Silvestri: Saunders Comprehensive Review for the NCLEX-RN Examination, 5th Edition

Silvestri: Saunders Comprehensive Review for the NCLEX-RN Examination, 5th Edition Pharmacology Test Bank MULTIPLE CHOICE 1. The nurse is caring for a client in labor. The nurse reviews the physician’s prescriptions and notes that the client has a prescription for butorphanol tartrate (Stadol). The nurse understands that this medication is prescribed for: 1. Pain relief 2. Increasing uterine contractions 3. Decreasing uterine contractions 4. Promoting fetal lung maturity ANS: 1 Rationale: The client in labor may be given parenteral analgesia during the first stage of labor, up to 2 to 3 hours before the anticipated delivery. Butorphanol tartrate is a medication that may be prescribed for pain relief. “Increasing uterine contractions,” “decreasing uterine contractions,” and “promoting fetal lung maturity” are not actions of this medication. Test-Taking Strategy: Knowledge of the action of butorphanol tartrate is required to answer this question. Remember that this medication is used for pain relief. Review the action of this medication if you had difficulty with this question and are unfamiliar with this medication. PTS: 1 DIF: Level of Cognitive Ability: Understanding REF: Lehne, R. (2010). Pharmacology for nursing care (7th ed.). St. Louis: Saunders. OBJ: Client Needs: Physiological Integrity TOP: Content Area: Pharmacology MSC: Integrated Process: Nursing Process—Planning 2. The postpartum nurse is caring for a client with an epidural catheter in place for opioid analgesic administration following cesarean birth. If the client develops respiratory depression and requires naloxone (Narcan) as an antidote, the client may complain of which of the following? 1. Increase in her pain level 2. Decrease in her pain level 3. Increase in the amount of itching from the opioid used in the epidural 4. Decrease in the amount of itching from the opioid used in the epidural ANS: 1 Rationale: Remember that opioids are used for epidural analgesia. Naloxone is an opioid antagonist, which reverses the effects of opioids. If it is given, the client may complain of an increase in her pain level. Therefore “decrease in her pain level,” “increase in the amount of itching from the opioid used in the epidural,” and “decrease in the amount of itching from the opioid used in the epidural” are incorrect. Test-Taking Strategy: To answer this question accurately, you must know that opioid analgesics are the medications used with epidural analgesia to relieve pain. Therefore if naloxone is administered as an antidote for an opioid analgesic, the client’s pain will increase. Review the effects of naloxone if this question was difficult. PTS: 1 DIF: Level of Cognitive Ability: Understanding REF: Lehne, R. (2010). Pharmacology for nursing care (7th ed.). St. Louis: Saunders. OBJ: Client Needs: Physiological Integrity TOP: Content Area: Pharmacology MSC: Integrated Process: Nursing Process—Assessment 3. A client experiencing preterm labor at the twenty-ninth week of gestation has been admitted to the hospital. The client has a prescription to receive betamethasone (Celestone). The nurse understands that the medication will do which of the following? 1. Prevent spontaneous delivery. 2. Stop the uterine contractions. 3. Promote maturation of the fetal lungs. 4. Accelerate the growth rate of the fetus. ANS: 3 Rationale: Betamethasone (Celestone) is classified as an anti-inflammatory and corticosteroid. It increases the surfactant level and lung maturity in the fetus, which reduces the incidence of respiratory distress syndrome. Delivery must be delayed for at least 48 hours after administration of betamethasone to allow time for the lungs of the fetus to mature. Test-Taking Strategy: Options that are comparable or alike are not likely to be correct. With this in mind, eliminate “prevent spontaneous delivery” and “stop the uterine contractions.” Note the strategic words “twenty-ninth week of gestation.” Specific knowledge about the medication and knowledge of the problems encountered by premature infants will assist in answering this question. Review the action of this medication if this question was difficult. PTS: 1 DIF: Level of Cognitive Ability: Understanding REF: McKinney, E., James, S., Murray, S., & Ashwill, J. (2009). Maternal-child nursing (3rd ed.). St. Louis: Saunders. OBJ: Client Needs: Physiological Integrity TOP: Content Area: Pharmacology MSC: Integrated Process: Nursing Process—Planning 4. A client with preeclampsia is receiving magnesium sulfate. The nurse assesses the client closely for which sign of magnesium toxicity? 1. Proteinuria 2. Hyperactive deep tendon reflexes 3. Respiratory rate of 10 breaths/min 4. Serum magnesium level of 5 mEq/L ANS: 3 Rationale: Magnesium toxicity is a risk associated with magnesium sulfate therapy. Signs of magnesium toxicity relate to central nervous system (CNS) depression and include respiratory depression, loss of deep tendon reflexes, and sudden drop in fetal heart rate and/or maternal heart rate and blood pressure. Magnesium is excreted through the kidneys. If renal impairment is present, magnesium toxicity can develop very quickly. Therapeutic serum levels of magnesium are 4 to 7 mEq/L. Test-Taking Strategy: To answer this question accurately, you must recall that magnesium sulfate is a CNS depressant. Begin to answer this question by eliminating “proteinuria” and “hyperactive deep tendon reflexes,” which are signs of preeclampsia. Select between the last two options using medication knowledge and recalling that the therapeutic serum levels of magnesium are 4 to 7 mEq/L. Review this medication and the normal magnesium level if this question was difficult. PTS: 1 DIF: Level of Cognitive Ability: Analyzing REF: Lowdermilk, D., Perry, S., & Cashion, K. (2010). Maternity nursing (8th ed.). St. Louis: Mosby. OBJ: Client Needs: Physiological Integrity TOP: Content Area: Pharmacology MSC: Integrated Process: Nursing Process—Assessment 5. A pregnant client who has human immunodeficiency virus (HIV) infection is being seen in the antenatal clinic. The nurse recalls that zidovudine (AZT) therapy will be initiated when the fetus has reached how many weeks of gestation? 1. 4 2. 14 3. 24 4. 34 ANS: 2 Rationale: The pregnant women with HIV infection will be prescribed oral AZT in the fourteenth week of gestation. Before this time, the fetus is at risk because of the teratogenic effects of the medication. In addition, a bolus of AZT is given intravenously during labor, and the neonate is treated for six weeks after birth. Test-Taking Strategy: To answer this question accurately, you must be familiar with pharmacological therapy for clients who are HIV-positive. Knowing that the fetus is most vulnerable to the effects of medications and chemicals during the period of organogenesis will assist you in selecting the correct answer. Review treatment measures for the pregnant client with HIV infection if you had difficulty with this question. PTS: 1 DIF: Level of Cognitive Ability: Understanding REF: Lehne, R. (2010). Pharmacology for nursing care (7th ed.). St. Louis: Saunders. OBJ: Client Needs: Physiological Integrity TOP: Content Area: Pharmacology MSC: Integrated Process: Nursing Process—Planning 6. The nurse has a routine prescription to instill erythromycin ointment (Ilotycin) into the eyes of a newborn. The nurse plans to explain to the parents that the purpose of the medication is to: 1. Help the newborn to see more clearly. 2. Guard against infection acquired during intrauterine life. 3. Ensure the sterility of the conjunctiva in the newborn. 