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Drug Therapy in Nursing 3rd Edition, Diane Test Bank

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Test Bank For Drug Therapy in Nursing 3rd Edition, Diane. Note: This is not a text book. Description: ISBN-13: 978-0781765879, ISBN-10: 0781765870.

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Test Bank Drug Therapy Nursing 3rd Edition, Diane

Chapter 1
1. A nurse has been assigned to care for a 52-year-old attorney who has hypertension and peptic ulcer disease. Before administering his medications, the nurse must complete an initial assessment. Core patient variables will be obtained from which of the following? (Select all that apply.)
A) The patient’s interview
B) The patient’s medical history
C) The patient’s medical record
D) The patient’s physical examination
E) The patient’s current laboratory and other diagnostic findings
2. A 68-year-old female patient who was diagnosed with hypertension 2 weeks ago and was prescribed a new hypertension medication has returned to the clinic for a follow-up visit. The nurse notes that the patient’s blood pressure is unchanged from her last clinic visit. When the patient was asked if she was taking the new medication on a regular basis, she stated, “I thought that I was supposed to take the new drug when I had a pounding headache or was in a stressful situation, not all the time.” An appropriate nursing diagnosis for this patient would be:
A) Knowledge, Deficient due to the lack of understanding concerning diagnosis of hypertension
B) Coping, Ineffective due to forgetfulness
C) Confusion, Acute concerning drug administration
D) Anxiety due to diagnosis of hypertension
3. In order to promote therapeutic drug effects, the nurse should always encourage patients to:
A) Take their medication with meals
B) Take their medication at the prescribed times
C) Increase medication dosages if necessary
D) Use alternative therapy to increase the effects of their medications
4. A patient is treated with an antibiotic for an infection of the leg. After 2 days of taking the antibiotic, the patient calls the clinic and reports that he has a rash all over his body. The nurse is aware that a rash can be an adverse effect of an antibiotic and can be either a biologic, chemical, or physiologic action of the drug, which is an example of:
A) Pharmacotherapeutics
B) Pharmacokinetics
C) Pharmacodynamics
D) Pharmacogenetics
5. A nurse has been assigned the task of preparing educational materials for patients with diabetes. The nurse has included the drug name, the reason the drug was prescribed, the intended effect of the drug, along with important adverse effects that should be reported to the nurse or health care provider. Which of the following information is essential to include in the educational materials?
A) Drug administration method
B) Core drug knowledge
C) Vital signs of the patient
D) Diagnosis and outcome identification mechanism
6. A 56-year-old female patient has been admitted to the hospital with chronic muscle spasms and has been prescribed a new medication to treat the spasms. She has a poorly documented allergy to eggs, synthetic clothes, and perfumes. What is the priority action of the nurse to ensure that prescribed medication does not aggravate the patient’s allergies?
A) Call the prescriber immediately regarding her allergic reactions.
B) Hold the medication for her muscle spasms until she can be treated for a possible allergic reaction.
C) Post an allergies notice on the front of the chart and document the allergies in the appropriate area of the patient’s record.
D) Call the dietary staff and make sure that the patient is not served eggs for breakfast.
7. The nurse has been assigned a 49-year-old patient who has acute colitis, and the nurse just completed gathering data concerning core drug knowledge and core patient variables. To implement nursing management of drug therapy for this patient, the nurse will then:
A) Evaluate the outcome of the drug therapy.
B) Devise strategies to maximize the therapeutic effects of the drug.
C) Implement planned nursing actions.
D) Assess for data that will indicate interactions between core drug knowledge and core patient variables.
8. Which of the following activities would the nurse expect to complete during the evaluation phase of the nursing process in drug therapy?
A) Compare the outcome expected with the actual patient outcome.
B) Reconsider core drug knowledge and core patient variables.
C) Ask questions to prepare an effective patient education program.
D) Establish a baseline for the patient’s treatment and care.
9. A nurse is caring for a post-surgical patient who has small tortuous veins and had a difficult IV insertion. The patient is now receiving IV medications on a regular basis. What is the best nursing intervention to minimize the adverse effects of this drug therapy?
A) Monitor the patient’s bleeding time.
B) Check the patient’s blood glucose levels.
C) Record baseline vital signs.
D) Monitor the IV site for redness, swelling, or pain.
10. A patient has been prescribed several drugs and fluids to be given intravenously. Before the nurse starts the intravenous administration, a priority assessment of the patient will be to note:
A) Heart rate
B) Body weight and height
C) Blood pressure
D) Skin surrounding the potential IV site
Chapter 2
1. A physician has ordered intramuscular injections of morphine, a narcotic, every 4 hours as needed for pain for a motor vehicle accident victim. The nurse is aware that there is a high abuse potential for this drug and that it is categorized as a:
A) C-I drug
B) C-II drug
C) C-III drug
D) C-IV drug
2. A nurse working for a drug company is involved in phase III drug evaluation studies. Which of the following might the nurse be responsible for during this stage of drug development?
A) Working with animals who are given experimental drugs
B) Monitoring drug effects in patients who are selected to participate in a study, who have the disease that the drug is meant to treat
C) Administering investigational drugs to patients
D) Informing healthy, young volunteer participants of possible risks that could occur from taking an experimental drug
3. Which of the following would be the best source of drug information for a nurse?
A) Drug Facts and Comparisons book
B) A nurse’s drug guide
C) A drug package insert
D) The Physician’s Drug Reference (PDR)
4. A nurse works in a private hospital in Canada. She needs to administer some narcotic drugs to one of her patients. Which of the following should the nurse consider when administering narcotics to patients in a Canadian hospital?
A) Narcotics are banned in Canada and cannot be used.
B) Narcotics can be used in the hospital after obtaining written approval from the Joint Commission for Accreditation of Hospitals and Healthcare Organizations (JCAHO).
C) Narcotics to be used in the hospital are dispensed only with a written prescription and “N” on the label.
D) Narcotics can be used in the hospital after obtaining written approval from the Health Protection Branch of Canada.
5. A nurse who is responsible for administering medications should understand that the goals of the MedWatch program are to: (Select all that apply.)
A) Provide regular feedback about product safety issues
B) Accredit new medical facilities and hospitals
C) Facilitate the reporting of adverse reactions of drugs
D) Increase awareness of serious reactions caused by drugs or medical devices
E) Report medication errors that occur in hospitals
6. A nurse is a member of a research team that is exploring unique differences in responses to drugs that each individual possesses, based on genetic make-up. This area of study is called:
A) Pharmacotherapeutics
B) Pharmacodynamics
C) Pharmacoeconomics
D) Pharmacogenomics
7. Which of the following statements best defines how a chemical becomes termed a drug?
A) A chemical must have a proven therapeutic value or efficacy without severe toxicity or damaging properties to become a drug.
B) A chemical becomes a drug when it is introduced into the body to cause a change.
C) A chemical is considered a drug when the Food and Drug Administration (FDA) approves its release to be marketed.
D) A chemical must have demonstrated therapeutic value to become a drug.
8. Which of the following serves to protect the public by ensuring the purity of a drug and its contents?
A) American Pharmaceutical Association
B) United States Adopted Names Council
C) United States Pharmacopeia
D) Federal legislation
9. A nurse is providing a patient with a list of drugs as a part of the patient’s plan of care. Which of the following drug nomenclatures should the nurse use to list the drugs?
A) The drugs’ chemical names
B) The drugs’ generic names
C) The drugs’ trade names
D) The drugs’ biologic name
10. The medication nurse is in charge of transcribing drug orders and administering drugs to assigned patients. While preparing the drugs for administration, the nurse should always check:
A) For drug composition
B) The chemical, generic, and trade name of each drug
C) The drug name at least three times—before, during, and after obtaining each drug
D) The cost of each drug
Chapter 3
1. A patient located on a medical–surgical unit has an order to receive ampicillin 500 mg PO tid ac. Which of the following medication administration schedules would be best for a medication ordered tid ac?
A) 4 AM, 12 noon, 8 PM
B) 7 AM, 11 AM, 6 PM
C) 7 AM., 1 PM, 8 PM
D) 8 AM, 12 noon, 4 PM., 8 PM
2. A mother brings her 4-year-old child, who is vomiting and has a temperature of 103°F into the emergency department (ED). The ED physician orders acetaminophen (Tylenol) for the fever. The best form of Tylenol to give the child, considering her presentation, would be:
A) Liquid
B) Lozenge
C) Tablet
D) Suppository
3. A nurse has received an order to administer a drug intravenously over a 60-minute period in a patient with NS running at TKO. The nurse should gather supplies and prepare to administer the drug by:
A) Intravenous piggyback (IVPB)
B) Intravenous push (IVP)
C) Peripherally inserted central line (PIC)
D) Continuous IV infusion
4. A nurse has received an order to administer a TB skin test. The nurse will inform the patient that TB skin tests are most often given subcutaneously in the:
A) Left thigh
B) Medial forearm
C) Abdomen
D) Buttocks
5. An unconscious patient has been brought to the hospital, and the physician has prescribed a life-saving drug to be administered parenterally. Which of the following methods would be most appropriate for the nurse to use when administering the medication?
