Test 6 Ch 20

Question 1

1. You are teaching a patient about taking over-the-counter (OTC) drugs. Which important safety information should you include in your teaching plan?
   a. “OTC drugs will only maintain their potency months after the expiration date.”
   b. “OTC drugs often interact with other drugs, and with food or alcohol.”
   c. “Be sure to take all the pills in the bottle.”
   d. “Adjust the dosage to your specific needs.”

Answer 1

ANS: B
OTC drugs often interact with other drugs, and with food or alcohol, or they might affect other existing health problems the patient has. Ask a pharmacist or the healthcare provider if you are unsure. Also, the healthcare professional must be aware of all over-the-counter drugs being taken because of the dangers of interaction.

Question 2

2. A patient informs you that she is buying over-the-counter (OTC) drugs online from another country because they are cheaper. What is your best response?
   a. “I agree with you, it is important to save money on expensive drugs when you can.” b. “There is no difference between generic OTC drugs from different countries.”
   c. “Avoid buying OTC drugs online, as they may be counterfeit or dangerous.”
   d. “Only buy OTC drugs online if your insurance company covers them.”

Answer 2

ANS: C
Patients should avoid buying these products online, outside of well-known internet insurance company sites, because many OTC preparations sold through the internet are counterfeit products and may be dangerous.

Question 3

3. What information is important to include when teaching parents about giving over-the-counter (OTC) drugs to children?
   a. Do not give drugs containing alcohol to children.
   b. OTC drugs are safe for children younger than 2 years of age.
   c. When giving OTC drugs to a child, always give one-half of the adult dose.
   d. Refrain from using a child-resistant cap in the event the drug must be given quickly.

Answer 3

ANS: A
One of the most important considerations in reading OTC product labels is to notice the hidden chemicals (used for various purposes) in the products. Drugs containing alcohol (such as some cough preparations) should not be given to children.

Question 4

4. Which of the following drug types is not regulated by the Food and Drug Administration?
   a. Opioids
   b. Vitamins
   c. Hormones
   d. Herbal supplements

Answer 4

ANS: D
The FDA does not regulate herbal supplements but protects consumers from misleading health claims by the supplement industry.

Question 5

5. During your assessment of a clinic patient, the patient asks you if using expired over-the- counter (OTC) drugs would cause harm. What is your best answer?
   a. “These drugs are safer than prescription drugs, so using expired OTC drugs is harmless.”
   b. “Disposing of expired drugs is only necessary if you have several drug allergies.”
   c. “You should always safely dispose all expired or discolored drugs.”
   d. “The chemical preservatives in OTC drugs prevent drug expiration.”

Answer 5

ANS: C
You should always tell patients to safely dispose of old, discolored, or expired drugs or any drug that has lost its label instructions. Your pharmacist can tell you about the ways to safely dispose of drugs.

Question 6

6. A patient with depression tells you she is using St. John’s wort to treat her symptoms because she would rather use a natural product, as she already takes many prescription drugs. What is your best response?
   a. “St. John’s wort has been proven effective in treating mild to moderate depression.”
   b. “You may take St. John’s wort with your other prescription drugs without concern.”
   c. “Avoid taking St. John’s wort because it interferes with many prescription drugs.”
   d. “Avoid using St. John’s wort unless you have weekly blood levels drawn.”

Answer 6

ANS: C
St. John’s wort may improve mild to moderate depression but has potentially dangerous interactions with many prescription drugs.

Question 7

7. Which statement about multivitamins is true?
   a. Most people will take multivitamins without consulting a healthcare professional.
   b. Many multivitamins are used with prescription drugs to prevent disease.
   c. Multivitamins are drug preparations that do not expire.
   d. Multivitamins do not pose a risk for adverse effects.

Answer 7

ANS: A
People take vitamins to maintain health or to correct specific nutritional deficiencies. Most people decided to take vitamins on their own without the advice of a healthcare professional.

Question 8

8. A patient with a severe upper respiratory infection tells you she is taking mega-doses of vitamin C to help her get rid of the infection quicker. What is your best response?
   a. “Taking high doses of vitamin C is recommended for this purpose.”
   b. “Taking high doses of vitamin C is not effective because it is excreted quickly.”
   c. “Vitamin C is a fat-soluble vitamin, and high doses can be dangerous.”
   d. “Vitamin C is only useful in treating malabsorption syndromes.”

Answer 8

ANS: B
Vitamin C is a water-soluble vitamin that is quickly excreted and thus mega-doses of this vitamin produce no additional benefit.