4. Protect the newborn from contracting an eye infection during birth. ANS: 4 Rationale: The use of eye prophylaxis with an agent such as erythromycin protects the newborn from contracting a conjunctival infection during birth. This infection, called ophthalmia neonatorum, results from maternal vaginal infection with chlamydia or gonorrhea. This prophylaxis is mandatory in the United States. “Help the newborn to see more clearly,” “guard against infection acquired during intrauterine life,” and “ensure the sterility of the conjunctiva in the newborn” do not describe the purposes of this medication. Test-Taking Strategy: Familiarity with the purpose of this medication is needed to answer this question. Remember erythromycin protects the newborn from contracting a conjunctival infection during birth. Review the purpose of this medication if you had difficulty with this question. PTS: 1 DIF: Level of Cognitive Ability: Applying REF: Lehne, R. (2010). Pharmacology for nursing care (7th ed.). St. Louis: Saunders. OBJ: Client Needs: Health Promotion and Maintenance TOP: Content Area: Pharmacology MSC: Integrated Process: Teaching and Learning 7. The nurse has a routine prescription to administer an injection of phytonadione (vitamin K) to the newborn. Before giving the medication, the nurse explains to the client that this medication will: 1. Prevent clotting abnormalities in the newborn. 2. Stimulate the liver to produce vitamin K. 3. Prevent vitamin deficiency of fat-soluble vitamins. 4. Supplement the infant, because breast milk and formula are low in vitamin K. ANS: 1 Rationale: Vitamin K is given to the newborn to prevent clotting abnormalities. Vitamin K is usually produced by bacteria in the gastrointestinal tract, which is sterile in the newborn. The other options are incorrect reasons for administering this medication to a newborn. Test-Taking Strategy: Use the process of elimination. Thinking about the action and purpose of vitamin K will assist in answering correctly. Review the rationale for this newborn prophylaxis if this question was difficult. PTS: 1 DIF: Level of Cognitive Ability: Applying REF: Perry, S., Hockenberry, M., Lowdermilk, D., & Wilson, D. (2010). Maternal child nursing care (4th ed.). St. Louis: Mosby. OBJ: Client Needs: Physiological Integrity TOP: Content Area: Pharmacology MSC: Integrated Process: Nursing Process—Implementation 8. The client who has developed atrial fibrillation is not responding to medication therapy and has been placed on warfarin (Coumadin). The nurse is doing discharge dietary teaching with the client. The nurse would tell the client to avoid which of the following foods while taking this medication? 1. Cherries 2. Potatoes 3. Broccoli 4. Spaghetti ANS: 3 Rationale: Anticoagulant medications work by antagonizing the action of vitamin K, which is needed for clotting. When a client is taking an anticoagulant, foods high in vitamin K are often omitted from the diet. Vitamin K is found in large amounts in green leafy vegetables, such as broccoli, cabbage, turnip greens, and lettuce. The other options listed are foods that are lower in vitamin K. Test-Taking Strategy: Knowledge about the relationship between warfarin and vitamin K is needed to answer this question. Note the strategic word “avoid” in the question. This tells you that the correct option is a food that is high in vitamin K. If you had difficulty with this question, review foods high in vitamin K. PTS: 1 DIF: Level of Cognitive Ability: Applying REF: Lehne, R. (2010). Pharmacology for nursing care (7th ed.). St. Louis: Saunders. OBJ: Client Needs: Physiological Integrity TOP: Content Area: Pharmacology MSC: Integrated Process: Nursing Process—Implementation 9. A client in preterm labor is being started on intravenous magnesium sulfate to stop the contractions. The nurse checks the medication to ensure that which medication is available as an antidote if needed? 1. Magnesium oxide 2. Vitamin K 3. Aluminum hydroxide 4. Calcium gluconate ANS: 4 Rationale: The antidote for magnesium sulfate is calcium gluconate. This medication should be available if the client experiences magnesium toxicity. The other options are incorrect. “Magnesium oxide” and “aluminum hydroxide” are antacids. Vitamin K is the antidote for warfarin (Coumadin). Test-Taking Strategy: Eliminate “magnesium oxide” and “aluminum hydroxide” first because they are comparable or alike and are antacids. For the remaining options, recall that vitamin K is the antidote for warfarin (Coumadin). Remember that the antidote for magnesium sulfate is calcium gluconate. If this question was difficult, review this medication and the relationship between magnesium and calcium. PTS: 1 DIF: Level of Cognitive Ability: Applying REF: Perry, S., Hockenberry, M., Lowdermilk, D., & Wilson, D. (2010). Maternal child nursing care (4th ed.). St. Louis: Mosby. OBJ: Client Needs: Physiological Integrity TOP: Content Area: Pharmacology MSC: Integrated Process: Nursing Process—Implementation 10. The nurse had just given an intramuscular dose of methylergonovine (Methergine) to a client following delivery of an infant. The nurse determines that this medication had the intended effect after evaluating for which of the following findings? 1. Decreased pulse rate 2. Increased urine output 3. Improved uterine tone 4. Increased blood pressure ANS: 3 Rationale: Methylergonovine is an ergot alkaloid that is given following delivery to treat postpartum hemorrhage. It acts by vasoconstricting arterioles and directly stimulating uterine muscle contractions. Blood pressure may increase, but this is not the intended therapeutic effect. “Decreased pulse rate” and “increased urine output” are unrelated to the effects of this medication. Test-Taking Strategy: To answer this question accurately, recall the action of the medication and its use in the immediate postpartum period. Remember that this medication improves uterine tone. Review the action of methylergonovine if you had difficulty with this question. PTS: 1 DIF: Level of Cognitive Ability: Evaluating REF: Perry, S., Hockenberry, M., Lowdermilk, D., & Wilson, D. (2010). Maternal child nursing care (4th ed.). St. Louis: Mosby. OBJ: Client Needs: Physiological Integrity TOP: Content Area: Pharmacology MSC: Integrated Process: Nursing Process—Evaluation 11. The nurse is told that the result of a serum carbamazepine (Tegretol) level for a child who is receiving the medication for the control of seizures is 10 mcg/mL. Based on this laboratory result, the nurse anticipates that the physician will prescribe: 1. Discontinuation of the medication 2. A decrease of the dosage of the medication 3. An increase of the dosage of the medication 4. Continuation of the presently prescribed dosage ANS: 4 Rationale: When carbamazepine is administered, blood levels need to be monitored periodically to check for the child’s absorption of the medication. The amount of the medication prescribed is based on the blood level achieved. The therapeutic serum range of carbamazepine is 4 to 12 mcg/mL. The nurse would anticipate that the physician will continue the presently prescribed dosage. Test-Taking Strategy: Knowing the therapeutic serum drug level of carbamazepine will direct you to the correct option. Remember that the therapeutic serum range is 4 to 12 mcg/mL. If you had difficulty with this question, learn the therapeutic serum drug level of carbamazepine. PTS: 1 DIF: Level of Cognitive Ability: Understanding REF: McKinney, E., James, S., Murray, S., & Ashwill, J. (2009). Maternal-child nursing (3rd ed.). St. Louis: Saunders. OBJ: Client Needs: Physiological Integrity TOP: Content Area: Pharmacology MSC: Integrated Process: Nursing Process—Planning 12. The nurse is providing instructions to a mother of a child with atopic dermatitis (eczema) regarding the application of topical cortisone cream to the affected skin sites. Which of the following statements, if made by the mother, indicates an understanding of the use of this medication? 1. “I shouldn’t rub the medication into the skin.” 2. “The medication is applied everywhere except the face.” 3. “I need to wash the sites gently before I apply the medication.” 