A) Intravenous infusion
B) Subcutaneous administration
C) Intrathecal administration
D) Intramuscular administration
6. A patient with diabetes has had a cough for 1 week and has been prescribed a cough syrup (an expectorant). What special instructions should the nurse include in the patient teaching for this situation?
A) Wash hands before and after taking the medicine.
B) Keep track of any gastrointestinal tract infections.
C) Monitor glucose levels closely.
D) Note the time the medicine is taken each day.
7. A patient is being treated for respiratory infection. He is a recovering alcoholic and has impaired liver function. The nurse will instruct the patient to be especially cautious when taking:
A) An elixir
B) A tablet
C) A syrup
D) A troche
8. A physician has ordered the use of an inhaler for a patient with a lung ailment, but the patient finds that taking deep breaths is very difficult. The nurse should:
A) Change the route of administration to liquid sprays.
B) Ask the patient to make a better effort to take deep breaths.
C) Use a spacer to facilitate easier inhalation of the drug.
D) Contact the prescriber for a recommendation.
9. What critical piece of information is missing from the following medication order: Amoxicillin 250 mg every 8 hours?
A) Dose
B) Route
C) Frequency
D) Trade name of the drug
10. A child is admitted to the burn unit with second and third degree burns on both arms and part of his face. When administering topical medications to the burned areas, the nurse should:
A) Cool the medication prior to administration.
B) Use sterile technique when applying the medication.
C) Allow the child to apply the medication if possible.
D) Use clean technique only when applying the medication.
Chapter 4
1. In which of the following patients would a nurse expect to experience alterations in drug metabolism?
A) A 35-year-old woman with cervical cancer
B) A 41-year-old man with kidney stones
C) A 50-year-old man with cirrhosis of the liver
D) A 62-year-old woman in acute renal failure
2. A patient has a blood serum drug level of 50 units/mL. The drug’s half-life is 1 hour. If concentrations above 25 units/mL are toxic and no more of the drug is given, how long will it take for the blood level to reach the non-toxic range?
A) 30 minutes
B) 1 hour
C) 3 hours
3. A nurse has been administering a drug to a patient intramuscularly (IM). The physician discontinued the IM dose and wrote an order for the drug to be given orally. The nurse notices that the oral dosage is considerably higher than the parenteral dose and understands that this due to:
A) Passive diffusion
B) Active transport
C) Glomerular filtration
D) First-pass effect
4. A nurse receives an order to administer a critically ill patient two drugs immediately (stat). The nurse begins the process by:
A) Washing her hands before handling the medications
B) Consulting a drug guide for compatibility
C) Questioning the patient concerning allergies
D) Identifying the patient by checking the armband and asking the patient to state his name
5. A 38-year-old patient is obese and has abscesses around his inner thigh muscles. He is receiving IV antibiotics, but no improvement has been seen. The patient questions the nurse about the most likely cause for the drug therapy failure. The nurse explains to the patient that the:
A) Surface area of the abscesses is not large enough for the drug to have the desired therapeutic effect
B) Route of administering the medication should not have been IV
C) Distribution of the drug to the area of the abscesses is impaired
D) Distribution of the drug to the thigh muscles is generally impaired, even in healthy individuals
6. A patient has been receiving regular doses of an agonist for 2 weeks. Which of the following should the nurse anticipate?
A) The drug will decrease in effectiveness.
B) The drug will increase in effectiveness.
C) There will be a steady state with no anticipated changes.
D) The drug will cause excessive therapeutic effects even when administered in small doses.
7. A nurse is discussing with a patient the efficacy of a drug that his physician has suggested he begin taking. Efficacy of a drug means which of the following?
A) The amount of the drug that must be given to produce a particular response
B) How well a drug produces its desired effect
C) A drug’s strength of attraction for a receptor site
D) A drug’s ability to stimulate its receptor
8. A patient has been admitted to the intensive care unit following a myocardial infarction. His nurse is preparing to administer his ordered medications when she notices that one drug ordered is used for treating seizure disorders. The nurse does not find a history of seizures in the patient’s record. The most appropriate action for the nurse is to:
A) Ask the charge nurse if she knows why the drug has been ordered.
B) Look up the drug to see if there are other conditions that the drug could be prescribed for.
C) Question the physician about the prescribed medication.
D) Call the pharmacist and inquire about therapeutic uses of the drug.
9. A nurse notes new drug orders for her patient who is already getting several medications. Which of the following is the most important consideration when she is preparing to administer the new drugs?
A) How the patient will feel about new medications added to her drug therapy
B) Possible drug–drug interactions that might occur
C) Any special nursing considerations that the nurse must be aware of
D) If generic preparations of the drugs can be used
10. A nurse is caring for a patient who has had part of her small intestine removed due to cancer. She has also now developed hypertension and has been prescribed a new medication to decrease her blood pressure. While planning her care, the nurse should consider a possible alteration in which of the following aspects of pharmacokinetics?
A) Absorption
B) Distribution
C) Metabolism
D) Elimination
Chapter 5
1. Talwin given in combination with Vistaril diminishes the adverse effects of nausea caused by the Talwin. This drug interaction affecting the pharmacodynamics of the Talwin is:
A) An additive effect
B) A synergistic effect
C) A potentiated effect
D) An antagonistic effect
2. On the 1 AM rounds, the nurse finds a patient awake and frustrated that she cannot go to sleep. The nurse administers an ordered hypnotic to help the patient sleep. Two hours later, the nurse finds the patient out of bed, full of energy, cleaning her room, and singing. The nurse evaluates the patient’s response to the hypnotic as:
A) An allergic reaction
B) An idiosyncratic response
C) A synergistic effect
D) A teratogenic effect
3. The nurse is caring for a patient receiving an aminoglycoside (antibiotic) which can be nephrotoxic. Which of the following will alert the nurse that the patient may be experiencing nephrotoxicity?
A) Visual disturbances
B) Yellowing of the skin
C) A decrease in urine output
D) Ringing noise in the ears
4. A nurse is caring for a patient who has recently moved from Vermont to south Florida. The patient has been on the same antihypertensive drug for 6 years and has had stable blood pressures and no adverse effects. Since her move, however, she reports “dizzy spells and weakness” and feels that the drug is no longer effective. The nurse suspects that the change in the effectiveness of the drug is related to:
A) The impact of the placebo effect on the patient’s response
B) The accumulative effect of the drug if it has been taken for many years
C) The impact of the warmer climate on the patient’s physical state
D) Problems with patient compliance with the drug regimen due to the move
5. A nurse is instructing a patient concerning a newly prescribed drug. Which of the following should be included to help improve patient compliance and safety?
A) A list of pharmacies where the drug can be obtained
B) Measures to alleviate any discomfort associated with adverse effects
C) The cost of the brand drug compared with the generic form
D) Statistics related to phase III of testing for the prescribed drug
6. A nurse is caring for a patient who is experiencing nausea and vomiting from chemotherapy. Which of the following would be an appropriate nursing diagnosis for this patient?
A) Infection, Risk for related to drug-induced bone marrow suppression
B) Nutrition, Imbalanced: Less Than Body Requirement related to adverse effects of drug
C) Poisoning, Risk for related to use of a drug with a narrow therapeutic index
D) Nutrition, Imbalanced: More Than Body Requirement related to adverse effects of drug
7. A nurse has administered a medication to a patient with hypertension. The prescribed drug is supposed to decrease cardiac output. A decrease in cardiac output would most likely:
A) Increase the serum creatinine level
B) Decrease drug absorption in the blood
C) Decrease the amount of circulating blood sent through the kidneys
D) Increase the synergistic effect of the drug
8. A home health nurse notes that there have been changes to a patient’s oral drug regimen. The nurse will closely monitor the new drug regimen to:
A) Track the exact route of metabolism as a research project
B) Identify any changes in drug absorption that would change the drug effect
C) Monitor only for the adverse effect of immunotoxicity
D) Determine the speed of chelation
9. Which of the following affects drug distribution throughout the body?
A) Presence of food in the gastrointestinal tract
B) Increase in hepatic enzymes
C) Protein binding
D) High blood levels
10. A patient is being seen in the emergency department for a sprained ankle and is given a drug to relieve pain. When a second dose of the pain medication is given, the patient develops redness of the skin, itching, and swelling at the site of injection of the drug. The most likely cause of this response is:
A) A hepatotoxic response
B) An idiosyncratic response
C) A paradoxical response
D) An allergic response
Chapter 6
1. A nurse working in a cancer center is preparing to administer medication to a 5-year-old child. The nurse will calculate the drug dosage by using:
A) Body surface area
B) Weight
C) Age in months
D) Age in years
2. A nurse is administering drugs to a 10-year-old child who has multiple health problems. The child is underweight and is on a special diet. Which of the following will the nurse consider when planning for the best absorption of the prescribed drugs? (Select all that apply.)
