. Potassium-sparing diuretic d. Thiazide diuretic

Answer 440

a. Furosemide is a loop diuretic, which promotes excretion of water, sodium, and potassium, primarily in the loop of Henle and some in the distal renal tubules. Other electrolytes that are excreted include magnesium, ammonium, phosphate, and calcium.

Question 441

A client has been prescribed spironolactone 100 mg/day to treat an irregular heart rhythm. Which statement by the client indicates an under-standing of the drug teaching the nurse provided? a. “I need sodium so my heart beats regularly.” b. “This drug is dangerous if you have had a heart attack.” c. “It helps keep potassium so my heart does not get irregular.” d. “I need to take it with lots of bananas to keep my potassium up.”

Answer 441

c. Spironolactone blocks the action of aldosterone and inhibits the sodium-potassium pump, so potassium is retained. This is important in maintaining a regular cardiac rhythm. It is frequently prescribed and is not contraindicated in clients who have had a myocardial infarction. Sodium is excreted with this drug. Clients should be advised not to overindulge in foods rich in potassium such as bananas, because this could cause above-normal levels of potassium (hyperkalemia).

Question 442

The nurse has received an order to administer 40 mg of furosemide intravenously (IV) to the client. What does the nurse know about how this drug should be administered? a. It must be mixed in 50 mL of normal saline. b. It can only be given in a central line. c. The patient must be on a cardiac monitor. d. It should be given over 1–2 minutes.

Answer 442

d. To prevent hearing loss, furosemide must be administered by slow IV push over at least 1–2 minutes. It does not need to be diluted and does not require a central line for administration. Cardiac monitoring is not essential, because furosemide does not generally cause arrhythmias.

Question 443

Which lab value(s) should a nurse monitor in a client receiving chlorothiazide? (Select all that apply.) a. Potassium b. Sodium c. Bicarbonate d. Calcium e. AST/ALT

Answer 443

a, b, d. Hypokalemia, or low serum potassium level, is a risk for clients taking thiazides. This could be a life-threatening condition. Sodium is also lost, causing hyponatremia. Calcium level is elevated be-cause thiazides block calcium excretion. There is minimal effect on bicarbonate levels. Cautious use in hepatic failure clients is recommended, but trending of AST/ALT levels is not always indicated. Baseline values may be beneficial.

Question 444

A client who has had an acute myocardial infarction has been started on spironolactone 50 mg/day. When evaluating routine laboratory work, the nurse discovers the client has a potassium level of 5.8 mEq/L. What is the priority intervention to be implemented? a. The spironolactone dose should be held and the intake of foods rich in potassium should be restricted. b. The spironolactone dose should be continued and the patient should be encouraged to eat fruits and vegetables. c. The spironolactone dose should be increased and the patient instructed to decrease foods rich in potassium. d. Instruct the patient to continue with the current dose of spironolactone and report any signs or symptoms of hypokalemia

Answer 444

a. The normal range for serum potassium level is 3.5–5 mEq/L. A level of 5.8 mEq/L is considered hyperkalemia. The dose of spironolactone may need to be held or decreased, and the client should decrease intake of potassium-rich foods such as bananas, apricots, leafy greens, and salmon.

Question 445

Which type of acid-base imbalance could occur if a patient is taking high doses of acetazolamide or uses the drug constantly? a. Metabolic acidosis b. Metabolic alkalosis c. Respiratory acidosis d. Respiratory alkalosis

Answer 445

a. Acetazolamide is a carbonic anhydrase inhibitor. It blocks the action of carbonic anhydrase, which is an enzyme that affects hydrogen ion balance. If the action is blocked, more bicarbonate will be excreted, leading to metabolic acidosis.

Question 446

The client with heart failure has been prescribed hydrochlorothiazide. Which statement by the client indicates understanding of the dosing regimen? a. “I need to take it on an empty stomach for it to work.” b. “I really only need to take my medicine when I am having a hard time breathing.” c. “It may take several weeks before it starts to work.” d. “I should take it in the morning so I don’t have to go to the bathroom at night.”

