TEST BANK Davis's Drug Guide for Nurses 17th Edition Vallerand Sanoski. MCQ Plus Rationale.

Davis’s Drug Guide for Nurses, 17e

Test Bank-1

Drug Guide Test Bank

MULTIPLE CHOICE

1. The nurse is providing care for a patient scheduled to take acarbose (Precose) 25 mg 3 times daily with meals. The patient reports feeling sweaty, weak, and tremulous. Which of the following actions by the nurse is best?

A. Reassure the patient that these are common side effects with the medication.

B. Call the pharmacy to report an adverse drug reaction.

C. Check the patient’s blood glucose level.

D. Determine if the patient has a history of anemia.

ANS: C See Assessment for acarbose: Observe the patient for signs and symptoms of hypoglycemia. Acarbose alone does not cause hypoglycemia; however, other concurrently administered hypoglycemic agents may produce hypoglycemia, requiring treatment. Ignoring these symptoms would be dangerous, but it is not considered an adverse drug reaction requiring an official report. The patient is experiencing symptoms of hypoglycemia not anemia.

KEY: Cognitive Level: Analysis DIF: Medium TOP: Therapeutic Classification: Antidiabetics REF: Drugguide.com

2. While responding to a rapid response called on the cardiac step-down unit, the nurse from intensive care observes the unit nurse massaging a patient’s neck and instructing the patient to bear down. Which of the following medications will most likely be used if the patient’s pulse does not return to normal?

A. Adenosine (Adenocard) B. Epinephrine (Adrenaline) C. Atenolol (Tenormin) D. Asenapine (Saphris) ANS: A See Indications for adenosine: Adenosine is used for the conversion of paroxysmal supraventricular tachycardia (PVST) to normal sinus rhythm when vagal maneuvers are unsuccessful. Epinephrine is a bronchodilator used in the management of reversible airway disease. Atenolol is a beta blocker used in the management of hypertension. Asenapine is an antipsychotic mood stabilizer used in the acute treatment of schizophrenia or manic/mixed episodes associated with bipolar I disorder.

KEY: Cognitive Level: Application DIF: Medium TOP: Therapeutic Classification: Antiarrhythmics REF: Page 112 | Page 505 | Page 191 | Page 188

Davis’s Drug Guide for Nurses, 17e

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3. The nurse is instructing the parent of a 6-year-old patient recently started on an albuterol (ProAir HFA) inhaler for exercise-induced asthma. The nurse recognizes that further teaching is necessary by which of the following client statements?

A. “He may feel like his heart is racing after he takes his inhaler.”

B. “He can use the inhaler as many times during football practice as he needs it.”

C. “He should avoid cola and other caffeinated drinks since they may increase his heart rate.”

D. “He should take 2 puffs about 15 min before gym class.”

ANS: B See Contraindications/Precautions, Interactions, and Dosage for albuterol. Excess inhaler use may lead to tolerance and paradoxical bronchospasm. Use with caffeine-containing herbs (cola nut, guarana, tea, coffee) increases stimulant effect. Two inhalations every 4–6 hr or 2 inhalations 15 min prior to exercise).

Tachycardia is an expected side effect with this medication.

KEY: Cognitive Level: Analysis DIF: Easy TOP: Therapeutic Classification: Bronchodilators REF: Page 117

4. While providing care for an adolescent patient newly prescribed amitriptyline (Elavil), the nurse should be most concerned by which of the following patient statements?

A. “My mouth seems really dry and I’m thirsty all the time.”

B. “I take a nap most afternoons now because I feel sleepy sometimes.”

C. “I’m not sure why we should even bother anymore; everything seems so pointless.”

D. “I drink a cup of coffee most days with breakfast.”

ANS: C See Contraindications/Precautions for amitriptyline: the use of this medication may increase the risk of suicide attempt/ideation especially during early treatment or dose adjustment; risk may be greater in children or adolescents. Sedation is an expected side effect. Dry mouth is an expected side effect. There is no directive to avoid caffeine with this medication.

KEY: Cognitive Level: Analysis DIF: Medium TOP: Therapeutic Classification: Antidepressants REF: Page 145

5. The nurse is caring for a patient with otitis media who reports an allergy to penicillin. Orders are received for amoxicillin 500 mg every 8 hr. Which of the following actions by the nurse is best?

A. Provide the medication as ordered.

B. Call the pharmacist to request a substitution.

C. Ask the patient if he or she has taken amoxicillin in the past.

D. Hold the medication.

ANS: D

Davis’s Drug Guide for Nurses, 17e

Test Bank-3

See contraindications/precautions for amoxicillin. Contraindicated in hypersensitivity to penicillin. This medication should be held due to the stated allergy to penicillin.

KEY: Cognitive Level: Application DIF: Easy TOP: Therapeutic Classification: Anti-infectives REF: Page 148

6. While caring for a patient in hospice who is actively dying, the nurse notes moderate respiratory distress, copious oral secretion, and a frequent moist cough. Which of the following prn medications would most promote comfort for the patient?

A. Morphine sulfate (Morphine) 2 mg IV bolus B. Atropine (AtroPen) 0.4 mg IV bolus C. Lorazepam (Ativan) 0.5 mg IV bolus D. Diphenhydramine (Benadryl) 25 mg IV bolus ANS: B See Action for atropine: Low doses decrease sweating, salivation, and respiratory secretions. Morphine is used for pain control. Lorazepam is used for anxiety. Benadryl is used for itching.

KEY: Cognitive Level: Analysis DIF: Medium TOP: Therapeutic Classification: Antiarrhythmics | Therapeutic Classification: Anticholinergics REF: Page 198

7. The nurse is counseling a patient started on azithromycin (Zithromax) for the treatment of an upper respiratory infection. The nurse recognizes that teaching has been effective by which of the following patient statements?

A. “The med pack will have 5 pills, 1 for each of the next 5 days.”

B. “If I don’t feel better next week, I can get a refill from the pharmacist.”

C. “I only need to take 1 pill, but my symptoms may not clear for 3 days.”

D. “I can take this medication safely even though I’m allergic to erythromycin.”

ANS: A See Route/Dosage for azithromycin: 500 mg on 1st day, then 250 mg/day for 4 more days. Instruct the patent to notify health care professional if symptoms do not improve. Teach the patient to take medication as directed and to finish the drug completely. Azithromycin is contraindicated in patients with an allergy to erythromycin.

KEY: Cognitive Level: Analysis DIF: Easy TOP: Therapeutic Classification: Anti-infectives REF: Page 202

Davis’s Drug Guide for Nurses, 17e

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8. The home-care nurse is preparing to see a patient being treated for diabetic foot ulcerations with becaplermin (Regranex). Which of the following instructions will the nurse include in the patient teaching?

A. “Apply the wound gel 3 times daily to promote healing.”

B. “Store the gel in the refrigerator.”

C. “Complete healing is expected within 3 days.”

D. “After applying the wound gel, cover with a transparent adhesive dressing.”

ANS: B See Implementation for becaplermin: Calculated amount is applied as a thin layer and covered with a moist saline dressing for 12 hr; dressing is removed, ulcer rinsed, and redressed with moist dressing without becaplermin for rest of day. Process is repeated daily. Store gel in refrigerator; do not freeze. If ulcer does not decrease in size by 30% within 10 wk, continuation of therapy should be reassessed. Cover with a moist saline dressing for 12 hr. Then, remove dressing, rinse ulcer, and redress with moist dressing without becaplermin for rest of day.

KEY: Cognitive Level: Analysis DIF: Hard TOP: Therapeutic Classification: Wound/Ulcer/Decubiti healing agents REF: Page 214

9. The nurse is tracking patient symptoms related to acute alcohol intoxication and withdrawal. Which of the following medications would the nurse expect to provide in the management of these symptoms?

A. Clopidogrel (Plavix) B. Bupropion (Zyban) C. Omeprazole (Prilosec) D. Clorazepate (Tranxene T-Tab) ANS: D See Indications for clorazepate: Clorazepate is used in the management of simple partial seizures, anxiety disorder, symptoms of anxiety, and acute alcohol withdrawal. Clopidogrel is an antiplatelet agent.

Bupropion is an antidepressant. Omeprazole is an antiulcer agent.

KEY: Cognitive Level: Application DIF: Medium TOP: Therapeutic Classification: Anticonvulsants REF: Drugguide.com

10. The nurse prepares to provide colchicine (Colcrvs) to a patient. The nurse should assess which of the following prior to administration of the medication?

A. Blood pressure B. Complete blood count C. Triglyceride level D. Oxygen saturation ANS: B

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See Nursing Implications/Assessment for colchicine: In patients receiving prolonged therapy, monitor baseline and periodic CBC; may cause decreased platelet count, leukopenia, aplastic anemia, and agranulocytosis. No alteration in the blood pressure, triglyceride, or oxygenation is expected.

KEY: Cognitive Level: Application DIF: Hard TOP: Therapeutic Classification: Antigout agents REF: Page 345

11. The nurse is transcribing new orders for a patient with multiple sclerosis. Cyclobenzaprine (Amrix) 10 mg orally 3 times daily has been ordered. Which of the following would require an immediate intervention by the nurse?

A. The patient has a noted allergy to acetaminophen.

B. The patient has a family history of breast cancer.

C. The patient is currently taking phenelzine (Nardil).

D. The patient is diabetic.

ANS: C See Contraindications/Precautions for cyclobenzaprine: Should not be used within 14 days of MAO inhibitor therapy. Phenelzine is an MAO inhibitor. The other factors will not impact the safe provision of cyclobenzaprine.

KEY: Cognitive Level: Analysis DIF: Hard TOP: Therapeutic Classification: Skeletal muscle relaxants REF: Page 377 | drugguide.com (phenelzine)

12. The nurse is preparing to provide medications for a patient newly admitted with a cerebral vascular accident who reportedly had difficulty swallowing pills during the previous shift. The nurse plans to crush the patient’s medications and provide them in applesauce. Which of the following medications will require an alternative form of administration?

A. Aspirin 81 mg daily B. Darifenacin-XR (Enablex) 15 mg daily C. Loratadine (Claritin) 10 mg daily D. Calcium carbonate (CalCarb) 500 mg daily ANS: B See Implementation/Nursing Implications for Enablex: Extended-release tablets must be swallowed whole; do not break or crush. Doing so can result in the immediate release of the full dose. DarifenacinXR (Enablex) is a urinary tract antispasmodic.

KEY: Cognitive Level: Application DIF: Easy TOP: Therapeutic Classification: Urinary tract antispasmodics REF: Page 401

Davis’s Drug Guide for Nurses, 17e

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13. The nurse receives a call from a patient who recently began taking cetirizine (Zyrtec)5 mg daily. The patient reports that her mouth frequently feels dry. Which of the following responses by the nurse is best?

A. “Dry mouth is a common side effect of Zyrtec. Rinse your mouth frequently, and try using sugarless chewing gum or candy for relief.”

B. “You may be taking too strong of a dose. You should take half a pill each day to reduce the risk of side effects.”

C. “You might be having an allergic reaction to the medication. Are you able to come to the doctor’s office today?”

D. “It is important that you take the medication with a full meal and drink at least 12 glasses of water each day.”

ANS: A See Patient/Family Teaching for cetirizine: Advise patient that good oral hygiene, frequent rinsing of the mouth with water, and sugarless gum or candy may minimize dry mouth. It is outside the nursing scope of practice to alter dosage of a medication. Dry mouth is not a symptom of an allergic reaction and the patient does not need to be seen by a physician—if dry mouth persists beyond 2 wk, the patient should notify a dentist. The medication can be taken without regard to food.

KEY: Cognitive Level: Analysis DIF: Medium TOP: Therapeutic Classification: Allergy, cold and cough remedies; Antihistamines REF: Page 318

14. The nurse is caring for a patient who takes dextroamphetamine (Dexedrine). The nurse should be most concerned by which of the following patient statements?

A. “I seem to be able to focus better and I’m less distracted now.”

B. “I’ve been having some trouble falling asleep at night lately.”

C. “I started taking St. John’s wort this week to help with my depression.”

D. “I forgot to take my medication in the morning last week so I took it at lunch time.”

ANS: C See Interactions for dextroamphetamine: St. John’s wort may increase serious side effects; concurrent use is not recommended. Dextroamphetamine is used in the treatment of ADHD, so improved focus is a desired effect. Insomnia is commonly seen and the patient should be instructed to take the medication at least 6 hr prior to bedtime. The medication is generally given 1–2 times each day, and missed doses should be taken as soon as remembered up to 6 hr prior to bedtime.

KEY: Cognitive Level: Analysis DIF: Medium TOP: Therapeutic Classification: Central nervous system stimulants REF: Drugguide.com

15. The nurse receives orders to begin doxazosin (Cardura) 1 mg daily, with the first dose to start today.

Which of the following assessments is the highest priority within the first 2–4 hr after provision?

A. Urinary output B. Respiratory rate

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C. Pain relief D. Orthostatic hypotension See Nursing Implications for doxazosin: Assess for first-dose orthostatic hypotension and syncope. The medication can be used in the treatment of benign prostatic hyperplasia, but orthostatic hypotension is a bigger concern and should be the first concern. No effect on the respiratory rate or pain is anticipated.

KEY: Cognitive Level: Application DIF: Easy TOP: Therapeutic Classification: Antihypertensives REF: Page 468

16. The nurse is providing care for a patient who returned from surgery 4 hr earlier. The patient reports adequate pain control with the use of patient-controlled analgesia but states she is having significant nausea. Which of the following medications should the nurse provide?

A. Droperidol (Inapsine) 2.5 mg IV B. Diphenhydramine (Benadryl) 25 mg IV C. Morphine sulfate (Morphine) 2 mg IV D. Colace 100 mg PO ANS: A See Indications for droperidol: Used to produce tranquilization and as an adjunct to general and regional anesthesia; useful in decreasing postoperative or postprocedure nausea and vomiting. Benadryl is an antihistamine used to treat itching. Morphine sulfate is a narcotic used to treat pain. Colace is a stool softener.

KEY: Cognitive Level: Application DIF: Medium TOP: Therapeutic Classification: Sedative/hypnotics REF: Drugguide.com

17. The nurse is counseling a patient with diabetes, hypertension, and chronic obstructive pulmonary disease on his medications. To verify patient understanding of his medications, the nurse states, “You are taking duloxetine (Cymbalta) 60 mg once a day; do you know why you take that medication?” The nurse determines the patient has a good understanding of his medications if which of the following responses is given?

A. “I take that one to keep my blood sugar under control.”

B. “I don’t know honey, is that my little blue pill?”

C. “That helps with the pain in my feet.”

D. “I think that is to lower my blood pressure.”

ANS: C See Indications for duloxetine: Duloxetine is used for major depressive disorder, diabetic peripheral neuropathic pain, generalized anxiety disorder, and fibromyalgia. Patient education and verification of his or her understanding regarding medication use and purpose is an important component of health care.

KEY: Cognitive Level: Analysis DIF: Medium

Davis’s Drug Guide for Nurses, 17e

Test Bank-8

TOP: Therapeutic Classification: Antidepressants REF: Page 480

18. While providing care for patients on a neuroscience unit, which of the following medications should the nurse provide first?

A. Dantrolene (Dantrium) 1 mg/kg IV to a patient with malignant hyperthermia B. Desipramine (Norpramin) 100 mg orally to a patient admitted with syncope C. Darifenacin (Enablex) 15 mg orally to a patient admitted for cerebrovascular accident D. Duloxetine (Cymbalta) 20 mg to a patient with diabetes ANS: A See Indications for dantrolene: Emergency treatment of malignant hyperthermia, which can cause seizures. This is an emergency situation and must be the nurse’s highest priority. Desipramine is an antidepressant. It is not a priority. Darifenacin is used to treat overactive bladder spasms. It is not a priority. Duloxetine is an antidepressant. It is not a priority.

KEY: Cognitive Level: Analysis DIF: Hard TOP: Therapeutic Classification: Skeletal muscle relaxants REF: Page 394 | Page 416 | Page 401 | Page 480

19. The nurse is caring for a patient with a history of Parkinson’s disease who recently started taking entacapone (Comtan). The nurse notes the patient’s urine has a brownish-orange discoloration. Which of the following actions should the nurse take next?

A. Notify the physician.

B. Determine the patient’s current weight.

C. Ask the patient what he or she ate for breakfast.

D. Note the assessment finding in the chart.

ANS: D See Adverse Reactions/Side Effects GU for entacapone: This is a normal finding for patients taking entacapone. There is no need to take a specific action, and the assessments listed will not help determine the presence of other side effects or concerns.

KEY: Cognitive Level: Analysis DIF: Hard TOP: Therapeutic Classification: Antiparkinson’s agents REF: Page 501

20. A young woman reports to the emergency department with frank vaginal bleeding and a stated history of being 10 wk pregnant. Ultrasound confirms an incomplete miscarriage, and the woman is scheduled for a dilatation and curettage. Which of the following medications should the nurse anticipate being provided after the surgical procedure?

A. Methotrexate (Rheumatrex) B. Methylergonovine (Methergine)

Davis’s Drug Guide for Nurses, 17e

Test Bank-9

C. Magnesium sulfate D. Terbutaline ANS: B See indications for methylergonovine: Prevention and treatment of postpartum or postabortion hemorrhage caused by uterine atony or involution. Methotrexate is a neoplastic agent that has been used to induce chemical abortion. Magnesium sulfate is given in the treatment of preeclampsia. Terbutaline is used off label to reduce uterine contraction in the prevention of preterm labor.

KEY: Cognitive Level: Application DIF: Medium TOP: Therapeutic Classification: Oxytocics REF: Pages 850

21. The nurse is assisting in the discharge of a patient with a peripherally inserted central catheter (PICC) who will receive antibiotic therapy with ertapenem (Invanz) at home under the direction of a home health care agency. The nurse recognizes that teaching has been effective by which of the following client statements?

A. “The nurses will come out every 6 hours to provide the IV antibiotic.”

B. “If the dressing over the PICC line pulls back, the nurse will change it the next day.”

C. “I will have to get the antibiotic once a day, usually for 2 weeks.”

D. “Since I’m not allergic to penicillin, I won’t be allergic to this medication.”

ANS: C See Route/Dosage and Nursing Implications for ertapenem: Ertapenem dosage is 1 g daily for up to 14 days (IV). The dressing on a PICC line must remain occlusive to prevent infection—if the dressing should pull back, the home care nurse should be notified immediately. Ertapenem is given once daily. Persons with a negative history of penicillin sensitivity may still have an allergic response.

KEY: Cognitive Level: Analysis DIF: Medium TOP: Therapeutic Classification: Anti-infectives REF: Page 520

22. A nursing faculty is observing a student nurse prepare and provide morning medications including delayed-released esomeprazole (Nexium) capsules to a patient with a nasogastric (NG) tube. The nurse should intervene if which of the following is noted?

A. The student asks the patient to state his name and birth date prior to preparing the medication.

B. The student opens the capsule and mixes the granules with 50 mL of water.

C. The student uses a 60 mL cath-tipped syringe to instill the medication into the NG tube.

D. The student waited for the granules to dissolve to prevent clogging of the NG tube.

ANS: D See Nursing Implications/Implementation for esomeprazole: The NG must be flushed after medication provision, and tube feeding should be held for at least 1 hr. Verifying patient identity with 2 unique identifiers is the correct way to ensure safe medication administration. For patients with an NG tube, delayed-release capsules can be opened and intact granules emptied into a 60 mL syringe and mixed with

Davis’s Drug Guide for Nurses, 17e

Test Bank-10

50 mL of water. Replace plunger and shake vigorously for 15 sec. Hold syringe with tip up and check for granules in tip. Attach syringe to NG tube and administer solution. After administering, flush syringe with additional water. Do not administer if granules have dissolved or disintegrated. Administer immediately after mixing. Provide at least 1 hr before meals. The NG tube must be flushed after medication provision, and tube feeding should be held for at least 1 hr.

KEY: Cognitive Level: Analysis DIF: Medium TOP: Therapeutic Classification: Antiulcer agents REF: Page 530

23. The nurse caring for patients on a gynecologic surgery unit would monitor which of the following women most closely for evidence of a deep vein thrombosis?

A. A 64-year-old patient taking mesalamine (Apriso) who has a history of ulcerative colitis.

B. A 47-year-old patient admitted for lumpectomy with a family history of breast cancer.

C. A 58-year-old patient taking estradiol (Estrace) with a 42-pack-per-year history of smoking.

D. A 61-year-old patient who had a bladder-sling procedure whose platelet count is 167,000 cells/mm3.

ANS: C See Adverse Reactions/Side Effects for estradiol: CV risk for MI and thromboembolism; smoking increases risk of adverse CV reactions. Mesalamine is a GI anti-inflammatory agent used in the treatment of ulcerative colitis and does not increase risk of thromboembolism. The platelet count is normal and although all surgical patients have an increased risk for thromboembolism, the patient taking estradiol is at higher risk.

KEY: Cognitive Level: Analysis DIF: Medium TOP: Therapeutic Classification: Hormones REF: Page 531

24. A student nurse is taking care of patients on a medical unit and receives new orders for eszopiclone (Lunesta) 2 mg orally each evening. In transcribing this order, the student should take which of the following actions?

A. Schedule the medication routinely at 6 PM. B. Schedule the medication 1 hr prior to the evening meal.

C. Call the pharmacy to ask what time the medication should be given.

D. Schedule the medication at bedtime.

ANS: D See Route/Dosage for eszopiclone: 2 mg immediately before bedtime.

KEY: Cognitive Level: Application DIF: Easy TOP: Therapeutic Classification: Sedative/Hypnotics REF: Page 537

Davis’s Drug Guide for Nurses, 17e

Test Bank-11

25. While reviewing medications to be provided by a student nurse, the instructor notes a patient is scheduled to take famciclovir 500 mg orally every 8 hr. The instructor suspects the patient most likely has which of the following diagnoses?

A. Methicillin-resistant Staphylococcus aureus (MRSA) infection B. Hepatic encephalopathy C. Herpes zoster D. Bacterial pneumonia ANS: C See Indications for famciclovir: Famciclovir is given for acute herpes zoster infection (shingles).

KEY: Cognitive Level: Analysis DIF: Easy TOP: Therapeutic Classification: Antivirals REF: Page 553

26. A nurse working in hospice is providing care for a patient reporting increased instances of pain.

Which of the following factors would indicate the patient is a good candidate for fentanyl transmucosal (ACTIQ) therapy?

A. The patient reports breakthrough pain 8 out of 10.

B. The patient currently takes >60 mg of oral morphine scheduled around the clock per day.

C. The patient has pancreatic cancer.

D. The patient has an allergy to hydromorphone.

ANS: B See Indications and Implementation for Fentanyl transmucosal: Used in the management of breakthrough pain in cancer patients already receiving and tolerant to around-the-clock opioid therapy for persistent cancer pain (60 mg/day of oral morphine or equivalent). The patient’s ranking of pain, cancer diagnosis, and allergy to hydromorphone do not necessarily indicate that buccal fentanyl is an appropriate therapy.

KEY: Cognitive Level: Analysis DIF: Hard TOP: Therapeutic Classification: Opioid analgesics REF: Page 566

27. While working with a patient who takes flurazepam (Dalmane), the nurse should be most concerned by which of the following patient statements?

A. “I usually take the medication at 10 PM.” B. “I have to take it every night or I won’t get any sleep.”

C. “I work out at the gym 3–4 times per week.”

D. “I stopped drinking coffee at dinner now.”

ANS: B See Patient/Family Teaching for flurazepam: Advise patient to take medication as prescribed (at bedtime).

Teach sleep hygiene techniques (dark room, quiet, bedtime ritual, limit daytime napping, avoid nicotine and caffeine). Prolonged use may lead to psychologic or physical dependence.

Davis’s Drug Guide for Nurses, 17e

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KEY: Cognitive Level: Analysis DIF: Easy TOP: Therapeutic Classification: Sedative/Hypnotics REF: Drugguide.com

28. The nurse caring for a patient who takes golimumab (Simponi) recognizes this as a relatively new agent in the class of monoclonal antibodies. In addition to their usefulness in the treatment of some tumor types, these agents play a role in the treatment of which of the following disease states?

A. Viral hepatitis B. Rheumatoid arthritis C. Pancreatitis D. Multiple sclerosis ANS: B See Indications for golimumab: Golimumab is used in the treatment of moderately to severely active rheumatoid arthritis (with methotrexate), treatment of active psoriatic arthritis (alone or with methotrexate), and treatment of active ankylosing spondylitis.

KEY: Cognitive Level: Knowledge DIF: Medium TOP: Therapeutic Classification: Antirheumatics REF: Page 632

29. The nurse providing therapy with golimumab (Simponi) recognizes the patient must be meticulously screened for which of the following?

A. A history of active or latent tuberculosis B. The presence of orthostatic hypotension C. Risk factors associated with acute respiratory distress syndrome D. A history of poorly controlled diabetes mellitus ANS: A See Contraindications/Precautions, Nursing Implication/Assessment for golimumab: Use cautiously in patient with history of latent or active tuberculosis; when adequate treatment cannot be confirmed, antitubercular therapy should be considered. An increased risk of hypotension is not associated with this medication. An increased risk of ARDS is not associated with this medication. An increased risk of uncontrolled blood glucose levels is not associated with this medication.

KEY: Cognitive Level: Analysis DIF: Hard TOP: Therapeutic Classification: Antirheumatics REF: Page 632

30. The nurse is caring for a patient receiving treatment for viral pneumonia. The nurse notes the patient has a persistent cough that is interfering with the patient’s ability to sleep. Which of the following medications should the nurse provide?

Davis’s Drug Guide for Nurses, 17e

Test Bank-13

A. Lorazepam (Ativan) 1 mg orally prn B. Guaifenesin (Guiatuss) 200 mg every 4 hr prn C. Acetaminophen (Tylenol) 325 mg orally prn D. Granisetron (Sustol) 2 mg orally prn ANS: B See Indications for guaifenesin: Guaifenesin is used for cough associated with viral upper respiratory tract infections. Lorazepam is a sedative. Acetaminophen is an analgesic. Granisetron is an antiemetic.

KEY: Cognitive Level: Application DIF: Medium TOP: Therapeutic Classification: Allergy, cold and cough remedies; Expectorants REF: Drugguide.com

31. A nurse on the cardiac unit is providing care to a 67-year-old patient who has recently been started on hydralazine/isosorbide dinitrate (BiDil) 1 tablet orally 3 times daily. The patient informs the nurse that he has a headache and rates his headache pain as 4 on a scale of 1–10. Which of the following actions by the nurse is best?

A. Hold all future doses of BiDil and notify the pharmacy that the patient is allergic to the medication.

B. Determine the patient’s oxygen saturation and call the physician.

C. Inform the patient this is a common side effect and provide acetaminophen (Tylenol) prn as ordered.

D. Provide earphones and teach the patient to use distraction techniques.

ANS: C See Patient/Family Teaching for hydralazine/isosorbide dinitrate: Inform the patient that headache is a common side effect that should decrease with continuing therapy. Aspirin or acetaminophen may be ordered to treat headache. Notify the health care provider if headache is persistent or severe. Do not dose to avoid headache. Valid assessment would include vital signs and neurologic examination because the medication is used in the treatment of heart failure; however, headache is not a symptom of allergic reaction, and there is no immediate need to notify the physician. Distraction techniques may be helpful but will not be the highest priority.

KEY: Cognitive Level: Analysis DIF: Hard TOP: Therapeutic Classification: Vasodilators REF: Page 663

32. A nursing student is preparing to join a college expedition in the tropics. Which of the following medications is most likely to be included in the medical preparation for this trip?

A. Levetiracetam (Keppra) B. Infliximab (Remicade) C. Memantine (Namenda) D. Hydroxychloroquine (Plaquenil) ANS: D See Indications for hydroxychloroquine. It is an antimalarial agent used in the suppression/chemoprophylaxis of malaria, which is common in tropical areas. See Indications for

Davis’s Drug Guide for Nurses, 17e

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levetiracetam. It is an antiseizure medication. See Indications for infliximab. It is a monoclonal antibody used as an antirheumatic. See Indications for memantine. It is an anti-Alzheimer’s agent.

KEY: Cognitive Level: Application DIF: Medium TOP: Therapeutic Classification: Antimalarial REF: Page 776 | Page 695 | Page 825 | Page 671

33. The nurse is providing discharge instructions to a patient taking ibandronate (Boniva). The nurse should intervene if the client makes which of the following statements?

A. “I usually walk 2 miles a day.”

B. “I take that every morning when I get up and can’t eat for an hour.”

C. “I realized at lunch time that I’d forgotten to take it once last week, so I just skipped the dose.”

D. “I always take that with my morning coffee.”

ANS: D See Implementation for Ibandronate: Ibandronate should be taken with 6–8 oz of plain water (mineral water, orange juice, coffee, and other beverages decrease absorption) 60 min before beverages or food.

Encourage patient to participate in regular exercise. Instruct patient on the importance of taking as directed, first thing in the morning, 60 min before other medications, beverages, or food. If a dose is missed, skip dose and resume the next morning.

KEY: Cognitive Level: Analysis DIF: Medium TOP: Therapeutic Classification: Bone resorption inhibitors REF: Page 675

34. A nurse caring for a patient who takes imipramine (Tofranil) 150 mg orally at bedtime would be most concerned by which of the following observations?

A. The patient’s urine has a blue-green tinge.

B. The patient reports fuzzy vision and difficulty seeing.

C. The patient reports feeling dizzy when getting out of bed.

D. The patient reports she has gained 2 pounds in the last 3 wk.

ANS: B See Patient/Family Teaching for imipramine: Instruct the patient to notify health care professional if visual changes occur. Inform patient that periodic glaucoma testing may be needed during long-term therapy. Alert patient that urine may turn blue-green in color. Caution patient to change positions slowly to minimize orthostatic hypotension. Inform patient of need to monitor dietary intake as possible increase in appetite may lead to undesired weight gain.

KEY: Cognitive Level: Analysis DIF: Medium TOP: Therapeutic Classification: Antidepressants REF: Page 689

Davis’s Drug Guide for Nurses, 17e

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35. A patient with asthma has multiple inhalants prescribed including albuterol (Ventolin), budesonide (Pulmicort Flexhaler), and ipratropium (Atrovent). The nurse verifies teaching is effective if which of the following is observed?

A. The patient takes the ipratropium (Atrovent) inhaler first.

B. The patient waits 1 min between each medication.

C. The patient rinses her mouth after using the inhalers.

D. The patient reports using ipratropium when experiencing severe, acute bronchospasms.

ANS: C See Nursing Implications and Patient/Family Teaching for albuterol: Advise patient that rinsing mouth after using inhaler, good oral hygiene, and sugarless gum or candy may minimize dry mouth. When ipratropium is administered concurrently with other inhalation medications, administer adrenergic bronchodilators (albuterol) first, followed by ipratropium, then corticosteroids. Wait 5 min between medications. Albuterol is the inhaler of choice with acute bronchospasm because the onset of action of ipratropium is too slow for patients in acute distress.

KEY: Cognitive Level: Analysis DIF: Medium TOP: Therapeutic Classification: Bronchodilators REF: Page 117

36. The nurse is caring for a patient recently started on quetiapine (Seroquel). Which assessment finding would indicate that treatment was effective?

A. BP = 178/82 B. Patient denies hearing voices in his head.

C. Urine output was 350 mL in 8 hr.

D. Patient reported pain was a 2 on a 1–10 scale.

ANS: B See Evaluation/Desired Outcomes for quetiapine: Decrease in positive symptoms (delusions, hallucinations) of schizophrenia.

KEY: Cognitive Level: Analysis DIF: Medium TOP: Therapeutic Classification: Antipsychotics, Mood stabilizers REF: Page 1075

37. The nurse is providing care for a patient diagnosed with candidiasis. The nurse expects the medication record to include which of the following medications?

A. Lamotrigine (Lamictal) B. Labetalol (Trandate) C. Ketorolac (Sprix) D. Ketoconazole (Nizoral) ANS: D

Davis’s Drug Guide for Nurses, 17e

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See Indications for ketoconazole: Ketoconazole is indicated in the treatment of candidiasis. See Indications for lamotrigine. It is an anticonvulsant. See Indications for labetalol. It is an antianginal beta blocker. See Indications for ketorolac. It is a nonsteroidal anti-inflammatory analgesic.

KEY: Cognitive Level: Application DIF: Hard TOP: Therapeutic Classification: Antifungals REF: Page 750 | Page 743 | Page 739 | Page 172

38. The nurse is caring for a patient on the operative day for a laparoscopic-assisted vaginal hysterectomy.

The patient complains of pain, and the nurse notes orders for ketorolac 30 mg intravenously every 6 hr as needed for pain. Which of the following actions should the nurse take?

A. Mix the ketorolac with 10 mL sterile normal saline prior to administration.

B. Check the patient’s magnesium level prior to administration.

C. Draw up the medication and administer in the nearest IV port over 15 sec.

D. Check to determine if the patient has an allergy to morphine.

ANS: C See IV Administration for Ketorolac: Administer undiluted. Ketorolac may alter BUN, serum lipoproteins, potassium, triglycerides, and uric acid levels, but no effect on magnesium is expected.

Allergy to morphine is not a contraindication for the use of ketorolac.

KEY: Cognitive Level: Application DIF: Medium TOP: Therapeutic Classification: Nonsteroidal anti-inflammatory agents; Nonopioid analgesics REF: Page 739

39. The nurse is caring for a patient admitted with hepatic encephalopathy who is receiving lactulose (Constilac). The nurse should be prepared to assist the patient in managing which of the following side effects?

A. Headache B. Somnolence C. Muscle aches D. Frequent loose stools ANS: D See Side Effects for lactulose: Belching, cramps, distention, flatulence, diarrhea, and hyperglycemia.

KEY: Cognitive Level: Application DIF: Medium TOP: Therapeutic Classification: Laxatives REF: Page 747

40. The nurse is caring for a patient who reports taking lansoprazole (Prevacid) 15 mg orally each day.

The nurse expects the pharmacy to substitute which of the following medications during hospitalization?

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A. Omeprazole (Prilosec) B. Ondansetron (Zofran) C. Sucralfate (Carafate) D. Calcium carbonate (Tums) ANS: A See Action for calcium carbonate, lansoprazole, omeprazole, ondansetron, and sucralfate. While each of the medications may be used in the treatment of gastric ulcer, the action of lansoprazole and omeprazole are similar; both are proton pump inhibitors, and therefore substitution based on availability per hospital pharmacy registry is possible.

KEY: Cognitive Level: Analysis DIF: Easy TOP: Therapeutic Classification: Antiulcer agents REF: Page 955 | Page 957 | Page 1157 | Page 267

41. The nurse is caring for a patient experiencing dysphagia and weight loss due to oral mucositis. Which of the following should be the nurse’s highest priority?

A. Instruct the patient to use hydrogen-peroxide-based mouthwash 3 times daily.

B. Provide Xylocaine viscous (lidocaine) topically prior to meals.

C. Encourage normal saline rinses each morning.

D. Order a puree diet.

ANS: B See Indications for lidocaine: Local infiltration/mucosal/topical anesthetic. Mouth rinses containing hydrogen peroxide help prevent infection but will not relieve the pain associated with oral mucositis.

Normal saline rinses should be recommended frequently (every 2–4 hr) to keep the mouth clean but will not help reduce pain with meals. Puree diet may be helpful but will not address the patient’s report of pain.

KEY: Cognitive Level: Application DIF: Medium TOP: Therapeutic Classification: Anesthetics—topical/local REF: Page 783

42. The nurse is caring for a pediatric patient who needs to have an IV line started. The nurse plans to provide EMLA cream (lidocaine/prilocaine) to the patient’s arm. Which of the following actions should the nurse take?

A. Rub the cream onto a 2-inch surface of the arm 15 min prior to the procedure.

B. Rub the cream onto a 6-inch surface of the arm 30–45 min prior to the procedure.

C. Place a thick layer of cream under an occlusive dressing on a 2-inch site 1 hr prior to the procedure.

D. Place a thin layer of cream under an occlusive dressing on a 6-inch site 20 min prior to the procedure.

ANS: C See Implementation for lidocaine/prilocaine: Apply the 2.5 g tube of cream (one-half of the 5 g tube) to each 2-inch by 2-inch area of skin in a thick layer. Cover so there is a thick layer of cream under the

Davis’s Drug Guide for Nurses, 17e

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occlusive dressing. Do not spread out or rub in the cream. It must be applied at least 1 hr before the start of the procedure.

KEY: Cognitive Level: Analysis DIF: Medium TOP: Therapeutic Classification: Anesthetics—topical/local REF: Page 783

43. The nurse is caring for a patient admitted from an extended care facility who has developed a moist, productive cough. A chest x ray was ordered and new orders for linezolid (Zyvox) 600 mg IV every 12 hr has been received. Which of the following orders should the nurse also complete prior to providing the first dose of medication?

A. Daily weight B. Sputum culture and sensitivity C. Complete blood count (CBC) D. Chemistry profile ANS: B See Nursing Implications for linezolid: Obtain specimens for culture and sensitivity prior to initiating therapy.

KEY: Cognitive Level: Application DIF: Easy TOP: Therapeutic Classification: Anti-infectives REF: Page 788

44. The nurse is caring for a patient who is to receive 1 mg of lorazepam (Ativan) intravenously as conscious sedation prior to a bedside procedure. Which of the following actions should the nurse take?

A. Infuse the medication using an insulin syringe directly into the nearest Y port of the IV. B. Dilute the medication with 10 mL of lactated Ringer solution prior to administration.

C. Administer the medication over at least 1 min.

D. Monitor the patient for hypertension immediately following administration.

ANS: C See IV Administration for lorazepam: Administer at a rate not to exceed 2 mg/min or 0.05 mg/kg over 2– 5 min. The medication should be diluted. Insulin syringes are reserved for insulin and are generally not used to provide IV medication. Dilute immediately before use with an equal amount of sterile water for injection, D5W or 0.9NS for injection. Rapid administration may result in apnea, hypotension, bradycardia, or cardiac arrest—hypertension is not expected.

KEY: Cognitive Level: Analysis DIF: Medium TOP: Therapeutic Classification: Anesthetic adjuncts REF: Page 804

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45. The nurse is working with a client who is undergoing a bowel prep prior to a scheduled colonoscopy.

Which of the following medications should the nurse expect to provide?

A. Magnesium chloride sustained-release tablets 535 mg/each, 2 tablets B. Magnesium citrate oral solution, 300 mL bottle C. Magnesium hydroxide chewable tablets, 300 mg D. Magnesium sulfate 1 g intravenously ANS: B See Indications for Magnesium citrate oral solution: Bowel evacuant in preparation for surgical/radiographic procedures. Magnesium citrate oral solution is used as a bowel prep. Sustainedrelease tablets will not aid in the evacuation of bowel contents. Chewable tablets are used as electrolyte replacement or as an antacid. IV provision is used for electrolyte replacement.

KEY: Cognitive Level: Application DIF: Easy TOP: Therapeutic Classification: Mineral and electrolyte replacements, laxatives REF: Page 815

46. The nurse is caring for a patient in the intensive care unit. The patient is receiving mannitol (Osmitrol) 0.5 g/kg infused over 60 min. Which of the following would indicate an effective response to the treatment?

A. Urine output is 50 mL over the next hr.

B. White blood cell count is 6.4 cells/mm3.

C. Patient oxygen status is 89% on 3 L of oxygen.

D. Patient’s blood pressure is 148/42.

ANS: A See Indications and Evaluation for mannitol: Mannitol is used in the treatment of acute oliguric renal failure, edema, and increased intracranial or intraocular pressure. Urine output of at least 30–50 mL/hr or an increase in urine output in accordance with parameters set by physician should be seen. Mannitol will have no effect on the WBC. Oxygenation may improve if intracranial pressure or fluid overload is affecting oxygenation, but this saturation is below normal and not indicative of effective treatment. Wide pulse pressures are indicative of increased intracranial pressure that should improve with mannitol treatment.