A) Age
B) Weight
C) Disease process
D) Diet
E) Route of administration
3. A nurse is explaining to the parents of a 6-year-old child suffering from angina why nitroglycerin patches for chest pain would not be appropriate. Which of the following will the nurse include in her explanation?
A) A child has an erratic blood flow from an immature peripheral circulation, which increases drug absorption, causing an increase in adverse effects.
B) A child’s gastric pH is decreased, causing less of the drug to be absorbed from the subcutaneous skin, therefore producing more adverse effects.
C) A child has a greater body surface area, creating greater permeability resulting in an increase in absorption of topical agents, which may result in more adverse effects.
D) A child has a smaller body surface area, resulting in an increase in topical absorption, which can cause more adverse effects.
4. A 7-year-old child has been taking tetracycline for a bacterial infection. The nurse will be sure to inform the parents that this drug could cause:
A) Orange-tinged urine
B) Staining of permanent teeth
C) Sleep deprivation
D) Deep muscle pain
5. A nurse is going to administer medication to an infant using a medicine dropper. The best method is to open the child’s mouth by gently squeezing the cheeks and placing the drops:
A) At the back of the mouth
B) In the buccal pouch
C) Under the tongue
D) On top of the tongue
6. A nurse is having difficulty administering a bitter drug to a 5-year-old child. The nurse should:
A) Have the parent gently force the child’s mouth open.
B) Give the drug in a pill form.
C) Involve the child in a play therapy session, and then tell the child the medicine is candy.
D) Offer the child a flavored ice chip or ice pop prior to administering the drug.
7. A 5-year-old boy needs an IM injection. The least painful and most effective injection site would be the:
A) Deltoid muscle
B) Rectus femoris muscle
C) Ventrogluteal muscle
D) Dorsogluteal muscle
8. A 12-year-boy is being discharged from the hospital after major surgery. The boy will be taking two medications at home for an extended period. The nurse who is discharging the patient should provide medication teaching specifically to:
A) The mother regarding why the boy needs to take the medications
B) Both the boy and his mother regarding all medication issued
C) The boy by telling him not to worry about the medications and to take them as directed
D) The mother and be sure to reinforce the need to force the medications, if her son does not want to take them
9. A 6-month-old has developed skin irritation due to an allergic reaction. He has been prescribed a topical skin ointment. The nurse will consider which of the following before administering the drug?
A) That the infant’s skin has greater permeability than that of an adult
B) That there is less body surface area to be concerned about
C) That there is decreased absorption rates of topical drugs in infants
D) That there is a lower concentration of water in an infant’s body compared with an adult
10. A 2-year-old is diagnosed with a minor ailment and is to be administered medications at home for 2 weeks. The child lives with his mother and grandmother and four other children between the ages of 14 months and 7 years. The home health nurse is asked to assess the home environment to determine if it is appropriate for the child to take his medication at home. Which of the following will have the greatest impact on the nurse’s assessment?
A) The mother and grandmother’s understanding about the drugs
B) How clean the house is
C) The health status of the other children
D) Where the medications will be stored
Chapter 7
1. A pregnant patient asks the nurse what she can take for recurring headaches. The nurse will recommend:
A) Aspirin
B) Advil
C) Tylenol
D) Motrin
2. A patient has had a positive diagnosis of pregnancy and is at 7 weeks’ gestation. She is diabetic and has been taking insulin since she was 13 years old. She asks the nurse if the insulin will be harmful to her baby. The best response to the patient by the nurse would be:
A) “I will tell your physician that you are concerned about taking insulin during your pregnancy.”
B) “You will have to discontinue the insulin therapy during your pregnancy but you will resume the medication after delivery.”
C) “You will need to continue taking your insulin because hyperglycemia is thought to increase the incidence of congenital anomalies during the first trimester.”
D) “Insulin is the drug of choice for controlling blood glucose levels during pregnancy because it does not cross into the placenta.”
3. A 36-year-old patient comes to the clinic and tells the nurse that she suspects that she is pregnant. During the initial assessment, the nurse learns that the patient is currently taking medications for diabetes, hypertension, and a seizure disorder. The nurse would be most concerned about which of the following medications:
A) Insulin
B) Ibuprofen (Advil)
C) Phenytoin (Dilantin)
D) Furosemide (Lasix)
4. A 38-year-old pregnant patient admits to the nurse that she is an alcoholic and has been consuming alcohol during her pregnancy. The nurse knows that using alcohol during pregnancy may result in a child who presents with:
A) A high-pitched cry
B) Microcephaly
C) An electrolyte imbalance
D) Thrombocytopenia
5. A 19-year-old pregnant patient is extremely upset about having to take medication for a pre-existing medical condition. She is consumed with fear that her baby will be born with a physical deformity or a congenital anomaly but knows that she has to take the medication. She talks constantly about this and is unable to sleep most nights. The most appropriate nursing diagnosis for this patient is:
A) Injury, Risk to the fetus related to adverse effects of maternal drug therapy
B) Injury, Risk to the patient related to failure to receive needed drug therapy
C) Anxiety related to perceived danger of drug therapy to fetus or infant
D) Noncompliance with Drug Therapy
6. A woman is receiving prolonged drug therapy during her complicated pregnancy, and it may pose a risk to both mother and the fetus. The primary care physician has made dosage adjustments to minimize adverse effects and prevent toxicity. The nurse should make sure:
A) That serum levels of the drug are being monitored
B) That the FDA is informed that the woman is receiving drug therapy
C) To check the drug’s FDA pregnancy category to determine safety
D) That only nonpharmacologic alternatives are being used
7. A patient is receiving radioactive treatment for an overactive thyroid gland and asks whether her milk is safe for her baby. If her treatment cannot be discontinued, what should the nurse recommend?
A) Advise her that it is safe to breast-feed her baby.
B) Recommend alternative medication that is compatible with breast-feeding.
C) Provide her with reports that identify several categories of drugs and their potential to cause problems with breast-feeding.
D) Advise her to discard her breast milk in a biohazard container, as it is unsafe for the baby.
8. The nurse practitioner has recommended that a breast-feeding woman take her prescribed medications just before her infant takes his longest nap of the day. The woman does not understand and asks the nurse to explain. The nurse will tell the woman the recommendation was made to:
A) Increase the blood concentrations of the drug in the breast-feeding infant
B) Reduce neonatal drug exposure
C) Reduce the half-life of the drug
D) Evaluate the drug’s potential adverse effects on the neonate
9. A nurse is explaining to a pregnant 21-year-old college student why she cannot continue to take ibuprofen (Advil) for her headaches. The nurse draws a picture depicting drug molecules crossing the placental membrane and entering into the fetal circulation. The nurse tells the patient that the main reason this happens is because:
A) There is a 40% increase in blood volume during pregnancy.
B) The mother’s heart rate is 10 to 15 beats per minute faster during pregnancy.
C) Drugs compete with the hormones of pregnancy for albumin-binding sites.
D) Hemodilution of plasma albumin occurs.
10. A nurse is working with a 16-year-old pregnant teen and assessing for behavior that may put the baby at risk. The most important assessment the nurse can make is:
A) Whether the pregnant woman shares prescription medication
B) Whether the pregnant woman obtains medication from a physician
C) The pregnant woman’s smoking habits
D) The pregnant woman’s dietary habits
Chapter 8
1. A nurse who is working with an older adult patient who takes eight medications a day wants to promote medication adherence. Which of the following nursing interventions would best promote medication adherence?
A) Take prescribed medication as needed.
B) Refill prescription medication when the last dose is taken.
C) Place pills in a daily or weekly pillbox organized according to hours of the day or mealtimes.
D) Ask for child-proof caps for all medication bottles.
2. A nurse is administering drugs to a 70-year-old patient who has a reduced plasma albumin level. When assessing the patient for therapeutic outcomes of drug therapy, the nurse will also be careful to observe for:
A) Possible drug toxicity
B) Decreased therapeutic effects
C) Altered drug absorption
D) Increased drug metabolism
3. A 72-year-old man who is unable to sleep since admission into the hospital is given a hypnotic medication at 9 PM. The nurse finds the patient drowsy and confused at 10 AM the next day. The nurse is aware that this behavior is most likely due to:
A) Decreased hepatic function
B) A toxic effect
C) An allergic reaction
D) Increased renal function
4. A nurse is teaching an older adult patient about polypharmacy. Which of the following statements best describe that term?
