Rosenthal: Lehne's
Pharmacotherapeutics for Advanced
Practice Nurses and Physician
Assistants
A 5-year-old child is brought to the emergency department after ingesting diphenhydramine
[Benadryl]. The child is uncoordinated and agitated. The nurse observes that the child's face is flushed,
the temperature is 37.1°C, and the heart rate is 110 beats/minute. The nurse will expect
to:
a. administer atropine to reverse the adverse effects.
b. apply ice packs to stop the flushing.
c. give activated charcoal to absorb the drug.
d. prepare to provide mechanical ventilation. ANS:ANS: C
In acute toxicity, patients present with agitation, a flushed face, tachycardia, and uncoordinated
movements. There is no specific antidote, so drug removal is the focus of treatment, starting with
activated charcoal to absorb the drug, followed by a cathartic to enhance excretion. Atropine would
cause an increase in the heart rate. Application of ice packs is recommended for hyperthermia and not
for flushing. The child's temperature is normal. Mechanical ventilation is not indicated with this
presentation of symptoms, although cardiovascular collapse may eventually develop. DIF:
Cognitive Level: Application REF: p. 601TOP: Nursing Process: Implementation MSC: NCLEX
Client Needs Category: Physiologic Integrity: Reduction of Risk Potential
A 5-year-old child with seasonal allergies has been taking 2.5 mL of cetirizine [Zyrtec] syrup once daily.
The parents tell the nurse that the child does not like the syrup, and they do not think that the drug is
effective. The nurse will suggest they discuss which drug with their child's health care provider?
a. Cetirizine [Zyrtec] 5-mg chewable tablet once daily
b. Loratadine [Claritin] 10-mg chewable tablet once daily
c. Fexofenadine [Allegra] syrup 5 mL twice daily
,d. Desloratadine [Clarinex] 5-mg rapid-disintegrating tablet once daily ANS:ANS: A
The child is receiving a low dose of cetirizine and can receive up to 5 mg/day in either a single dose or
two divided doses. Cetirizine is available in a chewable tablet, which this child may tolerate better, so
the parents should be encouraged to explore this option with their provider. The
loratadine 10-mg chewable tablet is approved for children 6 years and older. Fexofenadine would be
safe for this child, but it is unlikely that the syrup would be any better than the cetirizine syrup.
Desloratadine is not approved for children under the age of 12 years. DIF: Cognitive Level:
Application REF: p. 602TOP: Nursing Process: Implementation MSC: NCLEX Client Needs Category:
Physiologic Integrity: Pharmacologic and Parenteral Therapies
A 6-week-old infant who has not yet received immunizations develops a severe cough. While
awaiting nasopharyngeal culture results, the nurse will expect to administer which antibiotic?
a. Clindamycin [Cleocin]
b. Doxycycline [Vibramycin]
c. Erythromycin ethylsuccinate
d. Penicillin G ANS:ANS: C
Erythromycin is the drug of first choice for infections caused by Bordetella pertussis, the causative agent
of whooping cough. Infants who have not received their first set of immunizations are at increased risk
of pertussis. Clindamycin, doxycycline, and penicillin are not recommended. DIF: Cognitive Level:
Application REF: p. 805TOP: Nursing Process: Implementation MSC: NCLEX Client Needs Category:
Physiologic Integrity: Pharmacologic and Parenteral Therapies
A 7-year-old child has a cough, runny nose, congestion, and fever, and the parents ask the
nurse to recommend an over-the-counter product. Which response by the nurse is correct?
a. "Any product will be effective when combined with vitamin C and zinc."
b. "It is best to use single-agent medications to treat individual symptoms."
c. "The fever indicatesthat your child may need an antibiotic; you should call your provider."
d. "You should ask your provider to prescribe a combination product that will treat multiple
symptoms." ANS:ANS: B
Combination medications may provide ingredients that are not needed or may provide ingredients that
are either excessive or subtherapeutic. It is best to use single-agent drugs to treat individual symptoms.
The efficacy of vitamin C and zinc for treating colds in children has not been established. Fever may
,accompany viral respiratory infections and not necessarily bacterial infections that need an antibiotic.