Question 9

9. A patient in the clinic asks you if she should purchase an expensive brand name multivitamin because cheaper vitamins may not be as good. What is your best response to this patient?
   a. “All over-the-counter multivitamin preparations are the same.”
   b. “There is a price–quality relationship to the vitamin product you buy.”
   c. “The cost of the vitamin preparation is not an indication of effectiveness.”
   d. “The cost of multivitamins is related to the bioavailability of the vitamins in the formula.”

Answer 9

ANS: C
The costs for some products are high because of the claims made about their effectiveness, but few of the manufacturer claims can be substantiated by evidence.

Question 10

10. A newly pregnant patient is taking oral vitamin A to encourage embryo growth. What would you include in your teaching plan for this patient?
    a. “Vitamin A is a water-soluble vitamin, so it is safe for the fetus.”
    b. “Take only the amount prescribed; high doses can cause birth defects.”
    c. “Taking vitamin A during the first 12 weeks of pregnancy is recommended.”
    d. “Only take vitamin A in the last trimester of pregnancy to encourage fetal growth.”

Answer 10

ANS: B
Excess vitamin A ingestion during pregnancy can cause birth defects of the CNS.

Question 11

11. A patient has been admitted for suspected vitamin A overdose. What symptoms would you expect the patient to exhibit?
    a. Diarrhea and fever
    b. Constipation and changes in taste
    c. Ecchymosis of the lower extremities
    d. Yellowing of the skin on the nose and ears

Answer 11

ANS: D
An early indication of vitamin A overdose is anorexia, abdominal pain, malaise, and yellowing of the skin, especially on the nose and ears.

Question 12

12. You are getting ready to give an intravenous preparation containing vitamin B1 (thiamine) to a patient with alcoholism. What is the rationale for giving thiamine in an IV solution containing glucose?
    a. Glucose is necessary to assist thiamine in entering the cells.
    b. Glucose prevents the thiamine from being excreted.
    c. Glucose prevents precipitation of the IV fluid.
    d. Glucose is needed for thiamine absorption.

Answer 12

ANS: C
If giving thiamine to an alcoholic or thiamine deficient patient, intravenous glucose should also be given to prevent precipitation or worsening of Wernicke encephalopathy.

Question 13

13. You are teaching a patient with a dietary deficiency of riboflavin about foods that contain riboflavin that should be part of the patient’s diet. Which of the following foods would be recommended?
    a. Enriched flour
    b. Dairy products
    c. Whole grains such as barley
    d. Orange-colored vegetables such as carrots

Answer 13

ANS: B
Teach patients that common food sources of riboflavin include dairy products, eggs, green leafy vegetables, organ meats, and peanuts.

Question 14

14. A patient you are caring for has been started on niacin as part of a regimen to reduce hyperlipidemia. Which unpleasant side effects of niacin should you teach this patient to expect?
    a. Skin warmth and flushing
    b. Yellow-tinged skin and sclera
    c. Beefy-red tongue
    d. Watery eyes

Answer 14

ANS: A
Expected side effects of niacin supplementation are skin warmth, flushing, and itching that can be relieved when giving niacin with aspirin.

Question 15

15. Which drug category is associated with pyridoxine deficiency?
    a. Antibiotics
    b. Beta blockers
    c. Antilipidemics
    d. Oral contraceptives

Answer 15

ANS: D
Oral contraceptives may induce pyridoxine deficiency.

Question 16

16. A newly pregnant woman placed on folic acid states she does not want to take any drugs during her pregnancy. What is your best response?
    a. “Folic acid is crucial to the development of the sex organs of the fetus.”
    b. “Folic acid is crucial to the development of the cardiovascular system.”
    c. “Folic acid is given to prevent neural tube defects of the spinal cord.”
    d. “Folic acid will prevent nausea and vomiting during pregnancy.”

Answer 16

ANS: C
The US Public Health Service has issued an official recommendation that all women of childbearing age in the United States who are pregnant should consume folic acid for reducing their risk of having a pregnancy affected with spina bifida or other neural tube defects.

Question 17

17. You are evaluating a patient’s understanding of a newly prescribed drug regimen for the prevention of heart disease. Which response made by the patient demonstrates understanding of the drug regimen?
    a. “I will take folic acid every other day.”
    b. “I will take calcium supplements daily with meals.”
    c. “I will take a daily dose of folic acid and vitamins B6 and B12.”
    d. “I will take a quality multivitamin and additional ferrous sulfate daily.”

Answer 17

ANS: C
Folic acid and vitamins B6 and B12 have been shown to reduce homocysteine levels. Modestly elevated homocysteine levels in the blood are a risk factor for heart disease.

