Test Bank Nursing Educators for Pharmacology Clear and Simple A Guide to Drug Classifications and Do

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Test Bank Nursing Educators for Pharmacology Clear and Simple A Guide to Drug Classifications and Dosage Calculations 4th Edition Test Bank By Cynthia J. Watkins Chapter 1-21

Chapter 1. History of Pharmacology MULTIPLE CHOICE

1. Which term best describes the process of utilizing genetic information to develop pharmacological agents to treat diseases? a. Partially synthesized b. Pharmacogenetics c. Totally synthesized d. Scientific method

ANS: B

A B C D

Feedback Partially synthesized refers to medications made by adding a pure chemical to a natural substance.

Pharmacogenetics is the study of individual candidate genes as powerful tools to explain interindividual variability in drug response Totally synthesized refers to medications made by combining two or more pure chemicals to produce a new substance that could be used as a medication.

Scientific method refers to the process of using hypothesis, testing, and observation to make deductions.

PTS: 1 REF: 6 2. A client has been prescribed diuretic therapy to treat fluid volume excess and wants to know if any dietary modifications are necessary. Which of the following responses by the nurse is best? a. ―There is no need for any dietary modification as long as you eat a well-balanced diet.‖ b. ―As long as you take the medication as prescribed, there should be no dietary modifications needed.‖ c. ―I need to verify the medication order in order to provide you with information.‖ d. ―As long as you consume eight glasses of water a day, you will be able to replace all fluid losses.‖

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ANS: C

A

B

C

D

Feedback There are several types of diuretic medications that have different mechanisms of action; therefore, this statement is not accurate. It is critical to know the specific type of diuretic therapy that is prescribed in order to provide a logical response.

Diuretic therapy is aimed at fluid reduction, and depending on the type of diuretic therapy, electrolyte loss can also occur. This takes place based on the mechanism of action for the prescribed therapy. This is not an accurate statement.

The nurse should verify the medication order to find out what type of diuretic therapy has been prescribed. For example, furosemide is a loop diuretic that leads to fluid and potassium excretion, which in turn would require potassium supplementation.

Depending on the type of medication/mechanism of action, this is not an accurate statement, as this fluid intake will not be able to replace all fluid losses.

PTS: 1 REF: 8 3. The nurse is taking care of a patient who has thyroid disease. What type of mineral medication does the nurse anticipate that the health-care provider will order? a. Potassium b. Magnesium sulfate c. Gold d. Iodine

ANS: D

A B C D

Feedback Potassium is used to regulate fluid balance, maintain cardiac function, and promote bone health.

Magnesium sulfate is used in the treatment of constipation and eclampsia.

Gold is used in the treatment of arthritis.

Iodine is used to treat goiters.

PTS: 1 REF: 8

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4. While caring for a patient scheduled for knee replacement surgery, the nurse provides cefazolin as ordered 30 minutes preoperatively. Which statement indicates that teaching has been effective? a. ―This antibiotic is given as a prophylactic to help reduce the risk of infection after surgery.‖ b. ―This is a palliative medication to help ease the pain from surgery.‖ c. ―This medication will replace vitamins and minerals that may be lost due to bleeding during surgery.‖ d. ―This medication will help the surgeon identify areas of bone destruction due to arthritis.‖

ANS: A

A B C D

Feedback This medication is an example of an antibiotic used prior to surgery to prevent infection.

This medication is an antibiotic and does not provide pain relief.

This medication is an antibiotic and does not replace vitamins and minerals.

This medication is an antibiotic and does not assist in the identification of bone destruction.

PTS: 1 REF: 9 5. While caring for a patient with a history of hypothyroidism, the nurse expects which of the following medications to be included in the patient’s medication list? a. Levothyroxine sodium b. Estrogen c. Iodine 131 d. Carbimazole

ANS: A

A B C D

Feedback This medication replaces thyroid hormone in individuals who have low levels due to hypothyroidism.

This medication is used as hormone replacement, often for women in menopause.

Iodine 131 is used in the diagnosis, not treatment, of thyroid conditions.

Carbimazole is used to reduce thyroid hormone production in individuals who experience hyperthyroidism.

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PTS: 1 REF: 9 6. An oncology patient is admitted to the nursing unit under hospice care Which medication should the nurse anticipate that the health-care provider will order? a. Prophylactic antibiotics b. Diagnostic medication c. Palliative therapy d. Curative therapy

ANS: C

A B C D

Feedback Hospice care indicates that the patient’s condition is terminal; therefore, prophylactic antibiotics would not be indicated.

Hospice care indicates that the patient’s condition is terminal; therefore, diagnostic medications/procedures would not be indicated.

Palliative therapy is indicated for the care and treatment of terminal patients.

Hospice care indicates that the patient’s condition is terminal; therefore, there is no curative therapy available.

PTS: 1 REF: 9 7. A patient is scheduled for diagnostic testing, Which medication should the nurse anticipate that the health-care provider would order? a. Estrogen b. Penicillin (PCN) c. Naloxone d. Barium sulfate

ANS: D

A B C D

Feedback Estrogen is used for hormone replacement therapy.

PCN is an antibiotic used for the treatment of infections.

Naloxone is a medication used to reverse opioid overdose.

Barium sulfate is used as a contrast material during diagnostic imaging procedures.

PTS: 1 REF: 9

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8. A patient wants to know which plant contains vitamin C. What is the best nursing response? a. Coca b. Rose hips c. Foxglove d. Bark of white willow tree

ANS: B

A B C D

Feedback Digoxin is found in coca plants and is used to treat heart failure.

Rose hips is a good source of vitamin C/ascorbic acid.

Procaine is derived from the foxglove plant and is an anesthetic.

Salicin is found in the bark of the white willow tree and is a form of salicylic acid.

PTS: 1 REF: 7 9. Which of the following best describes the benefit of the use of pharmacogenetics in the treatment of conditions? a. Pharmacogenetics is a new area of pharmacology that is developing rapidly. b. Pharmacogenetics informs the family of inherited conditions. c. Pharmacogenetics assists the physician in learning about the family. d. Pharmacogenetics is used to identify the best drug and dose to be used.

ANS: D

A B C D

Feedback Although this statement is true, it does not describe the benefit of the use of pharmacogenetics.

Pharmacogenetics is used to learn about an individual’s response(s) to medications, not to reveal inherited conditions.

Pharmacogenetics does not assist the physician in learning about the family. The genetics specific to the individual are studied.

Pharmacogenetics identifies the best medication and dose to use for patient conditions such as cancer.

PTS: 1 REF: 7 10. A group of nurses are reviewing barbiturate medications. Which statement is accurate?

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a. b. c. d.

They are naturally derived drugs.

They are derived from animal sources.

They are derived from plant sources.

They are synthetic medications.

ANS: D

A B C D

Feedback Barbiturates are made from chemical sources and are synthesized.

Barbiturates are not derived from animal sources.

Barbiturates are not derived from plant sources.

Barbiturates are chemically derived and considered synthetic medications.

PTS: 1 REF: 7

MULTIPLE RESPONSE

11. Based on the classification system of pharmacodynamics, which category statements are accurate? (Select all that apply.) a. Palliative therapy provides pain relief. b. Diagnostic drugs help to identify pathological processes. c. Prophylactic medications are curative. d. Replacement medications provide needed physiological components. e. Destructive medications are always curative.

ANS: A, B, D Feedback A. This is a factual statement describing the function of palliative care.

B. Diagnostic drugs are used with imaging procedures to localize pathological processes.

C. Prophylactic medications are used to prevent infections, but they are not always curative.

D. This is a factual statement describing the function of replacement therapy.

E. Destructive medications are not always curative, but they help to destroy certain tumors or microbes.

PTS: 1 REF: 9 12. A nurse is reviewing insulin medication. Which statements are accurate? (Select all that apply.)

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a. b. c. d. e.

Escherichia coli is used in the recombinant form of human insulin.

Synthetic insulin preparations are more economical.

Human recombinant insulin provides less chance of allergic reactions.

Synthetic sources are not commonly used.

All insulins are derived from animal sources.

ANS: A, B, C Feedback A. This is a factual statement. Human insulin is produced by using recombinant technology to add the insulin gene to a non-pathogenic strain of E. coli.

B. This is a factual statement. Synthetic drugs are typically less expensive because they are mass produced.

C. This is a factual statement. There is less chance of a reaction if animal sources are not used.

D. Synthetic sources of insulin are used commonly, as they are less expensive.

E. Insulin can be derived from animal sources (pigs or cows), but synthetic forms are the most commonly used.

PTS: 1 REF: 8

13. A nurse is reviewing medication category relationships. Which statements are accurate? (Select all that apply.) a. Radiopaque dyes are considered to be prophylactic medications. b. Acetaminophen is considered to be a curative medication. c. Flu vaccine is considered to be a prophylactic medication. d. A neoplastic drug is considered to be a destructive medication. e. Thyroid hormone is considered to be a replacement medication.

ANS: C, D, E Feedback A. Radiopaque dyes are considered to be diagnostic medications.

B. Acetaminophen is considered to be a palliative medication.

C. This is a factual statement. Immunizations are considered to be prophylactic medications.

D. This is a factual statement. Neoplastic drugs are used in the treatment of cancers/tumors.

E. This is a factual statement. Thyroid hormones are used as replacement therapy to treat hypothyroid conditions.

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PTS: 1 REF: 9,10,10

14. A group of LPN students are reviewing state practice acts for nursing. Which statements represent best practice for the LPN role? (Select all that apply.) a. LPNs are not allowed to administer intravenous (IV) medications in the majority of states. b. LPNs are not allowed to administer medications via the rectal route. c. LPNs must be directly supervised during medication administration. d. LPNs may be allowed to start and discontinue IV fluids in selected states. e. LPNs may not administer medications through central lines.

ANS: A, D, E Feedback A. In most states, LPNs cannot administer medication via the IV route.

B. LPNs can administer medication via the rectal route.

C. LPNs usually work under the direct supervision of the RN, but they are not always directly supervised during medication administration.

D. This is a factual statement describing the functional role of the LPN. E. This is a factual statement, as central line medication administration is beyond the scope of practice for an LPN.

PTS: 1 REF: 10

15. An LPN is working in an acute care setting and the patient assigned has several medications to be administered via a central line. Which actions should the LPN implement? (Select all that apply.) a. Administer the medications as ordered, as the patient is part of the nursing assignment. b. Contact the health-care provider for an alternate delivery route. c. Hold the medications until the LPN can speak with the charge nurse. d. Arrange with the charge nurse to either administer the medications or assign an RN staff nurse to administer. e. Make sure that the medications are available to administer during the shift as ordered.

ANS: D, E Feedback A. LPNs cannot administer medications via a central line, as this is outside of the

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B. C. D.

E.

scope of practice.

There is no need to contact the health-care provider for an alternate delivery route.

The medication should not be held, but rather administered at the designated time.

The LPN should discuss with the charge nurse having alternative administration policies implemented either by the charge nurse directly or by assigning an RN staff nurse.

It is important to make sure that the medications are available to administer as ordered during the shift.

PTS: 1 REF: 10

16. A nurse is administering a diuretic medication to a patient on a medical-surgical unit. Which of the following is a factual statement? a. The medication is viewed as curative, as it will help to decrease fluid volume. b. The nurse should monitor intake and output during the course of therapy. c. Daily weights should be included as part of monitoring therapy. d. Assess the patient for pain relief following administration. e. Increase fluid intake during therapy.

ANS: A, B, C Feedback A. This is a factual statement, as diuretics help to restore physiological function by decreasing fluid volume.

B. This is a factual statement. Intake and output are an essential part of fluid volume status therapy.

C. This is a factual statement. Daily weights are an essential part of fluid volume status therapy.

D. Diuretics are not used for pain relief. While pain assessment is part of the nursing assessment, it is not done for this reason.

E. If the patient has been prescribed a diuretic, then the patient is experiencing fluid volume excess, not deficit, and additional fluids should not be administered.

PTS: 1 REF: 9, 10

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17. A nurse is caring for an oncology patient admitted for treatment of an acute infection. Which medications should the nurse anticipate that the health-care provider will prescribe? (Select all that apply.) a. Intravenous fluids as replacement therapy. b. Diuretic to restore fluid balance. c. Antineoplastic agents to treat cancer. d. Antibiotic therapy to treat infection. e. Pain medication for comfort.

ANS: A, D, E Feedback A. Intravenous fluids may be indicated to maintain hydration.

B. Diuretics are not likely to be ordered, as there is no evidence that the patient has fluid volume excess.

C. Antineoplastic agents would not be ordered, as the patient is admitted for an acute infection, not for the treatment/management of cancer.

D. Antibiotic therapy is indicated for the treatment of infection.

E. Pain medication may be indicated for patient comfort.

PTS: 1 REF: 9

18. A nurse is monitoring a patient during the postoperative period following a surgical procedure.

Which actions should be included in the plan of care? (Select all that apply.) a. Assess and document patient’s level of pain. b. Administer antineoplastic agents as ordered. c. Administer intravenous fluids as ordered. d. Administer pain medication as ordered. e. Administer contrast material.

ANS: A, C, D Feedback A. This is a factual statement based on postoperative care of a surgical patient.

B. There is no clinical indication for the administration of antineoplastic agents.

C. Intravenous fluids are part of the treatment plan for postoperative surgical patients.

D. Pain medication is included in the treatment plan for postoperative surgical patients.

E. There is no clinical indication to administer contrast material for the postoperative patient.

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PTS: 1 REF: 9, 10

19. A nurse is reviewing clinical indications for the use of botulinum toxin. Which statements are accurate? (Select all that apply.) a. This medication can be used to treat diabetic infections. b. This medication is used in large amounts for a therapeutic effect. c. This medication can be used to treat torticollis. d. This medication can be used to treat strabismus. e. This medication can be used to treat migraine headaches.

ANS: C, D, E Feedback A. This medication is not used in the treatment of diabetic infections.

B. This medication is used in tiny doses for a therapeutic effect.

C. This is a factual statement. It is used in the treatment of a condition in which neck muscles contract, causing the head to turn to one side (torticollis).

D. This is a factual statement. It is used in the treatment of eye misalignment (strabismus).

E. This is a factual statement. It is used in the treatment of migraine headaches.

PTS: 1 REF: 8

20. A nurse is monitoring a patient who has received iodine irradiation therapy to treat a tumor.

Which statements are accurate? (Select all that apply.) a. The medication was used as a destructive agent. b. Small doses of the medication were used during the treatment. c. The same dosages are used for identification as well as treatment. d. This medication is considered to be a toxin. e. The medication was used to shrink the tumor.

ANS: A, D, E Feedback A. This is a factual statement, as iodine irradiation therapy is used to destroy (shrink) a tumor.

B. High doses of this medication are used to shrink tumors.

C. Small doses of iodine can help pinpoint thyroid problems, whereas large doses are used to shrink tumors.

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D. E.

This is a factual statement, as the material is radioactive.

This is a factual statement based on the therapeutic action of the medication.

PTS: 1 REF: 8

Chapter 2. Basics of Pharmacology MULTIPLE CHOICE 1. The nurse is preparing to apply a topical ointment to a patient with a skin rash. Which of the

following actions should the nurse take first to help facilitate absorption of the medication? a. Don gloves prior to administration. b. Apply to nonirritated areas of the skin. c. Ensure that the skin is clean and dry. d. Take the patient’s vital signs.

ANS: C

A

B C D

Feedback The nurse should apply gloves prior to administration of the medication, but the first action is to ensure that the skin is clean and dry, which will help facilitate absorption.

The medication is prescribed for treatment of a skin rash, so applying ointment to nonirritated areas of the skin would not be relevant.

It is important to ensure that the skin is clean and dry to allow for the medication’s absorption at the site.

Taking a patient’s vital signs is part of a baseline assessment but does not affect absorption of the medication.

PTS: 1 REF: 17 2. The nurse is preparing to administer an intramuscular injection to a patient. Which assessment

finding should alert the nurse to a potential absorption problem? a. Tattoo present on upper arm. b. Presence of hair on arms bilaterally. c. Allergy to alcohol prep. d. Brisk capillary refill.

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ANS: A

A B C

D

Feedback A tattoo could lead to decreased absorption due to paint and/or scar tissue formation.

Presence of hair bilaterally on arms should not impair absorption of medication.

The nurse can use a different type of prep for the injection. The concern here would not be one of absorption, but rather of a potential allergic reaction if an alcohol prep was used.

Brisk capillary refill is a normal finding and would not affect absorption of medication.

PTS: 1 REF: 17 3. The nurse is assessing a patient who has been prescribed a prodrug. The patient asks what this

means. What is the best nursing response? a. ―The medication is given in a pure form so that it can act directly without being metabolized.‖ b. ―There is little difference between a prodrug and a typical drug.‖ c. ―As long as your liver function is normal, there is no need to be concerned.‖ d. ―The drug becomes activated when it enters the body.‖ ANS: D

A B C D

Feedback A prodrug is administered in an inactive form and through the process of metabolism becomes activated.

Unlike a typical drug, prodrugs require activation via metabolism.

While liver function is important, this response does not address the specific category of a prodrug.

This is a correct statement. A prodrug is administered in an inactive form and through the process of metabolism becomes activated.

PTS: 1 REF: 19 4. The nurse is administering a lozenge to a patient for treatment of a sore throat. Which

instruction by the nurse would lead to increased absorption of the medication? a. Swallow the medication with a drink of water. b. Break the lozenge in half, making it easier to swallow. c. Take the lozenge with a glass of milk. d. Suck on the lozenge until it dissolves.

ANS: D

Feedback

14 A B C D

A lozenge should not be swallowed, as this will minimize the desired effect.

A lozenge should not be broken in half and should not be swallowed.

A lozenge should not be administered with milk, as this will lead to decreased contact and absorption.

Sucking on the lozenge until it dissolves will increase the absorption of medication into the mouth.

PTS: 1 REF: 17 5. The nurse is providing care for a 48-year-old patient on the surgical unit who has been

prescribed intravenous gentamicin therapy for a postoperative infection. The nurse would be most concerned by which of the following findings? a. Blood levels have been ordered every 24 hours. b. The patient’s estimated glomerular filtration rate (eGFR) is 40 mL/min. c. The patient’s hemoglobin is 11.8 g/dL. d. The patient’s WBC count is 14,000 cells/mm3.

ANS: B

A

B

C D

Feedback Blood levels of gentamicin are ordered periodically to monitor for therapeutic medication levels. Although every 24 hours is not usually necessary, it poses little risk to the patient.

Gentamicin is excreted through the kidneys. The eGFR of 40 mL/min demonstrates that the kidneys are not working appropriately and may have been affected by the medication. The medication likely will be replaced with an alternate medication.

Although the hemoglobin is slightly low, this is not related to the medication and the patient is not in danger.

The patient’s WBC count is elevated. With an infection, this would be an expected abnormality.

PTS: 1 REF: 20 6. A 16-year-old patient comes to the urgent care clinic with symptoms of tonsillitis. The patient

tells the nurse she takes tetracycline daily for the treatment of acne. The nurse would be most concerned if the health-care provider prescribed which of the following? a. Amoxicillin clavulanate b. Cefdinir c. Cefixime d. Ciprofloxacin ANS: A

Feedback

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B C D

Penicillin taken with tetracycline causes the tetracycline to become inactive.

Amoxicillin clavulanate is derived from penicillin, leading to the nurse’s concern.

Cefdinir is not a penicillin derivative. It is a cephalosporin and should not alter the effectiveness of tetracycline.

Cefixime is not a penicillin derivative. It is a cephalosporin and should not alter the effectiveness of tetracycline.

Ciprofloxacin is not a penicillin derivative. It is a fluoroquinolone and should not alter the effectiveness of tetracycline.

PTS: 1 REF: 20 7. The nurse is providing care for a patient who is experiencing muscle spasms. The health-care

provider has ordered cyclobenzaprine. The nurse should inform the patient to anticipate which of the following side effects from this medication? a. Hypocalcemia and hypotension b. Dizziness and drowsiness c. Nausea and headache d. Flaccidity and urinary retention ANS: B

A B C D

Feedback Calcium levels and blood pressure are not affected by cyclobenzaprine.

Muscle relaxants, such as cyclobenzaprine, cause dizziness and drowsiness as a side effect.

Nausea and headache are not known side effects of cyclobenzaprine.

Flaccidity and urinary retention are not side effects of cyclobenzaprine.

PTS: 1 REF: 21 8. While caring for patients on the medical unit, the nurse should see which of the following

patients first? a. A 28-year-old patient with HIV who has a temperature of 99.2°F b. A 54-year-old patient with diverticulitis whose diet was just advanced to solid food c. A 61-year-old patient who takes ibuprofen for arthritis and is complaining of severe stomach pain d. A 37-year-old patient with a kidney stone who is due for pain medication in 20 minutes ANS: C

A

Feedback This minor temperature elevation is not of immediate concern. It does not demonstrate a severe or dangerous situation.

16 B C

D

The patient may be anxious to eat solid foods; however, this is not an emergent or severe situation that needs to be addressed immediately.

NSAIDs are known to cause gastrointestinal (GI) bleeding and/or ulcers. Severe stomach pain may be indicative of GI bleeding. The situation needs to be addressed right away to determine the patient’s most urgent needs. This patient is the most unstable.

The patient is not demonstrating any life-threatening or emergent needs.

PTS: 1 REF: 21 9. A patient has experienced an upset stomach from a medication taken previously and is

concerned about the possibility of additional side effects. What is the best nursing response? a. ―It is difficult to tell if you will have this reaction again.‖ b. ―You should not take this medication again, as the same thing might happen.‖ c. ―This is not a serious side effect, so there is no concern.‖ d. ―This is a mild side effect and may not lead to additional side effects.‖ ANS: D

A

B

C

D

Feedback While there is no way of predicting if gastrointestinal discomfort will occur again, this response does not address the patient’s concern of additional side effects.

While the same side effect may occur again, this response does not address the patient’s concern of additional side effects. Also, there are other administration options, such as taking the medication with food, which may prevent gastrointestinal upset.

Even though what the patient has experienced is considered to be a mild side effect, this response does not address the patient’s concern of additional side effects.

This response addresses both the reaction of the patient as a mild side effect and the concern for the possibility of additional side effects.

PTS: 1 REF: 24 10. The nurse is providing care for patients on the orthopedic unit. Which of the following

assessment findings would be most concerning to the nurse? a. A patient who takes lisinopril and is complaining of limited range of motion after shoulder surgery. b. A patient with a fractured pelvis who takes warfarin sodium and reports having black, tarry stool during the night. c. A patient 2 days postop knee replacement who takes hydrocodone/acetaminophen and refused to have labs drawn this morning. d. A patient taking omeprazole who ordered spinach for dinner 4 days after hip replacement surgery.

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ANS: B

A B C

D

Feedback Limited range of motion of the shoulder is expected after surgery.

Black, tarry stools indicate possible gastrointestinal bleeding. This is an urgent concern.

Patients may refuse to have laboratory tests completed as ordered.

Hydrocodone/ acetaminophen does not pose a major concern related to organ function.

Ordering spinach when taking omeprazole is not a concern, as this medication has no dietary restrictions.

PTS: 1 REF: 22 11. While working in the neonatal intensive care unit (ICU), the nurse notes an infant’s oxygen

saturation has been 98% for the past 4 hours. The infant has been receiving oxygen at 4 L/min. Which of the following actions by the nurse is best? a. Turn the oxygen level down to 3 L/min and monitor closely to reduce the risk of eye damage. b. Leave the oxygen level at its current rate to reduce the risk of lung damage. c. Turn the oxygen level down to 2 L/min and monitor closely to evaluate the infant’s readiness for transfer out of the ICU. d. Leave the oxygen level at its current rate and inform the parents the infant will need supplemental oxygen at home.

ANS: A

A

B C D

Feedback Some medications are toxic to certain organs. Oxygen can damage the eyes of a premature infant. It is important to reduce the amount of oxygen that is used when possible. Having an oxygen saturation of 98% over the last 4 hours demonstrates stability, indicating the oxygen can be decreased.

The use of more oxygen than necessary is harmful to a premature infant’s eyes, and the oxygen needs to be reduced as the infant tolerates it.

Decreasing the oxygen too fast can create problems. Slowly decreasing the oxygen as the infant tolerates it is important.

An oxygen saturation of 98% is normal, and weaning the infant off oxygen is important. It is too early to determine if the infant will need oxygen at home.

PTS: 1 REF: 22 MULTIPLE RESPONSE

18 12. A nurse is preparing to administer a medication to a patient. Which routes should the nurse

anticipate as leading to quicker systemic absorption? (Select all that apply.) a. Intravenous b. Oral pills c. Topical d. Intramuscular e. Transdermal f. Oral liquid ANS: A, D, F

A. B. C. D. E. F.

Feedback Intravenous route is the fastest route.

Oral pill form must be broken down before it can be absorbed.

Topical medication is applied locally, acts quickly at the local site, and can then be absorbed systemically over time.

Intramuscular medication provides fairly quick absorption.

Transdermal medication is applied locally and absorbed systemically over time.

Oral liquid medication is absorbed faster than pill form.

PTS: 1 REF: 17 13. A patient is receiving gentamicin therapy intravenously. Which assessment findings should

alert the nurse that the medication therapy should be stopped? (Select all that apply.) a. Urinary frequency b. Complaints of ringing in ears c. Decreasing glomerular filtration rate (GFR) d. Hiccoughs e. Resolving infection f. Temperature within normal range ANS: B, C

A. B. C. D. E. F.

Feedback Urinary frequency is not an indication to stop gentamicin therapy.

Gentamicin can be ototoxic. If the patient is experiencing ringing in ears (tinnitus), the medication should be stopped.

Gentamicin can be nephrotoxic. If the patient’s GFR is decreasing, this can indicate renal issues, and the medication should be stopped.

Hiccoughs are not an indication to stop gentamicin therapy.

A resolving infection is not an indication to stop gentamicin therapy, as the course of therapy should continue as prescribed in order to be effective.

Temperature within normal range is not an indication to stop gentamicin therapy.

PTS: 1 REF: 20

19 14. An oncology patient is receiving methotrexate therapy. Which priority information should

the nurse include in the plan of care? (Select all that apply.) a. Monitor ascorbic acid levels. b. Monitor folic acid levels. c. Monitor blood pressure. d. Have Narcan available. e. Have leucovorin available.

ANS: B, E

A. B. C. D. E.

Feedback Methotrexate does not affect ascorbic acid (vitamin C) levels.

Methotrexate is a folic acid antagonist, and as such it can lead to decreased levels of folic acid in the body.

Methotrexate does not affect systemic blood pressure.

Narcan is used to reverse the effects of narcotics, not methotrexate.

Leucovorin is the rescue drug or antidote used to reverse the effects of methotrexate in the body.

PTS: 1 REF: 19 15. A group of student nurses are reviewing factors that impact the bioavailability of medications.

Which assessment factors are relevant? (Select all that apply.) a. Alkalotic conditions improve absorption. b. Increased stomach acid can improve absorption. c. Deep breathing facilitates absorption of inhalants. d. Age is not a relevant factor in absorption of medications. e. Water-soluble medications are absorbed more rapidly than lipid-soluble medications.

ANS: B, C

A. B. C. D. E.

Feedback Alkalotic states (high pH) lead to decreased absorption.

Stomach acid facilitates absorption of medication.

Deep breathing increases maximal absorption of inhalants.

An individual’s age (very young or old) can affect the absorption of medication.

Fat-soluble medications are absorbed more rapidly in the stomach than water-soluble medications.

PTS: 1 REF: 17,18

Chapter 3. Patient Safety in Medication Administration MULTIPLE CHOICE

20 1. The nurse is uncertain of the meaning of an abbreviation used by the physician in ordering

medications for the patient. Which of the following is the best action to take regarding this abbreviation? a. Contact the physician and ask for clarification of the abbreviation. b. Ask the charge nurse to interpret the abbreviation. c. Check The Joint Commission’s ―do not use‖ list of abbreviations. d. Leave the order for the next nurse to complete.

ANS: A

A B C D

Feedback When one encounters an abbreviation he or she is uncertain about, it is best to contact the provider who used the abbreviation and ask for clarification.

Asking the charge nurse to clarify the abbreviation is not the best option since that person did not write the order.

Checking The Joint Commission’s list will not provide you with the information needed to safely carry out the medication order.

The patient deserves to have the physician orders carried out as soon as possible; delaying the ordered medication may lead to patient harm.

PTS: 1 REF: 34 2. When providing medications from floor stock to a patient on the Alzheimer’s unit of a

long-term care facility, the nurse demonstrates the principle of drug administration by performing which of the following? a. Checking the label before taking the medication out of the cabinet, pouring the medication, and placing the bottle back in the cabinet b. Checking the label before taking the medication out of the cabinet, pouring the medication, and leaving the medication room c. Checking the label after removing the bottle from the cabinet and pouring the dose of medication and before closing the cabinet door d. Checking the label while removing the bottle from the cabinet, after pouring the dose of medication, and while replacing the bottle in the cabinet ANS: A

A B C

D

Feedback These are the correct steps. The nurse is checking the medication throughout the process prior to measuring and administering the medication.

Checking the medication label prior to leaving the medication room does not provide consistent checking and may include interruptions.

Checking the label after removing it from the cabinet overlooks the first opportunity for error; the nurse must ensure the correct medication is being obtained.

Checking the label after pouring the medication can lead to waste, particularly if there is an error in pouring the ordered medication. Checking the label before

21

each step provides an opportunity to get the right medication to the patient with less waste.

PTS: 1 REF: 30 3. The nurse is preparing to administer medication to a pediatric patient. Which essential safety

action should the nurse take prior to administration? a. Ask the child if they have taken this medication before. b. Have a glass of water at the bedside. c. Verify dosage based on weight calculation. d. Make sure that the medication has a barcode.

ANS: C

A B C D

Feedback This is not an essential action, as it does not relate directly to safe drug administration.

Although water may be required for drug administration, it is not the essential action based on safe drug administration.

Verifying the dosage based on weight calculation is the essential safety action.

Although it is important that the medication has a barcode for scanning, it is not the essential action prior to administration for safe drug administration.

PTS: 1 REF: 37 4. A nurse is taking care of a culturally diverse patient who is reluctant to take the prescribed

medication from the health-care provider. What is the best nursing response? a. Tell the patient that the health-care provider would not order the medication unless it was necessary. b. Ask the patient if they have used any holistic medications previously. c. Notify the health-care provider that the patient has refused the medication. d. Tell the patient to talk to the health-care provider when they make rounds.

ANS: B

A B C D

Feedback While the health-care provider is ordering necessary medication, this response does not address the patient’s expressed concern.

This response acknowledges the patient’s expressed concern and seeks to find out if other holistic remedies might be considered an acceptable treatment.

This response does not address the expressed concern of this culturally diverse patient and provides no opportunity for any alternative therapy.

This response does not address the expressed concern of this culturally diverse patient.

22 PTS: 1 REF: 38 5. The nurse is obtaining a health history for a 20-year-old female who is 8 weeks pregnant.

Which finding should alert the nurse to a potential complication? a. The patient is taking over-the-counter (OTC) multivitamins daily. b. The patient smokes two to three cigarettes per week and characterizes herself as a social drinker. c. The patient reports this she has a decreased appetite and occasional nausea. d. The patient states that her breasts are tender.

ANS: B

A B C D

Feedback Even though the multivitamins are OTC, vitamin supplementation is considered to be a normal part of pregnancy treatment.

Smoking and alcohol can have a teratogenic effect on the developing fetus.

This is a normal finding during early pregnancy due to increased hormonal response.

This is a normal finding during early pregnancy due to increased hormonal response.

PTS: 1 REF: 39 6. The nurse is providing medications to an adult patient with a history of advanced cardiac

disease. Which laboratory finding indicates that the dosages of medications may need to be decreased? a. Creatinine 8 mg/dL b. Glucose 100 mg/dL c. Hemoglobin 12 mg/dL d. Potassium 4.0 mEq/L ANS: A

A B C D

Feedback Creatinine level is increased, indicating that renal function has deteriorated, requiring adjustment of medications to avoid complications.

This result is in the normal range.

This result is in the normal range.

This result is in the normal range.

PTS: 1 REF: 40 7. A nurse is preparing to administer medication to an adult patient who has a history of

hypertension (HTN). Which medication should the nurse question based on commonly confused drug names?

23 a. b. c. d.

Clonidine Captopril Losartan Klonopin

ANS: D

A B C D

Feedback Clonidine is a centrally acting alpha agonist used to treat HTN. Captopril is an angiotensin-converting enzyme (ACE) inhibitor used to treat HTN. Losartan is an angiotensin II receptor blocker used to treat HTN. Klonopin is an anticonvulsant medication used to treat seizures whereas its commonly confused drug name, clonidine, is used to treat HTN.

PTS: 1 REF: 34 8. A nurse is working with a patient who has been prescribed a different type of antihypertensive

medication than the prior treatment regimen. Which information should the nurse include in the plan of care? a. Take all medications previously and currently prescribed for the treatment of hypertension. b. Only take the medications that are currently being prescribed for the treatment of hypertension. c. Take medications early in the morning to have the best effect. d. Take all medications at the same time in order to achieve the best effect.

ANS: B

A

B C D

Feedback The information provided is that the treatment regimen has been changed; therefore, the nurse should not tell the patient to take all previously and currently prescribed medications, as this could lead to potential problems.

This is the correct response, for it addresses the change in the treatment regimen.

There is insufficient information to select this option, as there is no complete listing of all prescribed medications for this patient.

There is insufficient information to select this option, as there is no complete listing of all prescribed medications for this patient.

PTS: 1 REF: 37 9. While working in a surgical clinic, the nurse notes orders that read ―.25 mg digoxin (Lanoxin)

IV now.‖ Which action by the nurse is best? a. Give .25 mg of digoxin intravenously. b. Give 25 mg of digoxin as an injection into the skin.

24 c. Contact the physician for clarification of the order. d. Ask the charge nurse to verify the order.

ANS: C

A

B

C

D

Feedback The medication order should not be given due to the lack of a zero in front of the decimal point, as the order may be misinterpreted. This is an example of a common error leading to safety concerns in medication delivery.

This is not an appropriate dose of digoxin. The order appears to read .25 mg, NOT 25 mg. This is an example of a common error in medication safety, which requires clarification due to the lack of a leading zero in the order.

The nurse needs to contact the physician for clarification to ensure patient safety in medication administration. The order, as written, does not have a leading zero, potentially causing a medication error.

The order, as written, is potentially unsafe due to the lack of a leading zero (0.25), and the charge nurse is unable to verify the physician’s order as written due to the error. The lack of a leading zero indicates a need for clarification.

PTS: 1 REF: 36 10. A patient being seen in the outpatient clinic has been given a new prescription for tetracycline

orally each day. The patient reported that current medications include a multivitamin with calcium, St. John’s wort, and omeprazole. The nurse would provide additional teaching for which patient statement? a. ―I should try to take the medication at roughly the same time each day.‖ b. ―I can take this medication with my other morning meds.‖ c. ―I should take this medication at least an hour before or 2 hours after I eat.‖ d. ―Drinking extra water is important when taking this medication.‖ ANS: B

A

B

C

D

Feedback This statement does not require additional teaching because tetracycline is an antibiotic and should be spaced out as evenly as possible to maintain a therapeutic effect.

This statement requires additional teaching because tetracycline is not absorbed well when taken with calcium. The patient should take the calcium at a different time than the tetracycline.

This statement does not require additional teaching because it is best for the medication to be taken on an empty stomach whenever possible to improve absorption.

This statement does not require additional teaching because drinking extra fluid is helpful when an individual has been ill and requires antibiotic treatment.

PTS: 1

25 REF: 35 11. The nurse is working with a patient who has recently been prescribed daily statin therapy.

Which patient response would require a priority intervention? a. ―I take the medication in the evening following the dinner meal.‖ b. ―I take the medication once a day as prescribed.‖ c. ―I have increased my fluid intake to eight glasses a day." d. ―I drink grapefruit juice each day.‖ ANS: D

A B C D

Feedback Typically, statins are taken in the evening, as cholesterol synthesis occurs at that time.

The patient is taking the medication as prescribed; therefore, no intervention is needed.

Increasing fluid intake to eight glasses a day is within the normal range for fluid consumption.

Grapefruit juice can potentiate the action of statins and lead to problems; therefore, the nurse should immediately intervene, providing education to the patient related to this metabolic action.

PTS: 1 REF: 36 12. A nurse from the adult medical unit is pulled to the geriatric unit. The nurse notes that many

of the common medications provided are in lower doses than typically prescribed. What action by the nurse is the highest priority? a. Notify the charge nurse that patients may have received inappropriate medication dosages. b. Call the nursing supervisor to investigate the nurse’s concerns. c. Do not worry about the discrepancy because this is not the nurse’s unit. d. Evaluate the laboratory values of each patient to determine liver and kidney function.

ANS: D

A

B C

D

Feedback Adult doses of medications are often reduced when given to the elderly due to the decline in kidney and liver function with age. The doses are not likely inappropriate.

The nurse should recognize that adult doses of medications are often reduced in the elderly due to decline in kidney and liver function.