DIF: Cognitive Level: Application REF: p. 701TOP: Nursing Process: Implementation MSC: NCLEX Client
Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies
A 7-year-old child with asthma uses a daily inhaled glucocorticoid and an albuterol MDI as needed. The
provider has added montelukast [Singulair] to the child's regimen. Which statement by the child's parent
indicates understanding of this medication?
a. "I may notice mood changes in my child."
b. "I should give this medication twice daily."
c. "I will give my child one 4-mg chewable tablet daily."
d. "This drug can alleviate symptoms during an acute attack." ANS:ANS: A
Montelukast is given as an adjunct to inhaled glucocorticoids to help prevent inflammation. Some
patients have reported mood changes when taking this drug, so parents should be warned of this
effect. The medication is given once daily. The dose for a 7-year-old child is 5 mg daily. The drug does
not treat symptoms of an acute attack. DIF: Cognitive Level: Application REF: p. 680TOP: Nursing
Process: Planning MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and
Parenteral Therapies
A 20-year-old female patient has suprapubic discomfort, pyuria, dysuria, and bacteriuria greater than
100,000/mL of urine. Which are the most likely diagnosis and treatment?
a. Uncomplicated lower urinary tract infection treatable with short-course therapy
b. Complicated lower urinary tract infection treatable with single-dose therapy
c. Uncomplicated upper urinary tract infection requiring 14 days of oral antibiotics
d. Complicated upper urinary tract infection requiring parenteral antibiotics ANS:ANS: A These are
symptoms of uncomplicated cystitis, which is a lower urinary tract infection that can be treated with a
short course of antibiotics. Short-course therapy is more effective than single-dose therapy and is
preferred. A complicated lower urinary tract infection would be associated with some predisposing
factor, such as renal calculi, an obstruction to the flow of urine, or an indwelling catheter. Upper urinary
tract infections often include severe flank pain, fever, and chills. DIF: Cognitive Level: Analysis REF: p.
827TOP: "Nursing Process: Assessment, Nursing Process: Planning" MSC: NCLEX Client Needs Category:
Physiologic Integrity: Pharmacologic and Parenteral Therapies
A 30-year-old male patient reports having two to four urinary tract infections a year. What will the nurse
expect to teach this patient?
a. "Make sure you void after intercourse and drink extra fluids to stay well hydrated."
, b. "We will treat each infection as a separate infection and treat with short-coursetherapy."
c. "You will need to take a low dose of medication for 6 months to prevent infections."
d. "You will need to take antibiotics for 4 to 6 weeks each time you have an infection." ANS:ANS: C
This patient has reinfection of his urinary tract at a rate of more than three per year, which is an
indication for long-term prophylaxis. Voiding after intercourse is a good teaching point for sexually
active women to prevent urinary infections, but it is not a sufficient preventive measure for recurrent
infections in men. Short-course therapy may be used for each occurrence of infection if the reinfection
rate is less than three per year. Long-term treatment for individual infections is recommended if relapse
occurs or if infections do not clear with shorter-term therapy. DIF: Cognitive Level: Application REF: p.
828TOP: Nursing Process: Implementation MSC: NCLEX Client Needs Category: Physiologic Integrity:
Pharmacologic and Parenteral Therapies
A 60-year-old female patient is about to begin long-term therapy with a glucocorticoid. Which of the
following will be important for minimizing the risk of osteoporosis?
a. Baseline vitamin D level
b. Calcium and vitamin D supplements
c. Estrogen therapy
d. Skeletal x-rays before treatment ANS:ANS: B
Calcium and vitamin D supplements can help minimize the patient's risk of developing osteoporosis. A
baseline vitamin D level is not recommended. Estrogen therapy can help in
postmenopausal women, but its risks outweigh its benefits. Patients should undergo evaluation of the
bone mineral density of the lower spine, not skeletal x-rays. DIF: Cognitive Level:
Analysis REF: p. 627TOP: Nursing Process: Assessment MSC: NCLEX Client Needs Category:
Physiologic Integrity: Pharmacologic and Parenteral Therapies
A 65-year-old patient who receives glucocorticoids for arthritis is admitted to the hospital for treatment
of a urinary tract infection. The prescriber has ordered intravenous ciprofloxacin [Cipro]. Before
administering the third dose of this drug, the nurse reviews the bacterial culture report and notes that
the causative organism is Escherichia coli. The bacterial sensitivity report is pending. The patient
complains of right ankle pain. What will the nurse do?
a. Withhold the dose of ciprofloxacin and notify the provider of the patient's symptoms.
b. Instruct the patient to exercise the right foot and ankle to minimize the pain.
c. Question the patient about the consumption of milk and any other dairy products.