KEY: Cognitive Level: Analysis DIF: Hard TOP: Therapeutic Classification: Diuretics REF: Drugguide.com

47. The nurse is caring for a patient admitted with chronic pain who has been receiving meperidine 100 mg orally every 3–4 hr as needed for pain for the past 4 days. Which of the following actions is the highest priority in the patient’s care?

A. Monitor the patient for irritability or seizure activity.

B. Determine when the patient last moved his bowels.

C. Ask the patient if he is experiencing insomnia.

D. Check the patient’s labs to determine triglyceride levels.

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ANS: A See Nursing Implications for Meperidine: Monitor patients on chronic or high-dose therapy for CNS stimulation (restlessness, irritability, or seizures) due to accumulation of normeperidine metabolite. Risk of toxicity increases with doses greater than 600 mg/24 hr. Constipation is a concern for the patient but is not the highest priority. Insomnia is not expected because meperidine causes sedation. Triglyceride levels are not affected by meperidine.

KEY: Cognitive Level: Analysis DIF: Medium TOP: Therapeutic Classification: Opioid analgesics REF: Page 826

48. The nurse recognizes that mesalamine (Apriso) would most likely be included in the plan of care for which of the following patients?

A. A 52-year-old patient with chronic obstructive pulmonary disease (COPD).

B. A 49-year-old patient with acute cholelithiasis.

C. A 37-year-old patient with ruptured ectopic pregnancy.

D. A 27-year-old patient with ulcerative colitis.

ANS: D See Indications for mesalamine: Mesalamine is used for inflammatory bowel disease including ulcerative colitis, proctitis, and proctosigmoiditis.

KEY: Cognitive Level: Analysis DIF: Medium TOP: Therapeutic Classification: Gastrointestinal anti-inflammatories REF: Page 834

49. The nurse is caring for a patient who has been receiving chemotherapy for the past 4 mo. The patient takes metoclopramide (Reglan) 10 mg every 4 hr as needed for nausea and vomiting. The nurse should be most concerned with which of the following patient statements?

A. “I’m losing my balance a lot, and I noticed my hands are shaky.”

B. “I’ve lost 5 pounds in the past month.”

C. “I’m not sure what I’m going to do when I don’t have to come in here all of the time.”

D. “My kids are really struggling with the fact that I just don’t have any energy anymore.”

ANS: A See Nursing Implications for metoclopramide: Assess patient for extrapyramidal side effects—difficulty speaking or swallowing, loss of balance, pill rolling, mask-like face, shuffling gait, rigidity, tremors, and dystonic reactions. Weight loss is concerning but not the highest priority. Psychosocial concerns are important but are not the highest priority. Psychosocial concerns are important but are not the highest priority.

KEY: Cognitive Level: Analysis DIF: Medium TOP: Therapeutic Classification: Antiemetics REF: Page 856

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50. The nurse is caring for a patient who reports long-term use of nonsteroidal anti-inflammatory agents for the treatment of osteoarthritis. Which of the following medications would the nurse also expect as part of the patient’s treatment plan?

A. Misoprostol (Cytotec) B. Metoprolol (Lopressor) C. Metronidazole (Flagyl) D. Mirtazapine (Remeron) ANS: A See Indications for misoprostol. Misoprostol is used in the prevention of gastric mucosal injury from NSAIDs in high-risk patients. See Indications for metoprolol. Metoprolol is a beta blocker. See Indications for metronidazole. Metronidazole is an anti-infective. See Indications for mirtazapine.

Mirtazapine is an antidepressant.

KEY: Cognitive Level: Analysis DIF: Hard TOP: Therapeutic Classification: Antiulcer agent REF: Page 879 | Page 861 | Page 863 | Page 877

51. The nurse is counseling the parent of a 14-year-old patient with asthma who is to initiate maintenance therapy with montelukast (Singulair). Which of the following should the nurse include in the teaching?

A. “This medication can be helpful in acute asthmatic attacks.”

B. “Monitor your child for any behavior that indicates depression or suicidal thoughts.”

C. “If your child is not experiencing any asthma symptoms, she will not need to take the medication that day.”

D. “Now that your child is taking this medication, she will not need her other asthma medications.”

ANS: B See Nursing Implications and Patient/Family Teaching for montelukast: Monitor closely for changes in behavior that could indicate the emergence or worsening of depression or suicidal thoughts. Montelukast is not to be used to treat acute asthmatic attacks. Take medication daily even if not experiencing symptoms of asthma. Instruct patient not to discontinue or reduce other asthma medications without consulting a health care professional.

KEY: Cognitive Level: Analysis DIF: Medium TOP: Therapeutic Classification: Allergy, cold and cough remedies; Bronchodilators REF: Page 886

52. The student nurse is participating in discharge teaching for the parents of a 2-year-old patient diagnosed with impetigo who have been given a prescription for mupirocin (Centany). The student understands that this medication is provided in which of the following forms?

A. As an oral pill B. As a rectal suppository

Davis’s Drug Guide for Nurses, 17e

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C. As a topical ointment D. As a liquid suspension ANS: C See Availability for Centany: Ointment or cream. Impetigo is a skin infection characterized by honeycolored crusts often involving the nose or around the oral mucosa; treatment is topical.

KEY: Cognitive Level: Application DIF: Medium TOP: Therapeutic Classification: Anti-infectives REF: Page 892

53. The nurse is caring for a patient who has been started on nadolol (Corgard). Which of the following assessment findings would be most concerning to the nurse?

A. A fasting blood sugar of 92 g/dL B. A blood pressure of 116/70 mm Hg C. Noted jugular vein distension D. A resting pulse of 64 bpm ANS: C See Nursing Implications for nadolol: Assess patient routinely for evidence of fluid overload (including jugular vein distention). The fasting blood sugar is within accepted normal limits. Blood pressure is of a normal finding. Pulse is of a normal finding.

KEY: Cognitive Level: Analysis DIF: Medium TOP: Therapeutic Classification: Antianginals; Antihypertensives REF: Drugguide.com

54. The nurse is caring for a patient who has been on multiple antibiotics for the treatment of pneumonia.

The patient reports having a sore throat. The nurse notes a white coating on the patient’s tongue as well as redness to the lips and gums. The nurse would most likely contact the physician to request which of the following?

A. Nortriptyline (Pamelor) 25 mg capsules 3 times daily B. Nimodipine 30 mg capsules every 4 hr C. Olanzapine (Zyprexa) 5 mg tablet daily D. Nystatin (Nilstat) 400,000 unit lozenge 4 times daily ANS: D See Indications, Dosage, and Availability for nystatin. Nystatin is used for local treatment of oropharyngeal candidiasis and can be taken as an oral suspension or as a lozenge. See Indications, Dosage, and Availability for nortriptyline. Nortriptyline is an antidepressant. See Indications, Dosage, and Availability for nimodipine. Nimodipine is a calcium channel blocker. See Indications, Dosage and Availability for olanzapine. Olanzapine is an antipsychotic.

KEY: Cognitive Level: Application DIF: Medium

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TOP: Therapeutic Classification: Antifungals REF: Page 935 | Page 922 | Page 942 | Page 938

55. A nurse working in the chemotherapy outpatient department is providing antiemetic therapy using ondansetron (Zofran). The ordered dose is 32 mg. Which of the following actions should the nurse take to optimize the efficacy of the medication?

A. Provide the dose as an intramuscular injection 10 min prior to starting chemotherapy.

B. Provide the dose undiluted intravenously over 2 min just prior to starting chemotherapy.

C. Provide the dose diluted in 50 mL of D5W infused intravenously over 15 min at least 30 min prior to starting chemotherapy.

D. Provide the dose diluted in 50 mL of 0.9 NaCl infused intravenously over 5 min, 60 min prior to starting chemotherapy.

ANS: C See Route/Dosage and IV administration for ondansetron: Prevention of chemotherapy-induced nausea/vomiting can be given as a single 32 mg dose 30 min prior to chemotherapy. Ondansetron can be diluted in D5W and 0.9 NaCl. KEY: Cognitive Level: Application DIF: Medium TOP: Therapeutic Classification: Antiemetics REF: Page 957

56. A nurse in an outpatient clinic receives a call from a patient who reports having had symptoms of the flu for the past 4 days. The patient is seeking an appointment with the physician and wants, “the medication that treats the flu [oseltamivir (Tamiflu)].” Which of the following responses by the nurse is best?

A. “Tamiflu is only helpful for those who have had symptoms for 2 days or less.”

B. “Did you receive the flu shot this season?”

C. “What is your current temperature?”

D. “Do you have an allergy to eggs?”

ANS: A See Indications for oseltamivir: Oseltamivir is used in the treatment of uncomplicated acute illness due to influenza infection in adults and children who have had symptoms for ≤2 days. Flu shot, current temperature, and egg allergy are not contraindications for Tamiflu.

KEY: Cognitive Level: Analysis DIF: Medium TOP: Therapeutic Classification: Antivirals REF: Page 960

57. The student nurse is caring for a patient who currently takes oxybutynin (Ditropan XL). The student should include which of the following statements in the patient’s teaching?

A. “This medication will help reduce your pain.”

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B. “Some people who take this develop ringing in their ears.”

C. “This medication helps you control your bladder.”

D. “Some people complain of night sweats with this medication.”

ANS: C See Indications for oxybutynin: Oxybutynin is used for urinary symptoms that may be associated with neurogenic bladder including frequent urination, urgency, nocturia, urge incontinence. The side effect profile does not include ringing in the ears or night sweats.

KEY: Cognitive Level: Analysis DIF: Medium TOP: Therapeutic Classification: Urinary tract antispasmodics REF: Page 970

58. While reviewing a patient’s medications for the day, the nurse notes the patient is prescribed pancrelipase (Creon) 3 times daily. Which of the following actions by the nurse is best?

A. Provide the medication 30 min after the patient’s meals.

B. Provide the medication immediately before or with the patient’s meals.

C. Provide the medication at least 60 min before the patient’s meals.

D. Provide the medication evenly spaced throughout the day with no correlation with meals.

ANS: B See Route/Dosage for Creon: One to 3 capsules before or with meals.

KEY: Cognitive Level: Application DIF: Medium TOP: Therapeutic Classification: Digestive agent REF: Page 989

59. The nurse receives a call from a client who recently started taking paroxetine (Paxil). The parent reports the child has lost 6 pounds in the past 10 days. Which of the following statements by the nurse is best?

A. “Are you able to come into the clinic today?”

B. “That’s great news, the treatment must be working.”

C. “Weight loss is expected with this medication, so there is no reason for concern.”

D. “Has your child had any vomiting?”

ANS: A See Nursing Implications for Paxil: Paxil is an antianxiety/antidepressant. It is important to monitor appetite and nutritional intake, weigh weekly, and notify health care professional of continued weight loss.

KEY: Cognitive Level: Analysis DIF: Medium TOP: Therapeutic Classification: Antianxiety agents, Antidepressants REF: Pages 996

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60. The nurse is caring for a patient who needs emergency surgery. The patient’s history includes daily use of warfarin (Coumadin). Which of the following medications should the nurse anticipate being ordered?

A. Phenytoin (Dilantin) B. Phytonadione (Vitamin K) C. Phenobarbital (Luminal) D. Protamine sulfate ANS: B See Indications for Vitamin K, and Toxicity and Overdose for Warfarin. Phytonadione (vitamin K) is the antidote to oral anticoagulants. Phenytoin is an anticonvulsant. Phenobarbital is an anticonvulsant.

Protamine sulfate is the antidote to heparin.

KEY: Cognitive Level: Application DIF: Easy TOP: Therapeutic Classification: Antidotes REF: Pages 1035 and 1286

61. The nurse receives a call from a patient who recently started taking pioglitazone (Actos) 15 mg every morning. The patient states, “I forgot to take it for the past 2 days. What should I do?” Which of the following is the best response by the nurse?

A. “Simply take the medication as planned today.”

B. “Take 2 today and then 1 a day from this point forward.”

C. “You will need to come in and have some blood drawn.”

D. “Are you experiencing any pain today?”

ANS: A See Patient/Family Teaching for Actos: Instruct the patient to take the medication as directed. If the dose for 1 day is missed, do not double the dose the next day. Pioglitazone improves sensitivity to insulin and is used in the control of diabetes. Pain is not a side effect or the indication for treatment so assessing pain is not pertinent to the stated problem.

KEY: Cognitive Level: Analysis DIF: Medium TOP: Therapeutic Classification: Antidiabetics (oral) REF: Pages 1039

62. The nurse is caring for a patient in the intensive care unit with an NG tube to low intermittent suction after bowel surgery. Morning lab results include the following: Na + = 136 mEq, K+ = 3.3 mEq, Cl– = 100 mEq, Ca++ = 10 mg/dL. The patient has scheduled medications, which include potassium bicarbonate/potassium chloride 40 mEq via NG and furosemide (Lasix) 20 mg intravenous push daily.

Which of the following actions should the nurse take next?

A. Evaluate the patient’s telemetry reading.

B. Hold the patient’s daily dose of potassium chloride.

C. Assess the amount and color of the NG output over the past 2 hr.

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D. Provide the patient’s scheduled furosemide (Lasix).

ANS: A See Evaluation/Desired Outcomes and Nursing Implications for potassium bicarbonate/potassium chloride: Potassium bicarbonate/potassium chloride is used to prevent or correct serum potassium depletion. The patient’s serum potassium is low, and this places the patient at risk for cardiac arrhythmias.

The medication should be given. While the NG output is important, it is not the highest priority. While the scheduled furosemide dose is important, it is not the highest priority.

KEY: Cognitive Level: Analysis DIF: Medium TOP: Therapeutic Classification: Mineral and electrolyte replacements/supplements REF: Page 1047

63. The nurse is providing care for a patient who is being considered for treatment with risedronate (Actonel). Prior to initiating therapy, the nurse should evaluate the results from which of the following diagnostic tests?

A. Echocardiogram B. Pulmonary function tests C. Fasting blood sugar D. Bone density study ANS: D See Nursing Implications for Actonel: Assess patient via bone density study for low bone mass before and periodically during therapy.

KEY: Cognitive Level: Application DIF: Medium TOP: Therapeutic Classification: Bone resorption inhibitors REF: Page 1101

64. The nurse is caring for a patient who takes rosiglitazone 4 mg daily. The nurse should be most concerned by which of the following assessment findings?

A. Random glucose = 142 mg/dL B. Urine output is 200 mL in the past 4 hr.

C. Inspiratory crackles noted on auscultation D. Apical pulse = 72 bpm ANS: C See Assessment for rosiglitazone: Assess patient for edema and signs of CHF (dyspnea, rales/crackles, peripheral edema, weight gain, jugular venous distention). Rosiglitazone is used in the treatment of diabetes mellitus, so an elevated serum glucose of 142 mg/dL is expected. Urine output is within normal limits. Apical pulse is within normal limits.

KEY: Cognitive Level: Analysis DIF: Medium TOP: Therapeutic Classification: Antidiabetics

Davis’s Drug Guide for Nurses, 17e

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REF: Drugguide.com

65. The nurse is providing salmeterol (Serevent Diskus) to a patient on the medical unit who has a longterm history of chronic obstructive pulmonary disease. The nurse would intervene if which of the following were observed?

A. The patient did not attach a spacer prior to inspiration.

B. The patient closes the device after inhalation without washing the mouthpiece.

C. The patient held the diskus level in a horizontal position.

D. The patient exhaled into the diskus device.

ANS: D See Patient/Family Teaching for salmeterol: Instruct patient using powder for inhalation never to exhale into diskus device and to always hold the device in a level, horizontal position. The mouthpiece should be kept dry; never wash.

KEY: Cognitive Level: Analysis DIF: Medium TOP: Therapeutic Classification: Bronchodilators REF: Page 1124

66. The nurse is providing care for a patient who is taking sennoside (Senokot) 2 tablets orally each day.

Which of the following actions by the nurse will most promote effective treatment with this planned medication?

A. Give the medication with breakfast at 8 AM. B. Give the medication with a full glass of water.

C. Determine the patient’s resting pulse rate prior to provision.

D. Assess the patient’s level of consciousness 2 hr after provision.

ANS: B See Implementation sennoside: Take with a full glass of water. Administer medication at bedtime for evacuation 6–12 hr later. Administer on an empty stomach for more rapid results. Determining resting pulse is not necessary or related to the medications action or side effects. Determining level of consciousness is not necessary or related to the medication’s action or side effects.

KEY: Cognitive Level: Analysis DIF: Medium TOP: Therapeutic Classification: Laxatives REF: Page 1135

67. While providing care for a patient who takes sitagliptin (Januvia), the nurse should be most concerned by which of the following findings?

A. Patient reports persistent abdominal pain that radiates to the back B. Patient reports having a headache C. Hemoglobin A1C = 5% D. Patient takes metformin (Glucophage) concurrently

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ANS: A See Nursing Implications for sitagliptin: Monitor for signs of pancreatitis (nausea, vomiting, anorexia, persistent severe abdominal pain, sometimes radiating to the back). Sitagliptin is used to improve glycemic control in type 2 diabetes. Headache is a recognized side effect and is not the highest priority.

Sitagliptin can be taken as monotherapy or in combination with metformin and a thiazolidinedione and/or a sulfonylurea. The hemoglobin A1C is normal.

KEY: Cognitive Level: Analysis DIF: Medium TOP: Therapeutic Classification: Antidiabetics REF: Page 1145

68. While talking to a teen who stopped taking tetracycline a couple of weeks ago, the nurse learns the teenager has been having diarrhea and abdominal cramping for the past few days. Which of the following responses by the nurse is best?

A. “Does anyone else in your family have the flu?”

B. “Did you get a flu vaccine this year?”

C. “How much water are you drinking each day?”

D. “You need to contact your physician right away. This could be a serious complication of your medication.”

ANS: D See Nursing Implications for tetracycline: Monitor bowel function. Diarrhea, abdominal cramping, fever, and bloody stools should be reported to the health care professional promptly as a sign of pseudomembranous colitis. It may begin up to several wk following cessation of therapy.

KEY: Cognitive Level: Analysis DIF: Medium TOP: Therapeutic Classification: Anti-infectives REF: Page 1193

69. The nurse is preparing to provide routine morning medications, which include levothyroxine (Synthroid). Which of the following assessments should be done prior to administration?

A. Apical pulse rate B. Serum sodium level C. Deep tendon reflexes D. Pupils’ response to light ANS: A See Nursing Implications for levothyroxine: Assess apical pulse and blood pressure prior to and periodically during therapy. Assess for tachyarrhythmias and chest pain.

KEY: Cognitive Level: Application DIF: Medium TOP: Therapeutic Classification: Hormones REF: Page 781

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70. A nurse working in a physician’s office is collecting history information from a patient who reports experiencing erectile dysfunction and is seeking treatment with Levitra (vardenafil). This medication would be contraindicated if the patient is currently taking which of the following?

A. Cyanocobalamin (Vitamin B12) B. Nitroglycerin patch (Nitro-Dur) C. Varenicline (Chantix) D. Venlafaxine (Effexor) ANS: B See Interactions for vardenafil: Concurrent use of nitrates may cause serious life-threatening hypotension and is contraindicated. Concurrent use of Class IA antiarrhythmics (such as quinidine or procainamide) or Class III antiarrhythmics (such as amiodarone or sotalol) increase risk of serious arrhythmias and should be avoided.

KEY: Cognitive Level: Application DIF: Hard TOP: Therapeutic Classification: Erectile dysfunction agents REF: Page 1252

71. While working on a medical unit, the nurse answers a call light for a woman who asks to take her zolpidem (Ambien) 10 mg orally as ordered before going to sleep. After providing the medication, which of the following actions should the nurse take next?

A. Instruct the patient to drink at least 2 full glasses of water in the next 30 min.

B. Instruct the patient to wear her slippers if she gets up during the night.

C. Raise the patient’s bed side rail.

D. Document the medication provision in the patient’s chart.

ANS: C See Nursing Implications/Implementation for zolpidem: Protect patient from injury; raise bed side rails.

Assist with ambulation. Increasing fluid intake is not necessary and will increase risk of falls due to nocturnal urination. The patient should not get up without assistance in the hospital environment.

Documentation is not the highest priority.

KEY: Cognitive Level: Analysis DIF: Medium TOP: Therapeutic Classification: Sedative/Hypnotics REF: Pages 1297

72. While caring for a patient on post op day 1 after a total abdominal hysterectomy, the patient reports a pain level of 4 on a 1–10 scale. The nurse provides 2 tablets of hydrocodone/acetaminophen 5 mg/325 mg (Anexsia) orally along with the patient’s other morning medications, which include isosorbide (Isordil) 10 mg and furosemide (Lasix) 20 mg orally at 9 AM. Which of the following instructions should the nurse provide to the nursing assistant regarding the patient’s activity?

A. “Have her sit at the side of the bed for a minute before walking as she may be dizzy.”

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B. “She should only take a short walk right now since she just ate her breakfast.”

C. “Wait to walk her until after lunch so her pain is better.”

D. “Let’s not walk her today since she seems rather tired.”

ANS: A See Adverse Reactions/Side Effects for hydrocodone, isosorbide, and furosemide: May cause confusion, dizziness, sedation; dizziness, hypotension; hypotension. Orthostatic hypotension is a common concern for patients receiving these medications. There is no correlation between the patient’s breakfast and a need to take a short walk. Pain relief will be optimal approximately 1 hr after the administration of the Anexsia and will begin to fade within 3–4 hr. It is important to walk postoperative patients if at all possible to prevent the formation of thromboembolism.

KEY: Cognitive Level: Analysis DIF: Medium TOP: Therapeutic Classification: Opioid analgesics REF: Page 664 | Page 727 | Page 610

73. The nurse would be most concerned about ototoxicity for which of the following patients?

A. A 51-year-old patient receiving ciprofloxacin B. A 29-year-old patient receiving gentamicin C. A 37-year-old patient receiving cefazolin D. A 70-year-old patient receiving clindamycin ANS: B See Adverse Reactions/Side Effects for Aminoglycosides: Ototoxicity is a side effect associated with aminoglycosides including gentamycin. The other anti-infective agents are not associated with ototoxicity.

KEY: Cognitive Level: Analysis DIF: Medium TOP: Therapeutic Classification: Anti-infectives REF: Page 137

74. Prior to the administration of adalimumab (Humira) the nurse should assess which of the following laboratory values?

A. Blood glucose B. White blood cell count C. Red blood cell count D. Hemoglobin and hematocrit ANS: B See Nursing Implications for adalimumab: Adalimumab prevents and alters the action of tumor necrosis factor. This drug is used in the treatment of severe rheumatoid arthritis. Adverse side effects include the risk for serious infections. The nurse should monitor for early signs and symptoms of infection.

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KEY: Cognitive Level: Analysis DIF: Easy TOP: Drug: adalimumab (Humira) REF: Page 109

75. Dabigatran (Pradaxa) is approved for the treatment of which of the following conditions?

A. Deep vein thrombosis B. Pulmonary emboli C. Atrial fibrillation D. Prophylaxis for artificial heart valve ANS: C See Indications for dabigatran: Dabigatran is an anticoagulant that is approved for the treatment of atrial fibrillation. It lowers the risk of blood clot development.

KEY: Cognitive Level: Knowledge DIF: Easy TOP: Drug: Dabigatran (Pradaxa) REF: Page 387

76. The nurse immediately notifies the doctor of a reaction to pregabalin (Lyrica) based on which of the following assessments?

A. Petechiae on legs and back B. Poor appetite C. Increased heart rate D. Vomiting ANS: A See Adverse Reactions/Side Effects for pregabalin: An adverse reaction to pregabalin is thrombocytopenia, which would cause petechiae. Poor appetite, increased heart rate, and vomiting are not adverse reactions to pregabalin KEY: Cognitive Level: Analysis DIF: Hard TOP: Drug: Pregabalin (Lyrica) REF: Page 1055

77. Which of the following actions should the nurse perform to administer zoledronic acid (Reclast)?

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A. Instruct the patient to look up and gently pull down on the eyelid.

B. Select a syringe that will provide deep tissue insertion using a Z-track method.

C. Carefully peel back wrapper with extra caution not to touch the medication.

D. Assess patency of the intravenous site.

ANS: D See Implementation for zoledronic acid: Zoledronic acid is a bone resorption inhibitor that is administered intravenously as a single infusion over at least 15 min.

KEY: Cognitive Level: Application DIF: Medium TOP: Drug: Zoledronic acid (Reclast) REF: Page 1292

78. A public health nurse is administering the first dose of Gardasil (human papillomavirus quadrivalent vaccine) to a teenage girl. What action should the nurse take following the administration of this medication?

A. Schedule an appointment for an additional dose in 4 wk.

B. Schedule an appointment for an additional dose in 8 k.

C. Schedule an appointment for a 2nd dose in 1 mo and a 3rd dose in 5 mo.

D. Schedule an appointment for a 2nd dose in 2 mo and a 3rd dose in 6 mo.

ANS: D See Route/Dosage for Gardasil: Gardasil is a vaccine to protect against HPV. Gardasil is given in a series of 3 injections. After the first dose is administered, the 2nd dose should be administered 2 mo later. The last dose is given 6 mo after the first dose.

KEY: Cognitive Level: Synthesis DIF: Easy TOP: Drug: Gardasil (human papillomavirus quadrivalent vaccine, recombinant) REF: Page 660

79. Mr. Jacobs, who started taking atorvastatin (Lipitor) 8 wk ago, returns for a follow-up visit. He is angry because there has been no improvement in his cholesterol level. How should the nurse respond to his concern?

A. This medication helps to control but does not cure elevated serum cholesterol levels.

B. Continue to take the medication as you have been and you should see results within 3 mo.

C. It must be taken in conjunction with an antihypertensive to get the most beneficial response.

D. Did you eat something for breakfast this morning that would have caused the test result to be elevated?

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ANS: A See Indications and Nursing Implications for atorvastatin: Atorvastatin is given to help manage cholesterol levels, but when taken alone, it will not cure elevated serum cholesterol levels. The nurse should ask Mr. Jacobs about his dietary history. To lower serum cholesterol levels a diet low in fat, cholesterol, carbohydrates, and alcohol should be consumed in conjunction with taking Lipitor.

KEY: Cognitive Level: Synthesis DIF: Hard TOP: Drug: Atorvastatin (Lipitor) REF: Page 656

80. How is aripiprazole (Abilify) prescribed?

A. As an add-on treatment along with antidepressant medications B. To minimize side effects associated with antidepressant medications C. As an add-on treatment for those with schizophrenia D. To minimize the side effects associated with medications for schizophrenia ANS: A See Indications/Nursing Implications for aripiprazole: Aripiprazole is used as an add-on medication when an antidepressant alone is not effective. If antidepressants have been used for at least 6 wk and symptoms of major depressive disorder exist, aripiprazole can be added in addition to an antidepressant.

KEY: Cognitive Level: Knowledge DIF: Medium TOP: Drug: Aripiprazole (Abilify) REF: Page 183

81. Which of the following should be communicated to a patient who is being prescribed fluticasone and salmeterol (Advair Diskus)?

A. Open capsule and mix with water or juice.

B. Rinse mouth with water after each use.

C. Use a spacer device.

D. Shake medication container prior to administration.

ANS: B See Indications and Patient/Family Teaching for fluticasone and salmeterol (Advair Diskus): Advair Diskus is an anti-inflammatory and long-acting bronchodilator used for COPD, chronic bronchitis, and emphysema. Advair Diskus is an inhalation cased medication that carries a side effect of thrush in the

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mouth; therefore, the mouth should be rinsed with water after each use. Advair requires the person to puncture the capsule in a sealed container prior to inhalation.

KEY: Cognitive Level: Application DIF: Medium TOP: Drug: Fluticasone and salmeterol (Advair) REF: Page 357 | Page 1124

82. The intended therapeutic response after administering cyclosporine (Gengraf) is which of the following?

A. Increase tear production B. Relieve corneal pressure C. Decrease bacterial growth associated with use of contact lenses D. Facilitate increased growth of eyelashes ANS: A See Indications for Gengraf: Gengraf is an ophthalmic emulsion used to increase tear production and provide temporary relief for those with chronic dry eye syndrome.

KEY: Cognitive Level: Comprehension DIF: Easy TOP: Drug: Cyclosporine (Restasis) REF: Page 381 (See Appendix C: ophthalmic medications)

83. Which of the following assessments would indicate that dopamine is effective?

A. Increased blood pressure, peripheral circulation, and urine output B. Decreased respiratory rate and increased oxygen saturation C. Increased mental awareness, peripheral circulation, and respiratory rate D. Decreased blood pressure, increased urine output, and increased respiratory rate ANS: A See Indications and Evaluation/Desired Outcomes for dopamine: Dopamine (Intropin) is a vasopressor agent used to treat shock that does not respond to fluid replacement. A desired outcome of dopamine is increased blood pressure, cardiac output, and urine output.

KEY: Cognitive Level: Synthesis DIF: Easy TOP: Drug: Dopamine (Intropin) REF: Page 465

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84. A woman with severe rheumatoid arthritis is starting golimumab (Simponi). Which of the following tests should be performed prior to starting this medication?

A. CT scan B. x ray C. D-dimer D. Tuberculin skin test ANS: D See Nursing Implications/Implementation for golimumab: A tuberculin skin test should be administered prior to the administration of golimumab. There is serious risk for the development of tuberculosis while taking this medication. If a test indicates the presence of latent tuberculosis, treatment must be initiated prior to initiation of golimumab.

KEY: Cognitive Level: Synthesis DIF: Medium TOP: Drug: Golimumab (Simponi) REF: Page 632

85. A 7-year-old patient is to receive intravenous digoxin (Lanoxin). The apical rate is 66. What should the nurse do?

A. Administer Lanoxin as ordered.

B. Give fluid bolus and administer Lanoxin in 1 hr.

C. Hold Lanoxin and notify the doctor.

D. Hold Lanoxin and take apical rate again in 2 hr.

ANS: C See Nursing Implications for digoxin: Digoxin should be held if an apical pulse is >70 bpm in a child.

The health care provider should be notified.

KEY: Cognitive Level: Application DIF: Easy TOP: Drug: Digoxin (Lanoxin) REF: Page 435

86. A 37-year-old male was brought to the emergency room in thyroid crisis. Which medication will likely be ordered?

A. Potassium chloride B. Potassium gluconate

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C. Potassium iodide D. Potassium ANS: C See Indications for potassium iodide: Thyroid crisis is a severe hyperthyroid response. The therapeutic effect of potassium iodide is to slow the release and synthesis of thyroid hormones.

KEY: Cognitive Level: Comprehension DIF: Medium TOP: Drug: Potassium iodide (iodine, iodide) REF: Drugguide.com

87. When starting a patient on levothyroxine (Synthroid), which of the following requires close monitoring?

A. Neurologic status B. Heart rate and rhythm C. Respiratory rate and depth D. Urinary output ANS: B See Indications for levothyroxine: Levothyroxine is a thyroid supplement for the treatment of hypothyroidism. It is necessary to monitor the heart rate and rhythm, blood pressure, and chest pain.

These symptoms are associated with hyperthyroidism, indicating that the patient is overdosed or has a toxic level of levothyroxine.

KEY: Cognitive Level: Application DIF: Easy TOP: Drug: Levothyroxine (Synthroid) REF: Page 781

88. Which is the preferred route for administration of cyanocobalamin (vitamin B12)?

A. Sublingual B. Intravenous C. Intramuscular D. Dermal patch ANS: C See Route/Dosage for cyanocobalamin: Cyanocobalamin is a vitamin B12 preparation used in the treatment of pernicious anemia. The preferred route of administration is monthly intramuscular injection.

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KEY: Cognitive Level: Comprehension DIF: Easy TOP: Drug: Cyanocobalamin (Vitamin B12) REF: Page 1276

89. Which of the following examples should be provided as food to include with dietary intake when taking furosemide (Lasix)?

A. Cauliflower, cabbage, and yogurt B. Macaroni and cheese, deli meat, and buttermilk C. Clams, oysters, and broccoli D. Potatoes, milk, and prune juice ANS: D See Indications for furosemide: Furosemide is a diuretic that will decrease potassium levels. A diet high in potassium is needed to replace potassium that is lost. Cauliflower, cabbage, and yogurt are high in vitamin K. Macaroni and cheese, deli meat, and buttermilk are high in sodium. Clams, oysters, and broccoli are high in calcium. Potatoes, milk, and prune juice have high potassium levels.

KEY: Cognitive Level: Synthesis DIF: Medium TOP: Drug: Furosemide (Lasix) REF: Page 611 and see Appendix K

90. A 58-year-old woman with a history of cardiac arrhythmias visits her health care provider with complaints of sunburn on her arm while riding in a car. What should the health care provider suspect?

A. Allergic reaction related to Cardizem B. Photosensitivity related to amiodarone C. Dermatitis related to verapamil D. Hypersensitivity related to sotalol ANS: B See Indications and Adverse Reactions/Side Effects for amiodarone (Pacerone): Amiodarone is used to treat ventricular arrhythmias. A common side effect of amiodarone is photosensitivity that can occur through window glass and thin clothing.

KEY: Cognitive Level: Analysis DIF: Medium TOP: Drug: Amiodarone (Pacerone) REF: Page 142

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91. What times should be indicated for the administration of Maalox?

A. 6 AM, 10 AM, 3 PM, 7 PM B. 7 AM, 11 AM, 4 PM, 8 PM C. 8 AM, 12 PM, 5 PM, 9 PM D. 9 AM, 1 PM, 7 PM, 11 PM ANS: D See Route/Dosage for Maalox: Maalox is an antacid and should be given 1–3 hr after meals and at bedtime. This medication should not be given at the same time as other medications are being taken.

KEY: Cognitive Level: Synthesis DIF: Easy TOP: Drug: Maalox REF: Page 813

92. Memantine (Namenda) should be used cautiously in those with an impaired: A. Cognitive status B. Cardiac status C. Renal status D. Liver status ANS: C See Indications and Contraindications/Precautions for memantine: Memantine is an anti-Alzheimer’s agent. Its therapeutic effect is to decrease symptoms of dementia. Memantine is metabolized through tubular reabsorption and excreted by the kidneys. This drug should be used cautiously in those with renal impairment, urinary tract infections, or those with renal tubular necrosis.

KEY: Cognitive Level: Synthesis DIF: Easy TOP: Drug: Memantine (Namenda) REF: Page 865

93. What is niacin indicated for?

A. The treatment of inflammatory response B. As an adjunctive therapy for hyperlipidemia C. The treatment of thrush D. To prevent migraine headaches

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ANS: B See Indications for niacin: Also known as vitamin B3, niacin is required for lipid metabolism, glycogenolysis, and tissue repair. The therapeutic effect of niacin is to decrease blood lipids.

KEY: Cognitive Level: Analysis DIF: Medium TOP: Drug: Niacin (Niaspan) REF: Drugguide.com

94. A 52-year-old patient is going home with nitroglycerine translingual spray (NitroMist). How should the patient be taught to take this medication?

A. Shake canister, spray in mouth, and rinse with glass of water 5 min after administration.

B. Roll canister between hands and spray on tongue.

C. Inhale as the medication is being sprayed into the mouth.

D. Lift the tongue and spray under the tongue.

ANS: D See Nursing Implications/Implementation for NitroMist: can be applied as a spray under the tongue or on the tongue.

KEY: Cognitive Level: Application DIF: Medium TOP: Drug: NitroMist REF: Page 926

95. A 62-year-old male is started on sildenafil (Revatio) for treatment of pulmonary arterial hypertension.

What is a side effect of this medication?

A. Male erection B. Metallic taste in mouth C. Tinnitus D. Color of urine may turn orange ANS: A See Indications, Action, and Patient Family Teaching for Revatio: a form of sildenafil, a vasodilator for the treatment of pulmonary arterial hypertension or as an erectile dysfunction agent. The patient must know to notify a health care provider if an erection occurs that lasts for more than 4 hr.

KEY: Cognitive Level: Comprehension DIF: Medium TOP: Drug: Sildenafil (Revatio)

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REF: Page 1139

96. An overdose of nateglinide (Starlix) would present with which symptom?

A. Hypertension B. Hypotension C. Hyperglycemia D. Hypoglycemia ANS: D See Indications, Adverse Reactions and Assessment for nateglinide: Nateglinide is an antidiabetic agent intended to lower blood glucose. Too much of this medication or sensitivity to the medication could cause hypoglycemia. Symptoms such as weakness, dizziness, tachycardia, tremors, and anxiety would indicate hypoglycemia.

KEY: Cognitive Level: Comprehension DIF: Easy TOP: Drug: Nateglinide (Starlix) REF: Drugguide.com

97. Which laboratory value should be monitored during pharmacologic therapy of sitagliptin (Januvia)?

A. CBC B. Hemoglobin A1C C. Phosphorus levels D. Thiamine levels ANS: B See Indications and Nursing Implications for Januvia: an antidiabetic agent for those with type 2 diabetes.

A hemoglobin A1C provides a 3-month window of glycemic control.

KEY: Cognitive Level: Application DIF: Medium TOP: Drug: Sitagliptin (Januvia) REF: Page 1145

98. Oxycodone/aspirin (Percodan) should not be given to a person with: A. Bleeding tendencies B. An allergy to seafood C. An inability to stand on his or her own

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D. A respiratory rate greater than 24 breaths/min ANS: A See Nursing Implications for Percodan: should not be given to people with bleeding tendencies because it is a combination drug made of oxycodone and aspirin.

KEY: Cognitive Level: Application DIF: Medium TOP: Drug: Oxycodone and aspirin (Percodan) REF: Page 972 | Page 189

99. A patient was started on dalteparin (Fragmin). Which of the following assessment findings should cause concern?

A. Nosebleed B. Low urine output C. Fever D. Ecchymosis on the abdomen ANS: A See Indications, Nursing Implications/Assessment and Implementation for dalteparin: Dalteparin is an anticoagulant in the form of a low-molecular-weight heparin. It is administered in the abdomen and may cause ecchymosis or inflammation around the injection site. Bleeding gums, nosebleeds, hematuria, black tarry stools, or unusual bleeding may indicate an adverse reaction. Dalteparin can be injected into the abdomen, and ecchymosis around the abdomen is common.

KEY: Cognitive Level: Analysis DIF: Hard TOP: Drug: Dalteparin (Fragmin) REF: Page 648

100. Ciprofloxacin, Levaquin, and Avelox fall under which drug classification?

A. Aminoglycosides B. Carbapenems C. Macrolides D. Fluoroquinolones ANS: D See class of fluoroquinolones: These drugs fall under the category of fluoroquinolones, which are used in the treatment of bacterial infection by inhibiting bacterial synthesis.

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KEY: Cognitive Level: Comprehension DIF: Easy TOP: Drug classification: Fluoroquinolones REF: Page 586

101. As the nurse prepares to administer abacavir (Ziagen), which of the following would indicate the medication is effective?

A. Decreased creatinine clearance and increased BUN B. Increased creatinine clearance and decreased BUN C. Decreased viral load and increased CD4 cell count D. Increased viral load and decreased CD4 cell count ANS: C See Indications and Assessment/Lab, Evaluation/Desired Outcomes for abacavir: Abacavir is an antiretroviral used in combination with other drugs to manage HIV infection. The therapeutic action of abacavir is to slow the progression of HIV infection. The effectiveness of abacavir can be determined by a decreased viral load and an increased CD4 cell count.

KEY: Cognitive Level: Analysis DIF: Easy TOP: Drug: Abacavir (Ziagen) REF: Drugguide.com

102. When taking clonidine (Catapres), which of the following exercise activities should be avoided?

A. Weightlifting B. Squat thrusts C. Bicycling D. Jogging ANS: B See Indications and Patient/Family Teaching for clonidine: Clonidine is an antihypertensive. People taking clonidine should avoid activities that require sudden change in body positions because of risk for orthostatic hypotension. Squat thrusts require a person to go from an upright erect position to a squat with the legs extended and return to an upright position in a fluid motion.

KEY: Cognitive Level: Synthesis DIF: Medium TOP: Drug: Clonidine (Catapres) REF: Page 334

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103. What is the proper action to prepare for the administration of Pulmicort Respules?