The nurse needs to be aware of irregularities that cause concern even when floating to another unit. This situation is an expected variation from the normal medication dosing.

Since medications are metabolized through the liver and excreted through the

26

kidneys, the function of these organs is important in understanding possible side effects and dosing for older adults and those with kidney and/or liver dysfunction.

PTS: 1 REF: 40 13. While working on a geriatric unit, the nurse would be most concerned by which of these

findings? a. An 81-year-old patient is scheduled to take 12 pills at 9 a.m. b. A 72-year-old patient given a sleeping pill the night before seems confused. c. A 69-year-old patient with a deep vein thrombosis (DVT) has an order for an anticoagulant. d. A 74-year-old patient with diabetes has a fasting glucose result of 88 g/dL. ANS: B

A B

C D

Feedback Polypharmacy is common in the elderly. Although it is a concern, this is not the priority at this time.

Sedative-hypnotics can cause the elderly, who may have dementia, to experience a worsening of symptoms. Adverse drug events are more common in the elderly.

An anticoagulant should be ordered for a patient with a DVT. A fasting blood glucose of 88 g/dL is an appropriate glucose level.

PTS: 1 REF: 37 14. The nurse notes that an elderly patient admitted with metastatic cancer has a low serum

protein level. Which action by the nurse is best? a. Take no action because the patient is terminal. b. Increase the frequency of vital sign monitoring. c. Determine the most recent complete blood count (CBC) results. d. Increase awareness and assessment of potential medication side effects.

ANS: D

A

B

C

Feedback Just because metastatic cancer is diagnosed does not automatically indicate that the patient is terminal. Even if the patient is terminal, the nurse still needs to monitor for the possible increase in side effects from medications due to a low protein level.

Increasing the frequency of vital sign monitoring is not necessarily indicated due to a low protein level. The focus should be on the patient’s medication side effects, fluid volume shifts, and ability to heal any wounds.

The most recent CBC results may be affected by the low protein (such as low

27

D

lymphocyte counts); however, monitoring for medication side effects and signs of other complications is important.

When the protein level is low, medication is more likely to be circulating unbound to proteins and is more likely to produce side effects. The nurse needs to closely monitor for side effects from medications.

PTS: 1 REF: 39 15. Shortly after providing a new sleeping pill to a patient on the medical unit, the nurse answers

the patient’s call light. Which of the following findings would indicate to the nurse that the patient is experiencing an anaphylactic reaction to the medication? a. The patient’s respiratory rate is 28 breaths/min and slightly labored. b. The patient complains of continued wakefulness and agitation. c. The patient states that she feels nauseated and has a headache. d. The patient reports feeling hot, and her face appears flushed.

ANS: A

A B

C D

Feedback Respiratory changes during anaphylaxis include difficulty breathing, increased respirations, and wheezing.

This indicates the patient may need further education about the amount of time it takes for a medication to work or it may be an indication that the medication is not effective.

Nausea and headache are not typical signs of anaphylaxis.

Feeling hot is not a typical sign of anaphylaxis. Flushed appearance is also not typical.

PTS: 1 REF: 42 16. A nurse working at the poison control center receives a call from a young woman babysitting

a 4-year-old child who reportedly swallowed some of his parent’s medication. Which statement by the nurse is best at this time? a. ―I’m calling emergency personnel for you now.‖ b. ―What do the pills look like?‖ c. ―Have the child drink a glass of milk.‖ d. ―What is the name of the pills?‖ ANS: A

A B

Feedback Contacting emergency personnel is an important first step in getting care to the child.

After activating the emergency personnel, the nurse can attempt to determine what the pills were so an antidote may be administered or a treatment initiated

28

C

D

sooner.

This is not the priority, although it is helpful if it is important to reduce acidity.

The emergency personnel should be contacted before attempting to determine the type of pills and immediate treatment.

This is helpful in determining what the child swallowed; however, the emergency responders need to be sent to the home before an assessment of the pills is completed.

PTS: 1 REF: 40

17. A patient is admitted to the emergency room with an accidental overdose of a substance that is caustic. Which therapeutic option should the nurse question? a. Activated charcoal b. Gastric lavage c. Complete blood count (CBC) d. Placement on cardiac monitor

ANS: B

A B C D

Feedback Activated charcoal will help bind with the poison and is administered in emergency room settings.

Gastric lavage would not be indicated, as the substance has been identified as caustic and lavage would lead to increased damage.

A CBC may be ordered as part of routine lab work to help establish a baseline for the patient.

Placing the patient on a cardiac monitor would be part of the plan of care in this emergency situation.

PTS: 1 REF: 42 18. A nurse receives a phone call from a parent whose child has ingested a substance but does not appear to be in any apparent distress. What is the best nursing response? a. Tell the parent to administer syrup of ipecac. b. Monitor the child at home and call back if needed. c. Ask questions to obtain specific information about the substance. d. Tell the parent to call 911.

ANS: C

A

Feedback Syrup of ipecac is no longer advised, as it induces vomiting and can lead to

29

B C D

further complications.

While the parent should continue to monitor the child, this response does not address the acuity of substance ingestion and could lead to potential problems.

The nurse should determine the type of substance ingested in order to provide the best information for treatment.

As the parent states the child is not in any apparent distress, it is not necessary to activate the emergency response system by calling 911.

PTS: 1 REF: 41, 42

19. A group of nursing students are reviewing considerations for neonatal medication administration. Which statement indicates that the review has been effective? a. Gastric pH is more acidic in neonates. b. Absorption of rectally administered medication is decreased. c. Neonates tend to have lower blood levels of medication. d. There is an increased blood flow of medications given by injection.

ANS: C

A B C D

Feedback Gastric pH is more alkaline in neonates.

Absorption of rectally administered medication in neonates is increased.

This is a factual statement, as there is a higher ratio of water to lipids in neonates.

There is a variable blood flow of medication given by injection.

PTS: 1 REF: 38

20. A nurse is reviewing the medication profile of a geriatric patient who has several comorbidities.

Which finding would warrant priority action? a. The patient is able to describe each medication and why it is being taken. b. The patient states that the medications are delivered by the local pharmacy. c. The patient takes 10 medications each day. d. The patient skips a dose of certain medications sometimes.

ANS: D

30

A B C D

Feedback The patient should be able to identify medications and why they are being prescribed for treatment of health problems.

No intervention is required based on this statement, as the patient is receiving medications.

Many geriatric patients take multiple medications, and the information provided identifies that the patient has several comorbidities.

The nurse must intervene to find out about the ―skipped doses,‖ as this can lead to potential problems.

PTS: 1 REF: 36, 37

MULTIPLE RESPONSE 21. A nurse is reviewing a medication list. Which abbreviations are considered acceptable?

(Select all that apply.) a. Administer next dose of medication @ 3 pm. b. Administer medication p.c. during the day. c. Administer medication PO as directed. d. Administer 200 IU. e. Administer medication IM. ANS:

A. B. C. D. E.

B, C, E

Feedback The notation ―@‖ is no longer used and should be specified as ―at‖ in order to avoid confusion and possible medication error.

This is an acceptable abbreviation indicating after meals.

This is an acceptable abbreviation indicating by mouth (orally).

This notation is no longer used and should be spelled out as international units in order to avoid confusion and possible medication error.

This is an acceptable abbreviation indicating the intramuscular route.

PTS: 1 REF: 35 22. While supervising a student nurse providing morning medications to patients in the long-term

care facility, the nurse would intervene if the student was observed performing which of the following actions? (Select all that apply.) a. The student checks the patient’s wristband to verify identity. b. The student verifies the medication order. c. The student scans the medication with the computer scanner.

31 d. The student leaves the medication at the bedside for the patient to take. e. The student prepares a medication scheduled for several hours later in the shift.

ANS: D, E

A. B. C. D. E.

Feedback This is the correct way to check the patient’s identity prior to administering medication.

This is important for ensuring the medication order has been placed on the chart for the correct patient.

Scanning barcodes on name bands and medication packages in care settings assists in ensuring the rights of medication administration are being performed.

Medication should never be left at the patient’s bedside. The nurse is responsible for verifying that the medication has been taken.

The nurse should intervene in this situation. Medications should not be set up prior to the time scheduled for administration. The order could change before the dose is due, or the medication could be altered or tampered with, leading to a wrong dose or the wrong medication reaching a patient.

PTS: 1 REF: 31 23. A nurse is working on an inpatient medical-surgical unit. What actions should the nurse

incorporate into the daily routine in order to maintain Occupational Safety and Health Administration (OSHA) standards? (Select all that apply.) a. Administration of medications to patients via direct hand-to-hand contact. b. Use of hand hygiene prior to patient care. c. Obtaining an order from the health-care provider for use of personal protective equipment (PPE). d. Use of appropriate disposal systems for sharps. e. Use of needleless systems in emergency room settings only.

ANS: B, D

A. B. C.

D. E.

Feedback Nurses should wear gloves when dispensing medications in the clinical setting.

Nurses should perform hand hygiene before initiating patient care interactions.

The authorized use of PPE does not require a health-care provider’s order and is based on hospital policy and procedure related to the patient’s clinical condition/acuity of the patient’s situation.

Nurses should use specialized sharp disposal systems in the clinical setting.

Needleless systems are utilized in hospital settings regardless of clinical area in order to prevent accidental needle sticks.

PTS: 1 REF: 42

32 24. A nurse working in the emergency room is preparing for the admission of a 34-year-old

patient with a drug overdose. Which of the following equipment and/or orders will the nurse anticipate will be used for this patient? a. Telemetry monitoring b. Blood transfusion c. Activated charcoal d. Dialysis machine e. Nasogastric (NG) tube and 60-mL syringe for lavage ANS: A, C, E

A. B.

C. D.

E.

Feedback Telemetry monitoring is important to monitor for troublesome dysrhythmias or changes in heart rate, which may occur with drug overdoses.

A blood transfusion is not typically given to manage a drug overdose; this would be used to replace lost blood secondary to an injury or to replace red blood cells in patients with significant anemia.

Activated charcoal may be administered to bind with the drug/medication so that it cannot be absorbed, but rather excreted.

Dialysis is not used to enhance excretion of the drug responsible for the overdose; the kidneys will excrete the drug. If the kidneys are not functional enough to excrete the drug, dialysis could be used but not as part of the emergent treatment.

An NG tube may be used to lavage the stomach to remove the contents, including the drug ingested. A 60-mL syringe would be used to assist in the lavage process.

PTS: 1 REF: 42 25. A nurse is checking the medication orders for assigned patients. Which orders should the

nurse obtain additional clarification for? (Select all that apply.) a. ASA 81 mg qod b. Regular insulin 3U subcutaneously daily c. Flush nasogastric tube with 60 cc water d. MS 4 mg per oral route e. Tylenol 1 tab per oral route at 9 am ANS: A, B, C, D

A. B. C. D.

Feedback The notation ―qod‖ is no longer used; this abbreviation should be written out as ―every other day‖ to avoid possible confusion and medication error.

The notation ―U‖ is no longer used; this abbreviation should be written out as ―units‖ to avoid possible confusion and medication error.

The notation ―cc‖ is no longer used; this abbreviation should be written out as ―mL‖ or ―millimeters‖ to avoid possible confusion and medication error.

The notation ―MS‖ is no longer used; this abbreviation should be written out as either ―morphine sulfate‖ or ―magnesium sulfate‖ based on the actual order.

33

E.

No additional clarification is needed for this written order.

PTS: 1 REF: 36

Chapter 4. Regulations MULTIPLE CHOICE 1. While shopping for an over-the-counter (OTC) cough suppressant, the nurse identifies that the

medication will be classified as a: a. Schedule I medication b. Schedule III medication c. Schedule V medication d. Nonscheduled medication ANS: C

A

B C

D

Feedback Schedule I drugs are the most controlled substances; they are not considered to have medical use and are highly addictive. Heroin is an example of a Schedule I drug.

Schedule III drugs are moderately addictive and have limits on refills. Codeine is an example of a Schedule III drug.

This is the correct response. Schedule V medications have the lowest potential for abuse. These drugs may still need a prescription. OTC cough suppressants are in this category. Note that some OTC medications are considered Schedule II drugs if they are used for an unintended purpose, such as the drug pseudoephedrine, which is used in the manufacture of methamphetamine.

Since OTC cough medications often contain a substance that is scheduled in some way, they are usually considered a scheduled medication.

PTS: 1 REF: 61 2. Which of the following best describes the role of the Drug Enforcement Administration

(DEA) in maintaining patient safety? a. Determining which medication needs a prescription for the patient to obtain. b. Providing specific requirements for the manufacture of generic medications. c. Indicating which medications are controlled substances and enforcing the laws. d. Ensuring the patient taking a medication has an option for generic medications.

ANS: C

34

A B C D

Feedback This is the role of the Food and Drug Administration (FDA), not the DEA. This is the role of the FDA, not the DEA. The DEA decides which drugs are controlled and which schedule the drugs may belong to and enforces the laws about drugs/medications.

This decision is made by the manufacturers of medications.

PTS: 1 REF: 60 3. The nurse provides a patient who was admitted with gastroesophageal reflux a dose of

intravenous pantoprazole. Fifteen minutes later, the patient calls for help and is gasping for breath. Emergency measures are instituted, and the patient is transferred to the intensive care unit. Which is the priority nursing action? a. Notify the nursing supervisor that the patient experienced a common side effect to the medication. b. Identify the episode as an adverse reaction and ensure it is reported to the FDA. c. Call the hospital administrator to report an act of medication fraud. d. Contact the local news channel to arrange an investigation.

ANS: B

A B C D

Feedback This is not a common side effect. Difficulty breathing demonstrates potential anaphylaxis.

This is the correct response. The FDA tracks adverse reactions to monitor for the need to have the drug recalled. The MedWatch program is voluntary.

This is not fraud; it is an adverse response. The hospital administrator is not the appropriate person to notify. The physician needs to be notified.

The local news is unable to track medications and make decisions about keeping the medication on the market. The FDA needs to be informed.

PTS: 1 REF: 54 4. A patient with advanced colorectal cancer is going to start taking long-acting morphine

sulfate. Which of the following statements by the nurse is best? a. ―I will call the prescription in to your local pharmacy.‖ b. ―You are only allowed to have one refill on this medication before you have to see the doctor again.‖ c. ―This is considered a Schedule IV medication, so there are strict guidelines we must follow.‖ d. ―I am faxing the prescription to the pharmacy, but you must also take this written prescription with you to pick it up.‖ ANS: D

35

A B

C D

Feedback Morphine is a Schedule II drug and cannot be called in to the pharmacy. A written order is required to be faxed and/or taken to the pharmacy.

Morphine is a Schedule II drug. It is closely regulated. The patient may need more at some point, but no refills are given on the prescriptions. The health-care provider or advanced nurse practitioner must give a written prescription for each time the medication is filled.

Morphine is a Schedule II drug, not a Schedule IV. Schedule IV drugs have little risk for abuse but are still controlled.

This is an appropriate means to fill the prescription. The fax provides the pharmacy with the information needed to fill the prescription and the written prescription allows the patient to pick up the medication.

PTS: 1 REF: 61 5. A patient with a compressed disc in the lumbar region takes hydrocodone/acetaminophen

every 6 hours for pain control. The patient tells the nurse, ―This pain medication just doesn’t seem to be working anymore.‖ Which response by the nurse is best? a. ―Are you taking the medication with a full glass of water?‖ b. ―You may be developing a tolerance to the medication.‖ c. ―We will draw some blood to see if you are absorbing the medication.‖ d. ―How did you rank your pain on a 0 to 10 scale with your original injury?‖ ANS: B

A B

C

D

Feedback The use of water with this mediation does not affect the medication’s usefulness or effect.

Patients demonstrate tolerance when the medication no longer produces the desired effect. This indicates a need to change medication, increase the dose, or add an additional medication.

Laboratory results are not typically used to monitor the absorption of this medication. The physician relies on the patient’s report of pain to determine whether the medication is effective.

The current pain level may be a helpful piece of the assessment; however, the pain rating at the time of the injury is not relevant at this time.

PTS: 1 REF: 63 6. A co-worker tearfully confides that she is struggling with a growing dependence on sleeping

medication and other drugs to maintain her work schedule on the night shift. Which action by the nurse is best? a. Refer the co-worker to the employee assistance program (EAP). b. Encourage the co-worker to switch to herbal remedies. c. Suggest the co-worker try to get a daytime position.

36 d. Ask if the co-worker needs help with child care.

ANS: A

A

B C

D

Feedback The colleague has reported a sign consistent with approaching abuse of the medication and needs assistance from a professional. The EAP is a source for confidential assistance for employees.

Herbal remedies may or may not be well studied. The co-worker needs further support, which could be provided by the EAP. Herbals do not assist with this.

This might be a reasonable long-term solution; however, right now the co-worker is struggling with signs approaching addiction. This solution does not address the concern.

This action does not address the co-worker’s needs. Asking whether she needs help with child care does not address the issue with sleeping and tolerance to a drug.

PTS: 1 REF: 65

7.

The nurse is reviewing legal laws related to correct drug administration. Which legal act of legislation was enacted in response to birth defects caused by thalidomide? a. Controlled Substances Act b. Durham-Humphrey Amendment c. Orphan Drug Act d. Kefauver-Harris Amendment

ANS: D

A B C D

Feedback The Controlled Substances Act of 1970 established the Drug Enforcement Administration (DEA).

The Durham-Humphrey Amendment defined prescription drugs as drugs that must be administered under the supervision of a physician.

The Orphan Drug Act was established to facilitate the development of drugs for rare diseases (i.e., diseases that affect fewer than one in 200,000 people).

The Kefauver-Harris Amendment was enacted in response to thalidomide use during pregnancy and the drug’s direct link to birth defects.

PTS: 1 REF: 51

37 8.

A group of student nurses are reviewing the process of drug development. Which statement best identifies the concept of a placebo? a. Medication designed to have more benefits than risks b. The active ingredient in a drug preparation c. A substance that is used for comparison in drug studies d. A medication that supports physiological well-being

ANS: C

A

B C

D

Feedback The design of pharmaceutical preparations focuses on medication development having more benefits than risks, but this is not related to the concept of a placebo.

A placebo does not contain an active drug ingredient, but rather is an inert substance.

A placebo is an inactive (inert) substance that is sometimes given to participants in clinical trials to compare the response the patient has with an inert substance with the response they have to an active substance.

This statement best describes a function of a medication but does not specifically correlate to a placebo.

PTS: 1 REF: 52

9.

A nurse is working in a clinical research trial that has a control group and an experimental group but does not know which group is receiving the active drug. Which statement best identifies the research design? a. Double-blind b. Control group c. Experimental drug d. Placebo group

ANS: A

A B C

Feedback A double-blind research design is one in which neither the participants nor the clinicians know who is receiving the active drug.

A placebo group and control group are parts of the research design making up the clinical trial or study.

An experimental drug is one in which a substance goes through clinical trials to test the efficacy, identify potential side effects, and assess for risks versus

38

D

benefits of a medication.

A placebo group and control group are parts of the research design making up the clinical trial or study.

PTS: 1 REF: 52

10.

A nurse is working with a patient who has received an investigational new drug (IND) for treatment of terminal cancer without going through the full clinical trial process. How would the nurse document this in the medical record? a. The medication has been approved for widespread usage. b. The patient is terminal and has been assigned to hospice. c. Compassionate use has been approved. d. INDs do not require approval by the FDA.

ANS: C

A B C

D

Feedback IND medication approval through compassionate use is done via special exception and is not approved for widespread usage.

While most INDs are used to treat critically ill patients, the fact that the patient has been assigned to hospice care is not a direct factor.

If the drug is being developed to help critically ill patients, special exceptions can be made. The FDA allows some physicians the compassionate use of INDs before approval. If a patient is suffering greatly and may die without the drug, a physician can prescribe it before FDA approval All medications (including INDs) require approval by the FDA prior to being utilized.

PTS: 1 REF: 53,54

11.

A nurse is reviewing proper administration of controlled substances in the clinical setting.

Which action would the nurse deem as being essential? a. Narcotic counts must be reviewed every 24 hours. b. Substances should be maintained in a double lock.. c. A witness is required for administration. d. Policies are the same across clinical facilities.

39

ANS: B

A

B C D

Feedback Depending on the hospital policy and procedure, narcotic counts may be performed as often as once per day, once per shift, or once per week depending on the type of facility.

This is a factual statement that ensures that these medications are properly secured.

A witness is required for wasting of medication and/or counting of narcotics.

This is not an accurate statement, as clinical facilities may have different policies and procedures for the use/administration of controlled substances.

PTS: 1 REF: 63

12.

A nurse is working with a patient who has been taking medication for anxiety for several weeks and now reports that the medication doesn’t seem to work anymore. The patient has stopped taking the medication, as it doesn’t work. Which finding should the nurse suspect? a. The patient is experiencing withdrawal symptoms. b. The patient is addicted to the medication. c. The patient is habituated to the medication. d. The patient is experiencing tolerance.

ANS: D

A B

C

D

Feedback There is no information that correlates with the patient experiencing any withdrawal symptoms, just tolerance.

As the patient was able to stop taking the medication, there is no indication that the patient is addicted. Addiction means being compulsively driven to take a drug, often to the exclusion of all other activities.

Habituation means that the patient is psychologically dependent on the drug.

They may not physically need the drug but believe that they cannot live without it. As the patient has stopped taking the drug, this is not occurring.

The patient has developed a tolerance to the drug, as it is no longer having the desired effect.

PTS: 1 REF: 63

40

13.

A nursing student is reviewing the concept of a generic drug. Which statement is accurate? a. The name of a generic drug is capitalized. b. The same dosage form of the medication is used. c. Active ingredients can vary between generic and brand name drugs. d. Brand names are the same as generic names

ANS: B

A B

C D

Feedback The name of a generic drug is only capitalized if it begins the sentence.

It must have the same dosage form: tablets, patches, and liquids are examples of dosage forms. It must be administered in the same way (e.g., swallowed as a pill or given as an injection).

Generic medication must have the same active ingredient or ingredients and the same labeled strength as the reference product.

Once a drug’s patent period has ended, the drug’s trademark status is not protected, so other companies may produce the drug under its common or generic name. A brand name or trade name (also sometimes called a proprietary name), to which the company owns the rights, is assigned once the drug has received approval after going through clinical trials.

PTS: 1 REF: 58

14.

A nurse received a phone call from a patient stating that the medication received from the pharmacy looks different. Which is the best response by the nurse? a. Tell the patient to return the medication to the pharmacy. b. Ask the patient to provide the name of the medication. c. Contact the health-care provider for clarification. d. Assure the patient that it is okay to take this medication.

ANS: B

A B C

Feedback There is no immediate need to return the medication to the pharmacy at this time.

The nurse should question the patient about the specific name of the medication, as the prescription may have been filled with a generic equivalent.

There is no immediate need to contact the health-care provider, as the nurse

41

D

should obtain additional assessment information.

This response does not address the patient’s concern that the medication is different.

PTS: 1 REF: 58 MULTIPLE RESPONSE 15. A clinical trial nurse is helping to register a patient in a phase II double-blind trial comparing

a new medication with a placebo. Which of the following would the nurse include in the patient teaching? (Select all that apply.) a. ―Neither you nor the doctor nor I will know if you are getting the real medication or not.‖ b. ―A computer will randomly determine which people get the actual study drug.‖ c. ―This trial is designed to determine if a benefit is found when using the drug.‖ d. ―Fewer than 100 people will be participating in this study.‖ e. ―The results of the study will not be known for at least 5 years.‖ ANS: A, B, C

A. B. C. D. E.

Feedback A double-blind study does not allow the practitioner or patient to know who received the placebo and who received the medication.

This is a common means of ensuring random sampling in a study.

Clinical trials are designed to determine whether the drug is providing a benefit, what side effects may be experienced, the drug’s toxicity, and drug interactions.

Hundreds of people will be involved in the clinical trial of the drug. 100 people would not be an adequate sample to obtain the information desired.

It is difficult to specify when the results of the study will be known. If too many adverse effects occur, the study can be stopped suddenly. Some studies take many years to determine a drug’s effectiveness.

PTS: 1 REF: 52 16. A nurse working with a patient who is experiencing withdrawal from a medication would

track which of the following symptoms? (Select all that apply.) a. Tremors b. Pinpoint pupils c. Hallucinations d. Low blood pressure e. Emotional distress ANS: A, C, E

A.

Feedback Tremors, emotional distress, and hallucinations are common symptoms

42

B. C. D. E.

experienced during withdrawal.

Pinpoint pupils are not typically found during withdrawal.

Tremors, emotional distress, and hallucinations are common symptoms experienced during withdrawal.

Low blood pressure is not a typical sign of withdrawal.

Tremors, emotional distress, and hallucinations are common symptoms experienced during withdrawal.

PTS: 1 REF: 63 17. The nurse manager on a surgical unit suspects that one of the nurses may be dealing with a

substance abuse problem. Which of the following symptoms would support this suspicion?

(Select all that apply.) a. The individual’s uniform is frequently wrinkled or disheveled. b. The individual has called in sick three times in the past month. c. The individual has made two medication errors in the past week. d. The individual is irritable and withdrawn. e. The individual was seen crying in the medication room after a patient’s death.

ANS: A, B, C, D

A. B. C. D. E.

Feedback Common symptoms include changes in appearance.

Common symptoms include making excuses for absences, including calling in sick.

Common symptoms include poor work performance; making medication errors is an example of poor work performance.

Withdrawal and irritability are common signs of substance abuse.

Experiencing emotional situations may bring on feelings of grief in a nurse; crying in this case is not unusual.

PTS: 1 REF: 64,65

18.

A nurse is reviewing the medication profile for a patient who has a prescription for alprazolam. Which information should the nurse include in patient teaching for this medication? (Select all that apply.) a. The patient must see their health-care provider once a year in order to obtain refills. b. This medication cannot be refilled and is limited to a one-time written prescription. c. This medication is considered a controlled substance. d. Refills of this medication are allowed within defined time frames. e. The prescription requires a health-care provider’s signature, as this is a Schedule I drug.

43

ANS: C, D Feedback A. As this medication is a Schedule IV substance, the patient must see their health-care provider more frequently to obtain any refills during the defined time frame.

B. Refills of drugs in this category are allowed up to five times in 6 months.

C. This is a factual statement, as this medication is a Schedule IV substance (controlled).

D. This is a factual statement. Refills of drugs in this category are allowed up to five times in 6 months.

E. This medication is a Schedule IV substance (controlled), not a Schedule I drug.

PTS: 1 REF: 60 19.

A nurse is administering a narcotic to a patient and has to administer only a partial amount of medication from the vial. Which nursing actions represent best practice based on safe administration of partial amounts of controlled substances? (Select all that apply.) a. Contact the pharmacy for a different supply of medication. b. Obtain a witness for discarding the medication. c. Verify order in the medical record for correct dosage. d. Sign out medication from the clinical facility’s designated controlled substance area. e. Verify patient’s name and date of birth.

ANS: B,C, D Feedback A. This action is not required, as many medications are provided in specific amount vials that require wasting of medication.

B. As the nurse has to administer a partial amount of medication from the vial, a witness is required for any controlled substances wasted. In other words, if you do not administer a full dose, break a vial, or drop a pill, you need a witness to this event.

C. The nurse should always verify the medical order for the correct dosage prior to administration.

D. The nurse should follow the clinical facility’s policy and procedure as they relate to controlled substance administration.

E. This action is not required at this time but is required prior to administration of the medication to the patient.

PTS: 1 REF: 61

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Chapter 5. Prescriptions and Labels MULTIPLE CHOICE 1. The nurse has received a verbal STAT order for a critical care patient from the health-care

provider at 11:30 a.m. and is preparing to administer the medication. Which is the priority nursing action? a. Wait until the information is updated in the patient’s medication profile. b. Administer the medication now. c. Schedule the medication to be given at noon. d. Contact the pharmacist to verify the order.

ANS: B

A

B C D

Feedback A STAT order is the only instance in which you give a patient a medication without a written order when the prescriber is present. If the situation is not an emergency, you should write the order and have the prescriber sign it before the medication is administered or dispensed.

A STAT medication requires that the nurse administer the medication immediately.

The nurse should not wait to administer a STAT medication order.

There is no indication that the order needs to be clarified by the pharmacist.

PTS: 1 REF: 73 2. The following order is written for a 28-year-old patient with asthma: ―Triamcinolone

acetonide 2 sprays each nostril bid.‖ The nurse will instruct the patient to take this medication: a. Once daily with 2 sprays in each nostril b. Once each evening with 1 spray in each nostril c. Twice daily with 1 spray in each nostril d. Twice daily with 2 sprays in each nostril ANS: D

A B

C D

Feedback The abbreviation bid indicates it should be taken twice daily. Medications should be spaced evenly throughout the day for best results.

The abbreviation bid indicates it should be taken twice daily. Medications should be spaced evenly throughout the day for best results. The order also indicates 2 sprays, not 1 spray.

The order indicates 2 sprays in each nostril, not 1 spray.

This is correct. The patient should use 2 sprays in each nostril twice a day, typically 1 spray in the morning and 1 spray in the evening.

45

PTS: 1 REF: 72

3. The nurse is preparing to administer a medication and notes an unrecognized abbreviation.

Which of the following is the best action for the nurse to take in this situation? a. Refer to the institution’s approved abbreviation list. b. Ask a colleague what the abbreviation means. c. Do not administer the medication to the patient. d. Ask the patient about her medication regimen.

ANS: A Feedback A

B

C D

Each institution should have a list of approved abbreviations. Nurses who do not recognize an abbreviation should refer to the list to ensure correct understanding of the medication order.

While a colleague might know the abbreviation, the nurse cannot be certain. It is the nurse’s responsibility to ensure the correct interpretation of the abbreviation using the institution’s approved list.

The medication will need to be administered as ordered. It is a medication error to omit administering the medication.

The patient should not be asked about her medication regimen to determine the correct administration of the medication in question, as the regimen may have changed.

PTS: 1 REF: 72 4. A patient has a prescribed medication to be administered before meals. Which notation should

the nurse expect to see in the patient’s medication administration record? a. Ac b. Pc c. Hs d. Bid ANS: A

Page: Feedback A B C D

This is correct, as ac is the abbreviation for ―before meals.‖ This is incorrect, as pc is the abbreviation for ―after meals.‖ This is incorrect, as hs is the abbreviation for ―bedtime.‖ This is incorrect, as bid is the abbreviation for ―twice a day.

PTS: 1 REF: 35

46

5. A neighbor calls the nurse saying, ―This bottle of infant acetaminophen doesn’t have a

dropper; it has a little cup. How do I know how much to give to my 3-month-old daughter?‖ Which response by the nurse is best? a. ―How much did you give your 3-year-old son when he was a baby?‖ b. ―Read the label on the back of the box to find the strength and recommended dosage.‖ c. ―Why do you need to give the baby this medication?‖ d. ―This medication is no longer given to infants or children.‖ ANS: B

A

B C D

Feedback This response is incorrect because differences in the weights of the children may call for different doses. One cannot rely on recall of the dose from 3 years prior, and the dosing labels may have changed since then.

This is correct. The labels on over-the-counter (OTC) medications will include instructions for use.

This response does not address the question the neighbor has asked. The nurse needs to address the question asked.

This response is incorrect. This medication is given to infants and children.

PTS: 1 REF: 78 6. A patient is scheduled for a diagnostic testing procedure. What type of medication order

should the nurse anticipate being ordered by the health-care provider? a. Medication prn for pain should be administered. b. Standing orders per protocol for required test. c. Continue to take all prescribed medications. d. Continue to take over-the-counter (OTC) medications.

ANS: B

A B C

D

Feedback There is no information provided to indicate that the patient is experiencing pain and/or that prn pain medication should be administered.

The nurse can anticipate that standing medication orders are used in specific routine circumstances, such as diagnostic tests.

The nurse must verify the type of diagnostic testing procedure to be done and then follow the stated protocol. Certain diagnostic testing procedures require the patient to not have certain medications and/or be NPO. The nurse must verify the type of diagnostic testing procedure to be done and then follow the stated protocol. Certain diagnostic testing procedures require the patient to not have certain medications and/or be NPO. OTC medications can also impact diagnostic testing.

47 PTS: 1 REF: 81 7. An 18-year-old patient calls a physician’s office to request a refill for birth control pills.

Which response by the nurse is best? a. ―The physician must see you at least every 6 months to provide prescription refills.‖ b. ―If you’ve been seen by the doctor in the last year, a prescription refill can be called to your pharmacy.‖ c. ―All birth control medications require a handwritten prescription, so you will need to pick this up at the desk at your convenience.‖ d. ―Are you sexually active?‖ ANS: B

A

B C

D

Feedback Physicians and other health-care providers can authorize refills of medication for chronic conditions or birth control without seeing the patient; typically, the patient is seen at least once yearly.

This response is correct. Patients taking medications for chronic conditions or birth control do not have to be seen to refill these prescriptions.

Birth control pills are not a Schedule II drug or a similar drug with a high risk of dependence; therefore, the prescription can be provided without a handwritten prescription.

This response is not pertinent to the question the patient has asked. Sexual activity does not factor into whether or not refills can be obtained.

PTS: 1 REF: 77 8. The nurse is providing care for a patient who is taking dutasteride for benign prostatic

hyperplasia (BPH). The patient’s prescription reads, ―Take 1 capsule daily by mouth.‖ Thirty pills have been dispensed, and the prescription allows for five refills. The nurse anticipates seeing the patient again in: a. 1 month b. 3 months c. 6 months d. 1 year ANS: C

A

B

Feedback The patient will have 30 capsules dispensed for a 30-day supply. This means after 1 month the patient will need to get a refill. This will happen for a total of 6 months (1 month with the initial prescription and 5 more months), when the physician may want to see the patient again.

Three months is only about half of the prescription provided. A 30-day supply

48

C D

now and five more 30-day supplies equal a total of 6 months.

This response is correct. A 30-day supply now and five more 30-day supplies equal a total of 6 months.

The medication prescription provided suggests the patient needs to see the doctor after 6 months because only a 6-month supply was given. If the physician had wanted to see the patient after a year, the prescription would have been written for a year’s supply.

PTS: 1 REF: 74

9.

A nurse is utilizing an e-prescription system to verify patient information and dispense medication. How does this type of system help to decrease medication errors? a. Computer usage prevents system errors. b. All prescription information must be completed. c. Insurance information is verified. d. Patient’s medical information does not have to be updated.

ANS: B

A B C D

Feedback The use of a computer does provide a method by which to track orders, but system errors can occur as a result of input/operator or program error.

Completing all pertinent prescription information before a medication is dispensed leads to accurate verification.

Certain e-prescription systems can verify insurance information for patients, but this does not in itself help to decrease the incidence of medication errors.

Patient information should be updated and kept current within the computer system.

PTS: 1 REF: 73 10.

A patient is scheduled for a diagnostic test the following day and to be kept NPO (nothing by mouth) after midnight. What is the best nursing action? a. Call the health-care provider to see if intravenous fluids are needed. b. This is an example of a STAT order and should be documented in the patient’s chart. c. Remove the patient’s water pitcher at the bedside shortly before midnight. d. Increase fluid intake prior to midnight to make sure the patient remains hydrated.

49

ANS: C

A

B

C D

Feedback There is no need to call the health-care provider, as this is an example of a standing order that is typically reviewed by hospital policy and procedural review committees on an annual basis.

A STAT order is one that has to be implemented immediately as part of an emergent critical care situation. Documentation of NPO for the procedure should be noted in the patient’s chart.

This is the best nursing action, as it prevents the patient from taking fluids and interfering with the prep for the diagnostic test.

There is no clinical information that supports increased fluid intake for the patient at this time.

PTS: 1 REF: 74 11.

A nurse is performing a pain assessment, noting 5 on a 10-point scale, for a postoperative patient who is 24 hours post procedure. Which type of order should the nurse anticipate that the health-care provider has written? a. Automatic stop orders b. STAT orders c. Standing orders d. Verbal orders

ANS: A

A

B

C D

Feedback Postoperative patients typically require pain medication (Schedule II and Schedule III) every 4 to 6 hours as needed. This is a short-term medication order for the immediate postoperative period.

A STAT order would more likely be available in the immediate postoperative period. As the patient is now 24 hours postop, one would not anticipate that a STAT pain medication order would be needed.

Standing orders are typically written for use in routine circumstances, as with diagnostic testing.

As the patient is 24 hours post procedure, the nurse would not anticipate a verbal order, as pain management orders are addressed in the immediate postoperative period following the surgical intervention.

PTS: 1 REF: 74

50

12.

A patient has filled an antibiotic prescription for treatment of an infection and wants to know how long the medication has to be taken. The prescription reads ―amoxicillin 250-mg tablets bid and 20 dispensed‖ and indicates no refills. What is the best nursing response? a. Contact the health-care provider for clarification. b. More information is needed to answer this question. c. Based on the current prescription, the medication is to be taken for 10 days. d. The patient may stop the medication after 7 days if feeling better.

ANS: C

A B C D

Feedback There is no need to contact the health-care provider, as the nurse can assist the patient in verifying the information on the prescription bottle.

All pertinent information is provided, so the nurse can respond.