4. “I need to apply the medication generously and allow it to absorb.” ANS: 3 Rationale: Topical corticosteroids should be applied sparingly and rubbed into the area thoroughly. The affected area should be cleansed gently prior to application. It should not be applied everywhere or over extensive areas. Systemic absorption is more likely to occur with extensive application. It is applied to the affected sites. Test-Taking Strategy: Note the strategic words “indicates an understanding.” Look for the option that indicates that the mother understands how to apply the cream. Eliminate “The medication is applied everywhere except the face.” because cream should be applied only to areas that are affected. Eliminate “I need to apply the medication generously and allow it to absorb.” because of the strategic word “generously.” Eliminate “I shouldn’t rub the medication into the skin.” because of the strategic words “shouldn’t rub.” Review the procedure for application of this cream if you had difficulty with this question. PTS: 1 DIF: Level of Cognitive Ability: Evaluating REF: Perry, S., Hockenberry, M., Lowdermilk, D., & Wilson, D. (2010). Maternal child nursing care (4th ed.). St. Louis: Mosby. OBJ: Client Needs: Physiological Integrity TOP: Content Area: Pharmacology MSC: Integrated Process: Nursing Process—Evaluation 13. The nurse working in the ambulatory care center is providing medication instructions about methylphenidate (Ritalin) to the mother of a child with attention-deficit/hyperactivity disorder (ADHD). The nurse recommends that the mother give the medication to the child: 1. At bedtime 2. With the evening meal 3. Just before the noontime meal 4. In the morning, 2 hours before breakfast ANS: 3 Rationale: Methylphenidate is best taken shortly before a meal. It should not be taken after 12 noon or 1 PM for children or after 6 PM for adults, because the stimulating effect may keep the client awake. The other options are incorrect. Test-Taking Strategy: Knowledge about the correct administration procedure for this medication is required to answer this question. Remember that it is best to administer it shortly before the noontime meal. If you had difficulty with this question, review the client teaching points for methylphenidate. PTS: 1 DIF: Level of Cognitive Ability: Applying REF: Lehne, R. (2010). Pharmacology for nursing care (7th ed.). St. Louis: Saunders. OBJ: Client Needs: Physiological Integrity TOP: Content Area: Pharmacology MSC: Integrated Process: Teaching and Learning 14. A child has been prescribed to take tetracycline hydrochloride. The nurse providing medication information to the mother would plan to emphasize which of the following most important instructions about giving this medication to the child? 1. Give the medication with milk. 2. Give the medication with ice cream. 3. Mix the medication in a Styrofoam cup. 4. Use a straw when giving the medication. ANS: 4 Rationale: Because tetracycline can cause staining of the teeth, straws should be used and the mouth rinsed after administration. The medication should be administered 1 hour before or 2 hours after the administration of milk, which would eliminate “give the medication with milk” and “give the medication with ice cream.” “Mix the medication in a Styrofoam cup” is unnecessary. Test-Taking Strategy: Eliminate “give the medication with milk” and “give the medication with ice cream” first because they are comparable or alike—they are both milk products. Recalling that tetracycline can cause staining of the teeth will direct you to the correct option from those remaining. If you had difficulty with this question, review the client teaching points related to the administration of tetracycline hydrochloride. PTS: 1 DIF: Level of Cognitive Ability: Applying REF: Kee, J., Hayes, E., & McCuistion, L. (2009). Pharmacology: a nursing process approach (6th ed.). St. Louis: Saunders. OBJ: Client Needs: Physiological Integrity TOP: Content Area: Pharmacology MSC: Integrated Process: Teaching and Learning 15. The nurse is providing instructions to the parent of a child with iron deficiency anemia about the administration of a liquid oral iron supplement. Which of the following statements, if made by the parent, indicates an understanding of the administration of this medication? 1. “I should give the iron with food.” 2. “I can mix the iron with cereal to give it.” 3. “I should add the iron to the formula in the baby’s bottle.” 4. “I should use a medicine dropper and place the iron near the back of the throat.” ANS: 4 Rationale: Oral iron supplement should be administered through a straw or medicine dropper placed at the back of the mouth because it will stain the teeth. The parents should be instructed to brush or wipe the teeth after administration. Iron is administered between meals because absorption is decreased if there is food in the stomach. Iron requires an acidic environment to facilitate its absorption in the duodenum. Test-Taking Strategy: Eliminate “I should give the iron with food.” “I can mix the iron with cereal to give it.” and “I should add the iron to the formula in the baby’s bottle.” first because they are comparable or alike and because medication should not be added to formula and food. Also, note the strategic word “liquid” in the question. This should assist in recalling that liquid iron stains teeth. Review the teaching points related to this medication if you had difficulty with this question. PTS: 1 DIF: Level of Cognitive Ability: Evaluating REF: McKinney, E., James, S., Murray, S., & Ashwill, J. (2009). Maternal-child nursing (3rd ed.). St. Louis: Saunders. OBJ: Client Needs: Physiological Integrity TOP: Content Area: Pharmacology MSC: Integrated Process: Nursing Process—Evaluation 16. The client with psoriasis is being treated with calcipotriene (Dovonex) cream. Administration of high doses of this medication can cause which side effect? 1. Alopecia 2. Hyperkalemia 3. Hypercalcemia 4. Thinning of the skin ANS: 3 Rationale: Calcipotriene (Dovonex), an analogue of vitamin D3, is indicated for mild to moderate psoriasis. Responses are equal to those achieved with medium-potency topical glucocorticoids. The most common adverse effect is local irritation. Unlike glucocorticoids, calcipotriene does not cause thinning of the skin. At high doses, calcipotriene has caused hypercalcemia. Hyperkalemia is not a side effect. Test-Taking Strategy: Note the strategic words “high doses.” Remember that hypercalcemia is a concern. Note that the relationship between the name of the medication and “hypercalcemia.” The medication name begins with calci-, which is similar to calcium. Review this medication if you had difficulty with this question. PTS: 1 DIF: Level of Cognitive Ability: Analyzing REF: Lehne, R. (2010). Pharmacology for nursing care (7th ed.). St. Louis: Saunders. OBJ: Client Needs: Physiological Integrity TOP: Content Area: Pharmacology MSC: Integrated Process: Nursing Process—Assessment 17. Collagenase (Santyl) is prescribed for a client with a severe burn to the hand. The nurse is providing instructions to the client and spouse regarding wound treatment. Which of the following should the nurse include in the instructions? 1. Apply twice a day, and leave it open to the air. 2. Apply once a day, and leave it open to the air. 3. Apply twice a day, and cover it with a sterile dressing. 