A. Attach medication to a spacer.

B. Place medication in a nebulizer equipped with a mouthpiece or face mask.

C. Rotate diskus unit to proper dose prior to dispensing medication.

D. Shake medication vigorously to mix medication.

ANS: B See Nursing Implications and Patient/Family Teaching for Pulmicort Respules: Pulmicort Respules are administered through a nebulizer. Wash face after use of face mask.

KEY: Cognitive Level: Comprehension DIF: Medium TOP: Drug: Budesonide (Pulmicort Respules) REF: Page 357

104. What should the nurse communicate to the patient when teaching the proper technique for administration of 2 simultaneous doses of beclomethasone?

A. Allow at least 1 min between inhalations.

B. Allow at least 5 min between inhalations.

C. Take 2nd dose immediately following the first dose.

D. Rinse mouth between doses.

ANS: A See Implementation for Corticosteroids (inhalation)/beclomethasone: Beclomethasone is an inhaled corticosteroid used for those with asthma. Inhaled doses of corticosteroids should be spaced by at least 1 min.

KEY: Cognitive Level: Application DIF: Medium TOP: Drug: Beclomethasone REF: Page 360 and Appendix D

105. What is the proper administration when an inhaled corticosteroid and a bronchodilator are scheduled for the same time frame?

A. Take the corticosteroid, allow 1 min to elapse, and then take the bronchodilator.

B. Take bronchodilator, allow 1 min to elapse, and then take the corticosteroid.

C. Take the corticosteroid, allow 5 min to elapse, and then take the bronchodilator.

D. Take bronchodilator, allow 5 min to elapse, and then take the corticosteroid.

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ANS: D See Patient/Family Teaching for corticosteroids inhalation route: When taking inhaled corticosteroids and bronchodilators, the bronchodilator should be administered first. Allow 5 min to elapse and then administer the corticosteroid.

KEY: Cognitive Level: Application DIF: Medium TOP: Drug: Corticosteroids and Bronchodilators REF: Page 360

106. The nurse on the hospice unit receives an order to administer fentanyl via a transmucosal route.

Which of the following actions will the nurse take?

A. Place under the tongue and allow to dissolve.

B. Place between the cheek and lower gum moving it back and forth from one side to another.

C. Place between the cheek and gum and allow to dissolve.

D. Rub on tongue, instruct patient to move tongue in the mouth and then swallow.

ANS: B See Nursing Implications and Patient/Family Teaching for transmucosal fentanyl: Transmucosal fentanyl, available as Actiq, should be placed between the cheek and lower gum, moving it from one side to another using the handle of the applicator. The medication is consumed by sucking on the applicator over a period of 15 min or longer. The patient should not chew or swallow the medication.

KEY: Cognitive Level: Application DIF: Medium TOP: Drug: Fentanyl (Actiq) REF: Page 569

107. Intramuscular iron dextran should be administered in which site?

A. Deltoid with a 1.5-inch needle B. Upper outer quadrant of the buttock C. Ventrogluteal at a 90° angle D. Vastus lateralis ANS: C See Implementation for Iron dextran: Iron dextran is administered via intramuscular injection into the upper outer quadrant of the buttock. It should be injected deeply into the tissue using a z-track method.

Use a 2 – to 3-inch, 19- to 20-gauge needle. To decrease staining of subcutaneous tissue, change the needle between withdrawal of the medication prior to injection. Stains are usually permanent.

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KEY: Cognitive Level: Analysis DIF: Easy TOP: Drug: Iron dextran REF: Page 723

108. Which of the following laboratory values requires the closest monitoring with isoniazid therapy?

A. CBC B. AST and ALT C. BUN and Cr D. HbA1c and glucose ANS: B See Nursing Implications/Assessment/Labs for isoniazid: AST and ALT are associated with liver function tests. Isoniazid is an antitubercular medication used for the treatment and prevention of tuberculosis. This medication is primarily metabolized and excreted by the liver. Isoniazid should be used cautiously in those with liver disease or chronic alcoholism. Liver function tests must be evaluated prior to and monthly throughout therapy for drug-induced hepatitis.

KEY: Cognitive Level: Synthesis DIF: Medium TOP: Drug: INH (isoniazid) REF: Page 726

109. When taking eszopiclone (Lunesta), the following instructions should be followed.

A. Take at the same time every morning.

B. Take 1 hr before meals.

C. Take with food.

D. Take immediately before going to bed.

ANS: D See Indications and Nursing Implications/Implementation for Lunesta: given for the treatment of insomnia. Because of its rapid onset, Lunesta should be taken immediately before going to bed and during a time frame that allows for at least 8 hr of sleep. To maximize effectiveness, Lunesta should not be taken with a high-fat or heavy meal.

KEY: Cognitive Level: Comprehension DIF: Easy TOP: Drug: Eszopiclone (Lunesta) REF: Page 537

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110. Which cranial nerve needs to be routinely evaluated while a person is receiving vancomycin?

A. I B. II C. IV D. VIII E. XII ANS: D See Nursing Implications/Assessment for vancomycin: The eighth cranial nerve must be monitored during use of vancomycin because of risk for permanent hearing loss. Vancomycin is an anti-infective.

KEY: Cognitive Level: Synthesis DIF: Medium TOP: Drug: Vancomycin REF: Page 1249

111. Which drug is used in the treatment of scurvy?

A. Ascorbic acid B. Polyethylene glycol C. Kava kava D. Valerian ANS: A See Indications for Ascorbic acid (Vitamin C). Ascorbic acid is administered as a nutritional supplement and in the treatment of vitamin C deficiency as seen with scurvy.

KEY: Cognitive Level: Application DIF: Medium TOP: Drug: Ascorbic acid REF: Drugguide.com

112. For chondroitin to be effective it should be taken: A. As needed B. Once a wk C. Once a mo D. For an extended period of time

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ANS: D See Patient/Family Teaching for Chondroitin: Chondroitin helps to build bone cartilage and is often taken in conjunction with glucosamine. In order for chondroitin to be effective, it should be taken consistently for an extended period of time.

KEY: Cognitive Level: Comprehension DIF: Medium TOP: Drug: Chondroitin REF: Drugguide.com

113. Mrs. Lawson, a 2nd-grade teacher, tells the school nurse that she has started taking echinacea so that she will not get sick this school year. What is the nurse’s best response?

A. “That is terrific. I think you will notice a big difference in how you feel.”

B. “Echinacea should only be taken when you feel symptoms of a cold starting.”

C. “It is best to get a therapeutic level of echinacea before being exposed to sick children.”

D. “Are you taking vitamin C as well, because echinacea needs to be taken in conjunction with vitamin C?” ANS: B Echinacea is an herbal supplement used to ward off the severity of bacterial and viral infections by stimulating the immune system. It should be taken only when the symptoms of a cold appear. It should not be taken as a preventative and should not be used for more than 10–14 days. Using echinacea for more than 8 wk may generate an overstimulation of the immune system and cause immunosuppression.

KEY: Cognitive Level: Synthesis DIF: Easy TOP: Drug: Echinacea REF: Page 1331

114. A young man with an allergy to sulfa was recently diagnosed with ulcerative colitis. What medication is he likely to receive?

A. Bactrim B. Dipentum C. Glyburide D. Sulfasalazine ANS: B See Indications and Action for olsalazine (Dipentum): Dipentum is a gastrointestinal anti-inflammatory used in the treatment of ulcerative colitis for those who have an allergy to sulfa. Sulfasalazine is

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frequently the drug of choice for the treatment of ulcerative colitis but cannot be used in this scenario because of the allergy to sulfa.

KEY: Cognitive Level: Application DIF: Medium TOP: Drug: Olsalazine (Dipentum) REF: Page 949

115. The nurse is counseling a 55-year-old woman who is to begin taking alendronate (Fosamax) to prevent osteoporosis. Which of the following instructions by the nurse is best?

A. Instruct the patient to take each dose with breakfast.

B. Instruct the patient to take each dose on an empty stomach.

C. Instruct the patient to take each dose with orange juice.

D. Instruct the patient to take each dose just prior to bedtime.

ANS: B See Patient/Family Teaching for alendronate. The medication should be taken first thing in the morning, 30 min before any other medications, beverages, or food. Waiting longer than 30 min will improve absorption. Alendronate should be taken with 6–8 oz of plain water (mineral water, orange juice, coffee, and other beverages decrease absorption).

KEY: Cognitive Level: Application DIF: Medium TOP: Therapeutic Classification: Bone resorption inhibitors REF: Pages 121–122

116. A 26-year-old female prescribed almotriptan for use with migraine headache attacks, calls the nurse, stating, “I took a home pregnancy test last week and I know I’m pregnant but I haven’t seen the doctor yet. I have a terrible migraine starting and I don’t know what I should do.” Which of the following statements by the nurse is best?

A. “When was your last menstrual cycle?”

B. “It is usually safe to take medications early in a pregnancy.”

C. “What other migraine treatments have worked in the past?”

D. “You should not take almotriptan if you think you are pregnant.”

ANS: D See Patient/Family Teaching for almotriptan. A female patient should not use almotriptan if she is pregnant, suspects she is pregnant, plans to become pregnant, or is breastfeeding.

KEY: Cognitive Level: Analysis DIF: Medium TOP: Therapeutic Classification: Vascular headache suppressants REF: Page 127

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117. The nurse is caring for a 72-year-old woman admitted for a cerebral vascular accident who has dysphasia with orders to follow a diet of pureed foods. The patient takes alprazolam (Xanax) 0.5 mg TID. Which of the following actions by the nurse is best?

A. Crush the medication and administer it in pudding.

B. Hold the medication.

C. Contact the physician.

D. Give the medication with a small sip of water.

ANS: A See Implementation for alprazolam. Tablets may be crushed and taken with food or fluids if patient has difficulty swallowing.

KEY: Cognitive Level: Application DIF: Medium TOP: Therapeutic Classification: Antianxiety agents REF: Page 132

118. The nurse is caring for a patient receiving aluminum hydroxide (AlternaGEL) every 2 hr while awake for the treatment of a peptic ulcer. For which of the following side effects should the nurse monitor?

A. Constipation B. Headache C. Insomnia D. Sedation ANS: A See Adverse Reactions/Side Effects for aluminum hydroxide. Constipation is the most common side effect with this medication.

KEY: Cognitive Level: Application DIF: Medium TOP: Therapeutic Classification: Antiulcers REF: Drugguide.com

119. While admitting a client with a history of osteoporosis, the nurse notes a physician’s order reading, “Acetaminophen extra strength (500 mg), 2 tabs every 8 hr as needed for pain.” Which of the following actions by the nurse is best?

A. Call the physician to question the total daily dose.

B. Call the pharmacy to verify that this is a safe dose.

C. Transcribe the order as written.

D. Schedule the pain medication TID to maximize pain control.

ANS: C See Route/Dosage for acetaminophen. This order should be transcribed as written. Since it is a safe daily dose, there is no reason to question the safety of the order unless hepatic or renal insufficiency is suspected. Nurses cannot alter physician’s orders, and since this is written as a prn order, it cannot be

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scheduled TID. By mouth (adults and children greater than 12 yr): 325–650 mg every 4–6 hr or 1 g 3–4 times daily or 1,300 mg every 8 hr (not to exceed 4 g or 2.5 g/24 hr in patients with hepatic/renal impairment).

KEY: Cognitive Level: Analysis DIF: Medium TOP: Therapeutic Classification: Antipyretics, Nonopioid analgesics REF: Page 101

120. The nurse is caring for a patient with a long history of asthma. Which of the following medications should the nurse question?

A. Propanolol (Inderal LA) B. Albuterol (Proventil) C. Salmeterol (Serevent) D. Budesonide (Pulmacort) ANS: A See Contraindications for propanolol. Beta blockers (olol) are contraindicated in the presence of pulmonary disease, including asthma, due to the potential interaction with beta receptors in the pulmonary tissue.

KEY: Cognitive Level: Analysis DIF: Medium TOP: Therapeutic Classification: Antianginals, Antiarrhythmics, Antihypertensives REF: Page 1064

121. The nurse is counseling a patient who is to start taking amlodipine (Norvasc) for hypertension. The nurse recognizes that further teaching is required by which of the following statements?

A. “I need to call the doctor if my pulse is less than 50 beats in a minute.”

B. “I’ll get up slowly since I may be a little dizzy if I get up too fast.”

C. “It is important that I take this medication on an empty stomach.”

D. “I need to check with the doctor before taking any new over-the-counter cold medicines.”

ANS: C See Implementation and Patient/Family Teaching for amlodipine. Norvasc may be administered without regard to meals. Caution patient to change positions slowly to minimize orthostatic hypotension. Instruct patient to contact health care professional if heart rate is less than 50 bpm. Instruct patient to avoid concurrent use of alcohol or OTC medications, especially cold preparations, without consulting a health care professional.

KEY: Cognitive Level: Analysis DIF: Medium TOP: Therapeutic Classification: Antihypertensives REF: Page 148

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122. The nurse is providing care to a 9-year-old boy admitted with a broken tibia. The child takes Adderall XR 20 mg/day. The physician has prescribed Meperidine 25 mg IM every 4 hr as needed for pain. Which of the following actions by the nurse is best?

A. Give the Meperidine if the child complains of pain.

B. Hold the Meperidine and contact the physician.

C. Notify the charge nurse.

D. Hold the Adderall.

ANS: B See Interactions for amphetamine mixtures. The Meperidine must be held since use of Adderall XR with MAO inhibitors or Meperidine can result in hypertensive crisis.

KEY: Cognitive Level: Analysis DIF: Easy TOP: Therapeutic Classification: Central nervous system stimulants REF: Pages 152 and 826

123. While providing peri-care for a patient receiving multiple intravenous antibiotics, the nurse notes that the patient’s groin folds and perineal area are red, inflamed, and excoriated and that whitish discharge is noted from the vagina. When contacting the physician to report the patient’s condition, which of the following medications would the nurse anticipate being ordered?

A. Neomycin ointment B. Monistat cream C. Calamine lotion D. Hydrocortisone cream ANS: B See Indications for Antifungals vaginal: Miconazole (Monistat) is given for the treatment of vulvovaginal candidiasis, and the patient is both at risk for and has signs of a yeast infection.

KEY: Cognitive Level: Analysis DIF: Medium TOP: Therapeutic Classification: Antifungals (Vaginal) REF: Pages 174-175

124. A client calls the nurse at 2 PM stating, “I forgot to take my atenolol (Tenormin) at 8 AM like I usually do. Should I take it now?” Which of the following responses by the nurse is best?

A. “It would be best to simply take 2 pills tomorrow.”

B. “No, too much time has gone by so just skip that dose.”

C. “Yes, it is important to take the medication each day.”

D. “Why did you forget to take it today?”

ANS: C See Patient/Family Teaching for atenolol. Atenolol should be taken as directed at the same time each day, even if feeling well; do not skip or double up on missed doses. Take missed doses as soon as possible up to 8 hr before next dose. Abrupt withdrawal may cause life-threatening arrhythmias, hypertension, or

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myocardial ischemia. Atenolol is typically given in daily doses. It is not important to determine why the patient forgot the missed dose.

KEY: Cognitive Level: Analysis DIF: Medium TOP: Therapeutic Classification: Antihypertensives REF: Page 192

125. While reviewing medications for a patient with multiple sclerosis, the student nurse recognizes that baclofen (Lioresal) is given for which the following symptoms?

A. Depression B. Anxiety C. Muscle spasticity D. Headache ANS: C See Indications for baclofen. Baclofen is used in the treatment of reversible spasticity due to multiple sclerosis or spinal cord lesions.

KEY: Cognitive Level: Knowledge DIF: Easy TOP: Therapeutic Classification: Antispasticity agents, Skeletal muscle relaxants REF: Page 209

126. The nurse is caring for a patient with ulcerative colitis. New orders are received for salsalate (Anaflex) orally TID. The nurse recognizes the patient cannot received this drug due to an allergy to which of the following?

A. Meperidine B. Sulfa C. Penicillin D. Aspirin ANS: D See Contraindications/Precautions for Anaflex. Anaflex is a salicylate that is contraindicated in patients with hypersensitivity to aspirin or other salicylates. Patients should be assessed for allergy to salicylates.

KEY: Cognitive Level: Application DIF: Hard TOP: Therapeutic Classification: Antipyretics/nonopioid analgesics REF: Drugguide.com

127. The nurse is caring for a patient with bronchitis and prepares to provide benzonatate (Tessalon) as ordered. The patient states, “I don’t think I’ve had this before. What is it for?” Which of the following responses by the nurse is best?

A. “This helps thin the mucus so it is easier for you to cough it up.”

B. “It is a cough suppressant and will help reduce your coughing.”

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C. “This helps dilate the small airways in your lungs to help you breathe.”

D. “It is a muscle relaxer so you can rest more comfortably.”

ANS: B See Action for benzonatate: Tessalon anesthetizes cough or stretch receptors in vagal nerve afferent fibers found in lungs, pleura, and respiratory passages. It may also decrease transmission of the cough reflex centrally. Therapeutic Effects: Decrease in cough.

KEY: Cognitive Level: Comprehension DIF: Medium TOP: Therapeutic Classification: Allergy, cold, and cough remedies REF: Drugguide.com

128. While counseling a patient who takes bisacodyl (Dulcolax) for constipation, the nurse recognizes that further teaching is required by which of the following statements?

A. “I try not to take it very often, but when I need it, it sure helps.”

B. “If I take it at night, I can usually have a bowel movement in the morning.”

C. “They told me it was important not to strain when I move my bowels.”

D. “I usually drink about 3 cups of water or coffee every day; I don’t like milk or juice.”

ANS: D See Patient/Family Teaching for bisacodyl. It is important for clients to consume 1,500–2,000 mL of fluid each day. One cup is 240 mL, so this patient is not drinking sufficient quantities of fluid. The use of laxatives should be limited. Colace may be administered at bedtime for morning results. Instruct patients with cardiac disease to avoid straining during bowel movements.

KEY: Cognitive Level: Analysis DIF: Medium TOP: Therapeutic Classification: Laxatives REF: Page 230

129. A neighbor reports giving her 3-year-old daughter bismuth subsalicylate (Pepto-Bismol) for diarrhea stools for the past 2 days. Which of the following statements by the nurse is the highest priority?

A. “Has your child had a fever during this illness?”

B. “Is the diarrhea better now?”

C. “Has she had diarrhea before?”

D. “What does she think of the taste of that stuff?”

ANS: A See Contraindications/Precautions and Patient/Family Teaching for bismuth subsalicylates. It is important to determine if the child has a febrile illness since this product contains aspirin and it has been associated with Reye’s syndrome. Individuals with diarrhea need to notify a health care professional if diarrhea lasts more than 2 days or is accompanied by a fever. It will be important to determine if the child is improving, but that is not the highest priority. Determining if the child has had diarrhea in the past will not clarify the current concern, nor is the child’s preference for the medication important.

KEY: Cognitive Level: Application

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DIF: Hard TOP: Therapeutic Classification: Antidiarrheals, Antiulcer agents REF: Drugguide.com

130. The nurse is providing care to a patient with congestive heart failure who is taking digoxin (Lanoxin) and bumetanide. Which of the following statements indicates teaching has been effective?

A. “I need to restrict my intake of salt and potassium while I’m on these medications.”

B. “The bumetanide can increase my risk of digoxin overdose, so I should call the doctor if I have any nausea, vomiting, confusion, or muscle cramps.”

C. “I need to hold both medications if the top number of my blood pressure is less than 140.”

D. “These medications help my heart beat faster so I won’t feel so tired all the time.”

ANS: B See Nursing Implications for bumetanide. Assess patients receiving digoxin for anorexia, nausea, vomiting, muscle cramps, paresthesia, and confusion ↑ risk of digoxin toxicity due to the potassiumdepleting effect of diuretic. Potassium supplements or potassium-sparing diuretics may be used concurrently to prevent hypokalemia. Patients taking Lanoxin need to monitor pulse rate. The medications are given to improve cardiac output and reduce fluid overload; they are not intended to make the heart beat faster.

KEY: Cognitive Level: Analysis DIF: Medium TOP: Therapeutic Classification: Diuretics (bumetanide) and cardiac glycosides (Lanoxin) REF: Page 249

131. The nurse is assisting in the care of a 28-year-old woman who has been seen by a psychologist for depression. The woman is interested in starting treatment with bupropion (Wellbutrin SR). Which of the following factors would indicate this plan should be questioned?

A. The patient smokes a pack of cigarettes each day.

B. The patient is currently taking birth control pills.

C. The patient has a history of hypertension.

D. The patient has a history of seizures.

ANS: D See Indications and Contraindications/Precautions for bupropion. Extreme caution should be exercised in patients with a history of seizures. Wellbutrin SR can be used for smoking cessation, so there are no precautions necessary due to smoking. No contraindication for birth control pills or antihypertensives is listed.

KEY: Cognitive Level: Analysis DIF: Hard TOP: Therapeutic Classification: Antidepressants, Smoking deterrents REF: Page 257

132. The nurse is counseling a patient who will begin taking buspirone. Which of the following statements indicates further teaching is required?

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A. “I might feel dizzy or sleepy with this medication.”

B. “I shouldn’t drive until I know how I’m going to respond to this medication.”

C. “It’s all right to take most over-the-counter medications and things with this medication.”

D. “I should avoid alcohol or other medications that depress my nervous system.”

ANS: C See Patient/Family Teaching for buspirone. Advise patient to consult a health care professional before taking OTC medications or herbal products with this drug. It may cause dizziness or drowsiness. Caution patient to avoid driving or other activities requiring alertness until response to the medication is known.

Advise patient to avoid concurrent use of alcohol or other CNS depressants.

KEY: Cognitive Level: Analysis/Application DIF: Medium TOP: Therapeutic Classification: Antianxiety agents REF: Page 262

133. The nurse is providing care for a patient who received busulfan (Busulfex) 2 wk ago for chronic myelogenous leukemia (CML). Which of the following lab results would be most concerning to the nurse?

A. Ca++ = 5.1 mg/dL B. Glucose = 98 C. LDH = 120 IU/L D. Platelets = 84,000/mm3 ANS: D See Nursing Implications for busulfan. High Alert: Monitor for bone marrow depression. Assess for bleeding (bleeding gums, bruising, petechiae, guaiac stools, urine, or emesis). Institute thrombocytopenia precautions if platelet count is less than 150,000/mm³. The nonhematologic values are within normal limits.

KEY: Cognitive Level: Analysis DIF: Medium TOP: Therapeutic Classification: Antineoplastics agents REF: Page 263

134. The nurse is providing care for a woman who is in labor and is requesting something for pain. The order reads, “Butorphanol (Stadol) 2 mg every 4 hr as needed.” Which of the following assessments should the nurse complete prior to providing the medication?

A. Cervical dilation B. Respiratory rate C. Contraction rate D. Capillary refill ANS: B See Assessment for butorphanol. Assess blood pressure, pulse, and respirations before and periodically during administration. If respiratory rate is less than 10 breaths/min, assess level of sedation.

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KEY: Cognitive Level: Application DIF: Medium TOP: Therapeutic Classification: Opioid analgesics REF: Drugguide.com

135. The nurse is caring for a patient diagnosed with hypercalcemia related to cancer. Which of the following medications would the nurse anticipate being ordered?

A. Calcium carbonate (Rolaids) B. Calcitonin (Miacalcin) C. Capsaicin (Capsin) D. Nifedipine (Norvasc) ANS: B See Implications for calcitonin. Miacalcin is used as adjunct therapy in the treatment of hypercalcemia.

KEY: Cognitive Level: Application DIF: Medium TOP: Therapeutic Classification: Hypocalcemics REF: Page 265

136. A 38-year-old woman asks the nurse, “Can I just use calcium carbonate (Tums) to help prevent osteoporosis?” Which of the following responses by the nurse is best?

A. “Tums are really an antacid, so there isn’t any research to support their use that way.”

B. “You can use them that way, but they aren’t very effective.”

C. “Did your doctor tell you to start taking a calcium supplement?”

D. “It is safe to use them as a calcium supplement, but make sure you’re getting enough vitamin D as well.”

ANS: D See Patient/Family Teaching for Calcium Salts. Calcium carbonate is indicated for calcium supplementation, but patients should be instructed to get sufficient amounts of vitamin D in their diet.

KEY: Cognitive Level: Analysis DIF: Medium TOP: Therapeutic Classification: Mineral and electrolyte replacements/supplements REF: Page 270

137. The nurse recognizes that which of the following medications ordered for a patient may help reduce skeletal muscle spasms?

A. Cimetidine (Tagamet) B. Metoclopramide (Reglan) C. Carisoprodol (Soma) D. Carbamazepine (Tegretol) ANS: C

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See Indications for carisoprodol. Adjunct to rest and physical therapy in the treatment of muscle spasm associated with acute painful musculoskeletal conditions.

KEY: Cognitive Level: Knowledge DIF: Medium TOP: Therapeutic Classification: Skeletal muscles relaxants REF: Drugguide.com

138. The nurse is preparing to pass morning medications, including newly prescribed carvedilol (Coreg), for a patient admitted with an acute myocardial infarction and congestive heart failure. Which of the following actions should the nurse take first?

A. Check to make sure the medication has been delivered from pharmacy.

B. Take the patient’s blood pressure.

C. Monitor the patient’s respiratory rate and rhythm.

D. Determine the patient’s level of pain.

ANS: B See Nursing Implications for carvedilol. Coreg is an antihypertensive. The nurse must monitor patient pulse and blood pressure frequently during dose adjustments.

KEY: Cognitive Level: Application DIF: Medium TOP: Therapeutic Classification: Antihypertensives REF: Pages 289–290

139. The nurse is caring for a patient with rheumatoid arthritis who takes celecoxib (Celebrex). The patient is on a pureed diet, and the nurse from the previous shift reported some difficulty with oral pills.

Which of the following actions by the nurse is best?

A. Hold the medication.

B. Call the pharmacy to obtain a substitute medication that comes in liquid form.

C. Call the physician to request a different pain medication.

D. Open the capsule and sprinkle granules on applesauce.

ANS: D See Implementation for celecoxib. Capsules may be opened and sprinkled on applesauce.

KEY: Cognitive Level: Application DIF: Easy TOP: Therapeutic Classification: Antirheumatics; nonsteroidal anti-inflammatory agents REF: Page 301

140. The nurse caring for a patient taking cetirizine (Zyrtec) recognizes the treatment plan is effective by which of the following statements?

A. “I don’t feel nearly as tired as I used to feel.”

B. “I am able to sleep at least 6 or 7 hr every night now.”

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C. “My eyes itch less and I’m not sneezing as often.”

D. “My heartburn has essentially gone away.”

ANS: C See Evaluation for cetirizine. Patients taking Zyrtec expect to receive relief from seasonal allergy symptoms.

KEY: Cognitive Level: Analysis DIF: Medium TOP: Therapeutic Classification: Allergy, cold and cough remedies, Antihistamines REF: Page 319

141. A nurse caring for a patient who recently started taking cilostazol recognizes the further need for teaching by which of the following statements?

A. “I’m able to walk 3 blocks a day now instead of 1.”

B. “I take the medication with breakfast every day.”

C. “I’ve given up grapefruit juice and grapefruits entirely.”

D. “I’ve stopped smoking all together.”

ANS: B See Nursing Implications for cilostazol. Cilostazol is given to reduce the symptoms of intermittent claudication and improve walking endurance. It is taken on an empty stomach, 1 hr before or 2 hr after meals and should not be taken with grapefruit juice to avoid increased cilostazol levels.

KEY: Cognitive Level: Analysis DIF: Medium TOP: Therapeutic Classification: Antiplatelet agents REF: Page 322

142. The nurse recognizes that citalopram (Celexa) may be prescribed for which of the following patients?

A. A 42-year-old patient with a history of depression B. A 22-year-old patient with a history of schizophrenia C. A 37-year-old patient taking MAO inhibitors D. A 55-year-old patient with a history of alcoholism ANS: A See Indications for citalopram. Celexa is used in the treatment of depression. It may cause serious, potentially fatal reactions when used with MAO inhibitors and should be used cautiously with other centrally acting drugs including alcohol.

KEY: Cognitive Level: Application DIF: Medium TOP: Therapeutic Classification: Antidepressants REF: Page 326

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143. The nurse is taking a medication history over the phone for a patient scheduled for knee replacement in 3 days. Which of the following medications, if reported by the patient, should be reported to the surgeon?

A. Ranitidine (Zantac) B. Albuterol (Proventil) C. Clortrimazole (Lotrimin) D. Clonazepam (Klonopin) ANS: D Feedback: See Patient/Family Education for clonazepam. Klonopin is an anticonvulsant that cannot be stopped abruptly. It is important to notify health care professionals of medication regimen prior to treatment or surgery.

KEY: Cognitive Level: Comprehension DIF: Medium TOP: Therapeutic Classification: Anticonvulsants REF: Page 334

144. The nurse is providing care for a patient taking clopidogrel (Plavix). Which of the following laboratory results would be most important for the nurse to evaluate?

A. Urine specific gravity B. Albumin C. Bleeding time D. Potassium ANS: C See Nursing Assessment for clopidogrel. Plavix is an antiplatelet medication, so it is important to monitor bleeding time throughout therapy.

KEY: Cognitive Level: Comprehension/Application DIF: Medium TOP: Therapeutic Classification: Antiplatelet agents REF: Pages 337–338

145. The nurse is caring for a patient admitted with suspected overdose with codeine. Which of the following medications would the nurse anticipate being ordered?

A. Nortriptyline (Pamelor) B. Naloxone (Narcan) C. Naproxen (Naprosyn) D. Niacin (Nicobid) ANS: B See Indications for naloxone, and/or Nursing Implications/Toxicity Overdose for Codeine. Codeine is a narcotic, and Narcan is an antidote for narcotic overdose.

KEY: Cognitive Level: Application

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DIF: Medium TOP: Therapeutic Classification: Antidotes (narcotic) REF: Page 343 | Page 901–902

146. A patient undergoing chemotherapy for breast cancer tells the nurse, “I feel so tired I can barely do anything. Even getting out of bed makes me dizzy.” After laboratory results are obtained, which of the following medications would most likely help relieve these symptoms?

A. Darbepoetin (Aranesp) B. Filgrastim (Neupogen) C. Granisetron D. Clopidogrel (Plavix) ANS: A See Indications for darbepoetin, filgrastim, granisetron, and clopidogrel. The patient is exhibiting symptoms associated with anemia, which is common with chemotherapy. Aranesp is one of the erythroid colony–stimulating factors designed to stimulate production of red blood cells and improve symptoms associated with chemotherapy-induced anemia.

KEY: Cognitive Level: Application DIF: Medium TOP: Therapeutic Classification: Antianemics REF: Page 399 | Page 574 | Page 636 | Page 337

147. The nurse is caring for a patient who just received parenteral diazepam (Valium). Which of the following nursing actions is best?

A. Monitor patient’s serum calcium levels for the next 12 hr.

B. Ensure fluid intake of 3,000 mL over the next 24 hr.

C. Place patient on bed rest and monitor vital signs closely.

D. Call for a hypothermia blanket to prevent rigors.

ANS: C See Nursing Implications for diazepam. Parenteral therapy with Valium may alter vital signs or cause sedation, increasing the patient’s risk for falls. Patient should be kept on bed rest and observed for at least 3 hr following parenteral administration. Valium will not alter serum calcium levels, induce dieresis, or alter core temperature.

KEY: Cognitive Level: Application DIF: Hard TOP: Therapeutic Classification: Antianxiety agents, Anticonvulsants, Sedative/Hypnotics, Skeletal muscle relaxants REF: Page 430

148. The nurse is caring for a 56-year-old patient with a history of atrial fibrillation who takes digoxin (Lanoxin) 0.5 mg/day. Which of the following assessments should cause the nurse to hold the patient’s dose?

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A. BP = 112/70 mmHg B. Lung sounds with fine bibasilar crackles C. Urine output = 300 mL in 3 hr D. P = 58 bpm ANS: D See Nursing Assessment for digoxin. Monitor apical pulse for 1 full min before administering. Withhold dose and notify physician if pulse rate is less than 60 bpm in an adult.

KEY: Cognitive Level: Application DIF: Easy TOP: Therapeutic Classification: Antiarrhythmics, Inotropics REF: Pages 436–437

149. A nurse working with a patient who started taking dicyclomine (Bentyl) recognizes that further patient teaching is necessary by which of the following statements?

A. “I’ll call the doctor immediately if I have any eye pain or sensitivity to light.”

B. “I won’t have any restrictions on my driving or other activities if I take this drug.”

C. “I will get up slowly since this medication may make me dizzy.”

D. “People who take this medication sweat less, so it is important not to get overheated.”

ANS: B See Patient/Family Teaching for dicyclomine. Advise patient to notify a health care professional immediately if eye pain or increased sensitivity to light occurs. Medication may cause drowsiness and blurred vision. Caution patient to avoid driving or other activities requiring alertness until response to the medication is known. Advise patient receiving dicyclomine to make position changes slowly to minimize the effects of drug-induced orthostatic hypotension. Caution patient to avoid extremes of temperature.

This medication decreases the ability to sweat and may increase the risk of heat stroke.

KEY: Cognitive Level: Application DIF: Medium TOP: Therapeutic Classification: Antispasmodics REF: Drugguide.com

150. The nurse receives a call from the parent of an 8-year-old boy who is home sick from school with a headache, sinus congestion, and a cough. The parent asks, “Can I give him some Benadryl to help him breathe easier?” Which of the following statements by the nurse is best?

A. “How long has your child been ill?”

B. “It should be fine if he weighs more than 50 pounds.”

C. “What other over-the-counter medications have you given him?”

D. “That might make him sleepy, so it is best to give it at night.”

ANS: C See Patient/Family Teaching on diphenhydramine. Benadryl has many uses and can be safely given to children, but it is found in numerous OTC medications and risk of overdose may be present. Therefore, it is important to know what other medications the parent has given. Caution patient not to use oral OTC

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diphenhydramine products with any other product containing diphenhydramine. The other assessments are not as important, and answer B misses the opportunity to assess for potential overdose.

KEY: Cognitive Level: Application DIF: Medium TOP: Therapeutic Classification: Allergy, cold and cough remedies, Antihistamines, Antitussives REF: Page 446

151. The nurse is caring for a patient admitted with diarrhea for the past 3 days. Stool cultures are negative, and the physician orders Lomotil, 2 tablets orally now and 1 tablet after each loose stool OR every 3–4 hr as needed. Which of the following parameters would the nurse expect to accompany the order?

A. “Do not exceed 8 tablets per day.”

B. “Do not exceed 4 doses per day.”

C. “Do not give for more than 2 days.”

D. No parameters are necessary.

ANS: A See Dosage for diphenoxylate. By mouth (adults): 2 tablets initially, then 1 tablet after each loose stool, or every 3–4 hr as needed (not to exceed 8 tablets/day).

KEY: Cognitive Level: Application DIF: Medium TOP: Therapeutic Classification: Antidiarrheals REF: Drugguide.com

152. The nurse is providing care for a patient who received surgical intervention for mitral valve prolapse.

The patient is taking dipyridamole 75 mg PO. TID. The nurse recognizes the medication is effective by which of the following patient outcomes?

A. Patient reports chest pain is less after receiving the medication.

B. Patient remains free from deep vein thrombosis throughout hospital stay.

C. Patient’s heart rhythm is regular without ectopic beats for 48 hr postprocedure.

D. Patient’s lung sounds remain clear without evidence of fluid overload throughout hospital stay.

ANS: B See Indications for dipyridamole. Dipyridamole is given to prevent thromboembolism in patients with prosthetic heart valves.

KEY: Cognitive Level: Analysis DIF: Hard TOP: Therapeutic Classification: Antiplatelet agents REF: Drugguide.com

153. The nurse is providing care for a patient admitted after an acute myocardial infarction. Which of the following medications should the nurse anticipate to be part of the patient’s treatment plan?

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A. Dolasetron (Anzemet) B. Citalopram (Celexa) C. Donepezil (Aricept) D. Docusate (Colace) ANS: D See Indications for docusate. It is important to prevent additional strain on the heart during recovery.

Docusate is used in the prevention of constipation (in patients who should avoid straining, such as after a myocardial infarction or rectal surgery). Anzemet is an antiemetic used to prevent chemotherapy-induced nausea and vomiting, Celexa is used in the treatment of depression, and Aricept is used to improve cognition and slow Alzheimer’s disease.

KEY: Cognitive Level: Application DIF: Medium TOP: Therapeutic Classification: Laxative REF: Page 458 | Page 326 | Page 463 | Page 455

154. A nurse in the labor and delivery unit is caring for a patient who is receiving bupivacaine (Marcaine) epidural anesthesia. Which of the following symptoms would be recognized as indicative of systemic toxicity?

A. BP drops from 112/74 to 106/68.

B. Patient complains, “I can’t feel the baby moving anymore.”

C. Patient reports, “I can hear ringing in my ears.”

D. Respiratory rate drops from 22 to 16 respirations per minute.

ANS: C See Assessment for Epidural local anesthetics, Systemic Toxicity: Assess for systemic toxicity each shift (circumoral tingling and numbness, ringing in ears, metallic taste, dizziness, blurred vision, tremors, slow speech, irritability, twitching, seizures, and cardiac dysrhythmias). Report to physician or other health care professional. Mild hypotension is common. Respirations will most likely slow as pain is well controlled.

KEY: Cognitive Level: Application DIF: Medium TOP: Therapeutic Classification: Epidural local anesthetics REF: Drugguide.com

155. While counseling a patient receiving eplerenone (Inspra) for hypertension, the nurse recognizes the need for further teaching by which of the following statements?

A. “I’ll follow a cardiac diet to help lower my blood pressure.”

B. “It is important that I stop smoking to reduce my risk of a heart attack.”

C. “I can use salt substitutes if I want more seasoning.”

D. “It is important to check my blood pressure at home at least once a week.”

ANS: C See Patient/Family Teaching for eplerenone. Inform patient not to use potassium supplements, salt substitutes containing potassium, or other prescription or OTC medications without consulting a health

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care professional. Encourage the patient to comply with additional interventions for hypertension (weight reduction, discontinuation of smoking, moderation of alcohol consumption, regular exercise, and stress management). Medication controls, but does not cure, hypertension. Instruct patient and family on correct technique for monitoring blood pressure. Advise them to monitor blood pressure at least weekly.

KEY: Cognitive Level: Analysis DIF: Medium TOP: Therapeutic Classification: Antihypertensives REF: Page 512

156. A nurse working on the postpartum unit is caring for a woman who had a spontaneous delivery of a 9 lb, 6 oz baby 6 hr earlier. The nurse notes the patient has soaked 4 peri-pads and that her uterine fundus is boggy. Which of the following medications does the nurse anticipate being ordered?

A. Oxytocin (Pitocin) B. Methylergonovine (Methergine) C. Terbutaline (Brethine) D. Magnesium sulfate (magnesium sulfate) ANS: B See Indications for Methylergonovine. Methylergonovine is used in the prevention and treatment of postpartum or postabortion hemorrhage caused by uterine atony or involution.

KEY: Cognitive Level: Analysis DIF: Medium TOP: Therapeutic Classification: Oxytocics REF: Page 850

157. The nurse is working with a patient who has elevated triglyceride levels despite dietary changes. The physician has ordered fenofibric acid (Trilipix) 135 mg per day. Which of the following statements should the nurse include in the teaching?

A. “Since I take Coumadin, I’ll need to have my bleeding labs checked more frequently for a while.”

B. “This will be much easier than following all of those dietary restrictions; I know how hard that can be.”

C. “This medicine will really help you lose weight, just be sure you’re drinking enough water.”

D. “This medicine sometimes causes stomach pain and fatty, clay-colored stools, so if I experience that, I shouldn’t worry.”

ANS: A See Nursing Implications for fenofibric acid. Patients taking anticoagulants concurrently should have prothrombin time and INR monitored frequently until levels stabilize. Patients must still follow a low-fat, low-cholesterol diet. The medication is not designed to cause weight loss. Assess patient for cholelithiasis. If symptoms occur, gall bladder studies are indicated; fatty, clay-colored stools, and abdominal pain are symptoms of gall bladder dysfunction.