Question 18

18. Which patient would be most likely to develop a vitamin B12 deficiency?
    a. A patient who takes ibuprofen daily for arthritis
    b. A patient who smokes cigarettes daily
    c. A patient who is on a vegetarian diet
    d. A patient with sickle cell anemia

Answer 18

ANS: C
A patient who is on a strict vegetarian diet may develop vitamin B12 deficiency because vitamin B12 is found only in animal products.

Question 19

19. A patient with multiple vitamin deficiencies is prescribed oral vitamin C as part of a vitamin supplementation treatment. Which of the following instructions regarding vitamin C should be given to this patient?
    a. “Keep vitamin C tablets away from heat and light sources.”
    b. “Only take vitamin C when you are unable to eat citrus fruits.”
    c. “There are no interactions of vitamin C with other drugs you may be taking.”
    d. “Vitamin C is a fat-soluble vitamin primarily used to treat blood clotting disorders.”

Answer 19

ANS: A
Vitamin C is easily destroyed by air, heat, and light. This drug should be kept tightly capped in its own container.

Question 20

20. You are caring for a patient who has a family history of cancer. The patient reports taking vitamin E daily for cancer prevention.
    What is your best response?
    a. “Recent evidence shows that vitamin E is safe and effective for cancer prevention.”
    b. “You may take vitamin E for cancer prevention as long as it is the prescription form.”
    c. “There is currently no evidence that taking vitamin E will prevent cancer.”
    d. “Vitamin E is only useful in the prevention of heart disease.”

Answer 20

ANS: C
Many suggested uses of vitamin E are controversial and unproved. New evidence suggests that vitamin E supplements do not reduce the risk of cancer or major cardiovascular disease and may even increase the risk of heart failure.

Question 21

21. Which drug over-dosage would you expect vitamin K to be given as an antidote?
    a. Warfarin
    b. Heparin
    c. Pyridoxine
    d. Ascorbic acid

Answer 21

ANS: A
Vitamin K is the antidote for warfarin (Coumadin) overdose.

Question 22

22. For which condition would you expect the healthcare provider to prescribe iron supplementation?
    a. Esophageal reflux
    b. Constipation
    c. Osteoporosis
    d. Anemia

Answer 22

ANS: D
Iron is necessary for people with anemia caused by blood loss secondary to surgery or other conditions resulting in iron-deficiency anemia.

Question 23

23. A patient with a chronic malabsorption syndrome has been admitted to the hospital with a severe magnesium deficiency. What complication of magnesium deficiency should you be alert for?
    a. Ventricular tachycardia
    b. Vasoconstriction
    c. Severe diarrhea
    d. Pancreatitis

Answer 23

ANS: A
Magnesium is important in cardiac function, and only slight deficiencies may prolong the Q-T interval and lead to a very dangerous form of ventricular tachycardia (rapid heartbeat) called torsades de pointes.

Question 24

mult resp

1. You are seeing a patient in the clinic who is just started using CBD. You are preparing patient education regarding the side effects of CBD. Which of the following are common side effects of cannabis? (Select all that apply.)
   a. Cough
   b. Red eyes
   c. Tinnitus
   d. Altered vision
   e. Sedation
   f. Altered sense of taste

Answer 24

ANS: A, B, D, E
Some common side effects of cannabis are dry mouth, sedation, cough, dysphoria, anxiety (with higher doses), red eyes, altered visual perceptions, lack of coordination, and altered sense of time.

Question 25

mult resp
2. You are caring for a patient in a long-term care facility and you notice that he has symptoms that are consistent with a suspected vitamin B2 (riboflavin) deficiency. List the symptoms you would expect to see in a patient diagnosed with a vitamin B2 deficiency. (Select all that apply.)
a. Low blood counts
b. Upper quadrant abdominal pain
c. Sore throat
d. Cracks in the corners of the mouth
e. Confusion and short-term memory loss
f. Burning of the tongue and lips

Answer 25

ANS: C, D, F
Symptoms of riboflavin deficiency may include cracks in the corner of the mouth, soreness and burning of the tongue and lips, and sore throat.

Question 26

mult resp
3. You are planning patient education for a 65-year-old patient diagnosed with a vitamin B6 deficiency. You know it is important for this patient to include eating foods high in vitamin B6 (pyridoxine) in his regular diet. List the appropriate foods that this patient should include in his diet. (Select all that apply.)
a. Liver
b. Orange juice
c. Eggs
d. Whole grain bread
e. Soybeans
f. Bananas

Answer 26

ANS: A, C, D, E
Food sources of vitamin B6 include yeast, wheat, corn, egg yolk, liver, kidney, and muscle meats, soybeans, cereals, whole grain bread, and soybeans. Limited amounts are available from milk and vegetables.