4. Apply once a day, and cover it with a sterile dressing. ANS: 4 Rationale: Collagenase is used in the treatment of dermal lesions and severe burns. Its action is to débride the affected area. It is applied once daily and covered with a sterile dressing. “Apply twice a day, and leave it open to the air,” “apply once a day, and leave it open to the air,” and “apply twice a day, and cover it with a sterile dressing” are incorrect application procedures. Test-Taking Strategy: Knowledge regarding the use of this medication is required to answer this question. Remember that this medication is applied daily and covered with a sterile dressing. Review the procedure for applying collagenase if you had difficulty with this question. PTS: 1 DIF: Level of Cognitive Ability: Applying REF: Ignatavicius, D., & Workman, M. (2010). Medical-surgical nursing: patient-centered collaborative care (6th ed.). St. Louis: Saunders. OBJ: Client Needs: Physiological Integrity TOP: Content Area: Pharmacology MSC: Integrated Process: Teaching and Learning 18. A nurse is caring for a female client at home with a diagnosis of actinic keratosis. The client tells the nurse that her skin is very dry and irritated. The treatment includes diclofenac sodium (Solaraze). The nurse teaches the client that this medication is from which class of medications? 1. Anti-infectives 2. Vitamin A lotions 3. Coal tar preparations 4. Nonsteroidal anti-inflammatory drugs (NSAIDs) ANS: 4 Rationale: Diclofenac sodium (Solaraze) is a nonsteroidal anti-inflammatory drug (NSAID) for topical use. It is indicated for use for actinic keratosis. The mechanism underlying its benefits is unknown. The most common side effects are dry skin, itching, redness, and rash at the site of application. Diclofenac may sensitize the skin to ultraviolet radiation, and clients should therefore avoid sunlamps and minimize exposure to sunlight. Vitamin A would be contraindicated in the treatment of actinic keratosis. Coal tar is for psoriasis. Test-Taking Strategy: Focus on the client’s diagnosis and the name of the medication. Also noting the strategic word “irritated” in the question will direct you to “nonsteroidal anti-inflammatory drugs (NSAIDs).” Review this medication if you had difficulty with this question. PTS: 1 DIF: Level of Cognitive Ability: Applying REF: Lehne, R. (2010). Pharmacology for nursing care (7th ed.). St. Louis: Saunders. OBJ: Client Needs: Physiological Integrity TOP: Content Area: Pharmacology MSC: Integrated Process: Teaching and Learning 19. The client with muscle aches and a diagnosis of rheumatism has been given a prescription for capsaicin topical cream. The nurse evaluates that the client understands the use of the medication if the client states that: 1. The medication will act as a local analgesic. 2. The medication acts by decreasing muscle spasms. 3. The medication will cause redness, flaking, and the skin to peel. 4. A heating pad should be put on the area after applying the medication. ANS: 1 Rationale: Capsaicin is used for the temporary relief of muscular aches, rheumatism, arthritis, sprains, and neuralgia. It is one of a group of products known as rubs or liniments, which contain combinations of antiseptics, local anesthetics, analgesics, and counterirritants. The skin should not become red, flaky, or peel; if this occurs, the physician should be notified. The medication does not act systemically. A heating pad should not be applied, because it could cause skin irritation or burning. Test-Taking Strategy: Focus on the diagnosis to assist in eliminating “the medication will cause redness, flaking, and the skin to peel.” Next eliminate “a heating pad should be put on the area after applying the medication” because a heating pad should not be placed over this cream because of the risk of burns. Choose correctly between the remaining two options by differentiating a systemic from a topical response. Review this medication if you had difficulty with this question. PTS: 1 DIF: Level of Cognitive Ability: Evaluating REF: Ignatavicius, D., & Workman, M. (2010). Medical-surgical nursing: patient-centered collaborative care (6th ed.). St. Louis: Saunders. OBJ: Client Needs: Physiological Integrity TOP: Content Area: Pharmacology MSC: Integrated Process: Nursing Process—Evaluation 20. The client with a burn injury is applying mafenide (Sulfamylon) to the wound. The client calls the physician’s office and tells the nurse that the medication is uncomfortable and is causing a burning sensation. The nurse instructs the client to: 1. Discontinue the medication. 2. Apply a thinner film than prescribed to the burn site. 3. Continue with the treatment, as this is expected. 4. Come to the office to see the physician immediately. ANS: 3 Rationale: Mafenide is used to treat partial- and full-thickness burns. It is bacteriostatic for both gram- negative and gram-positive organisms present in avascular tissues. The client should be warned that the medication will cause local discomfort and burning. The nurse does not instruct a client to alter a medication prescription (“discontinue the medication” and “apply a thinner film than prescribed to the burn site”). It is not necessary that the client see the physician immediately at this time. Test-Taking Strategy: Eliminate “discontinue the medication” and “apply a thinner film than prescribed to the burn site” because they represent, in effect, a change in medication prescription, which is outside the realm of legal nursing practice. To choose correctly between the last two options, you must be familiar with this medication and its expected effects. Remember that this medication will cause local discomfort and burning. If you had difficulty with this question, review this medication now. PTS: 1 DIF: Level of Cognitive Ability: Applying REF: Lehne, R. (2010). Pharmacology for nursing care (7th ed.). St. Louis: Saunders. OBJ: Client Needs: Physiological Integrity TOP: Content Area: Pharmacology MSC: Integrated Process: Teaching and Learning 21. The client with an infected leg wound that is draining purulent material has a prescription for sodium hypochlorite (Dakin solution) to be used in the care of the wound. The nurse would do which of the following while using this solution? 1. Rinse off immediately following irrigation. 2. Pour onto sterile sponges, and pack in wound. 3. Let the solution run freely over normal skin tissue. 4. Use each bottle of solution for 2 weeks before replacing. ANS: 1 Rationale: Dakin solution is a hypochlorite solution that is used for irrigating and cleaning necrotic or purulent wounds. It cannot be used to pack purulent wounds, because the solution is inactivated by copious pus. (It can be used to pack necrotic wounds, however.) It should not come into contact with healing or normal tissue, and it should be rinsed off immediately if used for irrigation. The solution is unstable, and it is best to prepare a fresh solution for use during each dressing change. Test-Taking Strategy: Note the strategic words “draining purulent material.” This will direct you to “rinse off immediately following irrigation.” If you are unfamiliar with the use of this solution, review this content. PTS: 1 DIF: Level of Cognitive Ability: Applying REF: Lehne, R. (2010). Pharmacology for nursing care (7th ed.). St. Louis: Saunders. OBJ: Client Needs: Physiological Integrity TOP: Content Area: Pharmacology MSC: Integrated Process: Nursing Process—Implementation 22. An adolescent client with severe cystic acne has been prescribed isotretinoin (Accutane). Which statement by the client would suggest the need for further teaching? 1. “I will return to the clinic for blood tests.” 2. “If my lips begin to burn, it is probably because of the medication.” 3. “My eyes may become dry and burn as a result of the medication.” 4. “I need to take my vitamin A supplement so that the treatment will work.” ANS: 4 Rationale: Isotretinoin (Accutane) is used to inhibit inflammation in the client with severe cystic acne. Adverse effects include elevated triglyceride levels, skin dryness, and eye discomfort, such as dryness and burning. Lip inflammation, called cheilitis, can also occur. Vitamin A supplements are stopped during this treatment because of their additive effects. Test-Taking Strategy: Use the process of elimination and note the strategic words “need for further teaching.” These words indicate a negative event query and the need to select the incorrect option. Remember that vitamin A supplements are stopped during treatment. This will also assist in answering questions similar to this one. If you are unfamiliar with this medication and the client teaching points involved, review this content. PTS: 1 DIF: Level of Cognitive Ability: Evaluating REF: Lehne, R. (2010). Pharmacology for nursing care (7th ed.). St. Louis: Saunders. OBJ: Client Needs: Physiological Integrity TOP: Content Area: Pharmacology MSC: Integrated Process: Teaching and Learning 23. An ambulatory care client with allergic dermatitis has been given a prescription for a tube of diphenhydramine (Benadryl) 1% to use as a topical agent. The nurse determines that the medication was effective if which of the following was assessed? 