A) Taking more than one drug when the patient deems it necessary
B) Taking several drugs simultaneously
C) Increasing the dosage of a drug by the patient
D) Taking one drug one day and another drug the next day
5. A nurse is caring for a 73-year-old man who is receiving drug therapy. He is beginning to exhibit signs of decline in his renal system. Yet his current serum creatinine level is normal. The nurse will base her plan of care on the understanding that there is:
A) An increase in drug excretion
B) A decrease in the effectiveness of the prescribed drugs
C) An increase in the production of creatinine
D) A decrease in creatinine overall to be filtered
6. A nurse is caring for an 81-year-old patient in a long-term care facility who takes nine different medications each day. The patient has a recent diagnosis of seizure disorder and has begun treatment with phenytoin (Dilantin), a highly protein-bound drug. After 1 month of Dilantin therapy, the patient is still extremely drowsy and sluggish. The nurse determines that the prolonged adverse effect is likely due to:
A) An increase in creatinine to be filtered
B) Polypharmacy decreasing the number of available protein-binding sites
C) Increased efficiency of the blood–brain barrier
D) The normally low protein-binding properties of Dilantin
7. A nurse is caring for a 92-year-old patient who is taking multiple drugs and displaying increased cognitive impairment and memory loss. The initial action of the nurse would be to:
A) Try to distinguish between normal signs of aging and the adverse effects of drug therapy.
B) Report adverse effects of drug therapy to the prescriber.
C) Wait several days to see if the symptoms subside.
D) Hold the patient’s medications until a doctor can see the patient.
8. A 72-year-old man with peripheral vascular disease is being given a drug by the intramuscular route. His serum blood level concentrations have been erratic. The nurse suspects that this may be due to:
A) Altered gastric pH levels
B) Increased levels of plasma albumin
C) Decreased blood flow to tissues and muscles which decreases absorption
D) Decreased gastrointestinal motility
9. A physician has determined that a 79-year-old patient is not having significant results from his drug therapy. Tests indicate that there may be a problem with absorption. The patient eats a lot of red meat, smokes regularly, and is frequently constipated. Recently, he also reported that he is experiencing sleeplessness. Based on this information, which of the following should the nurse specifically question him about?
A) Dietary patterns
B) Unreported health problems, if any
C) Use of laxatives
D) Lifestyle
10. A 67-year-old man is admitted to the hospital with pneumonia. He reports to the nurse that he has chronic arthritis and circulation problems. Further assessment by the nurse reveals that the patient has a history of mild hypertension. He explains that he owns a business and lives alone. The nurse determines that he is within the normal weight range for his height and age but has a fondness for spicy foods and sweets. Which of the mentioned patient variables will have the greatest impact on the effectiveness of the patient’s drug therapy?
A) Vascular impairment
B) Mild hypertension
C) Dietary habits
D) Chronic arthritis
Chapter 9
1. A nurse is caring for a patient who abuses marijuana. The treatment for marijuana abuse consists mainly of:
A) Nonpharmacologic interventions combined with an exercise program
B) Drug therapy with bromocriptine (Parlodel)
C) Aggressive respiratory assistance
D) No nursing action unless the patient experiences a “bad trip”
2. A nurse is working in the emergency department and is assigned to a patient brought in by family members. The family thinks that the patient is on methamphetamine. Which of the following will the nurse assess for?
A) Increased appetite
B) Hypertension
C) Bradycardia
D) Stupor
3. A patient comes to the clinic asking for help to quit drinking alcohol. She has a 21-year history of the habit and is worried about developing cirrhosis of the liver. The patient agrees to take disulfiram (Antabuse). The nurse will teach the patient that the combination of alcohol and Antabuse will cause which of the following?
A) Bradycardia
B) Diarrhea
C) Facial flushing
D) Slight headache
4. A patient has been admitted to the hospital with acute cocaine intoxication. Family members are present and are observing prolonged seizure activity. The family is upset and asks the nurse how long the patient will experience the seizures. An appropriate response by the nurse would be:
A) “Not long, he should be fine in a couple of days.”
B) “Usually withdrawal symptoms occur within 24 hours of the last ingestion and the seizure activity should subside.”
C) “It is possible that the seizure activity could last a week or more.”
D) “Once a person has had a seizure there is always a possibility of other seizures.”
5. A Native-American man is admitted to the emergency department exhibiting a reddened face and an increased heart rate. He reports that he does not drink alcohol but at a party had punch that contained vodka, which is a form of ethanol. The nurse recognizes that this reaction may be related to the ethanol exposure and caused by:
A) Retarded absorption from the small intestine
B) Immediate distribution at the rate proportional to blood flow and water content
C) Metabolism using the enzyme alcohol dehydrogenase
D) Deficiency in the enzyme aldehyde dehydrogenase
6. A nurse is caring for a patient who recently began using cocaine. Which of the following vital signs would the nurse expect to find initially when assessing the patient?
A) Blood pressure (BP): 98/50, pulse (P): 120, respirations (R): 40
B) BP: 130/88, P: 92, R: 28
C) BP: 150/90, P: 80, R: 16
D) BP: 170/98, P:110, R: 20
7. A nurse is caring for a cancer patient who has been prescribed dronabinol (Marinol) to help reduce nausea and vomiting from the chemotherapy. The nurse will inform the patient that he should experience relief from the nausea and vomiting in:
A) 5 to 10 minutes
B) 15 to 20 minutes
C) 30 to 60 minutes
D) 1 to 2 hours
8. A patient is suffering from acute inhalant intoxication. The priority nursing intervention will be to:
A) Administer epinephrine
B) Monitor oxygen therapy
C) Provide an emesis basin
D) Monitor blood pressure and pulse
9. A nurse is caring for an adolescent who has a history of alcohol abuse. In order to develop a care plan for this patient, the nurse will need to explore and assess which of the following risk factors? (Select all that apply.)
A) Low self-esteem
B) Divorced parents
C) Financial problems
D) Health concerns
E) Depression
10. A patient has been hospitalized for treatment of substance abuse after being arrested and jailed for the past 24 hours. The patient is experiencing severe muscle and abdominal cramps, seizures, and acute psychosis due to abrupt withdrawal. Which of the following drug classes is the most likely cause of these severe and potentially fatal withdrawal symptoms?
A) Amphetamines
B) Sedative–hypnotic drugs
C) Benzodiazepines
D) Opioids
Chapter 10
1. Recently a 40-year-old woman has become interested in alternative therapy as a means to maintain and enhance her state of health. However, she has developed hypertension and will be prescribed an antihypertensive agent. The nurse’s health history reveals that the patient eats a balanced diet, swims regularly, and occasionally takes an over-the-counter medication for allergies. A priority assessment for the nurse will be to determine:
A) The amount of dietary fiber in the patient’s diet
B) How much exercise the patient gets daily
C) If the patient is taking any nutritional supplements
D) If the patient is taking herbal or botanical medications regularly
2. A 70-year-old woman is starting on an acidic drug. The nurse is aware that food and nutrient intake can affect drug excretion by changing the urinary pH. About which of the following will the nurse question the patient concerning her diet?
A) The intake of sodium
B) The amount of meat and vegetables
C) The use of grapefruit
D) The intake of foods high in protein
3. During a clinic visit, a patient complains of having frequent muscle cramps in her legs. The nurse’s assessment reveals that the patient has been taking over-the-counter laxatives for the past 7 years. The nurse informed the patient that prolonged use of laxatives:
A) May cause nutrient deficiencies
B) May counter the therapeutic effect of other drugs
C) Causes acidic urine and urinary tract infections
D) Inhibits biotransformation of drugs
4. A patient is in the advanced stages of atherosclerotic vascular disease and has diabetes mellitus. The nurse will advise him to include which of the following in his diet?
A) Amino acids
B) Vitamins
C) Complex carbohydrates
D) Trace elements
5. A 36-year-old man is frail and emaciated and often faints due to weakness. He has a history of movement disorder and has been prescribed appropriate drugs to treat it. A priority nursing assessment will be to question him concerning his:
A) Professional life
B) Marriage and sex life
C) Nutritional intake
D) Mental and emotional well-being
6. A nurse is evaluating a patient who is receiving the antituberculosis drug, isoniazid. The nurse should be careful to assess for:
A) A vitamin B6 deficiency
B) A folic acid deficiency
C) The use of bulk-producing laxatives
D) Changes in serum potassium levels
7. A nurse is talking to an 18-year-old patient who has had a seizure disorder since she was 10 years old and is taking phenytoin (Dilantin). The nurse suggests that she take which of the following?
A) A potassium supplement
B) An iron supplement
C) Folic acid
D) Vitamin C
8. A 79-year-old patient in a long-term care facility is to receive an intravenous fat emulsion. Which of the following lab values would be a priority for the nurse to assess before administration?
A) Blood glucose levels
B) Serum potassium levels
C) Serum sodium levels
D) Triglyceride levels
9. A nurse is counseling a 55-year-old woman who is going through menopause. When discussing the prevention of osteoporosis, the nurse will encourage the patient to consume:
A) 200 mg of potassium daily
B) 400 mg of magnesium daily
C) 1,000 mg of sodium daily
D) 1,500 mg of calcium daily
10. A patient has taken an overdose of vitamin/mineral supplement containing magnesium. The nurse will be sure to assess:
A) Blood pressure
B) Body temperature
C) Fluid intake
D) Skin changes
Chapter 11
1. A patient is taking an antibiotic that is known to cause photosensitivity in some patients. Which of the following nursing measures would ensure the comfort of this patient and hopefully avoid serious adverse effects?