The medication order is written for a 10-day supply based on bid administration.

The health-care provider is the only individual who can change the prescription order.

PTS: 1 REF: 74

13.

A patient brings a prescription to the clinic stating that it cannot be filled by the pharmacy.

The nurse reviews the prescription. Which information must be filled out on a prescription by the health-care provider in order for it to be filled? a. Health-care provider signature b. Date of the clinical office visit c. Age and name of the patient d. Address of the patient

ANS: A

A B C D

Feedback In order for a prescription to be filled, the health-care provider must provide either a written or electronic signature.

The Rx should be dated, but the date does not have to coincide with the clinical office visit and can be filled out by someone other than the health-care provider.

The age and name of the patient have to be noted but can be filled out by someone other than the health-care provider.

The address of the patient has to be noted but can be filled out by someone other than the health-care provider.

51

PTS: 1 REF: 77

14.

A patient has been taking oral contraceptives for a few years as their method of birth control and calls the clinic to get a refill. The patient’s last office visit was 3 months ago. What is the best nursing response? a. Schedule an appointment with the health-care provider. b. Document the message and ask the health-care provider for a refill. c. Ask the patient if this birth control method is effective. d. Verify that the patient is taking the medication as ordered.

ANS: B

A B

C D

Feedback As the patient was seen in the office recently, there is no need to schedule a visit with the health-care provider for a refill.

If a patient calls for a refill, the prescriber may refill the prescription without asking to see the patient again, especially if the patient has a chronic condition or is taking birth control pills. After the refill has been approved, the health-care professional must document in the patient’s medical record that the prescription was telephoned to the pharmacy.

This is not the best nursing response, as the health-care provider is the one who evaluates the efficacy of the treatment plan.

Although it is important to verify that the patient is taking a medication as ordered, there is no indication that there are any issues with administration, and this does not address the patient’s stated request for a refill.

PTS: 1 REF: 77

15.

A nurse is reviewing a new prescription order for a patient who questions information on the prescription bottle written in a bright color related to administration of the medication. What is the best nursing response? a. ―There is no need to worry, as this type of information is written on all prescription bottles.‖ b. ―This information is only present on a prescription bottle the first time the prescription is filled.‖ c. ―This information contains warnings that are associated with this type of

52

medication and should be reviewed by the patient as it relates to taking this medication.‖ d. ―This is a partial listing of side effects that commonly and rarely occur with the medication.‖

ANS: C

A B C

D

Feedback This is an incorrect statement and does not address the function of warning labels.

This is an incorrect statement, as warning labels are present on all prescription medications regardless of whether they are being filled for the first time.

The pharmacist places appropriate warning labels on the prescription container to make sure that patients understand the best way to take the medication and are aware of possible situations to avoid. These warning labels are usually a bright color to make sure they are not overlooked This is an incorrect statement, as warning labels relate to the best way to take the medication and make patients aware of possible situations to avoid.

PTS: 1 REF: 78

MULTIPLE RESPONSE 16. Which of the following information items would a nurse expect to see on the prescription

label? (Select all that apply.) a. Picture of the medication b. Drug dosage c. Physician Drug Enforcement Administration (DEA) number d. Number of pills in the bottle e. Patient’s name and address ANS: B, D, E

A. B. C. D. E.

Feedback Pictures of medications are not typically found on the label.

The drug dosage is found on the label, instructing patients how much medication to take with each dose.

The physician’s DEA number is not printed on the label; it is used on written, faxed, and phoned-in prescriptions.

The number of pills is included on the medication label.

The patient’s name and address are included so it is clear whose prescription the bottle contains.

53

PTS: 1 REF: 75 17. Which of the following measures are taken to keep the patient safe when dealing with

medication orders? (Select all that apply.) a. Use abbreviations for orders whenever possible. b. Obtain written or typed orders when possible. c. Read back any verbal orders to prevent errors. d. Ensure all prescriptions are accurate and legible. e. Educate the patient about new medications.

ANS: B, C, D, E

A.

B. C.

D. E.

Feedback The use of abbreviations can cause confusion and lead to medication errors. Use only approved abbreviations within your facility. Avoid all abbreviations on the lists of error-prone abbreviations from The Joint Commission and Institute for Safe Medication Practices (ISMP).

A written or typed prescription is helpful for preventing errors associated with verbal orders.

The nurse should write all verbal orders as they are given and read them back to the practitioner once the orders have been written to verify understanding and prevent errors.

This action is a safety check before having the patient take the prescription or having a nurse note and carry out orders.

All new medications should be administered after patient education to prevent injuries, overdose, and subtherapeutic treatment.

PTS: 1 REF: 72

18.

Which of the following are examples of information that would be found on a warning label of a prescription bottle? (Select all that apply.) a. Shake well b. Keep refrigerated c. Quantity 20 d. For the ear e. Take as directed

ANS: A, B, D Feedback A. ―Shake well‖ is an example of information that is found on a warning label of a prescription bottle.

B. ―Keep refrigerated‖ is an example of information that is found on a warning label of a prescription bottle.

54

C. D. E.

The amount of medication dispensed (quantity) is not found on a warning label of a prescription bottle. ―For the ear‖ is an example of information that is found on a warning label of a prescription bottle. ―Take as directed‖ is not found on a warning label of a prescription bottle.

PTS: 1 REF: 80 19.

A nurse is reviewing stock medications on the nursing unit. Which information should be noted on the bottles? (Select all that apply.) a. Measurement unit of the medication b. Food and Drug Administration (FDA) contact information c. Directions for reconstitution d. Lot number e. Expiration date

ANS: A, C, D, E Feedback A. This is a factual statement. This information is considered to be part of drug strength and form.

B. This information is not present on stock medication bottles.

C. This is a factual statement. This would be considered to be a critical factor in administering the correct dosage of the medication.

D. The lot number links the medication to a specific batch of drugs manufactured in a particular place over a given period of time.

E. The expiration date should be present on all stock medication bottles.

PTS: 1 REF: 79 Completion

20.

<Insert Fig 5-1> Which field on the image indicates whether a generic medication can be substituted for the medication prescribed? Insert the letter representing the relevant field.

ANS: C Feedback: This site indicates the number of refills.

55

PTS: 1 REF:

56 PU Fig from Text Fig 5-1

Chapter 6. Basic Review of Mathematics PROBLEM 1. The nurse is reviewing a patient’s meal plan in which 35% of a 2,000-calorie intake should be

taken in as carbohydrates (CHOs). How many calories should be consumed as CHOs? ANS:

700 35% of 2,000 = 0.35 × 2,000 = 700 calories PTS: 1 REF: 106 2. While caring for a patient on a 1,700-calorie diet restriction, the nurse notes the patient has

consumed 415 calories for breakfast. If 300 calories are allotted for beverages and snacks, how many calories remain for the patient’s meals?

ANS:

985 calories Total calories remaining = 1,700 1,700 – 415 – 300 = 985 calories remaining for the patient’s meals PTS: 1 REF: 87, Appendix H 3. The nurse is caring for a patient who takes lisinopril (Zestril) 10 mg tid. Discharge orders

include a prescription for a 30-day supply. How many pills will be in the bottle when the prescription is filled?

ANS:

90 pills Number of pills in the bottle = 3 tablets each day × 30 days = 90 pills in each bottle PTS: 1 REF: 87, Appendix H 4. A young girl is started on 5 mg of paroxetine (Paxil) daily. The pharmacy provides 10-mg

tablets. How many tablets will the nurse provide?

ANS:

1/2 tablet Tablets to provide = 1 tablet has 10 mg and each dose needs 5 mg; to get 5 mg, the nurse will give 1/2 tablet

57 PTS: 1 REF: 88 5. The nurse is providing ondansetron (Zofran) 4 mg as an intravenous injection. The pharmacy

provides ondansetron in vials of 8 mg/2 mL. How many mL of medication will the nurse draw up?

ANS:

1 mL mL = 2 mL contains 8 mg, 2 × 4 divided by 8 = 8/8 = 1 mL PTS: 1 REF: 95 6. The nurse is caring for a patient placed on a 2,000-calorie diet. If two snacks are responsible

for 20% of the caloric intake, how many calories can be consumed with each snack?

ANS:

200 calories Calories for each snack = 2,000 × 0.2 = 400 calories for both snacks, 400 calories divided by 2 = 200 calories per snack PTS: 1 REF: 99 7. While assisting with meal planning for a patient placed on an 1,800-calorie diet, the nurse

plans for meals to make up 80% of the calorie consumption and wants to make each meal equivalent. How many calories should the nurse plan for each of three meals?

ANS:

480 calories Calories per meal (three meals) = 1,800 × 0.8 = 1,440 calories for meals divided by 3 = 1,440 divided by 3 = 480 calories per meal.

PTS: 1 REF: 99 8. A patient consumes 1/2 cup of grape juice, 2/3 of a 10-oz bowl of broth, 1/4 of a 4-oz bowl of

gelatin, and 1/3 of a carton of milk, which holds 240 mL. Calculate the patient’s intake in mL. ANS:

430 mL Intake in mL: 30 mL per ounce Grape juice Broth Gelatin Milk

= 120 mL = 10 ounces = 300 mL, and 2/3 of 300 is 200 mL = 1/4 of 4 ounces = 1 ounce, and 1 ounce is 30 mL = 1/3 of 240 mL = 80 mL

58

Total: 120 + 200 + 30 +80 = 430 mL total intake PTS: 1 REF: 95 9. While working in the pediatric clinic, the nurse receives a call from a patient trying to figure

out how much infant acetaminophen (Tylenol) to give her child. The doctor has prescribed 45 mg every 4 hours. The medication is provided at a concentration of 60 mg/5 mL. How much medication (in mL) should the patient provide to her child per dose? Round to the nearest tenths place. (Rounding to the full mL would give the child too much medication.)

ANS:

3.8 mL mL = 5 mL contains 60 mg, need 45 mg, 5 × 45 = 225 divided by 60 = 3.75 mL Note: Rounding to the nearest tenths place allows for accurate measuring of the dose to administer to a child. This difference in dosing is significant in infants and children but not typically so in adults.

PTS: 1 REF: 101 10. The physician recommends a teenager start taking 600 mg ibuprofen (Advil) tid starting 2

days before her menstrual cycle and that she continue the medication for 1 week. The medication comes in 200-mg strength tablets. How many tablets will the patient consume during the week?

ANS:

63 tablets Tablets consumed in 1 week = 600 mg divided by 200 mg = 3 tablets per dose 3 tablets per dose 3 times daily = 9 tablets each day, 9 tablets per day × 7 days = 63 tablets PTS: 1 REF: 88 11. The physician orders a 20% Betadine solution, and the policy manual states that the solution

must be mixed with sterile saline solution. What is the ratio for the mixture of the two solutions?

ANS:

2:10 or 20/100 2:10 or 2/10 = 2 tenths Betadine and 8 tenths sterile saline PTS: 1 REF: 104

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12. The physician has ordered medication to be dispensed to a patient. The order reads for 60 mg

to be administered, and the medication is available as one tablet = 120 mg. How many tablets should the nurse administer?

ANS:

1/2 a tablet 1 tablet = 120 mg, 60 mg = 1/2 tablet PTS: 1 REF: 96

13. A patient has been prescribed antibiotic therapy at one pill four times a day for 7 to 10 days.

How many pills should the patient take if following a 7-day course of therapy?

ANS:

28 1 pill taken 4 times a day = 4 × 7 days = 28 PTS: 1 REF: 95

14. A patient has been prescribed antibiotic therapy at one pill four times a day for 7 to 10 days.

How many pills should the patient take if following a 10-day course of therapy?

ANS:

40 1 pill taken 4 times a day = 4 × 10 days = 40 PTS: 1 REF: 95

15. A patient has been prescribed pain medication that does not come in a scored tablet. The

dosage required is 1.75 tablets. How many pills should the nurse administer?

ANS:

2 If a tablet is not scored, you must round the amount: For 1.50 to 1.99, give two tablets.

PTS: 1 REF: 96

16. A nurse is reviewing math calculations for medication using decimals. If the decimal is moved

two places, how much does that change the value?

60

ANS:

100 Moving the decimal by one place increases or decreases the value of the number by 10, moving it two places changes the value by 100, and so forth. These differences are significant with regard to the amount of medication given to a patient. Thus, it is important to know how to compare numbers with decimals.

PTS: 1 REF: 97

17. A nurse is reviewing a medication order that incorporates a leading zero after the decimal point

of 3.0. How should the nurse interpret this number when administering medication?

ANS:

3 The addition of zeros to the right of the end of a decimal does not alter its value, so these zeros are usually deleted. For example, if the number is 3.0, we would write 3 instead of 3.0.

In addition, if the decimal is somehow missed (read as 30 instead of 3.0), an error would occur, resulting in a dosage that was 10 times too high.

PTS: 1 REF: 97

18. The nurse is administering medication that has a scored tablet. The dosage is 1.5 tablets. How

many tablets should the nurse administer?

ANS:

1-1/2 Medication that is scored is easy to cut/dispense into multiple units. For a dosage of 1.5 tablets, the nurse would administer 1-1/2 tablets.

PTS: 1 REF: 96

19. A nurse has to administer liquid medication at a dosage of 1.3 mL. What measurement should

the nurse use on the syringe to pull up the medication?

ANS:

1.3 With fluids, you can get an exact decimal (e.g., 1.3 mL) on the syringe.

PTS: 1 REF: 96

61

20. A nurse has to administer liquid medication at a dosage of 1.95 mL. What measurement should

the nurse use on the measuring cup to dispense the medication?

ANS:

2 You may need to round to 2 if the decimal is between marks on the measuring cup.

PTS: 1 REF: 96

Chapter 7. Measurement Systems COMPLETION 1. The nurse weighs a patient using a metric scale and notes a loss of 10 kg. How much weight

has the patient lost in pounds?

ANS:

22 lb 1 kg = 2.2 pounds; therefore, 10 kg (10 × 2.2) represents a weight loss of 22 pounds.

PTS: 1 REF: 116 2. While working in the pediatric clinic, the nurse weighs a 5-year-old child as 20.5 kg. The

mother asks, ―How much is that in pounds?‖ Provide the child’s weight to the nearest whole pound.

ANS:

45 lb 2.2 kg in each pound, so 2.2 × 20.5 = 45.1 pounds or 45 pounds PTS: 1 REF: 116 3. While removing the dinner tray from a client’s room, the nurse notes the client had 1 cup of

water, 6 oz of beef broth, 4 oz of gelatin, 120 mL of juice, and a 2-oz popsicle. What would the nurse record for intake in milliliters?

ANS:

720 mL Conversions: 30 mL in 1 ounce, 8 ounces in 1 cup mL consumed:

62

Water = 8 ounces × 30 mL = 240 mL Broth = 6 ounces × 30 mL = 180 mL Gelatin = 4 ounces × 30 mL = 120 mL Juice = 120 mL Popsicle = 2 ounces × 30 mL = 60 mL 240 + 180 + 120 + 120 + 60 = 720 mL PTS: 1 REF: 118 4. While attempting to track the intake of an elderly client, the nurse asks the client to identify

what the client drank that day. The client reports, ―I had a small cup of tea, a glass full of juice, and 2 cups of milk.‖ The nurse would record how many milliliters for this client’s intake?

ANS:

780 mL Tea = 6 ounces × 30 mL = 180 mL Juice = 4 ounces × 30 mL = 120 mL Milk = 16 ounces × 30 mL = 480 mL 180 + 120 + 480 = 780 mL PTS: 1 REF: 118 5. While preparing to dispense a dose of liquid medication for a client with a gastrostomy tube,

the nurse notes the ordered dose is 2.5 mg and the bottle indicates a dose of 5 mg/15 mL. How many milliliters will the nurse draw into the catheter-tipped syringe when dispensing the medication?

ANS:

7.5 mL Number of mL needed = 2.5 divided by 5 × 15 = 7.5 mL PTS: 1 REF: 123 6. The physician has ordered a child’s antibiotic dose as 5 mg/kg. The child weighs 14 kg. The

antibiotic is provided in a vial with 10 mg/mL. How many milliliters of antibiotic will be dispensed? Round to the nearest whole number.

ANS:

7 mL Number of mL needed = 14 × 5 = 70 mg of medication needed 70 divided by 10 = 7 mL needed

63 PTS: 1 REF: 123 7. The nurse is mixing diluent with a powdered medication. The package directions instruct the

nurse to mix 3 mL of sterile water to achieve a concentration of 4 mg/mL. The client’s dose is 6 mg. How many milliliters will the nurse withdraw to provide to the client? Round to the nearest tenth.

ANS:

1.5 mL Number of mL needed = 6 divided by 4 = 1.5 mL PTS: 1 REF: 123 8. A client is ordered 25 mg of diphenhydramine by intramuscular injection. The medication is

supplied in a 1-mL vial with a 50-mg dosage. How many milliliters will the nurse inject?

ANS:

0.5 mL mL needed = 25 divided by 50 = 0.5 mL PTS: 1 REF: 123 9. The nurse is preparing to provide an injection of ceftriaxone to a client. The order indicates

the patient needs 750 mg of the medication. The bottle is labeled 350 mg/mL. How many milliliters of ceftriaxone will the nurse inject?

ANS:

2.1 mL mL needed = 750 divided by 350 = 2.1 mL to inject PTS: 1 REF: 123 10. The nurse is caring for a client who is to receive cefoperazone 1.5 g in 100 mL normal saline

intravenously over 30 minutes. The nurse begins the infusion, and a little while later the client calls to report itching, so the nurse stops the infusion. The pump reading has recorded 44 mL infused. Approximately how much medication (in mg) did the client receive?

ANS:

660 mg How many mg did the patient receive?

1.5 g = 1,500 mg 1,500 divided by 100 = 15 mg per mL of solution 44 mL × 15 mg = 660 mg infused PTS: 1

64 REF: 123

11. The nurse has to administer 1 ounce of liquid medication. Using a measuring cup, how many

milliliters should the nurse use to dispense the medication?

ANS:

30 mL 1 ounce is equivalent to 30 mL. PTS: 1 REF: 118

12. The nurse has to administer medication dosed at 1 grain per tablet. How many milligrams of

medication are in the tablet?

ANS:

60 mg 1 grain = 60 mg PTS: 1 REF: 124

13. A nurse is reviewing the patient’s fluid intake. The patient has consumed 3 cups of tea and

two glasses of fruit juice. How many fluid ounces has the patient consumed?

ANS:

26 fluid ounces Teacup = 6 ounces and juice glass = 4 ounces, 3 × 6 = 18 and 2 × 4 = 8, 18 + 8 = 26 ounces PTS: 1

REF: 119

14. A nurse is reviewing the patient’s fluid intake, which is documented as 100 fluid ounces.

Using the metric system, how many milliliters should the nurse document in the patient’s chart for intake?

ANS:

3,000 mL 1 ounce = 30 mL; therefore, 100 × 30 = 3,000 mL PTS: 1 REF: 118

15. A nurse is reviewing the medication order, which is written as gr V. How many grains does

this represent?

ANS:

65

5 grains Roman numeral V represents 5 grains.

PTS: 1 REF: 124

16. A nurse is preparing to dispense medication that was ordered in grams but only available in

milligrams. What number should the nurse use as the multiplier?

ANS:

1,000 To convert grams to milligrams, one should use 1,000 as the multiplier.

PTS: 1 REF: 123

17. A nurse is preparing to dispense 75 mg of a medication that is available in a solution of 50 mg

per mL. How many milliliters of solution should the nurse draw up from the vial?

ANS:

1.5 mL 50 mg per mL, 1 mg = 50 mL and 0.5 mg = 25 mL, 1/50 = x/75 = 75 = 50 x = 1.5 PTS: 1 REF: 123

18. A nurse is reviewing the metric system. Which number serves as the framework?

ANS:

10 The most accepted measurement system is the metric system; it is the most accurate and is based on units of 10.

PTS: 1 REF: 120

19. A nurse is working with a patient who is using a tablespoon to administer medication at home.

How many tablespoons should the nurse tell the patient to use to administer 1 fluid ounce of medication?

ANS:

2 2 tablespoons are the equivalent of 1 fluid ounce.

PTS: 1 REF: 119 20. A nurse has to administer medication converting milligrams to grams. What mathematical

operation should the nurse use?

66

ANS: Division

One would convert milligrams to grams using 1,000 as the divisor.

PTS: 1 REF: 123

Chapter 8. Dosage Calculations MULTIPLE CHOICE 1. The nurse provides a patient with 20 mL of megestrol acetate (40 mg/mL strength) and the

patient reports, ―I usually take 1 teaspoon of the long-acting formulation. Are you sure this is the right stuff?‖ The nurse checks with the pharmacy and learns that 5 mL of megestrol extended release (125 mg/mL) is equivalent to 800 mg of the medication. Which response by the nurse is best? a. ―You are right. You should only take 5 mL of this medication.‖ b. ―We don’t carry the long-acting medication. This is the equivalent dose.‖ c. ―You should be taking 20 mL of medication at home as well.‖ d. ―We will hold the medication at this time and verify the order with the physician.‖ ANS: B

Dimensional analysis solution: 20 mL

A B C D

Feedback This is incorrect. The formulations are not equal, and the adjustment needs to be made to achieve the correct dose.

This is correct. A change in formulation requires a different dose.

This is incorrect. The differences in formulation apply to only the dose administered in the hospital.

This is incorrect. The pharmacy can provide the nurse with information about equivalent dosing when a substitute formulation is used.

PTS: 1 REF: 131 2. A patient admitted to the hospital with acute renal failure typically takes moexipril for

hypertension. The patient’s creatinine clearance is 32 mL/min, and the pharmacy recommends a 50% dose reduction for this medication. The patient’s typical dose is 7.5 mg. The nurse would expect the physician to order which of the following doses? a. 3.75 mg b. 2.25 mg c. 4.25 mg

67 d. 5.75 mg ANS: A

A B C D

Feedback This is correct; 50% of 7.5 mg is 3.75 mg.

This is an incorrect calculation of the dose reduction.

This is an incorrect calculation of the dose reduction.

This is an incorrect calculation of the dose reduction.

PTS: 1 REF: 131 3. The nurse is preparing potassium bicarbonate for a pediatric patient scheduled for a

colonoscopy. The directions state to provide the preparation at an estimated rate of 25 mL/kg/hr. The child weighs 55 lb. The nurse should encourage the child to drink how much of the solution each hour? a. 1,375 mL b. 480 mL c. 625 mL d. 3,025 mL ANS: C

Dimensional analysis solution: 625 mL

A B C D

Feedback This is an incorrect calculation.

This is an incorrect calculation.

This calculation is correct.

This is an incorrect calculation.

PTS: 1 REF: 139 4. The student nurse is preparing to give a patient 20 mEq of potassium chloride. Directions state

to mix the powdered medication with at least 4 oz of juice or water. The instructor would be satisfied with the student’s preparation if the student had which of the following liquids? a. 80 mL of apple juice b. 120 mL of grape juice c. 3 cups of water d. 1 cup of fruit punch ANS: B

Dimensional analysis solution: 120 mL

68

A B C D

Feedback This is an incorrect calculation; it is only approximately 2.7 oz.

This is the correct calculation.

This is an incorrect calculation; it is approximately 24 oz, which is too much for medication administration.

This is an incorrect choice for mixing the solution, which requires fruit juice or water.

PTS: 1 REF: 135 5. While monitoring a patient receiving chemotherapy set to infuse over 3 hours, the nurse notes

after the first hour that just over 160 mL of the original 500 mL has infused. Which action by the nurse is best? a. Alter the pump setting to infuse at 150 mL/hr. b. Alter the pump setting to infuse at 200 mL/hr to ensure the medication finishes on time. c. Assure the patient the physician will be informed and new medication orders will be received. d. Inform the patient the infusion rate is accurate.

ANS: D

Dimensional analysis solution: 166 mL/hr.

A B C D

Feedback The infusion rate is to be 166 mL/hr. There is no rate adjustment needed.

The infusion rate is to be 166 mL/hr. This rate could be too fast and lead to harm.

The infusion rate is as expected. There is no reason to inform the physician or get new orders.

This is the correct infusion rate, and the patient can be reassured of this.

PTS: 1 REF: 144 6. The nurse is caring for a patient who is starting diuretic therapy and has been placed on strict

intake and output measurements. In counseling, this patient is advised to maintain at least 1,500 mL of fluid intake per day. Which beverages should the nurse instruct the patient to avoid? a. Citrus juices and water b. Coffee, beer, and most sodas c. Tomato juice, diet drinks, and lemonade d. Electrolyte-based drinks, tea, and artificial sweeteners ANS: B

69

A B

C D

Feedback These are acceptable choices for the patient to consume.

These choices should be avoided to reduce their dehydrating effect on a patient who is starting diuretics, as dehydration risk is elevated when combining these drinks and diuretics.

These are acceptable choices for the patient to consume.

These are acceptable choices for the patient to consume.

PTS: 1 REF: 146 7. The nurse is preparing to provide evening medications, which are scheduled to be passed

distributed out at 8 p.m. Which military time is equivalent to 8 p.m.? a. 1600 b. 1800 c. 2000 d. 2200 ANS: C

A B C D

Feedback This is incorrect; 1600 is 4 p.m. (16 – 12 = 4) This is incorrect; 1800 is 6 p.m. (18 – 12 = 6) This is correct; 2000 is 8 p.m. (12 + 8 = 20) This is incorrect; 2200 is 10 p.m. (22 – 12 = 10)

PTS: 1 REF: 145 8.

A nurse is working with an oncology patient and is preparing to administer ordered medications. Which priority calculation should the nurse include in the plan of care? a. Body surface area (BSA) b. Weight c. Vital sign measurement d. Intake and output

ANS: A

A B C D

Feedback BSA is used for administering chemotherapy to adults when dosage accuracy is critical.

Weight is important but is included in the BSA measurement calculation.

Vital sign measurement is important, but BSA is critical to proper dosage verification in oncology patients.

Intake and output are important, but BSA is critical to proper dosage verification

70

in oncology patients.

PTS: 1 REF: 141 9.

A nurse is preparing to administer a medication that requires reconstitution. Which priority information should the nurse include in the plan of care? a. Ask the patient their name and date of birth. b. Read the drug label insert to obtain specific parameters. c. Have normal saline available as the diluent. d. Verify patient allergies.

ANS: B

A B

C

D

Feedback This is important prior to the actual dispensing of medication during the drug administration process.

The priority action is to read the drug label insert to find out specific factors related to the conversion ratio to obtain an accurate dose and which type of diluent should be used for the reconstitution process.

One cannot assume that normal saline is the diluent, as the medication could require sterile water for reconstitution; therefore, the priority is for the nurse to read the label.

This is an important part of medication administration, but it is not needed for the reconstitution process.

PTS: 1 REF: 141

10

A nurse is reviewing the medication profile of an elderly patient who has multiple medication orders and is experiencing deteriorating renal function. What type of order should the nurse anticipate that the health-care provider will provide related to medications? a. Continue all medications as ordered. b. Increase dosages to increase efficacy. c. Adjust dosages due to comorbidity. d. Hold all medications.

ANS: C Feedback

71

A B C

D

As a significant comorbidity has been identified, the nurse should expect that the medication dosages will be reviewed, adjusted, and decreased.

An increase in dosage could lead to significant problems due to the deteriorating renal function of the patient.

Geriatric (aged) patients need medications calculated very carefully because of the high risk of toxicity resulting from their aging body systems, particularly the renal (kidneys), hepatic (liver), and circulatory systems. The most common adjustments that must be made are reductions in dosage.

There is insufficient information provided to make this decision, and holding all medications may predispose the patient to additional health risks.

PTS: 1 REF: 140 11.

A nurse is administering medication via intravenous piggyback (IVPB) (100-mL bag) using an electronic infusion device. The piggyback solution is to be administered over 30 minutes.

Upon making rounds 1 hour later, the nurse finds that the medication has not finished infusing. What is the best nursing action? a. Increase the flow rate of the IVPB solution. b. Flush the tubing. c. Check the intravenous (IV) insertion site. d. Notify the physician.

ANS: C

A B

C D

Feedback The nurse should not immediately increase the flow rate, as there could be an issue with the IV insertion site.

This action may be needed, but the priority is to check the IV insertion site to see if there are any problems related to infiltration or swelling/ irritation that may be impeding flow.

This is the priority action, as the nurse has to assess the IV insertion site for any problems related to infiltration or swelling/irritation that may be impeding flow.

The physician should not be notified at this time, as the priority is nursing assessment of the IV insertion site.

PTS: 1 REF: 144 12.

A nursing instructor is making rounds of nursing students monitoring intravenous therapy.

Which observation, if noted, would warrant intervention by the nursing instructor?

72

a. The IVPB solution bag is higher than the primary fluid solution. b. The electronic infusion pump is showing a volume of 0, but there is fluid in the primary bag. c. The roller clamp on the secondary line is open. d. There is fluid remaining in the primary line solution.

ANS: B

A B C D

Feedback This is a correct action, as IVPB solutions are hung higher than the primary fluid solution.

This finding requires action, as the volume must be adjusted to the correct amount.

To run secondary solutions, the roller clamp on the secondary line should be open.

This finding does not require action, as it is a normal finding.

PTS: 1 REF: 143

COMPLETION 13. The nurse is preparing to provide finasteride 5 mg daily in combination with doxazosin 2 mg

daily to a patient with benign prostatic hyperplasia. The pharmacy provides the finasteride in a 5-mg tablet and the doxazosin in a 1-mg tablet. How many tablets will the nurse provide?

ANS:

Three tablets Finasteride 5-mg tablet: give one tablet.

Doxazosin 1-mg tablet: give two tablets.

Total tablets = 3 PTS: 1 REF: 132

14. The nurse is preparing to provide losartan suspension (2.5 mg/mL) to a patient whose dose is

50 mg. How many milliliters will be provided?

ANS:

20 mL

73

50 mg divided by 2.5 × 1 = 20 Dimensional analysis solution: 20 mL

PTS: 1 REF: 131

15. The nurse is hanging a 100-mL IVPB medication to be infused over 1 hour using an electronic

infusion pump. What volume should the nurse select for the administration of this medication?

ANS:

100 The amount of medication solution is noted at 100 mL, and this should be programmed into the electronic infusion device.

PTS: 1 REF: 144 16. A nurse is reviewing the patient’s chart and notes medication administration at 2100 hours.

What time does this correspond to on a 12-hour clock?

ANS:

9 p.m.

Some facilities use military time, which is based on a 24-hour clock. The hours pass from 0100 to 1200 and then continue the next sweep from 1300 (1 p.m.) to 2400 (midnight). To convert to standard time, deduct 12 hours from the military clock time (21 – 12 = 9).

PTS: 1 REF: 145

17. A nurse is to administer medication at 10 p.m. using military time. What time should the nurse

document in the patient’s record?

ANS:

2200 Some facilities use military time, which is based on a 24-hour clock. The hours pass from 0100 to 1200 and then continue the next sweep from 1300 (1 p.m.) to 2400 (midnight). To convert to military time, add 12 hours to the 12-hour clock time (10 + 12 = 22).

PTS: 1 REF: 145

74 18. The health-care provider has ordered 500 mL to be infused over 6 hours using macrodrip

tubing at 15 gtt/mL. Calculate the drip rate. Round to the nearest whole number.

ANS:

21 mL Convert hours to minutes: 60 × 6 = 360; volume/time × dose = rate: 500/360 × 15 = 20.83 = 21 PTS: 1 REF: 145 19. The health-care provider has ordered 1,000 mL to be infused over 8 hours using macrodrip

tubing at 10 gtt/mL. Calculate the drip rate. Round to the nearest whole number.

ANS:

21 mL Convert hours to minutes: 60 × 8 = 480; volume/time × dose = rate: 1,000/480 × 10 = 20.83 = 21 PTS: 1 REF: 145

20. A nurse is reviewing an intravenous order for fluids for a pediatric patient. What would be the

expected drop factor for the tubing?

ANS:

60 gtt/mL One would expect that microdrip tubing would be used for a pediatric patient, and the microdrip drop factor is 60 gtt/mL. PTS: REF:

1 145

Chapter 9. Enteral Medications and Administration MULTIPLE CHOICE

75 1. The nursing instructor is supervising medication administration for a client prescribed

prednisone. The instructor would intervene if which of the following were observed? a. The student provided the medication with a glass of water when the patient had not eaten. b. The student verified the client’s name and birthdate prior to opening the medication. c. The student checked the available dosage of medication against the order. d. The student identified side effects of the medication and educated the patient.

ANS: A

A B C D

Feedback The instructor should intervene because prednisone needs to be taken with food or milk to prevent irritation to gastric mucosa.

The instructor would not need to intervene because the student is taking the correct steps in verifying the patient prior to administration.

The instructor would not need to intervene because the student is appropriately ensuring the correct dose for the patient.

The instructor would not need to intervene because the student is appropriately aware of side effects and educating the patient, which is an important aspect of delivering medication.

PTS: 1 REF: 156 2. A patient has been prescribed oral medication by the health-care provider. Which finding

should alert the nurse to a potential problem with administering medication via the oral route? a. Medication must be taken with food. b. Patient is experiencing nausea and vomiting. c. Patient prefers to have an injection. d. Patient is on limited fluid intake.

ANS: B

A B C D

Feedback Taking oral medication with food is not a potential issue unless the patient is NPO. This is a contraindication to administering medication via the oral route.

Patient preference does not typically restrict medication administration via the oral route.

Oral medication can be provided with sips of water, thereby not impacting fluid intake.

PTS: 1 REF: 156

76 3. A nurse is preparing to administer an oral medication that is in a blister pack. What is the best

method for administering the medication? a. Use scissors to open the package. b. Tear the pack open using the precut tab. c. Peel the outer layer off the medication pack. d. Press on the tablet to dispense.

ANS: D

A B C D

Feedback There is no need to use scissors to open the blister pack to retrieve the medication.

There is no precut tab on blister pack medication.

There is no peel-off layer on blister pack medication.

The nurse can open the blister pack by gently pressing on the tablet so that the pill falls into the medicine cup

PTS: 1 REF: 156 4. A student nurse asks a friend in the program, ―What does it mean when a medication is

buffered?‖ Which response by the friend is best? a. ―Buffered medications have been dissolved in oils or fats.‖ b. ―It means the medication has added antacids to reduce stomach upset.‖ c. ―Buffering extends the metabolism of the drug so it stays in the system longer.‖ d. ―You cannot crush a tablet if it is buffered because it has a special coating.‖ ANS: B

A B C D

Feedback Buffered medications are mixed with antacids rather than fats or oils.

This is correct. Buffered medications are mixed with antacids.

Buffering does not affect the metabolism of the medication.

Buffered medications do not contain special coatings.

PTS: 1 REF: 157 5. At home, a nurse finds an open bottle of cough medicine elixir in the bathroom sink and

realizes it was left there in the middle of the night when the nurse’s spouse was taking the medication. Which of the following actions is most appropriate? a. Determine how much elixir was taken. b. Recap the bottle of medication and place it back in the medicine cabinet. c. Discard any remaining medication. d. Insist the spouse be more responsible with medications in the future.

ANS: C

77

A B C

D

Feedback This is not necessary; the spouse is old enough to take medication according to instructions on the bottle.

This is not the best option because the concentration of the medication may be altered, leading to potential overdosing if taken as directed.

This is correct. Elixirs are mixed with alcohol, which evaporates easily. This evaporation could lead to a more concentrated medication and potential overdose if taken as directed on the bottle.

This response does not address the potentially altered medication concentration.

PTS: 1 REF: 158 6. The nurse must shake which of the following prior to preparation and administration? a. Emulsion b. Elixir c. Suspension d. Solution ANS: C

A B C

D

Feedback Emulsions do not separate and do not need to be shaken.

Elixirs are medications dissolved in alcohol, which ensures even distribution of the medication in the liquid.

A suspension tends to separate, leading to irregular distribution of the medication in the bottle after sitting. Shaking ensures even distribution of the medication.

Solutions have a consistent distribution of components and do not need to be shaken.

PTS: 1 REF: 159 7. The nurse is preparing liquid acetaminophen solution. The recommended dose is 30 mL,

which will be provided via the client’s gastrostomy tube. A tube feeding is currently infusing through the gastrostomy tube. Which of the following actions by the nurse is best? a. Measure the liquid in a medicine cup with the meniscus at the 30-mL mark, disconnect the tube feeding, aspirate stomach contents, flush with water, instill the acetaminophen, flush with water, and reconnect the tube feeding. b. Measure the liquid in a medicine cup with the bottom of the fluid at the 30-mL mark, disconnect the tube feeding, aspirate stomach contents, instill the acetaminophen, flush with water, and reconnect the tube feeding. c. Measure the medication with a tablespoon, disconnect the tube feeding, flush with water, instill the acetaminophen, flush with water, and reconnect the tube feeding. d. Measure the liquid with a syringe, disconnect the tube feeding, aspirate stomach contents, instill the acetaminophen, and reconnect the tube feeding.

78

ANS: A

A

B C D

Feedback This is the correct response. It ensures placement of the gastrostomy tube prior to medication administration as well as flushing of the tube prior to and after administration.