1. Nighttime sedation 2. Decrease in urticaria 3. Absence of ecchymoses 4. Healing of burned tissue ANS: 2 Rationale: Diphenhydramine reduces the symptoms of allergic reaction, such as itching or urticaria, when used as a topical agent on the skin. The oral form also has other uses, such as to provide mild nighttime sedation. It is not used to treat burns or ecchymoses. Test-Taking Strategy: The strategic words are “dermatitis” and “effective.” This tells you that the correct option is one that indicates relief of an allergic skin condition. Knowledge of the medication’s antihistamine effect will direct you to the correct option. Review this medication if you had difficulty with this question. PTS: 1 DIF: Level of Cognitive Ability: Evaluating REF: Lehne, R. (2010). Pharmacology for nursing care (7th ed.). St. Louis: Saunders. OBJ: Client Needs: Physiological Integrity TOP: Content Area: Pharmacology MSC: Integrated Process: Nursing Process—Evaluation 24. The client with cancer has received a course of chemotherapy and received fluorouracil (Adrucil). The nurse should plan to tell the client to report which of the following immediately? 1. Alopecia 2. Headache 3. Stomatitis and diarrhea 4. Changes in color vision ANS: 3 Rationale: Fluorouracil (Adrucil) should be discontinued as soon as reactions (stomatitis, diarrhea) occur. Dosage can also be limited by palmar-plantar erythrodysesthesia syndrome (also called hand-foot syndrome), characterized by tingling, burning, redness, flaking, swelling, and blistering of the palms and soles. Alopecia is common and would not require immediate reporting. Headache and vision changes are not associated with fluorouracil. Test-Taking Strategy: General knowledge of the adverse effects associated with the administration of antineoplastic medications is required to answer this question. Remember that stomatitis and diarrhea is a concern with fluorouracil (Adrucil). Review the adverse effects of this medication if you had difficulty with this question. PTS: 1 DIF: Level of Cognitive Ability: Applying REF: Lehne, R. (2010). Pharmacology for nursing care (7th ed.). St. Louis: Saunders. OBJ: Client Needs: Physiological Integrity TOP: Content Area: Pharmacology MSC: Integrated Process: Nursing Process—Implementation 25. The nurse reviewing a medical record notes that high concentrations of methotrexate followed by leucovorin (citrovorum factor, folic acid) are being given to the client with cancer. The nurse correctly interprets that the reason for therapy with leucovorin is to: 1. Preserve normal cells. 2. Promote protein synthesis. 3. Promote medication excretion. 4. Hasten the effect of the methotrexate. ANS: 1 Rationale: The administration of leucovorin with methotrexate is known as leucovorin rescue. High concentrations of methotrexate cause harm and damage to normal cells. Leucovorin bypasses the metabolic block caused by methotrexate, thereby permitting normal cells to synthesize. Leucovorin rescue is potentially hazardous, because failure to administer leucovorin in the right dose at the right time can be fatal. Test-Taking Strategy: To answer this question accurately, it is necessary to understand the action of leucovorin and the reason for administering it with methotrexate. Eliminate “hasten the effect of the methotrexate” first, because increased fluids and diuretics normally are prescribed and administered to hasten the effect of methotrexate. To select from the remaining options, you must be familiar with this medication. If you had difficulty with this question, review leucovorin rescue. PTS: 1 DIF: Level of Cognitive Ability: Understanding REF: Lehne, R. (2010). Pharmacology for nursing care (7th ed.). St. Louis: Saunders. OBJ: Client Needs: Physiological Integrity TOP: Content Area: Pharmacology MSC: Integrated Process: Nursing Process—Analysis 26. The nurse understands that an indication for the use of asparaginase (Elspar) is: 1. Lung cancer 2. Breast cancer 3. Metastatic prostate cancer 4. Acute lymphocytic leukemia ANS: 4 Rationale: Asparaginase is indicated for the treatment of acute lymphocytic leukemia. “Lung cancer,” “breast cancer,” and “metastatic prostate cancer” are treated with other antineoplastic agents. Test-Taking Strategy: Knowledge regarding the indications for use of specific antineoplastic agents is required to answer this question. Remember that acute lymphocytic leukemia may be treated with asparaginase. Review the specific uses of this medication if you had difficulty answering this question. PTS: 1 DIF: Level of Cognitive Ability: Understanding REF: Lehne, R. (2010). Pharmacology for nursing care (7th ed.). St. Louis: Saunders. OBJ: Client Needs: Physiological Integrity TOP: Content Area: Pharmacology MSC: Integrated Process: Nursing Process—Planning 27. The nurse is caring for a client on the oncology unit who has developed stomatitis during chemotherapy. The nurse would plan which of the following measures to treat this complication? 1. Rinse the mouth with diluted baking soda or saline. 2. Use lemon and glycerin swabs liberally on painful oral lesions. 3. Place the client on NPO status for 12 hours, then resume liquids. 4. Brush the teeth and use nonwaxed dental floss at least twice a day. ANS: 1 Rationale: Stomatitis, or mouth ulcerations, occurs with the administration of many antineoplastic medications. The client’s mouth should be examined daily for signs of ulceration. If stomatitis occurs, the client should be instructed to rinse the mouth with baking soda or saline. Food and fluids are important and should not be restricted. If chewing and swallowing are painful, the client may switch to a liquid diet. Instruct the client to avoid spicy foods and foods with hard crusts or edges. The client should avoid tooth brushing and flossing when stomatitis is severe. Lemon and glycerin swabs may cause pain and further irritation. Test-Taking Strategy: Begin to answer this question by recalling the characteristics of stomatitis. Eliminate “use lemon and glycerin swabs liberally on painful oral lesions,” because lemon can be irritating to ulcerated lesions. Eliminate “place the client on NPO status for 12 hours, then resume liquids,” because foods and fluids would not be restricted for a client who received antineoplastic medication. Eliminate “brush the teeth and use nonwaxed dental floss at least twice a day,” because a toothbrush and floss will irritate ulcerations and also may cause bleeding. If you had difficulty with this question, review the procedures for caring for stomatitis. PTS: 1 DIF: Level of Cognitive Ability: Applying REF: Black, J., & Hawks, J. (2009). Medical-surgical nursing: clinical management for positive outcomes (8th ed.). St. Louis: Saunders. OBJ: Client Needs: Physiological Integrity TOP: Content Area: Pharmacology MSC: Integrated Process: Nursing Process—Planning 28. The client who has been diagnosed with cancer is to receive chemotherapy with both cisplatin (Platinol- AQ) and vincristine (Oncovin). The client asks the nurse why both medications must be given together. The nurse's response is based on the understanding that the purpose of using both medications is to: 1. Prevent the destruction of normal cells. 2. Increase the destruction of tumor cells. 3. Decrease the risk of the alopecia and stomatitis. 