Answer 446

d. Because the onset of action HCTZ is 2 hours, it may be best to take the drug when the client will be awake for several hours so sleep is not disturbed. Hydrochlorothiazide can be taken with food to prevent GI upset. The drug needs to be taken consistently, even if the client is not having symptoms of heart failure.

Question 447

The client with a complicated medical history including heart failure, cardiac arrhythmias, arthritis, and depression was started on furosemide for heart failure. Which drug would be of major concern to the nurse? a. Amiodarone b. Acetaminophen c. Amitriptyline d. Zolpidem

Answer 447

a. Furosemide will cause an increased loss of potassium (hypokalemia) when given with amiodarone, which may predispose the client to ventricular arrhythmias.

Question 448

A client taking furosemide reports being weak, having severe leg cramps, and unable to ambulate. Knowing the mechanism of action of furosemide, the nurse is concerned about which electrolyte imbalance? a. Hyponatremia b. Hypermagnesemia c. Hypokalemia d. Hyperchloremia

Answer 448

c. Muscle weakness, abdominal distention, severe leg cramping, and cardiac arrhythmias are indications of hypokalemia (low potassium levels). Low potassium levels may occur with the use of loop diuretics.

Question 449

In which client are loop diuretics contraindicated? a. The client with anuria b. The client with asthma c. The client with allergy to ceftriaxone d. The client with gastric ulcers

Answer 449

a. Loop diuretics are contraindicated in clients with anuria. Giving diuretics to a client without any urine output will not force urine production. Clients allergic to sulfa drugs should not take furosemide or bumetanide; these are derivatives of sulfonamides.

Question 450

A client diagnosed with hypertension and diabetes was started on hydrochlorothiazide. Which statement by the client indicates understanding of the drug teaching the nurse has provided? a. “It will start working within minutes.” b. “I don’t need to monitor my blood sugar.” c. “I should take my drug on an empty stomach so it works better.” d. “I need to keep track of my weight and blood pressure at home.”

Answer 450

d. Daily weights and vital signs need to be trended at home on a daily basis. The client and family should be educated on how to take these measurements or arrangements should be made for assessment by home health services, at least initially. The onset of action for hydrochlorothiazide is 2 hours. Hyperglycemia is a side effect of hydrochlorothiazide, so blood sugar level should be monitored. This medication can be taken with food to prevent nausea.

Question 451

When hypertension cannot be controlled nonpharmacological, antihypertensive drugs may be prescribed. Three of the five sympatholytic groups are ________________, ________________, and ________________.

Answer 451

beta-adrenergic blockers; centrally acting alpha2 agonists; alpha-adrenergic blockers; also adrenergic neuron blockers, alpha1-and beta1-adrenergic blockers

Question 452

Two categories of antihypertensives in addition to the sympatholytic are __________________ and _________________

Answer 452

diuretics, direct-acting arteriolar vasodilators; also ACE inhibitors, angiotensin II-receptor blockers, and calcium channel blockers

Question 453

Thiazide diuretics may be combined with other antihypertensive drugs. Examples of other antihypertensives include ________________ and ________________.

Answer 453

beta blockers; ACE inhibitors; also angiotensin II–receptor blockers, potassium-sparing diuretics, centrally acting alpha2 agonist

Question 454

Many antihypertensive drugs can cause fluid retention. To decrease body fluid, the drug group often administered with antihypertensive drugs is _______________

Answer 454

diuretics

Question 455

Beta-adrenergic blockers reduce cardiac output by diminishing the sympathetic nervous system response. With continued use of beta blockers, vascular resistance is (increased/diminished) and blood pressure is (lowered/in-creased). (Circle correct answers.)

Answer 455

diminished; lowered

Question 456

Atenolol and metoprolol are examples of (cardioselective/noncardioselective) antihypertensive drugs. (Circle correct answer.

Answer 456

cardioselective

Question 457

The alpha blockers are useful in treating hypertensive patients with lipid abnormalities. The effects they have on lipoproteins include (decreased/increased) VLDL and LDL; and (decreased/increased) HDL. (Circle correct answers.)