KEY: Cognitive Level: Analysis DIF: Medium TOP: Therapeutic Classification: Lipid-lowering agents

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REF: Pages 559–560

158. A nurse working in hospice is providing care for a patient recently started on a transdermal fentanyl patch. Which of the following statements, made by the patient’s caretaker, indicates further teaching is required?

A. “I can wash right over the patch, and it won’t come off.”

B. “I should change the patch every 3 days.”

C. “I put the first patch on him this morning at 8 AM, so he shouldn’t need any more pain medicine today.”

D. “The medicine can cause constipation, so it is important to give him the stool softener and increase fluid if possible.”

ANS: C See Dosage and Nursing Implications for fentanyl transdermal. It is important to use supplemental doses of short-acting opioid analgesics to manage pain until relief is obtained with the transdermal system. The patch may be worn while bathing, showering, or swimming. Transdermal patches lasts 72 hr in most patients. Prevent constipation with increased intake of fluids and bulk as well as laxatives to minimize constipating effects.

KEY: Cognitive Level: Analysis DIF: Medium TOP: Therapeutic Classification: Opioid analgesics REF: Pages 564–565

159. The nurse is providing a follow-up phone call to a patient who recently started taking fexofenadine (Allegra Allergy). Which of the following statements by the patient would indicate the medication has been effective?

A. “My arthritis is much better; I can even write letters again.”

B. “My nose isn’t running and itchy all the time now.”

C. “I don’t have to get up to go to the bathroom in the middle of the night anymore.”

D. “I’m sleeping a lot better, and I don’t have any headaches anymore.”

ANS: B See Evaluation/Desired Effects for fexofenadine. Allegra Allergy is designed to decrease in allergic symptoms.

KEY: Cognitive Level: Analysis DIF: Medium TOP: Therapeutic Classification: Cold, cough, and allergy medications REF: Page 573

160. The nurse is caring for a patient with colorectal cancer who has been receiving continuous infusion chemotherapy at home. The patient complains of mouth sores and difficulty swallowing. Upon examination, the home care nurse notes a whitish coating on the tongue and mucosal breakdown on the inner cheeks and lips. The nurse informs the patient, “The sores in your mouth are caused by the

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chemotherapy, but it looks like you may also have a secondary yeast infection in your mouth and throat. I will call the doctor so you can be seen right away.” The nurse recognizes which of the following medications will most likely be ordered to treat the esophageal candidiasis once the patient is seen by a physician?

A. Oxybutynin (Ditropan XL) B. Alendronate (Fosamax) C. Fluorouracil (Fluoroplex) D. Fluconazole (Diflucan) ANS: D See Indications for alendronate, fluconazole, fluorouracil, and oxybutynin. Diflucan is used to treat fungal infections caused by susceptible organisms, including oropharyngeal or esophageal candidiasis. Ditropan XL is used in the management overactive bladder, and alendronate is a bisphosphonate used to decrease bone resorption. Fluorouracil is a chemotherapy agent commonly used in the treatment of colorectal cancer and causes stomatitis—it is most likely what the patient is receiving for his treatment, and it will need to be held at this time with probable dose reduction when treatment resumes.

KEY: Cognitive Level: Application DIF: Medium TOP: Therapeutic Classification: Antifungals (systemic) REF: Page 970 | Page 120 | Page 592 | Page 581

161. The nurse is talking to a friend who recently revealed that she is 6 wk pregnant. The woman says, “The doctor told me to take prenatal vitamins that have folic acid in them; what is that for?” Which of the following is the best response by the nurse?

A. “Folic acid helps prevent miscarriage.”

B. “Folic acid boosts your immune system.”

C. “Folic acid actually helps fetal development.”

D. “Folic acid reduces the amount of nausea caused by prenatal vitamins.”

ANS: C See Indications for folic acid. Folic acid is given during pregnancy to promote normal fetal development.

KEY: Cognitive Level: Analysis DIF: Medium TOP: Therapeutic Classification: Antianemics, Vitamins REF: Drugguide.com

162. The nurse is providing care for a 12-year-old child whose order reads, “Ciprofloxacin 15 mg/kg PO every 12 hr.” The child weighs 88 pounds (40 kg). What dose of Ciprofloxacin should be provided?

A. 500 mg tablet every 12 hr B. 500 mg tablet and a 100 mg tablet every 12 hr C. 750 mg tablet every 12 hr D. Two 500 mg tablets every 12 hr ANS: B

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See Route/Dosage and Availability for fluoroquinolones. Ciprofloxacin dosage for a child is 10–15 mg/kg every 12 hr (not to exceed 750 mg/dose). Tablets are available as 100 mg, 250 mg, 500 mg, and 750 mg.

The child’s order is 15 mg/kg, and the child weighs 40 kg; 15 mg/kg × 40 kg = 600 mg per dose.

KEY: Cognitive Level: Application DIF: Medium TOP: Therapeutic Classification: Anti-infectives REF: Pages 588–589

163. While providing care to a 68-year-old man taking gemfibrozil (Lopid), the nurse recognizes that which of the following assessments indicates the medication and treatment plan are effective?

A. The patient has lost 4 pounds this mo.

B. The patient’s HDL drops from 55 mg/dL to 49 mg/dL. C. The patient’s cholesterol drops from 265 mg/dL to 238 mg/dL. D. The patient’s LDL is 175 mg/dL. ANS: C See Evaluation for gemfibrozil. Lopid is given to decrease serum triglyceride and cholesterol levels and to improve HDL to total cholesterol ratios. Weight loss may be seen with low-fat, low-cholesterol dietary restrictions but is not wholly reflective of the medication’s efficacy. With HDL (good) cholesterol, higher levels are better. Low HDL cholesterol (less than 40 mg/dL for men, less than 50 mg/dL for women) puts one at higher risk for heart disease. An LDL between 160 and 189 mg/dL is considered high and indicates increased risk for heart disease.

KEY: Cognitive Level: Analysis DIF: Hard TOP: Therapeutic Classification: Lipid-lowering agents REF: Page 624

164. The nurse is providing care for a 54-year-old woman with insulin-dependent diabetes. The woman is pale, diaphoretic, groggy, and difficulty to arouse. Her blood glucose result is 49. Which of the following actions should the nurse take next?

A. Notify the physician.

B. Encourage the patient to drink orange juice with a teaspoon of added sugar.

C. Request a stat lab blood draw and await results.

D. Provide 1 mg IV glucagon per protocol.

ANS: D See Indications for glucagon. Glucagon is used in the acute management of severe hypoglycemia with the administration of glucose is not feasible. Because this patient is groggy, it would be dangerous to provide oral fluids. Use of bedside fingerstick blood glucose determination methods is recommended for rapid results. Follow-up lab results may be ordered to validate fingerstick values, but do not delay treatment while awaiting lab results, as this could result in neurologic injury or death.

KEY: Cognitive Level: Application DIF: Easy TOP: Therapeutic Classification: Hormones

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REF: Page 626

165. A nurse working in an outpatient psychiatric clinic is assessing a 39-year-old patient with a history of schizophrenia who started taking haloperidol (Haldol) 3 mg PO TID last wk. Which of the following should be reported to the physician immediately?

A. The patient is smacking his lips and chewing while the nurse is asking questions.

B. The patient says, “I heard the angels talking again last night.”

C. The patient reports he is staying at a homeless shelter downtown.

D. The patient tells the nurse he forgot to bring in his pills but that he needs more.

ANS: A See Nursing Assessment for haloperidol. Monitor for tardive dyskinesia (uncontrolled rhythmic movement of mouth, face, and extremities; lip smacking or puckering; puffing of cheeks; uncontrolled chewing; rapid or worm-like movements of tongue; and excessive eye blinking). Report these immediately, as they may be irreversible. Hallucinations are a positive sign of schizophrenia and may be seen despite medication since it may require several wk of therapy to obtain desired effects. Individuals with psychiatric disorders may be homeless; since this patient has housing, this is not the priority. It is important to monitor compliance with the medication schedule and prevent hoarding of pills, but this is not the priority.

KEY: Cognitive Level: Application DIF: Medium TOP: Therapeutic Classification: Antipsychotics REF: Page 644

166. The nurse is caring for an 82-year-old woman with superior vena cava syndrome due to a clot formed around the patient’s implanted port. The patient is on a heparin drip at 12 units/hr. Which of the following laboratory values will be used to titrate the infusion rate?

A. Hemoglobin (Hgb) B. Platelet count (Plt) C. Partial thromboplastin time (aPTT) D. Clotting time ANS: C See Nursing Assessment/Lab Test Considerations for heparin. During continuous administration, monitor aPTT levels every 4 hr during early therapy.

KEY: Cognitive Level: Application DIF: Easy TOP: Therapeutic Classification: Anticoagulants REF: Page 647

167. The nurse is asked by the parent of a 13-year-old girl, “How does the new cervical cancer vaccine work?” Which of the following statements by the nurse is best?

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A. “It is a series of 3 vaccinations over a 6-month period of time designed to prevent cervical cancer and genital warts caused by a virus we call human papilloma virus (HPV).”

B. “Gardasil helps reduce sexually transmitted diseases and female cancers by stimulating an immune response to the herpes virus.”

C. “Your daughter would get a single shot to help prevent cervical, ovarian, and vaginal cancer.”

D. “You should really ask the doctor about the vaccination because it is still controversial.”

ANS: A See Route/Dosage and Indications for the HPV Vaccine. It is given via three 0.5 mL doses at 0, 2, and 6 mo. The vaccine is designed to prevent squamous cell cervical cancer, other cervical and vaginal neoplasias, and genital warts related to the HPV. Gardasil will not prevent other sexually transmitted diseases or other “female” cancers such as ovarian, uterine, or breast cancer, and it is not associated with the herpes virus. Three doses (shots) are required for the series. The nurse should be able to answer this parent’s questions, and teaching is considered a nursing function.

KEY: Cognitive Level: Application DIF: Medium TOP: Therapeutic Classification: Vaccines REF: Page 661

168. A nurse caring for a patient with a history of diabetes mellitus notes that his prebreakfast blood glucose is 268. The nurse understands the patient most likely has sliding scale insulin using which of the following?

A. Novolog Mix 70/30 B. Humulin R C. Humulin N D. Lantus ANS: B See Pharmacokinetics for subcutaneous Insulin Regular. Humulin R is short-acting insulin with an onset of action of 30–60 min when given subcutaneously. Novolog 70/30 is mixed insulin with both short- and long-acting insulins. Humulin N is an intermediate-acting insulin. Lantus is a long-acting insulin.

KEY: Cognitive Level: Comprehension DIF: Easy TOP: Therapeutic Classification: Antidiabetics, Hormones REF: Page 703

169. While checking orders for a patient newly admitted with abdominal pain and suspected pancreatitis, the nurse notes the following order, “meperidine 50–100 mg IM every 3–4 hr prn for pain.” Which of the following medications currently taken by the patient would cause the nurse to contact the physician?

A. Isosorbide (Isordil) 20 mg PO every 6 hr B. Labetalol (Trandate) 100 mg BID C. Phenelzine (Nardil) 15 mg PO TID D. Indomethacin (Indocin) 25 mg PO QID

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ANS: C See Interactions for meperidine. Do not use in patients receiving MAO inhibitors or procarbazine (may cause fatal reaction—contraindicated within 14–21 days of MAO inhibitor therapy).

KEY: Cognitive Level: Analysis DIF: Hard TOP: Therapeutic Classification: Opioid analgesic/Monoamine oxidase inhibitors REF: Page 826

170. The nurse contacts a patient whose physician has ordered carbonyl iron (Feosol) 60 mg BID after routine lab work revealed mild iron-deficiency anemia. Which of the following statements would be included in the patient teaching?

A. “Since you are taking an iron supplement, you should reduce the amount of iron in your diet to prevent overdose.”

B. “The iron may make your stool a dark green or black color; this is nothing to worry about.”

C. “It is alright to take both doses together if you prefer.”

D. “Iron is fairly harmless, so there is little concern if you take extra when you are on your menstrual cycle.”

ANS: B See Patient/Family Teaching for iron supplements. Advise patient that stools may become dark green or black and that this change is harmless. Instruct patient to follow a diet high in iron. Encourage patient to comply with medication regimen. Take missed doses as soon as remembered within 12 hr; otherwise, return to regular dosing schedule. Do not double doses. Discuss with parents the risk of children overdosing on iron.

KEY: Cognitive Level: Application DIF: Easy TOP: Therapeutic Classification: Antianemics REF: Pages 723–724

171. The nurse is assisting in the care of a patient complaining of severe pruritis. Which of the following medications does the nurse anticipate being available on an as-needed basis for the patient?

A. ketorolac B. Hydroxyzine (Atarax) C. Hydromorphone (Dilaudid) D. Hydrocodone (Zohydro ER) ANS: B See Indications for hydroxyzine. Atarax is an antipruritic, ketorolac is a nonsteroidal anti-inflammatory, Dilaudid is an opioid analgesic, and Zohydro ER is an opioid analgesic, antitussive.

KEY: Cognitive Level: Application DIF: Hard TOP: Therapeutic Classification: Antihistamines REF: Drugguide.com

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172. The nurse is caring for a patient being treated for tuberculosis who is taking isoniazid (INH). Which of the following statements indicates the need for further teaching?

A. “I know I need to take this medication for at least 6 months.”

B. “I need to call the doctor if I notice any yellow color to my skin or eyes.”

C. “I’ll have to have regular checkups and eye exams to monitor for side effects.”

D. “I should limit my alcohol intake to no more than 3 beers a day while I’m taking this medicine.”

ANS: D See Patient/Family Teaching for isoniazid. Caution patient to avoid the use of alcohol during this therapy, as this may increase the risk of hepatotoxicity. Emphasize the importance of continuing therapy even after symptoms have subsided. Therapy may be continued for 6 mo to 2 yr. Advise patient to notify health care professional promptly if signs and symptoms of hepatitis (yellow eyes and skin, nausea, vomiting, anorexia, dark urine, unusual tiredness, or weakness) or peripheral neuritis (numbness, tingling, or paresthesia) occur. Emphasize the importance of regular follow-up physical and ophthalmologic exams to monitor progress and to check for side effects.

KEY: Cognitive Level: Analysis DIF: Medium TOP: Therapeutic Classification: Antitubercular REF: Pages 726–727

173. The nurse is providing care for a patient with hepatic encephalopathy who is receiving lactulose via a nasogastric tube QID. Which of the following indicates the patient is responding appropriately to the medication?

A. The patient’s serum ammonia level returns to normal limits.

B. The patient’s potassium level returns to normal limits.

C. The patient’s blood alcohol level returns to normal limits.

D. The patient’s serum calcium level returns to normal limits.

ANS: A See Action of lactulose. It lowers the pH of the colon, which inhibits the diffusion of ammonia from the colon into the blood, thereby reducing blood ammonia levels.

KEY: Cognitive Level: Analysis DIF: Medium TOP: Therapeutic Classification: Laxatives REF: Page 747

MULTIPLE RESPONSE

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174. As part of a new treatment regimen for migraine headaches, an 18-year-old girl is prescribed almotriptan. The nurse should include which of the following statements in the patient teaching? Select all that apply.

A. “You will take this medication daily to help prevent the onset of migraines.”

B. “You should avoid alcohol when you are taking this medication.”

C. “You can take this medication every 2–4 hr as needed for up to 8 doses per day.”

D. “Take the medication as soon as you notice the onset of a migraine headache.”

E. “Avoid taking over-the-counter medications that have not been prescribed by your doctor while taking this medication.”

F. “If taking this medication causes any pain or tightness in your chest, you should notify the physician immediately.”

ANS: B, D, E, F See Nursing Implications for almotriptan. Instruct the patient to administer almotriptan as soon as symptoms of a migraine attack appear, but it may be administered any time during an attack. If migraine symptoms return, a 2nd dose may be used. Allow at least 2 hr between doses, and do not use more than 2 doses in any 24-hr period. Advise patients to notify health care professional prior to next dose of almotriptan if pain or tightness in the chest occurs during use. Advise patient to avoid alcohol, which aggravates headaches, during almotriptan use. Advise patient to consult a health care professional before taking other prescriptions or OTC or herbal products concurrently.

KEY: Cognitive Level: Analysis DIF: Medium TOP: Therapeutic Classification: Vascular headache suppressants REF: Pages 126–127

175. The nurse is providing care for a patient who has new orders to start amiodarone (Pacerone) PO 400 mg BID. Which of the following orders should the nurse anticipate? Select all that apply.

A. Monitor vital signs every 4 hr.

B. Telemetry monitoring.

C. Liver function tests every morning for the next 3 days.

D. Initiate seizure precautions.

E. Notify physician of visual changes.

F. Do not serve grapefruit juice.

ANS: A, B, C, E, F See Adverse Reactions, Nursing Implications, and Patient/Family Teaching for amiodarone: Seizures are not an identified adverse reaction to amiodarone, so seizure precautions are not necessary. The ECG should be monitored continuously, and the nurse should assess for signs of pulmonary toxicity and monitor blood pressure frequently. Ophthalmic examinations should be performed before and regularly during therapy and whenever visual changes occur. Advise patient to avoid drinking grapefruit juice during therapy.

KEY: Cognitive Level: Analysis DIF: Hard TOP: Therapeutic Classification: Antiarrhythmics REF: Pages 141–144

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176. A nurse from the medical unit is floated to the cardiology floor. While preparing to provide morning medications, the nurse realizes many patients are taking bisoprolol and knows the drug must be given cautiously or in reduced doses to which of the following patients? Select all that apply.

A. A 56-year-old patient with a history of pulmonary disease.

B. A 68-year-old patient with a history of gastroesophageal reflux disease.

C. A 71-year-old patient with chronic renal failure.

D. A 66-year-old patient with elevated liver enzymes.

E. A 59-year-old patient with a history of diverticulitis.

F. A 74-year-old patient with a history of Alzheimer’s disease.

ANS: A, C, D See Contraindications/Precautions for bisoprolol: Use cautiously in renal impairment (dosage reduction recommended), hepatic impairment (dosage reduction recommended), pulmonary disease (including asthma; beta-1 selectivity may be lost at higher doses; avoid use if possible), diabetes mellitus (may mask signs of hypoglycemia), and thyrotoxicosis (may mask symptoms). There is no contraindication for gastroesophageal reflux, diverticulitis, or Alzheimer’s disease.

KEY: Cognitive Level: Analysis DIF: Hard TOP: Therapeutic Classification: Antihypertensives REF: Page 230

177. A nurse caring for a patient who is to initiate therapy with capsaicin (Zostrix) would include which of the following statements in the patient teaching? Select all that apply.

A. “This medication is used to treat local skin infections.”

B. “Apply the medication topically 3–4 times daily.”

C. “Keep the ointment away from the eyes or any open skin areas.”

D. “Rub the cream into the affected area well so little or no cream is left on the surface.”

E. “The medication helps reduce the pain associated with arthritis.”

F. “Capsaicin is taken in pill form on an empty stomach once daily.”

ANS: B, C, D, E See Indications, Contraindications, and Nursing Implications for capsaicin: Capsaicin offers temporary management of pain due to rheumatoid arthritis and osteoarthritis and treatment of pain associated with postherpetic neuralgia or diabetic neuropathy. It is not for use near eyes or on open or broken skin.

Topical: Apply to affected areas 3–4 times daily. Rub cream into affected area well so that little or no cream is left on the surface.

KEY: Cognitive Level: Analysis DIF: Medium TOP: Therapeutic Classification: Nonopioid analgesics (topical) REF: Pages 277–278

178. While providing initial chemotherapy teaching for a patient who is scheduled to receive cisplatin for metastatic ovarian cancer, the nurse recognizes that teaching has been effective by which of the following client statements? Select all that apply.

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A. “This medication is usually taken as a pill every day for a week.”

B. “You will need to check my lab values each time I’m due for chemotherapy to make sure I can safely take each scheduled treatment.”

C. “It is very important that I continue to take the medication that prevents nausea and vomiting consistently throughout my day of treatment.”

D. “Aside from nausea, this medication has few other side effects.”

E. “I may have nausea or loss of appetite for up to a week after taking this medication.”

F. “I will come into an infusion center to get my chemotherapy in an IV.” ANS: B, C, E, F See Nursing Implications for cisplatin: Severe and protracted nausea and vomiting usually occur 1–4 hr after a dose; vomiting may last for 24 hr. Administer parenteral antiemetic agents 30–45 min before therapy and routinely around the clock for the next 24 hr. Nausea and anorexia may persist for up to 1 wk.

Monitor CBC with differential and platelet count before and routinely throughout therapy. Additional side effects occur including bone marrow suppression, ototoxicity, neurotoxicity, and renal compromise. The medication is given as an intravenous infusion.

KEY: Cognitive Level: Analysis DIF: Medium TOP: Therapeutic Classification: Antineoplastics REF: Pages 324–325

179. Which of the following would cause the nurse to suspect that a patient taking escitalopram (Lexapro) may be developing serotonin syndrome? Select all that apply.

A. Pulse = 122 bpm B. Patient reports seeing blue spiders on the wall.

C. Patient’s blood glucose = 93 g/dL. D. Patient complains of nausea and diarrhea.

E. White blood cell count = 5,500 cell/mm3.

F. Urinary output = 600 mL in 8 hr.

ANS: A, B, D See Nursing Implications for escitalopram. Assess for serotonin syndrome (mental changes [agitation, hallucinations, and coma], autonomic instability [tachycardia, labile blood pressure, and hyperthermia], neuromuscular aberrations [hyperreflexia and incoordination], and/or GI symptoms [nausea, vomiting, and diarrhea]), especially in patients taking other serotonergic drugs (SSRIs, SNRIs, or triptans).

KEY: Cognitive Level: Analysis DIF: Hard TOP: Therapeutic Classification: Antidepressants REF: Page 525

180. The nurse is caring for a patient taking esomeprazole (Nexium). The nurse knows teaching has been effective by which of the following statements? Select all that apply.

A. “I should take this pill with my meals.”

B. “This medication helps reduce the release of stomach acid and reduces my reflux.”

C. “I should not chew or crush the pellets.”

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D. “If I miss a dose, it should be skipped for the day.”

E. “I’ve eliminated alcohol from my diet completely.”

F. “I can keep taking Advil for my arthritis pain.”

ANS: B, C, E See Nursing Implications for esomeprazole: Esomeprazole is an antiulcer agent that prevents the final transport of hydrogen ions into the gastric lumen. It is given at least 1 hr before meals. Capsules should be swallowed whole; do not crush or chew pellets. Advise patients to avoid alcohol, products containing aspirin or NSAIDs, and foods that cause an increase in GI irritation.

KEY: Cognitive Level: Analysis DIF: Medium TOP: Therapeutic Classification: Antiulcer agents REF: Pages 530–531

181. While providing care for a patient who receives furosemide (Lasix) 20 mg IV push twice daily, the nurse would include which of the following in the plan of care? Select all that apply.

A. Change the patient’s incontinence brief 30–60 min after medication administration.

B. Check patient’s platelet count prior to medication administration.

C. Schedule the first dose at 11 AM and the 2nd dose at 11 PM. D. Provide the dose undiluted.

E. Give the medication over 30 sec.

F. Institute high fall risk protocol interventions.

ANS: A, D, F See Action and Nursing Implications for furosemide. Furosemide half-life is 30–60 min, and urine production is expected. Electrolytes and renal and hepatic function should be monitored, but there is no expected effect on platelet level. If administering twice daily, give the last dose no later than 5 PM to minimize disruption of sleep cycle. Lasix can be given undiluted in a concentration of 10 mg/mL up to 20 mg/min. Elderly individuals are at higher risk for falls when taking diuretics.

KEY: Cognitive Level: Analysis DIF: Medium TOP: Therapeutic Classification: Diuretics REF: Pages 610–612

182. While reviewing a patient’s medication list, the nurse notes the patient takes gabapentin (Neurontin) 300 mg 3 times daily. The nurse recognizes this medication has multiple indications and is used both on and off label for various reasons including which of the following? Select all that apply.

A. Adjunct treatment of partial seizures B. Prevention of migraine headaches C. Treatment of diabetic peripheral neuropathy D. Treatment of postherpetic neuralgia E. Treatment for insomnia F. Reduction of increased intracranial pressure ANS: A, B, C, D

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See Indications for gabapentin: Partial seizures (adjunct treatment) and postherpetic neuralgia. Unlabeled uses: neuropathic pain, prevention of migraine headaches, bipolar disorder, anxiety, diabetic peripheral neuropathy.

KEY: Cognitive Level: Analysis DIF: Medium TOP: Therapeutic Classification: Analgesic adjunct therapeutic, Anticonvulsants, Mood stabilizers REF: Page 613

183. The nursing instructor is reviewing the administration of insulin-detemir (Levemir) via injectable pen. The instructor would be most concerned by which of the following statements by the student? Select all that apply.

A. “I have to rotate the pen a few times before I set the dose.”

B. “I need a special needle so I make sure to get the insulin into muscle tissue.”

C. “It is important to rotate sites to prevent tissue damage.”

D. “The expiration date is not important on single-patient administration devices.”

E. “This medication is usually given once a day with dinner or at bedtime.”

F. “I should store this pen in the refrigerator once I provide the dose.”

ANS: B, D, F See Implementation for Insulins (Long-Acting): Prior to withdrawing dose, rotate vial between palms to ensure uniform solution; do not shake. Insulin is provided subcutaneously. Rotate injection sites. After initial use, cartridges may be stored in a cool place for 42 days; expiration dates should be noted.

Administer daily with evening meal or at bedtime. Do not store in-use cartridges and prefilled syringes in refrigerator.

KEY: Cognitive Level: Analysis DIF: Medium TOP: Therapeutic Classification: Antidiabetics REF: Pages 707–708

184. The nurse is caring for a patient who is to start taking lithium (Lithobid) 300 mg 3 times daily.

Which of the following statements should be included in the patient teaching? Select all that apply.

A. “You will need to have blood levels checked frequently for the first few months of treatment.”

B. “You should report any muscle twitches or change in coordination since those could be symptoms of too much medication in your system.”

C. “This medication will help level out your mood.”

D. “Please make sure you limit your fluid intake to 3 glasses of liquid per day.”

E. “Avoid dairy products while you are taking this medication.”

F. “You must have a baseline electromyogram before you start this medication.”

ANS: A, B, C See Indications, Assessment, and Patient Teaching for Lithium: Monitor serum lithium levels twice weekly during initiation of therapy. Assess patient for signs and symptoms of lithium toxicity (vomiting, diarrhea, slurred speech, decreased coordination, muscle weakness, or twitching). Lithium is used in the treatment of manic episodes of manic depressive illness. Advise patients to drink at least 2,000–3,000 mL of fluid each day, avoiding coffee, tea, and cola due to the inherent diuretic property of the medication.

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Those with cardiovascular disease or over 40 years old should have a baseline ECG, but an EMG is not needed.

KEY: Cognitive Level: Analysis DIF: Hard TOP: Therapeutic Classification: Mood stabilizers REF: Pages 794–796

185. While admitting a patient to the medical unit at 9:30 AM for an acute episode of Crohn’s disease, the nurse learns the patient typically takes loperamide (Imodium A-D) 2 mg 4 times each day. The nurse recognizes that further patient teaching is needed by which of the following statements? Select all that apply.

A. “That is the medicine that helps control my diarrhea.”

B. “I have to be careful about loperamide when I’m taking my narcotic pain medication.”

C. “I didn’t take my loperamide this morning so I’d like to take 2 when it is due at 11 AM.” D. “I usually drink 1 or 2 beers a day.”

E. “I’m always sure to drink at least 10 glasses of water or juice each day.”

F. “I chew a lot of sugarless gum.”

ANS: C, D See Indications and Interactions for loperamide: Loperamide is used in the adjunctive treatment of acute diarrhea. Interactions include increased CNS depression with other CNS depressants. Patient/Family Teaching: Do not take missed doses and do not double doses. Avoid using alcohol and other CNS depressants concurrently. Administer with clear fluids to help prevent dehydration. Frequent mouth rinses, good oral hygiene, and sugarless gum may relieve dry mouth.

KEY: Cognitive Level: Analysis DIF: Medium TOP: Therapeutic Classification: Antidiarrheals REF: Pages 799–800

186. While providing discharge instructions for a patient who is taking naproxen (Naprosyn) for rheumatoid arthritis, the nurse would include which of the following statements? Select all that apply.

A. “You should limit your alcohol consumption to a maximum of 1 glass per day.”

B. “Please notify your physician if you notice your stools become dark or tarry in appearance.”

C. “Extended release tablets can be broken into smaller pieces to make it easier to swallow.”

D. “You should not take any over-the-counter products that contain aspirin while you are taking this medication.”

E. “Consult your doctor before taking anything that contains Tylenol.”

F. “Ringing in the ears is a potential side effect of this medication, so don’t worry if that happens.”

ANS: A, B, D, E See Patient/Family Teaching and Nursing Implications for naproxen. Caution patient to avoid the concurrent use of alcohol, aspirin, acetaminophen, or other OTC medications without consulting the health care professional. Use of naproxen with 3 or more glasses of alcohol per day may increase risk of GI bleeding. Advise patient to consult the physician if rash, itching, visual disturbances, tinnitus, weight

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gain, edema, black stools, persistent headache, or influenza-like syndrome (chills, fever, muscle aches, and pain) occur.

KEY: Cognitive Level: Analysis DIF: Hard TOP: Therapeutic Classification: Nonopioid analgesics, Nonsteroidal anti-inflammatory agents, Antipyretics REF: Pages 906–907

187. While caring for a client who chose to start taking niacin (vitamin B3) rather than a statin agent, the nurse determines that the treatment has been effective by which of the following findings? Select all that apply.

A. Serum triglyceride = 136 mg/dL B. Protein = 7.2 g/dL C. Prothrombin time = 12 sec D. Total cholesterol = 168 mg/dL E. Random glucose = 108 g/dL F. Glycosylated hemoglobin (A1C) = 4.4% ANS: A, D See Evaluation/Desired Outcomes for niacin. Niacin leads to a decrease in serum cholesterol and triglyceride levels. All listed levels are within normal limits, but niacin is taken to reduce lipid levels.

KEY: Cognitive Level: Analysis DIF: Hard TOP: Therapeutic Classification: Lipid-lowering agents, Vitamins REF: Druggide.com

188. The nurse is counseling a patient who wants to start using Nicorette (nicotine chewing gum). Which of the following statements indicates that teaching has been effective? Select all that apply.

A. “Since I used to smoke about 12 cigarettes a day, I will use the 2 mg gum.”

B. “I should not chew more than 5 pieces per day.”

C. “I should start out chewing 1 piece of gum every 1 or 2 hr.”

D. “I will gradually decrease the amount of gum I chew over about 10 weeks.”

E. “The gum comes in a number of flavors so I can have variety.”

F. “There are no side effects to the gum, so I can use more if I need it.”

ANS: A, C, D, E See Route/Dosage for nicotine gum: If a patient smokes >25 cigarettes per day, they should start with the 2 mg gum. If first cigarette is desired >30 min after waking, start with 2 mg gum. If first cigarette is desired <30 after waking, start with 4 mg gum. Patients should chew 1 piece of gum every 1–2 hr for 6 wk, then 1 piece of gum every 2–4 hr for 3 wk, then 1 piece of gum every 4–8 hr for 3 wk, and then discontinue. They should not exceed 24 pieces of gum/day. Chewing gum is available in cinnamon, mint, orange, and fruit chill flavors. Multiple side effects exist.

KEY: Cognitive Level: Analysis DIF: Medium

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TOP: Therapeutic Classification: Smoking deterrents REF: Page 916

189. The nurse is counseling a patient who is newly prescribed pregabalin (Lyrica). Which of the following statements should be included in the patient’s teaching? Select all that apply.

A. “This medication may increase depression or suicidal thoughts, so be sure to notify your physician if this occurs.”

B. “The medication is used to reduce the pain associated with diabetic neuropathy.”

C. “Do not stop using this medication quickly.”

D. “Weight loss and decreased interest in food may be experienced with this medication.”

E. “Call the doctor right away if you have muscle pain or weakness.”

F. “You must take this medication with your meals to avoid severe gastric irritation.”

ANS: A, B, C, E See Indications and Patient/Family Teaching and Implementation for pregabalin: Pregabalin is used in the treatment of diabetic neuropathy. Do not discontinue abruptly. Instruct patient to promptly report unexplained muscle pain, tenderness, or weakness. Advise patient and family to notify their health care professional if thoughts about suicide or dying, new or worse depression, or anxiety occur. Weight gain and edema are potential side effects. The medication can be taken without regard to food.

KEY: Cognitive Level: Analysis DIF: Hard TOP: Therapeutic Classification: Analgesics, Anticonvulsants REF: Pages 1055–1057

190. A nurse working in the psychiatric unit receives report for a new patient being admitted with symptoms of depressive disorder and possible schizophrenia. The nurse knows the treatment regimen may include which of the following medications? Select all that apply.

A. Quinidine (Apo-Quinidine) B. Quetiapine (Seroquel) C. Glimepiride (Amaryl) D. Risperidone (Risperdal) E. Temazepam (Restoril) F. Tiotropium (Spiriva Respimat) ANS: B, D See Indications for each medication listed. Quetiapine is used in schizophrenia and depressive episodes with bipolar disorder. Risperidone is used for schizophrenia in adults and adolescents ages 13–17.

Quinidine is used to restore and maintain sinus rhythm in patients with atrial fibrillation. Temazepam is used in the short-term management of insomnia. Tiotropium is used in the long-term maintenance treatment of bronchospasm.

KEY: Cognitive Level: Analysis DIF: Hard TOP: Therapeutic Classification: Antipsychotics REF: Drugguide.com (Quinidine and temazepam) | Page 1075 | Page 1160 | Page 1103 | Page 1209

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191. While planning care for a patient who takes ropinirole (Requip), the nurse would develop which of the following nursing diagnoses? Select all that apply.

A. Impaired gas exchange related to chronic obstructive pulmonary disease B. Decreased cardiac output related to heart failure C. Impaired physical mobility related to Parkinson’s disease D. Risk for injury related to fall risk E. Risk for fluid volume deficit related to diuresis F. Ineffective coping related to depression.

ANS: C, D See Indication and Potential Nursing Diagnoses. Ropinirole is used in the management of signs and symptoms of idiopathic Parkinson disease. Impaired physical mobility and risk for injury are potential nursing diagnoses.

KEY: Cognitive Level: Analysis DIF: Medium TOP: Therapeutic Classification: Antiparkinson agents REF: Pages 1118-1119

192. Prior to administering Lovaza, what laboratory values should be obtained? Select all that apply.

A. Na+ B. K+ C. HDL D. LDL E. Triglycerides F. LFT ANS: C, D, E See Indications and Nursing Implications/Labs for Lovaza: used to treat high triglyceride levels; that is, those greater than 500 mg/dL. High-density lipoproteins and triglycerides should be monitored to gauge effectiveness of the medication. Low-density lipoproteins may increase because of the medication and should be monitored during pharmacologic treatment with Lovaza.

Key: Cognitive Level: Analysis DIF: Medium TOP: Therapeutic Classification: Lipid-lowering agents REF: Pages 954–955

193. A patient in the hospital is going to receive her first dose of zoledronic acid (Reclast) prior to being discharged from the hospital. Which of the following actions are required of the nurse? Select all that apply.

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A. Keep patient NPO for 1 hr after the first dose is given.

B. Encourage high fluid intake within a few hrs prior to the administration of Reclast.

C. Assess patency of intravenous line.

D. Select a syringe that will provide deep tissue injection.

E. Provide patient with written instruction for follow-up dose in 2 mo.

F. Tell patient to notify the health care provider if he or she has muscle spasms or cramps.

ANS: B, C, F See Indications, Nursing Implications, and Patient/Family Teaching for Reclast: Reclast is prescribed to increase bone mass and is administered annually via intravenous infusion. Reclast is associated with serious side effects such as hypocalcemia and severe kidney problems. Those taking Reclast should notify their health care provider immediately if they experience muscle spasms or muscle cramps because these are indicative of hypocalcemia. To decrease potential side effects on the kidney, it is recommended that at least 2 glasses of water should be consumed within the hours prior to the administration of Reclast.

KEY: Cognitive Level: Synthesis DIF: Medium TOP: Therapeutic Classification: Bone resorption inhibitors, Electrolyte modifiers, Hypocalcemics REF: Pages 1292–1294

194. Which laboratory values should be monitored for a person receiving heparin? Select all that apply.

A. CBC B. WBC C. PT D. aPTT E. Platelet count F. D-dimer ANS: A, D, E See Nursing Implications/Lab Test Considerations, Evaluation/Desired Outcomes for heparin: The CBC includes a hemoglobin and hematocrit. The aPTT is activated partial thromboplastin time and should be 1.5–2.5 times the control level, without signs of hemorrhage. A platelet count should be monitored to provide early identification of heparin-induced thrombocytopenia.

KEY: Cognitive Level: Analysis DIF: Medium TOP: Therapeutic Classification: Anticoagulants REF: Page 647

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195. An oral dose of zinc sulfate is being prescribed for a patient in the wound clinic. Patient education should emphasize that the following products should not be taken with zinc sulfate because they will decrease absorption. Select all that apply.

A. Caffeine products B. Bran C. Dairy products D. Seafood ANS: A, B, C See Indications, Assessment and Patient/Family Teaching for Zinc sulfate: Zinc is necessary for tissue repair and wound healing. Those with impaired wound healing may be prescribed zinc sulfate as a supplement to dietary intake. Zinc sulfate should be taken with food to decrease gastrointestinal irritation.

However, zinc sulfate should not be taken with caffeine products, dairy products, and bran, as these will decrease the absorption of zinc. Seafood is a source of food that is high in zinc.

KEY: Cognitive Level: Analysis DIF: Medium TOP: Therapeutic Classification: Mineral supplement REF: Drugguide.com

196. Which of the following laboratory values must be closely monitored when taking amiodarone (Pacerone)? Select all that apply.

A. Liver function tests B. Thyroid level C. Electrolytes D. Chest x ray E. Pulmonary function tests ANS: A, B, C, D, E See Nursing Implications/Lab Test Considerations, and Patient/Family Teaching for Amiodarone: Liver and thyroid function tests need to be monitored before treatment and every 6 mo after initiation of amiodarone because of the high risk for liver toxicity and thyroid dysfunction. May cause hypokalemia, hypocalcemia, and hypomagnesemia. A chest x ray and pulmonary function tests need to be monitored every 3–6 mo because of risk for pulmonary toxicity and acute respiratory distress syndrome.

KEY: Cognitive Level: Synthesis DIF: Hard TOP: Therapeutic Classification: Antiarrhythmics REF: Pages 143–144

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197. When administering bisacodyl, which of the following implications should the nurse consider?

Select all that apply.

A. Increase fluid intake up to 2,000 mL/day.

B. Administer with food.

C. Dilute with normal saline prior to administration.

D. Assess fluid and electrolyte status.

E. If giving rectally, encourage retention of enema for 15–30 min.

ANS: A, D, E See Indications and Nursing Implications, and Patient/Family Teaching for Bisacodyl: Bisacodyl is a laxative that will alter fluid and electrolyte transport, producing accumulation of fluid in the colon.

Encourage fluid intake from 1,500–2,000 mL/day to prevent dehydration. Do not give oral dose with food. It is best to take bisacodyl on an empty stomach. If given rectally, lubricate the enema with watersoluble lubricant with insertion and encourage retention of enema for 15–30 min.

KEY: Cognitive Level: Application DIF: Easy TOP: Therapeutic Classification: Laxatives REF: Pages 229–230

198. After the administration of rifampin, what should be included in patient education? Select all that apply.

A. Take dose at the same time daily.

B. Avoid use of soft contacts while taking rifampin.

C. If taking oral contraceptives, an alternate form should be used.

D. Keep medication refrigerated until time of use.

E. Notify patient that bodily fluids such as sweat, urine, saliva, and feces may turn reddish-orange in color.

ANS: A, B, C, E See Indications and Patient/Family Teaching for rifampin: used for the treatment and prevention of tuberculosis. It must be taken at the same time daily even when symptoms have subsided. People receiving this drug should know that soft contacts will be permanently discolored if worn while taking rifampin. In addition, saliva, tears, sweat, urine, feces, and sputum will change to a red-orange or redbrown color. The effectiveness of oral contraceptives may be decreased. The use of a nonhormonal form of contraceptives should be used while on rifampin.