4. Increase the likelihood of erythrocyte and leukocyte recovery. ANS: 2 Rationale: Cisplatin (Platinol-AQ) is an alkylating-like medication, and vincristine (Oncovin) is a vinca alkaloid. Alkylating medications are cell cycle phase–nonspecific. Vinca alkaloids are cell cycle phase– specific and act on the M phase. Single-agent medication therapy seldom is used. Combinations of medications are used to increase the destruction of tumor cells. Test-Taking Strategy: Knowledge of the rationale for combination medication therapy is required to answer the question. Read each option carefully and remember that combinations of medications are used to increase the destruction of tumor cells. If this question was difficult, review the purpose of combination chemotherapy. PTS: 1 DIF: Level of Cognitive Ability: Understanding REF: Lehne, R. (2010). Pharmacology for nursing care (7th ed.). St. Louis: Saunders. OBJ: Client Needs: Physiological Integrity TOP: Content Area: Pharmacology MSC: Integrated Process: Nursing Process—Planning 29. The nurse tells the client with leukemia who is receiving chemotherapy that allopurinol (Zyloprim) has been added to the medication list. When the client asks the purpose of the new medication, the nurse responds that the allopurinol is intended to prevent: 1. Nausea 2. Diarrhea 3. Muscle spasms 4. Hyperuricemia ANS: 4 Rationale: Chemotherapy destroys cells leading to the release of uric acid into the blood stream. The client is then at risk of experiencing uric acid nephropathy, renal stones, and acute renal failure. Allopurinol (Zyloprim), an antigout medication, is used with chemotherapy to prevent or treat this complication of therapy. It also may be used in mouthwash following fluorouracil (Adrucil) therapy to prevent stomatitis. Allopurinol is not used to treat nausea, diarrhea, or muscle spasms. Test-Taking Strategy: Focus on the subject, the purpose of allopurinol in the client receiving chemotherapy. Remember that allopurinol is also used to remove uric acid from the body in clients with gout. This will assist in directing you to “hyperuricemia.” Review the purpose of allopurinol in the client receiving chemotherapy if you had difficulty with this question. PTS: 1 DIF: Level of Cognitive Ability: Applying REF: Lehne, R. (2010). Pharmacology for nursing care (7th ed.). St. Louis: Saunders. OBJ: Client Needs: Physiological Integrity TOP: Content Area: Pharmacology MSC: Integrated Process: Nursing Process—Implementation 30. The client with breast cancer has been given a prescription for cyclophosphamide (Cytoxan). The nurse determines that the client understands the proper use of the medication if the client states that he or she will: 1. Increase dietary intake of potassium. 2. Take the medication with large meals. 3. Decrease dietary intake of magnesium. 4. Increase fluid intake to 2 to 3 L/day. ANS: 4 Rationale: A toxic effect of cyclophosphamide (Cytoxan) is hemorrhagic cystitis. The client should drink large amounts of fluid during the administration of this medication. Clients also should observe for hematuria. The medication should be taken on an empty stomach, unless gastrointestinal upset occurs. Hyperkalemia can result from the use of the medication; therefore, the client would not be encouraged to increase potassium intake. The client would not be instructed to alter magnesium intake. Test-Taking Strategy: Knowledge of the toxic effects of cyclophosphamide will assist you to answer this question correctly. If you correlated cyclophosphamide with hemorrhagic cystitis, by the process of elimination, “increase fluid intake to 2 to 3 L/day” would then be selected. If you had difficulty with this question, review the toxic effects associated with this medication. PTS: 1 DIF: Level of Cognitive Ability: Evaluating REF: Lehne, R. (2010). Pharmacology for nursing care (7th ed.). St. Louis: Saunders. OBJ: Client Needs: Physiological Integrity TOP: Content Area: Pharmacology MSC: Integrated Process: Nursing Process—Evaluation 31. The nurse should be prepared to institute bleeding precautions in the client receiving antineoplastic medication if which of the following results were reported from the lab? 1. Clotting time, 12 seconds 2. Ammonia level, 28 mcg/dL 3. Platelet count, 50,000 cells/mm3 4. White blood cell count (WBC), 4500/mm3 ANS: 2 Rationale: Platelets are the building blocks of blood clots. The normal platelet count is 150,000 to 450,000 cells/mm3. Bleeding precautions should be instituted when the platelet count drops to a critically low level, as defined by agency policy. Bleeding precautions include avoiding all trauma, such as rectal temperatures or injections. The normal clotting time is 8 to 15 seconds. The normal ammonia value is 10 to 80 mcg/dL. The normal WBC is 5000 to 10,000 cells/mm3. When the WBC count drops, neutropenic precautions should be implemented. Test-Taking Strategy: Knowledge of normal laboratory values and the significance of the specific laboratory tests is required to answer the question. Eliminate “clotting time, 12 seconds” and “ammonia level, 28 mcg/dL,” because they identify normal laboratory values. To select between the last two options, correlate a low platelet count with the need for bleeding precautions and a low WBC count with the need for neutropenic precautions. Review bleeding precautions if you had difficulty with this question. PTS: 1 DIF: Level of Cognitive Ability: Applying REF: Ignatavicius, D., & Workman, M. (2010). Medical-surgical nursing: patient-centered collaborative care (6th ed.). St. Louis: Saunders. OBJ: Client Needs: Safe and Effective Care Environment TOP: Content Area: Pharmacology MSC: Integrated Process: Nursing Process—Planning 32. The client with cancer is about to be started on mitomycin (Mutamycin). The nurse should suggest contacting the physician after noting that the client is also taking which of the following medications? 1. Furosemide (Lasix) 2. Ondansetron (Zofran) 3. Warfarin (Coumadin) 4. Allopurinol (Zyloprim) ANS: 3 Rationale: Mitomycin is an antitumor antibiotic. The use of aspirin, anticoagulants, and thrombolytic agents should be avoided concurrent with this medication, because mitomycin causes thrombocytopenia. Warfarin (Coumadin) is an anticoagulant, and the risk of bleeding is increased if administered during mitomycin therapy. Furosemide is a diuretic and is not related to the question. Ondansetron (Zofran) is an antiemetic used to prevent or treat nausea and vomiting during chemotherapy. Allopurinol is an antigout medication, which prevents or treats hyperuricemia resulting from blood dyscrasias caused by cancer chemotherapy. Test-Taking Strategy: To answer this question accurately, you must be familiar with the adverse effects of this medication and how to minimize the risk of their occurrence. Remember that warfarin increases the risk of bleeding. If you are unfamiliar with this medication, review this content. PTS: 1 DIF: Level of Cognitive Ability: Analyzing REF: Ignatavicius, D., & Workman, M. (2010). Medical-surgical nursing: patient-centered collaborative care (6th ed.). St. Louis: Saunders. OBJ: Client Needs: Safe and Effective Care Environment TOP: Content Area: Pharmacology MSC: Integrated Process: Nursing Process—Analysis 33. A client with diabetes mellitus taking daily NPH insulin has been started on therapy with dexamethasone (Decadron). The nurse anticipates that which of the following adjustments in medication dosage will be made? 1. Decreased NPH insulin 2. Increased NPH insulin 3. Lower dose of dexamethasone (Decadron) than usual 4. Higher dose of dexamethasone (Decadron) than usual ANS: 2 Rationale: Dexamethasone is a glucocorticoid (corticosteroid) and therefore can elevate the blood glucose level. Diabetic clients may need their dosage of insulin or oral hypoglycemic medications increased during glucocorticoid therapy. This is most often a temporary change, needed to compensate for the actions of the medication. Test-Taking Strategy: Focus on the medications in the question and recall that medication names ending in the letters -sone are glucocorticoids. Next, remember that glucocorticoids can increase the blood glucose level. This concept will direct you to the correct option. Review the effects of corticosteroids if you had difficulty with this question. PTS: 1 DIF: Level of Cognitive Ability: Analyzing REF: Lehne, R. (2010). Pharmacology for nursing care (7th ed.). St. Louis: Saunders. OBJ: Client Needs: Physiological Integrity TOP: Content Area: Pharmacology MSC: Integrated Process: Nursing Process—Planning 34. The nurse monitors the blood glucose level of the client who received NPH insulin at 7 AM with an understanding that the client may experience a hypoglycemic reaction between: 1. 