A) Avoiding the use of aspirin and other over-the-counter pain products
B) Getting a wig or other head cover to avoid heat loss
C) Avoiding exposure to sunlight or using a sunscreen and protective clothing if exposure is inevitable
D) Providing frequent rest periods in a dark room
2. A patient with rheumatoid arthritis has been diagnosed with hypertension and has been prescribed an antihypertensive drug. In order to prevent the adverse effects of orthostatic hypotension, the nurse will instruct the patient to avoid:
A) Meals high in proteins
B) Spas and/or hot tubs
C) Walking more than 1 mile a day
D) Large crowds
3. A nurse is working in an outpatient unit. She has been assigned to administer intramuscular gold salts to a patient. Prior to the administration of the drug, the nurse will notify the:
A) Doctor so he or she can be present during the drug administration
B) Lab to draw blood for a complete blood count and obtain a urine sample for urinalysis
C) Dietary department so that the patient’s lunch is held until after the drug administration
D) Social worker so he or she can plan a visit before the patient is discharged
4. A patient has been prescribed a drug that can be self-administered at home. Which of the following would be the most important information for the nurse to relate to the patient concerning self-administration of a drug?
A) Where to purchase the medication
B) The cost of the drug
C) The therapeutic effects and possible adverse effects
D) The pharmacokinetics of the drug
5. When educating a patient concerning how the environment affects safe drug administration, the nurse will include the importance of:
A) Rapport between the patient and the health care provider
B) A well-balanced life including work and family
C) Avoiding bad habits
D) The proper methods to discard used medications
6. A home health nurse has thoroughly evaluated the home environment of a patient who will continue receiving a narcotic analgesic at home after discharge from the hospital. The nurse was very concerned when she found:
A) A lack of air conditioning in the home
B) A lack of cleanliness in the kitchen
C) Loose rugs on the floor throughout the house
D) No washer or dryer
7. A nurse has just completed a medication history on a newly admitted patient. In order to complete medication reconciliation for this patient the nurse will:
A) Determine the best pharmacy for the patient to buy his medications
B) Compare the medications ordered by the health care provider with the list of medications obtained from the patient and communicate discrepancies to the health care provider
C) Provide instructions pertaining to each medication the patient is currently taking and then add the medications ordered during the hospitalization
D) Explain to the patient the pharmacokinetics of each drug he will be taking in the hospital
8. A patient with multiple injuries from a motor vehicle accident was recently moved into a semi-private room in an acute rehabilitative unit (ARU) away from the main campus of the hospital. Three days after the move, the patient developed a cardiac complication and was in need of intravenous medications and cardiac monitoring. In order for the patient to receive the care that he needs the nurse will:
A) Move the patient into a private room in the ARU and begin the intravenous medications and cardiac monitoring.
B) Ask the family to provide a private nurse to administer the IV medications and monitor cardiac function.
C) Prepare for the patient to be transferred into the acute care hospital.
D) Start intravenous fluids and connect the patient to the cardiac monitor in the patient’s room.
9. A patient is in the clinic after a week of skiing in the mountains. He reports that his prescribed medication for a chronic condition does not seem to be working. The nurse will inform the patient that environmental factors can render some drugs ineffective. The nurse will likely discuss which of the following topics with the patient?
A) High altitude and stress
B) Moisture in the air and increased drug clearance
C) Cloudy weather and sun exposure
D) Cold weather and low drug absorption
10. A nurse has cared for a patient who is being discharged later today. The patient will begin three new medications as part of her treatment plan. The primary role of the nurse in regard to the patient’s drug therapy will be to:
A) Refer the patient to a social worker who will help her purchase the medications
B) Consult with several pharmacists to determine the cost of each drug
C) Educate the patient concerning the medications
D) Consult with the physician concerning choice of medications for the patient
Chapter 12
1. A new immigrant to the United States comes to the clinic. She reports living in a crowded, poor urban area. Considering her residence and immigration status, which of the following should the nurse screen for?
A) Tuberculosis
B) Malaria
C) Diabetes
D) Hypertension
2. A traditional Middle Eastern man has type 2 diabetes and is being seen in a primary care clinic with his wife. The nurse would like to provide culturally sensitive education regarding the time of administration of his medication and what he is permitted to eat. The nurse should be careful to:
A) Direct the conversation to the patient regarding his illness
B) Educate the patient’s wife about his illness
C) Inform the patient’s employer about his illness
D) Inform the patient’s medical insurance provider about his illness
3. A nurse is assigned to a Caucasian patient who has a phenotype in which the CYP2D6 gene is duplicated. In order to plan appropriate care with regard to drug therapy, the nurse is aware that the patient would:
A) Exhibit no change in metabolic activity through the CYP2D6 pathway
B) Metabolize drugs poorly through the CYP2D6 pathway
C) Exhibit reduced CYP2D6 activity
D) Exhibit ultra-rapid metabolism through the CYP2D6 pathway
4. A nurse is caring for a 46-year-old Chinese man who is living in the United States and has bipolar disorder. The physician has prescribed lithium carbonate (Eskalith) to treat the disorder. The nurse is aware that the lithium dose will likely be given in a:
A) Higher-than-normal dose
B) Lower-than-normal dose
C) Child’s dose
D) Weight-based protocol dose
5. A nurse is caring for a middle-aged man of Navajo Indian origin who has type 2 diabetes and who is living a traditional Navajo lifestyle. The nurse will be sure to discuss the adverse effects of drug therapy with which of the following family members?
A) The patient’s father
B) The patient’s spouse
C) The patient’s grandmother
D) The patient’s grandfather
6. A 32- year-old African female who has just arrived in the United States is suffering from hypertension. She has come to the clinic for an office visit and states she has always used “traditional healing preparations” when ill. In discussing her new antihypertensive drug, the nurse will assess her use of:
A) Analgesics
B) Diuretics
C) Ginseng
D) Antidepressants
7. A Spanish woman is hospitalized for complications of type 1 diabetes. The nurse speaks only English; the patient understands only Spanish. The patient is being discharged from the hospital, and the nurse needs to provide education related to her diabetes. However, the discharge instructions are in English. The nurse should use:
A) Body language to educate her and then give her the discharge instructions
B) An interpreter to educate her and then give her the English version of the discharge instructions so she can begin to learn the language
C) A translator to translate the materials and give them to her
D) An interpreter to review the discharge instructions with the patient and then give her the printed material translated into Spanish
8. A 46-year-old white American has been prescribed a drug that binds to acid glycoproteins. The nurse understands that white Americans usually receive:
A) A higher-than-normal dose of drugs that bind to acid glycoproteins
B) A lower-than-normal dose of drugs that bind to acid glycoproteins
C) The recommended normal dose of drugs that bind to acid glycoproteins
D) One half the recommended dose of drugs that bind to acid glycoproteins
9. A nurse is admitting a Mexican woman to the hospital who cannot speak or understand English. The patient is alone, and there is no interpreter available. When trying to communicate with the patient the nurse will:
A) Speak loudly
B) Exaggerate her mouth movements
C) Use nonverbal language
D) Speak fast
10. A Native American man is scheduled to have heart surgery. The tribal chief has requested that the tribe’s medicine man perform a ritual before the patient goes to surgery. The nurse’s response to this request should be:
A) “I’m sorry, but that will not be possible.”
B) “I will need to inform the doctor and see if he will allow this.”
C) “As long as the ritual does not interfere with the patient’s preoperative care, it will be okay.”
D) “I don’t think that will help, but you have the right to perform the ritual.”
Chapter 13
1. Which of the following patients should be advised by the nurse to avoid over-the-counter cold and allergy preparations that contain phenylephrine?
A) A 47-year-old female with hypertension
B) A 52-year-old male with adult-onset diabetes
C) A 17-year-old female with symptoms of an upper respiratory infection
D) A 62-year-old male with gout
2. A nurse receives an order for clonidine (Catapres) for a child. Which of the following would be the most appropriate action by the nurse?
A) Weigh the child to get the correct body surface area.
B) Have a second nurse check the dose before administering the drug.
C) Question the order because the drug is for use in only adults.
D) Make sure the child is on a cardiac monitor.
3. A nurse is caring for a patient who is taking propranolol (Inderal). Which of the following statements would indicate that teaching by the nurse concerning the beta-adrenergic antagonist has been effective?
A) “I may have a very dry mouth while taking this drug.”
B) “I should never stop taking this drug abruptly but will taper the dose gradually.”
C) “I can stop walking a mile a day.”
D) “Since I am taking this drug, I no longer need to worry about my diet.”