KEY: Cognitive Level: Synthesis DIF: Hard TOP: Therapeutic Classification: Antituberculars REF: Pages 1097–1099

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199. A person taking Questran should restrict intake of foods high in which of the following components?

Select all that apply.

A. Sugar B. Fat C. Carbohydrates D. Cholesterol E. Potassium F. Sodium ANS: B, C, D See Indications, Assessment, and Patient/Family Teaching for Questran. Questran is a lipid-lowering agent used in the treatment of hypercholesterolemia or to treat pruritis associated with increased bile acids. Questran should be taken in conjunction with a diet that will aid in lowering cholesterol and lowdensity lipoproteins. Foods that are high in fats, carbohydrates, and cholesterol should be avoided.

KEY: Cognitive Level: Application DIF: Easy TOP: Therapeutic Classification: Lipid-lowering agents REF: Drugguide.com

200. Which of the following assessments should cause concern for a patient who is receiving vancomycin? Select all that apply.

A. Black, furry growth on the tongue B. Tinnitus C. Vertigo D. Yellow sclera E. Pink-tinged urine ANS: A, B, C, E See Adverse Reactions/Side Effects, and Nursing Implications/Assessment for vancomycin: Black, furry growth on the tongue is associated with a superinfection and should be reported immediately. Tinnitus and vertigo are associated with ototoxicity. Pink-tinged urine may be a sign of nephrotoxicity. Yellow sclera does not occur as an adverse reaction or side effect of vancomycin.

KEY: Cognitive Level: Synthesis DIF: Hard TOP: Therapeutic Classification: Anti-infectives REF: Pages 1248–1250

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201. The nurse is providing education for an immunosuppressed patient with recurrent oral herpes simplex lesions (cold sores) who is being treated with topical acyclovir ointment. Which of the following statements would be included in the nurse’s teaching? Select all that apply.

A. “Apply the ointment every 3 hr each day for 7 days.”

B. “Other topical ointments should be avoided as they may cause the lesions to spread or worsen.”

C. “This medication should cure the lesions and recurrence is rare.”

D. “You should wear a glove when applying the ointment to prevent spreading.”

E. “You cannot eat or drink for 2 hr after application.”

F. “There are no activity restrictions while you are taking this medication.”

ANS: A, B, D See Route/Dosage and Patient/Family Teaching for acyclovir: Instruct patient to apply ointment in sufficient quantity to cover all lesions every 3 hr, 6 x day for 7 days. Additional use of OTC creams, lotions, and ointments may delay healing and may cause spreading of lesions. Use a finger cot or glove when applying to prevent inoculation of other areas or spread to other people. Inform patient that acyclovir is not a cure. The virus lies dormant in the ganglia, and acyclovir will not prevent the spread of infection to others. No eating or drinking restrictions are required. No sexual contact should be made while lesions are present.

KEY: Cognitive Level: Analysis DIF: Medium TOP: Therapeutic Classification: Antivirals REF: Pages 106–109

202. A nurse working in the intensive care unit would expect albumin as part of the treatment plan for which of the following patients? Select all that apply.

A. A 33-year-old patient with profound aplastic anemia B. A 55-year-old patient with 2nd- and 3rd-degree burns to 40% of the body C. A 29-year-old patient with rectal bleeding D. A 71-year-old patient with lung cancer and congestive heart failure E. A 68-year-old patient with symptoms of septic shock F. A 37-year-old patient with end-stage liver disease ANS: B, C, E, F See Indications for albumin. These include expansion of plasma volume and maintenance of cardiac output in situations associated with fluid volume deficit, including shock, hemorrhage, and burns.

Temporary replacement of albumin in diseases associated with low levels of plasma proteins, such as nephrotic syndrome or end-stage liver disease, results in relief or reduction of associated edema. Albumin is contraindicated in patients with allergic reactions to albumin, severe anemia, CHF, and normal or increased intravascular volume.

KEY: Cognitive Level: Application DIF: Hard TOP: Therapeutic Classification: Volume Expanders REF: Drugguide.com

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203. The nurse is providing care for a patient with recurrent lymphocytic leukemia who is receiving weekly treatment with alemtuzumab (Lemtrada). Which of the following lab results would the nurse be expected to monitor prior to initiating therapy? Select all that apply.

A. Prothrombin time (PTT) B. Urine-specific gravity C. White blood cell count (WBC) D. Platelet count E. CD8 count F. Red blood cell count (RBC) ANS: C, D, F See Assessment for alemtuzumab. Lab Test Considerations: Obtain CBC and platelet counts weekly during therapy and more frequently if worsening anemia, neutropenia, or thrombocytopenia is observed.

CD4 counts are assessed after treatment until recovery.

KEY: Cognitive Level: Application DIF: Medium TOP: Therapeutic Classification: Antineoplastics REF: Drugguide.com

204. The nurse is caring for a patient receiving intravenous antibiotic therapy with tobramycin 100 mg every 8 hr. Which of the following nursing actions are appropriate for this medication? Select all that apply.

A. Mixed IVPB solutions are stable at room temperature for 24 hr.

B. IVPB doses should be administered over 30–60 min.

C. Monitor the patient for signs of tinnitus, dizziness, or hearing loss.

D. Monitor renal function before and during therapy.

E. May mix or infuse simultaneously with other antibiotics.

F. Monitor for symptoms of a super infection.

ANS: A, B, C, D, F See Nursing Implications/IV Administration (tobramycin) for Aminoglycosides: IVPB mixtures are stable for 24 hr at room temperature. Infuse slowly over 30–60 min in both adult and pediatric patients.

Evaluate the 8th cranial nerve function by audiometry before and throughout therapy. Hearing loss is usually in the high-frequency range. Prompt recognition and intervention are essential in preventing permanent damage. Also monitor for vestibular dysfunction (vertigo, ataxia, nausea, and vomiting).

Monitor renal function by urinalysis, specific gravity, BUN, creatinine, and CCr before and during therapy. Manufacturer recommends administering separately; do not admix. Assess patient for signs of super infection.

KEY: Cognitive Level: Application DIF: Hard TOP: Therapeutic Classification: Anti-infectives REF: Pages 138–140

205. A nurse providing hypertension screening and education recognizes which of the following medications as an ACE inhibitor? Select all that apply.

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A. Atenolol (Tenormin) B. captopril C. Enalapril (Vasotec) D. Eprosartan (Teveten) E. Benazepril (Lotensin) F. Candesartan (Atacand) ANS: B, C, E See drug list for angiotensin-converting enzyme inhibitors. ACE inhibitors can be recognized by the ending “pril.” Atenolol is a beta blocker—recognized by the ending “olol.” Teveten and Atacand are angiotensin II receptor antagonists—recognized by the ending “sartan.”

KEY: Cognitive Level: Knowledge DIF: Medium TOP: Therapeutic Classification: Antihypertensives REF: Page 161

206. The nurse is teaching a patient with prostate cancer about the planned treatment of bicalutamide (Casodex) and goserelin (an LHRH analog). Which of the following statements should be included in the patient teaching? Select all that apply.

A. “Diarrhea is common, so it is important to increase fluid intake.”

B. “You may experience hot flashes while taking these medications.”

C. “The doctor will follow CA-125 levels periodically to monitor the tumor’s response to the medications.”

D. “You may experience hair loss while taking Casodex.”

E. “These medications block the effects of testosterone in your body and keep the prostate cancer from growing.”

F. “You must take this medication first thing in the morning while sitting upright and wait for at least an hour before eating anything.”

ANS: A, B, D, E See Nursing Implications and Adverse Reactions/Side Effects for bicalutamide: Diarrhea and hot flashes are common with Casodex, and potential hair loss should be discussed. Casodex antagonizes the effects of androgen at the cellular level and is used to decrease the spread of prostate cancer. Prostate-specific antigen levels are followed to indicate tumor response. Casodex can be taken without regard to food.

KEY: Cognitive Level: Application DIF: Hard TOP: Therapeutic Classification: Antineoplastics REF: Pages 224–225 and 635–636

207. The nurse is providing care for a 59-year-old patient with a long-term history of asthma for an acute exacerbation. The client is started on an infusion of aminophylline. Which of the following orders would the nurse expect to be written?

A. Place on telemetry and monitor patient for reports of chest pain.

B. Theophylline levels every 6 hr ×4.

C. O2 to keep saturation >93%.

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D. Strict I/O. E. NG to intermittent suction.

F. Pleurovac to 20 cm water seal.

ANS: A, B, C, D See Assessment for Aminophylline. Aminophylline is a xanthine. Patients with a history of cardiovascular problems should be monitored for chest pain and ECG changes. Monitor drug levels routinely. Ensure that oxygen therapy is correctly instituted during acute asthma attacks. Monitor intake and output ratios for an increase in diuresis or fluid overload.

KEY: Cognitive Level: Analysis DIF: Hard TOP: Therapeutic Classification: Bronchodilators REF: Drugguide.com

208. Which of the following lab values must be monitored during therapy with carbamazepine (Tegretol)?

Select all that apply.

A. Uric acid level B. Hemoglobin C. Creatinine D. Alkaline phosphatase E. Platelet count F. Serum iron ANS: B, E, F See Nursing Implications/Lab Test Considerations for carbamazepine: Monitor CBC, including platelet count, reticulocyte count, and serum iron, weekly during the first 2 mo and yearly thereafter for evidence of potentially fatal blood cell abnormalities. Medication should be discontinued if bone marrow depression occurs.

KEY: Cognitive Level: Knowledge DIF: Hard TOP: Therapeutic Classification: Anticonvulsants REF: Page 280

209. The nurse is preparing to provide the first dose of cefepime (Maxipime) 1 g in 50 mL D5W via intravenous piggyback to a patient diagnosed with febrile neutropenia. Place the following steps in the appropriate order: A. Set rate at 100 mL/hr.

B. Verify right drug, dose, and time.

C. Observe for symptoms of anaphylaxis.

D. Discontinue the infusion.

E. Verify correct patient using 2 identifiers.

F. Begin infusion.

ANS: B, E, A, F, C, D

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See Nursing Implications for cefepime. Correct medication administration requires using the 5 rights— right medication, right dose, right time, right route, and right patient. The medication order (drug, dose, route, and time) should be verified when the nurse obtains the medication in preparation for provision.

The right patient should be identified using 2 patient identifiers once the drug is verified. Maxipime should be infused over 30 min (100 mL/hr), and the patient should be monitored for signs of anaphylaxis.

Finally the infusion can be discontinued upon completion.

Verify right drug, dose, and time.

Verify correct patient using 2 identifiers.

Set IV pump rate at 100 mL/hr.

Begin infusion.

Observe for symptoms of anaphylaxis.

Discontinue the infusion.

KEY: Cognitive Level: Application DIF: Hard TOP: Therapeutic Classification: Anti-infectives REF: Pages 293294

210. A nurse assisting in the care of an elderly patient who received PO chlordiazepoxide (Librium) in the treatment of acute alcohol intoxication would include which of the following in the plan of care? Select all that apply.

A. Place patient in leather restraints.

B. Institute seizure precautions.

C. Assess for tremors.

D. Administer higher doses in morning E. Institute fall precautions.

F. Administer after meals or with milk ANS: B, C, E, F See Assessment for chlordiazepoxide: With alcohol withdrawal assess for tremors, agitation, delirium, and hallucinations. Protect patient from injury. Institute seizure precautions. Geri: Assess risk of falls and institute fall prevention strategies. Administer greater dose at bedtime to avoid daytime sedation. Patients should only be placed in restraints as a last resort—there are no indications restraints are needed in this scenario. Administer Librium after meals or with milk to minimize GI irritation.

KEY: Cognitive Level: Comprehension DIF: Medium TOP: Therapeutic Classification: Antianxiety agents REF: drugguide.com

211. Which of the following medications can be used to prevent or treat nausea and vomiting? Select all that apply.

A. Chlorpromazine B. Ondansetron (Zofran) C. Epinephrine (Adrenaline) D. Metoclopramide (Reglan)

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E. Aprepitant (Emend) F. Clonidine (Catapres) ANS: A, B, D, E See Classification for chlorpromazine, ondansetron, epinephrine, metoclopramide, aprepitant, and clonidine: Medications that prevent or treat nausea and vomiting are known as antiemetics.

KEY: Cognitive Level: Knowledge/Comprehension DIF: Medium TOP: Therapeutic Classification: Antiemetics REF: Drugguide.com (chlorpromazine) | Page 957 | Page 505 | Page 856 | Page 178 | Page 334

212. The nurse providing patient education about cholestyramine (Questran) would include which of the following statements in the education? Select all that apply.

A. “Diarrhea may occur.”

B. “This medication should be taken before meals.”

C. “It can be mixed with water, milk, juice, or another noncarbonated beverage.”

D. “It is still important to follow a low-fat, low-cholesterol diet.”

E. “Notify the physician if your stool becomes frothy or foul smelling.”

F. “This medication may cause dry mouth or a rapid heart rate; that is normal.”

ANS: B, C, D, E See Patient/Family Teaching for cholestyramine: Instruct patient to take medication before meals. Mix cholestyramine with 4–6 oz water, milk, fruit juice, or other noncarbonated beverages. Shake vigorously.

Slowly stir in a large glass. Rinse glass with small amount of additional beverage to ensure all medication is taken. Advise patient that this medication should be used in conjunction with dietary restrictions (fat, cholesterol, carbohydrates, and alcohol), exercise, and cessation of smoking. Explain that constipation may occur. Increase in fluids and bulk in diet, exercise, stool softeners, and laxatives may be required to minimize the constipating effects. Instruct patient to notify a health care professional if constipation, nausea, flatulence, and heartburn persist or if stools become frothy and foul smelling.

KEY: Cognitive Level: Analysis DIF: Medium TOP: Therapeutic Classification: Lipid-lowering agents REF: Drugguide.com

213. The nurse is preparing to provide amlodipine (Norvasc) to a 69-year-old patient with a history of multifocal premature ventricular contractions (PVCs). His cardiac monitor has shown normal sinus rhythm with rare PVCs for the past 24 hr. Which of the following assessment findings would cause the nurse to withhold the medication? Select all that apply.

A. Blood pressure = 86/50 B. Blood pressure = 112/68 C. Pulse = 88 bpm D. Pulse = 48 bpm E. Monitor shows normal sinus rhythm F. Monitor shows 3 PVCs in past 24 hr

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ANS: A, D See Nursing Implications for amlodipine: Norvasc is used in the management of hypertension, angina pectoris, and vasospastic angina. Monitor blood pressure and pulse before therapy, during dose titration, and periodically during therapy. Contraindicated in systolic blood pressure less than 90 mmHg. Instruct patient to contact health care provider if heart rate is less than 50 bpm.

KEY: Cognitive Level: Application/Analysis DIF: Medium TOP: Therapeutic Classification: Antihypertensives REF: Pages 147–148

214. Which of the following are classified as potassium-sparing diuretics? Select all that apply.

A. Furosemide (Lasix) B. Spirinolactone (Aldactone) C. Triamterene (Dyrenium) D. Chlorothiazide (Diuril) E. Amiloride (Midamor) F. Hydrochlorothiazide (Microzide) ANS: B, C, E See Drug List/Classification for Diuretics (potassium sparing, thiazide) and furosemide: Aldactone, Dyrenium, and Midamor are all potassium-sparing diuretics. Furosemide is a loop diuretic and depletes potassium. Diuril and Microzide are thiazide diuretics and deplete potassium.

KEY: Cognitive Level: Knowledge DIF: Medium TOP: Therapeutic Classification: Diuretics REF: Page 610 | Page 447 | Page 447 | Page 449 | Page 447 | Page 449

215. A nurse working with patients in an HIV clinic recognizes the following medications as antivirals that may be included in patient medication regimens. Select all that apply.

A. Famciclovir (Famvir) B. Emtricitabine (Emtriva) C. Efavirenz (Sustiva) D. Etodolac (Lodine) E. Everolimus (Afinitor) F. Etanercept (Enbrel) ANS: A, B, C See Indications for famciclovir, emtricitabine, efavirenz, etodolac, everolimus, and etanercept. Famvir, Emtriva, and Sustiva are all antivirals or antiretrovirals used in the treatment of HIV or in the treatment of recurrent herpes simplex virus infection in patients with HIV. Etodolac and Enbrel are used in the treatment of arthritis. Afinitor is a chemotherapy agent.

KEY: Cognitive Level: Knowledge DIF: Hard TOP: Therapeutic Classification: Antiretrovirals

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REF: Drugguide.com (Sustiva) | Page 553 | Page 495 | Page 541 | Page 543 | Page 538

216. The nurse is counseling a patient who has been given a prescription for fluoxetine (Prozac). Which of the following statements should the nurse include in the patient’s teaching? Select all that apply.

A. “The medicine can cause some dizziness, so you should change position slowly.”

B. “Sugarless gum or candy may help the feeling of dry mouth that some patient’s experience with this medicine.”

C. “Most likely you will notice a huge change in your mood immediately.”

D. “You may experience a decrease in your sex drive while on this medication.”

E. “It is important to wear protective clothing and sunscreen since the drug can cause increased sensitivity to the sun.”

F. “This medicine should always be taken on an empty stomach.”

ANS: A, B, D, E See Patient/Family Teaching and Desired Effects for fluoxetine: Caution patient to change positions slowly to minimize dizziness. Inform patient that frequent mouth rinses, good oral hygiene, and sugarless gum or candy may minimize dry mouth. Inform patient that medication may cause decreased libido.

Caution patient to wear protective clothing and use sunscreen to prevent photosensitivity reactions. May be administered with food to minimize GI irritation.

KEY: Cognitive Level: Analysis DIF: Medium TOP: Therapeutic Classification: Antidepressants REF: Page 597

217. The nurse is caring for a patient who had a total hip replacement yesterday. Based on the patient’s risk of developing deep vein thrombosis or pulmonary emboli, which of the following would the nurse expect to find in the patient’s plan of care? Select all that apply.

A. Bilateral thigh-high sequential compression stockings B. Dalteparin (Fragmin) 5,000 IU SQ every day C. Strict bed rest for 3 days D. Vital signs and pulse oximetry every 4 hr E. Enoxaparin (Lovenox) 30 mg IV push—single dose now F. Aspirin 650 mg every 4 hr while awake ANS: A, B, D See Nursing Implications for Heparins (low molecular weight): Compression device stockings are routinely used in the prevention of DVT and PE postoperatively. Fragmin is dosed 5000 IU evening before surgery, then once daily for 5–10 days. Patients are encouraged to increase activity unless contraindicated; most patients with hip replacement surgery are assisted out of bed on the first postoperative day. Intravenous push Lovenox is used in the treatment of acute ST segment MI, not as DVT prophylaxis. Instruct patient not to take aspirin or NSAIDs without consulting a health care professional while on therapy since aspirin products will increase the risk of bleeding.

KEY: Cognitive Level: Application DIF: Medium TOP: Therapeutic Classification: Anticoagulants

Davis’s Drug Guide for Nurses, 17e

Test Bank-93

REF: Pages 648–649

218. The nurse is providing care for a patient who is to take cimetidine (Tagamet) 400 mg BID upon discharge. Which of the following statements should the nurse include in the patient’s teaching? Select all that apply.

A. “The medication may make your stool black; this is normal.”

B. “Smoking interferes with the action of this medication, so it is important not to smoke after taking your last dose of the day.”

C. “Do not take any over-the-counter medications with aspirin or nonsteroidal anti-inflammatory agents without talking to your physician.”

D. “You should take this medication first thing in the morning on an empty stomach.”

E. “This medication may make you feel sleepy.”

F. “This medication will improve your heartburn symptoms and help reduce stomach acid from irritating your esophagus.”

ANS: B, C, E, F See Patient/Family Education and Evaluation/Desired Outcomes for Histamine H2 Antagonists: Advise patient to report onset of black, tarry stools; fever; sore throat; diarrhea; dizziness; rash; confusion; or hallucinations to a health care professional promptly. Inform patient that smoking interferes with the action of histamine antagonists. Encourage patient to quit smoking or at least not to smoke after last dose of the day. Administer with meals or immediately afterward and at bedtime to prolong effect. It may cause drowsiness or dizziness. Caution patient to avoid driving or other activities requiring alertness until response to the drug is known. Advise patient to avoid alcohol, products containing aspirin or NSAIDs, and foods that may cause an increase in GI irritation. Decreased symptoms of esophageal reflux and treatment of heartburn, acid indigestion, and sour stomach.

KEY: Cognitive Level: Application DIF: Medium TOP: Therapeutic Classification: Antiulcer agents REF: Page 655

219. While caring for elderly residents in a nursing home, the nurse recognizes the use of ibuprofen (Advil) places these clients at increased risk for which of the following? Select all that apply.

A. Gastrointestinal bleeding B. Renal toxicity C. Hepatic toxicity D. Cerebrovascular accident E. Pulmonary embolism F. Peripheral vascular disease ANS: A, B, C See Nursing Implications for ibuprofen. Geri: Higher risk for poor outcomes or death from GI bleeding.

Age-related renal impairment increases risk of hepatic and renal toxicity. Assess for signs and symptoms of GI bleeding (tarry stools, lightheadedness, and hypotension), renal dysfunction (elevated BUN and creatinine levels and decreased urine output), and hepatic impairment (elevated liver enzymes and jaundice).

Davis’s Drug Guide for Nurses, 17e

Test Bank-94

KEY: Cognitive Level: Knowledge DIF: Medium TOP: Therapeutic Classification: Antipyretics, antirheumatics, nonopioid analgesics, nonsteroidal antiinflammatory agents REF: Page 678

220. The nurse caring for a patient taking hydrochlorothiazide and digoxin (Lanoxin) instructs the patient to notify the physician with which of the following symptoms? Select all that apply.

A. Systolic blood pressure less than 150 B. Anorexia, nausea, and vomiting C. Muscle cramps D. Confusion E. Numbness and tingling in extremities F. Nocturia ANS: B, C, D, E See Nursing Implications for Diuretics (thiazide) and Lanoxin: Assess patient, especially if taking digoxin, for anorexia, nausea, vomiting, muscle cramps, paresthesia, and confusion; report signs of electrolyte imbalance. Patients taking digoxin have an increased risk of digitalis toxicity due to the potassium-depleting effect of the diuretic. Hydrochlorothiazide is an antihypertensive/diuretic; systolic BP less than 150 is a desired effect; nocturia may be present when the patient is taking a diuretic.

KEY: Cognitive Level: Application DIF: Medium TOP: Therapeutic Classification: Antihypertensives, Antiarrhythmics REF: Pages 436–437 | Pages 449–450

221. A patient with newly diagnosed type 2 diabetes has been instructed on administration of insulin, human inhalation (Afrezza). Which of the following statements should be included in the patient teaching? Select all that apply.

A. Administer at beginning of each meal.

B. Do not take your subcutaneous insulin with Afrezza.

C. Use the Afrezza inhaler upside down.

D. Avoid smoking while taking inhaled insulin.

E. Monitor blood glucose every 6 hr.

E. Monitor your weight daily. Afrezza may cause weight loss.

ANS: A, D, E See Assessment and Patient/Family Teaching for Insulin, Human Inhalation (Afrezza): Afrezza should be administered at the beginning of each meal. It must be used in combination with subcutaneous long-acting insulin. The inhaler must be level while in use. Patients should not smoke while using Afrezza. Monitor blood glucose every 6 hr. Afrezza may cause weight gain.

KEY: Cognitive Level: Application DIF: Medium TOP: Therapeutic Classification: Insulins REF: Drugguide.com

Davis’s Drug Guide for Nurses, 17e

Test Bank-95

COMPLETION

222. The nurse receives new orders to start clindamycin 25 mg/kg/day in 4 equal intravenous doses every 6 hr to a child who weighs 20 kg. The dose of medication the nurse should provide with each administration is ___________________mg.

ANS: 125 KEY: Cognitive Level: Application DIF: Medium TOP: Therapeutic Classification: Anti-infectives REF: Page 330

223. The nurse is caring for a patient in the intensive care unit who is to be started on dopamine 1 mcg/kg/min. The patient weighs 220 pounds. The drip rate in mg/hr should be ____________________.

ANS: 6 KEY: Cognitive Level: Application DIFF: Hard TOP: Therapeutic Classification: Inotropics, Vasopressors REF: Page 464

224. Prior to initiating continuous drip intravenous therapy with dopamine, the nurse checks the infusion bag that lists 250 mg dopamine has been added to 250 mL of 0.9 NS. The nurse determines the concentration, expressed as mg/mL, is ____________________.

ANS: 1 KEY: Cognitive Level: Application DIF: Easy TOP: Therapeutic Classification: Inotropics, Vasopressors REF: Page 464

225. A nurse working in the neonatal intensive care unit receives an order to provide furosemide (Lasix) 2 mg/kg orally now. The neonate weighs 2.5 kg, and the medication is available as a liquid with a concentration of 10 mg/mL. The calculated dose the nurse will provide in mL is __________________ mL. ANS: 0.5 KEY: Cognitive Level: Application DIF: Medium TOP: Therapeutic Classification: Diuretics

Davis’s Drug Guide for Nurses, 17e

Test Bank-96

REF: Page 610

226. The nurse is caring for a patient who is to receive 40 mg of furosemide (Lasix) as an intravenous push. If the recommended administration time is 20 mg/min, the nurse will take ____________________ min to administer the medication.

ANS: 2 KEY: Cognitive Level: Application DIF: Easy TOP: Therapeutic Classification: Diuretics REF: Page 610

227. The nurse is caring for a patient who reports taking 20 mg nifedipine (Adalat CC) 3 times daily. The hospital has 10 mg capsules. The patient should take ____________________ capsules in a 24-hr period.

ANS: 6 KEY: Cognitive Level: Application DIF: Easy TOP: Therapeutic Classification: Antianginals, Antihypertensives REF: Page 917

228. A nurse in the intensive care unit is establishing a continuous infusion of norepinephrine (Levophed). The pharmacy has supplied 1,000 mL of D5NS with 4 mg of norepinephrine. In terms of mL/hr, the rate the nurse should program into the pump to keep the patient on a continuous infusion of 2 mcg/min is ____________________.

ANS: 30 mL/hr KEY: Cognitive Level: Application DIF: Medium TOP: Therapeutic Classification: Vasopressors REF: Page 934

229. The nurse is caring for a 9-day-old infant who weighs 4.5 kg. IV penicillin G at 25,000 units/kg every 8 hr has been ordered. The amount of penicillin in each dose is ____________________ units.

ANS: 112,500 KEY: Cognitive Level: Application DIF: Medium TOP: Therapeutic Classification: Anti-infectives REF: Page 1013

Davis’s Drug Guide for Nurses, 17e

Test Bank-97

230. The nurse is preparing to infuse IV cefazolin 1 g in 50 mL over 30 min. To infuse 50 mL of fluid over 30 min, the pump should be set at __________________ mL/hr (= hourly rate).

ANS: 100 (mL/hr) See IV Administration for cephalosporin first generation. To infuse 50 mL of fluid over 30 min, the pump should be set at 100 mL/hr (= hourly rate).

KEY: Cognitive Level: Application DIF: Medium TOP: Therapeutic Classification: Anti-infectives REF: Page 301

231. A nurse passing medications at the nursing home is supposed to provide diltiazem (Cardizem) 90 mg PO TID. The pharmacy stocks 60 mg tablets. The nurse should provide ____________________ tablets.

ANS: 1.5 (tablets) See Route/Dosage for diltiazem. The patient’s dose is 90 mg, and 60 mg tablets are available, so the nurse must give 1.5 tablets.

KEY: Cognitive Level: Application DIF: Easy TOP: Therapeutic Classification: Antianginals, antihypertensives, antiarrhythmics REF: Page 439

232. The nurse is passing medications for a patient whose medication administration record reads, “gabapentin (Neurontin) 300 mg PO TID.” Gabapentin is provided by the pharmacy in 600 mg scored tablets. The nurse should provide ____________________ tablets with each dose.

ANS: 0.5 See Dosage and Availability for gabapentin. Typical dose is 300 mg 3 times daily initially. Titration may be continued until desired (range is 900–1,800 mg/day in 3 divided doses; 600 mg and 800 mg tablets are scored and can be broken to administer a half tablet). If a half tablet is used, administer other half at the next dose. Discard half tablets not used within several days. A 300 mg ordered dose for this patient is one-half of an available 600 mg tablet.

KEY: Cognitive Level: Application DIF: Easy TOP: Therapeutic Classification: Analgesic adjuncts therapeutic, Anticonvulsants, Mood stabilizers REF: Page 614

MATCHING

Davis’s Drug Guide for Nurses, 17e

Test Bank-98

Match the instructions for using an inhaler in the following section with the number that represents the order of the steps they should occur in.

A. Press down on the inhaler to release medication.

B. Hold your breath for 10 sec.

C. Shake the inhaler.

D. Tilt your head back and breathe out slowly.

E. Breathe in slowly through the mouth.

F. Connect the inhaler to a spacer/chamber.

233. Step 1 234. Step 2 235. Step 3 236. Step 4 237. Step 5 238. Step 6

ANS: C ANS: F ANS: D ANS: A ANS: E ANS: B

KEY: Cognitive Level: Application DIF: Medium TOP: Therapeutic Classification: Respiratory inhalant REF: Appendix D

SEQUENCING

239. Place the following steps in proper sequence to provide 12 units NPH insulin and 4 units regular insulin.

A. Draw up 12 units NPH insulin.

B. Draw up 4 units regular insulin.

C. Administer subcutaneous injection.

D. Select and prep the site.

E. Mix NPH insulin vial by rotating briskly between hands.

F. Verify order and current blood glucose result.

ANS: F, E, B, A, D, C See Nursing Implications and Patient/Family Teaching for NPH insulin: NPH insulin is an intermediateacting insulin. It is important with all medication administration that the order be verified. The current blood sugar result should be determined for safety to prevent hypoglycemia. Roll intermediate-acting insulin vial between palms to mix, rather than shaking (may cause inaccurate dose). Completing this step before drawing up any insulin will decrease the need to recap the needle between vials. When mixing insulins, draw regular insulin, insulin aspart, insulin glulisine, or insulin lispro into syringe first to avoid contamination of regular insulin vial. The site should be selected and prepped prior to administration KEY: Cognitive Level: Application DIF: Medium TOP: Therapeutic Classification: Antidiabetics, Hormones

Davis’s Drug Guide for Nurses, 17e

Test Bank-99

REF: Page 701

240. Place the following steps in the correct order for the nurse to provide lansoprazole (Prevacid) 15 mg capsule daily through an NG tube.

A. Flush NG tube with 20 mL water B. Check chest x ray results to verify NG tube placement.

C. Flush NG tube with additional 20 mL water or apple juice.

D. Open capsule and mix contents with 40 mL apple juice.

E. Administer medication mixture through the NG tube.

F. Aspirate NG tube and check pH of aspirate.

ANS: B, F, A, D, E, C See Implementation for lansoprazole. Prior to giving anything into an NG tube, placement must be verified via chest x ray. Prior to medication administration, exact placement should be checked by aspirating stomach contents and checking the pH of the aspirate; flush the NG tube with water after this procedure. For patients with an NG tube getting Prevacid, capsules may be opened and intact granules may be mixed in 40 mL of apple, cranberry, grape, orange, pineapple, prune, or V8 vegetable juice and injected through the NG tube into stomach. Flush NG tube with additional apple juice or water to clear tube.

KEY: Cognitive Level: Analysis DIF: Medium TOP: Therapeutic Classification: Antiulcer agents REF: Page 755

Davis’s Drug Guide for Nurses, 17e

Test Bank 2-1

MULTIPLE CHOICE

1. A nurse is caring for a 14-year-old patient with epilepsy. The child takes phenytoin and started taking lamotrigine (Lamictal) 50 mg/day approximately 10 days ago. The child’s mother calls to report a newly noted rash across the girl’s face and arms. Which of the following statements by the nurse is best?

A. “Did your daughter use a new soap?”

B. “Has your daughter been exposed to poison ivy or other plant irritants?”

C. “Do not give her Lamictal; your daughter will need to be seen by the doctor today.”

D. “This is commonly seen with Lamictal. A mild soap and calamine lotion may reduce any itching.”

ANS: C See Nursing Implications/Assessment for lamotrigine: Assess patient for skin rash frequently during therapy. Discontinue lamotrigine at first sign of rash; it may be life-threatening. Stevens-Johnson syndrome or toxic epidermal necrolysis may develop. The rash usually occurs during the initial 2–8 wk of therapy, is more frequent in patients taking multiple antiepileptic agents, especially valproic acid, and is much more frequent in patients <16 yr.

KEY: Cognitive Level: Application DIF: Medium TOP: Therapeutic Classification: Anticonvulsants REF: Pages 752–753

2. The nurse receives a call from an 82-year-old patient with advanced prostate cancer who is being treated with leuprolide (Eligard) therapy. Which of the following statements requires immediate notification of the physician?

A. “I’ve been having hot flashes lately, what should I do?”

B. “The pain in my bones seems worse since I started this medication.”

C. “I forgot to get my shot 3 hours ago like I usually do, so I was going to take it now; is that okay?”

D. “My legs feel numb and weak; is that normal with this medication?”

ANS: D See Patient/Family Teaching for leuprolide: Instruct patient to notify a health care professional promptly if difficulty urinating, weakness, or numbness occurs. Advise patient that medication may cause hot flashes. Advise patient that bone pain may increase at initiation of therapy. This will resolve with time.

Instruct patient to take medication exactly as directed. If a dose is missed, take as soon as remembered unless not remembered until next day.

KEY: Cognitive Level: Analysis DIF: Medium TOP: Therapeutic Classification: Antineoplastics REF: Page 774

3. The nurse is caring for a woman with metastatic breast cancer who was recently admitted with hypercalcemia. Which of the following medications does the nurse anticipate would be included in the treatment plan?

Davis’s Drug Guide for Nurses, 17e

Test Bank 2-2

A. Zoledronic acid (Zometa) B. Calcium carbonate (Os-Cal) C. Octreotide (Sandostatin) D. Aprepitant (Emend) ANS: A See Indications and Actions for zoledronic acid: Zometa is used in the treatment of hypercalcemia of malignancy. It inhibits bone resorption by inhibiting increased osteoclast activity and skeletal calcium release induced by tumors. Therapeutic effects include decreased serum calcium. Os-Cal is a calcium supplement and should be avoided if the patient’s serum calcium level is too high. Sandostatin is used in the treatment of severe diarrhea, including that caused by carcinoid tumors. Emend is used in the treatment of nausea/vomiting during chemotherapy.

KEY: Cognitive Level: Application DIF: Medium TOP: Therapeutic Classification: Bone resorption inhibitors, Electrolyte modifiers, Hypocalcemics REF: Page 1292

4. The nurse is providing care for a 92-year-old patient who has a standing order for zolpidem (Abien) prn for insomnia. When providing the medication for the patient as requested, which of the following actions by the nurse is best?

A. Inform the patient the medication will work within 10 min.

B. Ensure the patient is in bed, ready for sleep, and raise the bed side rails.

C. Instruct the patient to eat some crackers to reduce stomach irritation caused by the medication.

D. Suggest the patient take the medication routinely every night.

ANS: B See Patient/Teaching for zolpidem: Because of rapid onset, advise patient to go to bed immediately after taking zolpidem. Onset of action is 30 min or more and is increased in geriatric patients and patients with hepatic impairment. Do not administer with or immediately after a meal as food slows absorption. Due to the habit-forming nature of this medication, it should not be used for more than 7–10 days.

KEY: Cognitive Level: Application DIF: Medium TOP: Therapeutic Classification: Sedative/Hypnotics REF: Page 1298

5. The nurse is caring for a patient with multiple medications, including carbidopa/levodopa (Sinemet) QID. The nurse knows this medication is effective by which of the following signs or symptoms?

A. The patient has fewer hand tremors.

B. The patient’s apical pulse is regular.

C. The patient has less edema in the ankles bilaterally.

D. The patient’s cough is well controlled.

ANS: A

Davis’s Drug Guide for Nurses, 17e

Test Bank 2-3

See Evaluation/Desired Effect for carbidopa/levodopa: Effects include resolution of parkinsonian signs and symptoms. Therapeutic effects usually become evident after 2–3 wk of therapy but may require up to 6 mo.

KEY: Cognitive Level: Analysis DIF: Medium TOP: Therapeutic Classification: Antiparkinson agents REF: Page 284

6. While caring for a patient who is taking loperamide (Imodium), the nurse would be most concerned by which of the following symptoms?

A. Patient reports abdominal cramping and loose stool.

B. Patient complains of a headache and a sore throat.

C. Pupils are equal, round, and reactive to direct and indirect light.

D. Tenting across the clavicular region and decreased reflexes are noted.

ANS: D See Assessment for loperamide: Assess fluid and electrolyte balance and skin turgor for dehydration.

Tenting is an indication of dehydration, and decreased deep tendon reflexes are indicative of hypokalemia. The patient is taking Imodium, which is used in the treatment of diarrhea, so symptoms of abdominal cramping and loose stool are expected. Viral symptoms are not the first priority and may be related to the cause of the diarrhea. PERRL is a normal finding. Diarrhea places the patient at risk for dehydration and hypokalemia, so this is the first priority.

KEY: Cognitive Level: Analysis DIF: Hard TOP: Therapeutic Classification: Antidiarrheals REF: Page 799

7. The nurse prepares to provide ondansetron (Zofran) in orally disintegrating tablet. Which of the following instructions should the nurse provide?

A. “Simply suck on the pill like a lozenge, and it will dissolve over a few minutes.”

B. “Place the tablet on your tongue; it will melt in seconds and then you can swallow.”

C. “Take this with a full swallow of water.”

D. “I will dissolve this in some water, and you can drink it in one sip.”

ANS: B See Implementation for ondansetron: Immediately place tablet on tongue; it will dissolve in seconds.

Then swallow with saliva.

KEY: Cognitive Level: Application DIF: Easy TOP: Therapeutic Classification: Antiemetics REF: Page 958

Davis’s Drug Guide for Nurses, 17e

Test Bank 2-4

8. The nurse is caring for a patient taking orlistat (Xenical). Which of the following symptoms would be most concerning to the nurse?

A. Nausea and vomiting B. Orange-colored oil noted in stool C. Reports of fecal urgency D. Flatus with discharge ANS: A See Side Effects for orlistat: Nausea and vomiting are not expected with this drug. Common GI side effects include fecal urgency, flatus with discharge, increased defecation, oily evacuation, oily spotting, and fecal incontinence.

KEY: Cognitive Level: Analysis DIF: Medium TOP: Therapeutic Classification: Weight control agents REF: Drugguide.com

9. The nurse is caring for a client who is to receive oxcarbazepine (Trileptal). The nurse recognizes this client most likely has a history of which of the following?

A. Diabetes mellitus B. Depression C. Seizures D. Hypothyroidism ANS: C See Indications for oxcarbazepine: Trileptal is used as monotherapy or adjunctive therapy of partial seizures in adults and children 4 yr and older with epilepsy.

KEY: Cognitive Level: Knowledge DIF: Medium TOP: Therapeutic Classification: Anticonvulsants REF: Page 968

10. The nurse is caring for a patient receiving pamidronate (Aredia) for the treatment of Paget’s disease.

Which of the following symptoms would be most concerning to the nurse?

A. Anorexia B. Bone pain C. Constipation D. Muscle twitching ANS: D See Side Effects and Assessment for pamidronate: Observe for evidence of hypocalcemia (paresthesia, muscle twitching, laryngospasm, and Chvostek’s or Trousseau’s sign).

KEY: Cognitive Level: Application DIF: Medium TOP: Therapeutic Classification: Bone resorption inhibitors

Davis’s Drug Guide for Nurses, 17e

Test Bank 2-5

REF: Page 987

11. A student nurse caring for a patient who is taking pancrelipase (Creon) would include which of the following statements when reviewing medications with the instructor?