9 to 11 AM 2. 1 to 7 PM 3. 7 to 11 PM 4. Midnight to 6 AM ANS: 2 Rationale: NPH insulin is an intermediate-acting insulin. It peaks in 6 to 12 hours after administration. (Its onset is in 1 to 2 hours, and its duration is 18 to 24 hours.) If the medication was given at 7 AM, the nurse would monitor for hypoglycemia during the time of peak action, which would be between 1 and 7 PM. Test-Taking Strategy: Read the question carefully, noting that the question is asking about NPH insulin. Knowledge regarding the timing of the peak action is required to answer the question. Peak action time is the time that a hypoglycemic reaction will most likely occur. Review these points regarding NPH (and regular) insulin if you are unfamiliar with them. PTS: 1 DIF: Level of Cognitive Ability: Understanding REF: Lehne, R. (2010). Pharmacology for nursing care (7th ed.). St. Louis: Saunders. OBJ: Client Needs: Physiological Integrity TOP: Content Area: Pharmacology MSC: Integrated Process: Nursing Process—Assessment 35. The nurse evaluates that the family of a client newly diagnosed with diabetes mellitus correctly understands the reason for having glucagon on hand for emergency home use if the family indicates that the purpose of the medication is to treat: 1. Diabetic ketoacidosis 2. Hypoglycemia from insulin overdose 3. Hyperglycemia from insufficient insulin 4. Hyperglycemia occurring on “sick days” ANS: 2 Rationale: Glucagon is used to treat hypoglycemia resulting from insulin overdose. The family of the client is instructed in how to administer the medication. In an unconscious client, consciousness usually returns within 20 minutes of glucagon injection. After the client has regained consciousness, oral carbohydrates should be given. The other options are incorrect. Test-Taking Strategy: Note that the word “glucagon” is similar to the word “glucose.” This may help you recall that the medication raises blood glucose levels. Remember also that options that are comparable or alike are not likely to be correct. Each incorrect option contains hyperglycemia as the clinical problem. If you are unfamiliar with the use of glucagon, review this medication. PTS: 1 DIF: Level of Cognitive Ability: Evaluating REF: Lehne, R. (2010). Pharmacology for nursing care (7th ed.). St. Louis: Saunders. OBJ: Client Needs: Physiological Integrity TOP: Content Area: Pharmacology MSC: Integrated Process: Nursing Process—Evaluation 36. The nurse is teaching a client with hyperthyroidism regarding the prescribed medication propylthiouracil (PTU). The nurse determines that teaching has been successful if the client states that he will report which of the following symptoms to the physician? 1. Fever 2. Nervousness 3. Tiredness 4. Fatigue ANS: 1 Rationale: An adverse effect of propylthiouracil (PTU) is agranulocytosis. The client should be alert for this effect by noting the presence of fever or sore throat, which should be reported immediately. Muscle aches and excitability are neither side effects nor adverse effects of this medication. Tiredness may be an occasional side effect of the medication but does not warrant physician notification. Test-Taking Strategy: Eliminate “tiredness” and “fatigue” because they are comparable or alike. Next eliminate “nervousness” because it is a characteristic of hyperthyroidism. If you are unfamiliar with this medication, review its adverse effects. PTS: 1 DIF: Level of Cognitive Ability: Evaluating REF: Lehne, R. (2010). Pharmacology for nursing care (7th ed.). St. Louis: Saunders. OBJ: Client Needs: Physiological Integrity TOP: Content Area: Pharmacology MSC: Integrated Process: Nursing Process—Evaluation 37. The nurse teaches the client with hypocalcemia to take calcium carbonate (Os-Cal) at which time? 1. With breakfast 2. At lunch time 3. Just before a meal 4. One hour after a meal ANS: 4 Rationale: Calcium carbonate is best administered 1 to 1½ hours after meals. The tablets should be given with a full glass of water. Therefore “with breakfast,” “at lunch time,” and “just before a meal” are incorrect. Test-Taking Strategy: Eliminate “with breakfast,” “at lunch time,” and “just before a meal” because they are comparable or alike and indicate that the medications should be taken with food. Remember that it is best to take calcium carbonate 1 to 1½ hours after meals. If you had difficulty with this question, review the administration of this medication. PTS: 1 DIF: Level of Cognitive Ability: Applying REF: Skidmore-Roth, L. (2011). Mosby’s drug guide for nurses (9th ed.). St. Louis: Mosby. OBJ: Client Needs: Physiological Integrity TOP: Content Area: Pharmacology MSC: Integrated Process: Teaching and Learning 38. The nurse teaches the client being discharged to home with a prescription for a daily dose of prednisone to take the medication: 1. In the early morning 2. In the middle of the day 3. An hour before bedtime 4. Anytime of the day ANS: 1 Rationale: The client should be instructed to take glucocorticoids (corticosteroids) before 9 AM. This helps minimize adrenal insufficiency and also mimics the burst of glucocorticoids released naturally by the adrenal glands each morning. Therefore “in the middle of the day,” “an hour before bedtime,” and “anytime of the day” are incorrect. Test-Taking Strategy: Knowledge regarding the administration of glucocorticoids is required to answer this question. Remember that it is best to take the medication in the early morning. If you had difficulty with this question, review the procedure for the administration of glucocorticoids. PTS: 1 DIF: Level of Cognitive Ability: Applying REF: Lehne, R. (2010). Pharmacology for nursing care (7th ed.). St. Louis: Saunders. OBJ: Client Needs: Physiological Integrity TOP: Content Area: Pharmacology MSC: Integrated Process: Teaching and Learning 39. The nurse monitors the client taking octreotide acetate (Sandostatin) for acromegaly for which most frequent side effect of this medication? 1. Diarrhea 2. Dyspnea 3. Constipation 4. Bradycardia ANS: 1 Rationale: Octreotide acetate (Sandostatin) is used to reduce growth hormone levels in clients with acromegaly. The most common side effects of this medication are diarrhea, nausea, gallstone formation, and abdominal discomfort. Hypertension, although rare, may occur. Constipation, bradycardia, and dyspnea are not associated with use of this medication. Test-Taking Strategy: Knowledge regarding the side effects associated with octreotide acetate is required to answer the question. Remember that diarrhea can occur with this medication. Review the side effects of this medication if you had difficulty with this question. PTS: 1 DIF: Level of Cognitive Ability: Analyzing REF: Lehne, R. (2010). Pharmacology for nursing care (7th ed.). St. Louis: Saunders. OBJ: Client Needs: Physiological Integrity TOP: Content Area: Pharmacology MSC: Integrated Process: Nursing Process—Assessment 40. A client with a history of coronary artery disease has developed diabetes insipidus as a result of cranial surgery. The client's medication therapy will include vasopressin (Pitressin). The nurse monitors this client most carefully for which of the following sign/ symptom that indicates an adverse effect of this medication? 