4. A priority nursing assessment for a patient who is to receive an alpha- or beta-adrenergic antagonist would be to:
A) Assess heart rate
B) Check blood glucose level
C) Measure urine output
D) Monitor respiratory rate
5. A 70-year-old man with diabetes mellitus is taking metipranolol (OptiPranolol) to manage ocular hypertension. The nurse would be sure to instruct the patient to:
A) Take his pulse at least four times a day
B) Weigh himself once a week at the same time of day
C) Avoid smoke-filled rooms
D) Understand the signs and symptoms of hypoglycemia
6. A patient experiencing a serious allergic reaction to a bee sting is brought to the emergency department. The patient’s right hand is swollen, red, and painful. She is extremely upset, short of breath, and the nurse detects wheezing and stridor. The nurse is ordered to administer epinephrine to relieve the patient’s:
A) Pain and swelling around the sting site
B) Discoloration in her hand
C) Acute anxiety
D) Acute bronchospasm
7. A nurse in the emergency department has started IV administration of dopamine (Intropin) and has been steadily titrating the dosage upward. For a patient in shock, dopamine helps to:
A) Decrease heart rate
B) Decrease blood pressure
C) Increase blood pressure
D) Increase body temperature
8. A patient is prescribed epinephrine via a nebulizer, 1 to 3 inhalations 4 to 6 times a day. Which of the following nursing diagnoses would be most appropriate for this patient related to comfort?
A) Imbalanced Nutrition: Less Than Body Requirements
B) Disturbed Sleep Pattern, Insomnia related to CNS excitation
C) Disturbed Sensory Perception
D) Ineffective Tissue Perfusion
9. A man with a history of cardiac arrhythmias is taking propranolol 30 mg three times a day. He calls the clinic at 11 AM and reports that he failed to take his 8 AM dose and his next dose is at 2 PM. What should the nurse instruct him to do?
A) Take two doses when the next dose is due at 2 PM.
B) Take two doses as soon as possible.
C) Take the missed dose as soon as possible.
D) Skip the missed dose and return to the regular dose at 2 PM.
10. A nurse is caring for a patient in the critical care unit. Phentolamine (Rogitine) has been ordered for the management of tissue necrosis caused by extravasation of parenterally administered drugs. Before administering this drug, the nurse will check the patient’s chart for indications of:
A) Peptic ulcer disease
B) History of acute myocardial infarction
C) Diabetes mellitus
D) Obesity
Chapter 14
1. A 47-year-old woman has been diagnosed with open-angle glaucoma. Pilocarpine drops are prescribed. The nurse’s assessment reveals that the patient has worn soft contact lenses for 15 years. The nurse will instruct the patient to:
A) Apply the contact lenses and wait 5 minutes before applying the drops.
B) Remove the contact lenses before applying the drops.
C) Apply the drops directly on the contact lenses.
D) Stop wearing the contact lenses during the pilocarpine therapy.
2. A patient is being discharged from the hospital and will be taking dicyclomine (Bentyl) for irritable bowel syndrome. The nurse will instruct the patient to take the medication:
A) Once in the morning and once at night
B) Before bedtime
C) Thirty minutes before meals and at bedtime
D) At noon only
3. A patient is taking flavoxate hydrochloride (Urispas) to help control an overactive bladder. On a follow-up visit to the clinic, the nurse will question the patient about which of the following?
A) Chronic diarrhea
B) Dental hygiene practices
C) Headaches
D) Diet
4. A nurse is working in a women’s hospital where she is caring for a new mother who is experiencing postpartum urinary retention. Bethanechol (Urecholine) has been ordered. The nurse will observe for which of the following?
A) Bradycardia
B) Hypertension
C) Hypotension
D) Decreased salivation
5. A patient who is going on a cruise is concerned about motion sickness and sees his physician, who prescribes scopolamine. The nurse informs the patient that using scopolamine may cause him to experience:
A) Pupil constriction
B) Tachycardia
C) Diarrhea
D) Urinary incontinence
6. An anticholinergic drug is given to a 73-year-old man to treat his Parkinson disease. The man also has benign prostatic hyperplasia (BPH). The most important instruction the nurse can give to the patient with regard to his medication and medical diagnosis is to:
A) Avoid a warm environment
B) Avoid driving his car while taking the drug
C) Call his doctor if he cannot urinate
D) Take the drug with food to avoid gastrointestinal (GI) upset
7. Which of the following would be an expected outcome in a patient who has been given atropine to cause mydriasis and cycloplegia?
A) Constricted pupils and blurred vision
B) Dilated pupils and improved vision
C) Dilated pupils and blurred vision
D) Dry eyes and constricted pupils
8. A 4-year-old child is brought to the emergency department by her mother. The mother reports that the child has been vomiting, and the nurse notes that the child’s face is flushed and she is diaphoretic. The mother thinks that the child may have swallowed carbachol drops. A diagnosis of cholinergic poisoning is made. Which of the following drugs would be administered?
A) Acetylcholine
B) Atropine
C) Cevimeline
D) Nicotine
9. A 29-year-old man comes to the clinic requesting a scopolamine patch. His company is sponsoring a deep-sea fishing trip in 2 weeks and he is afraid that he will get sick. The medication is prescribed for him, and the nurse’s instructions concerning use of the patch will include which of the following?
A) Do not clean the application area before applying the patch.
B) When replacing the patch apply the new patch in the same area.
C) The onset of action is 30 minutes.
D) Shave the area before applying the patch.
10. A 63-year-old patient has a confirmed diagnosis of Alzheimer disease. Memantine hydrochloride (Namenda) has been prescribed. Which of the following would be the appropriate dose for this patient?
A) 5 to 20 mg/day in divided doses
B) 25 mg once a day
C) 25 to 50 mg/day in divided doses
D) 100 mg once a day
Chapter 15
1. A nurse is working on a presurgical floor and is assessing patients who will receive isoflurane as part of balanced anesthesia for surgery. For which of the following patients will the nurse plan for a longer recovery period and a greater incidence of adverse effects from isoflurane?
A) A 32-year-old male with a history of drug abuse
B) A 27-year-old female who weighs 298 pounds
C) A 45-year-old male with a history of cigarette smoking and asthma
D) A 53-year-old female with a history of alcohol abuse
2. A 90- year-old frail, elderly woman has arrived at the emergency department with a broken hip and in acute respiratory distress. Succinylcholine will be used because of the need for rapid endotracheal intubation, and then the woman will be sent to surgery. Due to the woman’s frail condition, she is at risk for skin breakdown. Which of the following nursing diagnoses would be most appropriate?
A) Impaired Spontaneous Ventilation
B) Impaired Physical Mobility
C) Fear
D) Disturbed Sensory Perception
3. A surgical nurse is documenting the different stages of anesthesia on a patient’s chart. Which stage will the nurse describe in documentation just before the surgeon makes the incision?
A) Stage I
B) Stage II
C) Stage III
D) Stage IV
4. A nurse in the recovery room has been assigned to a patient who had an ocular surgical procedure and received isoflurane. The nurse will observe for which of the following during the recovery period?
A) Urticaria and angioedema
B) Facial flushing and hypotension
C) Wheezing and bronchospasm
D) Shivering and tremors
5. A patient has been admitted to the ICU because of multiple traumas due to a motor vehicle accident. The physician has ordered propofol (Diprivan) to be used for maintenance of sedation. Before administration of propofol, a priority assessment by the nurse would be to check for a history of:
A) Seizure disorders
B) Low blood pressure
C) Increased intraocular pressure
D) Diabetic hyperlipidemia
6. A surgical nurse is picking up a patient from the ICU for surgery and notes the recent use of theophylline in the patient’s chart. The nurse will question the use of which of the following drugs during surgery?
A) Etomidate (Amidate)
B) Thiopental (Pentothal)
C) Ketamine (Ketalar)
D) Remifentanil (Ultiva)
7. A postsurgical patient is awake and extremely anxious while in the post anesthesia recovery unit. She states that “my arms and legs feel like tree trunks and they are hard to move.” She also states that “my head feels fuzzy and the right words will not come out.” Which of the following is the most appropriate nursing action for this patient?
A) Provide analgesia medication for the discomfort.
B) Stay with the patient as much as possible and provide reassurance.
C) Provide fluids to increase her wakefulness.
D) Encourage the patient to turn from side to side periodically.
8. A nurse is caring for a 68-year-old woman who has just returned to her room after a gastroscopy. Prior to beginning the procedure, lidocaine was given to numb her throat. Which of the following is the priority nursing intervention?
A) Check blood pressure and heart rate every 30 minutes for the next 12 hours.
B) Ask the patient if she needs to urinate.
C) Instruct the patient and family that she should not eat or drink for at least 1 hour.
D) Allow the patient to ambulate only with assistance.
9. A 71-year-old patient with a history of asthma and heart disease is receiving tubocurarine to prevent trauma during electroconvulsive therapy. The nurse will assess respiratory and cardiac status every:
A) 5 minutes
B) 10 minutes
C) 15 minutes
D) 30 minutes
10. A patient is transferred to the recovery room after a 4-hour surgery. Balanced anesthesia was used to produce loss of consciousness, analgesia, and muscle relaxation. In order to help prevent aspiration, the nurse will:
A) Assess the need for postoperative analgesia.
B) Monitor the patient’s vital signs.