This is incorrect. The measurement of the medication is incorrect, and the nurse has not flushed the tube prior to administration of the medication.

This is incorrect because measuring with a tablespoon is not appropriate.

This is incorrect because the tube has not been flushed with water prior to medication administration.

PTS: 1 REF: 159, 160 8. The nurse notes a new client order as ―Antifungal troches to buccal mucosa tid.‖ The nurse

explains to the client that this medication will be delivered: a. As a capsule inserted rectally b. As a liquid applied under the tongue c. As a pill to be swallowed d. As a lozenge to be held in the cheek ANS: D

A B C D

Feedback Buccal mucosa is the oral mucosa of the cheek.

A troche is not a liquid.

A troche is not a pill to be swallowed.

A troche is a lozenge that is held in the cheek to dissolve slowly.

PTS: 1 REF: 160

9.

A nursing student is preparing to administer an extended-release (ER) medication to a patient.

Which observation should alert the nursing instructor to intervene? a. Verification of patient identification using barcode scan. b. Asking the patient to state their name and date of birth. c. Providing a glass of water to the patient. d. Opening up the capsule contents and placing them in applesauce.

ANS: D

A

Feedback This is an expected medication administration procedure.

79

B C D

This is an expected medication administration procedure.

Water is needed so that the patient can swallow the medication.

Time-release capsules cannot be opened or crushed because doing so releases the drug all at once, causing an overdose.

PTS: 1 REF: 157 10.

The nurse is administering daily nystatin oral medication to a patient. Which action is contraindicated? a. Telling the patient to swish and swallow. b. Administering once a day. c. Providing water to the patient following administration. d. Documenting administration in the medical record.

ANS: C

A B C D

Feedback This is the method of administration for this medication.

Daily indicates once a day.

Nystatin oral medication is a swish-and-swallow formulation, so no water should be provided to the patient.

Documenting administration of medication is required.

PTS: 1 REF: 160 11.

A nurse is preparing to administer a suppository to a patient. What is the best action to take when administering this type of medication? a. Administer the medication immediately after opening the package. b. Allow the medication to warm to room temperature. c. Place the patient in a semi-Fowler’s position for comfort. d. Encourage the patient to go to the bathroom following insertion.

ANS: A

A

B

Feedback Because suppositories soften when warm to release the medication, they must be kept cool before administration. Be sure to insert a rectal suppository immediately after opening it or it will melt in your hand.

This would not be appropriate, as the medication would melt.

80

C D

This position choice is not appropriate for suppository administration. Lateral recumbent position would be appropriate.

This is not appropriate, as it may lead to expulsion of the suppository and prevent the medication from having the desired effect. The patient is typically asked to lie still for approximately 30 minutes.

PTS: 1 REF: 160,161 12.

A group of student nurses are reviewing best practice for oral medication administration.

Which action indicates that additional teaching is required? a. Performing hand hygiene prior to administration. b. Asking the patient to state their name and birthdate. c. Leaving medication at the bedside for the patient to take later. d. Asking the patient if they have any questions about their medications.

ANS: C

A B C D

Feedback Hand hygiene is a cornerstone of nursing practice and safe medication administration.

Verification of patient information is required for safe medication administration.

One must always verify that the medication has been swallowed and taken. The nurse should never leave medication at the patient’s bedside for later use.

The nurse should verify that the patient does not have any questions about their prescribed medications.

PTS: 1 REF: 158 13.

A nurse is preparing to administer oral medication to a toddler. Which nursing action is most appropriate? a. Administer the medication in a sippy cup. b. Draw up the medication in a syringe and administer in the buccal cavity c. Dissolve the medication in water to mask the taste. d. Administer the medication in a medication cup.

ANS: B Feedback

81

A B

C

D

The nurse should not use the child’s sippy cup to administer medication, as this might prevent the child from using it again.

If the patient is a small child or has trouble swallowing a liquid medication, the medication can be drawn up into a syringe (without a needle) and injected slowly and gently into the buccal pouch (cheek).

Additional water may be offered following administration for the taste, but diluting the medication initially may impact administration and require more fluid to be taken.

As the patient is a toddler, it may well be easier to administer the medication using a syringe and injecting it gently into the buccal pouch (cheek).

PTS: 1 REF: 159

MULTIPLE RESPONSE 14. Which of the following medications should not be used for a client with diabetes? (Select all

that apply.) a. Emulsions b. Elixirs c. Magmas d. Solutions e. Syrups ANS: B, E

A. B. C. D. E.

Feedback Emulsions are appropriate for a diabetic; they do not contain alcohol or sweeteners.

An elixir contains alcohol and should not be administered to a person with diabetes.

Magmas are fine particles mixed in water and can be administered to a person with diabetes.

Solutions are liquids that do not contain alcohol or sweeteners and can be administered to a diabetic patient.

Syrups contain sweeteners and are therefore not appropriate for administration to a diabetic patient.

PTS: 1 REF: 158

82 15.

All of the following medications have been ordered for a patient who has suffered a stroke.

The patient can swallow pills if they are crushed and placed in applesauce. Which should the nurse recognize as appropriate to administer in this manner? (Select all that apply.) a. Enteric-coated aspirin tablet b. Chewable acetylsalicylic acid (ASA) tablets c. Adderall XR capsule d. Extended-release morphine e. Acetaminophen tablet ANS: B, E

A

B C

D E

Feedback This is an enteric-coated tablet, which should not be crushed for administration.

The coating is present to assist with the release of the drug and should not be altered.

Chewable aspirin tablets can be crushed.

This is an extended-release (XR) capsule and should not be crushed. Crushing would cause all of the medication to be released at once rather than over an extended time.

This is an extended-release medication. Crushing it would cause all of the medication to be released at once rather than over a longer period of time.

This tablet can be crushed because it is not enteric-coated or extended-release.

PTS: 1 REF: 157

16.

A nursing student is reviewing the steps of solid medication administration. Which nursing actions reflect best practice? (Select all that apply.) a. Performing hand hygiene prior to administration. b. Comparing the order and container once. c. Leaving the room after the patient has taken the pill. d. Checking the expiration date of the medication. e. Asking the patient to swallow all medications at one time.

ANS: A, C, D Feedback A. Hand hygiene reflects best practice in medication administration.

B. The nurse should compare the order and container three times.

C. The nurse can leave the room once the patient has swallowed the medication.

D. Checking the expiration date reflects best practice in medication administration.

E. Depending on the number of medications and/or the ability of the patient to swallow, this is not an appropriate nursing action.

PTS: 1

83

REF: 158 17.

A nurse is administering an oral medication that is an effervescent preparation. Which nursing actions should be included in medication administration? (Select all that apply.) a. Administer with a glass of water or fruit juice. b. Dissolve the medication in the appropriate liquid solution. c. Verify that the patient has no difficulty swallowing. d. Lower the head of the bed to administer. e. Read the ingredient list to confirm potential allergies.

ANS: B,C, E Feedback A. The nurse should verify which types of liquids can be used for dissolving this type of medication.

B. This reflects best practice. The nurse should verify directions for how to dissolve the medication with regard to the type and amount of liquid.

C. This is a correct nursing action, as one would not want to administer this type of medication to a patient who had difficulty swallowing.

D. This is not appropriate, as the nurse would want to make sure that the patient’s head was raised to facilitate swallowing of the medication.

E. Because of possible allergy to inactive ingredients, nurses must read the ingredient list carefully before using this form of liquid medication.

PTS: 1 REF: 158 18.

A nurse is preparing to administer medications to a patient who has complaints of gastric irritation. Which types of medications should the nurse anticipate that the health-care provider might order? (Select all that apply.) a. Buffered b. Enteric-coated c. Extended-release d. Gelatin capsules e. Caplets

ANS: A, B, C Feedback A. Buffered tablets have added antacids to prevent stomach irritation.

B. Enteric-coated drugs are released not in the stomach but in the intestines; they are especially useful for patients with stomach ulcers or sensitivity.

C. A capsule can be in a time-release or delayed-action form that prevents it from being broken down in the acidic environment of the stomach. Instead, the capsule breaks down in the more alkaline environment of the small intestine.

84

D. E.

Gelatin capsules make it easier to swallow, but they do not address the issue of stomach irritation.

Caplets make it easier to swallow, but they do not address the issue of stomach irritation.

PTS: 1 REF: 157,158

19.

A nurse is preparing to administer medication using a unit dose system. Which nursing actions reflect best practice? (Select all that apply.) a. Pouring the medication from a multidose bottle. b. Dispensing an individual dose of the medication. c. Verifying medication against the original health-care provider order. d. Documenting medication administration in the medical record. e. Using the barcode scan system.

ANS: B, C, D, E Feedback A. Unit dose medication is based on individual packaged doses.

B. Unit dose relates to individual packaged doses.

C. Verifying the original order reflects best practice for medication administration.

D. Documenting administration in the medical record reflects best practice for medication administration.

E. Using the barcode scan system reflects best practice for medication administration.

PTS: 1 REF: 156 20.

A nurse is preparing to administer oral solid medications to a patient with a glass of water.

What physiological actions does water provide during this process? (Select all that apply.) a. Prevents dehydration b. Facilitates swallowing c. Prevents stomach irritation d. Dissolves the medication e. Decreases absorption

ANS: A, B, C Feedback A. Water administered with oral medication helps to prevent dehydration.

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B. C. D. E.

Water administered with oral medication helps to facilitate swallowing.

Water administered with oral medication helps to prevent stomach irritation.

Water administered with oral medication does not help to dissolve the medication.

Water administered with oral medication does not decrease absorption.

PTS: 1 REF: 156

Chapter 10. Parental Medications and Administration MULTIPLE CHOICE

1. The instructor is supervising medication administration in a home setting. Which action would

require an intervention? a. The student wears gloves to remove a medication patch and cleans the area after removal. b. The student removes a patch from the left arm and then places the new patch on the right arm. c. The student folds the old patch in half and discards it in the trash can. d. The student places the patch on an area of skin that has minimal hair.

ANS: C

A B C D

Feedback This is the correct procedure for a patch delivery system for medication. Any excess needs to be cleaned from the skin to prevent incorrect dosing.

This is the correct procedure for administering a patch delivery system of medication.

This requires an intervention because patches left in the trash can be found by pets or children and lead to improper exposure to medication.

This is the correct procedure for administering a patch medication. Minimal hair allows for better adhesion and medication absorption.

PTS: 1 REF: 169 2. The nurse is providing instructions to a patient on how to administer prescribed eye drops.

Which action, if observed by the nurse, indicates that additional teaching is needed? a. Touching the eye with the applicator while dispensing medication b. Washing hands prior to dispensing medication c. Checking the expiration date of the medication

86 d. Verifying the number of drops to be dispensed ANS: A

A B C D

Feedback This action can lead to contamination and infection. One should not touch the applicator directly to the eye.

Hand hygiene is a critical step in medication administration.

One should check the expiration date of the medication prior to dispensing.

One should verify the exact amount of drops to be dispensed prior to administration.

PTS: 1 REF: 171 3. The health-care provider has ordered ear drops for a patient who has otitis media without

effusion. The nurse is preparing to administer the ear drops but finds that the ear canal is filled with cerumen. What is the best nursing action? a. Contact the health-care provider for a medication with an alternate route of administration. b. Administer the medication as ordered. c. Flush the ears with hydrogen peroxide and use a loop to remove cerumen. d. Administer Debrox, wait for a response, and then administer the medication.

ANS: D

A B C

D

Feedback Otitis media without effusion is treated with otic medications that are instilled directly into the ear.

As there is cerumen in the ear, the medication cannot be administered until it has been removed.

While hydrogen peroxide solutions can be used to soften cerumen, the nurse should not utilize a loop, as this action should be performed by the health-care provider or advanced practice nurse.

Debrox is an over-the-counter (OTC) medication used for the removal of cerumen. Once cerumen removal has been accomplished, the medication can be applied.

PTS: 1 REF: 172 4. The nurse is preparing to administer albuterol to a patient with a history of asthma. Which

route does the nurse anticipate will be used to administer this medication? a. Metered-dose inhaler b. Nebulizer c. Nasal cannula d. Mask

87 ANS: A

A B C D

Feedback Metered-dose inhalers are used to deliver albuterol directly to the lung tissue, which helps to dilate the airways in a rapid manner.

Nebulizers deliver medication in an aerosolized manner and are typically administered by a respiratory therapist.

Nasal cannulas deliver oxygen to body tissues.

A mask is used to deliver oxygen therapy.

PTS: 1 REF: 176

5. A nurse working at the health clinic is administering tuberculosis tests. The test will need to

be repeated if which of the following is noted? a. A wheal is seen at the site of injection. b. The needle is inserted at a 15-degree angle. c. The nurse notes a tiny amount of blood when removing the needle. d. Some of the medication leaks after completion of the injection.

ANS: D

A B C D

Feedback A wheal is expected at the site of injection. If a wheal is not seen, the test will need to be repeated.

The needle should be inserted at a 10- to 15-degree angle for injection.

A tiny amount of blood appearing when the needle is removed is a common and normal finding when the test is administered.

If some of the medication leaks, the patient has not received the appropriate dose to complete the test and the test needs to be repeated.

PTS: 1 REF: 180 6. The nurse is preparing to administer a vaccination to an 18-month-old toddler for which the

intramuscular route is indicated. Which site should the nurse use? a. Vastus lateralis b. Deltoid c. Ventral gluteal d. Buttock ANS: A

A

Feedback The deltoid muscle is not well developed in infants and small children, so a better site is the vastus lateralis thigh muscle

88 B C D

The deltoid muscle is not well developed in infants and small children, so a better site is the vastus lateralis thigh muscle This site is not as commonly used but is considered safe for all patients older than 2 years.

The buttock is not the preferred site for injections in infants and small children.

PTS: 1 REF: 182 7. The student is asked to demonstrate the Z-track method of intramuscular (IM) injection in a

laboratory model. Which action would cause the instructor to intervene? a. The student prepares the dorsal gluteal site. b. The student pulls the skin laterally one-half inch from the injection site. c. The student uses a dart-like motion for needle insertion. d. The student waits 10 seconds before removing the needle.

ANS: B

A B C D

Feedback A large muscle site like the dorsal gluteal area is an appropriate place to administer medication using the Z-track method.

The skin should be pulled 1.5 inches rather than 0.5 inches for the Z-track method.

A dart-like motion is appropriate for administering IM injections.

Waiting 10 seconds to remove the needle is appropriate when using the Z-track method.

PTS: 1 REF: 186 8. The nurse is instructing a patient diagnosed with diabetes on self-injection technique for

insulin. Which action, if observed by the nurse, warrants immediate intervention? a. The patient performs hand hygiene prior to administration. b. The patient allows insulin to warm to room temperature prior to administering. c. The patient performs aspiration following injection into the skin. d. The patient bunches the skin area prior to administering.

ANS: C

A B C D

Feedback Hand hygiene is an important step in medication administration.

If insulin is stored in the refrigerator, the patient should allow it to warm to room temperature before administering.

As insulin is administered subcutaneously (SC), you do not need to aspirate to check for blood return because SC tissue has few blood vessels.

The patient would bunch up the skin tissue instead of holding it taut before administering.

89

PTS: 1 REF: 185 9. While preparing a patient with diabetes for discharge, the nurse recognizes that teaching has

been effective by which of the following statements? a. ―I will recap the needles before discarding them in the trash can.‖ b. ―I will rotate sites along my thighs and across my abdomen.‖ c. ―I will pull the skin taut before inserting the needle.‖ d. ―I will insert the needle at a 45-degree angle.‖ ANS: B

A B C D

Feedback Needles should be placed in a puncture-proof container prior to disposal at home.

This is correct. These sites are easier for someone to reach when doing self-injection.

The skin is not pulled taut for a subcutaneous injection; it is pinched upward.

The needle should not be inserted at a 45-degree angle.

PTS: 1 REF: 185

10. The nurse is attempting to flush an intravenous (IV) catheter without success. The site has no

redness, swelling, or pain. The nurse determines the difficulty is most likely due to which of the following? a. Air embolism b. Infiltration c. Phlebitis d. Thrombus ANS: D

A B C D

Feedback An air embolism would not make the catheter unable to be flushed. An air embolism is an air bubble that enters the bloodstream.

Infiltration occurs when the IV catheter is outside the cannulated vein and creates redness, swelling, and pain when the line is flushed.

Phlebitis is inflammation of the vein causing redness, swelling, and pain along the vein.

A thrombus is a blood clot that would create an occlusion of the catheter, making the catheter unable to be flushed.

PTS: 1 REF: 199

90 11. A patient turns on his call light and reports his IV site is painful and seems to be leaking.

Which action by the nurse is best? a. Assess the site for any local tissue damage and remove the IV. b. Attempt to flush the IV site with 3 mL of normal saline (NS). c. Elevate the patient’s arm on a pillow and resecure the dressing. d. Place a tourniquet above the insertion site and cleanse the area with an alcohol preparation.

ANS: A

A B C D

Feedback The symptoms reported are consistent with IV infiltration. The site needs to be assessed and the IV catheter removed to prevent further tissue damage.

This could cause further tissue damage in a site that already demonstrates the symptoms of infiltration.

This does not address the symptoms of infiltration reported by the patient and could lead to further tissue damage.

This is a step in the process of starting an IV line and does not address the symptoms of infiltration reported by the patient.

PTS: 1 REF: 199 12. Which action by the nurse will help reduce the risk of air emboli in a patient receiving

intravenous therapy? a. Maintaining sterility when spiking a new IV bag. b. Using the flow regulator to adjust the rate of the IV fluid. c. Making sure all tubing and ports are sufficiently filled when priming the tubing. d. Wearing gloves when starting the IV site.

ANS: C

A

B C D

Feedback Maintaining sterility is important when initiating a new bag; however, this action does not address air potentially entering the IV line and then the bloodstream, which would lead to an air embolism.

A flow regulator does not manage the potential for air emboli; it will only control the rate of flow.

This action prevents the entrance of air into the patient’s bloodstream, which reduces the risk of air emboli.

While wearing gloves is an important step in starting an IV line, it does not address the risk of an air embolism developing. Wearing gloves prevents infection that can develop as a result of the IV therapy.

PTS: 1 REF: 199,200

91 13.

A nurse is monitoring a patient with a clinical diagnosis of hemophilia. Which type of infusion therapy should the nurse anticipate that the health-care provider will order? a. Platelets b. Crystalloid c. Whole blood d. Dextrose solution

ANS: A

A B C D

Feedback Patients with hemophilia require clotting factors and platelets.

Crystalloid solution is required for volume replacement and hydration.

Patients with hemophilia require clotting factors and platelets, not whole blood.

Dextrose solution is used as replacement therapy for patients who have decreased blood glucose levels and require volume replacement.

PTS: 1 REF: 190 14.

The nurse is preparing to administer a blood transfusion of packed red blood cells (RBCs).

Which type of nursing action is essential for blood product administration? a. Ringer’s lactate (RL) solution to prime the tubing b. Use of Y-site tubing with NS c. Dextrose solution to prime the tubing d. Use of a central line for access

ANS: B

A B C D

Feedback NS is used to prime Y-site tubing for RBC administration, not RL. NS is used to prime Y-site tubing for RBC administration.

NS is used to prime Y-site tubing for RBC administration, not dextrose solution.

RBCs can be administered via a peripheral line; they do not require central line access.

PTS: 1 REF: 191 15. A nurse is preparing to administer a unit dose patient medication via the intramuscular route, which requires reconstitution with sterile water. Which type of injectable product should the nurse use to obtain the medication?

92

a. b. c. d.

Ampule Multidose vial Vial Prefilled cartridge

ANS: C

A

B C D

Feedback An ampule is a small glass container that holds only one dose of a medication in solution for injection but does not require reconstitution, as it is already in a liquid form.

A multidose vial contains several doses of medication. The information provided specifies a unit dose; therefore, this would not be correct.

A vial can contain powder and require fluid to reconstitute the product for administration. The information provided specifies a unit dose for the patient.

A prefilled cartridge contains medication that is already prepared for administration and can be easily dispensed. It does not require reconstitution.

PTS: 1 REF: 192 16. The nurse is preparing an injectable medication for administration in the medication room prior to administering to the patient. What is the best nursing action to take to maintain safe drug administration? a. Recap the needle using a gloved hand and administer. b. Use the scoop method to recap the needle, change the needle, and administer. c. Do not recap and bring the medication to the room to administer. d. Use a prefilled cartridge to administer the medication.

ANS: B

A B

C D

Feedback One should not use the hand, regardless of whether or not it is gloved, to recap a needle.

After the medication has been prepared, the needle may be recapped so it can be taken to the patient for administration of the medicine. The safest procedure is called the ―scoop‖ method, in which you lay the cap on a flat surface and scoop it onto the needle. The needle should be changed prior to administration of the medication.

It is not safe to walk through the halls (medication room to patient room) with an exposed needle.

There is insufficient information to select this option, as the medication is not

93

specified.

PTS: 1 REF: 193 17. The nurse is attempting to start an intravenous infusion. Which statement reflects best nursing practice? a. Perform hand hygiene and connect tubing with hands. b. Fill the drop chamber completely. c. Maintain sterile tubing connections. d. Ensure that the clamp is wide open after priming.

ANS: C

A B C D

Feedback While it is important to perform hand hygiene, there is no mention of gloving, which should be used during intravenous setup.

The drop chamber should be filled halfway.

It is important to maintain sterile connections with all intravenous tubing products so as to prevent possible contamination and infection.

The clamp should be wide open during priming but not following priming, as it is used to regulate the flow rate.

PTS: 1 REF: 197 18. The nursing instructor is in the simulation lab setting observing the nursing student, who is attempting venipuncture. Which observation warrants immediate intervention? a. Using alcohol prep pad to clean area b. Tourniquet applied for 5 minutes c. Checking extremities to determine best site d. Preparing equipment by bedside

ANS: B

A B C

Feedback Alcohol prep is used to cleanse the skin prior to venipuncture attempt.

A tourniquet should not be applied longer than 2 minutes. The tourniquet should be removed before causing skin irritation and compromise.

One should always check both extremities to determine the best access site.

94

D

Preparing equipment and having it readily available at the bedside is an example of best practice.

PTS: 1 REF: 199 19. A nurse is preparing to administer pain medication intramuscularly using a prefilled cartridge.

What equipment does the nurse need to administer this type of medication? a. 3-mL syringe b. 5-mL syringe c. 10-mL syringe d. Holder

ANS: D

A B C D

Feedback Prefilled cartridges are self-contained units and do not require a 3-mL syringe for administration.

Prefilled cartridges are self-contained units and do not require a 5-mL syringe for administration.

Prefilled cartridges are self-contained units and do not require a 10-mL syringe for administration.

Prefilled syringes require a cartridge holder for drug administration.

PTS: 1 REF: 197 20. The nurse is assisting in a code situation for a critically ill patient. What type of drug route administration should the nurse anticipate being used? a. Intradermal b. Intravenous c. Intramuscular d. Otic

ANS: B

A B C

Feedback In a medical emergency, intradermal administration is typically not used.

In a medical emergency, the nurse should anticipate that medications will be administered intravenously, as this is the quickest route of absorption.

In a medical emergency, intravenous administration is preferred over intramuscular administration.

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D

In a medical emergency, otic administration is typically not used.

PTS: 1 REF: 186

Chapter 11. Integumentary System Medications MULTIPLE CHOICE 1. A nurse’s teenage daughter tearfully states, ―I keep getting pimples on my face even though I

wash it every day and I’m not eating any chips or cookies. What can I do?‖ While considering over-the-counter treatment options, what common ingredient will the nurse most likely find in topical creams and lotions? a. Hydrocortisone b. Lidocaine c. Clotrimazole d. Benzoyl peroxide ANS: D

A B C D

Feedback Hydrocortisone is an anti-inflammatory medication; it is not used to manage acne.

Lidocaine is a topical anesthetic; it is not used to manage acne.

Clotrimazole is an antifungal agent; it is not used to manage acne.

Benzoyl peroxide is bacteriostatic and is used to manage acne.

PTS: 1 REF: 211 2. While playing at the park with her children, the nurse notes a toddler who has honey-colored

crusts and open areas on the lips and nose. Which of the following actions should the nurse take first? a. No action is required, as the child is exhibiting symptoms of a common cold and medications will not alter the child’s symptoms. b. Ask the child’s parent if the child has food allergies and suggest the use of an antihistamine. c. Inform the child’s parent the child may have a common bacterial infection and should be seen by a physician for topical or systemic antibiotics. d. Suggest the child’s parent seek treatment for suspected thrush with an oral antifungal agent.

ANS: C

96

A B C D

Feedback The child is not exhibiting signs of a common cold. The honey-colored crusts are associated with a bacterial infection.

The honey-colored crusts are not associated with food allergies; they are indicative of a bacterial infection.

The honey-colored crusts are a sign of impetigo, a contagious bacterial infection common in children, which can be treated with topical or systemic antibiotics.

The child is not exhibiting signs of a yeast infection; the signs indicate a common bacterial infection that occurs often in children.

PTS: 1 REF: 212 3. A nurse is assessing a patient who presents with reddened cheeks and dry, flaky skin.

Inflamed areas surround the nose and cheeks. What clinical condition should the nurse suspect? a. Comedones b. Rosacea c. Verruca d. Seborrhea ANS: B

A B

C D

Feedback Comedones (blackheads and whiteheads) are associated with acne, which is an inflammatory disorder of the sebaceous glands.

Rosacea is a type of skin irritation without pus. Small bumps, or papules, redden the skin. Even though these papules do not contain pus, they may produce pain because of the thickening and swelling. A patient with rosacea appears flushed, especially on the nose and cheeks.

A verruca is a wart caused by a virus.

Seborrhea (scaly skin) is a clinical condition caused by overproduction of skin oils.

PTS: 1 REF: 211 4. A nurse is providing instructions to a patient for the application of a topical skin medication.

Which nursing action should be included in the plan of care? a. Use a clean cloth to remove prior medication. b. Wash area using hot water prior to medication administration. c. Apply using a thick layer directly to the area. d. Rinse the area following medication administration.

ANS: A

97

A B C D

Feedback When applying skin medications, teach the patient to wash the affected area with a clean, damp cloth to remove any old medication and/or microorganisms.

Although the area should be cleansed prior to medication administration, the use of hot water is not advised, as it will cause skin irritation.

One should apply a thin layer of medication to the area.

One should not rinse the area following medication administration, as this would remove the medication.

PTS: 1 REF: 212 5. A patient presents to the clinic with a persistent verruca following treatment with antiviral

medication. What type of therapeutic treatment should the nurse anticipate that the health-care provider will order? a. Continued antiviral medication b. Cryosurgery c. Antibiotics d. Pain medication ANS: B

A

B

C D

Feedback As the verruca (viral wart) has not responded to antiviral therapy, the nurse should anticipate that cryosurgery with liquid nitrogen or topical products containing salicylic acid may be necessary to remove it.

As the verruca (viral wart) has not responded to antiviral therapy, the nurse should anticipate that cryosurgery with liquid nitrogen or topical products containing salicylic acid may be necessary to remove it.

Antibiotic therapy is not indicated for viral infections.

Pain medication will only treat symptoms; it will not cure viral infections.

PTS: 1 REF: 213 6. A nurse working in a gynecology office is asked to assist in the treatment of a patient with

condylomata. Which of the following actions should the nurse take? a. Prepare the patient for full-body phototherapy. b. Ask the patient if there are any known allergies to iodine. c. Make a list of the patient’s sexual partners for the past 3 weeks. d. Ask the patient to remove clothing below the waist.

ANS: D

A B

Feedback Condylomata are genital warts and are not treated with phototherapy.

There is no need to determine an allergy to iodine because iodine is not used in

98

C

D

the treatment of condylomata (genital warts).

The condylomata may have occurred prior to the past 3 weeks and the patient may not have known. Any partners may also have been unaware of the infection.

Condylomata are genital warts and are treated with cryotherapy, salicylic acid, or liquid nitrogen applied directly to the warts. The genital area will need to be exposed to allow for treatment.

PTS: 1 REF: 213 7. While performing a skin assessment for a newly admitted 82-year-old patient, the nurse notes

that the patient has reddened, peeling areas between his toes and around the soles of his feet.

Which of the following medications would the nurse request? a. Nystatin b. Lidocaine c. Clotrimazole d. Calcipotriene ANS: C

A B C D

Feedback Nystatin is an antifungal; however, it is used for oral fungal infections, not the described infection of the feet.

Lidocaine is a topical anesthetic; it does not treat the described infection.

Clotrimazole is an antifungal medication used in the treatment of fungal infections of the feet, trunk, extremities, and groin.

Calcipotriene is used in the treatment of psoriasis, not the described infection.

PTS: 1 REF: 213 8. An elderly patient presents with a small skin lesion on the right forearm with a biopsy report

of squamous cell carcinoma. What type of therapeutic treatment should the nurse anticipate? a. Surgical removal with possible radiation b. Incision and drainage c. Chemotherapy d. Antibiotic therapy ANS: A

A B C

Feedback Surgical removal is the treatment of choice, and radiation therapy may be needed.

Incision and drainage are not indicated, as the lesion has already been biopsied and results have been obtained.

Chemotherapy is not indicated, as surgical removal is the treatment of choice,

99

D

and radiation therapy may be needed.

Antibiotic therapy is not indicated unless there is an underlying infection.

PTS: 1 REF: 217 9. A group of nurses are preparing for a health screening of an elderly population related to skin

cancers. What priority information should be included in the health screening? a. Have a biopsy taken of all skin lesions. b. Monitor for changes in skin lesions. c. Do not sit out in the sun anymore. d. Apply liberal amounts of skin lotion daily.

ANS: B

A B C

D

Feedback A biopsy is indicated for suspicious lesions, not all skin lesions.

It is important to monitor (observe) for any changes in skin lesions.

While it would be important to limit sun exposure, it would not be appropriate to tell an elderly patient not to sit out in the sun anymore, as this would potentially impact the conversion of vitamin D in the body.

While it is important to maintain skin hydration, applying liberal amounts of skin lotion is not warranted.

PTS: 1 REF: 210

10. A patient is being treated for severe acne with a retinoid. Which laboratory finding should the

nurse monitor for during this type of treatment? a. Blood urea nitrogen (BUN) and creatinine b. Amylase and lipase c. Hemoglobin and hematocrit d. Serum sodium and potassium ANS: B

A B C D

Feedback Monitoring BUN and creatinine levels is not indicated with retinoid therapy.

Side effects of retinoid therapy include pancreatitis. The nurse should monitor amylase and lipase levels.

Monitoring hemoglobin and hematocrit levels is not indicated with retinoid therapy.

Monitoring serum sodium and potassium levels is not indicated with retinoid therapy.

PTS: 1

100 REF: 218 11. The nurse is making a home visit at 1 week follow-up for an elderly patient diagnosed with

and treated for scabies. Which observation warrants immediate action? a. Patient has completed medication administration as required. b. All towels used previously have been washed in hot water. c. All family members living in the household have been treated. d. The patient’s bed linen has not been changed.

ANS: D

A B C D

Feedback To be effective, the medication regimen must be followed as prescribed.

Towels should be washed in hot water.

All individuals living in the household should be treated, as scabies is highly contagious.

This is a serious concern, as bed linen should be washed in hot water to prevent further spread of infection or reinfection.

PTS: 1 REF: 212 12. A patient presents with a fever blister on the upper lip. Which medication should the nurse

anticipate that the health-care provider will order? a. Topical antibiotic b. Oral antibiotic c. Topical/oral antiviral d. Topical antifungal ANS: C

A

B

C

D

Feedback A fever blister indicates a viral infection with herpes simplex virus 1 (HSV-1), which typically causes cold sores, or fever blisters, on the mouth and lips. A topical antibiotic is not indicated for treatment of a viral infection.

A fever blister indicates a viral infection with HSV-1, which typically causes cold sores, or fever blisters, on the mouth and lips. An oral antibiotic is not indicated for treatment of a viral infection.

A fever blister indicates a viral infection with HSV-1, which typically causes cold sores, or fever blisters, on the mouth and lips and is treated with a topical/oral antiviral.

A fever blister indicates a viral infection with HSV-1, which typically causes cold sores, or fever blisters, on the mouth and lips. It is not a fungal infection.

PTS: 1 REF: 213

101 13. A burn patient has been prescribed topical silver sulfadiazine medication for a second-degree

burn. Which nursing action best reflects evidence-based practice? a. The burn area should be left open to air. b. Debridement of the area may be indicated prior to application. c. This therapy can be used during pregnancy. d. The medication is applied once a week.

ANS: B

A B C D

Feedback Typically, burn dressing using silver sulfadiazine should be covered all the time.

This is a factual statement. For the medication to be effective, debridement of the area may be indicated prior to application.

This medication is contraindicated during pregnancy.

This medication is typically applied one to two times a day.

PTS: 1 REF: 213 14. A nurse is assessing a patient’s mouth and observes patchy white plaques on the oral mucosa.

What clinical condition should the nurse suspect? a. Ulcers b. Irritation caused by a burn c. Thrush d. Gum abscess ANS: C

A B C D

Feedback There is no evidence to support ulcers based on the provided information.

There is no evidence to support irritation from a burn based on the provided information.

Patchy white plaques on the oral mucosa are suggestive of an infection with Candida, which, when found in the oral cavity, is categorized as thrush.

There is no evidence to support a gum abscess based on the provided information.

PTS: 1 REF: 214 15. A nurse is monitoring a patient with a third-degree burn over 10% of the right arm. Which

finding indicates that the nurse understands burn physiology? a. The patient may not complain of pain. b. Debridement of tissue is not needed. c. The burn does not extend into the subcutaneous tissue. d. Antibiotics are not indicated.

ANS: A

102

A B C D

Feedback The patient may or may not complain of pain because the nerves have been destroyed in this area.

Debridement of necrotic tissue is needed to prepare for the development of granulation tissue.

A third-degree burn is the most severe and affects all layers of skin, subcutaneous tissue, and possibly even muscle and bone.

Systemic medications may include analgesics, anti-inflammatory agents, and antibiotics.

PTS: 1 REF: 214 16. A patient has been using long-term diphenhydramine for treatment of atopic dermatitis.

Which finding by the nurse suggests a priority intervention? a. Affected area of skin is dry with no visible patches noted. b. Patient denies itching at affected area. c. Patient reports increasing agitation. d. Affected area of skin has reduced in size and diameter.

ANS: C

A B C D

Feedback One would expect to see dry skin in atopic dermatitis, but the fact that no visible patches are present indicates that the treatment is effective.

This would indicate that the medication is effective.

One adverse effect of diphenhydramine is mood changes, so the fact that the patient is identifying behavioral changes is significant.

This finding would indicate that the medication is effective.

PTS: 1 REF: 215 MULTIPLE RESPONSE 17. A school nurse is preparing a letter to parents to notify them of a recent case of head lice in a

second-grade student. Which of the following statements should be included in the letter?

(Select all that apply.) a. ―Any child found to have lice during the school day will immediately be given oral antibiotic therapy.‖ b. ―Lice rarely spread from child to child, so no special precautions need to be taken.‖ c. ―Children’s hair should be examined for small, round, white eggs or nits at home daily using a fine-toothed comb.‖ d. ―Over-the-counter shampoo products are available for the treatment of lice.‖

103 e. ―If your child is found to have lice, your health-care provider should be seen to

obtain a prescription for antifungal therapy.‖ ANS: C, D

A. B. C. D. E.

Antibiotics are not used in the treatment of lice.

Lice spread fairly easily when sharing combs or hats or similar garments.

Children need to be taught to avoid sharing items that spread lice.

Lice eggs are also called nits. The eggs are small, round, and attached to the hair shaft. A fine-toothed comb will assist in seeing the signs of a lice infestation.

Shampoos can be obtained over the counter for management of lice infestations.

Lice are a parasite, not a fungus. The health-care provider does not need to provide a prescription for lice treatment because it is available over the counter.

PTS: 1 REF: 212 18. A nurse working with adolescents recognizes that which of the following can be used to help

treat acne? (Select all that apply.) a. Topical immunomodulators b. Oral contraceptives c. Systemic antibiotics d. Salicylic acid e. Sulfur ANS: B, C, D, E

A. B. C. D. E.

Topical immunomodulators are used to treat atopic dermatitis, not acne.

Oral contraceptives can be helpful in managing acne and have been prescribed for this purpose.

Systemic antibiotics are used to manage extreme cases of acne.

Salicylic acid ointments or creams can be used to manage acne.

Sulfur can be used topically to manage severe acne.

PTS: 1 REF: 211 19. A patient has been diagnosed with impetigo and is running a fever. Which medications should

the nurse anticipate that the health-care provider will order? (Select all that apply.) a. Topical antibiotics b. Topical corticosteroids c. Systemic antibiotics d. Topical antiviral e. Topical antifungal ANS: A,B,C

A. B.

Impetigo is a bacterial infection that is treated with topical antibiotics, topical corticosteroids, and, if the infection is severe, systemic antibiotics.

Impetigo is a bacterial infection that is treated with topical antibiotics, topical corticosteroids, and, if the infection is severe, systemic antibiotics.

104

C. D. E.

Impetigo is a bacterial infection that is treated with topical antibiotics, topical corticosteroids, and, if the infection is severe, systemic antibiotics.