A. “This reduces inflammation of the pancreas seen with pancreatitis.”

B. “This increases absorption of fats since the pancreas is not excreting normal enzymes.”

C. “This is used to bind with proteins and reduce protein excretion in the urine.”

D. “This helps relieve abdominal pain caused by liver damage in patients with a history of alcohol abuse.”

ANS: B See Action/Therapeutic Effect for pancrelipase: Effects include increased digestion of fats, carbohydrates, and proteins in the GI tract.

KEY: Cognitive Level: Application DIF: Medium TOP: Therapeutic Classification: Digestive agents REF: Page 989

12. Which of the following would cause the nurse to intervene for a patient taking pantoprazole (Protonix)?

A. The client takes the medication an hr before breakfast.

B. The client orders eggs and bacon for breakfast.

C. The client drinks a glass of orange juice when taking the medication.

D. The client chews the medication before swallowing.

ANS: D See Implementation for pantoprazole: Do not break, crush, or chew tablets.

KEY: Cognitive Level: Application DIF: Medium TOP: Therapeutic Classification: Antiulcer agents REF: Page 995

13. Which of the following lab values should be followed periodically for a patient taking paroxetine (Paxil)?

A. Complete blood count B. Electrolytes C. Thyroxine D. Creatinine ANS: A See Assessment/Lab Test Considerations for paroxetine: Lab Test Considerations: Monitor CBC and differential periodically during therapy. Report leukopenia or anemia.

KEY: Cognitive Level: Knowledge

Davis’s Drug Guide for Nurses, 17e

Test Bank 2-6

DIF: Hard TOP: Therapeutic Classification: Antianxiety agents, Antidepressants REF: Page 998

14. While caring for a patient who uses oral birth control pills and is taking PO penicillin V, which of the following instructions should the nurse include in the client teaching?

A. “You should stop taking your birth control pills for at least 3 months since you have to take this medication.”

B. “You will need to use a barrier method of birth control through this therapy and until your next menstrual cycle.”

C. “The doctor will want to give you a hormone patch in addition to the birth control pills for the next 30 days.”

D. “There is no need to alter your method of birth control while you are taking this medication.”

ANS: B See Patient/Family Teaching for penicillin V: Advise patient taking oral contraceptives to use an additional nonhormonal method of contraception during therapy with penicillin and until next menstrual period.

KEY: Cognitive Level: Application DIF: Medium TOP: Therapeutic Classification: Anti-infectives REF: Page 1015

15. The nurse is caring for a woman in labor who is given IV pentazocine (Talwin). Which of the following actions should the nurse take next?

A. Elevate the side rails and instruct the patient to call before attempting to ambulate.

B. Prepare for the placement of an internal monitoring device.

C. Encourage the client to lie on her right side.

D. Monitor the patient’s blood pressure every 15 min.

ANS: A See Patient/Family Teaching for pentazocine: Medication may cause drowsiness, dizziness, or hallucinations, particularly in geriatric patients. Advise patient to call for assistance when ambulating.

KEY: Cognitive Level: Application DIF: Medium TOP: Therapeutic Classification: Opioid analgesics REF: Drugguide.com

16. The nurse would be most concerned if a patient taking phenobarbital reported daily consumption of which of the following?

A. Grapefruit juice B. Beer C. Milk

Davis’s Drug Guide for Nurses, 17e

Test Bank 2-7

D. Coffee ANS: B See Patient/Family Teaching for phenobarbital: Caution patient to avoid taking alcohol or other CNS depressants concurrently with this medication.

KEY: Cognitive Level: Application DIF: Medium TOP: Therapeutic Classification: Anticonvulsants REF: Page 1026

17. A student nurse caring for a client with a history of anxiety disorder would expect which of the following medications to be included in the patient’s treatment plan?

A. Hydroxyzine (Atarax) B. Meclizine (Bonine) C. Lorazepam (Ativan) D. Nifedipine (Adalat CC) ANS: C See Indications for lorazepam: Ativan is an antianxiety agent. Atarax is provided for itching. Bonine is provided for vertigo. Adalat CC in provided for hypertension.

KEY: Cognitive Level: Application DIF: Medium TOP: Therapeutic Classification: Antianxiety agents REF: Page 804

18. The nurse is caring for a patient who has an order for mannitol (Osmitrol) 1 g/kg to be infused over an hr. Which of the following actions should the nurse take prior to administering the medication?

A. Assess deep tendon reflexes.

B. Determine the blood pressure.

C. Evaluate level of consciousness.

D. Listen to bowel sounds.

ANS: B See Assessment for mannitol: Mannitol is a diuretic used in the treatment of acute oliguric renal failure, edema, and increased intracranial or intraocular pressure. Monitor vital signs, urine output, CVP, and pulmonary artery pressures before and hourly throughout administration.

KEY: Cognitive Level: Application DIF: Medium TOP: Therapeutic Classification: Diuretics REF: Drugguide.com

Davis’s Drug Guide for Nurses, 17e

Test Bank 2-8

19. The nurse is caring for a patient who is NPO after midnight for a cardiac catheterization scheduled for 1 PM. The patient normally receives metformin (Glucophage) 1000 mg PO BID, and the morning dose is due at 8:30 AM. The patient’s blood glucose result was 115. Which of the following actions should the nurse take?

A. Hold the medication.

B. Give the medication with a glass of juice.

C. Give the medication with a sip of water.

D. Call the physician for direction.

ANS: A See Implementation for metformin: Because the patient is NPO, the medication should be held and blood sugars should be monitored frequently. Patients stabilized on a diabetic regimen who are exposed to stress, fever, trauma, infection, or surgery may require administration of insulin. Withhold metformin and reinstitute after resolution of an acute episode.

KEY: Cognitive Level: Application DIF: Medium TOP: Therapeutic Classification: Antidiabetics REF: Page 840

20. The nurse is caring for a patient with a known history of narcotic abuse. The patient is started on methadone 30 mg PO daily during detoxification. Which of the following assessments would indicate the patient’s dose may need to be decreased?

A. Chills B. Irritability C. Respirations = 8 per min D. Diaphoresis ANS: C See Assessment for methadone: If respiratory rate is less than 10 breaths per min, assess level of sedation.

Dose may need to be decreased by 25–50%. Chills, irritability, and diaphoresis are all symptoms of narcotic withdraw and may be expected during detoxification.

KEY: Cognitive Level: Application DIF: Easy TOP: Therapeutic Classification: Opioid analgesic REF: Page 842

21. A nurse working on the postpartum floor is checking orders and notes the following, “Methylergonovine (Methergine) 200 mcg PO every 6 hr for 48 hr.” Which of the following nursing interventions should be added to the patient’s plan of care?

A. Assess respiratory rate and rhythm every 2 hr.

B. Monitor for signs of uterine atony or change in menstrual bleeding.

C. Instruct patient to wear a tight-fitting bra and avoid facing the water during shower.

D. Collect urine for protein dipstick every 4 hr.

ANS: B

Davis’s Drug Guide for Nurses, 17e

Test Bank 2-9

See Assessment for methylergonovine: Methergine is used in the treatment of postpartum hemorrhage.

Monitor blood pressure, heart rate, and uterine response frequently during medication administration.

KEY: Cognitive Level: Application DIF: Medium TOP: Therapeutic Classification: Oxytocics REF: Page 851

22. While preparing to discharge a patient who has started taking metoprolol (Lopressor) during hospitalization, the nurse recognizes further teaching is necessary by which of the following statements: A. “I should take my pulse every day before taking this medication.”

B. “I need to stay on a low-salt diet to help control my blood pressure.”

C. “I’ll have to have my blood drawn frequently to monitor for toxic levels of this medication.”

D. “I should contact the physician immediately if I notice any wheezing, difficulty breathing, or dizziness.”

ANS: C See Patient/Family Teaching for metoprolol: Blood levels are not followed for this medication. Teach patient and family how to check pulse daily and blood pressure biweekly and to report significant changes to a health care professional. Reinforce the need to continue additional therapies for hypertension (weight loss, sodium restriction, stress reduction, regular exercise, moderation of alcohol consumption, and smoking cessation). Advise patient to notify health care professional if slow pulse, difficulty breathing, wheezing, cold hands and feet, dizziness, lightheadedness, confusion, depression, rash, fever, sore throat, unusual bleeding, or bruising occurs.

KEY: Cognitive Level: Analysis DIF: Medium TOP: Therapeutic Classification: Antihypertensives, Antianginals REF: Page 863

23. The nurse is providing care for a patient in hospice who has been converted to a continuous infusion of morphine for pain control via the use of a patient-controlled analgesia pump. The nurse recognizes that breakthrough pain should be handled in which of the following ways?

A. No breakthrough pain is expected since the patient is on a continuous infusion of narcotic.

B. Additional intravenous bolus doses can be given by the nurse every 15–30 min.

C. Additional predetermined bolus doses can be programmed to be available at patient request every 90 min.

D. Oral morphine can be given in liquid form every 2 hr.

ANS: B See Assessment for morphine: Patients on a continuous infusion should have additional bolus doses provided every 15–30 min, as needed, for breakthrough pain.

KEY: Cognitive Level: Application DIF: Medium TOP: Therapeutic Classification: Opioid analgesics REF: Page 889

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24. A patient is admitted with suspected overdose of neostigmine(Bloxiverz). Which of the following will be used as an antidote?

A. Narcan B. Vitamin K C. Atropine D. Epinephrine ANS: C See Assessment/Toxicity and Overdose for neostigmine: If an overdose occurs, atropine is the antidote.

KEY: Cognitive Level: Knowledge DIF: Medium TOP: Therapeutic Classification: Antimyasthenics REF: Drugguide.com

25. The nurse is caring for an infant with oral thrush whose medications include nystatin (Mycostatin) suspension 5 mL QID. Which of the following actions should the nurse take?

A. Dilute the medication in 30 mL of water and provide it to the infant in a bottle.

B. Use a needleless syringe to gently squirt small amounts into the baby’s mouth.

C. Dip a pacifier into the medication and allow the infant to suck on the pacifier; repeat until the dose is consumed.

D. Use a cotton swab to paint the inside of the infant’s cheeks, gums, and tongue.

ANS: D See Implementation for nystatin: For neonates and infants, paint suspension into recesses of the mouth.

KEY: Cognitive Level: Application DIF: Medium TOP: Therapeutic Classification: Antifungals REF: Page 938

26. The nurse is caring for a patient who recently started taking prochlorperazine (Compro) 10 mg PO QID. Which of the following symptoms would cause the nurse to contact the physician immediately?

A. Temp = 104.5°F, and there is a new onset of urinary incontinence.

B. Pulse = 70 bpm and patient complains of constipation.

C. Blood pressure = 126/64 mmHg and patient complain of hiccups.

D. Respirations = 18 per min and patient reports mild nausea.

ANS: A See Assessment for prochlorperazine: Monitor for development of neuroleptic malignant syndrome (fever, respiratory distress, tachycardia, seizures, diaphoresis, hypertension or hypotension, pallor, tiredness, severe muscle stiffness, and loss of bladder control). Notify physician or other health care professional immediately if these symptoms occur. Constipation is a known side effect with this medication, and the pulse is normal. Blood pressure is within normal limits and hiccups are not

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immediately concerning. Respirations are within normal parameters, and Compro is taken for nausea, so mild nausea may be expected.

KEY: Cognitive Level: Application DIF: Medium TOP: Therapeutic Classification: Antiemetics, Antipsychotics REF: Page 1058

27. A hospice nurse is caring for a patient with end-stage stomach cancer who has a new order to be kept NPO. The patient complains of nausea and has a standard order for promethazine for this complaint.

Which of the following actions should the nurse take?

A. Request intravenous dosing from pharmacy and start an IV. B. Call pharmacy to request an oral tablet, and allow the patient to take it with 1 sip of water.

C. Obtain oral liquid preparation and add thick-it to reduce aspiration risk.

D. Request and provide the medication in rectal suppository form.

ANS: D See Routes/Dosages for promethazine: Because the patient has orders to be kept NPO, any oral preparation is contraindicated without an overriding order. Rectal dosing is available and can be used effectively, although it may be less reliable. This noninvasive route should be chosen over starting an IV. KEY: Cognitive Level: Application DIF: Medium TOP: Therapeutic Classification: Antiemetics, Antihistamines REF: Drugguide.com

28. To monitor the peak efficacy after providing oral hydromorphone (Dilaudid) Immediate Release for a patient reporting pain ranked 6 out of 10 on a numeric pain scale, the patient should report some relief in pain at the peak action of the drug. Which of the following reflects the peak action of Dilaudid Immediate Release?

A. 15–30 min B. 30–90 min C. 1–2 hr D. Over 2 hr ANS: B See Pharmacokinetics for hydromorphone: The peak action for this medication is 30–90 min.

KEY: Cognitive Level: Comprehension DIF: Medium TOP: Therapeutic Classification: Opioid analgesics REF: Page 668

29. A patient who is prescribed propranolol (Inderal LA) is being tapered off over a 2-wk period. The nurse would include which of the following statements in the patient teaching?

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A. “I bet you’re glad to be getting off this medication since it is so expensive.”

B. “Stopping this medication suddenly can be very dangerous, so it is important that you follow the taper schedule carefully.”

C. “Patients usually only take this drug for a 1–2 wk cycle before switching to another medication.”

D. “By slowly weaning you from this drug, the risk of rebound headaches is reduced.”

ANS: B See Assessment for propranolol. Abrupt withdrawal of propranolol may precipitate life-threatening arrhythmias, hypertension, or myocardial ischemia. Drug should be tapered off over a 2-wk period before discontinuation. Assess patient carefully during tapering and after medication is discontinued. Consider that patients taking propranolol for noncardiac indications may have undiagnosed cardiac disease. Abrupt discontinuation or withdrawal over too short a period of time (less than 9 days) should be avoided. While the cost of medications is important, it is not the highest priority.

KEY: Cognitive Level: Comprehension DIF: Medium TOP: Therapeutic Classification: Antianginals, antiarrhythmics (Class II), antihypertensives, and vascular headache suppressants REF: Pages 1065–1066

30. Which of the following would indicate to the nurse that treatment was effective in a patient being treated with propylthiouracil?

A. Patient reports sleeping 12 hr a day.

B. Fine tremors are noted in both hands.

C. Patient gains 2 pounds in 4 days.

D. Pulse is 110 bpm.

ANS: C See Evaluation for propylthiouracil: PTU decreases the severity of symptoms of hyperthyroidism (lowered pulse rate and weight gain). Symptoms of hyperthyroidism include tachycardia, palpitations, nervousness, insomnia, fever, diaphoresis, heat intolerance, tremors, weight loss, and diarrhea. Symptoms of hypothyroidism include intolerance to cold, constipation, dry skin, headache, listlessness, tiredness, or weakness.

KEY: Cognitive Level: Analysis DIF: Medium TOP: Therapeutic Classification: Antithyroid agents REF: Page 1069

31. While caring for a patient with myasthenia gravis and a history of dysphasia who is taking pyridostigmine (Mestinon), the nurse recognizes the need for further teaching by which of the following statements?

A. “I should set an alarm clock to make sure I take my medication on time.”

B. “I may have trouble swallowing if I do not take my medication correctly.”

C. “I will have to take this medication for a few months before my condition resolves.”

D. “I should carry an identification card with my diagnosis and medication list at all times.”

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ANS: C See Patient/Family Teaching for pyridostigmine: Patients with a history of dysphagia should have a nonelectric or battery-operated back-up alarm clock to remind them of exact dose time. Patients with dysphagia may not be able to swallow medication if the dose is not taken exactly on time. Taking a dose late may result in myasthenic crisis. Taking a dose early may result in cholinergic crisis. Patients with myasthenia gravis must continue this regimen as a lifelong therapy. Advise patient to carry identification describing their disease and medication regimen at all times.

KEY: Cognitive Level: Analysis DIF: Hard TOP: Therapeutic Classification: Antimyasthenics REF: Drugguide.com

32. A client taking pyridoxine (vitamin B6) calls the nurse at 3 PM to report she is at work and did not take the pill at breakfast. Which of the following statements by the nurse is best?

A. “You should make arrangements to take the missed dose as soon as possible.”

B. “Missing a single dose is not critical.”

C. “Why didn’t you take the medication?”

D. “How are you feeling right now?”

ANS: B See Patient/Family Teaching for pyridoxine: Instruct patient to take medication as directed. If a dose is missed, it may be omitted because an extended period of time is required to become deficient in vitamin B6.

KEY: Cognitive Level: Application DIF: Medium TOP: Therapeutic Classification: Vitamin REF: Page 1074

33. The nurse is caring for a patient with tuberculosis who is on a diet with honey-thick liquids. Which action should the nurse take to administer the dose of rifampin (Rifadin)?

A. Obtain the medication in liquid form.

B. Give the pill with a small sip of water.

C. Call the pharmacy to request a parenteral dose.

D. Open the capsule onto a spoonful of applesauce.

ANS: D See Implementation for rifampin: Capsules may be opened and contents mixed with applesauce or jelly for patients with difficulty swallowing. While the pharmacist can compound a syrup for patients unable to swallow solids, this patient has difficulty swallowing liquids. If honey-thick liquids are ordered, nonthickened water should be avoided. Parenteral therapy is not required.

KEY: Cognitive Level: Application DIF: Medium TOP: Therapeutic Classification: Antituberculars REF: Page 1098

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34. A nurse working at an adult care center for individuals with mental illness provides an individual with a dose of risperidone (Risperdal). The nurse should intervene if the client mixes the liquid medication with which of the following?

A. Milk B. Cola C. Orange juice D. Water ANS: B See Implementation for risperidone: Oral solution can be mixed with water, coffee, orange juice, or lowfat milk; do not mix with cola or tea.

KEY: Cognitive Level: Application DIF: Hard TOP: Therapeutic Classification: Antipsychotics REF: Pages 1105–1106

35. A nurse caring for an individual taking rosiglitazone (Avandia) monitors which of the following lab results to help evaluate treatment effectiveness?

A. Glycosylated hemoglobin B. Serum calcium C. Serum iron D. Cardiac troponin ANS: A See Assessment/Lab Test Considerations for rosiglitazone: Monitor serum glucose and glycosylated hemoglobin periodically during therapy to evaluate effectiveness.

KEY: Cognitive Level: Application DIF: Medium TOP: Therapeutic Classification: Antidiabetics REF: Drugguide.com

36. The nurse observing a patient who uses a prescribed salmeterol (Serevent Diskus) recognizes that teaching has been effective if which of the following is observed?

A. The patient shakes the diskus vigorously before taking a dose.

B. The patient rinses the mouthpiece after administration.

C. The patient keeps the diskus horizontal at all times throughout administration.

D. The patient exhales into the diskus before inhaling a dose of medication.

ANS: C See Patient/Family Teaching for salmeterol: Instruct patient using powder for inhalation never to exhale into diskus device and always to hold device in a level horizontal position. Mouthpiece should be kept dry and should never be washed.

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KEY: Cognitive Level: Analysis DIF: Medium TOP: Therapeutic Classification: Bronchodilator REF: Page 1125

37. A nurse caring for a patient with non-Hodgkin’s lymphoma prepares to provide sargramostim (Leukine). Which of the following will indicate successful response to the medication?

A. Patient’s white blood cell count increases.

B. Patient’s platelet count increases.

C. Patient denies nausea or vomiting with chemotherapy.

D. Patient’s hair does not fall out after chemotherapy.

ANS: A See Action for sargramostim: Indications include accelerated recovery of bone marrow after autologous bone marrow transplantation, resulting in decreased risk of infection and other complications.

KEY: Cognitive Level: Application DIF: Medium TOP: Therapeutic Classification: Colony-stimulating factors REF: Drugguide.com

38. While in the recovery room, the nurse cares for a postanesthesia patient who reports severe nausea.

The nurse would most likely request an order for which of the following medications?

A. Selegiline (Eldepryl) B. Scopolamine (Transderm-Scop) C. Sitagliptin (Januvia) D. Tadalafil (Cialis) ANS: B See Indications for scopolamine: Scopolamine is used in the management of nausea and vomiting associated with opioid analgesia or general anesthesia/recovery from anesthesia. Eldepryl is used in the management of Parkinson’s disease. Januvia is used in the management of diabetes. Cialis is used for erectile dysfunction.

KEY: Cognitive Level: Application DIF: Medium TOP: Therapeutic Classification: Antiemetics REF: Page 1130 | Page 1128 | Page 1145 | Page 1173

39. An infant being treated for colic was prescribed simethicone (Mylicon) drops and has returned to the clinic for follow-up evaluation. Which of the following nursing action has the highest priority?

A. Assessment of the infant’s startle reflex B. Gentle palpation of the anterior fontanel C. Inspection and auscultation of the abdomen

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D. Measurement of the infant’s head circumference ANS: C See Assessment for simethicone: Assess patient for abdominal pain, distention, and bowel sounds prior to and periodically throughout course of therapy.

KEY: Cognitive Level: Application DIF: Medium TOP: Therapeutic Classification: Antiflatulents REF: Drugguide.com

40. At a follow-up appointment at the urologist’s office, the nurse is gathering data on a patient who takes solifenacin (VESIcare) for an overactive bladder. Which of the following statements would be most concerning to the nurse?

A. “I started taking an aerobics class twice a week.”

B. “I drink three cups of coffee each day.”

C. “I smoke a half pack of cigarettes a day.”

D. “A friend recommended St. John’s wort and I have been taking that for a few weeks now.”

ANS: D See Patient/Family Teaching for solifenacin: Advise patient to consult a health care professional prior to taking prescription, OTC, or herbal products with solifenacin. Drug-Drug: Drugs that induce or inhibit the CYP3A4 enzyme system may significantly alter blood levels of solifenacin; ketoconazole ↑ blood levels and risk of toxicity (do not exceed 5 mg/day).

KEY: Cognitive Level: Application DIF: Medium TOP: Therapeutic Classification: Urinary tract antispasmodics REF: Page 1155

41. The nurse is caring for a patient who takes sotalol (Betapace) 80 mg PO BID. Prior to administering the dose, which of the following actions should the nurse take first?

A. Assess respiratory rate and depth.

B. Determine apical pulse rate and rhythm.

C. Identify recent food intake.

D. Check color and presence of pulses in lower extremities.

ANS: B See Implementation for sotalol: Take apical pulse prior to administering. If less than 50 bpm or if arrhythmia occurs, withhold medication and notify physician or other health care professional.

KEY: Cognitive Level: Application DIF: Medium TOP: Therapeutic Classification: Antiarrhythmics REF: Page 1157

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42. While caring for a patient taking sucralfate (Carafate), the nurse recognizes the medication is effective by which of the following?

A. Patient is able to pass formed stool daily.

B. Patient has increased range of motion in the small joints of her hands.

C. Patient reports decreased abdominal pain.

D. Patient remains afebrile for 24 hr.

ANS: C See Evaluation for sucralfate: Carafate is used in the treatment of duodenal ulcers, and desired results include decrease in abdominal pain.

KEY: Cognitive Level: Analysis DIF: Medium TOP: Therapeutic Classification: Antiulcer agents REF: Page 1158

43. While caring for a 31-year-old female client who is initiating therapy with thalidomide (Thalomid), the nurse recognizes the need for further teaching by which of the following statements.

A. “I can’t start the medication until I’ve had a negative pregnancy test.”

B. “I must have a pregnancy test every month for the first 3 months I take this medication.”

C. “I must use two methods of birth control while I am taking this medication.”

D. “I will not be able to donate blood while taking this medication.”

ANS: B See Implementation for thalidomide: Pregnancy testing must occur weekly during first mo of therapy.

Due to teratogenic effects, thalidomide may be prescribed only by prescribers registered in the System for Thalidomide Education and Prescribing Safety (STEPS) program. Thalidomide is started within 24 hr of a negative pregnancy test with a sensitivity of at least 50 mIU/mL and then monthly thereafter in women with a regular menstrual cycle. For women of childbearing years, 2 methods of reliable contraception must be used unless complete abstinence is used. For women with irregular menses, pregnancy testing should occur every 2 wk. If pregnancy occurs, thalidomide should be discontinued immediately. Instruct patient not to donate blood and male patients not to donate sperm while taking thalidomide.

KEY: Cognitive Level: Application DIF: Medium TOP: Therapeutic Classification: Immunosuppressants REF: Page 1198

44. While caring for an individual taking torsemide (Demadex) for hypertension, the nurse would be most concerned by which of the following assessments?

A. Patient’s resting pulse is 68 bpm.

B. Patient reports abdominal cramps and nausea.

C. Patient has lost 2 pounds in 1 day.

D. Patient eats 2 bananas for breakfast.

ANS: B

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See Patient/Family Teaching for torsemide: Advise patient to contact a health care professional immediately if muscle weakness, cramps, nausea, dizziness, numbness, or tingling of extremities occurs.

Advise patient to contact a health care professional if the patient gains more than 2–3 pounds per day.

Instruct the patient to consult a health care professional regarding a diet high in potassium.

KEY: Cognitive Level: Application DIF: Medium TOP: Therapeutic Classification: Antihypertensives REF: Pages 1227–1228

45. The nurse is caring for an individual receiving intravenous vancomycin (Vancocin). Which of the following assessments is most important to prevent permanent complication?

A. Serum vancomycin levels B. Visual acuity C. Gag reflex D. Deep tendon reflexes ANS: A See Assessment for vancomycin: Evaluate 8th cranial nerve function by audiometry and serum vancomycin levels prior to and throughout therapy in patients with borderline renal function or those older than 60 years of age. Prompt recognition and intervention are essential in preventing permanent damage. No alteration in vision or reflexes is anticipated with vancomycin.

KEY: Cognitive Level: Application DIF: Medium TOP: Therapeutic Classification: Anti-infectives REF: Page 1249

46. A nurse is caring for an individual with diabetes insipidus who is taking vasopressin (Vasostrict).

Which of the following assessments would indicate treatment has been effective?

A. Urine output is 800 mL at the end of an 8-hr shift.

B. Urine specific gravity is 0.998.

C. Patient has lost 2 pounds in 1 day.

D. Mucous membranes are dry and sticky.

ANS: A See Evaluation for vasopressin: Desired outcome includes decrease in urine volume, relief of polydipsia, and increased urine osmolality in patients with central diabetes insipidus. Normal urine output is 60–100 mL/hr, so this value is within normal limits and indicates successful management of diabetes insipidus.

Normal urine specific gravity is 1.010–1.030. Signs of dehydration indicate on-going fluid loss associated with diabetes insipidus.

KEY: Cognitive Level: Analysis DIF: Hard TOP: Therapeutic Classification: Hormones REF: Page 1258

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47. The nurse recognizes which of the following individuals is at highest risk for developing orthostatic hypotension?

A. A 53-year-old patient taking tigecycline (Tigacil) B. A 61-year-old patient taking warfarin (Coumadin) C. A 49-year-old patient taking zinc sulfate (Zincate) D. A 64-year-old patient taking verapamil (Calan) ANS: D See Adverse Reactions/Side Effects for verapamil: Calan is an antihypertensive that can cause orthostatic hypotension. Tigacil is an anti-infective that causes sedation. Coumadin is an anticoagulant without noted CNS side effects. Zincate is a mineral supplement without noted CNS side effects.

KEY: Cognitive Level: Analysis DIF: Medium TOP: Therapeutic Classification: Antihypertensives, Antiarrhythmias, Antianginals, Vascular headache suppressants REF: Page 1265

48. The nurse recognizes that which of the following individuals will need to receive supplemental vitamin B12 injections?

A. A 37-year-old patient with acute renal calculi B. A 59-year-old patient with gastric resection for stomach cancer C. A 24-year-old patient with sickle cell anemia D. A 58-year-old patient with congestive heart failure ANS: B See Implementation for vitamin B12 preparation: Patients with small bowel disease, malabsorption syndrome, or gastric or ileal resections require parenteral administration.

KEY: Cognitive Level: Analysis DIF: Easy TOP: Therapeutic Classification: Vitamins, Antianemics REF: Page 1277

49. The nurse is counseling a patient who has been given a prescription for sumatriptan (Imitrex) for migraine headaches. Which of the following statements indicates teaching has been effective?

A. “This medication will prevent migraine headaches.”

B. “I can take this medication at any time during a migraine headache attack.”

C. “I can repeat the medication in 15 minutes if I have not gotten relief from the first injection.”

D. “I can use up to 4 doses in a 24-hour period.”

ANS: B See Patient/Family Teaching for sumatriptan: Instruct patient to administer sumatriptan as soon as symptoms of a migraine attack appear, but it may be administered at any time during an attack. Inform patient that sumatriptan should be used only during a migraine attack. It is meant to be used for relief of

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migraine attacks but not to prevent or reduce the number of attacks. If migraine symptoms return, a second injection may be used. Allow at least 1 hr between doses, and do not use more than 2 injections in any 24-hr period.

KEY: Cognitive Level: Analysis DIF: Medium TOP: Therapeutic Classification: Vascular headache suppressants REF: Page 1164

50. Which of the following patients would most likely be taking quinidine (Quinidine Gluconate)?

A. A 45-year-old patient with atrial fibrillation B. A 59-year-old patient with pneumocystis carni pneumonia C. A 68-year-old patient with gastroesophageal reflux disease D. A 33-year-old patient with acute pyelonephritis ANS: A See Indications for quinidine: They include restoration and maintenance of sinus rhythm in patients with atrial fibrillation or flutter, prevention of recurrent ventricular arrhythmias, and treatment of malaria.

KEY: Cognitive Level: Analysis DIF: Medium TOP: Therapeutic Classification: Antiarrhythmics REF: Drugguide.com

51. An individual with a history of angina takes sublingual nitroglycerine to relieve chest pain ranked 6/10. Five min later, the chest pain is 4/10. What action should the nurse take next?

A. Have a family member call 911.

B. Tell the individual to take a warm shower.

C. Instruct the individual to take another sublingual nitroglycerine tablet.

D. Monitor the individual for an additional 10 min before taking any action.

ANS: C See Patient/Family Teaching for nitroglycerin: For an acute anginal attack, advise patient to sit down and use medication at first sign of attack. Relief usually occurs within 5 min. Dose may be repeated if pain is not relieved in 5–10 min. Call health care professional or go to nearest emergency room if anginal pain is not relieved by 3 tablets in 15 min.

KEY: Cognitive Level: Application DIF: Medium TOP: Therapeutic Classification: Antianginals REF: Page 929

52. An individual with chronic schizophrenia who recently started taking Zyprexa (olanzapine) is smacking his lips, puffing his cheeks, and chewing. Which of the following statements by the nurse is best?

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A. “Don’t worry, this is commonly seen with advancing schizophrenia; you may need a higher dose of medication.”

B. “These are symptoms seen in withdrawal from the medication; have you stopped taking your medication for some reason?”

C. “These movements are a side effect of the medication; you should stop taking it.”

D. “We see this a lot, it will go away after you’ve been on the medication for a month or so.”

ANS: C See Assessment for olanzapine: Monitor for tardive dyskinesia (uncontrolled rhythmic movement of mouth, face, and extremities; lip smacking or puckering; puffing of cheeks; uncontrolled chewing; rapid or worm-like movements of tongue; and excessive blinking of eyes). Report immediately, as it may be irreversible.

KEY: Cognitive Level: Application DIF: Medium TOP: Therapeutic Classification: Antipsychotics, Mood stabilizers REF: Page 944

MULTIPLE RESPONSE

53. A nurse is counseling the parent of a 3-year-old child with chronic ear infections and fluid in the ears.

The physician recommends pseudoephedrine (Silfedrine Children’s) as a decongestant. Which of the following statements indicate that teaching has been effective? Select all that apply.

A. “The decongestant will help clear the fluid from his ears.”

B. “I should give this medication at bedtime to help him sleep.”

C. “I should call the doctor if I notice he is having any difficulty breathing.”

D. “This medication will kill the bacteria causing the infection in his ears.”

E. “Too much of this medication can alter his heart rate, so I need to keep it out of his reach.”

F. “I should limit his fluid intake to help reduce the congestion in his ears.”

ANS: A, C, E See Indications and Patient/Family Teaching and Assessment for pseudoephedrine: It is used to open obstructed eustachian tubes in chronic otic inflammation or infection; it does not kill bacteria. Instruct patient to notify a health care professional if nervousness, slow or fast heart rate, breathing difficulties, hallucinations, or seizures occur because these symptoms may indicate overdose. Administer pseudoephedrine at least 2 hr before bedtime to minimize insomnia. Maintain fluid intake of 1500–2000 mL/day to decrease viscosity of secretions.

KEY: Cognitive Level: Analysis DIF: Medium TOP: Therapeutic Classification: Allergy, cold, and cough remedies, Nasal drying agents/decongestants REF: Pages 1071–1072

54. The nurse recognizes that the treatment plan for which of the following individuals would likely include psyllium (Metamucil)? Select all that apply.

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A. A 72-year-old patient who drinks prune juice on a daily basis and has a soft brown stool daily B. A 61-year-old patient hospitalized for an anterior myocardial infarction C. A 29-year-old patient with the flu who reports having diarrhea D. A 57-year-old patient reporting increased difficulty with constipation since the onset of menopause E. A 65-year-old patient who recently had a hemorrhoidectomy F. An 84-year-old patient who reports walking 3 miles every day in the mall ANS: B, D, E See Indications for psyllium: They include management of simple or chronic constipation, particularly if associated with a low-fiber diet. It is useful in situations in which straining should be avoided (after MI, rectal surgery, or prolonged bed rest). It is used in the management of chronic watery diarrhea.

KEY: Cognitive Level: Analysis DIF: Medium TOP: Therapeutic Classification: Laxatives REF: Drugguide.com

55. A nurse working in the health department recognizes that the shingles vaccine (Zostavax) is contraindicated for which of the following individuals? Select all that apply.

A. A 55-year-old patient with a history of atrial fibrillation B. A 49-year-old patient with HIV C. A 61-year-old patient with an upper respiratory infection; T = 101.4F D. A 33-year-old patient who is 6 wk pregnant E. A 42-year-old patient with an allergy to eggs F. A 51-year-old patient with a history of chronic obstructive pulmonary disease ANS: B, C, D See Contraindications for the zoster vaccine: It is contraindicated in a history of anaphylactic/anaphylactoid reactions to gelatin, neomycin; active infections; immunosuppression (including HIV); and pregnancy. There is no contraindication for chronic medical conditions that do not impart immunosuppression. Sensitivity to eggs is contraindicated for flu vaccine, but not for the shingles vaccine.

KEY: Cognitive Level: Analysis DIF: Hard TOP: Therapeutic Classification: Vaccines REF: Drugguide.com

56. Which of the following would be included in the patient teaching for a client receiving lithium (Lithobid) therapy? Select all that apply.

A. “This medication may cause dizziness or drowsiness so you should avoid driving until you know how the medication will affect you.”

B. “It is important to reduce your fluid intake while taking this medication.”

C. “Avoid drinking excessive amounts of coffee, tea, and colas while on this medication.”

D. “Weight loss may occur with this medication, so you should try to eat at least 3000 calories a day.”

E. “Since you have a history of heart disease, you will need to have periodic electrocardiogram tests done.”

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F. “Notify the physician immediately if you have any fainting or difficulty breathing while taking this medication.”

ANS: A, C, E, F See Patient/Family Teaching for lithium: Lithium may cause dizziness or drowsiness. Caution patient to avoid driving or other activities requiring alertness until response to medication is known. Advise patient to drink 2000–3000 mL fluid each day and eat a diet with consistent and moderate sodium intake.

Excessive amounts of coffee, tea, and cola should be avoided because of diuretic effect. Advise patient that weight gain may occur. Review principles of a low-calorie diet. Explain to patients with cardiovascular disease or over 40 years of age the need for ECG evaluation before and periodically during therapy. Patient should inform health care professional if fainting, irregular pulse, or difficulty breathing occurs.

KEY: Cognitive Level: Analysis DIF: Hard TOP: Therapeutic Classification: Mood stabilizers REF: Pages 795–796

57. Which of the following interventions would be helpful for a patient taking loratadine (Claritin) who complains of a dry mouth? Select all that apply.

A. Frequent oral rinses with water B. Sugarless gum or candy C. Flossing twice daily D. Increased intake of caffeine E. Fluid intake of 1000 mL/day F. Use of alcohol-based mouth wash ANS: A, B See Patient/Family Teaching for loratadine: Advise patient that good oral hygiene, frequent rinsing of mouth with water, and sugarless gum or candy may minimize dry mouth. Patient should notify dentist if dry mouth persists longer than 2 wk. Flossing is not helpful in addressing dry mouth. Caffeine has a diuretic effect and will not be helpful. Normal recommended fluid intake is 1500–2000 mL/day. Alcoholbased mouth rinse may increase a sensation of dryness.

KEY: Cognitive Level: Comprehension DIF: Easy TOP: Therapeutic Classification: Antihistamines REF: Page 804

58. The nurse is advising a client whose triglyceride levels remain elevated despite 3 mo of following a low-fat, low-cholesterol diet. The client is started on omega-3 acid ethyl esters (Lovaza). Which of the following statements would the nurse include in the teaching? Select all that apply.

A. “You still need to follow a low-fat diet while you’re taking this medication.”

B. “This medication may be taken with meals.”

C. “Limiting cholesterol intake is not as critical as limiting intake of carbohydrates.”

D. “Diabetes contributes to elevated triglyceride levels, so it is important to maintain good control or your diabetes.”

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E. “It is important to establish an exercise routine that works with diet and medication to help control your weight.”

F. “You probably inherited this from one of your parents, so aside from medication, there isn’t much you can do.”

ANS: A, B, D, E See Patient/Family Teaching for omega-3 acid ethyl esters: It may be administered with meals. Advise patient that this medication should be used in conjunction with diet restrictions (fat, cholesterol, carbohydrates, and alcohol), exercise, weight loss in overweight patients, and control of medical problems (such as diabetes mellitus and hypothyroidism) that may contribute to hypertriglyceridemia.

KEY: Cognitive Level: Comprehension/Application DIF: Hard TOP: Therapeutic Classification: Lipid-lowering agents REF: Page 955

59. While caring for a client who reports taking omeprazole (Prilosec), the nurse recognizes the need for further teaching if the client also reports taking which of the following? Select all that apply.

A. Tylenol for occasional headaches B. Ibuprofen daily for arthritis C. Baby aspirin daily to prevent heart pain D. Maalox occasionally to reduce heartburn E. Flaxseed supplement to increase omega-3 intake F. Multi-vitamin with iron to promote health ANS: B, C See Patient/Family Teaching for omeprazole: Advise patient to avoid alcohol, products containing aspirin or NSAIDs, and foods that may cause an increase in GI irritation.

KEY: Cognitive Level: Application DIF: Hard TOP: Therapeutic Classification: Antiulcer agents REF: Page 957

60. While caring for a client with a history of epilepsy, the nurse would expect which of the following medications to be included in the patient’s treatment plan? Select all that apply.

A. Sulindac (Clinoril) B. Phenytoin (Dilantin) C. Phenobarbital D. Divalproex sodium (Depakote) E. Nabumetone F. Carbamazepine (Tegretol) ANS: B, C, D, F See Indications for sulindac, phenytoin, phenobarbital, divalproex sodium, nabumetone, and carbamazepine: Phenytoin, phenobarbital, divalproex sodium, and carbamazepine are all used in the

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treatment/prevention of tonic-clonic (grand mal) seizures and complex partial seizures. Sulindac and nabumetone are used in the treatment of arthritis.

KEY: Cognitive Level: Knowledge DIF: Hard TOP: Therapeutic Classification: Anticonvulsants REF: Drugguide.com (sulindac, nabumetone) | Page 279 | Page 1022 | Page 1029 | Page 1245

61. Which of the following laboratory values will be closely monitored for a patient newly started on procainamide after cardioversion? Select all that apply.

A. Mean corpuscular volume B. Triglycerides C. White blood cell count D. Platelet count E. Magnesium F. Protein ANS: C, D See Lab Considerations for procainamide: Monitor CBC every 2 wk during the first 3 mo of therapy. May cause ↓ leukocyte, neutrophil, and platelet counts. Therapy may be discontinued if leucopenia occurs.