Pharmacotherapeutics for Advanced
Practice Nurses and Physician
Assistants
A 5-year-old child is brought to the emergency department after ingesting diphenhydramine
[Benadryl]. The child is uncoordinated and agitated. The nurse observes that the child's face is flushed,
the temperature is 37.1°C, and the heart rate is 110 beats/minute. The nurse will expect
to:
a. administer atropine to reverse the adverse effects.
b. apply ice packs to stop the flushing.
c. give activated charcoal to absorb the drug.
d. prepare to provide mechanical ventilation. ANS:ANS: C
In acute toxicity, patients present with agitation, a flushed face, tachycardia, and uncoordinated
movements. There is no specific antidote, so drug removal is the focus of treatment, starting with
activated charcoal to absorb the drug, followed by a cathartic to enhance excretion. Atropine would
cause an increase in the heart rate. Application of ice packs is recommended for hyperthermia and not
for flushing. The child's temperature is normal. Mechanical ventilation is not indicated with this
presentation of symptoms, although cardiovascular collapse may eventually develop. DIF:
Cognitive Level: Application REF: p. 601TOP: Nursing Process: Implementation MSC: NCLEX
Client Needs Category: Physiologic Integrity: Reduction of Risk Potential
A 5-year-old child with seasonal allergies has been taking 2.5 mL of cetirizine [Zyrtec] syrup once daily.
The parents tell the nurse that the child does not like the syrup, and they do not think that the drug is
effective. The nurse will suggest they discuss which drug with their child's health care provider?
a. Cetirizine [Zyrtec] 5-mg chewable tablet once daily
b. Loratadine [Claritin] 10-mg chewable tablet once daily
c. Fexofenadine [Allegra] syrup 5 mL twice daily
,d. Desloratadine [Clarinex] 5-mg rapid-disintegrating tablet once daily ANS:ANS: A
The child is receiving a low dose of cetirizine and can receive up to 5 mg/day in either a single dose or
two divided doses. Cetirizine is available in a chewable tablet, which this child may tolerate better, so
the parents should be encouraged to explore this option with their provider. The
loratadine 10-mg chewable tablet is approved for children 6 years and older. Fexofenadine would be
safe for this child, but it is unlikely that the syrup would be any better than the cetirizine syrup.
Desloratadine is not approved for children under the age of 12 years. DIF: Cognitive Level:
Application REF: p. 602TOP: Nursing Process: Implementation MSC: NCLEX Client Needs Category:
Physiologic Integrity: Pharmacologic and Parenteral Therapies
A 6-week-old infant who has not yet received immunizations develops a severe cough. While
awaiting nasopharyngeal culture results, the nurse will expect to administer which antibiotic?
a. Clindamycin [Cleocin]
b. Doxycycline [Vibramycin]
c. Erythromycin ethylsuccinate
d. Penicillin G ANS:ANS: C
Erythromycin is the drug of first choice for infections caused by Bordetella pertussis, the causative agent
of whooping cough. Infants who have not received their first set of immunizations are at increased risk
of pertussis. Clindamycin, doxycycline, and penicillin are not recommended. DIF: Cognitive Level:
Application REF: p. 805TOP: Nursing Process: Implementation MSC: NCLEX Client Needs Category:
Physiologic Integrity: Pharmacologic and Parenteral Therapies
A 7-year-old child has a cough, runny nose, congestion, and fever, and the parents ask the
nurse to recommend an over-the-counter product. Which response by the nurse is correct?
a. "Any product will be effective when combined with vitamin C and zinc."
b. "It is best to use single-agent medications to treat individual symptoms."
c. "The fever indicatesthat your child may need an antibiotic; you should call your provider."
d. "You should ask your provider to prescribe a combination product that will treat multiple
symptoms." ANS:ANS: B
Combination medications may provide ingredients that are not needed or may provide ingredients that
are either excessive or subtherapeutic. It is best to use single-agent drugs to treat individual symptoms.
The efficacy of vitamin C and zinc for treating colds in children has not been established. Fever may
,accompany viral respiratory infections and not necessarily bacterial infections that need an antibiotic.