Answer 457

decreased; increased

Question 458

Which client would be most suited for treatment with a nonselective alpha-adrenergic blocker? a. A client with mild to moderate renal failure b. A client with hypertension associated with pheochromocytoma c. A client with hyperlipidemia d. A client with type 2 diabetes

Answer 458

b. Nonselective alpha-adrenergic blockers are used for severe hypertension associated with pheochromocytomas (catecholamine-secreting tumors of the adrenal medulla).

Question 459

Where in the body do direct-acting vasodilators act to decrease blood pressure? a. Cardiac valves b. Dopaminergic receptors in kidneys c. Renal tubules d. Smooth muscles of the blood vessels

Answer 459

d. Direct-acting vasodilators relax the smooth muscles of the blood vessels, mainly the arteries, resulting in vasodilation. This promotes blood flow to the brain, kidneys, and other vital organs. Vasodilation causes the blood pressure to decrease.

Question 460

With use of direct-acting vasodilators, sodium and water are retained and peripheral edema occurs. Which category of drugs should be given to avoid fluid retention? a. Anticoagulants b. Antidysrhythmics c. Cardiac glycosides d. Diuretics

Answer 460

d. Diuretics are frequently given with a variety of antihypertensive to decrease fluid retention and peripheral edema.

Question 461

Which is/are action(s) of angiotensin II–receptor blockers (ARBs)? (Select all that apply.) a. Block angiotensin II b. Cause vasodilation c. Decrease peripheral resistance d. Increase sodium retention e. Slow heart rate

Answer 461

a, b, c. Angiotensin II binds to cell receptors to in-crease blood pressure. Angiotensin II also causes vasoconstriction and increases vascular resistance. ARBs inhibit the binding of angiotensin II at receptor sites; thereby, decreasing blood pressure. With-out the binding, vasoconstriction does not occur and the peripheral resistance is not increased. ARBs do not increase sodium retention or decrease heart rate.

Question 462

An angiotensin II–receptor blocker (ARB) can be combined with the thiazide diuretic hydrochlorothiazide. What is the purpose of combining these two drugs? a. To decrease rapid blood pressure drop b. To enhance the antihypertensive effect by promoting sodium and water loss c. To increase sodium and water retention for controlling blood pressure d. To promote potassium retention

Answer 462

b. ARBs inhibit the binding of angiotensin II to receptor sites; thereby blood pressure does not increase. Diuretics, such as thiazides, assist in lowering blood pressure by promoting water and sodium loss.

Question 463

Angiotensin II–receptor blockers (ARBs) may be prescribed for hypertensive clients instead of an angiotensin-converting enzyme (ACE) inhibitor. What is the most limiting factor in the use of ACE inhibitors? a. Coughing b. Dizziness c. Shortness of breath d. Sneezing

Answer 463

a. The primary side effect of ACE inhibitors is a constant, irritated cough and may be relieved upon discontinuation of the drug. ARBs do not have the side effect of coughing.

Question 464

A nurse is preparing to administer cardiac drugs to several clients. The nurse would be concerned about administering an ACE inhibitor as a mono-therapy to which client? a. A Hispanic client b. An Asian client c. A Caucasian client d. A African American client

Answer 464

d. African Americans are not as responsive to ACE inhibitors as monotherapy but may respond better if they are combined with a diuretic.

Question 465

A African American client presents to a health care provider for continued high blood pressure. Which group of drugs would be more effective for this client? a. Angiotensin II blockers b. Beta blockers c. Calcium blockers d. Direct renin inhibitor

Answer 465

c. Calcium channel blockers and alpha1 blockers may be more effective in African American clients for treating hypertension. They do not respond well to direct renin inhibitors, beta blockers, and ACE inhibitors. ARBs have similar mechanism of actions as ACE inhibitors, affecting the RAAS.

Question 466

Which drug-herb interaction can occur when Mahuang (ephedra) is taken concomitantly with an antihypertensive drug? a. A decrease or counteraction of the effects of the antihypertensive drug b. A decrease in the hypertensive state c. An increase in the hypotensive effects of the antihypertensive drug d. No effect on the action of the antihypertensive drug

Answer 466

a. Mahuang decreases or counteracts the effects of antihypertensives and can even increase the hypertensive state.