Question 27

mult resp
4. You are taking a diet history from a patient who has a vitamin B12 deficiency from pernicious anemia. Which of the following foods demonstrates understanding of an appropriate dietary choice for this patient? (Select all that apply.)
a. Fermented cheeses such as Camembert
b. Organ meats, such as liver or kidneys
c. Shellfish, such as clams or scallops
d. Whole grain foods such as barley
e. Leafy greens, such as spinach
f. Nonfat milk

Answer 27

ANS: A, B, C, F
Food sources of B12 include organ meats, clams and oysters; nonfat dry milk; fermented cheese such as Camembert and Limburger; and seafood such as lobster, scallops, flounder, haddock, swordfish, and tuna.

Question 28

mult resp

5. Which of the following represent the effects of calcium on the body? (Select all that apply.)
   a. Large doses of calcium will not harm the body when taken on a full stomach.
   b. Calcium can limit the absorption of iron and other trace elements.
   c. Calcium can cause constipation and reduce kidney function.
   d. Calcium may prevent bone loss in older men.
   e. Calcium can reduce kidney function.

Answer 28

ANS: B, C, D, E
Large doses of calcium can limit the absorption of iron and other trace elements. Calcium can cause constipation and reduce kidney function. Older men, as well as older women, need calcium in their diet to prevent bone loss.

Question 29

mult resp

6. You are collecting information on a new patient’s drug history, which includes the use of over- the-counter (OTC) drugs. The patient asks you why this important. List the following statements that are true regarding OTC drugs. (Select all that apply.)
   a. “Assessment of OTC drugs isn’t necessary unless the patient has an acute event.”
   b. “There may be unsafe interactions of OTC drugs with prescription drugs.”
   c. “Patients often neglect to tell healthcare providers about OTC drugs routinely taken.”
   d. “OTC drugs may worsen existing medical problems.”
   e. “The insurance company needs to determine the monthly costs of all drugs taken.”
   f. “OTC preparations have been proven safe for infants and children.”

Answer 29

ANS: B, C, D
Nurses should always assess the patient’s use of OTC products, as many patients do not disclose the use of OTC products to healthcare providers. Some of the active chemicals in OTC products may make existing medical problems worse or interact with a patient’s prescribed drugs.

Question 30

mult resp

7. What patient teaching points should be included in the care of a patient taking iron for the treatment of iron deficiency anemia? (Select all that apply.)
   a. Liquid iron solutions can discolor teeth.
   b. Take the iron tablets on an empty stomach.
   c. Expect to take iron for a period of 4 to 6 months.
   d. Do not eat foods high in iron while on iron supplements.
   e. Calcium should be given along with iron for maximal absorption.
   f. Iron supplements can cause the stool to appear dark green or black in color.

Answer 30

ANS: A, B, C, F
Patients taking iron should be instructed that liquid iron solutions can discolor teeth. They should take the iron tablets on an empty stomach. Most iron regimens last for 4 to 6 months. Iron supplements can cause the stool to appear dark green or black in color.

Question 31

mult resp
8. A patient taking a diuretic for congestive heart failure (CHF) asks the nurse you to suggest potassium-rich foods that can be eaten to supplement potassium loss from the diuretic. List the following foods that should be included in this patient’s teaching plan. (Select all that apply.)
a. Dried fruits
b. Citrus fruits
c. Rice and pasta
d. Nuts
e. Cantaloupe and watermelon
f. Cruciferous vegetables
g. Apples
h. Green leafy vegetables

Answer 31

ANS: A, B, D, E, F, H
Green leafy vegetables, such as spinach, bok choy, and Swiss chard, are some of the best sources of potassium. A potassium-rich diet includes foods such as bananas, citrus fruits (especially tomatoes and oranges), apricots, and dried fruits such as raisins, prunes, and dates. Fresh cantaloupe and watermelon, nuts, dried beans, beef, and fowl also contain ample quantities of potassium.

Question 32

mult resp

9. You are taking care of a patient and preparing to give thiamine IV. You know that it is important to check the patient continuously throughout the infusion for signs of an allergic reaction. List the following indications that would alert the LPN/LVN of an allergic reaction. (Select all that apply.)
   a. Headache
   b. Dyspnea
   c. Angioedema
   d. Cyanosis
   e. Joint pain
   f. Pruritus

Answer 32

ANS: B, C, D, F
When giving parenteral thiamine, the patient should be continuously assessed for indications of an allergic reaction, such as feelings of warmth, pruritus, urticaria, angioedema, dyspnea, sweating, tightness of the throat, and cyanosis.