Impetigo is a bacterial infection, so antiviral medication would not be effective.

Impetigo is a bacterial infection, so antifungal medication would not be effective.

PTS: 1 REF: 212 20. While performing an admission history with a patient who has extensive eczema, the nurse

should anticipate that the patient will report a history of which other conditions? (Select all that apply.) a. Asthma b. Recurrent urinary tract infections c. Frequent/severe sunburn d. Allergic rhinitis e. Cardiomyopathy ANS: A, D

A. B. C. D. E.

Eczema is an allergic condition that is associated with other allergic conditions, such as asthma.

Urinary tract infections are associated with a bacterial infection, not an allergy.

Previous sunburn is a risk factor for skin cancer, not eczema.

Eczema is an allergic condition that is associated with other allergic conditions, such as allergic rhinitis.

Cardiomyopathy is not associated with eczema.

PTS: 1 REF: 214

Chapter 12. Musculoskeletal System Medications MULTIPLE CHOICE 1. A nurse is reviewing the treatment plan for a patient diagnosed with fibromyalgia. Which

priority intervention should the nurse include in the plan of care? a. Increasing fluid intake b. Increasing coping mechanisms c. Long-term antibiotic therapy d. Antihistamine ANS: B

A

Feedback While it is important for the patient to remain hydrated, increasing fluids does

105

B

C D

not provide any additional effect.

Fibromyalgia is a disorder of chronic pain in muscles and the soft tissue surrounding joints. Best treatment practice is aimed at decreasing contributory factors, of which stress is one.

Long-term antibiotic therapy is not indicated in the treatment of fibromyalgia.

Antihistamines are not indicated in the treatment of fibromyalgia.

PTS: 1 REF: 226 2. A nurse discussing home medications with a paralyzed patient who is taking cyclobenzaprine

determines that further teaching is required if the patient makes which of the following statements? a. ―This medication helps my muscles relax so I don’t have as many spasms.‖ b. ―I’ve been taking this medication since I was paralyzed.‖ c. ―I have trouble emptying my bladder sometimes, which might be due to the medication.‖ d. ―Now that it is getting to be spring, I’ll need to take my antihistamines.‖ ANS: D

A B

C D

Feedback Cyclobenzaprine works to reduce muscle spasms that cause pain.

Cyclobenzaprine would have been administered since becoming paralyzed for the common problems of rigidity and muscle spasms that can occur with paralysis.

One side effect of cyclobenzaprine is urinary retention.

Further teaching is required because antihistamines may be contraindicated while taking cyclobenzaprine, and a physician should monitor the use of these medications if used together.

PTS: 1 REF: 225, 231

3. A student nurse is preparing to pass out medications on the rehab unit. Which statement

would be included in the patient teaching for an individual taking metaxalone? a. ―This medication helps reduce the spasticity in your muscles.‖ b. ―This medication may cause liver damage, but your current liver enzymes are fine.‖ c. ―Please let us know if you have any stomach pain or black, tarry stools.‖ d. ―This medication is delivered as a nasal spray once daily.‖ ANS: A

A

Feedback Metaxalone is an antispasmodic; thus, it will reduce spasticity in the muscles.

106 B C D

Metaxalone does not cause liver damage.

Metaxalone does not cause black, tarry stools or stomach pain.

Metaxalone is given as an oral pill, not through a nasal spray.

PTS: 1 REF: 225 4. The nurse is caring for a 10-year-old child with profound cerebral palsy who takes muscle

relaxants and antispasmodics and has continued neck muscle rigidity, which increasingly interferes with his ability to turn his head. Which of the following medications is most likely to be added to the child’s treatment plan? a. Ibuprofen b. Baclofen c. Botulinum toxin A d. Zyloprim ANS: C

A B

C

D

Feedback Ibuprofen treats pain and inflammation, not muscle rigidity.

Baclofen is used to treat muscle rigidity but is one of the first medications used.

The child is already on muscle relaxants and may be using baclofen or a similar drug already.

Botulinum toxin A is used for more severe cases in which the patient is not responding to treatment with other first-line medications. This is likely the next medication to be added to the child’s treatment plan.

Zyloprim is used to treat gout by decreasing uric acid; it is not for muscle spasms.

PTS: 1 REF: 225 5. The nurse is assessing a patient who has been prescribed pregabalin for treatment of

neuropathic pain. Which finding warrants immediate intervention? a. The patient also takes a beta blocker for hypertension (HTN). b. The patient has 1+ pedal edema noted bilaterally. c. The patient indicates depressive changes. d. The patient denies pain.

ANS: C

A

B C

Feedback There is no need for immediate intervention if the patient is taking a beta blocker. There is a risk of a hypersensitivity reaction, but that is associated with angiotensin-converting enzyme (ACE) inhibitors.

This is an expected finding with this type of therapy.

Some patients may experience suicidal thoughts with this medication, so if the

107

D

patient is identifying a behavioral change, this warrants immediate intervention.

This finding indicates that the medication is effective.

PTS: 1 REF: 227 6. The LPN is reviewing the patient’s medication profile and finds that the patient is taking

NSAIDs to relieve generalized arthritic pain. Which physiological action does the nurse identify with NSAIDs? a. Blocking of the cyclooxygenase 1 (COX-1) enzyme b. Increased risk of gastric irritation c. Blocking of the cyclooxygenase 2 (COX-2) enzyme d. Decreased risk of bleeding ANS: B

A B C D

Feedback NSAIDs block both COX-1 and COX-2 enzymes, leading to increased risk of gastrointestinal bleeding and renal and cardiac damage with long-term use.

This is a factual statement, as blocking of the COX-1 enzyme can lead to gastric irritation and bleeding.

NSAIDs block both COX-1 and COX-2 enzymes, leading to increased risk of gastrointestinal bleeding and renal and cardiac damage with long-term use.

This is not an accurate statement, as NSAIDs, by blocking the COX-1 enzyme, can cause gastric irritation and gastrointestinal bleeding.

PTS: 1 REF: 228 7. While providing a calcium supplement to a patient with osteopenia, the nurse would also

counsel the patient to ensure sufficient intake of which additional supplement? a. Protein b. Vitamin C c. Potassium d. Vitamin D ANS: D

A B C D

Feedback Protein does not assist with the absorption of calcium.

Vitamin C does not assist with the absorption of calcium.

Potassium does not assist with the absorption of calcium.

Vitamin D assists with the absorption of calcium.

PTS: 1 REF: 226

108 8. The nurse recognizes that which of the following individuals is most likely to be taking

calcitonin? a. A 21-year-old patient with a fractured femur b. A 44-year-old patient with thyroid cancer c. A 51-year-old patient with gastroesophageal reflux disease (GERD) d. A 67-year-old patient with hypertension ANS: B

A B C D

Feedback Calcitonin is given to individuals who have hypercalcemia. It does not treat a fracture or improve healing.

Calcitonin would be given to this patient because the thyroid gland and parathyroid gland will assist in absorbing calcium.

Calcitonin does not treat gastroesophageal reflux disease; it treats hypercalcemia.

Calcitonin does not treat hypertension; it treats hypercalcemia.

PTS: 1 REF: 226 9. Upon admission, an 85-year-old patient reports taking alendronate sodium once weekly but

states, ―I can’t remember why I take that one; I just know I take it on Monday.‖ The best response by the nurse would be: a. ―Ok. I’ll ask the pharmacy to give you some literature on that medication.‖ b. ―Oh heavens, who can keep track of all the medications people take nowadays?‖ c. ―That sounds like one of the new medications given for memory problems.‖ d. ―That medication helps strengthen your bones and prevent fractures.‖ ANS: D

A B C D

Feedback The patient needs simple reeducation on the use of alendronate, which the nurse can do immediately.

This is not an appropriate response because the patient needs reeducation about the use of alendronate.

Alendronate is given for the treatment of osteoporosis, not memory problems.

This statement is correct. It addresses the patient’s needs and is an appropriate explanation of the medication’s use.

PTS: 1 REF: 227 10. A 51-year-old neighbor is considering the use of hormone replacement therapy now that

menopause has started. She asks the nurse, ―Do you think I need hormone replacement therapy?‖ Which of the following responses by the nurse is best? a. ―You do know that hormones increase your risk of blood clots, right?‖

109 b. ―Have you talked to your husband about taking hormone supplements?‖ c. ―What have you and your doctor discussed about hormone replacement therapy for

you?‖ d. ―Some people really suffer from symptoms of menopause, but it’s been pretty easy

for me.‖ ANS: C

A

B

C

D

Feedback While it is true that hormone replacement therapy may increase the risk of blood clots, it does not address the patient’s question. The risks versus benefits will be discussed by the physician.

It might be important to talk to her husband at some point about her decision; however, this does not address the patient’s question and is not the best response at this time.

This is correct because the nurse needs to know what the neighbor already knows about the therapy and encourage the patient to discuss the options with her physician. Knowing what the patient already knows will assist the nurse in providing additional education.

This is not an appropriate response. It does not address the neighbor’s question and does not provide an opportunity to continue the conversation in an open manner.

PTS: 1 REF: 226, 227 11. The nurse prepares to admit a 71-year-old patient with a long-standing history of rheumatoid

arthritis who has been taking ibuprofen 600 mg tid for many years. The nurse would be most concerned if the patient reported which of the following symptoms? a. Sharp, stabbing pain in the midepigastric region b. Dull, aching joint pain in both hands c. Small squirts of urine with sneezing d. Stiffness in her joints first thing in the morning ANS: A

A

B C D

Feedback This is most concerning because of the risk of developing a gastrointestinal (GI) bleed and/or gastric ulcer when taking medications such as ibuprofen for a long period of time.

This symptom is typical of rheumatoid arthritis and is expected in this scenario.

Older women often have difficulty with stress incontinence. This symptom describes stress incontinence and is not a priority concern.

Stiff joints first thing in the morning are common and expected with rheumatoid arthritis.

PTS: 1

110 REF: 228 12. A nurse working in the orthopedic clinic reviews a list of patient appointments for the day.

Which of the following patients is most likely to need uric acid level labs drawn? a. An 83-year-old patient using capsaicin for the treatment of osteoarthritis b. A 76-year-old patient taking ibuprofen for rheumatoid arthritis c. An 84-year-old patient taking celecoxib for degenerative joint disease d. A 69-year-old patient taking Zyloprim for gouty arthritis ANS: D

A B C D

Feedback Capsaicin and osteoarthritis do not affect uric acid levels.

Ibuprofen and rheumatoid arthritis do not affect uric acid levels.

Celecoxib and degenerative joint disease do not affect uric acid levels.

Gouty arthritis is caused by an accumulation of uric acid. Zyloprim is taken to lower these levels and reduce the incidence of gouty arthritis.

PTS: 1 REF: 228

MULTIPLE RESPONSE 13. A nurse is providing care to a patient who had a leg amputation and is experiencing phantom

limb pain. Which medications should the nurse anticipate being ordered for the patient?

(Select all that apply.) a. Enoxaparin b. NSAIDs c. Carbamazepine d. Colchicine e. Amitriptyline ANS: C, E

A. B. C. D. E.

Enoxaparin is an example of a low-molecular-weight heparin and is not clinically indicated for the treatment of phantom limb pain.

NSAIDs are not used to treat phantom limb pain.

Carbamazepine is an anticonvulsant used to treat chronic pain, including phantom limb pain.

Colchicine is used to treat gout.

Amitriptyline is a tricyclic antidepressant used to treat chronic pain, including phantom limb pain.

PTS: 1 REF: 230

111 14. A nurse is reviewing clinical manifestations of osteoarthrosis. Which of the following are

characteristic of this condition? (Select all that apply.) a. It is seen in adults rather than children. b. It is characterized by erosion of bone. c. It affects more women than men. d. Pain is seen upon ambulation. e. It is considered to be an autoimmune disease.

ANS: A, B, D

A. B. C. D. E.

Osteoarthritis strikes middle-aged or older persons; extremely sedentary and extremely active persons are at increased risk.

Degeneration (erosion) of bones where they meet, or articulate, at the joints is seen in osteoarthritis.

Rheumatoid arthritis, not osteoarthritis, mostly affects women, with symptom onset at age 30 to 50 years.

Pain is a common symptom associated with osteoarthritis.

Osteoarthritis is a degenerative disease, not an autoimmune disease.

PTS: 1 REF: 228

15. While providing care for a patient taking dantrolene the nurse should monitor for which

adverse reactions? (Select all that apply.) a. Hypertension b. Dry mouth c. Hypoventilation d. Diarrhea e. Dependent edema ANS: B, C, D

A. B. C. D. E.

Hypotension can be seen with dantrolene administration.

Dry mouth is seen with dantrolene administration.

Decreased respirations can be seen with dantrolene administration.

Diarrhea can be seen with dantrolene administration.

Dependent edema is not seen with dantrolene administration.

PTS: 1 REF: 232

16. A patient has been prescribed methotrexate for the treatment of rheumatoid arthritis. Which information should be included in the plan of care? (Select all that apply.) a. Monitoring of alanine transaminase b. Monitoring of complete blood count (CBC) c. Chest x-ray d. Hepatobiliary iminodiacetic acid (HIDA) scan

112

e. Monitoring of aspartate transaminase

ANS: A, B, E Feedback A. Liver function tests (LFTs), including liver enzymes, should be monitored during the course of methotrexate therapy, as it can cause hepatotoxicity.

B. CBC should be monitored during the course of methotrexate therapy, as it can cause blood dyscrasias.

C. A chest-x ray is not indicated as part of the treatment plan when administering methotrexate.

D. A HIDA scan is used to assess for gallbladder problems.

E. LFTs, including liver enzymes, should be monitored during the course of methotrexate therapy, as it can cause hepatotoxicity.

PTS: 1 REF: 232 17. A patient is taking naproxen for relief of arthritic pain. Which findings indicate that the patient is experiencing an adverse reaction? (Select all that apply.) a. Tinnitus b. Dizziness c. Constipation d. Paresthesia e. Reflux

ANS: A, B, C, E Feedback A. Tinnitus is an example of an adverse reaction to naproxen.

B. Dizziness is an example of an adverse reaction to naproxen.

C. Constipation is an example of an adverse reaction to naproxen.

D. Paresthesia is not associated with naproxen.

E. Reflux is an example of an adverse reaction to naproxen.

PTS: 1 REF: 231

18. A nurse is reviewing systemic diseases that have an effect on bone mineralization. Which clinical diseases are affected by hypocalcemia? (Select all that apply.) a. Osteoporosis

113

b. c. d. e.

Gout Osteomalacia Paget’s disease Fractures

ANS: A, C, E Feedback A. Osteoporosis can be due to low calcium levels leading to bone degeneration.

B. Gout is caused by increased uric acid levels.

C. Osteomalacia can be due to low calcium levels leading to bone degeneration.

D. Paget’s disease is caused by high calcium levels.

E. Fractures can be due to low calcium levels leading to increased bone fragility.

PTS: 1 REF: 226 19. The nurse is reviewing the musculoskeletal system. Which statements related to hormonal regulation of calcium are accurate? (Select all that apply.) a. The thyroid gland plays a significant role in calcium regulation. b. Calcitonin regulates calcium by a positive feedback mechanism. c. Vitamin D is needed to regulate calcium. d. The majority of calcium in the body is in the blood. e. Parathyroid hormone increases calcium levels in the bone.

ANS: A, B, C Feedback A. The thyroid gland secretes calcitonin, which allows calcium to remain in the bone and not move into the blood.

B. Calcitonin is secreted in response to high calcium levels in the blood, which is a negative feedback mechanism.

C. Vitamin D plays a role in calcium regulation.

D. The majority of calcium is within the bones in the body.

E. Parathyroid hormone secretion increases serum calcium levels and decreases calcium levels in the bone.

PTS: 1 REF: 224

20.

A patient is having painful muscle spasms. Which medications does the nurse anticipate that the health-care provider might prescribe? (Select all that apply.)

114

a. b. c. d. e.

Oral antibiotics Calcium supplements Benzodiazepines Muscle relaxants Diuretics

ANS: C, D Feedback A. Oral antibiotics are indicated for the treatment of infections, not muscle spasms.

B. Calcium supplements will not provide pain relief for muscle spasms.

C. Benzodiazepines may be used to treat muscle spasms and thereby provide pain relief.

D. Muscle relaxants are used to treat muscle spasms and thereby provide pain relief.

E. Diuretics are indicated for fluid volume excess.

PTS: 1 REF: 225

Chapter 13. Nervous System Medications MULTIPLE CHOICE 1. The nurse is providing care for a patient who is taking atenolol to treat hypertension (HTN).

Which physiologic action does this type of medication provide? a. Parasympathetic b. Sympathomimetic c. Alpha-adrenergic blocker d. Beta-adrenergic blocker ANS: D

A B C D

Feedback Parasympathetics exhibit cholinergic activity, releasing acetylcholine, which relaxes the body.

Sympathomimetics stimulate the body’s fight-or-flight impulse.

Alpha-adrenergic blockers affect vascular smooth muscle.

Atenolol is an example of a beta-adrenergic blocker, which blocks the effect of epinephrine.

PTS: 1 REF: 240 2. A nursing student is reviewing pain management for pediatric patients who are also febrile.

Which medication should not be used for its antipyretic effect in children?

115 a. b. c. d.

Acetaminophen Salicylate NSAIDs Ibuprofen

ANS: B

A B C D

Feedback Acetaminophen is an example of an NSAID, which can be used for both pain relief and as an antipyretic.

Salicylates should not be used in children with viral infections because of the danger of Reye’s syndrome.

NSAIDs can be used for both pain relief and as an antipyretic.

Ibuprofen is an example of an NSAID, which can be used for both pain relief and as an antipyretic.

PTS: 1 REF: 241 3. While studying for the medication exam, the nursing student determines that norepinephrine,

if given to a patient, would be contraindicated for which of the following individuals? a. A 52-year-old patient with a blood pressure of 186/94 b. A 49-year-old patient with a pulse of 65 c. A 61-year-old patient with a respiratory rate of 18 d. A 75-year-old patient with a history of seizures ANS: A

A

B C D

Feedback This patient has elevated blood pressure (BP). Because norepinephrine triggers the flight-or-fight impulse (sympathetic nervous system), which increases heart rate (HR) and BP, it is dangerous for someone with elevated blood pressure to take the medication.

The heart rate is low enough that the patient could safely take norepinephrine, which increases heart rate and blood pressure.

This patient’s respiratory rate is low enough that norepinephrine, which stimulates the flight-or-fight response, can be safely administered.

There is no contraindication to the use of norepinephrine in a patient with a history of seizures.

PTS: 1 REF: 240 4. The LPN is collecting history information for a patient planning outpatient surgery. Which of

the following statements by the patient would cause the nurse to contact the anesthesiologist? a. ―I forgot to sign the consent form while I was in the office last time.‖ b. ―I usually take alprazolam to help me sleep a couple times a week.‖

116 c. ―I used my pilocarpine eye drops this morning but didn’t take any of my pills.‖ d. ―I brushed my teeth this morning with just a sip of water.‖ ANS: C

A B C

D

Feedback This can be handled without the anesthesiologist. The patient can sign the consent before being medicated.

There is no contraindication to the use of alprazolam when receiving anesthesia.

Pilocarpine is a cholinergic medication, which is contraindicated when using anesthesia. It must be stopped several weeks prior to receiving anesthesia because of the risk of breathing problems.

This is an appropriate action and does not create problems for the administration of anesthesia.

PTS: 1 REF: 252 5. A nurse is reviewing a medication prescribed for moderate pain that is a combination-type

therapy—NSAID and narcotic. Which observation by the nurse warrants immediate intervention? a. The patient states that pain while taking the medication is 5/10 compared with 8/10 taking just the NSAID. b. The patient is taking additional ibuprofen for breakthrough pain. c. The patient reports trouble sleeping at night. d. The patient denies any gastric upset.

ANS: B

A B

C D

Feedback The medication regimen is effective at reducing the patient’s level of pain.

As the patient is already taking a combination medication (NSAID and narcotic), taking additional ibuprofen, which is also an NSAID, can lead to kidney damage. This warrants immediate nursing intervention.

Although the patient reports trouble sleeping at night, this finding does not warrant immediate intervention.

This patient report constitutes a normal finding.

PTS: 1 REF: 241 6. The LPN is providing care for a patient who reports an allergy to acetaminophen and

penicillin. The patient has orders for morphine 1 mg intramuscular (IM) every 2 hours prn for severe pain and Percocet two tablets every 4 hours prn for moderate pain. The patient reports pain of 4 on a 10-point scale. Which of the following actions should the nurse take first? a. Determine what kind of reaction the patient experienced when penicillin was taken.

117 b. Ask the patient which medication she would like to use at this time for the pain. c. Provide the patient with two tablets of Percocet. d. Contact the RN so orders can be clarified.

ANS: D

A B C D

Feedback The allergic reaction to penicillin is not relevant since the patient is not being given penicillin-containing medication.

The guidelines provided by the physician are to be used.

The patient should not be given any Percocet because it contains acetaminophen, which the patient is allergic to.

This is the correct response. The RN will need to contact the physician to clarify the order due to the allergy reported. The LPN cannot carry this out due to scope of practice.

PTS: 1 REF: 241, 251, 252 7. The LPN is monitoring a patient who has previously received morphine 4 mg intravenous

(IV) for pain relief. The patient appears drowsy and cannot respond in complete sentences.

Vital signs: Temperature 37.6 degrees, blood pressure (BP) 90/50, pulse 58, and respirations 12. Which action by the nurse is the priority? a. Document that pain relief has been achieved. b. Initiate a code. c. Contact the RN to obtain an order for naloxone. d. Record vital signs.

ANS: C

A

B C

D

Feedback Based on the provided information, the patient is experiencing a reaction to morphine and exhibiting signs of a narcotic overdose. This action is not appropriate.

The patient is presenting with signs of a narcotic overdose; therefore, there is no need to activate a code at this time.

Based on the provided information, the patient is experiencing a reaction to morphine and exhibiting signs of a narcotic overdose. The LPN must contact the RN to obtain an order for naloxone, which is given to reverse the effects of opioid analgesia.

While vital sign information should be documented in the medical record, the priority action is to intervene and reverse the effects of the administered opioid.

PTS: 1 REF: 241, 242

118 8. The LPN is caring for a patient being treated for clinical obesity. Phentermine has been

prescribed. What information should the LPN include in discharge teaching? a. Dietary modification is not needed. b. The effects of exercise will be minimal. c. Decrease fluid intake. d. This medication is taken prior to eating meals.

ANS: D

A B C D

Feedback Dietary modification and exercise, in conjunction with medication, are part of a successful treatment plan for clinically obese patients.

Dietary modification and exercise, in conjunction with medication, are part of a successful treatment plan for clinically obese patients.

The patient should maintain adequate fluid intake.

This medication is typically taken 30 to 60 minutes before meals.

PTS: 1 REF: 245 9. The LPN is working with an elderly patient who reports difficulty sleeping and has been

prescribed eszopiclone. Which finding warrants immediate intervention? a. The patient is able to provide a list of all medications prescribed. b. The patient reports nonspecific joint pain. c. The patient uses a cane to ambulate. d. The patient states that he has been speaking to his deceased wife.

ANS: D

A B C D

Feedback This finding does not require immediate intervention.

This finding does not require immediate intervention.

Reporting the use of an assistive device for ambulation requires no further intervention.

Eszopiclone can cause hallucinations and confusion. Therefore, the nurse should intervene, as the patient is reporting conversations with his deceased wife.

PTS: 1 REF: 253 10. While assisting with the care of a patient with a history of alcohol abuse, the LPN determines

that the patient’s withdrawal symptoms are worsening. Which of the following actions should the nurse take next? a. Provide the patient with warm blankets and reduce stimulation. b. Call the family to see if someone can stay with the patient. c. Determine if the patient has an order for prn diazepam. d. Inform the RN that the patient needs an order for wrist restraints.

119 ANS: C

A

B C D

Feedback Reducing stimulation is a helpful nonpharmacologic measure; however, it does not protect the patient from possible seizures associated with alcohol withdrawal symptoms.

Family support is a good nonpharmacologic measure; however, it does not protect the patient from possible seizures associated with alcohol withdrawal.

Administering diazepam is an appropriate action to assist in preventing seizures and other physiologic symptoms associated with alcohol withdrawal.

Restraints are not appropriate at this time.

PTS: 1 REF: 254 11. An LPN working in a physician’s office receives a call from the parent of a child who recently

started taking dexmethylphenidate hydrochloride. The parent reports, ―My son says he hasn’t slept well for the past 3 days.‖ Which of the following responses by the nurse is most appropriate? a. ―Does your son watch TV or play video games in his room at night?‖ b. ―Insomnia is a common side effect with this type of medication.‖ c. ―I suggest you just give him half a pill in the morning today.‖ d. ―What time of day does he usually take the medication?‖ ANS: D

A

B C D

Feedback While the stimulation of TV or video games prior to bed can affect sleep, it is not a priority at this time since the child recently started taking a medication that can interfere with sleep.

While this is a true statement, it does not address the concern the parent has or the sleep disturbance the child is experiencing.

The nurse’s scope of practice does not allow for suggesting a different dosing schedule.

This is the most appropriate response. Knowing the time of day the child is taking the medication can assist in determining the best action to recommend.

Taking the medication early in the morning can reduce sleep disturbances.

PTS: 1 REF: 251, 252 12. While working with a patient who is taking selegiline, the LPN recognizes that the patient

understands the required dietary restrictions if the patient selects which of the following lunches? a. Bologna sandwich on wheat bread with chips and a diet soda b. Hamburger with an onion bun, coleslaw, and a glass of milk c. Pepperoni pizza with a side salad and ranch dressing with iced tea

120 d. Stir fried rice and vegetables with soy sauce and a cup of coffee ANS: B

A B C D

Feedback Bologna is high in tyramine. Selegiline is a monoamine oxidase inhibitor (MAOI), which requires a diet low in tyramine.

This is an appropriate choice since none of these foods is high in tyramine.

Pepperoni is high in tyramine. Selegiline is an MAOI, which requires a diet low in tyramine.

Soy sauce is high in tyramine. Selegiline is an MAOI, which requires a diet low in tyramine.

PTS: 1 REF: 255

13. The LPN is working with a patient whose medication list includes lithium. The LPN would be

most concerned by which of the following? a. The patient reports blurry vision and sensitivity to light. b. The patient’s urinary output was 1,600 mL the previous day. c. The patient reports consistently following a low-salt diet. d. The lab report indicates the patient’s lithium level is therapeutic.

ANS: A

A B C D

Feedback Lithium can cause light sensitivity and blurry vision if the levels are toxic.

These symptoms are a concern.

Increased urinary output is a common side effect of lithium. A urinary output of 1,600 mL is not of concern.

Patients should be following a low-salt diet because lithium is a salt.

Therapeutic levels are the goal for patients taking lithium, so this is not a concern.

PTS: 1 REF: 247 14. An LPN is monitoring a patient diagnosed with Parkinson’s who is experiencing

extrapyramidal symptoms. Which of the following is the best nursing action? a. Continue to administer medication as ordered. b. Contact the health-care provider for a drug holiday. c. Increase fluid and fiber intake. d. Provide half the dose of prescribed medication.

ANS: B

Feedback

121 A B

C D

This action is not appropriate, as the patient is experiencing extrapyramidal symptoms.

The presence of extrapyramidal symptoms in Parkinson’s patients is typically treated by initiating a drug holiday. When the dose cannot be increased or the side effects become intolerable, the physician will request a drug holiday in which the patient stops taking antiparkinsonian medications for a week or so and then restarts them at a lower dose that still produces the desired effects.

While fluid and fiber intake should be increased in Parkinson’s patients, this action does not address the extrapyramidal symptoms and is not a priority.

The LPN cannot administer half the dose of a medication, as that would require a physician’s order. Additionally, the preferred treatment plan is to institute a drug holiday.

PTS: 1 REF: 248 15. The nurse is monitoring a patient who is being treated for alcohol dependence. Which vitamin

therapy should the nurse expect the health-care provider to order? a. B vitamins b. Fat-soluble vitamins c. Ascorbic acid d. Vitamin E ANS: A

A B C D

Feedback B vitamins, specifically thiamine, are used to treat patients who are recovering from alcohol toxicity.

Fat-soluble vitamins are not used in the clinical treatment of alcohol dependence.

Ascorbic acid (vitamin C) is not used in the clinical treatment of alcohol dependence.

Vitamin E is not used in the clinical treatment of alcohol dependence.

PTS: 1 REF: 250

16. A group of nurses are preparing a teaching plan for patients who take MAO inhibitors. Which

food selection by a patient correctly identifies a food that should not be eaten? a. Ice cream b. Hot dogs c. Cream cheese d. Canned fruit ANS: B

122

A B C D

Feedback When taking MAO inhibitors, one should avoid foods that are high in tyramine.

Dairy foods such as ice cream are considered to be low in tyramine.

When taking MAO inhibitors, one should avoid foods that are high in tyramine.

Hot dogs are processed foods, which are considered to be high in tyramine.

When taking MAO inhibitors, one should avoid foods that are high in tyramine.

Dairy foods such as cream cheese are considered to be low in tyramine.

When taking MAO inhibitors, one should avoid foods that are high in tyramine.

Canned fruit is considered to be low in tyramine.

PTS: 1 REF: 245,246

MULTIPLE RESPONSE 17. While passing out medications in a long-term care facility, the nurse recognizes that a

medication affecting the autonomic nervous system may cause which of the following symptoms? (Select all that apply.) a. Changes in pupil size b. Spastic twitching in the legs c. Fine tremors in the hands d. Altered heart rate e. Flushing of the skin ANS: A, D, E

A. B. C. D. E.

The autonomic nervous system controls pupil size and response. Medications that affect the autonomic nervous system can affect the pupils.

Skeletal muscles are controlled by the peripheral nervous system, not the autonomic nervous system.

Skeletal muscles are controlled by the peripheral nervous system, not the autonomic nervous system.

The autonomic nervous system controls the heart rate, so medications that affect the autonomic nervous system can affect the heart rate.

The autonomic nervous system controls vasodilation, so medications that affect the autonomic nervous system can affect vasodilation. Flushing of the skin is due to vasodilation.

PTS: 1 REF: 252

18. The nurse is reviewing the use of local anesthetics. Which of the following are attributed to

the use of amides? (Select all that apply.)

123 a. b. c. d. e.

Potential for severe allergic reactions Greater duration of effect More likely to be topically administered Used in more clinical applications Less likely to cause an adverse reaction

ANS: B, D, E

A. B. C. D. E.

Esters have more potential for allergic reactions and anaphylactic shock.

Amides tend to last longer.

Esters are more likely to be topically administered.

Amides are more popular due to increased duration and minimal side effects.

Amides are less likely to cause an adverse reaction.

PTS: 1 REF: 249

19. The LPN is reviewing the use of general anesthesia. Which of the following medications are

best used for this purpose? (Select all that apply.) a. Midazolam b. Novocain c. Propofol d. Ketamine e. Lidocaine ANS: A, C, D

A. B. C. D. E.

Midazolam is administered via IV infusion.

Novocain is considered to be a local anesthetic.

Propofol is administered via IV infusion.

Ketamine is administered via IV infusion.

Lidocaine is considered to be a local anesthetic.

PTS: 1 REF: 250

Chapter 14. Eye and Ear Medications MULTIPLE CHOICE 1. The nurse is performing a gait assessment of an elderly patient and observes that the patient is

having difficulty maintaining balance. Which priority physical assessment should the nurse perform? a. Auscultation of lungs b. Snellen chart c. Otoscopic examination of ears d. Pulse oximetry ANS: C

124

A B C D

Feedback As the patient is experiencing issues with balance, auscultation of lung fields is not a priority assessment.

The Snellen chart is used to assess visual acuity. This is not a priority at this time.

As the patient is experiencing issues with balance, otoscopic examination of the ears would be the priority assessment.

Pulse oximetry measures oxygen saturation. As the patient is experiencing issues with balance, this is not a priority assessment.

PTS: 1 REF: 268 2. A patient has been diagnosed with increased intraocular pressure (IOP). Which medication

does the nurse anticipate that the health-care provider will order? a. Loop diuretics b. Calcium channel blockers c. Gentamicin drops d. Osmotic diuretics ANS: D

A B C D

Feedback Loop diuretics are not used to treat increased IOP, but rather address specific conditions related to fluid volume excess.

Calcium channel blockers are used to treat hypertension (HTN).

Gentamicin drops are not used to treat infections.

Osmotic diuretics are used to treat increased IOP.

PTS: 1 REF: 264 3. The LPN is reviewing the medication profile of a patient being treated for glaucoma with an

ophthalmic alpha blocker. Which medication on the patient’s profile warrants that the LPN immediately contact the health-care provider for clarification? a. Digoxin b. Statin c. Multivitamin d. Acetylsalicylic acid (ASA) 81 mg ANS: A

A B

Feedback There can be interactions between digoxin and ophthalmic alpha blocker medication. This finding warrants contacting the health-care provider.

Statins do not affect aqueous humor flow or intraocular pressure and may be

125

C D

taken by patients with glaucoma.

Antibiotics do not affect aqueous humor flow or intraocular pressure and may be taken by patients with glaucoma.

NSAIDs do not affect aqueous humor flow or intraocular pressure and may be taken by patients with glaucoma.

PTS: 1 REF: 269

4. A patient presents with complaints of dry eyes. Which medication does the nurse anticipate

that the health-care provider will order? a. Gentamicin ophthalmic b. Cyclosporine ophthalmic c. Carbachol ophthalmic d. Tobramycin ophthalmic ANS: B

A B C D

Feedback Gentamicin ophthalmic is used to treat eye infections.

Cyclosporine ophthalmic is an immune modulator used to treat dry eye.

Carbachol ophthalmic is a miotic used to treat glaucoma.

Tobramycin ophthalmic is used to treat eye infections.

PTS: 1 REF: 266 5. While reviewing patients scheduled at the optometrist’s office, the LPN determines which of

the following individuals is most likely to take medications for the treatment of glaucoma? a. A 32-year-old patient with a history of asthma and astigmatism b. A 74-year-old patient with a history of hypertension and diabetes c. A 61-year-old patient with a history of gout and hiatal hernia d. A 49-year-old patient with a history of breast cancer and anemia ANS: B

A B C D

Feedback Asthma and astigmatism do not increase the risk of developing glaucoma.

Patients with a history of hypertension and diabetes have increased incidence of glaucoma.

Gout and hiatal hernia do not increase the risk of developing glaucoma.

Breast cancer and anemia do not increase the risk of developing glaucoma.

PTS: 1 REF: 264

126

6. An LPN working in an ophthalmologist’s office is monitoring a patient post procedure related

to removal of a foreign object. Which medication does the LPN anticipate that the health-care provider will order? a. Tetracaine b. Diclofenac ophthalmic c. Glycerin d. Pilocarpine hydrochloride (HCl) gel ANS: B

A B C D

Feedback Tetracaine is a local anesthetic that would be used prior to removal of the foreign object.

Diclofenac ophthalmic is an anti-inflammatory medication that can be used to treat eye pain post procedure.

Glycerin is an osmotic diuretic used to treat increased intraocular pressure.

Pilocarpine HCl gel is a miotic used to treat glaucoma.

PTS: 1 REF: 270 7. An LPN working in an eye, ear, nose, and throat clinic determines that long-term use of which

medication should be avoided? a. Tetracaine b. Glycerin c. Meclizine d. Prednisolone ophthalmic ANS: D

A B C D

Feedback Tetracaine is a local anesthetic and is used to manage pain in the eye; it is typically used for procedures.

Glycerin is an osmotic diuretic used to manage glaucoma and would be expected to be used as a long-term treatment.

Meclizine is an antihistamine used to treat vertigo and motion sickness. It can be used daily to manage symptoms associated with vertigo.

Ophthalmic corticosteroids can suppress the immune response and should not be used for long periods.

PTS: 1 REF: 270 8. An LPN is assisting a physician with the removal of a foreign object from the eye of a

29-year-old individual. The LPN anticipates that the physician will use which of the following medications? a. Prednisolone ophthalmic

127 b. Glycerin c. Tetracaine d. Latanoprost ANS: C

A B C D

Feedback Prednisolone ophthalmic is an anti-inflammatory agent and would not be used in the removal of a foreign body.

Glycerin is an osmotic diuretic used to manage glaucoma.

Tetracaine is a local anesthetic used to control pain during procedures on the eye, including foreign body removal.

Latanoprost is a prostaglandin used to treat glaucoma; it would not be used in the removal of a foreign body.

PTS: 1 REF: 270 9. A patient recovering from minor eye surgery was given proparacaine during the procedure.

Which of the following statements would the nurse include in the patient teaching? a. ―Your eyes will probably tear uncontrollably for the next few hours.‖ b. ―It is important that you wear dark glasses outside.‖ c. ―You may notice that your tears are a strange orange color for a few days.‖ d. ―The medication may cause dizziness, dry mouth, and tremors.‖ ANS: B

A B C D

Feedback Proparacaine is a local anesthetic that is not associated with excess tearing.