Blood counts usually return to normal within 1 mo of discontinuation of therapy. Monitor ANA periodically during prolonged therapy or if symptoms of lupus-like reaction occur. Therapy is discontinued if a steady increase in ANA titer occurs. May cause ↑ AST, ALT, alkaline phosphatase, LDH, and bilirubin, as well as a positive Coombs’ test result.

KEY: Cognitive Level: Knowledge DIF: Hard TOP: Therapeutic Classification: Antiarrhythmics REF: Drugguide.com

62. In the treatment of a postmenopausal woman with osteoporosis who has been prescribed raloxifene (Evista), which of the following should be included in the patient’s plan of care? Select all that apply.

A. Daily weight-bearing exercises B. Supplemental iron C. Education on smoking cessation D. Instruction to limit alcohol consumption E. Prolonged bed rest F. Dietary teaching to increase protein intake ANS: A, C, D See Patient/Family Teaching for raloxifene: Emphasize the importance of regular weight-bearing exercise. Discuss the importance of adequate calcium and vitamin D intake or supplementation; iron supplementation will not improve osteoporosis. Advise patient to discontinue smoking and alcohol consumption. Prolonged inactivity should be avoided due to increased risk of thrombosis. Dietary teaching should focus on increased/adequate intake of calcium and vitamin D. KEY: Cognitive Level: Application

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DIF: Hard TOP: Therapeutic Classification: Bone resorption inhibitors REF: Page 1081

63. A neighbor says to the nurse, “My arthritis is getting worse in this cold weather; what can I take?”

The nurse would base the response on the knowledge that which of the following medications would provide both pain relief and help decrease inflammation associated with arthritis. Select all that apply.

A. Aspirin (Ecotrin) B. Magnesium salicylate C. Acetaminophen (Tylenol) D. Ibuprofen (Advil) E. Excedrin F. Acetaminophen (Acephen) ANS: A, B, D, E See Indications for magnesium salicylate, ibuprofen, and acetaminophen: Aspirin, other salicylates, and ibuprofen have anti-inflammatory and pain-relieving properties. Acetaminophen has no significant antiinflammatory property.

KEY: Cognitive Level: Application DIF: Medium TOP: Therapeutic Classification: Antipyretics REF: Drugguide.com (magnesium salicylates, Excedrin) | Page 100 | Page 189 | Page 676

64. An order for temazepam (Restoril) 30 mg PO prn for sleep would be questioned for which of the following patients? Select all that apply.

A. A 42-year-old patient hospitalized with a broken femur B. A 29-year-old patient admitted with depression and attempted suicide C. A 51-year-old patient admitted with migraine headache D. A 33-year-old patient admitted with exacerbation of Crohn’s disease E. A 79-year-old patient admitted with a hip fracture F. A 48-year-old patient admitted with cirrhosis ANS: B, E, F See Contraindications/Precautions for temazepam: Use cautiously when there is a pre-existing hepatic dysfunction or history of a suicide attempt or drug addiction. Elderly patients have increased sensitivity to benzodiazepines. It appears on Beers list and is associated with increased risk of falls (↓ dose required).

KEY: Cognitive Level: Analysis DIF: Hard TOP: Therapeutic Classification: Sedative/hypnotics REF: Drugguide.com

COMPLETION

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65. The nurse is preparing to provide memantine (Namenda) in liquid form. The ordered dose is 10 mg PO BID. Liquid preparation is available in 2 mg/mL. The nurse should provide __________________ mL. ANS: 5 mL See Dosage for memantine: With a dose of 10 mg due at this time and liquid preparation of 2 mg/mL, the provided dose is 5 mL (10 mg ÷ 2 mg/mL = 5 mL).

KEY: Cognitive Level: Knowledge DIF: Easy TOP: Therapeutic Classification: Anti-Alzheimer agents REF: Page 825

66. The nurse is caring for a patient receiving chemotherapy that includes ifosfamide 1.2 g/m2 and mesna; 20% of the mesna dose is to be given via IV at the same time as the ifosfamide; repeat 4 hr and 8 hr later.

The patient’s body surface area is 2 m2. The nurse anticipates that the pharmacy will supply a ____ mg dose of mesna.

ANS: 480 mg See Dosage for mesna: Since you need mg at the end of the calculation, change the dose to mg now. 1.2 g = 1200 mg. The ifosfamide dose is now 1200 mg/m2. Multiply the dose, 1200 mg/m2, times the BSA, 2 m2: 1200 mg/m2 × 2 m2 = 2400 mg. The mesna dose must be 20% of ifosfamide dose: 20% of 2400 mg = 480 mg. Dosage: Give a dose of mesna equal to 20% of the ifosfamide dose at the same time as ifosfamide and 4 and 8 hr after. Ifosfamide is given via IV (adults) 1.2 g/m²/day for 5 days; it should be coadministered with mesna.

KEY: Cognitive Level: Knowledge DIF: Hard TOP: Therapeutic Classification: Antidotes REF: Page 680 | Page 836

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MULTIPLE CHOICE

1. The nurse is providing care for an 82-year-old client with glaucoma. Acetazolamide (Diamox) 250 mg orally twice daily has been ordered as a new medication. The nurse would be most concerned by which of the following?

A. The client has a listed allergy to sulfonamides.

B. The client has a history of rheumatoid arthritis.

C. The client takes benztropine (Cogentin) daily.

D. The client’s potassium is 3.6 mEq/dL. ANS: A See Contraindications/Precautions for acetazolamide: Hypersensitivity or cross-sensitivity with sulfonamides may occur.

KEY: Cognitive Level: Application DIF: Medium TOP: Therapeutic Classification: Anticonvulsants, Antiglaucoma agents REF: Drugguide.com

2. A 21-year-old client is brought to the emergency room with suspected overdose with acetaminophen (Tylenol). Which of the following medications would the nurse expect to be ordered?

A. Protamine sulfate B. Imipenem (Primaxin) C. Acetylcysteine (Acetadote) D. Glyburide (Diabeta) ANS: C See Toxicity and overdose for acetaminophen and Indications for acetylcysteine: Acetylcysteine is the antidote for the management of potentially hepatotoxic overdose of acetaminophen.

KEY: Cognitive Level: Application DIF: Medium TOP: Therapeutic Classification: Antidotes, mucolytic REF: Pages 102–103

3. The nurse is providing care for a 64-year-old client on the telemetry unit whose heart rate suddenly jumps to 144 bpm. Telemetry shows supraventricular tachycardia, and the client reports feeling a bit lightheaded and dizzy. The nurse attempts vagal stimulation without success and prepares to administer adenosine (Adenocard) 6 mg IV push. The nurse would expect which of the following to occur?

A. A gradual slowing of the heart rate over the next 30 min with an end result of normal sinus rhythm and improved symptoms.

B. Slowing of the tachycardia with an end rate between 100–120 bpm and improved dizziness within 5 min.

C. Loss of consciousness for the client in preparation for electric shock/cardioversion.

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D. A short period of heart block or asystole immediately after injection followed by conversion to normal sinus rhythm.

ANS: D See Nursing Implications adenosine: Monitor heart rate frequently (every 15–30 sec) and monitor ECG continuously during therapy. Short transient periods of 1st-, 2nd-, or 3rd-degree heart block or asystole may occur following injection; this usually resolves quickly due to short duration of adenosine. Once conversion to normal sinus rhythm is achieved, transient arrhythmias may occur, but generally last a few seconds.

KEY: Cognitive Level: Application DIF: Hard TOP: Therapeutic Classification: Antiarrythmics REF: Page 113

4. The nurse is caring for a 34-year-old patient with a large hilar mass due to lymphoma. Chemotherapy is being provided, and the client also has orders for allopurinol (Zyloprim) 300 mg orally twice daily. When providing this medication, the nurse would include which of the following statements in the client teaching?

A. “This medication will help prevent gout, which occurs when clients are given radiation therapy.”

B. “Allopurinol binds to the uric acid being released by the destroyed cancer cells and prevents it from damaging your kidneys.”

C. “Chemotherapy agents can reduce the number of white blood cells, red blood cells, and platelets in your body; this medication helps protect those cells.”

D. “This is part of the chemotherapy regimen since some chemo agents are given in your IV and others are given by mouth.”

ANS: B See Indications for allopurinol: Treatment of secondary hyperuricemia, which may occur during treatment of tumors or leukemias.

KEY: Cognitive Level: Analysis DIF: Hard TOP: Therapeutic Classification: Antigout, antihyperuremics REF: Page 124

5. The nurse is providing amifostine (Ethyol) to a 51-year-old woman with ovarian cancer who is also receiving Cisplatin. Which of the following nursing assessments during the infusion is of the highest priority?

A. Monitor client blood sugar every hr.

B. Monitor client’s respiratory rate every 30 min.

C. Monitor client’s blood pressure every 5 min.

D. Monitor client’s urine output every 4 hr.

ANS: C See Nursing Implications Assessment for amifostine: Monitor BP before and every 5 min during infusion.

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Discontinue antihypertensives 24 hr prior to the treatment. If significant hypotension requiring interruption of therapy occurs, place client in Trendelenburg position and administer an infusion of 0.9% NaCl using separate IV line.

KEY: Cognitive Level: Analysis DIF: Hard TOP: Therapeutic Classification: Cytoprotective agents REF: Page 133

6. While preparing to give amphotericin B (Fungizone) to a client who is also receiving dexamethasone (Dexasone), the nurse recognizes the client is at increased risk for which of the following?

A. Hypoglycemia B. Hyponatremia C. Hypocalcemia D. Hypokalemia ANS: D See Interactions for amphotericin B with corticosteroids: Concurrent use with corticosteroids increases risk of hypokalemia.

KEY: Cognitive Level: Knowledge DIF: Hard TOP: Therapeutic Classification: Antifungals REF: Page 155

7. A client with breast cancer is taking anastrozole (Arimidex). The nurse recognizes that teaching has been effective by which of the following client statements?

A. “If I miss a dose, I should take a double dose the next day.”

B. “I must take this medication on an empty stomach before going to bed each night.”

C. “Oral chemotherapy generally has fewer side effects and is much safer.”

D. “There is a risk of allergic reaction for this medication so I need to notify the doctor right away if I have any swelling in my face, difficulty swallowing, or rashes.”

ANS: D See Patient/Family Teaching for anastrozole: Inform client of potential for adverse reactions and advise client to notify health care professional immediately if allergic reactions or chest pain occurs.

KEY: Cognitive Level: Analysis DIF: Easy TOP: Therapeutic Classification: Antineoplastics REF: Page 161

8. A nurse is receiving a shift-to-shift report for a client in the intensive care unit with multiple medical problems. The client is receiving Argatroban infusion. The nurse recognizes this medication is ordered to

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address which of the following health care problems for the client?

A. Ventilator-associated pneumonia B. Deep vein thrombosis C. Hypotension D. Urosepsis ANS: B See Indications for Argatroban: Prophylaxis or treatment of thrombosis in client with heparin-induced thrombocytopenia.

KEY: Cognitive Level: Application DIF: Easy TOP: Therapeutic Classification: Anticoagulations REF: Page 181

9. The nurse is caring for a 6-month-old patient receiving oral amoxicillin 25 mg/kg/day divided into 2 doses and distributed as 50 mg/mL oral suspension. The child weighs 33 pounds. How much medication (in mL) will this nurse pour/provide each dose?

ANS: 3.75 mL = 3.8 mL See Availability for amoxicillin and Perform drug calculation: 2.2 pounds = 1 kg so weight conversion is 33 pounds divided by 2.2 = 15 kg. Calculate daily drug dose by multiplying 25 mg/kg and 15 = 375 mg.

Divide by 2 for single dose = 187.5. Since medication comes 50 mg/mL, divide by 50 to calculate oral amount in each dose = 3.75 mL KEY: Cognitive Level: Analysis DIF: Hard TOP: Therapeutic Classification: Anti-infectives, Anti-ulcer agents REF: Page 149

10. While providing care for a client who is to receive aripiprazole (Abilify), the nurse recognizes that the client understands this medication by which of the following statements?

A. “This medication may cause me to have a dry mouth or lower my saliva production.”

B. “This medication will reduce my nicotine cravings and help me quit smoking.”

C. “I need to let the doctor know right away if I have any thoughts of suicide or worsening depression.”

D. “I need to be sure and drink at least 4 quarts of water each day while I’m taking this medication.”

ANS: C See Patient Family Teaching for aripiprazole: Advise patient and family to notify health care professional if thoughts about suicide or dying, attempts to commit suicide, new or worse depression, or new or worse anxiety occur. The medication can cause tardive dyskinesia or neuroleptic malignant syndrome but does not typically cause a dry mouth nor are increased fluids required.

KEY: Cognitive level: Application DIF: Medium TOP: Therapeutic Classification: Antipsychotics, Mood stabilizers

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Test Bank 3-5

REF: Pages 186–187

11. In reviewing new orders, the nurse notes aztreonam (Azactam) 1 g IV every 8 hr has been ordered.

Before initiating therapy, the nurse should assess for an allergy history to which of the following? Select all that apply.

A. Penicillins B. MAO inhibitors C. Antifungals D. Cephalosporins E. Nonsteroidal anti-inflammatory agents ANS: A, D See Nursing Implications Assessment for aztreonam: Obtain a history before initiating therapy to determine previous use of and reaction to penicillins and cephalosporins.

KEY: Cognitive Level: Knowledge DIF: Medium TOP: Therapeutic Classification: Anti-infectives REF: Page 206

12. While caring for a client with Parkinson’s disease who has recently started taking benztropine (Cogentin), the client reports, “My mouth seems so dry all the time.” Which of the following statements by the nurse is best?

A. “Dry mouth is common with your new medications. You should rinse frequently and consider using hard sugarless candies or gum to help with the symptom.”

B. “I wonder if your dose is too high; try taking half the pill twice a day instead of all at once and see if that helps.”

C. “You should call your doctor and let them know about that—it could be a serious side effect of the new medication.”

D. “Have you noticed any fever or night sweats lately?”

ANS: A See Patient/Family Teaching for benztropine: Instruct patient that frequent rinsing of mouth and good oral hygiene, and sugarless gum or candy may decrease dry mouth.

KEY: Cognitive Level: Analysis DIF: Medium TOP: Therapeutic Classification: Antiparkinson agents REF: Page 220

13. The nurse is providing instructions to a client who has started therapy with buprenorphine (Buprenex) to assist with opioid withdrawal. The nurse instructs the client to avoid which of the following natural substances/herbs? Select all that apply.

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A. Kava kava B. Valerian C. Garlic D. Ginger E. Chamomile F. Hops ANS: A, B, E, F See Drug-Natural Products under Interactions for buprenorphine: Concomitant use of kava kava, valerian, chamomile, or hops can increase CNS depression.

KEY: Cognitive Level: Knowledge DIF: Hard TOP: Therapeutic Classification: Opioid analgesics REF: Page 252

14. While providing care for an 84-year-old patient with Parkinson’s disease who is taking carbidopa/levodopa (Sinemet), the nurse notes abnormalities in the client’s lab values. Which of the following could be attributed to the medication?

A. Platelet count—440,000 c/mm3 B. Hemoglobin—10.4 g/dL C. Albumin—3.2 g/dL D. B-type natriuretic peptide (BNP)—449 pg/mL ANS: B See Nursing Implications for carbidopa/levodopa: May cause decreased hemoglobin/hematocrit, agranulocytosis, hemolytic and nonhemolytic anemia, thrombocytopenia, leucopenia, and increased WBC. The listed platelet count is high, which is not expected with the drug, the hemoglobin is low and could be attributed to the drug, the protein value is low with no correlation to the drug, and the BNP is high with no correlation to the drug.

KEY: Cognitive Level: Analysis DIF: Hard TOP: Therapeutic Classification: Anti-Parkinson Agents REF: Page 283

15. While caring for a client taking clozapine (Clozaril), the nurse determines the medication is effective by which of the following findings?

A. Decreased swelling noted at the site of cellulitis in the left hand.

B. Apical heart rate is regular at 72 bpm.

C. Client is cooperative; oriented to person, place, and time; and has no hallucinations or delusions.

D. Breath sounds are clear throughout anterior, lateral, and posterior aspects.

ANS: C See Indications and Evaluation/Desired Outcomes for clozapine: Used in the treatment of schizophrenia.

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The medication will have no impact on infection, heart rate, or breath sounds but will help reduce psychotic behaviors.

KEY: Cognitive Level: Analysis DIF: Medium TOP: Therapeutic Classification: Antipsychotics REF: Pages 338–341

16. While caring for a client who is taking cyclosporine (Sandimmune) after a cardiac transplant, the nurse is aware that it is most important to monitor for which of the following?

A. Hypokalemia B. Hypotension C. Anorexia D. Nephrotoxicity ANS: D See Adverse Reactions/Side Effects for cyclosporine: Can cause hyperkalemia and hypertension (not hypokalemia or hypotension) as well as anorexia and nephrotoxicity—the highest priority of those listed (anorexia and nephrotoxicity) is nephrotoxicity.

KEY: Cognitive Level: Application DIF: Hard TOP: Therapeutic Classification: Immunosuppressants REF: Page 381

17. A client admitted with atrial fibrillation would most likely be started on which of the following medications to reduce the risk of embolization?

A. Dabigatran (Pradaxa) B. Desmopressin (DDAVP) C. Venlafaxine (Effexor) D. Tamsulosin (Flomax) ANS: A See Indications for dabigatran: to reduce the risk of stroke/systemic embolization associated with nonvalvular atrial fibrillation: DDAVP is used in the treatment of diabetes insipidus. Venlafexine is an antidepressant and tamsulosin is an antiadrenergic agent used for prostatic hyperplasia.

KEY: Cognitive Level: Knowledge DIF: Hard TOP: Therapeutic Classification: Anticoagulants REF: Page 387

18. While caring for a client who is receiving deferoxamine (Desferal), the nurse notes the client’s urine is reddish colored. Which of the following conclusions should the nurse draw?

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A. There is a risk of hemolytic cystitis with this medication and the next dose should be held.

B. The client may be experiencing liver toxicity; the physician should be contacted to request laboratory analysis be done.

C. This is an expected and normal finding with the medication due to the excretion of iron.

D. The client may have a secondary urinary tract infection and a urinalysis should be sent.

ANS: C See Action and Adverse Reactions/Side Effects of deferoxamine: Chelates unbound iron, forming a water-soluble complex that is easily excreted by the kidneys; red urine is a frequent side effect.

KEY: Cognitive Level: Analysis DIF: Hard TOP: Therapeutic Classification: Antidotes REF: Pages 411–412

19. The nurse is providing care for a 41-year-old patient with a severe head injury following a motor vehicle accident. The nurse notes the client’s urinary output for the past 4 hr is 900 mL. Which of the following medications would the nurse anticipate being ordered?

A. Desmopressin (DDAVP) B. Furosemide (Lasix) C. Allopurinol (Lopurin) D. Dextroamphetamine (Dexedrine) ANS: A See Indications for desmopressin: Treatment of central diabetes insipidus caused by deficiency of vasopressin. Diabetes insipidus, often seen in the presence of a head injury, result in profound dieresis.

Treatment with diuretics (Lasix and Allopurinol) would be contraindicated. Dextroamphetamine is a CNS stimulant used in the treatment of ADHD and narcolepsy.

KEY: Cognitive Level: Analysis DIF: Medium TOP: Therapeutic Classification: Antidiuretic hormones REF: Page 418

20. While counseling a client taking desvenlafaxine (Pristiq), the nurse recognizes that further teaching is necessary based on which of the following client statements?

A. “I’ll be sure to let my doctor know if I have any thoughts of suicide.”

B. “If I need something for pain, I should take aspirin, ibuprofen, or another nonsteroidal antiinflammatory instead of Tylenol while I’m taking this medication.”

C. “I shouldn’t drive a car for a few weeks since this medication can cause dizziness.”

D. “I should avoid drinking alcohol while I’m taking this medication.”

ANS: B See Patient/Family Teaching for desvenlafaxine: Increased risk of bleeding with concomitant use of NSAIDs, aspirin, or other drugs that affect coagulation. Advise patient and family to look for suicidality.

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May cause dizziness or drowsiness. Caution patient to avoid driving until response to the drug is known.

Caution patient to avoid taking alcohol or other CNS depressants.

KEY: Cognitive Level: Application DIF: Medium TOP: Therapeutic Classification: Antidepressants REF: Page 422

21. The nurse is caring for a 68-year-old male who is taking doxazosin (Cardura). He denies any history of hypertension. The nurse recognizes this medication can also be used to treat which of the following conditions?

A. Psoriasis B. Gout C. Lymphoma D. Benign prostatic hypertrophy ANS: D See Indications for doxazosin: Symptomatic benign prostatic hypertrophy.

KEY: Cognitive Level: Knowledge DIF: Medium TOP: Therapeutic Classification: Antihypertensives, Peripherally acting anti REF: Page 468

22. The nurse is providing epoetin (Epogen) subcutaneously to a client with chronic kidney disease.

Which of the following would indicate that the therapy is effective? Select all that apply.

A. The client’s hematocrit rises from 27.4 to 32.9%.

B. The client’s serum creatinine falls from 5.6 mg/dL to 4.9 mg/dL. C. The client reports decreased fatigue and dyspnea.

D. The client reports 500 mL of urine output in a 24-hr period.

E. The client’s WBC = 7.4 u/L. F. The client has remained afebrile for 2 wk.

ANS: A, C See Evaluation/Desired Outcomes for epoetin: Increase in hematocrit to 30–36% with improvement in symptoms of anemia in patients with chronic renal failure.

KEY: Cognitive Level: Analysis DIF: Hard TOP: Therapeutic Classification: Antianemics REF: Page 515

23. The nurse is providing erlotinib (Tarceva) intravenously for a client who has small cell lung cancer.

The client begins to appear slightly short of breath, respiratory rate has gone from 14 breaths per min to

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20 breaths per min, and he has been coughing mildly for the past 10 min. Which of the following actions should the nurse take first?

A. Listen to breath sounds to determine if the client is experiencing fluid volume overload.

B. Stop the infusion since there is a risk of interstitial lung disease with this medication.

C. Check the client’s temperature to determine if he is developing pneumonia.

D. Reassure the client that a cough is normal as cancer cells are destroyed and continue to monitor closely.

ANS: B See Nursing Implications for erlotinib: Assess respiratory status prior to and periodically during therapy.

If dyspnea, cough, or fever occur, discontinue erlotinib, assess for interstitial lung disease, and institute treatment as needed. Treatment must be stopped as the first priority.

KEY: Cognitive Level: Analysis DIF: Hard TOP: Therapeutic Classification: Antineoplastics REF: Page 519

24. The nurse is talking to a neighbor who spent 3 days in the hospital on intravenous antibiotics including erythromycin the wk before. The individual states, “I’ve had such bad diarrhea all night and it really isn’t any better today.” Which of the following statements by the nurse is best?

A. “Are you taking any oral antibiotics now?”

B. “Antibiotics commonly cause diarrhea; be sure to drink plenty of fluids.”

C. “Have you noticed any blood or pus in the stool?”

D. “Is anyone else in the family experiencing the same symptoms?”

ANS: C See Nursing Implications for erythromycin: Monitor bowel function. Diarrhea, abdominal cramping, fever, and bloody stools should be reported promptly as a sign of pseudomembranous colitis. May begin up to several wks following cessation of therapy.

KEY: Cognitive Level: Analysis DIF: Medium TOP: Therapeutic Classification: Anti-infectives REF: Page 523

25. The nurse is reviewing the home medication list for a client with identified hypercholesterolemia. The client reports taking ezetimibe (Zetia) daily. The nurse understands this medication is designed to reduce the client’s risk for which of the following?

A. Atherosclerosis B. Angina C. Deep vein thrombosis D. Gastric ulceration

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ANS: A See Indications and Therapeutic Effects for ezetimibe: Lowers cholesterol, a known risk factor for atherosclerosis.

KEY: Cognitive Level: Comprehension DIF: Easy TOP: Therapeutic Classification: Lipid-lowering agents REF: Page 551

26. While investigating the medications taken by a client in the hospital, the student nurse understands that felodipine (Plendil) works to lower blood pressure by causing which of the following physiologic changes?

A. Dilatation of the vascular wall B. Blocking the transport of calcium C. Inhibiting the beta receptors on cell membranes D. Reducing the formation of ectopic beats ANS: B See Action for felodipine: Inhibits the transport of calcium into myocardial and vascular smooth muscle cells, resulting in inhibition of excitation-contraction coupling and subsequent contraction.

KEY: Cognitive Level: Comprehension DIF: Easy TOP: Therapeutic Classification: Antianginals, Calcium channel blockers REF: Page 555

27. A nurse caring for a client with chronic obstructive pulmonary disease notes the recent addition of a new inhaler, formoterol. The nurse knows this medication is designed to prevent which of the following symptoms?

A. Mucous production B. Salivation C. Bleb formation D. Bronchospasm ANS: D See Indications for formoterol: As concomitant therapy for the treatment of asthma and the prevention of bronchospasm.

KEY: Cognitive Level: Knowledge DIF: Easy TOP: Therapeutic Classification: Bronchodilators REF: Drugguide.com

28. A client with Alzheimer’s is started on galantamine (Razadyne) 4 mg twice daily. The family has been told to return to the physician’s office in 4 wk. Which of the following statements by the nurse is

Davis’s Drug Guide for Nurses, 17e

Test Bank 3-12

best?

A. “Sometimes a higher dose of this medication is needed to see improvement.”

B. “You should notice improvement within a day or two.”

C. “If you forget a dose one day, just have her take two the next day.”

D. “This medication can cause dizziness so be extra careful to avoid falls.”

ANS: D See Patient/Family Teaching: Increased dosage may be needed but the risk of falls due to dizziness is a higher priority. Improvement may not been seen for wk to mo and doses should not be doubled.

KEY: Cognitive Level: Analysis DIF: Medium TOP: Therapeutic Classification: Anti-Alzheimer agents REF: Page 616

29. While observing in the operating room, the student nurse notes a client was given glycopyrrolate (Cuvposa) preoperatively as part of the anesthesia regimen. The student recognizes this medication will cause which of the following?

A. Decreased pain perception during the procedure B. Reduced oral and respiratory secretions C. Neuromuscular blockage and paralysis D. Reduced consciousness and sedation ANS: B See Indications for glycopyrrolate: Inhibits salivation and excessive respiratory secretions when given preoperatively.

KEY: Cognitive Level: Comprehension DIF: Medium TOP: Therapeutic Classification: Antispasmodics REF: Page 628

30. The nurse is preparing to provide a chemotherapy treatment for a client with non-small cell lung cancer. It is day 8 of the 28-day chemotherapy cycle, and the client is scheduled to receive gemcitabine (Infugem) IV. Match the following nursing actions in the correct order for provision.

A. Infuse over 30 min.

B. Identify absolute granulocyte and platelet counts.

C. Monitor vital signs every 15 min.

D. Obtain medication from pharmacy.

1. ANS: B 2. ANS: D 3. ANS: A 4. ANS: C

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See Nursing Implications/labs for gemcitabine: Dose guidelines are based on CBC results, so this must be determined first. Administer over 30 min—longer infusions have a greater incidence of toxicity. Monitor vital signs before and frequently during therapy.

KEY: Cognitive Level: Analysis DIF: Easy TOP: Therapeutic Classification: Antineoplastics REF: Page 622

31. While working in the psychiatric hospital, the nurse provides iloperidone (Fanapt) 2 mg twice daily.

Which of the following assessments indicates the medication is effective?

A. The client’s mood is stabilized.

B. The client is able to sleep for 8 hr at night.

C. The client denies hearing voices.

D. The client’s weight is stabilized.

ANS: C See Action/Therapeutic Effects: Decreased symptoms of schizophrenia.

KEY: Cognitive Level: Application DIF: Medium TOP: Therapeutic Classification: Antipsychotics REF: Page 682

32. The nurse is caring for a client newly admitted with pelvic inflammatory disease. An order for imipenem/cilastatin (Primaxin) 500 mg IV every 6 hr is noted. The nurse would be most concerned by which of the following findings in the client’s history?

A. Use of an intrauterine device for birth control B. Family history of hypertension C. Order for morphine sulfate 2 mg IV every 4 hr as needed for pain D. History of seizures ANS: D See Contraindications/Precautions for imipenem/cilastatin: Previous history of seizure disorder— medication can cause seizures.

KEY: Cognitive Level: Application DIF: Easy TOP: Therapeutic Classification: Anti-infectives REF: Page 687

33. The nurse responds to a call light for a client with chronic obstructive pulmonary disease and finds the client slightly dyspneic with a respiratory rate of 20 and wheezing noted in the anterior and posterior upper lung fields. The nurse knows the client has orders for indacaterol (Arcapta) inhaler once daily,

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which is due in 1 hr. Which of the following actions by the nurse is best?

A. Provide the indacaterol (Arcapta) inhaler at this time.

B. Check the client’s temperature.

C. Determine if the client has an order for other respiratory inhalers/treatment.

D. Identify the most recent chest x-ray results.

ANS: C See Nursing Implications: Consult health care professional about alternative medications if severe bronchospasm is present; onset of action is too slow for client in acute distress.

KEY: Cognitive Level: Analysis DIF: Medium TOP: Therapeutic Classification: Bronchodilators REF: Page 692

34. The nurse is providing care for a client with end stage renal disease who is receiving lanthanum carbonate (Fosrenol). The nurse recognizes this medication is effective by which of the following laboratory values?

A. Serum potassium = 3.7 mEq/L B. Hemoglobin = 10.2 g/dL C. Uric acid = 3.7 mg/dL D. Serum phosphate = 5.4 mg/dL ANS: D See Evaluation/Desired Outcome: Decrease in serum phosphate to below 6.0 mg/dL in clients with end stage renal disease.

KEY: Cognitive Level: Analysis DIF: Medium TOP: Therapeutic Classification: Hypophosphatemics REF: Page 756

35. While observing in the oncology clinic, a student nurse is reviewing chemotherapy orders for a client with advanced colorectal cancer. The nurse providing care explains the client is to receive “high-dose methotrexate with leucovorin rescue.” The student understands the leucovorin calcium is given for which of the following reasons?

A. As a catalyst to increase the number of cancer cells destroyed by the methotrexate.

B. As an antidote to the methotrexate to reduce the destruction of blood cells.

C. As a second chemotherapeutic agent that will destroy cancer cells using a different mechanism.

D. As a carrying agent to ensure delivery of the methotrexate into the cells.

ANS: B See Indications of leucovorin calcium: Minimizes hematologic effects of high-dose methotrexate therapy.

KEY: Cognitive Level: Comprehension DIF: Medium TOP: Therapeutic Classification: Antidotes

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REF: Page 770

36. The student nurse reviews a list of medications a client takes at home. Levalbuterol (Xopenex) is on the list. The student expects this medication is provided in which of the following ways?

A. Orally B. Topically C. Rectally D. Metered dose inhaler ANS: D See Availability: Metered dose inhaler.

KEY: Cognitive Level: Knowledge DIF: Easy TOP: Therapeutic Classification: Bronchodilators REF: Page 775

MULTIPLE RESPONSE

37. A student nurse is preparing to participate in a mission trip to South Africa and is prescribed hydroxychloroquine (Plaquenil). Which of the following side effects may be experienced by the student?

Select all that apply.

A. Rash B. Headache C. Ringing in the ears D. Anorexia E. Diarrhea F. Hypertension ANS: B, C, D, E See Adverse Reactions/Side Effects of hydroxychloroquine: Can cause headache, fatigue, hypotension (not hypertension), abdominal cramps, diarrhea, anorexia, alopecia, photosensitivity, and hyper pigmentation (not rash).

KEY: Cognitive Level: Knowledge DIF: Hard TOP: Therapeutic Classification: Antimalarials REF: Page 672

38. As part of a new treatment regimen for hypothyroidism, a 48-year-old woman is prescribed levothyroxine (Levoxyl). The nurse should include which of the following statements in the client teaching? Select all that apply.

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A. “You should take this medication at roughly the same time each day.”

B. “Once you’ve been taking this medication for a few weeks, you should be cured and the doctor will stop it.”

C. “Let the doctor know if you lose more than 2 pounds per week while taking this medication.”

D. “Do not take this medication at the same time as any other medications.”

E. “Avoid eating beef or pork while taking this medication.”

F. “Some clients experience headaches, nervousness, sweating, and palpitations while taking this medication.”

ANS: A, C, D, F See Patient/Family Teaching for levothyroxine. Instruct patient to take medication as directed at the same time each day. Explain the medication does not cure hypothyroidism; therapy is life-long. Advise patient to notify health care provider if headache, nervousness, diarrhea, excessive sweating, heat intolerance, weight loss of more than 2 lb/wk, or any unusual symptoms occur. Caution patient to avoid taking other medications concurrently.

KEY: Cognitive Level: Analysis DIF: Medium TOP: Therapeutic Classification: Hormones REF: Page 783

39. The nurse is providing care for a client who has new orders to start liraglutide (Victoza) 0.6 mg subcutaneously each day. Which of the following orders should the nurse anticipate? Select all that apply.

A. Check blood sugar before meals and at bedtime.

B. Teach client self-injection techniques.

C. Conduct liver function tests every morning for the next 3 days.

D. Discontinue low-molecular-weight heparin.

E. Notify physician of acute abdominal pain, nausea, or vomiting.

F. Hold all aspirin products.

ANS: A, B, E See Indications, Availability, and Assessment for liraglutide: Used in the management of type 2 diabetes, provided as a subcutaneous injection with/without prefilled pen, monitor for pancreatitis. No contraindication for heparin or aspirin products; no change in liver enzymes expected.

KEY: Cognitive Level: Application DIF: Medium TOP: Therapeutic Classification: Antidiabetics REF: Pages 790–792

40. A nurse from the medical unit is floated to the surgical unit. While preparing to provide morning medications, the nurse realizes many clients are taking meperidine (Demerol) and knows the drug must be given cautiously or in reduced doses to which of the following clients? Select all that apply.

A. A 42-year-old patient taking nitroglycerine (Nitro-Time) B. A 68-year-old patient taking fluoxetine (Prozac) C. A 74-year-old patient taking procarbazine (Matulane)

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D. A 66-year-old patient taking phenytoin (Dilantin) E. A 51-year-old patient taking acyclovir (Zovirax) F. A 76-year-old patient taking levothyroxine (Synthroid) ANS: C, D, E See Interactions Drug-Drug for meperidine: Do not use in clients receiving MAO inhibitors or procarbazine. Phenytoin increases metabolism and may decrease effects. Acyclovir may increase plasma concentrations. No listed interaction with nitroglycerine, fluoxetine, or levothyroxine.

KEY: Cognitive Level: Application DIF: Hard TOP: Therapeutic Classification: Opioid analgesics REF: Page 827

41. A nurse caring for a client who is to initiate therapy with meropenem (Merrem) 500 mg intravenously every 12 hr would include which of the following statements in the client teaching? Select all that apply.

A. “This medication is used to treat various infections.”

B. “The dose is reduced since you have a history of renal impairment.”

C. “Be sure to let us know if you develop any diarrhea.”

D. “Since you have an allergy to penicillin, there is no risk of allergy to this medication.”

E. “The medication can cause dizziness for some people so be sure to call for help when you need to get up out of bed.”

ANS: A, B, C, E See Indications, Route/Dosage (Renal Impairment) and Patient/Family Teaching for meropenem: Treatment of intra-abdominal infections, bacterial meningitis, skin and skin structure infections, reduce dose to 500 mg every 12 hr CCr 10–25 mL/min, caution patient to notify health care provider if patient has fever and diarrhea; may cause dizziness.

KEY: Cognitive Level: Application DIF: Medium TOP: Therapeutic Classification: Anti-infectives REF: Pages 831–833

42. Which of the following would cause the nurse to suspect that a client taking metformin (Glucophage) may be developing lactic acidosis? Select all that apply.

A. Client reports chills and muscle aches.

B. Blood pressure = 98/54 mmHg. C. Client reports profound headache and ringing in the ears.

D. Client complains of dizziness and diarrhea.

E. White blood cell count = 7500 cell/mm3.

F. Pupils are dilated and unresponsive to light.

ANS: A, B, D See Patient/Family Teaching for metformin: Explain to patient the risk of lactic acidosis. Symptoms

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include chills, diarrhea, dizziness, low BP, muscle pain, sleepiness, slow heartbeat or pulse, dyspnea, or weakness.

KEY: Cognitive Level: Analysis DIF: Hard TOP: Therapeutic Classification: Antidiabetics REF: Pages 840–841

43. The nurse is caring for a client taking metaxalone (Skelaxin). The nurse knows teaching has been effective by which of the following statements? Select all that apply.

A. “I might be constipated while I’m on this medication.”

B. “Most people who take this medication have fewer muscle spasms and less pain.”

C. “This can cause dizziness, blurred vision, and sleepiness so I shouldn’t drive while I’m on it.”

D. “I need to move slowly so I don’t faint.”

E. “I can drink up to 2 beers per day safely while I’m on this medication.”

F. “If I forget this medication, I can take it within one hour or skip that dose and remain on the schedule.”

ANS: B, C, D, F See Patient/Family Teaching for metaxalone: Used for muscle spasm. Medication may cause dizziness, drowsiness, and blurred vision. Advise patient to avoid driving and other activities requiring alertness.

Instruct patient to make position changes slowly to minimize orthostatic hypotension. Instruct patient to take medication as directed, take missed doses within 1 hr, if not, and return to regular dosing schedule.

Advise patient to avoid concurrent use of alcohol and other CNS depressants. Does not usually cause constipation.

KEY: Cognitive Level: Application DIF: Medium TOP: Therapeutic Classification: Skeletal muscle relaxants REF: Pages 838–839

44. While providing care for a 45-year-old woman client who has been started on methimazole (Tapazole) 15 mg every 4 hr, the nurse would include which of the following in the plan of care? Select all that apply.

A. Teach client self-injection techniques.

B. Monitor for signs and symptoms of hyper- or hypothyroidism.

C. Place client in protective isolation.

D. Assess white blood cell and differential counts.

E. Strain all urine.

F. Monitor for signs or symptoms of bleeding.

ANS: B, D See Nursing Implications for methimazole: Monitor response for symptoms of hyperthyroidism; assess for development of hypothyroidism. Monitor WBC and differential counts periodically during therapy.

Medication is provided orally, has no effect on urine or formation of kidney stones, does not require protective isolation or cause bleeding.

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KEY: Cognitive Level: Application DIF: Hard TOP: Therapeutic Classification: Antithyroid agents REF: Pages 844–845

45. While reviewing a client’s medication list, the nurse notes the client takes mirtazapine (Remeron) 15 mg daily. The nurse recognizes this medication has multiple indications and is used both on and off label for various reasons including which of the following? Select all that apply.

A. Major depressive disorder B. Schizophrenia C. Anorexia nervosa D. Panic disorder E. Generalized anxiety disorder F. Post-traumatic stress disorder ANS: A, D, E, F See Indications for mirtazapine: Major depressive disorder. Unlabeled use: panic disorder, generalized anxiety disorder, post-traumatic stress disorder.

KEY: Cognitive Level: Application DIF: Hard TOP: Therapeutic Classification: Antidepressants REF: Page 877

46. While caring for a client receiving methyldopa for hypertension, the nurse recognizes elevations in which of the following labs may be caused by the medication? Select all that apply.

A. Serum creatinine B. White blood cells C. Amylase D. Albumin E. Potassium F. Sodium ANS: A, E, F See Nursing Implications for methyldopa: May cause increase in BUN, serum creatinine, potassium, sodium, prolactin, uric acid, AST, ALT, alkaline phosphatase, and bilirubin concentration.

KEY: Cognitive Level: Application DIF: Medium TOP: Therapeutic Classification: Antihypertensives REF: Pages 849–850

COMPLETION

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47. A new order for foscarnet (Foscavir) 60 mg/kg IV every 8 hr has been noted. The patient weighs 50 kg. With a dilution required concentration of 12 mg/mL, what size IV bag will the nurse need to infuse this medication ___________________?