C) Instruct the patient to turn, cough, and deep breathe.
D) Position the patient in a side-lying position.
Chapter 16
1. A patient has been prescribed methocarbamol (Robaxin) for fibromyalgia. The nurse has spent an hour educating the patient on the use of methocarbamol for muscle pain. Which of the following statements by the patient indicates that he has an understanding of at least one of the significant side effects of methocarbamol?
A) “My urine could be discolored while I take this drug.”
B) “I should have lots of energy while taking this drug.”
C) “I will probably have diarrhea while taking this drug.”
D) “This drug will help my tension headaches.”
2. Which of the following patients would have the highest risk for hepatotoxicity from dantrolene (Dantrium)?
A) A 32-year-old male who is taking an antipsychotic drug
B) A 45-year-old female who is taking an antihypertensive agent
C) A 57-year-old female who is on hormone replacement therapy
D) A 70-year-old male who is taking a cardiac glycoside
3. A 32-year-old female patient is taking tizanidine (Zanaflex) for spasticity related to her multiple sclerosis. The nurse will inform the patient and her husband that the adverse effect that poses the greatest safety risk to the patient is:
A) Constipation
B) Dry mouth
C) Fatigue
D) Hypotension
4. A nurse is working with a 39-year-old patient who is experiencing muscle spasms associated with multiple sclerosis. The patient reports that she needs help with basic care and that her 15-year-old daughter has been helping bathe and dress her for a week. The patient’s physician has prescribed baclofen (Lioresal). The nurse and the patient agree that an appropriate goal related to helping her maintain her self-worth would be to:
A) Experience relief of pain
B) Experience improved motor function
C) Increase self-care in activities of daily living
D) Take her medication independently
5. A patient has been experiencing muscle spasms in his neck from a four-wheeler accident. He is receiving 10 mg of cyclobenzaprine (Flexeril) PO t.i.d. The nurse’s teaching plan should include which of the following instructions?
A) Take the medication with a small amount of water.
B) Do not drive or operate heavy machinery for the first week.
C) Increase the dosage if necessary.
D) Stop the drug if dizziness occurs.
6. A nurse is caring for a male patient who has a spinal cord injury due to a motorcycle accident. He has been taking dantrolene (Dantrium) for 2 weeks. The nurse will monitor which of the following?
A) Prothrombin time and partial thromboplastin time
B) Urine specific gravity
C) Alanine aminotransferase and total bilirubin levels
D) Follicle-stimulating hormone levels
7. A nurse is assessing a patient who has come to the Emergency Department complaining of back spasms. The patient states that he is a recovering drug addict and does not want to take any drug that “puts me at risk of becoming physically dependent.” Which of the following medications would the nurse question, if ordered?
A) Methocarbamol (Robaxin)
B) Orphenadrine (Norflex)
C) Cyclobenzaprine (Flexeril)
D) Metaxalone (Skelaxin)
8. A patient is taking gabapentin (Neurontin) for spasticity associated with multiple sclerosis. Which of the following should the nurse monitor?
A) Hepatic function
B) Cardiac function
C) Respiratory function
D) Renal function
9. A nurse is instructing a patient who was recently diagnosed with multiple sclerosis about dantrolene (Dantrium). The patient is a 38-year-old-male and the foreman for a construction company. In order to minimize one important adverse effect of the drug, the nurse will give the patient which of the following instructions?
A) Eat a high-protein diet.
B) Decrease the dosage if any adverse effect is experienced.
C) Wear appropriate clothing and sunscreen whenever he is in direct sunlight.
D) Have a complete blood cell count done weekly.
10. Which of the following would be the most important safety-related instruction for a nurse to give to a patient taking baclofen (Lioresal)?
A) Do not walk or drive after taking the drug.
B) Discontinue the use of alcohol.
C) Learn to self-administer the drug.
D) Take a laxative when needed.
Chapter 17
1. A nurse is caring for a patient who has just been diagnosed with Parkinson disease. The patient does not understand how the medication ordered, carbidopa-levodopa, is going to help her condition. Which of the following is the correct response by the nurse?
A) “Carbidopa-levodopa will delay the loss of muscle strength and limb function for several months.”
B) “This drug will change the immune processes in your body to help decrease the tissue damage.”
C) “Carbidopa-levodopa increases the activity of dopamine in your body, which will decrease your symptoms.”
D) “Your drug therapy will reduce excessive reflex activity causing your muscle spasms and will allow for muscle relaxation.”
2. A nurse is developing a care plan for a patient who has multiple sclerosis. An expected outcome for the patient who is receiving glatiramer would be a decrease in:
A) Chest pain
B) Fatigue
C) Breathing difficulties
D) Heart palpitations
3. A patient has a diagnosis of Parkinson disease, and the physician will prescribe carbidopa-levodopa. Before drug therapy, a priority assessment would be:
A) Open-angle glaucoma
B) Closed-angle glaucoma
C) Peptic ulcer disease
D) Diabetes mellitus
4. A physician has asked the nurse to educate the patient regarding diet. The patient has Parkinson disease and is taking carbidopa-levodopa. The nurse will assess the patient’s diet for:
A) Apples and green leafy vegetables
B) Oranges and corn
C) Tomatoes and shrimp
D) Bananas and chicken
5. Constipation is a major problem in patients with amyotrophic lateral sclerosis (ALS). The nurse will educate the patient and family to:
A) Choose a laxative at the local drug store
B) Use prune juice only
C) Consult their physician before purchasing a laxative
D) Walk at least 2 miles a day
6. A nurse has been invited to speak to a support group for persons with movement disorders and their families. Which of the following statements by the nurse addresses the chronic nature of the disease and the drug therapy to treat it?
A) “Drug therapy can consist of one or more drugs to enhance quality of life.”
B) “Drugs do not cure these disorders; they are only palliative.”
C) “Drugs to treat these disorders can be given to people of Chinese/Filipino descent.”
D) “Drugs used to treat these disorders always pose a risk of severe liver and kidney dysfunction.”
7. A nurse has been assigned to a 52-year-old woman who has been hospitalized and has a diagnosis of Parkinson disease. The patient has been taking carbidopa-levodopa for about 1 year. The patient states that she has been having “more side effects from her drugs lately” and the nurse observes that the client appears to be extremely tired and has dark circles under her eyes. Which of the following would be an appropriate nursing diagnosis based on the statement of the patient and the observations of the nurse?
A) Disturbed Thought Processes
B) Disturbed Sleep Pattern
C) Impaired Physical Mobility
D) Risk for Injury
8. A male patient with a diagnosis of relapsing-remitting multiple sclerosis is in the clinic to discuss with the nurse the possibility of self-administration of glatiramer. During the patient education session for self-administration, the nurse will emphasize:
A) The need to rotate the injection site of the drug
B) The need to avoid crushing the tablet
C) The need to place the tablet under the tongue
D) The need to use only the thigh muscle for the drug injection site
9. A patient is in the clinic after 6 weeks of taking riluzole (Rilutek) for a recent diagnosis of amyotrophic lateral sclerosis. The nurse will assess for which of the following?
A) Weight gain
B) Constipation
C) Increased energy
D) Dizziness
10. A nurse is caring for a 59-year-old patient with Parkinson disease. Which of the following would indicate to the nurse that the patient is experiencing an adverse reaction related to the drug carbidopa-levodopa?
A) Altered complete blood count
B) Blurred vision
C) Dark urine
D) Increased urine glucose levels
Chapter 18
1. A patient has been prescribed zolpidem (Ambien) for short-term treatment of insomnia. Which of the following will the nurse include in her teaching plan for this patient? (Select all that apply.)
A) The drug should not be used for longer than 1 month.
B) It should be taken 1 hour before going to bed.
C) The drug does not cause sleepiness in the morning.
D) One of the most common adverse effects of the drug is headache.
E) It is available in both quick-onset and continuous-release oral forms.
2. A nurse works in a sleep disorder clinic and is responsible for administering medications to the patients. Which of the following patients would be most likely to receive zaleplon (Sonata)?
A) A 35-year-old man who is having difficulty falling asleep, but once asleep can stay asleep
B) A 20-year-old woman who will take the drug about once a week
C) A 52-year-old woman who needs to fall asleep quickly and stay asleep all night
D) A 46-year-old man who receives an antidepressant and needs a sleep aid
3. A patient who has been taking buspirone (BuSpar) for 1 week calls the clinic and reports to the nurse that the drug is not working. The patient informs the nurse that she is still having symptoms of anxiety. The nurse will tell the patient that:
A) She will report this to the physician immediately
B) Obviously the drug is not going to work for her and the medication needs to be changed
C) Optimum relief of anxiety usually occurs after 3 to 4 weeks of treatment
D) It may take up to 6 months for the drug to relieve her anxiety
4. A 64-year-old-patient has been prescribed lorazepam (Ativan) because of increasing periods of anxiety. The nurse should be careful to assess for:
A) A diet high in fat
B) A history of current or past alcohol use
C) Current nicotine use
D) A diet high in carbohydrates
5. A truck driver is experiencing a generalized anxiety disorder (GAD). Lorazepam has been prescribed. The patient asked the nurse how this medication will affect his job. The nurse advised him to:
A) Avoid driving until he is aware of the adverse effects.