Proparacaine is a local anesthetic, and patients should protect themselves by wearing dark glasses outside until the effect wears off.

Proparacaine is a local anesthetic that does not affect the color of the tears.

Proparacaine is a local anesthetic that is not associated with dizziness, dry mouth, or tremors. These symptoms could be caused by medications used to treat glaucoma.

PTS: 1 REF: 265

10. A patient complaining of motion sickness has been prescribed a Bonine patch and wants to

know how to apply the medication. Which of the following responses by the nurse is best? a. ―Place the patch on the abdomen.‖ b. ―Place the patch on your upper arm.‖ c. ―Place the patch on your upper leg.‖ d. ―Place the patch behind the ear.‖ ANS: D

128

A B C D

Feedback A transdermal patch for motion sickness should not be applied to the abdomen.

A transdermal patch for motion sickness should not be applied to the upper arm.

A transdermal patch for motion sickness should not be applied to the upper leg.

A transdermal patch for motion sickness should be applied behind the ear.

PTS: 1 REF: 268 11. An LPN working in an outpatient clinic is assessing a patient with complaints of decreased

hearing and ear pain. Which priority assessment should the LPN perform? a. Obtain temperature b. Inspect the ear c. Auscultate the lungs d. Count respirations ANS: B

A B C D

Feedback Taking the patient’s temperature as part of a vital sign assessment may be needed but is not the priority at this time.

As the patient is complaining of decreased hearing and ear pain, the priority is to inspect the ear to identify potential problems such as cerumen buildup.

Auscultating the lungs may be needed but is not the priority at this time.

Counting respirations is part of a vital sign assessment but is not the priority at this time.

PTS: 1 REF: 265 12. A patient has been prescribed gentamicin therapy for treatment of an ear infection and is on

day 2 of therapy. Which finding, if observed by the nurse, calls for immediate intervention? a. The patient is having difficulty responding to questions, stating it is hard to hear. b. The patient is still complaining of slight ear discomfort. c. No drainage is observed from the ear canal. d. The patient states that appetite is slightly decreased.

ANS: A

A B C D

Feedback Gentamicin has the potential to cause ototoxicity (hearing loss or tinnitus) even in normal doses. A finding of hearing loss requires immediate intervention.

As the patient is on day 2 of gentamicin therapy, slight discomfort may still be expected.

This is a normal finding and requires no further intervention.

This finding is unrelated to gentamicin administration.

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PTS: 1 REF: 268 13. The nurse is monitoring a patient who has a history of styes. Which medication does the nurse

anticipate that the health-care provider will order? a. Gentamicin ophthalmic ointment b. Ranibizumab c. Doxycycline d. Aflibercept ANS: C

A B C D

Feedback Gentamicin ophthalmic ointment is used to treat conjunctivitis.

Ranibizumab is used to treat macular degeneration.

Doxycycline is used to treat persistent styes.

Aflibercept is used to treat macular degeneration.

PTS: 1 REF: 265

MULTIPLE RESPONSE 14. The LPN is working with the mother of a 10-year-old patient diagnosed with conjunctivitis.

The nurse would determine teaching was effective by which of the following statements?

(Select all that apply.) a. ―I will have my daughter wash her hands frequently and thoroughly.‖ b. ―Eye infections aren’t really contagious, so we don’t have to worry about her siblings.‖ c. ―There isn’t much that can be done; we just have to wait for it to heal on its own.‖ d. ―It is important to remind her not to rub her eyes.‖ e. ―This is an inflammatory condition she’ll learn to live with.‖ ANS: A, D

A. B. C. D. E.

Feedback Conjunctivitis is a contagious bacterial infection, and handwashing will reduce the chance of transmission to others.

Bacterial eye infections such as conjunctivitis are contagious, and the siblings will need to be taught handwashing and monitored for signs of infection.

Conjunctivitis is a bacterial infection that will not improve without treatment.

Rubbing her eyes can increase the chance of spreading the infection. The child’s eyes may be irritated, but she should be reminded not to rub them.

This is not a chronic inflammatory condition; it is a treatable infection.

PTS: 1

130 REF: 265 15. In reviewing eye medications used at the ophthalmologist’s office, the LPN is aware that

diclofenac solution would be contraindicated for use in which of the following individuals?

(Select all that apply.) a. An 18-year-old patient with iritis who has diabetes b. A 34-year-old patient with uveitis who has hypertension c. A 41-year-old patient with a minor eye injury who has a broken wrist d. A 55-year-old patient with conjunctivitis who has asthma e. A 24-year-old patient with local eye irritation who is 4 months pregnant ANS: A, E

A. B. C. D. E.

Feedback Diclofenac solution is an NSAID, which is contraindicated for use in patients with diabetes.

Diclofenac solution is an NSAID and can be administered to patients with hypertension.

Diclofenac solution is an NSAID and can be administered to patients with a broken bone such as a wrist.

Diclofenac solution is an NSAID and can be administered to patients with asthma.

Diclofenac solution is an NSAID, which is contraindicated for use in patients who are pregnant.

PTS: 1 REF: 270 16. The LPN recognizes that systemic antibiotics such as clavulanate potassium would be

necessary for which of the following patients? (Select all that apply.) a. A 2-year-old patient with an outer ear infection b. A 5-year-old patient with an inner ear infection c. A 10-year-old patient with a middle ear infection d. A 12-year-old patient with excess cerumen e. A 15-year-old patient with recurring vertigo ANS: B, C

A. B. C. D. E.

Feedback Outer ear infections are treated with antibiotic ear drops rather than systemic antibiotics.

Inner ear infections must be treated with systemic antibiotics.

Middle ear infections must be treated with systemic antibiotics.

Excess cerumen is treated with mineral oil, hydrogen peroxide, or cerumenolytics.

Recurring vertigo is treated with medications such as meclizine.

PTS: 1 REF: 267

131

17. While participating in the care of a patient who received gentamicin ophthalmic, the LPN may

suspect ototoxicity if the patient reports which of the following symptoms? (Select all that apply.) a. Altered balance b. Seizure activity c. Hearing loss d. Ringing in the ears e. Swelling in the ankles ANS: A, C, D

A. B. C. D. E.

Feedback Ototoxicity can occur with the antibiotic gentamicin, and problems with balance can be a sign of ototoxicity.

Seizure activity is not a symptom of ototoxicity.

Hearing loss is a sign of ototoxicity, which can be caused by medications like gentamicin.

Ringing in the ears is a sign of ototoxicity, which can be caused by medications like gentamicin.

Swelling in the ankles is not a symptom of ototoxicity.

PTS: 1 REF: 268

18. A patient has been prescribed combination antibiotic ear drops to treat an infection of the right ear. The LPN understands that this type of therapy is indicated for which clinical conditions?

(Select all that apply.) a. Middle ear infection with effusion b. Inner ear infection c. Otitis externa d. Swimmer’s ear e. Otitis media

ANS: C, D Feedback A. Combination antibiotic therapy is indicated for treatment of middle or inner ear infections with or without effusion.

B. Combination antibiotic therapy is indicated for treatment of middle or inner ear infections with or without effusion.

C. Otitis externa (swimmer’s ear) is considered to be an external ear infection and is typically treated with ear drops rather than oral antibiotic therapy.

D. Otitis externa (swimmer’s ear) is considered to be an external ear infection and is typically treated with ear drops rather than oral antibiotic therapy.

E. Combination antibiotic therapy is indicated for treatment of middle or inner ear infections with or without effusion.

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PTS: 1 REF: 267 19. A group of nursing students are reviewing complications of eye diseases. Which types of conditions can lead to potential blindness? (Select all that apply.) a. Conjunctivitis b. Styes c. Glaucoma d. Dry eye e. Acute angle glaucoma

ANS: C, E Feedback A. Conjunctivitis is a common infection of the eye known as pink eye. It does not lead to blindness.

B. Styes are eye infections due to a bacterial infection. They do not lead to blindness.

C. Glaucoma is a group of eye diseases that, if not treated properly, can lead to blindness.

D. Dry eye occurs as a result of decreased tear production. It does not lead to blindness.

E. Acute angle glaucoma is an especially serious form of glaucoma that can lead to blindness.

PTS: 1 REF: 263 20.

The nurse is working with a patient who wants to have the wax removed from both ears. Upon inspection of the ear canals, the nurse identifies no cerumen buildup. What is the best nursing response to the patient’s concern? (Select all that apply.) a. Offer to remove the wax and apply hydrogen peroxide solution. b. Educate the patient about the protective function of ear wax. c. Provide the patient with appropriate educational materials about the ear. d. Tell the patient to use Q-tips on a routine basis to remove ear wax. e. Maintain adequate fluid intake to prevent dehydration.

ANS: B, C, E Feedback A. As the physical exam reveals no abnormality, this response is not required.

133

B. C. D. E.

Providing patient teaching about the protective function of ear wax would be required.

Providing the patient written material about the protective function of ear wax would be required to support patient teaching.

It is not appropriate to instruct patients to insert Q-tips on a routine basis, as this could potentially lead to problems.

Maintaining adequate fluid intake will help maintain hydration of body tissues.

PTS: 1 REF: 267

Chapter 15. Endocrine System Medications MULTIPLE CHOICE

1. An LPN working in a family practice office talks to a patient who recently received sodium

iodide I 131 for the treatment of hyperthyroidism. Which of the following assessments by the nurse is best? a. Determine if the patient has been experiencing any hair loss. b. Ask the patient to report sleeping patterns since treatment. c. Obtain a diet history for the past 24 hours. d. Take the patient’s vital signs and note any tachycardia.

ANS: D

A B C

D

Feedback Hair loss is not a side effect of sodium iodide I 131.

Changes in sleeping patterns are not a side effect of sodium iodide I 131.

A diet history is not a priority. It could be pertinent if the patient was suffering from nausea and vomiting; however, it would not be a priority due to the potential effects of tachycardia.

Vital signs are important due to the potential effect on the heart rate, tachycardia, and any other effects the tachycardia might have.

PTS: 1 REF: 281

2. The LPN is monitoring a patient who has been noncompliant with treatment for

hyperthyroidism. Which clinical condition should the LPN be most concerned with as a potential complication? a. Diabetic ketoacidosis (DKA) b. Thyroid storm c. Myxedema coma

134 d. Sepsis ANS: B

A B

C D

Feedback DKA is a complication of diabetes.

Thyroid storm, which is a life-threatening condition and includes such symptoms as tachycardia, hyperthermia, chest pain, sweating, weakness, heart failure, anxiety, shortness of breath, and disorientation, can occur if hyperthyroidism is untreated.

Myxedema coma is a medical emergency related to hypothyroidism.

Sepsis occurs due to overwhelming infection that is either bacterial or viral in etiology.

PTS: 1 REF: 281

3. The LPN is reviewing the medication administration record for a patient who received Lantus

(long-acting) insulin. Which finding warrants immediate intervention?

Accu-Chek before meals and at bedtime with sliding scale insulin aspart subcutaneous (SQ): a. Documented as given at 1800 hours. b. Accu-Chek result 150 g/dL prior to administration. c. Order indicates to be administered every other day. d. Injection site documented.

ANS: C

A B C

D

Feedback Lantus (long-acting insulin) is typically administered once a day in the evening.

Documentation of Accu-Chek result requires no intervention.

The effects of Lantus (long-acting insulin) last 24 hours; therefore, it is unusual for this medication to be administered every other day. The LPN needs to contact the health-care provider for clarification.

Documentation of injection site requires no intervention.

PTS: 1 REF: 283 4. At 10 p.m. the LPN notes that one of the patients has a blood glucose of 451. The patient has

sliding scale insulin ordered as noted below. What action by the nurse is best?

Accu-Chek before meals and at bedtime with sliding scale insulin aspart SQ: Glucose 0–150 0 units 151–200 2 units 201–250 4 units 251-300 6 units

135

301–350 351–400 >400 a. b. c. d.

8 units 10 units Notify physician

Provide 10 units insulin aspart SQ. Provide 8 units insulin aspart SQ. Notify the physician of the result.

Ask the patient if she feels shaky.

ANS: C

A

B

C D

Feedback The patient’s blood sugar is greater than 400, so the physician needs to be notified according to the orders; 10 units is not likely adequate to manage the current blood sugar level.

The patient’s blood sugar is greater than 400, so the physician needs to be notified according to the orders; 8 units is not likely adequate to manage the current blood sugar level.

The blood sugar level is greater than 400; therefore, the physician needs to be notified as written in the prescriber’s orders.

Shakiness is associated with hypoglycemia, not hyperglycemia, and would not be relevant at this time.

PTS: 1 REF: 283

5. The LPN is working with a patient who has cystic fibrosis and takes pancrelipase daily with

each meal. Which of the following is a side effect of the medication? a. Greasy stools and gas production b. Clay-colored stool that floats c. Dark, tarry stools d. Soft, brown stool ANS: A

A B C D

Feedback Greasy stools and gas are a side effect of pancrelipase.

Clay-colored stools are associated with a lack of bile production and are not a side effect of pancrelipase.

Dark, tarry stools are indicative of gastric bleeding or are found in patients who are taking iron supplements. They are not associated with pancrelipase.

Soft, brown stools are a normal bowel pattern not typically associated with cystic fibrosis or pancrelipase.

PTS: 1 REF: 290

136

6. The LPN performs a routine finger stick to check glucose and obtains a reading of 279 g/dL.

The LPN would anticipate standing orders to provide sliding scale coverage with which of the following types of insulin? a. Humalog 75/25 b. Regular c. Ultralente d. Novolin 70/30 ANS: B

A B C D

Feedback Humalog 75/25 is used for longer blood glucose control. The patient needs short-term control at this time.

Regular insulin is short-acting and used for managing single instances of blood sugar elevations.

Ultralente was a long-acting insulin and not used for isolated instances of blood sugar elevations.

Novolin 70/30 is an intermediate-acting insulin and is not used for isolated instances of blood sugar elevations. It is used for maintenance of blood sugar levels throughout the day.

PTS: 1 REF: 286 7. The LPN provides a patient with daily long-acting insulin at bedtime. The patient states, ―I’ve

never really understood why I take insulin at night when I eat during the day.‖ Which response by the nurse is best? a. ―This insulin doesn’t start to work for 6 to 8 hours, so you need to take it at bedtime.‖ b. ―Your pancreas makes insulin at night, and the medication is stimulating your pancreas.‖ c. ―We give insulin at night to help cover the glucose released as you digest your dinner.‖ d. ―This is a long-acting insulin that lasts 18 to 24 hours for sustained control of your blood sugar.‖ ANS: D

A B C D

Feedback The onset of Lente insulin is 1 to 2.5 hours, not 6 to 8 hours.

The pancreas is unable to make sufficient insulin, and the medication replaces what the pancreas can no longer make.

Insulin for dinner is not given at night. Lente insulin manages blood sugar for 18 to 24 hours.

Lente is an intermediate-acting insulin with an onset of 1 to 2.5 hours and a

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duration of 18 to 24 hours PTS: 1 REF: 284 8. The LPN prepares to administer chlorpropamide to a type 2 diabetic patient. Which priority

assessment should the nurse perform? a. Monitor blood glucose level closely. b. Auscultate the lungs. c. Obtain pulse oximetry. d. Continue to monitor daily weight.

ANS: A

A

B C D

Feedback Chlorpropamide is a first-generation sulfonylurea. The major drawback to first-generation medications is that they can be dislodged from the proteins they bind to by other drugs, leading to very serious and prolonged hypoglycemia.

Auscultation of the lungs is not a priority assessment at this time.

Obtaining a pulse oximetry reading is not a priority at this time.

While monitoring daily weights is important, it is not the priority at this time.

PTS: 1 REF: 289 9. A patient with type 2 diabetes is taking rosiglitazone. Which mechanism of action does this

medication use to improve glucose balance? a. Decreases renal absorption of glucose b. Inhibits incretin secretion c. Stimulates insulin secretion d. Increases insulin sensitivity ANS: D

A B C D

Feedback Sodium–glucose cotransporter 2 (SGLT-2) inhibitors decrease renal absorption of glucose.

Dipeptidyl peptidase 4 (DPP-4) inhibitors inhibit incretin secretion.

Meglitinides stimulate insulin secretion from the pancreas, thereby lowering glucose levels.

Rosiglitazone is a thiazolidine that stimulates insulin sensitivity.

PTS: 1 REF: 283

138 10. A nurse is reviewing best practice methods for home insulin administration with a newly

diagnosed type 2 diabetic patient who has transitioned to insulin therapy. Which information is essential for the nurse to include in the teaching plan? a. Insulin products do not have to be refrigerated. b. Insulin can be administered orally. c. Once left at room temperature, an opened insulin vial should be used for only 30 days and then discarded. d. Use the same site for injection each day.

ANS: C

A B C D

Feedback Refrigerating insulin products prior to opening does increase their shelf life.

Insulin cannot be administered orally, as it will not be absorbed.

This is a factual statement, and the nurse should include this in patient teaching about insulin.

When administering insulin, injection sites should be rotated.

PTS: 1 REF: 284

MULTIPLE RESPONSE 11. A patient taking levothyroxine should be counseled to report which of the following side

effects? (Select all that apply.) a. Tremors b. Weight gain c. Palpitations d. Hypotension e. Somnolence ANS: A, C

A. B. C. D. 5.

Feedback Tremors can occur as a side effect or indicate the dose is too high; therefore, tremors need to be reported.

Weight gain is not anticipated with levothyroxine. Weight loss may occur.

Palpitations can occur as a side effect or indicate the dose is too high; therefore, palpitations need to be reported.

Hypotension is not associated with the use of levothyroxine Somnolence is not associated with the use of levothyroxine.

PTS: 1 REF: 290

139 12. The LPN is teaching an insulin-dependent patient about rotating injection sites. Which of the

following items should be included in the teaching plan? (Select all that apply.) a. Provision of a chart to help the patient indicate injection sites b. Helps to increase absorption of medication c. Promotes skin hydration d. Prevents skin irritation e. Increases fluid retention ANS: A, B, D

A. B. C. D. E.

Feedback Providing a chart to help the patient indicate injection sites will help prevent overuse of sites.

Rotation of sites helps to increase absorption of medication and thereby maintain steady glucose levels.

Rotating injection sites does not affect skin hydration.

Rotating injection sites decreases the likelihood of abscess or development of scar tissue from repeated injections.

Rotating injection sites is not associated with increased fluid retention.

PTS: 1 REF: 285. 286 13. An LPN is preparing to administer an insulin admixture (30 units regular and 15 units NPH)

to a patient. Which should the LPN implement? (Select all that apply.) a. Use two syringes to draw up the medication. b. Inject air first into the regular vial and then into the NPH vial. c. Draw up the regular insulin first, then the NPH. d. Use an alcohol prep to clean each vial prior to use. e. There will be a total of 50 units in the syringe to administer.

ANS: C, D

A. B. C. D. E.

Feedback The nurse needs only one syringe to administer this medication.

Inject air first into the NPH vial and then into the regular insulin vial.

Regular insulin should be drawn up first when administering an admixture to a patient to prevent contamination.

Swabbing the vials with an alcohol prep is part of the administration process.

There will be a total of 45 units of insulin to administer.

PTS: 1 REF: 284 14. An LPN supporting a patient who has recently been taught how to provide self-injection of

insulin recognizes that the patient understands the teaching if which of the following sites are chosen? (Select all that apply.) a. Front of the abdomen about 2 inches from the belly button b. Back of the upper arm

140 c. Along the front of the lower arm d. Top of the thigh slightly lateral of midline e. Inner aspect of the thigh just above the knee ANS: A, B, D

A. B. C. D. E.

Feedback Insulin is given subcutaneously, and the front of the abdomen 2 inches away from the navel is an appropriate location.

Insulin is given subcutaneously, and the back of the upper arm is an appropriate location.

Along the front of the lower arm is not an appropriate choice for a subcutaneous injection.

Insulin is given subcutaneously, and the top of the thigh slightly lateral of midline is an appropriate location.

The inner aspect of the thigh just above the knee is not an appropriate site for subcutaneous injection.

PTS: 1 REF: 285 15. The LPN is reviewing a patient’s lab result indicating increased growth hormone (GH) post

puberty. Which clinical appearance should the nurse anticipate as being present upon physical examination? (Select all that apply.) a. Increased hand size b. Petite stature c. Increased foot size d. Height greater than 7 feet e. Shoulder hump ANS: A, C

A. B. C. D. E.

Feedback An increase in GH occurring post puberty relates to acromegaly, where one would expect to see an increase in hand size.

A petite stature is associated with dwarfism and decreased GH. An increase in GH occurring post puberty relates to acromegaly, where one would expect to see an increase in foot size.

Great height in an individual occurs when GH is increased prior to puberty and is known as gigantism.

A shoulder hump is seen in patients who have Cushing’s disease.

PTS: 1 REF: 278 16. While walking in the mall an LPN notices an obese woman with a rounded face and facial

hair. The LPN suspects the woman has Cushing’s disease. Which of the following health concerns would most likely also be present in the woman? (Select all that apply.) a. Anemia

141 b. c. d. e.

Hypertension Hyperglycemia Cirrhosis Hypercoagulability

ANS: B, C

A. B. C. D. E.

Feedback Anemia is not associated with Cushing’s disease.

Cushing’s disease results in the oversecretion of glucocorticoid steroids and is associated with hypertension.

Cushing’s disease results in the oversecretion of glucocorticoid steroids and is associated with hyperglycemia.

Cirrhosis is not associated with Cushing’s disease.

Hypercoagulability is not associated with Cushing’s disease.

PTS: 1 REF: 287 17. The LPN is reviewing the patient’s medical record and notes a clinical diagnosis of Addison’s

disease. What findings are consistent with this diagnosis? (Select all that apply.) a. Increased thyroid-stimulating hormone (TSH) levels b. Blood sugar 50 mg/dL c. Complaints of nausea d. Diarrhea e. Edema ANS: B, C, D

A. B. C. D. E.

Feedback Increased TSH levels are associated with hypothyroidism.

Hypoglycemia is associated with Addison’s disease.

Complaints of nausea are associated with Addison’s disease.

Diarrhea is associated with Addison’s disease.

Dehydration, not edema, is associated with Addison’s disease.

PTS: 1 REF: 286

18.The nurse is reviewing the clinical indications for treatment with corticosteroids. Which conditions are treated with corticosteroids? (Select all that apply.) a. Certain types of skin irritations b. Cushing’s disease c. Pneumonia d. Addison’s disease e. Rheumatoid arthritis

ANS: A, C, D, E

142

A. B. C. D. E.

Feedback Corticosteroids can be used to treat certain types of skin irritations.

Cushing’s disease is associated with an overabundance of glucocorticoids and is typically not treated with corticosteroids.

Pneumonia represents an inflammatory response, and corticosteroids can be used for treatment.

Corticosteroids can be used to treat Addison’s disease.

Corticosteroids can be used to treat rheumatoid arthritis.

PTS: 1 REF: 286 19. A patient has been admitted to the medical unit for treatment of Addison’s disease. Which clinical manifestations of the disease does the nurse anticipate being present? (Select all that apply.) a. Weight gain of 25 pounds b. Blood pressure 90/70 c. Glucose 50 mg/dL d. Nausea e. Increased hair growth

ANS: B, C, D Feedback A. One would expect to see weight loss in Addison’s disease, not weight gain.

B. Hypotension is seen in Addison’s disease.

C. Hypoglycemia is seen in Addison’s disease.

D. Nausea with or without vomiting is seen in Addison’s disease.

E. Increased hair growth is seen in Cushing’s disease.

PTS: 1 REF: 286 20. A group of nursing students are reviewing potential side effects of anabolic steroids. Which of the following are potential consequences of anabolic steroid use? (Select all that apply.) a. Infertility b. Susceptibility to infections c. Elevated liver enzymes d. Bipolar disorder e. Aggressive behavior

143

ANS: A, C, E Feedback A. Prolonged use of anabolic steroids can lead to sterility and infertility.

B. Anabolic steroid use does not correlate with an increased risk of infections.

C. Use of anabolic steroids can lead to elevated liver enzymes, which could indicate liver cancer.

D. Bipolar disorder is a mood disorder that is not directly linked to anabolic steroid use, but rather to a chemical imbalance in the body.

E. Aggressive behavior is associated with anabolic steroid use.

PTS: 1 REF: 287

Chapter 16. Cardiovascular System Medications MULTIPLE CHOICE

1. The LPN is called into the room of a patient with known cardiac disease at 7:30 a.m. The

patient reports heavy pressure and chest pain. Which action by the nurse is best? a. Provide the patient with the atenolol scheduled for 9 a.m. b. Provide the patient nitroglycerin sublingual scheduled prn. c. Determine the patient’s level of consciousness. d. Assess the patient’s respiratory rate and effort.

ANS: B

A B

C D

Feedback Atenolol is not indicated for acute symptoms of a myocardial infarction (MI) or ischemic pain associated with cardiac disease.

Nitroglycerin is indicated for acute symptoms of an MI. It works by dilating cardiac blood vessels, allowing for improved oxygenation of the myocardium and decreased symptoms of chest pain.

The patient’s level of consciousness is not as relevant at this time due to the symptoms of ischemia in the myocardium.

The patient’s respiratory rate and effort are nice to have; however, they are not the priority at this time due to the symptoms of ischemia in the myocardium.

PTS: 1 REF: 297

144 2. The LPN is providing care for a patient in a rehab facility with angina pectoris and a prn order

for sublingual nitroglycerin up to three times in 30 minutes. The patient reports chest pain, and her blood pressure (BP) is 155/72. Five minutes after administering Nitrostat, the patient’s blood pressure is 124/60 and chest pain is not relieved. What action should the nurse take next? a. Call for emergency treatment and evaluation. b. Provide a second dose of nitroglycerin (Nitrostat). c. Contact the RN for additional assessment. d. Determine if the patient has any other medications ordered.

ANS: B

A B C

D

Feedback The LPN can still give more medication based on the order parameters.

Emergency treatment is not indicated at this time.

The provider’s order allows for repeating the medication dose up to three times.

A second dose should be administered due to continued symptoms.

The RN does not need to be consulted at this time. The LPN is monitoring the patient’s condition, and it is within the LPN’s scope of practice to continue managing the situation at this time.

Whether any other medications are ordered is not relevant at this time. The nitroglycerin is the appropriate medication to be used for the symptoms described.

PTS: 1 REF: 297

3. A nurse working in the emergency department is assisting in the care of a patient who came in

with symptoms of a cerebrovascular accident (CVA). As the team considers the use of tissue plasminogen activator (tPA), the nurse recognizes the most important assessment would be: a. When the symptoms of stroke began b. Whether the patient has a history of hypertension c. When the patient last ate or drank anything d. Whether the patient has an allergy to aspirin ANS: A

A B C D

Feedback Tissue plasminogen activator can only be administered if the symptoms started less than 60 minutes prior to treatment.

A patient’s history of hypertension may contribute to the risk of a CVA. It is not relevant in the decision to administer tissue plasminogen activator.

Tissue plasminogen activator can be given without regard for when food or drink was last consumed.

Tissue plasminogen activator does not contain aspirin and can be given whether the patient has an allergy or not.

145

PTS: 1 REF: 300 4. While working in a primary care physician’s office, the LPN is collecting history data for a

patient who takes sargramostim. The nurse would be most interested in which of the following lab results for this patient? a. Serum sodium b. Serum magnesium c. White blood cell count d. Blood urea nitrogen ANS: C

A B C

D

Feedback Sargramostim does not have an effect on serum sodium levels.

Sargramostim does not have an effect on serum magnesium levels.

Sargramostim promotes the production of white blood cells (WBCs) after chemotherapy, stem cell transplant, and bone marrow transplant. Monitoring the WBCs is important.

Sargramostim does not have an effect on blood urea nitrogen.

PTS: 1 REF: 300 5. The LPN is reviewing the concept of cardiac output (CO). Which physiological response

would the nurse anticipate in a patient whose CO was decreased? a. Bradycardia b. Increase in heart rate c. Decrease in blood pressure d. Decrease in respirations ANS: B

A B C D

Feedback CO = stroke volume (SV) × heart rate (HR). One would expect the heart rate to increase in an attempt to maintain CO. CO = SV × HR. One would expect the heart rate to increase in an attempt to maintain CO. CO = SV × HR. One would expect the blood pressure to increase in an attempt to maintain CO. CO = SV × HR. The physiological response would be an increase in respirations, but this would not have a direct effect on CO.

PTS: 1 REF: 301

146 6. A patient has been diagnosed with iron deficiency anemia (IDA). Which medication does the

nurse anticipate to be ordered? a. Cyanocobalamin b. Lovastatin c. Ferrous sulfate d. Ascorbic acid ANS: C

A B C D

Feedback Cyanocobalamin is used to treat pernicious anemia.

Lovastatin is used to treat hypercholesterolemia.

Ferrous sulfate is used to treat IDA. Ascorbic acid is vitamin C.

PTS: 1 REF: 300 7. The LPN is called to the room of a patient because the nurse aide determined that the patient’s

blood pressure is 195/101. The patient complains of a moderate headache but denies blurry vision or other symptoms. What action should the nurse take next? a. Notify the RN that the patient needs to be transferred to the hospital. b. Provide the patient’s morning dose of ramipril 30 minutes early. c. Instruct the aide to check the blood pressure again in 15 minutes. d. Inform the patient that he should reduce his salt intake with evening meals.

ANS: B

A

B

C D

Feedback Although the patient is exhibiting symptoms associated with elevated blood pressure, it does not require emergency treatment because the patient has not yet had his morning dose of antihypertensive.

Because the patient has not had his morning dose of antihypertensive, the medication needs to be administered ASAP to manage the elevated blood pressure and associated symptoms.

The patient has elevated blood pressure and associated symptoms. Repeating the blood pressure in 15 minutes will do nothing to resolve the current problem.

Salt intake reduction is a long-term management strategy for elevated blood pressure and would be recommended at all meals. It does not address the current problem.

PTS: 1 REF: 309 8. The LPN is monitoring lab results for a patient receiving anticoagulant therapy. Which lab

finding provides the best estimate of the patient’s anticoagulation status? a. PT

147 b. aPTT c. FDPs d. INR ANS: D

A B C D

Feedback Prothrombin time (PT) is used to assess the ability of the blood to clot and is typically done prior to operative procedures.

Activated partial thromboplastin time (aPTT) is used to evaluate the effectiveness of heparin therapy.

Fibrin degradation products (FDPs) indicate the potential for the development of disseminated intravascular coagulation (DIC).

International normalized ratio (INR) is a standardized reference test that provides an indicator of how long blood takes to clot and is used to assess anticoagulant therapy.

PTS: 1 REF: 300

9. The LPN is passing out morning medications, which include digoxin for a 68-year-old man

with congestive heart failure. The nurse notes that the patient’s BP is 112/68, pulse is 58, and respirations are 18. Which action by the nurse is best? a. Determine if the patient has eaten breakfast. b. Hold the medication and contact the RN. c. Provide the medication as ordered. d. Ask the patient if he is short of breath.

ANS: C

A B C D

Feedback Eating breakfast does not have any significance with regard to digoxin.

Digoxin slows the heart rate and can cause bradycardia. If the heart rate is less than 60, the medication should be held.

The patient’s heart rate is less than 60; therefore, digoxin should not be administered.

The respiratory rate is within normal limits. Assessing for shortness of breath is not needed at this time.

PTS: 1 REF: 304

10. The nurse is reviewing lab results for a patient on heparin therapy and notes an elevated

aPTT level. What is the first nursing action? a. Call the health-care provider

148 b. Administer naloxone c. Increase heparin drip rate d. Administer protamine sulfate ANS: D

A

B C D

Feedback Patients on heparin therapy have a heparin protocol in place. The best action is to treat the patient for an overdose of heparin per the protocol and then notify the physician.

Naloxone is used to treat opioid overdose.

The heparin drip should be stopped, not increased.

Protamine sulfate is the antidote for heparin overdose.

PTS: 1 REF: 300

11. The LPN is reviewing new orders prescribed by the health-care provider for a patient who has

elevated triglyceride levels. Which medication should the LPN anticipate that the health-care provider will order? a. Cholestyramine b. Fenofibrate c. Lovastatin d. Vitamin B12

ANS: B

A B C D

Feedback Cholestyramine is a bile acid sequestrant used to treat hyperlipidemia.

Fenofibrate is a fibric acid derivative used to treat elevated triglycerides.

Lovastatin is an HMG-CoA reductase inhibitor (statin) used to treat hyperlipidemia.

Vitamin B12 is used to treat pernicious anemia and/or vitamin B12 deficiency.

PTS: 1 REF: 307 12. The LPN is reviewing the patient’s medication profile. Which medication suggests a cardiac

condition? a. Ibuprofen 800 mg b. Acetaminophen 650 mg c. Aspirin 325 mg d. Acetylsalicylic acid (ASA) 81 mg

149

ANS: D

A B C D

Feedback Ibuprofen is an NSAID used for the treatment of pain.

Acetaminophen is an analgesic/antipyretic medication.

This dose of aspirin is not considered to be a cardiac dose.

Low-dose ASA therapy is indicated in cardiac patients for the prevention of heart attack or stroke.

PTS: 1 REF: 299

13.

A patient is being treated with Coumadin status post deep vein thrombosis (DVT). Intake of which food can lead to an increased risk of complications during the course of therapy? a. Salad b. Milk c. Ice cream d. Butter

ANS: A

A B C D

Feedback Green leafy vegetables, including lettuce, are high in vitamin K and can interfere with the efficacy of Coumadin therapy.

There is no effect of milk on Coumadin therapy.

There is no effect of ice cream on Coumadin therapy.

There is no effect of butter on Coumadin therapy.

PTS: 1 REF: 298 14. A nurse is monitoring a postoperative orthopedic patient for repair of a right hip fracture. Which

order should the nurse question? a. Enoxaparin via subcutaneous (SQ) route daily b. Aspirin by mouth (PO) every other day c. Compression stockings to both legs d. Pain medication parameters for relief of mild to moderate pain

ANS: B

150

A

B

C D

Feedback Enoxaparin is an anticoagulant used to prevent DVT in postoperative orthopedic patients who may be at risk due to either surgical intervention or limited mobility.

Aspirin would be contraindicated in a patient who is receiving prophylactic treatment for DVT. Postoperative orthopedic patients are routinely treated for DVT prophylaxis.

Compression stockings in addition to DVT prophylaxis are seen in the prevention of DVT. The nurse should expect pain medication parameters for mild to moderate pain as part of the postoperative orders.

PTS: 1 REF: 298 15. The LPN is reviewing the treatment plan for a patient diagnosed with angina. Which

observation, if noted by the LPN, indicates that therapy has not been effective? a. Blood pressure has decreased since last office visit. b. Patient has switched to vaping. c. Patient has lost 2 pounds since last office weight. d. Patient has switched to low-fat yogurt.

ANS: B

A B C D

Feedback Maintaining a lower blood pressure can decrease the incidence of anginal pain.

Both smoking and vaping are considered irritants and can contribute to anginal pain.

Weight loss can decrease the incidence of anginal pain.

Switching to low-fat products can decrease the incidence of anginal pain.

PTS: 1 REF: 297

MULTIPLE RESPONSE 16. The nurse is monitoring a patient with a confirmed ventricular arrhythmia. Which medications

does the nurse anticipate being ordered? (Select all that apply.)

151 a. b. c. d. e.

Digoxin Amiodarone Sotalol Amlodipine Losartan

ANS: B, C

A. B. C. D. E.

Feedback Digoxin is a cardiac glycoside used in the management of congestive heart failure and atrial fibrillation.

Amiodarone is a potassium channel blocker used in the treatment of life-threatening ventricular arrhythmias.

Sotalol is a potassium channel blocker used in the treatment of life-threatening ventricular arrhythmias.

Amlodipine is a calcium channel blocker used in the management of hypertension (HTN).

Losartan is an angiotensin receptor blocker used in the treatment of HTN.

PTS: 1 REF: 305

17. The nurse would counsel patients to avoid aspirin-containing products if they were taking

which of the following medications? (Select all that apply.) a. Heparin b. Ticlopidine c. Tirofiban d. Cyanocobalamin e. Inamrinone ANS: A, B, C

A. B. C. D. E.

Feedback Aspirin is an antiplatelet medication, which increases the risk of bleeding, and should be avoided when on anticoagulants such as heparin.

Aspirin is an antiplatelet medication, which increases the risk of bleeding, and should be avoided when on anticoagulants such as ticlopidine.

Aspirin is an antiplatelet medication, which increases the risk of bleeding, and should be avoided when on anticoagulants such as tirofiban.

Vitamin B12 has no effect on coagulation and can be given with aspirin products.

Inamrinone does not affect coagulation and can be taken with aspirin products.

PTS: 1 REF: 308

152 18. A student nurse observing in an intensive care unit would expect albumin to be part of the

treatment plan for which of the following patients? (Select all that apply.) a. A 25-year-old patient with second- and third-degree burns to 40% of his body b. A 69-year-old patient with gastrointestinal bleeding c. A 61-year-old patient with lung cancer and congestive heart failure d. A 48-year-old patient with sepsis e. A 37-year-old patient with end-stage liver disease ANS: A, B, D

A. B. C.

D. E.

Feedback Albumin is a plasma expander used in patients experiencing shock. Patients with second- and third-degree burns would be at risk of shock.