ANS: 250 mL IV bag See Implementation/IV Administration for foscarnet: Drug calculation: 60 mg × 50 kg = 3000 mg. 3000 mg divided by 12 mg = 250. The nurse will need a 250 mL IV bag.

KEY: Cognitive Level: Application DIF: Easy TOP: Therapeutic Classification: Antivirals REF: Page 604

48. The nurse receives orders to begin methocarbamol (Robaxin) 4.5 g per day in 3 equally divided doses.

The medication is available in 500 mg tablets. How many pills will the nurse provide with each dose? __________ pills ANS: 3 Dose calculation: 4.5 g divided by 3 is 1.5 g per dose. 1.5 g × 1000 mg/g divided by 500 mg/tablet = 3 tablets.

KEY: Cognitive Level: Application DIF: Easy TOP: Therapeutic Classification: Skeletal muscle relaxants REF: Drugguide.com

49. The nurse is preparing to start therapy with IV dobutamine (Dobutrex). The premixed solution has 250 mg in 250 mL. The orders read 5 mcg/kg/min and the client weighs 165 lb. At what rate, expressed in mL/hr, should the infusion be started? (Round to the nearest tenths place.) ___________ mL/hr ANS: 22.5 See Route/Dosage and Availability for dobutamine: Drug calculation involves converting client’s weight to kg [165 divided by 2.2 = 75 kg] followed by calculation of the dose [5 mcg × 75 kg = 375 mcg/min] followed by dose conversion to mg [375 divided by 1000 = 0.375 mg/min] followed by calculation for an hourly rate [0.375 × 60 = 22.5 mg/hr] since the solution has 1 mg/mL, the final conversion does not change the rate [22.5 × 1 = 22.5 mL/hr].

KEY: Cognitive Level: Knowledge DIF: Hard TOP: Therapeutic Classification: Inotropics REF: Page 451

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MULTIPLE CHOICE

1. The nurse works in a pediatric psychiatry unit. Methylphenidate (Ritalin) 5 mg 3 times daily is commonly prescribed for many of the clients. The nurse recognizes this drug needs to be used cautiously in which of the following children?

A. An 8-year-old patient with a history of cardiovascular disease B. A 12-year-old patient with a history of scoliosis C. A 6-year-old patient who takes montelukast (Singulair) daily D. A 7-year-old patient with a history of sickle cell anemia ANS: A See Contraindications/Precautions for methylphenidate: Sudden death has occurred in children with structural cardiac abnormalities or other cardiovascular disease.

KEY: Cognitive Level: Application DIF: Medium TOP: Therapeutic Classification: Central nervous system stimulants REF: Page 853

2. A 71-year-old client was newly prescribed metolazone (Zaroxolyn). The nurse recognizes the drug has been effective by which of the following assessments?

A. White blood cell count = 5500 cells/mm3 B. Client reports sleeping 8 hr per night C. BP = 132/74 D. Client denies hallucinations ANS: C See Evaluation for metolazone: Decrease in BP and edema, increase in urine output.

KEY: Cognitive Level: Application DIF: Medium TOP: Therapeutic Classification: Antihypertensives, Diuretics REF: Page 861

3. The nurse is providing care for a 64-year-old client being prepped for a colonoscopy who is given midazolam. The nurse would expect to see which of the following responses?

A. Decrease in oral secretions B. Increased heart rate C. Decrease in abdominal cramping

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D. Increased drowsiness ANS: D See Nursing Implications for midazolam: Preprocedural sedation.

KEY: Cognitive Level: Application DIF: Medium TOP: Therapeutic Classification: Anti-anxiety agents; Sedative/Hypnotics REF: Pages 869–870

4. The nurse is providing milrinone to a 71-year-old woman with heart failure. Which of the following nursing assessments during the infusion is of the highest priority?

A. Monitor client’s blood sugar every 4 hr.

B. Monitor client’s sedation level hourly.

C. Monitor client’s telemetry continuously.

D. Monitor client’s urine output every 4 hr.

ANS: C See Nursing Implications Assessment for milrinone: Monitor ECG continuously during infusion.

Arrhythmias are common and may be life threatening.

KEY: Cognitive Level: Analysis DIF: Hard TOP: Therapeutic Classification: Inotropics REF: Page 875

5. While preparing to give morning medications, mirtazapine (Remeron) was newly ordered for the patient to begin this morning. The nurse would immediately call the physician to question this order if which of the following medications was included in the patient’s list of home medications?

A. Enteric coated aspirin B. Furosemide (Lasix) C. Lanoxin (Digoxin) D. Phenelzine (Nardil) ANS: D See Interactions for mirtazapine: Concurrent use with MAO inhibitors can cause hypertension, seizures, and death.

KEY: Cognitive Level: Analysis DIF: Hard TOP: Therapeutic Classification: Antidepressants

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REF: Page 878

6. A nurse is receiving a shift-to-shift report for a client with multiple medical problems. The client is receiving nabumetone. The nurse recognizes this medication is ordered to address which of the following health care problems for the client?

A. Benign prostatic hypertrophy B. Rheumatoid arthritis C. Venous-thrombosis embolic prophylaxis D. Urinary tract infection ANS: B See Indications for nabumetone: Symptomatic management of rheumatoid arthritis.

KEY: Cognitive Level: Application DIF: Medium TOP: Therapeutic Classification: Antirheumatics, Nonsteroidal anti-inflammatory agents REF: Drugguide.com

7. While providing care for a client who is to receive naratriptan (Amerge), the nurse recognizes that the client understands this medication by which of the following statements?

A. “If my migraine headache doesn’t go away, I can repeat the dose within 30 minutes.”

B. “This medication will typically make me very sleepy after I take it.”

C. “I need to let the doctor know right away if I have any chest pain or tightness after taking this medication.”

D. “I need to be sure and take a laxative when I take this medication.”

ANS: C See Patient/Family Teaching for naratriptan: Advise patient and family to notify health care professional prior to next dose of naratriptan if pain or tightness in the chest occurs during use.

Dose may be repeated in 4 hr if response is inadequate. Medication does not cause sedation or constipation.

KEY: Cognitive level: Analysis DIF: Medium TOP: Therapeutic Classification: Vascular headache suppressants REF: Page 908

8. In reviewing new orders, the nurse notes nateglinide (Starlix) 120 mg 3 times daily before meals has been ordered. Before initiating therapy, the nurse should assess for which of the following?

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A. Blood sugar B. Respiratory rate C. Level of consciousness D. Creatinine clearance ANS: A See Assessment for nateglinide: Monitor serum glucose.

KEY: Cognitive Level: Application DIF: Medium TOP: Therapeutic Classification: Antidiabetics REF: Drugguide.com

9. While caring for a client with hypertension who has recently started taking nebivolol (Bystolic), the client reports, “This medication seems to give me a headache.” Which of the following statements by the nurse is best?

A. “Headaches are common with your new medications. You should continue to take the medication to help control your blood pressure.”

B. “That’s too bad. You could try taking half a pill twice a day.”

C. “You should call your doctor and let them know about that—it could be a serious side effect of the new medication.”

D. “Have you noticed any muscle twitching or facial numbness?”

ANS: A See Adverse Reactions/Side Effects for nebivolol: Can cause dizziness, fatigue, and headache.

KEY: Cognitive Level: Analysis DIF: Medium TOP: Therapeutic Classification: Antihypertensives REF: Page 909

10. The nurse is providing instructions to a client who has started therapy with nicardipine. The nurse instructs the client to avoid which of the following foods?

A. Kiwi B. Grapefruit juice C. Garlic D. Ginger ANS: B See Drug-Food under Interactions for nicardipine: Grapefruit and grapefruit juice increases serum levels and effect.

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KEY: Cognitive Level: Knowledge DIF: Easy TOP: Therapeutic Classification: Antianginals, Antihypertensives REF: Page 913

11. While providing care for a client in the intensive care unit, the nurse is preparing to initiate therapy with nitroprusside (Nitropress). Orders are to start the infusion at 0.3 mcg/kg/min. The client weighs 154 lbs. The IV fluid has been sent with 50 mg in 250 mL D5W. Calculate the rate of medication in mL/hr. ______________ mL/hr ANS: 6.3 Drug calculation: Multiple 50 mg by 1000 mcg/mg and divide by 250 mL = 200 mcg/mL to determine solution concentration. Divide 154 lb by 2.2 = 70 kg to determine client weight.

Multiply 0.3 mcg by 70 kg = 21 mcg/min to determine dose. Multiply 21 mcg/min × 60 min/hr × 1 mL/200 mcg = 6.3 mL/hr.

KEY: Cognitive Level: Application DIF: Hard TOP: Therapeutic Classification: Antihypertensives REF: Page 918

12. While caring for a client who is taking olsalazine (Dipentum) for ulcerative colitis, the nurse is aware that it is most important to determine if the patient has an allergy to which of the following?

A. Penicillins or cephalosporins B. NSAIDs or opioids C. Beta blockers or nitrosoureas D. Sulfonamides or salicylates ANS: D See Nursing Implications/Assessment for olsalazine: Assess patient for allergy to sulfonamides and salicylates. Patients allergic to sulfasalazine may take mesalamine or olsalazine without difficulty, but therapy should be discontinued if rash or fever occurs.

KEY: Cognitive Level: Application DIF: Hard TOP: Therapeutic Classification: Gastrointestinal anti-inflammatories REF: Page 950

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13. A client admitted with neutropenia would most likely be started on which of the following medications to promote neutrophil differentiation?

A. Epoetin (Epogen) B. Pegfilgrastim (Neulasta) C. Gabapentin (Neurontin) D. Nifedipine (Procardia) ANS: B See Indications for pegfilgrastim: Decreases incidence of infection in patients with nonmyeloid malignancies receiving myelosuppressive antineoplastics associated with a high-risk febrile neutropenia.

KEY: Cognitive Level: Knowledge DIF: Medium TOP: Therapeutic Classification: Colony-stimulating factors REF: Pages 1003–1004

14. While caring for a client who is receiving oxazepam (Serax), the nurse notes the client is drowsy and slightly confused upon waking. Which of the following conclusions should the nurse draw?

A. The client may be experiencing symptoms of a stroke and the physician should be contacted immediately.

B. The client may be experiencing hypersensitivity and the drug should be held.

C. This is an expected and normal finding with the medication and the patient should be monitored for safety concerns.

D. The client may have underlying psychiatric disorders and should be assessed for the presence of hallucinations.

ANS: C See Action and Adverse Reactions/Side Effects of oxazepam: Management of anxiety. Depresses CNS. Common side effects include dizziness, and drowsiness, confusion, and impaired memory may occur.

KEY: Cognitive Level: Analysis DIF: Medium TOP: Therapeutic Classification: Anti-anxiety agents, Sedative/Hypnotics REF: Page 967

15. The nurse is providing care for a 31-year-old patient with a history of seizures. Which of the following medications would the nurse anticipate is part of the patient’s home medication regimen?

A. Oxcarbazepine (Trileptal)

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B. Pentoxifylline (Pentoxil) C. Allopurinol (Zyloprim) D. Dextroamphetamine (Dexedrine) ANS: A See Indications for oxcarbazepine: Monotherapy or adjunctive therapy of partial seizures in adults and children. Pentoxifylline is used to treat leg cramps associated with intermittent claudication. Allopurinol is a diuretic. Dextroamphetamine is a CNS stimulant used in the treatment of ADHD and narcolepsy.

KEY: Cognitive Level: Knowledge DIF: Hard TOP: Therapeutic Classification: Anticonvulsants REF: Page 968

16. While counseling a client taking palifermin (Kepivance), the nurse recognizes that further teaching is necessary based on which of the following client statements?

A. “I’ll be sure to let my doctor know if I develop a rash or any tongue discolorations.”

B. “As long as I’m taking this, I won’t get any side effects from my chemotherapy.”

C. “This medication helps prevent the mouth sores that were so bad with my last chemotherapy treatment.”

D. “I have to get this medication in an IV 3 days before and 3 days after my chemotherapy.”

ANS: B See Indications, Side Effects and Patient/Family Teaching for palifermin: To decrease incidence/duration of severe oral mucositis associated with myelotoxic therapy. Advise patient to notify health care professional if rash, erythema, edema, pruritus, or tongue discoloration occur.

Provided IV 3 days prior to and 3 days after chemotherapy.

KEY: Cognitive Level: Analysis DIF: Medium TOP: Therapeutic Classification: Cytoprotective agents REF: Page 982

17. The nurse caring for clients in the psychiatric unit provides paliperidone (Invega) to one of the clients. The nurse recognizes this medication is effective by which of the following observations?

A. The client’s weight is stable for 3 days.

B. The client reports the voices in his head have stopped talking to him.

C. The client stops pacing the halls and ringing his hands.

D. The client is able to focus on completing a puzzle in the day room.

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ANS: B See Indication for paliperidone: Acute and maintenance treatment of schizophrenia. Clients with schizophrenia often have auditory hallucinations. Stable weight is associated with eating disorders. Pacing and ringing of hands is more indicative of mania. Increased focus and attention may be related to depression or ADHD. KEY: Cognitive Level: Analysis DIF: Medium TOP: Therapeutic Classification: Antipsychotics REF: Page 983

18. The nurse is preparing to give an initial dose of palonosetron (Aloxi) as ordered prior to starting chemotherapy for breast cancer. Which of the following nursing actions is of the highest priority?

A. Infuse the medication undiluted 30 min prior to planned chemotherapy.

B. Monitor symptoms of nausea or vomiting.

C. Provide the client with written materials on the chemotherapy agents being used.

D. Determine the client’s typical food intake.

ANS: A See Nursing Implications and Implementation for palonosetron: Prevention of acute and delayed nausea and vomiting caused by initial or repeat courses of moderate or highly emetogenic chemotherapy. Administer dose undiluted 30 min prior to chemotherapy. Symptoms of nausea and vomiting will be associated with chemotherapy provision, which is timed after the provision of palonosetron. Written material provision is not time sensitive. Typical food intake will not impact timing or provision of the drug.

KEY: Cognitive Level: Application DIF: Medium TOP: Therapeutic Classification: Antiemetics REF: Pages 986–987

19. The nurse is caring for a 58-year-old male who has been prescribed pegfilgrastim (Neulasta).

The nurse recognizes provision of this medication is based on which of the following lab results?

A. Hgb = 11.7 g/dL B. CPK = 25 mcg/L C. Platelets = 114,000 cells/mm3 D. WBC = 2.3 cells/mm3 ANS: D See Indications for pegfilgrastim. To decrease incidence of infection in patients with nonmyeloid malignancies receiving myelosuppressive antineoplastics. The WBC count will be affected by

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the medication and the listed value is very low. The Hgb is slightly low; the CPK and platelet counts are normal.

KEY: Cognitive Level: Analysis DIF: Medium TOP: Therapeutic Classification: Colony-stimulating factors REF: Pages 1003–1004

20. The nurse is providing care for an elderly woman with a urinary tract infection. The nurse understands the patient is receiving phenazopyridine (Pyridium) for which of the following reasons?

A. To reduce the frequency and severity of bladder spasms.

B. To provide local anesthetic effects to the bladder mucosa.

C. To kill E. coli bacteria commonly associated with urinary tract infection.

D. To promote diuresis and subsequently prevent stone formation.

ANS: B See Action for phenazopyridine: Acts locally on the urinary tract mucosa to produce analgesic or local anesthetic effects.

KEY: Cognitive Level: Comprehension DIF: Medium TOP: Therapeutic Classification: Nonopioid analgesic REF: Pages 1022–1023

21. The nurse is reviewing the home medication list for a client with a history of head and neck cancer who has been receiving radiation therapy. The client reports taking PO pilocarpine (Salagen) 3 times daily. The nurse understands this medication is designed to help treat which of the following?

A. Xerostomia B. Nausea C. Metastatic disease D. Taste changes ANS: A See Indications for pilocarpine: Management of xerostomia (dry mouth), which may occur as a consequence of radiation therapy.

KEY: Cognitive Level: Comprehension DIF: Easy TOP: Therapeutic Classification: None assigned

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Test Bank 4-10

REF: Drugguide.com

22. While investigating the medications taken by a client in the hospital, the student nurse understands that piperacillin/tazobactam (Zosyn) has an extended spectrum compared to other penicillins for which of the following reasons?

A. Neither drug is able to cross the placenta well.

B. Tazobactam inhibits an enzyme that destroys penicillins.

C. The half-life of the combined drugs is over 6 hr.

D. Piperacillin is highly metabolized with less than 10% excreted in an unchanged form.

ANS: B See Action and Pharmacokinetics for piperacillin/tazobactam: Piperacillin binds to bacterial cell wall membrane causing cell death. Spectrum is extended. Tazobactam inhibits beta-lactamase, an enzyme that can destroy penicillins. The drugs are widely distributed. Half-life is 0.7–1.2 hr and cross the placenta at low concentrations. Respectively, 68 and 80% are excreted unchanged by the kidneys.

KEY: Cognitive Level: Comprehension DIF: Hard TOP: Therapeutic Classification: Anti-infectives REF: Page 1040

23. A new order for potassium phosphate (K-Phos) 250 mg 4 times daily has been noted. When preparing to administer the medication, which of the following actions will the nurse take?

A. Provide the tablets orally at least 2 hr before meals.

B. Provide the tablets orally directly after meals.

C. Dissolve the tablets in a full glass of water and let stand for 2–5 min to ensure it is fully dissolved.

D. Provide medication simultaneously with antacid to reduce stomach irritation.

ANS: C See Implementation for potassium phosphate: Tablets should be dissolved in a full glass of water. Allow mixture to stand for 2–5 min. Medication should be administered after meals. Do not administer simultaneously with antacids.

KEY: Cognitive Level: Application DIF: Medium TOP: Therapeutic Classification: Antiurolithics, Mineral and electrolyte replacements/supplements REF: Page 1046

Davis’s Drug Guide for Nurses, 17e

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24. A client with Parkinson disease is started on pramipexole (Mirapex) 0.125 mg 3 times daily.

The family has been told to return to the physician’s office in 4 wk. Which of the following statements by the nurse is best?

A. “This medication may cause insomnia, so you may want to take melatonin to help you sleep.”

B. “You can break the extended release tablet up to make it easier to swallow.”

C. “If you forget to take the extended release tablet in the morning, just take it at bedtime.”

D. “Be sure to let the physician know if you notice any confusion or hallucinations.”

ANS: D See Nursing Implications and Patient/Family Teaching for pramipexole: Drowsiness is a common side effect of the medication. Extended release tablets should be swallowed whole. If extended release tablets are missed, skip dose and take next regular scheduled dose. The medication can cause hallucinations and confusion—the health care provider should be notified.

KEY: Cognitive Level: Analysis DIF: Medium TOP: Therapeutic Classification: Anti-Parkinson agents REF: Page 1044

25. While preparing to pass medications on a medical unit, the student nurse notes a client is scheduled to receive prazosin (Minipress). The student recognizes this medication will cause which of the following?

A. Decreased gastric acid production B. Reduced oral and respiratory secretions C. Dilatation of arteries and veins D. Increased cardiac preload and afterload ANS: C See Action for prazosin: Dilates both arteries and veins by blocking postsynaptic alpha adrenergic receptors; decreased cardiac preload and afterload.

KEY: Cognitive Level: Comprehension DIF: Medium TOP: Therapeutic Classification: Antihypertensives REF: Page 1053

26. While working in the oncology clinic, the nurse provides Matulane (procarbazine) for a patient with Hodgkin’s disease. Which of the following medications could potentially cause deep coma and/or death if given concurrently?

A. Ibuprofen (Advil) B. Digoxin (Lanoxin)

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C. Meperidine (Demerol) D. Sucralfate (Carafate) ANS: C See Interactions Drug-Drug for procarbazine: Deep coma and death may result from concurrent use of opioid analgesics; avoid meperidine.

KEY: Cognitive Level: Knowledge DIF: Medium TOP: Therapeutic Classification: Antineoplastic REF: Drugguide.com

27. The nurse is caring for a client who was newly prescribed progesterone (Crinone). The nurse would provide additional education in response to which of the following client statements?

A. “I should stop taking this medication if I suspect I may be pregnant.”

B. “If I have spotting or a change in my bleeding pattern, I should call the physician.”

C. “I should use sunscreen and protective clothing to reduce the chance of irritation.”

D. “This medication is designed to halt ovulation.”

ANS: D See Patient/Family Teaching and Therapeutic Effect for progesterone: Instruct patient to notify health care professional if change in vaginal bleeding pattern or spotting occurs. Instruct patient to stop taking medication and notify health care professional if pregnancy is suspected. Caution patient to use sunscreen and protective clothing to prevent photosensitivity reactions. Medication restores hormonal balance with control of uterine bleeding and supports successful outcome in assisted reproduction.

KEY: Cognitive Level: Analysis DIF: Medium TOP: Therapeutic Classification: Hormones REF: Page 1061

28. The nurse is providing medications for a male patient who has been taking pyrazinamide (Tebrazid) 30 mg/kg daily. The nurse notes the patient’s AST = 45 units/L. Which of the following actions by the nurse is best?

A. Provide the pyrazinamide at this time.

B. Check the client’s total protein level.

C. Hold the medication and call the physician regarding dosage.

D. Contact the pharmacy and ask them to split the dose.

ANS: C See Nursing Implications for pyrazinamide: Evaluate hepatic function before and every 2–4 wk

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during therapy. Patients with impaired liver function should receive pyrazinamide therapy only if crucial to treatment. Normal AST for males is 14–20 units/L. KEY: Cognitive Level: Analysis DIF: Medium TOP: Therapeutic Classification: Antituberculars REF: Page 1073

29. The nurse is providing care for a client who is receiving rabeprazole (Aciphex). The nurse recognizes this medication is effective by which of the following assessment findings?

A. Patient voids 250 mL urine and reports feeling reduced bladder spasms.

B. Patient denies abdominal pain or heartburn.

C. Patient reports improvement in itching.

D. Patient’s white blood cell count is less than 10,000/mm3.

ANS: B See Evaluation/Desired Outcome for rabeprazole: Decrease in abdominal pain or prevention of gastric irritation.

KEY: Cognitive Level: Analysis DIF: Hard TOP: Therapeutic Classification: Antiulcer agents REF: Page 1080

30. While working on the medical unit, the nurse is notified that one of the patients has requested a sleeping pill. A new order has been received for ramelteon (Rozerem) 8 mg orally 30 min prior to sleep. The nurse will monitor most closely for which of the following potential adverse reactions?

A. Dizziness B. Angioedema C. Nausea D. Hallucinations ANS: B See Patient/Family Teaching and Adverse Reactions for ramelteon: Advise patient to notify health care professional immediately if anaphylaxis or angioedema occurs—may occur as early as the first time the product is taken. Dizziness, nausea, and hallucinations can occur but are not as high a priority.

KEY: Cognitive Level: Application DIF: Medium TOP: Therapeutic Classification: Sedative/Hypnotics

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REF: Drugguide.com

31. The student nurse reviews a list of medications a client takes at home. Repaglinide (Prandin) is on the list. The student expects this medication is provided in which of the following ways?

A. Topically B. Rectally C. Orally D. Subcutaneously ANS: C See Route/Dosage for repaglinide: Orally 0.5–4 mg taken before meals.

KEY: Cognitive Level: Knowledge DIF: Easy TOP: Therapeutic Classification: Antidiabetic REF: Drugguide.com

32. While preparing to provide morning medications, a new nurse realizes many clients are taking sildenafil (Viagra) and knows the drug must be given cautiously or in reduced doses to which of the following clients?

A. A 52-year-old patient with a history of coronary artery disease B. A 68-year-old patient with a history of benign prostatic hypertrophy C. A 64-year-old patient admitted with cellulitis D. A 56-year-old patient admitted for knee replacement surgery ANS: A See Contraindications for sildenafil (Viagra): Use cautiously in serious underlying cardiovascular disease including history of MI, stroke, arrhythmia, cardiac failure, or coronary artery disease.

KEY: Cognitive Level: Application DIF: Medium TOP: Therapeutic Classification: Erectile dysfunction agents, Vasodilators REF: Page 1140

33. A nurse caring for a client who is to initiate therapy with glimepiride (Amaryl) 1 mg once daily would include which of the following statements in the client teaching?

A. “This medication is used to treat infections.”

B. “You should take this in the evening on an empty stomach for optimal effectiveness.”

C. “You can continue to eat or drink whatever you like, including alcohol, while taking this

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medication.”

D. “Please notify me if you have any feelings of low blood sugar such as sweating, dizziness, or tremors.”

ANS: D See Indications, Implementation and Patient/Family Teaching for sulfonylureas: Control of blood glucose in type 2 diabetes mellitus. May be administered once in the morning with breakfast or divided into 2 doses. Concurrent use of alcohol may cause a disulfiram-like reaction.

Observe for signs/symptoms of hypoglycemia (sweating, hunger, weakness, dizziness, tremor, tachycardia, anxiety).

KEY: Cognitive Level: Analysis DIF: Medium TOP: Therapeutic Classification: Antidiabetics REF: Pages 1160–1162

34. Which of the following would allow the nurse to determine that a client taking tamsulosin (Flomax) was achieving clinical benefit from the medication?

A. Client’s white blood cell count = 10,500/mm3.

B. Client blood pressure = 142/88 mmHg. C. Client reports decreased nocturia.

D. Family reports noting improved cooperation and cohesive thought patterns.

ANS: C See Action/Therapeutic Effect for tamsulosin: Decreased symptoms of prostatic hyperplasia (urinary urgency, hesitancy, nocturia).

KEY: Cognitive Level: Analysis DIF: Medium TOP: Therapeutic Classification: None assigned REF: Page 1176

MULTIPLE RESPONSE

35. The nurse is caring for a 44-year-old patient with fibromyalgia. Milnacipran (Savella) has been prescribed. Which of the following statements would be included in the client teaching?

Select all that apply.

A. “This medication can cause dizziness so move slowly and call for assistance if you feel dizzy.”

B. “One side effect of this medication is headaches; let me know if you experience that.”

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C. “This can be constipating, so I suggest increasing your fluid and fiber intake.”

D. “We will be monitoring your blood pressure and heart rate more frequently since this medication can cause an increase in blood pressure.”

E. “There are minimal risks for fetal harm with this medication so you don’t need to worry.”

ANS: A, B, C, D See Adverse Reactions/Side Effects for milnacipran: Dizziness, headache, insomnia, hypertension, tachycardia, constipation, dry mouth, nausea, vomiting, hot flushes, hyperhidrosis, serotonin syndrome, neuroleptic malignant syndrome, elevated liver enzymes.

KEY: Cognitive Level: Analysis DIF: Hard TOP: Therapeutic Classification: Antifibromyalgia agents REF: Pages 873–874

36. A diabetic patient treated with a sulfonylurea has been ordered a beta blocker for hypertension. The nurse is aware that beta blockers taken with sulfonylureas may mask the signs and symptoms of hypoglycemia. The nurse recognizes which of the following medications is included in the class of sulfonylureas? Select all that apply.

A. Sitagliptin (Januvia) B. Glimepiride (Amaryl) C. Glyburide (Diabeta) D. Metformin (Glucophage) E. Glipizide (Glucotrol) ANS: B, C, E See Drug List and Interactions for sulfonylureas: Sulfonylureas taken with beta blockers may mask the signs and symptoms of hypoglycemia. Januvia and Glucophage are also antidiabetic drugs but do not negatively interact with beta blockers.

KEY: Cognitive Level: Knowledge DIF: Medium TOP: Therapeutic Classification: Antidiabetics REF: Pages 1160

37. The nurse is providing care for a client receiving pentamidine (Pentam 300). The nurse should monitor for which of the following complications associated with this medication? Select all that apply.

A. Steven-Johnson syndrome B. Severe hypotension C. Respiratory arrest D. Cardiac arrhythmia

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E. Hypoglycemia F. Hemolytic anemia ANS: A, B, D, E See Assessment for pentamidine: May cause Stevens-Johnson syndrome. Sudden, severe hypotension may occur following a single dose. Assess patient for signs of hypoglycemia.

Fatalities due to cardiac arrhythmias, tachycardia, and cardiotoxicity have been reported.

KEY: Cognitive Level: Application DIF: Hard TOP: Therapeutic Classification: Anti-infectives REF: Drugguide.com

38. The physician has ordered polyethylene glycol/electrolyte (Moviprep) for an 82-year-old patient. Which of the following actions will be included in the nurse’s plan of care? Select all that apply.

A. Add powdered fruit punch to the prep before serving.

B. Instruct the patient to restrict food intake to clear liquids during the prep.

C. Encourage the client to drink the fluid over a 2- to 3-hr period of time.

D. Shake vigorously after reconstituting with tap water.

E. Assess client hydration status prior to and throughout the prep.

F. Initiate the prep 1 hr prior to the procedure.

ANS: B, C, D, E See Implementation for polyethylene glycol: Do not add extra flavorings or additional ingredients. Patient should avoid solid food 1–2 hr prior to administration and be allowed only clear liquids after administration. Solution may be reconstituted with tap water—shake vigorously until powder is dissolved. May be administered the morning of the exam as long as 4 hr is allotted for proper prep. Patient should be adequately hydrated prior to, during, and after the administration.

KEY: Cognitive Level: Application DIF: Medium TOP: Therapeutic Classification: Laxatives REF: Drugguide.com

39. A student nurse is preparing to provide pregabalin (Lyrica). Which of the following side effects should be monitored by the student? Select all that apply.

A. Rash B. Suicidal thoughts C. Decreased serum potassium D. Weight gain

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E. Dry mouth F. Hypertension ANS: B, D, E See Adverse Reactions/Side Effects for pregabalin: Can cause suicidal thoughts, dizziness, drowsiness, edema, dry mouth, weight gain, decreased platelet count, constipation, abdominal pain, blurred vision (not rash, decreased potassium, or hypertension).

KEY: Cognitive Level: Knowledge DIF: Hard TOP: Therapeutic Classification: Analgesics, Anticonvulsants REF: Page 1056

40. As part of a new treatment regimen for Alzheimer’s, a 78-year-old woman is prescribed rivastigmine (Exelon). The nurse should include which of the following statements in the client teaching? Select all that apply.

A. “This medication can be given in transdermal patch form that is changed every 24 hours.”

B. “Rivastigmine can cause dizziness so it is important to use caution until your body adjusts to it.”

C. “Let the doctor know if you have nausea, vomiting, anorexia, or weight loss.”

D. “You should notice an improvement in your memory and thinking within a few days.”

E. “The oral form of this medication should be taken on an empty stomach.”

F. “Some clients experience headaches, weakness, and diarrhea with this medication.”

ANS: A, B, C, F See Patient/Family Teaching and Adverse Reactions for rivastigmine: Each 24 hr, remove old patch; rotate sites. Caution patient and caregiver that rivastigmine may cause dizziness. Advise patient and caregiver to notify health-care professional if nausea, vomiting, anorexia, or weight loss occurs. Inform patient and caregivers that improvements in cognitive function may take weeks to months and that the degenerative process is not reversed. Administer oral form in the morning and evening with food. Headache, weakness, and diarrhea are all potential side effects.

KEY: Cognitive Level: Analysis DIF: Hard TOP: Therapeutic Classification: Anti-Alzheimer’s agents REF: Pages 1114–1115

41. The nurse is providing care for a client who has new orders to start sevelamer (Renagel) 800 mg with each meal. Which of the following orders should the nurse anticipate? Select all that apply.

A. Serum calcium and phosphorous in the morning.

B. Teach client self-injection techniques.

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C. Administer with meals.

D. Do not give other medications less than 1 hr before or 3 hr after sevelamer.

E. Low protein, renal diet.

ANS: A, C, D, E See Nursing Implications and Patient/Family Teaching for sevelamer: Monitor serum phosphorous, calcium, bicarbonate, and chloride levels periodically during therapy. Provided in oral form only. Administer with meals and adhere to prescribed diet. Sevelamer is used to help reduce phosphate levels in patients with end-stage renal disease. Caution patient to space concurrent medications at least 1 hr before or 3 hr after sevelamer.

KEY: Cognitive Level: Application DIF: Hard TOP: Therapeutic Classification: Electrolyte modifiers REF: Page 1139

42. The nurse is overseeing medication provision by a student nurse for a client taking thiamine (vitamin B 1). The nurse knows the student has a solid understanding of this medication by which of the following statements? Select all that apply.

A. “The patient may have some diarrhea while taking this medication.”

B. “Many people who take this medication have a history of alcohol use.”

C. “This medication helps prevent Wernicke’s encephalopathy.”

D. “Sometimes thiamine is given in IV form.”

E. “This medication helps prevent bone loss.”

F. “We typically get thiamine from foods such as whole grains, pork, and fresh vegetables.”

ANS: B, C, D, F See Indication, Adverse Reactions, and Patient/Family Teaching for thiamine: Used for prevention of Wernicke’s encephalopathy and as a dietary supplement in patients with GI disease, alcoholism, or cirrhosis. GI side effects include GI bleeding and nausea, not diarrhea. It can be given orally, IM, or IV. Foods high in thiamine include cereals, meats (especially pork), and fresh vegetables. It does not alter bone loss.

KEY: Cognitive Level: Analysis DIF: Medium TOP: Therapeutic Classification: Vitamins REF: Pages 1199–1200

43. While providing care for a 35-year-old client who has been started on topiramate (Topamax) 25 mg twice daily, the nurse would include which of the following in the plan of care? Select all that apply.

A. Ensure patient drinks 2000–3000 mL of fluid to prevent kidney stone formation.

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B. Monitor for signs and symptoms of hyper- or hypokalemia.

C. Initiate seizure precautions.

D. Monitor for suicidal thoughts or depression.

E. Place patient in contact isolation.

F. Place patient on telemetry monitoring.

ANS: A, C, D See Indications, Adverse Reactions, and Nursing Implications for topiramate: Used for seizures.

Advise patient to maintain fluid intake of 2000–3000 mL of fluid to prevent formation of kidney stones. Monitor closely for suicidal thoughts or depression. No significant risk for alteration in potassium levels, infection, or arrhythmias.

KEY: Cognitive Level: Application DIF: Hard TOP: Therapeutic Classification: Anticonvulsants, Mood stabilizers REF: Pages 1221–1224

44. While reviewing a client’s medication list, the nurse notes the client takes trazodone (Oleptro) 50 mg 3 times daily. The nurse recognizes this medication has multiple indications and is used both on and off label for various reasons, including which of the following? Select all that apply.

A. Insomnia B. Chronic pain syndromes C. Appetite stimulation D. Major depression E. Migraine headaches F. Diabetic neuropathy ANS: A, B, D, F See Indications for trazodone: Major depression. Unlabeled use: Insomnia, chronic pain syndromes including diabetic neuropathy, and anxiety.

KEY: Cognitive Level: Application DIF: Hard TOP: Therapeutic Classification: Antidepressant REF: Page 1233

45. While caring for a client receiving tramadol (Ultram) for moderate pain control, the nurse recognizes increased CNS depression can occur if this medication is given concurrently with which of the following? Select all that apply.

A. Antineoplastic agents B. Antihistamines C. Opioid analgesics

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D. Anticoagulants E. Sedative/hypnotics F. Bisphosphonates ANS: B, C, E See Interactions for tramadol: Increased risk of CNS depression when used concurrently with other CNS depressants including alcohol, antihistamines, sedative/hypnotics, opioid analgesics, anesthetics, or psychotropic agents.

KEY: Cognitive Level: Application DIF: Medium TOP: Therapeutic Classification: Analgesics REF: Page 1229

PRIORITIZE

46. The nurse is caring for a woman in active labor. IV nalbuphine (Nubain) 10 mg every 4 hr as needed has been ordered. Prioritize the following nursing actions in the correct order to depict safe administration.

A. Administer slowly over 3–5 min.

B. Explain therapeutic value of the medication.

C. Assess respiratory rate and pain control in 30 min D. Assess location and intensity of the pain.

E. Advise client to call for assistance with ambulation.

ANS 1: D ANS 2: B ANS 3: A ANS 4: E ANS 5: C See Nursing Implications, Implementation, and Patient/Family Teaching for nalbuphine: Assess type, location, and intensity of pain before administration. Explain therapeutic value before administration. Administer slowly over 3–5 min. May cause drowsiness or dizziness—advise patient to call for assistance. Assess pain control 30 min after IV administration.

KEY: Cognitive Level: Analysis DIF: Easy TOP: Therapeutic Classification: Opioid analgesics REF: Page 900

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47. While working in the intensive care unit, the nurse is preparing to initiate an IV infusion of norepinephrine (Levophed) ordered at 1 mcg/min. Prioritize the following steps in the correct order of infusion.

A. Titrate as ordered to maintain SBP between 80–100 mmHg. B. Have second nurse verify order and dose calculations.

C. Calculate rate of IV solutions and pump settings.

D. Obtain IV solutions from pharmacy.

E. Monitor urinary output.

ANS 1: D ANS 2: C ANS 3: B ANS 4: A ANS 5: E See Dosage and Nursing Implications for norepinephrine: 0.5–1 mcg/min initially followed by maintenance of 2–12 mcg/min titrated by BP response. Vasoactive medications are inherently dangerous. The infusion solution must be available to program the pump. Have a second practitioner independently check original order, dose calculation, and infusion pump. Monitor urinary output and notify health care professional if it decreases to less than 30 mL/hr.

KEY: Cognitive Level: Analysis DIF: Medium TOP: Therapeutic Classification: Vasopressors REF: Pages 934–935

48. The nurse is preparing to provide phosphate/biphosphate (Fleet Enema). Prioritize the following steps in correct order for this procedure.

A. Gently squeeze until the bottle is empty.

B. Assist the client onto the left side with knees flexed.

C. Discontinue with resistance or abdominal cramping.

D. Insert prelubricated tip about 2 in. into the rectum.

E. Perform hand hygiene and don clean gloves.

ANS 1: E ANS 2: B ANS 3: D ANS 4: A ANS 5: C See Implementation for phosphate/biphosphate: Hand hygiene should be done prior to any procedure that involves direct patient contact. Position the patient on left side with knees slightly

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flexed. Insert prelubricated tip about 2 in. into rectum aiming toward the umbilicus. Gently squeeze bottle until empty. Discontinue if resistance is met.

KEY: Cognitive Level: Application DIF: Easy TOP: Therapeutic Classification: Laxatives REF: Pages 1033–1034

49. The nurse is preparing to provide a pramlintide (Symlin) to a client with diabetes. Prioritize the following nursing actions in the correct order for provision.

A. Adjust insulin dose.

B. Assess recent blood glucose data.

C. Inject pramlintide and insulin separately.

D. Provide meal immediately.

ANS 1: B ANS 2: A ANS 3: C ANS 4: D See Indications and Implementation for pramlintide: Assess hemoglobin A1C and recent blood glucose data. Adjust dose of insulin to optimize glycemic control. Administer pramlintide and insulin separately immediately prior to a major meal.

KEY: Cognitive Level: Analysis DIF: Easy TOP: Therapeutic Classification: Antidiabetics REF: Drugguide.com

50. The nurse receives orders to use alteplase (Cathflo Activase) 2 mg/2 mL for a patient with an occluded venous access device. Prioritize the following nursing actions in correct order for alteplase usage.

A. Withdraw 2.2 mL sterile water and inject into Cathflo vial.

B. Instill 2 mL of solution into occluded catheter.

C. Gently swirl vial to dissolve powder.

D. Irrigate catheter with 0.9% NaCl E. Allow 30 min of dwell time F. Attempt to aspirate blood, withdrawing 4–5 mL for discard.

ANS 1: A ANS 2: C ANS 3: B

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ANS 4: E ANS 5: F ANS 6: D See Implementation for Cathflo Activase. Withdraw 2.2 mL sterile water and inject into Cathflo vial; gently swirl vial to dissolve powder; instill 2 mL of solution into occluded catheter; allow 30 min of dwell time; attempt to aspirate blood, withdrawing 4–5 mL to discard; gently irrigate catheter with 0.95 NaCl. KEY: Cognitive Level: Application DIF: Easy TOP: Therapeutic Classification: Thrombolytics REF: Pages 1203–1204