B) Change his profession, because the drug has long-term effects after cessation of therapy.
C) Avoid driving at night, because lorazepam affects the wake–sleep cycle and can lead to drowsiness.
D) Drive only 2 hours after consuming the drug and stop when it’s time for the subsequent dose.
6. A 28-year-old patient is to receive a large dose of lorazepam intravenously for sedation during a procedure. The nursing priority would be to assess for which of the following?
A) Ataxia and confusion
B) Respiratory disturbances and partial airway obstruction
C) Seizures
D) Leukopenia and diplopia
7. A 70-year-old patient has just started taking lorazepam for anxiety issues related the loss of her husband. She is staying with her daughter for a couple of weeks. The patient’s daughter has noticed that her mother is having difficulty walking and seems to be confused at times and calls the clinic to report this to the nurse. The nurse will inform the daughter that:
A) A dose adjustment should be made if these symptoms persist.
B) The drug should be stopped immediately if these effects persist.
C) The drug should be administered intravenously if these effects persist.
D) No changes should be made at this time; the adverse effects will reduce with continued use.
8. A 39-year-old patient who is having trouble sleeping is beginning drug treatment with zaleplon (Sonata). The nurse will be sure to ask the patient if she is taking:
A) Secobarbital (Seconal)
B) Oxycodone (Percodan)
C) Cimetidine (Zantac)
D) Meperidine (Demerol)
9. An 80-year-old patient has been taking lorazepam since his wife died a year ago. He has been staying with his son, but will now move to an assisted living facility. Before admission to the assisted living facility, the patient’s physician has determined that the drug is no longer needed. The nurse at the facility will plan to:
A) Stop the drug immediately.
B) Suggest that another anti-anxiety drug be prescribed to stop the craving for a benzodiazepine.
C) Withdraw the drug gradually over a 2 to 3 week period.
D) Observe for urticaria and rash.
10. Which of the following drugs used to treat anxiety would be appropriate for a patient who is a school teacher and is concerned about feeling sedated at work?
A) Alprazolam (Xanax)
B) Buspirone (BuSpar)
C) Diazepam (Valium)
D) Lorazepam (Ativan)
Chapter 19
1. A nurse is caring for a 38-year-old female patient who just started taking lithium for bipolar disorder. Which of the following outcomes would be most appropriate for this patient?
A) The patient will re-establish and maintain a normal pattern of bowel functioning.
B) The patient will identify appropriate interventions to promote sleep.
C) The patient will identify satisfying and acceptable sexual practices and some alternative ways of dealing with sexual expression.
D) The patient will adopt strategies to restore and maintain proper fluid balance.
2. Each of the following patients requires sertraline therapy. Which patient would require the closest monitoring by the nurse?
A) A 32-year-old man who is a chronic alcoholic
B) A 38-year-old woman who has diabetes
C) An 11-year-old child with no other illnesses
D) A 45-year-old man with liver impairment
3. A 12-year-old child who has been taking sertraline for the past 2 weeks has returned to the clinic to be seen. It will be critical for the nurse to assess for:
A) Onset of suicidal ideation
B) Weight loss
C) Feelings of grandiosity
D) Decreased sleep
4. A 28-year-old man has been taking sertraline for a few months. On a follow-up visit to the clinic, he reports a change in sexual functioning, flu-like symptoms, dizziness, uneasiness, lack of sleep, and frequent headaches. The most appropriate response by the nurse would be:
A) How much of the drug are you taking at one time?
B) Have you stopped taking the drug?
C) Do you eat a lot of fat in your diet?
D) How much alcohol do you consume?
5. A patient has been prescribed lithium therapy. Which of the following signs and symptoms will the nurse tell the patient to report immediately?
A) Increased urination
B) Muscle twitching
C) Hair loss
D) Increased thirst
6. A nurse is working with a Chinese immigrant who is taking an MAOI. The most important instruction to the patient by the nurse will be to:
A) Avoid use of soy sauce in the diet.
B) Adhere to combination drug therapy.
C) Discuss the cultural significance of taking an MAOI.
D) Report adverse effects of the MAOI.
7. A 28-year-old patient asks his nurse how phenelzine therapy would help him. An appropriate response by the nurse would be:
A) “This therapy will help reduce the severity of your bipolar episodes.”
B) “The drug will enable you to gain the appropriate weight.”
C) “The drug will help increase your attention level.”
D) “This therapy will improve your overall mood and increase your social activity.”
8. A 30-year-old woman is taking phenelzine (Nardil) 30mg PO tid. The nurse knows that at that dosage, the patient will need to be carefully monitored for:
A) Dizziness
B) Diarrhea
C) Increased secretions
D) Facial flushing
9. The following patients are receiving nortriptyline therapy. Which patient would the nurse most closely monitor for cardiotoxicity?
A) A 44-year-old woman with a seizure disorder
B) A 19-year-old man with organic brain disease
C) A 45-year-old man with cardiovascular disease
D) A 20-year-old woman with renal dysfunction
10. A nurse is assigned to a patient who is taking lithium. Which of the following drug serum levels would indicate that the patient is at risk for adverse effects of the drug?
A) 0.3 mEq/L
B) 0.6 mEq/L
C) 1.7 mEq/L
D) 1.2 mEq/L
Chapter 20
1. The wife of a patient who is taking haloperidol calls the clinic and reports that her husband has taken the first dose of the drug and it is not having a therapeutic effect. An appropriate response by the nurse would be:
A) “Continue the prescribed dose. It may take several days to work.”
B) “I’ll ask the nurse practitioner if the dosage can be increased.”
C) “I’ll ask the nurse practitioner if the haloperidol can be discontinued and another drug started.”
D) “I’ll report this to the nurse practitioner and see if he will add another drug to enhance the effects of the haloperidol.”
2. A nurse is working with a 29-year-old Asian American man who was recently diagnosed with schizophrenia and is starting to take haloperidol. The patient is currently working as a professional gardener. When developing a teaching plan for the patient, which of the following patient variables will the nurse consider most important when trying to minimize the risk of neuroleptic malignant syndrome?
A) Dietary habits
B) Work environment
C) Daily fluid intake
D) Ethnicity
3. A nurse is caring for a patient who is taking haloperidol. He has orders for a new drug, and the nurse notes that it is highly protein bound. The nurse will plan care based on which of the following?
A) A decreased risk for toxic effects of haloperidol therapy
B) An increased risk for toxic effects of haloperidol therapy
C) A decreased risk for muscular contractions and spasms
D) A high drug efficacy of haloperidol
4. A nurse is caring for a patient who is to start antipsychotic drug therapy. In order to best promote adherence to the drug therapy, the nurse will begin by:
A) Developing a trusting relationship with the patient
B) Planning an easy-to-follow drug schedule
C) Always administering the medication and not allowing the patient or his family to administer the drug
D) Encouraging the patient and family to report adverse effects
5. A 62-year-old woman with a history of asthma and alcoholism is beginning drug therapy with an acetylcholinesterase enzyme inhibitor for Alzheimer disease. The most important part of the health history data for the nurse to consider is the patient’s:
A) Age
B) Gender
C) History of alcoholism
D) History of asthma
6. A nurse is caring for a patient who is taking rivastigmine. The patient’s nursing care plan will include which of the following nursing diagnoses?
A) Imbalanced Nutrition: More Than Body Requirements related to increased appetite and secondary to the drug therapy
B) Imbalanced Nutrition: Less Than Body Requirements related to decreased desire to eat secondary to nausea and vomiting from drug therapy
C) Risk for Fluid and Electrolyte Imbalance and hyperglycemia related to adverse effects of medication
D) Risk for Injury related to extrapyramidal symptoms
7. A 28-year-old woman has been diagnosed with schizophrenia. The physician has prescribed a typical antipsychotic, haloperidol.. Which of the following will the nurse include in the teaching related to the most common adverse effects?
A) Neuroleptic malignant syndrome
B) Agranulocytosis
C) Extrapyramidal symptoms
D) Gastrointestinal problems
8. A patient is prescribed olanzapine for combination therapy with lithium for the treatment of acute manic episodes in bipolar disorder. The nurse will monitor this patient regularly for which of the following?
A) Hypoglycemia
B) Hyperglycemia
C) Hyponatremia
D) Hypernatremia
9. A patient taking rivastigmine reports to the clinic nurse that she has been having gastrointestinal problems since she started the medication. The nurse will advise the patient to:
A) Stop taking the medication.
B) Take the medication one hour before eating.
C) Take the medication with food.
D) Continue taking the medication as prescribed.
10. A patient is taking rivastigmine for Alzheimer disease. The nurse will evaluate the patient regularly for:
A) Weight gain
B) Weight loss
C) Increased blood pressure
D) Decreased blood pressure

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