Albumin is a plasma expander used in patients experiencing shock. Patients with gastrointestinal bleeding would be at risk of shock.

Albumin is a plasma expander used in patients experiencing shock. A patient with lung cancer and congestive heart failure (CHF) would be at low risk of shock and not likely to receive albumin.

Albumin is a plasma expander used in patients experiencing shock. Patients with sepsis would be at risk of shock.

Albumin is a plasma expander used in patients experiencing shock. A patient with end-stage liver disease would be at low risk of shock and not likely to receive albumin.

PTS: 1 REF: 306

19. The nurse is taking a patient history from a 48-year-old female patient who is being evaluated for cardiac issues. Which findings does the nurse attribute to a female cardiac presentation?

(Select all that apply.) a. Crushing chest pain b. Fatigue over several days c. Back discomfort d. Shoulder discomfort e. Feeling faint

ANS: B, C, D, E Feedback A. Crushing chest pain is typically associated with male cardiac presentations.

B. Fatigue over several days is seen in female cardiac presentations.

C. Back discomfort is seen in female cardiac presentations.

D. Shoulder discomfort is seen in female cardiac presentations.

E. Feeling faint (lightheadedness) is seen in female cardiac presentations.

PTS: 1

153

REF: 295

20. The nurse is monitoring a patient in moderate congestive heart failure (CHF) who has been admitted to the hospital for an exacerbation. What should the nurse anticipate as part of therapeutic management? (Select all that apply.) a. Regular diet as tolerated b. Furosemide administered via intravenous (IV) line c. Maintaining prone position d. Limiting fluid intake e. Oxygen therapy as needed

ANS: B, D, E Feedback A. A CHF patient in moderate heart failure should be on a 2-g sodium-restricted diet.

B. Furosemide (loop diuretic) will be included in the treatment plan to decrease fluid volume excess.

C. A CHF patient in moderate heart failure should not be maintained in a prone position but rather in a semi-Fowler’s position to facilitate lung expansion.

D. A CHF patient in moderate heart failure will have fluids restricted to prevent further fluid retention.

E. Oxygen therapy as needed will be beneficial to improve tissue perfusion and help decrease the workload of the heart.

PTS: 1 REF: 303

Chapter 17. Immunologic System Medications MULTIPLE CHOICE 1. A patient has been prescribed methotrexate therapy to treat rheumatoid arthritis (RA). Which

information should the nurse include in the plan of care? a. Once you start feeling better, you can stop taking the medication. b. Do not drink alcohol as long as you are taking this medication. c. There is no follow-up testing required while on this medication. d. There are few gastrointestinal side effects.

ANS: B

A

Feedback The health-care provider will indicate when the medication can be stopped, not the nurse. Methotrexate is used on an ongoing basis with appropriate monitoring

154

B C D

to treat RA. This is an accurate statement. Patients on methotrexate should refrain from drinking alcohol.

Methotrexate can impact the liver and cause blood dyscrasias; therefore, follow-up diagnostic testing is required.

Taking this medication can cause gastrointestinal complaints, including nausea, vomiting, and diarrhea.

PTS: 1 REF: 342 2. The LPN answers the phone call of a patient who has been taking prednisolone for treatment

of an acute flare of systemic lupus erythematosus. The patient says, ―The doctor said something about stopping this medication, but I can’t remember what she said.‖ Which response by the nurse is best? a. ―It is important to taper steroid medications slowly. What does the label say?‖ b. ―Once you need to start taking steroids, you usually stay on them indefinitely.‖ c. ―I will have to check your chart and call you back next week.‖ d. ―What did the pharmacy tell you about the medication?‖ ANS: A

A B C D

Feedback Glucocorticoids must be stopped slowly (called a taper), and the instructions for this taper would be included in the prescription.

Many people who take steroids will do so for a period of time and then stop taking them. Most people are not on glucocorticoids indefinitely.

It is important to get the information to the patient earlier than a week.

The pharmacy would not provide the instructions for tapering the medication outside of the physician’s instructions.

PTS: 1 REF: 334

3. An LPN is caring for a patient who has orders for ketorolac. The nurse notes that the patient

has allergies to ibuprofen and diphenhydramine. Which of the following actions by the nurse is best? a. Call the pharmacy to determine if there is any contraindication. b. Give the medication and monitor for any signs or symptoms of rash. c. Ask the RN to contact the physician for alternative orders for pain control. d. Hold the medication and flag the chart for investigation by the RN. ANS: C

A

Feedback Ketorolac is an NSAID that is similar to ibuprofen. The patient should not

155

B C D

receive both medications. The pharmacy would know this; however, the nurse is responsible for knowing this as well.

These medications should not be given together since they are both NSAIDs and have similar properties.

Since ketorolac and ibuprofen are both NSAIDs with similar properties, the RN should contact the physician for alternative pain medication orders.

The RN needs to be notified right away so the patient does not experience a delay in pain management. Flagging the chart does not bring immediate attention to the need for new orders.

PTS: 1 REF: 320

4. An LPN is assisting in the care of a patient with rheumatoid arthritis who takes celecoxib. The

patient is on a pureed diet, and the previous nurse on duty reported that the patient had some difficulty with oral pills. Which of the following actions by the nurse is best? a. Crush the medication and sprinkle it on applesauce. b. Contact the RN for direction. c. Ask the physician for a different pain medication. d. Hold the medication.

ANS: A

A B C D

Feedback The medication can be safely crushed and administered to the patient using applesauce.

The LPN can independently make the decision to crush and administer the medication with applesauce and does not need direction from the RN. The medication can be safely crushed for administration. The physician does not need to order a different medication.

The patient needs to be given the medication for continued management of the rheumatoid arthritis.

PTS: 1 REF: 320

5. The LPN is working with a patient being treated for leukemia. Which medication should the

nurse anticipate that the health-care provider will order to increase blood cell production? a. Interferon alfa-2a b. Alemtuzumab c. Estradiol d. Vincristine ANS: A

156

A B C D

Feedback Interferon alfa-2a is a biological response modifier used in the treatment of leukemia to promote an immune response.

Alemtuzumab is a monoclonal antibody used to kill tumor cells.

Estradiol is a hormone that affects tumor growth.

Vincristine is a plant alkaloid that affects cellular division.

PTS: 1 REF: 332

6. The LPN is assisting in the care of a patient taking gentamicin. The nurse would be most

concerned by which of the following lab values for this patient? a. Hgb = 12.7 g/dL b. Na+ = 138 mEq/L c. K+ = 3.6 mEq/L d. Creatinine = 1.8 mg/dL ANS: D

A B C D

Feedback The hemoglobin (Hgb) level is within normal limits for women.

The sodium (Na+) level is within normal limits.

The potassium (K+) level is within normal limits.

The creatinine level is higher than normal, and gentamicin is an antibiotic that can cause renal compromise.

PTS: 1 REF: 337

7. The LPN is caring for an oncology patient who is to start chemotherapy. The patient asks the

LPN if everyone get the same type of chemotherapy. What is the best nursing response? a. ―Chemotherapy is a general term used to describe oncology treatments.‖ b. ―Chemotherapy is based on the preference of the health-care provider.‖ c. ―Chemotherapy is individualized based on the type of cancer and patient.‖ d. ―Everyone gets the same chemotherapy treatment for malignancies.‖ ANS: C

A

B

Feedback Chemotherapy, which is usually a combination of several antineoplastic (anticancer) and cytotoxic (toxic to cells) medications, is frequently given in several doses for maximum effectiveness.

Chemotherapy is not based on the health-care provider’s preference, but rather

157

C D

on the type of cancer that the individual patient has in conjunction with evidence-based practice.

This is an accurate statement indicating evidence-based practice.

Chemotherapy is individualized based on patient presentation and type of cancer.

PTS: 1 REF: 319

8. The nurse is reviewing the medication profile for a patient who has AIDS. The patient wants

to know why so many medications have to be taken to treat this disease. What is the best nursing response? a. ―HIV is a combination of viral and bacterial agents that attack the body, thereby requiring several different medications.‖ b. ―You may be taking several medications, but they are similar in their action.‖ c. ―AIDS requires that several medications be given around the clock to maintain an effective serum level.‖ d. ―As the virus mutates, several medications are given so as to allow for a better response.‖ ANS: D

A B C D

Feedback AIDS arises from a viral infection; it is not bacterial in origin.

The drugs used to treat AIDS differ in their mechanism of action.

The AIDS treatment plan does not require round-the-clock dosing.

Because HIV mutates easily, it is imperative that patients with AIDS take several medications according to a specific regimen to fight the retrovirus, prevent its reproduction, and protect their immune system.

PTS: 1 REF: 326

9. The LPN working at the health department provides multiple vaccinations each day. Which

type of immunity is being transferred to the patients in this process? a. Active natural immunity b. Passive natural immunity c. Active artificial immunity d. Passive artificial immunity ANS: C

A

Feedback Active natural immunity is obtained by coming in contact with the microbe

158

B C D

unintentionally, not through vaccinations.

Passive natural immunity is immunity that is provided to the fetus from the mother when in utero, not through vaccinations.

Active artificial immunity is obtained through vaccinations.

Passive artificial immunity is obtained when antibodies are passed from a donor to a recipient, not through vaccination.

PTS: 1 REF: 328 - 329

10. The LPN is assisting in the care of a patient who received chlorambucil 2 weeks ago for

chronic myelogenous leukemia. Which of the following lab results would be most concerning to the nurse? a. Glucose = 154 g/dL b. Potassium = 4.2 mEq/L c. Platelets = 84,000/mm3 d. Albumin = 4.0 g/dL ANS: C

A B C D

Feedback Chlorambucil can cause bone marrow suppression but does not affect blood glucose.

Chlorambucil can cause bone marrow suppression but does not affect potassium.

Chlorambucil can cause bone marrow suppression, and the platelet count is low, which indicates that there may be bone marrow suppression.

Chlorambucil can cause bone marrow suppression but does not affect albumin.

PTS: 1 REF: 333

11. The LPN is working with a patient who has had iodine-125 seeds implanted for the treatment

of cervical cancer. The LPN is aware that this patient is best placed in which of the following rooming situations? a. A semiprivate room with a woman who has breast cancer b. A private room at the end of the hall with lead-lined walls c. A private room near the nurses’ station for close monitoring d. A semiprivate room with a woman who has uterine cancer ANS: B

A

Feedback Iodine-125 radioisotopes must be handled carefully to avoid exposure to others who are not being treated with the implants. A semiprivate room would place

159

B C

D

the roommate at risk of exposure.

A private room at the end of the hall with lead-lined walls is appropriate to protect others from exposure to the radioactive isotopes.

Placement of the patient’s room near the nurses’ station would put others at risk of exposure to the radioactive isotopes and thus is not the best choice for room placement.

Placement in a semiprivate room would put the roommate at risk of exposure to the radioactive isotopes and thus is not the appropriate choice.

PTS: 1 REF: 332

12.

The LPN is administering the flu vaccine to a patient. The patient wants to know why they have to take yearly booster shots for the flu each season and not just the same shot from year to year. What is the best nursing response? a. ―Flu vaccines have a limited shelf life and must be repeated each year.‖ b. ―If you take the flu vaccine each year, you will never get the flu.‖ c. ―A flu vaccine is effective for 6 months at best.‖ d. ―As the flu variant changes each year, booster shots help to stimulate a B-cell memory response.‖

ANS: D

A B C D

Feedback The shelf life of the vaccine does not address the needed immune response that is specific to new variants that appear each year.

This statement is not accurate. Vaccines limit the potential risk of getting the flu, but an individual may still get the flu despite being vaccinated.

This statement is not accurate and does not address the needed immune response that is specific to new variants that appear each year.

This statement addresses all of the patient’s concerns, specifically the needed immune response that is specific to new variants that appear each year.

PTS: 1 REF: 329 13.

A patient has been diagnosed with a Trichomonas vaginal infection. Which medication does the nurse anticipate that the health-care provider will order? a. Antibiotic b. Anthelmintic c. Antiprotozoal d. Pediculicide

160

ANS: C

A B C D

Feedback Trichomoniasis is a protozoal infection; therefore, antibiotics will not be effective.

Anthelmintics are used to treat tapeworms, roundworms, and flukes.

As trichomoniasis is a protozoal infection, antiprotozoal medication would be effective.

Pediculicides are used to treat skin lice and other parasites.

PTS: 1 REF: 327 14.

A patient has acquired a severe nosocomial infection following abdominal surgery. Which medication does the nurse anticipate will be ordered? a. Cefepime b. Amoxicillin c. Cefazolin d. Cefuroxime

ANS: A

A B C D

Feedback Cefepime is a fourth-generation cephalosporin used to treat severe nosocomial surgical infections.

Amoxicillin is a penicillin (PCN) indicated for the treatment of mild to moderate infections.

Cefazolin is a first-generation cephalosporin used for the treatment of infections in individuals who are allergic to PCN. Cefuroxime is a second-generation cephalosporin used to treat nosocomial infections such as pneumonia and pelvic or intra-abdominal infections.

PTS: 1 REF: 323

15.

The LPN has received the results of a urine culture and sensitivity report. Findings indicate that the pathogen is sensitive to the prescribed medication. What is the next action the nurse should take?

161

a. b. c. d.

Contact the health-care provider.

Hold the next dose of the medication.

Continue to administer the medication.

Contact the RN.

ANS: C

A B C D

Feedback There is no need to contact the health-care provider, as the pathogen is sensitive to the prescribed medication.

There is no need to hold the next dose of the medication, as it is effective against the pathogen.

The nurse should continue to administer the medication as ordered.

There is no need to contact the RN, as the medication is effective against the pathogen.

PTS: 1 REF: 323

MULTIPLE RESPONSE 16. The nurse is reviewing immune responses of the elderly population, Which factors contribute

to a decreased immune response in the elderly? (Select all that apply.) a. Decreased production of B cells b. Desensitized memory cells c. Increased cytokine release d. Strong antibody response e. Decreased production of T cells ANS: A, B, E

A. B. C. D. E.

Feedback In the elderly population, one sees fewer B (bone marrow) and T (thymus) white blood cells in the immune system.

Memory cells require activation by immunization to become more responsive.

Memory cells are decreased due to less B-cell production in the elderly.

Decreased cytokine release is seen as a consequence of decreased T-cell production.

A strong initial antibody response is not seen in the elderly population due to a decrease in B cells.

In the elderly population, one sees fewer B (bone marrow) and T (thymus) white blood cells in the immune system.

162

PTS: 1 REF: 319

17. The LPN is monitoring a patient who has taken a new prescribed oral antibiotic medication

for a skin infection. Which of the physical findings should alert the nurse to an increased likelihood of an anaphylactic reaction? (Select all that apply.) a. Presence of hives b. Sneezing c. Nasal congestion d. Watery eyes e. Swelling of extremities ANS: A, E

A. B. C. D. E.

Feedback The presence of hives indicates an autoimmune inflammatory response that is significant.

Sneezing would be noted as a mild allergic response.

Nasal congestion would be noted as a mild allergic response.

Watery eyes would be noted as a mild allergic response.

The presence of edema indicates an autoimmune inflammatory response that is significant.

PTS: 1 REF: 319

18 The nurse is caring for a patient receiving a nasal decongestant (tetrahydrozoline). Which

observations indicate the potential for the development of rebound congestion? (Select all that apply.) a. The patient is using the medication prophylactically. b. The patient has been using the medication for 3 days. c. The patient is performing hand hygiene prior to administration. d. The patient is continuing to use the medication past 7 days. e. The patient is frequently blowing their nose.

ANS: A, D

A. B. C. D. E.

Feedback Nasal decongestants should not be used prophylactically, as repeated long-term use can lead to the development of rebound congestion.

Nasal decongestant therapy is prescribed for 3 to 7 days.

Hand hygiene is a critical step in medication administration and does not lead to rebound congestion.

Using nasal decongestants longer than 7 days can lead to the development of rebound congestion.

This is an expected part of relieving nasal congestion and does not lead to the

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development of rebound congestion.

PTS: 1 REF: 320

19. The LPN is assisting in the care of a patient who receives fluorouracil in the treatment of

colorectal cancer. Which of the following assessments would be appropriate in the care of this patient? (Select all that apply.) a. Determine if the patient is experiencing nausea or vomiting. b. Maintain strict intake and output measurements. c. Encourage high-fiber and spicy foods. d. Monitor vital signs, particularly temperature, frequently. e. Place the patient on contact precautions.

ANS: A, B, D

A. B. C. D. E.

Feedback Fluorouracil is a chemotherapeutic agent that can cause nausea and vomiting.

The patient needs to be monitored for these side effects.

Strict intake and output need to be monitored due to the risk of nausea, vomiting, and decreased intake.

High-fiber and spicy foods are not encouraged in patients receiving chemotherapy, as they may experience gastrointestinal (GI) irritation.

Vital signs, particularly temperature, are monitored closely due to the potential side effects associated with chemotherapy treatment.

There is no reason the patient should be placed on contact precautions at this time.

PTS: 1 REF: 332 - 333

Chapter 18. Pulmonary System Medications MULTIPLE CHOICE 1. The LPN is monitoring a patient who presents to the clinic with complaints of congestion.

Auscultation of lung fields reveals slightly diminished breath sounds. Chest x-ray reveals no pathology. Vital signs are stable. Which therapeutic intervention does the nurse anticipate next? a. Antibiotic injection followed by oral antibiotic therapy b. Admission to the hospital c. Oral antibiotic therapy for 3 days d. Over-the-counter (OTC) ibuprofen as needed

164 ANS: A

A

B C D

Feedback A patient is given an injection of an antibiotic followed by an oral medication course. This injection jump starts the healing process without the need for intravenous (IV) infusions and hospitalization. As the imaging study identifies no pathology, this option would be anticipated.

There is no need to admit the patient to the hospital at this time, as the imaging study identifies no pathology and vital signs are stable.

Oral antibiotic therapy for treatment of respiratory infections is typically ordered over 10 to 14 days.

The patient has no fever and no complaints of pain or discomfort are noted.

While ibuprofen may be needed, it is not the priority at this time.

PTS: 1 REF: 353 2. The LPN is talking to a patient newly prescribed nedocromil who asks, ―Why do I have to

take this medication? Why can’t I just take my inhaler when I have an asthma attack?‖ Which of the following responses by the nurse is best? a. ―This medication helps block asthma triggers from entering your lungs.‖ b. ―By suppressing your immune system, this medication helps treat your asthma.‖ c. ―This medication helps decrease your body’s reaction to things that set off an asthma attack.‖ d. ―The nedocromil helps thin secretions so it is easier for you to clear your lungs.‖ ANS: C

A B C D

Feedback Nedocromil does not stop asthma triggers from entering the body.

Nedocromil does not suppress the immune system.

Nedocromil is a mast cell stabilizer that reduces the body’s reaction to asthma triggers, reducing asthma attacks.

Nedocromil does not have an effect on the consistency of secretions.

PTS: 1 REF: 351 3. The LPN is assisting a patient newly diagnosed with influenza who has been given a

prescription for oseltamivir. The nurse recognizes that the patient is aware of potential side effects by which of the following statements? a. ―I might feel my heart racing when I take this medication.‖ b. ―Some people get really constipated when they take this.‖ c. ―The medication is likely to make me feel hungry often.‖ d. ―This medication may cause nervousness or difficulty sleeping.‖ ANS: D

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A B C D

Feedback Oseltamivir is not known to cause alterations in heart rate.

Oseltamivir is not known to cause constipation.

Oseltamivir is not known to cause changes in appetite.

Oseltamivir is known to cause nervousness or difficulty sleeping.

PTS: 1 REF: 359

4. A patient admitted to the hospital for management of hypertension (HTN) is found to have

latent tuberculosis (TB). Based on this information, which room assignment would be best? a. Private or semi-private room on medical floor b. Isolation room on medical floor c. Private room closest to the nurses’ station d. Intensive care unit (ICU) ANS: A

A B C D

Feedback Individuals who have latent TB are not considered contagious. Therefore, the patient can be placed in either a private or semi-private room as needed.

Individuals who have latent TB are not considered contagious. Therefore, they do not need to be placed in an isolation room.

The patient is being admitted for management of HTN. There is no need to have a room closest to the nurses’ station.

The patient is being admitted for management of HTN. There is no clinical information to support an ICU admission.

PTS: 1 REF: 353

5. The LPN is caring for a cystic fibrosis patient who has been prescribed Mucomyst. Which

action should the nurse anticipate related to the administration of this medication? a. A respiratory therapist (RT) will administer the medication. b. This medication is available as an oral formulation. c. Fluid intake will be limited during the course of therapy. d. This medication is used in conjunction with antitussive medications.

ANS: A

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A B C D

Feedback This is a mucolytic medication administered as an aerosol preparation by the RT. This is a mucolytic medication that is administered as an aerosol preparation.

Fluid intake is not limited, as it is important to maintain hydration.

Antitussive medications are not used because with frequent daily mucolytics as part of their respiratory care, patients are able to remove secretions through coughing and thus decrease the occurrence of lung infections.

PTS: 1 REF: 356

6. The LPN is monitoring a patient who has started smoking cessation gum therapy. Which

patient statement warrants immediate attention? a. The patient takes gum on a daily basis. b. The patient indicates a decrease in cigarettes from four to two a day. c. The patient reports a slight weight gain of 1 pound since last visit. d. The patient likes the taste of the gum.

ANS: B

A B C D

Feedback This action does not require immediate attention.

A patient who is on smoking cessation therapy should not smoke at all, as this can lead to a nicotine overdose.

Weight gain is sometimes seen during smoking cessation therapy. This amount of weight gain is not significant and does not require immediate attention.

This finding does not require immediate attention.

PTS: 1 REF: 361 7. After reviewing a new prescription for theophylline, the nurse would ensure the patient

understood which of the following? a. Careful monitoring with blood tests will be necessary. b. The medication can greatly increase the patient’s risk of bleeding. c. Seizure medications may need to be increased to maintain effectiveness. d. The medication can dampen libido in some patients.

ANS: A

A B

Feedback Theophylline has a narrow safety range, and blood tests are needed to monitor for appropriate dosing.

Theophylline does not increase the risk of bleeding.

167 C D

Theophylline does not interfere with seizure medications.

Theophylline does not alter libido.

PTS: 1 REF: 359

8. The LPN is working with a patient in a long-term care facility who takes metaproterenol . The

nurse is aware that the patient’s blood pressure that morning was 118/68. Which action should the nurse take? a. Provide the metaproterenol. b. Hold the metaproterenol. c. Contact the RN for instructions. d. Contact the physician for instructions.

ANS: A

A B C D

Feedback The medication should be administered. The blood pressure (BP) is within normal limits, but the medication can increase the BP. The metaproterenol should not be held.

There is no need to contact the RN for instructions. The blood pressure is within normal limits, so there is no concern.

The physician does not need to be contacted. The blood pressure is within normal limits, so there is no concern.

PTS: 1 REF: 354, 360

9. The nurse is working with a patient who wants to stop smoking but does not want to do it cold

turkey. Which medication should the nurse anticipate that the health-care provider will order? a. Varenicline b. Bupropion hydrochloride c. NicoDerm d. Nicorette ANS: A

A

B C

Feedback Varenicline is a newer type of smoking cessation medication that can be used with behavioral modification. One can still smoke during treatment but eventually will lose the desire to smoke.

Bupropion hydrochloride is an antidepressant used to treat smoking cessation but has a high risk of suicidal ideation.

When using NicoDerm, one must stop smoking to prevent possible nicotine

168

D

overdose.

When using Nicorette, one must stop smoking to prevent possible nicotine overdose.

PTS: 1 REF: 358

10. The nurse is caring for a patient recently returned from surgery who is on oxygen at 2 L per

minute via nasal cannula. The patient has a continuous pulse oximeter in place, and the monitor alarms and indicates that the patient’s oxygen saturation is 88%. Which action by the nurse is best? a. Replace the nasal cannula with a simple face mask. b. Notify the RN of the need for emergency treatment. c. Instruct the patient to take deep breaths through the nose. d. Reset the alarm to indicate a saturation of 85% or less.

ANS: C

A B C D

Feedback The use of a nasal cannula is appropriate; however, changing to a mask would be dangerous due to the low flow rate of oxygen.

This patient does not have a need for emergency treatment.

The patient may still be sedated from surgery and need to be aroused and reminded to take deep breaths through the nose.

The oxygen saturation should be between 90% and 95% (at least), and resetting the alarm to 85% would be potentially dangerous for the patient.

PTS: 1 REF: 357 11. The LPN is working with a patient diagnosed with tuberculosis (TB). Which patient statement

indicates that additional teaching is needed? a. ―This condition can be treated with several medications.‖ b. ―Antibiotic therapy is part of the treatment plan.‖ c. ―The disease is bacterial in origin.‖ d. ―The therapy should last 30 days.‖ ANS: D

A

B C

Feedback TB is treated with several different medications for a prolonged course of therapy. Pharmacological treatment of TB requires exact adherence to a regimen of several drugs over 6 to 12 months because the bacteria that cause TB are eradicated very slowly.

Antibiotics are included in the TB treatment plan.

TB is caused by Mycobacterium tuberculosis, which is highly contagious.

169 D

Pharmacological treatment of TB requires exact adherence to a regimen of several drugs over 6 to 12 months because the bacteria that cause TB are eradicated very slowly.

PTS: 1 REF: 353

12. The LPN is counseling a patient who is taking bupropion. Which of the following statements

is most important to include in the teaching? a. ―Smoking is a very hard addiction to break, so we encourage you to seek support from others.‖ b. ―Be sure you do not smoke while you are taking this medication or you could overdose on nicotine and end up in the emergency room.‖ c. ―This medication can cause people to think about killing themselves, so it is imperative that you notify the doctor if you have any thoughts like that.‖ d. ―Your prescription is only good for 10 days, so you must have it filled soon or it will expire.‖ ANS: C

A B C D

Feedback Although support from others while stopping smoking is important, it is not the priority safety concern for the patient.

Bupropion does not contain nicotine and does not cause a person to overdose on nicotine.

The most serious side effect associated with bupropion is thoughts of suicide, and this teaching needs to be completed to keep the patient safe.

Bupropion is not a controlled substance, so the prescription will not expire in a short period of time.

PTS: 1 REF: 358

13. The nurse is assisting in the care of a patient who smokes two packs of cigarettes per day. The

patient has been prescribed a 14-mg nicotine patch. The patient expresses a desire to smoke.

Which action by the nurse is best? a. Allow the patient to smoke one cigarette four times daily to curb cravings. b. Contact the physician to request an order for Nicorette gum as needed. c. Contact the pharmacy and request a 21-mg patch to replace the 14-mg patch. d. Inform the patient that smoking is against institutional policy and is not good for her.

ANS: B

A

Feedback Patients should not smoke while using the nicotine patch to avoid the risk of

170

B C D

nicotine overdose.

The use of nicotine gum may assist in curbing breakthrough cravings and can safely be used.

The patient may need a 21-mg dose; however, the physician must order the dose change. The nurse cannot.

The policy may not allow for smoking; however, the best way to support smoking cessation is to assist the patient in reducing the desire to smoke.

PTS: 1 REF: 361

14.The LPN is working with a patient who has a positive purified protein derivative (PPD) test but

does not have active TB. What is the best explanation for this finding? a. The patient has been successfully treated for the disease in the past. b. This is a false-positive finding, and the test should be repeated. c. The patient has active disease and should be quarantined. d. There are changes noted on imaging studies.

ANS: A

A

B C D

Feedback A positive PPD test is seen in both active and latent TB. In latent TB, patients do not have any signs of active disease, such as changes in their chest radiographs. They have been exposed to the disease and the tubercles are in their bodies, but they are not making them sick.

This is not an accurate statement, as a positive PPD test can be seen in both active and latent TB. This is not an accurate statement, as the patient does not have active disease.

This is not an accurate statement, as in latent TB patients do not have any changes in their chest radiographs.

PTS: 1 REF: 353 15.

A patient presents to the clinic with complaints of flu-like symptoms. Temperature is 39°C. The patient reports recent onset of symptoms within the last 24 hours. What priority medication does the LPN anticipate that the health-care provider will order? a. Ibuprofen b. Acetylsalicylic acid (ASA) c. Tamiflu d. Amoxicillin

171

ANS: C

A B C D

Feedback Ibuprofen can be ordered but is not the priority medication.

ASA is typically not ordered for treatment of the flu.

Presentation with flu-like symptoms within a 48-hour window can be treated with Tamiflu to reduce signs and symptoms.

Antibiotics are not ordered, as the flu is viral in nature.

PTS: 1 REF: 359

MULTIPLE RESPONSE 16. The nurse is providing care for a patient with a long-term history of asthma and an acute

exacerbation. The patient is started on aminophylline. Which of the following side effects would the nurse include in the patient teaching? (Select all that apply.) a. Altered heart rhythm b. Excitability/central nervous system (CNS) stimulation c. Drowsiness d. Increased blood sugar e. Constipation ANS: A, B, D

A. B. C. D. E.

Feedback Aminophylline is known to cause heart dysrhythmias.

Aminophylline is known to cause excitability/CNS stimulation.

Aminophylline is not known to cause drowsiness.

Aminophylline can cause an increase in blood sugar.

Aminophylline is not known to cause constipation.

PTS: 1 REF: 359 17. The LPN is reviewing the medication profile of a patient who takes OTC decongestants on a

regular basis for seasonal allergies. Which medications, if noted on the profile, warrant immediate intervention? (Select all that apply.) a. Acetaminophen as needed for pain relief b. Daily multivitamin c. Ibuprofen as needed for pain relief

172 d. Furosemide 20 mg once a week e. Vitamin D3 at 2,000 units daily ANS: A, C

A.

B. C.

D. E.

Feedback Dosages of medications such as acetaminophen and ibuprofen need to be monitored closely to avoid overdose situations, as OTC decongestants can include antipyretics and analgesics in allergy remedies.

There is no interaction between a daily multivitamin and OTC decongestants.

Dosages of medications such as acetaminophen and ibuprofen need to be monitored closely to avoid overdose situations, as OTC decongestants can include antipyretics and analgesics in allergy remedies.

There is no interaction between diuretic therapy and OTC decongestants.

There is no interaction between vitamin D3 and OTC decongestants.

PTS: 1 REF: 356 18. A nurse is monitoring a patient who has an exacerbation of chronic obstructive pulmonary

disease (COPD). Which actions would lead to decreased oxygenation? (Select all that apply.) a. Administering low-dose oxygen therapy b. Placing the patient in a semi-Fowler’s position c. Providing oxygen via mask at 70% d. Administering oxygen above 4 L/min via nasal cannula e. Administering oxygen therapy at 15 L/min.

ANS: C, D, E

A. B. C. D. E.

Feedback Low-dose oxygen therapy would not lead to decreased oxygenation.

Placing the patient in a semi-Fowler’s position would assist in supporting ventilation and would not lead to decreased oxygenation.

Patients with COPD are adapted to a low-oxygen environment, and delivery of a high level of oxygen can be dangerous, reducing the drive to breathe.

Patients with COPD are adapted to a low-oxygen environment, and delivery of a high level of oxygen can be dangerous, reducing the drive to breathe.

Patients with COPD are adapted to a low-oxygen environment, and delivery of a high level of oxygen can be dangerous, reducing the drive to breathe. 15L/min is too high a dosage for patients who have COPD.

PTS: 1 REF: 352

19. A patient has been prescribed cromolyn sodium for treatment of asthma. Which information should the LPN include in patient teaching for this medication? (Select all that apply.) a. Best effect is achieved when used during an acute asthma attack.

173

b. c. d. e.

It may take several weeks for the medication to be effective.

The medication is available in capsules for easy administration.

The medication can be administered via nebulizer or metered-dose inhaler (MDI).

The medication can be administered intranasally.

ANS: B, D, E Feedback A. Cromolyn sodium is a mast cell stabilizer and is not indicated for use in acute asthma attacks.

B. Cromolyn sodium may take several weeks (2 to 6) to start working.

C. Cromolyn sodium is not available in an oral formulation.

D. Cromolyn sodium is available via nebulizer or MDI. E. Cromolyn sodium is available in intranasal form for seasonal allergies.

PTS: 1 REF: 351

20. A patient presents to the clinic with a productive cough with clear drainage. Auscultation of lung fields reveals no abnormalities. Vital signs are stable except for a temperature of 38°C. Which medication does the nurse anticipate that the health-care provider will order? (Select all that apply.) a. Antibiotic b. Antitussive c. Expectorant d. Antiviral e. Antipyretic

ANS: C, E Feedback A. As there is clear drainage, no antibiotic therapy is indicated at this time.

B. Antitussive medication would help to suppress the cough. As the patient has a productive cough, an expectorant medication would be indicated to help clear the lungs and upper airway by thinning secretions.

C. As the patient has a productive cough, an expectorant medication would be indicated to help clear the lungs and upper airway by thinning secretions.

D. There is no evidence of a viral infection; therefore, antiviral medication would not be indicated.

E. Antipyretic medication should be ordered to treat the patient’s low-grade fever.

PTS: 1

174

REF: 356

Chapter 19. Gastrointestinal System Medications MULTIPLE CHOICE 1. A patient is preparing to take sorbitol for constipation. Which finding warrants immediate

intervention by the nurse? a. Respirations 20 b. Blood pressure (BP) 180/100 c. Temperature 38°C d. Pulse oximetry 99% on room air ANS: B

A B C

D

Feedback This is a normal finding.

Sorbitol is an osmotic laxative and is contraindicated in hypertensive patients.

Even though this assessment indicates a low-grade fever, this does not require immediate intervention and can be addressed following attention to the elevated BP. This is a normal finding.

PTS: 1 REF: 369 2. The LPN is assisting in the care of a patient who requests a suppository to aid in the passage

of hard stool. Which of the following medications ordered on a prn basis would the nurse provide? a. Orlistat b. Polyethylene glycol c. Glycerin d. Cimetidine ANS: C

A B C D

Feedback Orlistat is a lipase inhibitor and is not indicated for the treatment of constipation.

Polyethylene glycol is given orally rather than as a suppository.

Glycerin is given as a suppository to assist in the management of constipation.

Cimetidine is usually used to treat nausea rather than constipation.

PTS: 1 REF: 369

175 3. The patient is preparing for a colonoscopy and was given a prescription for polyethylene

glycol electrolyte solution. The patient was instructed to remain on clear liquids and then perform the prep from 10 a.m. to 11 a.m., remain nothing by mouth (NPO) after the prep, and report for the procedure at 4 p.m. She typically takes her morning blood pressure medication and vitamins at 9 a.m. with her breakfast. Which of the following actions is best? a. Do not take the morning medications until after the procedure. b. Take the morning medications with a liquid breakfast at 8 a.m. or earlier. c. Take the morning medications with breakfast at 9 a.m. as usual. d. Take the blood pressure medication at 9 a.m. with a clear liquid meal, but not the vitamins.

ANS: B

A B

C

D

Feedback The patient needs to have her blood pressure managed with medication, and the medication should not be delayed until after the procedure.

Medications taken within an hour of the gastrointestinal (GI) prep may be flushed from the GI tract rather than absorbed. The medication may be given earlier than usual to ensure the patient receives her dose of medication prior to the procedure.

Taking the medication at 9 a.m. risks the medication being flushed from her system without being absorbed when the prep is started at 10 a.m. The medication should be given earlier.

The medication needs to be taken to avoid elevations in blood pressure and needs to be taken more than an hour prior to the prep being started to avoid flushing the medication from the GI tract.

PTS: 1 REF: 369 4. The LPN is talking to a pregnant patient who complains of constipation and wants to take an

over-the-counter (OTC) medication. Which medication does the nurse suggest for this patient to alleviate constipation? a. Psyllium b. Castor oil c. Docusate d. Senna ANS: A

A B C D

Feedback Psyllium is a bulk-forming laxative that can be used during pregnancy.

Castor oil is a stimulant laxative that should not be used during pregnancy due to the possibility of stimulating premature labor.

Docusate is a stool softener but will not have a direct effect on constipation.

Senna is a stimulant laxative that should not be used during pregnancy due to the possibility of stimulating premature labor.

176

PTS: 1 REF: 368 5. A patient has been diagnosed with traveler’s diarrhea. Which medication does the nurse

anticipate that the health-care provider will order? a. Loperamide b. Sulfasalazine c. Mesalamine rectal d. Ciprofloxacin ANS: D

A B C D

Feedback Loperamide is available OTC and is not used to treat this severe type of diarrhea.

Sulfasalazine is an anti-inflammatory medication used to treat ulcerative colitis.

Mesalamine rectal is an anti-inflammatory medication used to treat ulcerative colitis.

Ciprofloxacin is a common antibiotic used to treat traveler’s diarrhea.

PTS: 1 REF: 370 6. The student nurse is studying the various types of medications that can be used to treat nausea

and vomiting. If asked which classification of these medications can also be used to treat motion sickness, the student nurse would select which of the following? a. 5-hydroxytryptamine 3 receptor antagonists b. Antihistamines c. Anticholinergic medications d. Phenothiazines ANS: B

A B C D

Feedback The 5-hydroxytryptamine 3 receptor antagonists are antiemetics but are not used to treat motion sickness.