1. Depression 2. Chest pain 3. Nagging cough 4. Joint stiffness ANS: 2 Rationale: Because of its powerful vasoconstrictor actions, vasopressin can cause adverse cardiovascular effects. By constricting arteries of the heart, vasopressin can cause angina pectoris and even myocardial infarction (MI), especially if administered to clients with coronary artery disease. In addition, vasopressin may cause gangrene by decreasing blood flow in the periphery. The other options are incorrect are nit signs/symptoms of adverse effects of the medication. Test-Taking Strategy: Use the process of elimination to answer the question. The name “vasopressin” implies an effect on blood vessels. Therefore, correlate this name with an option that represents a cardiovascular problem. If you are unfamiliar with precautions associated with administering vasopressin, review this content. PTS: 1 DIF: Level of Cognitive Ability: Analyzing REF: Lehne, R. (2010). Pharmacology for nursing care (7th ed.). St. Louis: Saunders. OBJ: Client Needs: Physiological Integrity TOP: Content Area: Pharmacology MSC: Integrated Process: Nursing Process—Assessment 41. The client has a prescription for sucralfate (Carafate) four times daily. The nurse writes in the medication record to administer the medication at which of the following times? 1. With meals and at bedtime 2. Every 6 hours around the clock 3. One hour after meals and at bedtime 4. One hour before meals and at bedtime ANS: 4 Rationale: Sucralfate is a gastric protectant. The medication should be scheduled for administration 1 hour before meals and at bedtime. The medication is scheduled so that it has time to bind to the base of ulcers and erosions and form a protective coating before food intake stimulates chemical and mechanical irritation in the stomach. Therefore “with meals and at bedtime,” “every 6 hours around the clock,” and “one hour after meals and at bedtime” are incorrect. Test-Taking Strategy: Specific knowledge of this medication and its action and timing is needed to answer this question. Recalling that this medication is a gastric acid protectant will help you eliminate “with meals and at bedtime,” “every 6 hours around the clock,” and “one hour after meals and at bedtime.” If needed, review this medication and its method of administration. PTS: 1 DIF: Level of Cognitive Ability: Applying REF: Skidmore-Roth, L. (2011). Mosby’s drug guide for nurses (9th ed.). St. Louis: Mosby. OBJ: Client Needs: Physiological Integrity TOP: Content Area: Pharmacology MSC: Integrated Process: Nursing Process—Implementation 42. The client who chronically uses nonsteroidal anti-inflammatory drugs (NSAIDs) has begun taking misoprostol (Cytotec). Evaluation of the effectiveness of the misoprostol in preventing a side effect of chronic NSAID use is determined by the nurse if the client reports which of the following? 1. “I have fewer muscle aches.” 2. “My joint mobility has improved.” 3. “I no longer have pain above my stomach.” 4. “I am no longer experiencing constipation.” ANS: 3 Rationale: The client who chronically uses NSAIDs is prone to gastric mucosal injury. Misoprostol is a gastric protectant and is given specifically to prevent this occurrence. Constipation is not associated with the use of NSAIDs. “I have fewer muscle aches.” and “My joint mobility has improved.” are incorrect because they are intended effects of the NSAID. Test-Taking Strategy: Focus on the name of the medication to eliminate “I have fewer muscle aches.” and “My joint mobility has improved.” To select from the remaining options, recall that NSAIDs are irritating to the gastrointestinal tract. Review the side effects of NSAIDs if you had difficulty with this question. PTS: 1 DIF: Level of Cognitive Ability: Evaluating REF: Lehne, R. (2010). Pharmacology for nursing care (7th ed.). St. Louis: Saunders. OBJ: Client Needs: Physiological Integrity TOP: Content Area: Pharmacology MSC: Integrated Process: Nursing Process—Evaluation 43. The client in the preoperative holding area has been given a dose of scopolamine. The nurse assesses the client for which of the following side effects of the medication? 1. Dry mouth 2. Diaphoresis 3. Excessive urination 4. Pupillary constriction ANS: 1 Rationale: Scopolamine is an anticholinergic medication that can be used preoperatively. It causes frequent side effects, such as dry mouth, urinary retention, decreased sweating, and dilation of the pupils. The other options are incorrect. Test-Taking Strategy: To answer this question accurately, you must be familiar with this medication and its uses and/or the fact that it is an anticholinergic medication. Focusing on the strategic word “preoperative” and recalling the purpose of administering medications in the preoperative period will assist in directing you to the correct option. If the medication is unfamiliar to you, review its side effects. PTS: 1 DIF: Level of Cognitive Ability: Applying REF: Lehne, R. (2010). Pharmacology for nursing care (7th ed.). St. Louis: Saunders. OBJ: Client Needs: Physiological Integrity TOP: Content Area: Pharmacology MSC: Integrated Process: Nursing Process—Assessment 44. The client with gastroesophageal reflux disease (GERD) has a new prescription for pantoprazole (Protonix). Which of the following instructions should the nurse plan to provide to the client? 1. Chew the pill thoroughly. 2. Swallow the tablet whole. 3. Crush the pill if it is difficult to swallow. 4. Headache is expected to occur. ANS: 2 Rationale: Protonix, a proton pump inhibitor, is a delayed-release medication and should be swallowed whole. It should not be chewed or crushed. Headache is a potential side effect of the medication and should be reported to the health care provider. Test-Taking Strategy: To answer this question accurately, you must be familiar with this medication and its administration. “Chew the pill thoroughly” and “crush the pill if it is difficult to swallow” can be eliminated first, because chewing and crushing will interrupt the delayed release of the medication. Eliminate “headache is expected to occur” because headache is a potential side effect of the medication and should be reported to the health care provider. If this medication is unfamiliar to you, review its method of administration. PTS: 1 DIF: Level of Cognitive Ability: Applying REF: Skidmore-Roth, L. (2010). 2010 Mosby’s nursing drug reference (23rd ed.). St. Louis: Mosby. OBJ: Client Needs: Physiological Integrity TOP: Content Area: Pharmacology MSC: Integrated Process: Teaching and Learning 45. The client is experiencing diarrhea. The nurse reviews the client’s PRN medication prescription sheet and plans to administer which of the following medications for this problem? 1. Sennosides (Senokot) 2. Bisacodyl (Dulcolax Bowel Prep Kit) 3. Psyllium (Metamucil) 4. Loperamide (Imodium) ANS: 4 Rationale: Loperamide is an antidiarrheal agent. It inhibits peristalsis in the intestinal wall and inhibits intestinal secretion so that the number of stools and water content are decreased. “Sennosides (Senokot),” “bisacodyl (Dulcolax Bowel Prep Kit),” and “psyllium (Metamucil)” are laxatives. Test-Taking Strategy: Eliminate “sennosides (Senokot),” “bisacodyl (Dulcolax Bowel Prep Kit),” and “psyllium (Metamucil)” because they are comparable or alike, and because they are laxatives. If needed, review the uses of the medications listed in the options. PTS: 1 DIF: Level of Cognitive Ability: Applying REF: Lehne, R. (2010). Pharmacology for nursing care (7th ed.). St. Louis: Saunders. OBJ: Client Needs: Physiological Integrity TOP: Content Area: Pharmacology MSC: Integrated Process: Nursing Process—Planning 46. The client with recurrent constipation has been prescribed psyllium (Metamucil). Teaching provided by the nurse should include which of the following instructions? onal 8 ANS: 4 Rationale: Metamucil is a bulk-forming laxative. It should be m