DIF: Cognitive Level: Application REF: p. 701TOP: Nursing Process: Implementation MSC: NCLEX Client
Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies
A 7-year-old child with asthma uses a daily inhaled glucocorticoid and an albuterol MDI as needed. The
provider has added montelukast [Singulair] to the child's regimen. Which statement by the child's parent
indicates understanding of this medication?
a. "I may notice mood changes in my child."
b. "I should give this medication twice daily."
c. "I will give my child one 4-mg chewable tablet daily."
d. "This drug can alleviate symptoms during an acute attack." ANS:ANS: A
Montelukast is given as an adjunct to inhaled glucocorticoids to help prevent inflammation. Some
patients have reported mood changes when taking this drug, so parents should be warned of this
effect. The medication is given once daily. The dose for a 7-year-old child is 5 mg daily. The drug does
not treat symptoms of an acute attack. DIF: Cognitive Level: Application REF: p. 680TOP: Nursing
Process: Planning MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and
Parenteral Therapies
A 20-year-old female patient has suprapubic discomfort, pyuria, dysuria, and bacteriuria greater than
100,000/mL of urine. Which are the most likely diagnosis and treatment?
a. Uncomplicated lower urinary tract infection treatable with short-course therapy
b. Complicated lower urinary tract infection treatable with single-dose therapy
c. Uncomplicated upper urinary tract infection requiring 14 days of oral antibiotics
d. Complicated upper urinary tract infection requiring parenteral antibiotics ANS:ANS: A These are
symptoms of uncomplicated cystitis, which is a lower urinary tract infection that can be treated with a
short course of antibiotics. Short-course therapy is more effective than single-dose therapy and is
preferred. A complicated lower urinary tract infection would be associated with some predisposing
factor, such as renal calculi, an obstruction to the flow of urine, or an indwelling catheter. Upper urinary
tract infections often include severe flank pain, fever, and chills. DIF: Cognitive Level: Analysis REF: p.
827TOP: "Nursing Process: Assessment, Nursing Process: Planning" MSC: NCLEX Client Needs Category:
Physiologic Integrity: Pharmacologic and Parenteral Therapies
A 30-year-old male patient reports having two to four urinary tract infections a year. What will the nurse
expect to teach this patient?
a. "Make sure you void after intercourse and drink extra fluids to stay well hydrated."
, b. "We will treat each infection as a separate infection and treat with short-coursetherapy."
c. "You will need to take a low dose of medication for 6 months to prevent infections."
d. "You will need to take antibiotics for 4 to 6 weeks each time you have an infection." ANS:ANS: C
This patient has reinfection of his urinary tract at a rate of more than three per year, which is an
indication for long-term prophylaxis. Voiding after intercourse is a good teaching point for sexually
active women to prevent urinary infections, but it is not a sufficient preventive measure for recurrent
infections in men. Short-course therapy may be used for each occurrence of infection if the reinfection
rate is less than three per year. Long-term treatment for individual infections is recommended if relapse
occurs or if infections do not clear with shorter-term therapy. DIF: Cognitive Level: Application REF: p.
828TOP: Nursing Process: Implementation MSC: NCLEX Client Needs Category: Physiologic Integrity:
Pharmacologic and Parenteral Therapies
A 60-year-old female patient is about to begin long-term therapy with a glucocorticoid. Which of the
following will be important for minimizing the risk of osteoporosis?
a. Baseline vitamin D level
b. Calcium and vitamin D supplements
c. Estrogen therapy
d. Skeletal x-rays before treatment ANS:ANS: B
Calcium and vitamin D supplements can help minimize the patient's risk of developing osteoporosis. A
baseline vitamin D level is not recommended. Estrogen therapy can help in
postmenopausal women, but its risks outweigh its benefits. Patients should undergo evaluation of the
bone mineral density of the lower spine, not skeletal x-rays. DIF: Cognitive Level:
Analysis REF: p. 627TOP: Nursing Process: Assessment MSC: NCLEX Client Needs Category:
Physiologic Integrity: Pharmacologic and Parenteral Therapies
A 65-year-old patient who receives glucocorticoids for arthritis is admitted to the hospital for treatment
of a urinary tract infection. The prescriber has ordered intravenous ciprofloxacin [Cipro]. Before
administering the third dose of this drug, the nurse reviews the bacterial culture report and notes that
the causative organism is Escherichia coli. The bacterial sensitivity report is pending. The patient
complains of right ankle pain. What will the nurse do?
a. Withhold the dose of ciprofloxacin and notify the provider of the patient's symptoms.
b. Instruct the patient to exercise the right foot and ankle to minimize the pain.
c. Question the patient about the consumption of milk and any other dairy products.