Antihistamines can be used to treat motion sickness as well as nausea and vomiting.

Anticholinergic medications can be used to treat nausea and vomiting but are not used to treat motion sickness.

Phenothiazines can be used to treat nausea and vomiting but are not used to treat motion sickness.

PTS: 1 REF: 370 7. Which of the following would cause the nurse to intervene for a patient taking pantoprazole?

177 a. b. c. d.

The patient takes the medication an hour before breakfast.

The patient has a history of gastric ulceration.

The patient has an allergy to sulfa antibiotics.

The patient reports having just taken a Tums for heartburn.

ANS: D

A B C D

Feedback Taking pantoprazole prior to a meal reduces acid and improves absorption.

Patients with a history of gastric ulceration commonly take pantoprazole to reduce acid, thereby reducing gastric ulceration.

Patients with an allergy to sulfa antibiotics can take pantoprazole.

Taking Tums prior to taking pantoprazole will reduce absorption of the medication and reduce its effectiveness.

PTS: 1 REF: 373 8. A patient has been taking bismuth subsalicylate OTC for treatment of occasional gastric upset.

Which finding warrants immediate intervention by the nurse? a. Occasional stomach cramping b. Black tongue c. Passage of two stools daily d. Drinking 8 glasses of fluid daily ANS: B

A B C D

Feedback This finding does not warrant immediate intervention.

A black tongue indicates an adverse reaction, and the medication should be discontinued.

This finding is within normal limits.

This finding indicates adequate fluid replacement.

PTS: 1 REF: 371 9. The nurse is caring for a patient receiving magnesium hydroxide every 2 hours while awake

for the treatment of a peptic ulcer. Which of the following side effects should the nurse monitor for? a. Kidney stone formation b. Headache c. Blood clot formation d. Tremors ANS: A

Feedback

178 A B C D

Antacids can cause kidney stones.

Antacids are not known to cause headaches.

Antacids are not known to contribute to blood clot formation.

Antacids are not known to cause tremors.

PTS: 1 REF: 381 10. A patient with chronic nausea that has been resistant to both OTC and prescribed medications

asks the LPN what other options are available for treatment. What is the best nursing response? a. Evaluation for medical marijuana b. Referral to pain management c. Behavioral modification strategies to ease stress d. Limiting fluid intake with meals ANS: A

A B C

D

Feedback Medical marijuana can be prescribed in certain states, and the patient may ask for evaluation for this type of therapy since no prior therapy has been effective.

The patient is not complaining of pain; therefore, this referral is not needed.

Behavioral modifications to limit stress may be indicated, but this option does not address the physical complaint of the patient and attributes it to a psychological etiology without confirmation.

While limiting fluid intake with meals can be used to treat nausea, as the patient has chronic nausea that has been resistant to previous therapies, this is not the best option.

PTS: 1 REF: 371 11. A nurse is working with a pregnant patient who complains of nausea without vomiting. What

medication should the nurse suggest to manage this complaint? a. Bismuth subsalicylate b. Phosphorated carbohydrate solution c. Chlorpromazine d. Ondansetron ANS: B

A B C

Feedback Bismuth subsalicylate should not be used during pregnancy.

Phosphorated carbohydrate solution is sold OTC and can be safely used during pregnancy to treat nausea without vomiting.

Chlorpromazine is a phenothiazine used to treat nausea and vomiting and requires a physician’s prescription.

179 D

Ondansetron is a 5-hydroxytryptamine 3 receptor antagonist that is used to treat nausea and vomiting associated with chemotherapy and requires a physician’s prescription.

PTS: 1 REF: 370 12. The LPN is counseling a patient with a history of peptic ulcers. Which statement by the

patient indicates that immediate intervention is needed? a. ―I limit my alcohol intake to one beer a week.‖ b. ―I try to drink decaffeinated beverages as much as possible.‖ c. ―I drink four glasses of milk a day.‖ d. ―I occasionally eat spicy foods.‖ ANS: C

A B C D

Feedback Alcohol intake should be limited in patients with a history of peptic ulcers.

It is best to stay away from caffeine, so this statement requires no intervention.

Helicobacter pylori grows very well in milk, and milk is perhaps one of the worst treatments to recommend. Immediate intervention is therefore required.

Occasionally eating spicy foods does not require immediate intervention.

PTS: 1 REF: 373 13. The LPN is monitoring a patient who has been prescribed a lipase inhibitor. Which finding

indicates noncompliance with the treatment? a. Flatulence b. Frequent oily stools c. Cough d. Constipation ANS: B

A B C D

Feedback Flatulence is an expected side effect of the medication.

If ingesting high-fat meals, frequent oily stools are seen as a response. When on a lipase inhibitor, the patient should limit their fat intake.

Cough does not occur with the use of a lipase inhibitor.

Constipation does not occur with the use of a lipase inhibitor.

PTS: 1 REF: 382 14. An LPN working in a long-term care facility would use nystatin for which of the following

patients? a. A 75-year-old patient who has oral candidiasis

180 b. A 69-year-old patient who has gallstones c. An 88-year-old patient who has peptic ulcer disease d. A 91-year-old patient who has loose or liquid stools ANS: A

A B C D

Feedback Nystatin is an antifungal agent used for the treatment of oral candidiasis.

Nystatin is an antifungal agent; it does not reduce the formation of gallstones.

Nystatin is an antifungal agent; it does not treat peptic ulcer disease.

Nystatin is an antifungal agent; it does not treat loose stools.

PTS: 1 REF: 377 15. A patient has been diagnosed with thrush and the prescription is available as a troche. Which

instructions should the LPN provide to the patient? a. Swallow with a glass of water. b. Insert the troche into the vaginal area. c. Place the troche in the mouth to dissolve. d. Cut the troche in half and take 30 minutes apart.

ANS: C

A B C D

Feedback A troche should not be chewed or swallowed.

Thrush is a Candida infection of the oral cavity.

This is a factual statement indicating correct administration.

This is not correct. A troche should not be chewed or swallowed or cut in half.

PTS: 1 REF: 377

MULTIPLE RESPONSE 16. The LPN would expect that the treatment plan would likely include psyllium for which of the

following individuals? (Select all that apply.) a. A 52-year-old patient who drinks prune juice with breakfast and has a soft brown stool daily b. A 51-year-old patient hospitalized for an anterior myocardial infarction c. A 60-year-old patient who reports walking over a mile every day d. A 52-year-old patient reporting increased constipation since the onset of menopause e. A 35-year-old patient who recently had a hemorrhoidectomy ANS: B, D, E

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A. B. C. D. E.

Feedback This patient does not need further treatment for constipation.

This patient should avoid straining due to the history of myocardial infarction (MI), and psyllium will assist in managing constipation.

This patient is not demonstrating any signs of constipation or a history that calls for constipation management.

Psyllium is used for management of constipation and can be used for long-term management.

Psyllium is used for management of constipation and can be used to prevent trauma to the site of the hemorrhoidectomy and the return of hemorrhoids.

PTS: 1 REF: 376 17. The LPN is working with a group of elderly patients in an assisted living facility (ALF).

Which findings contribute to gastrointestinal (GI) issues in the elderly? (Select all that apply.) a. Polypharmacy b. Constipation c. Diarrhea d. Decreased gastric motility e. Decreased stomach lining ANS: A, B, D, E

A. B. C. D. E.

Feedback The elderly population tends to be on multiple medications (polypharmacy), which can significantly impact the gastrointestinal tract.

Constipation is seen in elderly patients due to the interactions of polypharmacy and decreased fluid intake.

Diarrhea is not associated with aging.

The motility of the GI system slows with aging.

The lining of the stomach thins with aging, which can lead to the development of peptic ulcers.

PTS: 1 REF: 366 18. The LPN is caring for a patient who has had gastrointestinal problems for many years and

takes several GI medications. Which priority information should the LPN obtain in order to assess proper administration of medications? (Select all that apply.) a. Patient’s present height and weight b. Specific names of the prescribed medications c. Timing of the medications d. Whether the medications are to be taken with food e. Name of the pharmacy the patient uses ANS: B, C, D

Feedback

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A. B. C. D.

E.

Present height and weight are not a priority at this time.

The LPN should obtain the specific names of the prescribed medications so as to verify the order.

The LPN should obtain specific information about when the medications are scheduled to be taken to check compliance and efficacy of treatment.

The LPN should obtain specific information about whether the medications are to be taken with food or if the patient is to take them on an empty stomach, as this will affect the efficacy of the medications.

The name of the pharmacy where the medications are obtained is not a priority at this time.

PTS: 1 REF: 368 19. An LPN is assessing an elderly patient who is complaining of constipation. What findings

does the LPN associate with an increased risk of constipation? (Select all that apply.) a. Exercise b. Furosemide 40 mg daily c. Decreased fluid intake d. Aging e. Dairy products ANS: B, C, D

A. B. C. D. E.

Feedback Exercise is not associated with constipation.

Diuretic therapy such as furosemide can contribute to constipation due to fluid removal leading to the formation of hard stools.

Decreased fluid intake can contribute to constipation.

Aging can contribute to constipation due to slowing of GI tract motility.

Dairy products are not associated with constipation but can be associated with diarrhea.

PTS: 1 REF: 368 20. The LPN would expect which of the following individuals to take some type of digestive

medication? (Select all that apply.) a. A 5-year-old patient with cystic fibrosis b. A 15-year-old patient with type 1 diabetes c. A 27-year-old patient with Crohn’s disease d. A 34-year-old patient with lactose intolerance e. A 28-year-old patient with an allergy to eggs ANS: A, D

A.

Feedback Patients with cystic fibrosis often cannot digest fats and need digestive medications.

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B. C. D. E.

Patients with diabetes do not have difficulty digesting food.

Patients with Crohn’s disease do not have difficulty digesting food; Crohn’s disease creates difficulty absorbing nutrients.

Patients with lactose intolerance need medications such as Lactaid to assist in digesting lactose.

Patients with allergies to eggs do not need medications to aid digestion.

PTS: 1 REF: 378

Chapter 20. Reproductive and Urinary System Medications MULTIPLE CHOICE

1. A group of student nurses are reviewing medications used to stop premature labor. Which

statement indicates that this review has been effective? a. ―Tocolytic therapy enhances the effect of oxytocin.‖ b. ―Off-label uses are noted for tocolytic therapy.‖ c. ―There are few side effects with tocolytic agents.‖ d. ―No additional monitoring is required for tocolytic therapy.‖ ANS: B

A B C D

Feedback Tocolytic therapy opposes the action of oxytocin.

Tocolytic medications are labeled for other uses, but they are commonly used to stop labor.

Tocolytic therapy has significant side effects, and the patient and fetus require additional monitoring, as they are considered to be at high risk.

The patient and fetus require additional monitoring, as they are considered to be at high risk.

PTS: 1 REF: 394 2. A woman at 42 weeks’ gestation is in for an appointment with the gynecologist. The woman

reports inconsistent contractions on and off for 3 days, and it is determined the cervix is not dilated at this time. The doctor informs the woman that they would like to administer dinoprostone . The nurse would help the woman understand this medication by stating which of the following? a. ―It is given in IV form and is designed to stimulate labor within a few minutes.‖ b. ―It is a gel placed into the cervix to help soften it and should allow labor to start in 6 hours or less.‖ c. ―It is a cream inserted into the vagina to help prevent cervical dilation and

184

postpone delivery.‖ d. ―It is an intramuscular injection given to help reduce muscle tension and stop

contractions.‖ ANS: B

A B C D

Feedback Dinoprostone is not given via intravenous (IV) line; it is a cervical ripening gel placed into the cervix.

Dinoprostone is a cervical ripening gel that will cause labor to start in approximately 6 hours.

Dinoprostone is a gel, not a cream.

Dinoprostone is a gel that is placed into the cervix; it is not given via the intramuscular (IM) route.

PTS: 1 REF: 393

3. The LPN is working in an obstetrics and gynecology (OB/GYN) office and taking the history

of a patient who is seeking treatment for infertility. Which medication is most commonly prescribed when there is no specific reason for infertility? a. Estrogen b. Clomiphene c. Menotropins d. Chorionic gonadotropin ANS: B

A B C

D

Feedback Estrogen is not used as a treatment for infertility.

Clomiphene is the drug of choice when infertility has no obvious cause, and the medication is taken orally with minimal side effects.

Menotropins are given as an injection that stimulates follicle ripening and release. This treatment is indicated in women who have functional ovaries but in whom hormonal stimulation is lacking.

Chorionic gonadotropin is given as an injection in combination with clomiphene to stimulate the release of a mature egg.

PTS: 1 REF: 402 4 An LPN is assessing a patient with a confirmed diagnosis of trichomoniasis. Which

medication does the nurse anticipate that the health-care provider will order? a. Acyclovir b. Metronidazole c. Miconazole

185 d. Penicillin ANS: B

A B C D

Feedback Acyclovir is an antiviral used to treat herpes.

Metronidazole is an antibacterial used to treat trichomoniasis.

Miconazole is an antifungal used to treat yeast infections.

Penicillin is an antibiotic used to treat syphilis.

PTS: 1 REF: 394 5. An LPN working at a community health fair recognizes that which of the following

individuals is at highest risk of erectile dysfunction? a. A 44-year-old man with a history of inguinal hernia b. A 50-year-old man with a history of asthma c. A 48-year-old man with a history of diabetes d. A 52-year-old man with a history of cholecystitis ANS: C

A B C D

Feedback Inguinal hernia does not carry a risk of erectile dysfunction.

Patients with asthma do not have an increased risk of erectile dysfunction.

Patients with diabetes have an increased risk of erectile dysfunction; it is fairly common.

Patients with cholecystitis do not have an increased risk of erectile dysfunction.

PTS: 1 REF: 394 6. The LPN is working with a patient who is breastfeeding. Which hormone is responsible for

breast milk production? a. Prolactin b. FSH c. LH d. ICSH ANS: A

A B C

Feedback Prolactin stimulates milk production in the mammary gland.

Follicle-stimulating hormone (FSH) stimulates sperm production in men and egg production in women.

Luteinizing hormone (LH) stimulates release of a ripened egg in women (ovulation); it also helps in the production of female hormones (estrogens and progestins).

186 D

Interstitial cell-stimulating hormone (ICSH) stimulates production of androgens (male hormone testosterone).

PTS: 1 REF: 390

7. An LPN is caring for a patient at the long-term care facility who has a history of heart failure

and routinely takes furosemide. The nurse will be most concerned by which of the following assessment findings? a. The patient has a urinary output of 1,900 mL in 24 hours. b. The patient’s blood pressure is 124/68 mm Hg. c. The patient’s apical pulse is irregular. d. The patient has gained 3 pounds in 2 weeks.

ANS: C

A B C

D

Feedback Furosemide increases urinary output. This is within normal range and is not of concern.

The patient’s blood pressure is within normal limits.

Furosemide decreases potassium. When hypokalemia occurs, the patient can experience irregular heart rate, and the symptom is a priority concern due to the potential serious nature of the condition.

Weight gain in patients who have heart failure needs to be monitored; however, this is not the priority at this time.

PTS: 1 REF: 402 8. The nurse is monitoring a patient who has increased intracranial pressure. Which type of

diuretic therapy is indicated? a. Loop b. Thiazide c. Osmotic d. Potassium-sparing ANS: C

A B C

Feedback Loop diuretics are used to treat congestive heart failure by decreasing the volume of blood the heart must circulate through the body.

Thiazides, which block sodium reabsorption and increase water excretion, are used to treat moderate hypertension.

Osmotic diuretics such as mannitol are used in patients who have increased intracranial pressure as a result of head trauma, a brain tumor, or other illness

187

D

affecting the brain.

Potassium-sparing diuretics are frequently prescribed instead of or in combination with loop or thiazide diuretics to minimize the risk of potassium imbalances.

PTS: 1 REF: 398 9. The LPN is providing care for a patient in the long-term care facility and is preparing to

administer medication for benign prostatic hyperplasia (BPH). Which medication does the nurse administer? a. Triamterene b. Finasteride c. Furosemide d. Desmopressin ANS: B

A B C D

Feedback Triamterene is a potassium-sparing diuretic and is not used to treat BPH. Finasteride is an alpha-adrenergic blocker used to treat BPH. Furosemide is a loop diuretic and is not used to treat BPH. Desmopressin (DDAVP) is used for the management of bedwetting.

PTS: 1 REF: 398

10. An LPN is monitoring a patient and identifies a color change in the urine from amber to dark

brown. The patient exhibits no signs of bleeding and/or infection. Which priority nursing action is required? a. Obtain a urine specimen for culture and sensitivity. b. Contact the health-care provider. c. Keep the patient nothing by mouth (NPO). d. Review the medication profile.

ANS: D

A B C D

Feedback While collecting a urine specimen may eventually be needed, it is not the priority action at this time.

Additional assessment data are required before notifying the health-care provider.

Keeping the patient NPO at this time is not required.

There are several medications that can cause urine to change color; therefore, the priority action is for the nurse to check the medication profile to see if any prescribed therapy has this type of reaction.

188

PTS: 1 REF: 400 11. The LPN is working at an OB/GYN office and reviewing contraceptive therapy with a patient.

The patient wants a type of therapy she will not have to self-administer. What type of contraceptive therapy should the nurse suggest? a. Transdermal patch b. IUD c. Monophasic tablet d. Barrier device ANS: B

A B C D

Feedback A transdermal patch must be self-administered.

An intrauterine device (IUD) is inserted by the health-care provider to prevent implantation and kill sperm.

Monophasic tablets are self-administered.

A barrier device must be self-administered.

PTS: 1 REF: 390 12. The LPN is reviewing the medical history for a patient who is taking hydrochlorothiazide

(HCTZ). Which finding may lead to the medication being stopped? a. Hypertension (HTN) b. Type 2 diabetes c. Asthma d. Pneumonia

ANS: B

A B C D

Feedback HCTZ is a thiazide diuretic and can lead to decreased blood pressure (BP).

HCTZ is a thiazide diuretic and can be associated with hyperglycemia; therefore, if the patient has type 2 diabetes, this can become an issue.

HCTZ has no effect on asthma.

HCTZ has no effect on pneumonia.

PTS: 1 REF: 403 13. A patient has been prescribed triamterene as diuretic therapy. Which information should the

nurse include as part of patient teaching?

189

a. b. c. d.

Decrease fluid intake.

Limit foods that are high in potassium.

Increase fiber intake.

Decrease intake of dairy products.

ANS: B

A B C D

Feedback While fluid intake should be monitored, it should not be decreased while taking diuretic therapy.

Triamterene is a potassium-sparing diuretic, so foods high in potassium should be avoided to prevent hyperkalemia from occurring.

Increasing fiber intake is not related to diuretic therapy.

Decreasing intake of dairy products is not related to diuretic therapy.

PTS: 1 REF: 403 14. The LPN is working on a labor and delivery unit. Which patient should not be given oxytocin

therapy? a. A patient whose pregnancy is post term. b. A patient who is not progressing in labor. c. A patient with cephalopelvic disproportion (CPD). d. A patient admitted for induction.

ANS: C

A B C D

Feedback Oxytocin is used to stimulate labor and can be administered to a patient who is post term.

Oxytocin is used to stimulate labor and can be used as augmentation to help a patient progress in labor.

Oxytocin is contraindicated in CPD, as it can lead to fetal distress and/or death.

Oxytocin is used to stimulate labor in patients who are admitted for induction.

PTS: 1 REF: 401

190 MULTIPLE RESPONSE

15. An LPN is reviewing side effects of hormone-based contraceptive therapy. Which of the

following would be considered a side effect of this type of birth control? (Select all that apply.) a. Blood clot formation b. Mood swings c. Abdominal cramping d. Increased libido e. Breast tenderness ANS: A, B, E

A. B. C. D. E.

Feedback The risk of blood clots increases with the use of birth control pills.

Mood swings are a common side effect of birth control pills.

Abdominal cramping is not a known side effect of birth control pills.

Increased libido is not a known side effect of birth control pills.

Breast tenderness is a common side effect of birth control pills.

PTS: 1 REF: 403 16. The LPN working in a physician’s office determines that which of the following patients

would be appropriate for hormone replacement therapy (HRT) with estrogen? (Select all that apply.) a. A 52-year-old woman with vaginal dryness and hot flashes b. A 44-year-old woman status post (s/p) robotic hysterectomy for dysmenorrhea c. A 68-year-old man with prostate cancer d. A 28-year-old man with testicular cancer e. A 35-year-old woman seeking oral birth control pills ANS: B, C

A. B. C. D. E.

Feedback Vaginal dryness and hot flashes are not an indication for HRT. Women who have had their uterus removed can have HRT to replace estrogen due to the lack of uterine cancer risk.

Estrogen can be used to treat prostate cancer because it decreases testosterone.

HRT is not used to treat testicular cancer.

HRT is not used as birth control.

PTS: 1 REF: 394 17. The nurse working on the labor and delivery special care unit is providing care for a woman

who has been started on magnesium sulfate. The nurse would anticipate which of the following orders to be initiated as well? (Select all that apply.)

191 a. b. c. d. e.

Monitor cardiac status.

Monitor vital signs every 2 to 4 hours.

Record strict intake and output.

Check serum calcium and magnesium every 6 hours.

Monitor serum amylase daily.

ANS: A, B, C, D

A. B. C. D. E.

Feedback Magnesium can cause cardiac arrhythmias, and the patient needs to be monitored for potential cardiac disturbances.

Magnesium can cause hypotension and cardiac arrhythmias. Monitoring vitals will assist in alerting the nurse to these side effects.

Strict intake and output are needed because magnesium is excreted in the urine.

A decrease in urine output increases the risk of magnesium toxicity.

Magnesium and calcium levels need to be monitored for possible toxicity.

Serum amylase is not monitored with magnesium sulfate therapy.

PTS: 1 REF: 393

18. The LPN is aware that diuretic therapy may be included in the treatment plan for which of the

following individuals? (Select all that apply.) a. A 65-year-old patient with hypertension b. A 40-year-old patient with acute kidney failure c. A 51-year-old patient with bladder cancer d. A 69-year-old patient with heart failure e. A 74-year-old patient with glaucoma ANS: A, B, D, E

A. B. C. D. E.

Feedback Diuretic therapy reduces fluid volume and may be used to treat hypertension.

Diuretic therapy reduces fluid volume and may be used to treat acute kidney failure.

Diuretic therapy reduces fluid volume and is not used to treat bladder cancer.

Diuretic therapy reduces fluid volume and may be used to heart failure.

Diuretic therapy reduces fluid volume and may be used to treat glaucoma.

PTS: 1 REF: 396

19.

The LPN is monitoring a patient who is being treated for abnormal uterine bleeding (AUB). Which medications are used to treat AUB? (Select all that apply.) a. Leuprolide b. Goserelin c. Progestins

192

d. Progesterone/estrogen e. Testosterone

ANS: A,B,C, D Feedback A. Leuprolide is a gonadotropin-releasing hormone agonist. These substances are frequently used to suppress buildup of the endometrial lining in patients with endometriosis by reducing estrogen levels, thus creating an artificial menopause-like condition that allows the endometrial lining to heal.

B. Goserelin is a gonadotropin-releasing hormone agonist. These substances are frequently used to suppress buildup of the endometrial lining in patients with endometriosis by reducing estrogen levels, thus creating an artificial menopause-like condition that allows the endometrial lining to heal.

C. Progestins (synthetic progesterone) can be prescribed to regulate the rhythm and amount of menstruation.

D. Progesterone/estrogen combination therapy can be prescribed as an oral contraceptive to regulate the rhythm and amount of menstruation.

E. Testosterone is an androgen and is not used to treat AUB.

PTS: 1 REF: 393 20. A patient has been admitted to the labor and delivery unit for cervical ripening to help stimulate labor. Which actions are part of the treatment plan? (Select all that apply.) a. Prostaglandin is applied topically to the skin. b. Monitoring of the patient and fetus is required. c. If labor does not ensue after the first dose, additional doses may be given. d. Oxytocin may be used to stimulate labor. e. The patient must be kept NPO.

ANS: B, C, D Feedback A. Prostaglandin is administered in the vagina.

B. Fetal and maternal monitoring is required during this type of treatment.

C. If labor does not begin in approximately 6 hours, a second dose may be administered or the patient may be started on oxytocin, which is the pituitary hormone that causes the uterus to contract.

D. The patient may be started on oxytocin, which is the pituitary hormone that causes the uterus to contract.

E. The patient does not have to be kept NPO.

193

PTS: 1 REF: 393

Chapter 21. Herbs, Vitamins, and Minerals MULTIPLE CHOICE 1. When asked what type of natural product can be used for cuts and burns, the LPN would

recommend which of the following? a. Ginger b. Peppermint c. Rosemary d. Aloe vera ANS: D

A B C D

Feedback Ginger is used as a digestive aid.

Peppermint is used as a digestive aid.

Rosemary is used to improve hair texture and decrease muscle tension.

Aloe vera is used to treat skin conditions, including burns, cuts, and shingles.

PTS: 1 REF: 415 2. While working with a patient who takes warfarin, the nurse would caution the patient to avoid

foods that are highest in which of the following vitamins? a. Vitamin A b. Vitamin K c. Vitamin E d. Vitamin C ANS: B

A B C D

Feedback Vitamin A does not alter the effectiveness of warfarin; it has anticancer properties and helps to heal the skin.

Vitamin K can make warfarin less effective and should be avoided or reduced.

Vitamin E does not alter the effectiveness of warfarin; it is an antioxidant and diuretic.

Vitamin C does not alter the effectiveness of warfarin.

PTS: 1 REF: 409

194 3. The LPN is working with a patient who has a long-standing history of alcohol abuse.

Although the patient is most likely deficient in numerous vitamins and minerals, the LPN is aware that which particular vitamin is credited with protecting against imbalances caused by alcohol? a. Vitamin D b. Vitamin B1 c. Vitamin C d. Vitamin E ANS: B

A B C D

Feedback Vitamin D is not known to protect the body from imbalances caused by alcohol consumption.

Vitamin B1 is known to protect the body from imbalances caused by alcohol consumption.

Vitamin C is not known to protect the body from imbalances caused by alcohol consumption.

Vitamin E is not known to protect the body from imbalances caused by alcohol consumption.

PTS: 1 REF: 410 4. The LPN is providing care for a patient with anorexia who has also been diagnosed with

anemia. The nurse recognizes that teaching has been effective if the patient chooses a diet that is high in which of the following? a. Calcium b. Potassium c. Iron d. Magnesium ANS: C

A B C D

Feedback Calcium is needed for bone strength and neuromuscular activity, not management of anemia.

Potassium is needed for neurological function, not management of anemia.

Iron will assist in the management of anemia; it is needed to produce red blood cells (RBCs).

Magnesium is needed for neurological function, not management of anemia.

PTS: 1 REF: 413

195 5. In reviewing various trace minerals, the LPN recognizes that which of the following elements

is necessary for the formation of thyroxine and that its deficiency has been linked to myasthenia gravis? a. Manganese b. Selenium c. Zinc d. Fluoride ANS: A

A B C D

Feedback Manganese is needed for the formation of thyroxine in the thyroid gland, and a deficiency is linked to myasthenia gravis.

Selenium is used to benefit heart health and is not needed for the formation of thyroxine.

Zinc is needed for immune health and the senses of taste and smell. It is not necessary for thyroxine formation.

Fluoride is used to reduce tooth decay and is not needed for the formation of thyroxine.

PTS: 1 REF: 409

6. The LPN is assisting in the care of a patient who has a family history of high triglycerides.

Which of the following supplements would the nurse anticipate the physician will suggest? a. Iron-fortified multivitamin pills b. Fish oil capsules c. Selenium tablets d. Zinc oxide-containing products ANS: B

A B C D

Feedback Iron-fortified vitamins are not helpful in managing triglycerides.

Fish oil is considered helpful in reducing triglycerides.

Selenium is not helpful in managing triglycerides.

Zinc oxide is not helpful in managing triglycerides.

PTS: 1 REF: 414 7. The LPN working in an obstetrician’s office is aware that the physician recommends

increasing folic acid intake during pregnancy to help decrease the occurrence of which of the following infant disorders? a. Cleft palate b. Spina bifida

196 c. Cerebral palsy d. Tracheoesophageal fistula ANS: B

A B C D

Feedback Folic acid has no impact on cleft palate formation.

Folic acid is needed to reduce the incidence of spina bifida.

Folic acid is not a factor in the development of cerebral palsy.

Folic acid is not a factor in the development of tracheoesophageal fistula.

PTS: 1 REF: 411

8. The nurse is reviewing the practice of homeopathy. Which statement best describes this type

of therapy? a. Needles and pressure are applied to body parts. b. Vaccinations stimulate an antigenic response. c. Exposure to a substance triggers a response. d. Manipulation of joints provides relief.

ANS: C

A B C

D

Feedback The use of needles and applied pressure to body parts is known as acupuncture.

The administration of vaccines provides active immunity.

Homeopathy is a type of complementary and alternative medicine that uses highly diluted preparations based on the principle that ―like cures like.‖ The idea is that a patient takes a small amount of a substance similar to the one that is harming his or her body, thereby training the body to fight the dangerous substance.

Manipulation of joints to provide relief is the practice of chiropractic.

PTS: 1 REF: 416 9. While working for a hematologist, the LPN learns that which of the following minerals is

essential to the formation of red blood cells? a. Cobalt b. Phosphorus c. Magnesium d. Copper ANS: A

A

Feedback Cobalt decreases pernicious anemia and increases RBCs.

197 B C D

Phosphorus is needed for the formation of bones and teeth.

Magnesium assists in transmitting nerve impulses.

Copper helps prevent the spread of cancer, decreases the risk of cardiac disorders, and improves the immune system.

PTS: 1 REF: 411 10. A patient reports changes in taste and smell. Which mineral deficiency does the nurse

suspect? a. Selenium b. Chromium c. Zinc d. Iron

ANS: C

A B C D

Feedback Selenium is important for immune function and acts as an antioxidant.

Chromium is important for insulin production and macronutrient (carbohydrate, lipid, and protein) metabolism.

Zinc is important for taste and smell.

Iron is important for energy, growth, development, RBC production, reproduction, and wound healing.

PTS: 1 REF: 414 11.

A patient complains of increased fatigue after eating the annual Thanksgiving Day meal of turkey and fixings. Which amino acid does the nurse identify as causing this issue? a. Tryptophan b. Glycine c. Tyrosine d. Methionine

ANS: A

A B C D

Feedback Tryptophan affects appetite, is a precursor for serotonin, and can cause fatigue.

Glycine is needed for wound healing.

Tyrosine is needed for the production of thyroid hormones.

Methionine is needed for healthy skin.

198

PTS: 1 REF: 414 12.

The LPN observes that a pediatric patient is eating a nonfood item. Which mineral deficiency does the nurse suspect? a. Iodine b. Fluoride c. Iron d. Selenium

ANS: C

A B C D

Feedback Iodine deficiency leads to thyroid problems.

Fluoride deficiency leads to tooth decay.

Iron deficiency is associated with the ingestion of nonfood items; this disorder is known as pica.

Selenium deficiency leads to immune disorders.

PTS: 1 REF: 413

13.

The patient asks the LPN whether herbal therapy preparations bought at different stores will help to maintain well-being. What is the best response by the nurse? a. Read the label to compare ingredients. b. Food and Drug Administration (FDA) regulation ensures that all preparations are equivalent. c. Preparations prepared by the same manufacturing company are similar. d. There is a possibility that herbal therapy preparations may vary, as they are not regulated.

ANS: D

A

B C

Feedback Reading the label, although recommended for any type of herbal preparation, will not ensure that all ingredients are listed and similar, as there is no FDA regulation.

This statement is not correct. The FDA does not regulate herbal preparations.

This statement is not correct. The FDA does not regulate herbal preparations,

199

D

and there might be inconsistent amounts of an herb in different manufacturers’ products or hidden ingredients.

Herbal preparations are not regulated by the FDA as strictly as most pharmaceutical preparations, and there might be inconsistent amounts of an herb in different manufacturers’ products or hidden ingredients.

PTS: 1 REF: 418 14. A patient asks the LPN whether complementary and alternative medicine (CAM) is covered by

medical insurance. What is the best nursing response? a. CAM therapy is a covered benefit on most insurance policies. b. The patient should contact their insurance provider to verify if CAM is covered. c. Traditional acupuncture therapy is the only CAM treatment that is covered. d. There is a limit to the type and amount of CAM therapy that are covered.

ANS: B

A B C D

Feedback Many insurance companies do not cover all types of CAM therapy due to lack of scientific research.

The best source of information regarding whether CAM therapy is covered is the patient’s insurance carrier.

Although acupuncture is typically covered, the LPN has no way of knowing what benefits the patient has based on their particular policy.

The best source of information regarding whether CAM therapy is covered is the patient’s insurance carrier. Therefore, this would be an inappropriate statement, as the LPN would not know the specific information in the patient’s insurance policy.

PTS: 1 REF: 418

15.

A patient interested in complementary and alternative medicine (CAM) asks the LPN if this type of therapy is effective. What is the best nursing response? a. ―CAM is not based on the scientific method and should be used cautiously.‖ b. ―You should discuss this with your health-care provider.‖ c. ―CAM therapy provides a multidisciplinary approach to health issues.‖ d. ―CAM therapy is not long-lasting, so it may require additional treatments.‖

200

ANS: C

A

B C D

Feedback Although scientific research related to CAM may not be as prevalent as that available for traditional Western medicine, it does not mean that it cannot be effective. Telling the patient this would not be appropriate.

Referral to the health-care provider does not address the patient’s stated concern.

This is the correct response. CAM therapy is based on different philosophies of medicine and consists of a multidisciplinary approach to health issues.

The effectiveness of CAM therapy varies from individual to individual.

PTS: 1 REF: 417 16.

A patient presents to the urgent care clinic complaining of facial flushing followed by a burning sensation of the face. Which vitamin does the nurse suspect might be the etiology for this presentation? a. Multivitamin b. Niacin supplement c. B complex vitamin d. Vitamin E

ANS: B

A B C D

Feedback A multivitamin would not cause this presentation.

Niacin, when taken in excess, can cause facial flushing, warmth, and a burning sensation.

A B complex vitamin would not cause this presentation.

Vitamin E would not cause this presentation.

PTS: 1 REF: 410 17.

The nurse observes scaling of the mouth margins. Which vitamin deficiency does the nurse suspect? a. Vitamin B2 b. Vitamin B6 c. Vitamin K

201

d. Vitamin E

ANS: A

A B C D

Feedback Vitamin B2 deficiency can lead to cheilosis.

Vitamin B6 deficiency can lead to anemia.

Vitamin K deficiency can lead to bruising and coagulation issues.

Vitamin E deficiency rarely occurs but can be associated with retinopathy in prematurity and childhood.

PTS: 1 REF: 410

18.

The LPN is assessing a pediatric patient and observes bilateral bowing of the legs. Which vitamin deficiency does the nurse suspect? a. Vitamin A b. Vitamin E c. Vitamin D d. Vitamin C

ANS: C

A B C D

Feedback Vitamin A deficiency leads to visual changes and decreased immune function.

Vitamin E deficiency rarely occurs but can be associated with retinopathy in prematurity and childhood.

Vitamin D deficiency leads to rickets, and bilateral bowing of the legs is noted.

Vitamin C deficiency leads to scurvy, fragility of capillaries, poor wound healing, and degenerative joint disease.

PTS: 1 REF: 409

MULTIPLE RESPONSE 19. A student nurse is reviewing functions of vitamins. Which vitamins help to support blood cell

hemostasis? (Select all that apply.)

202 a. b. c. d. e.

Vitamin K Vitamin C Vitamin D Vitamin A Vitamin E

ANS: A, E

A. B. C. D.

E.

Feedback Vitamin K is important in the clotting processes of the human body, and without it, bleeding abnormalities may occur.

Vitamin C (ascorbic acid) is needed for the production and maintenance of connective tissue, bones, and teeth.

Vitamin D plays a key role in the healthy development of bone and the retention and absorption of calcium and phosphorus in the body.

Vitamin A is a requirement for healthy skin, teeth, bone, and soft tissue such as mucous membranes. It is also essential for vision, reproductive health, and immune system health.

Vitamin E is thought to have a role in the formation of red blood cells and muscles as well as in supporting the immune system.

PTS: 1 REF: 409

20. The LPN is providing information about over-the-counter (OTC) herbal therapies to a

community group. Which routes of administration can be used for OTC herbal therapies?

(Select all that apply.) a. Aromatherapy b. Brewed as a tea c. Chewed as a root d. Swallowed as a tablet/capsule e. Injected subcutaneously ANS: A, B, C, D

A. B. C. D. E.

Feedback Herbal therapy preparations can be administered as aromatherapy in which they are burned and their aroma inhaled.

Herbal therapy preparations can be brewed as a tea.

Herbal therapy preparations can be chewed as a root.

Herbal therapy preparations can be swallowed as a tablet or capsule.

Herbal therapy preparations typically are not administered subcutaneously.

PTS: 1 REF: 415