Pharmacology and the Nursing Process-Pharmacology Test Bank for NCLEX _RN

2 Chapter 01 The Nursing Process and Drug Therapy MULTIPLE CHOICE 1. The nurse is writing a nursing diagnosis for a plan of care for a patient who has been newly diagnosed with type 2 diabetes. Which statement reflects the correct format for a nursing diagnosis? A. Anxiety B. Anxiety related to new drug therapy C. Anxiety related to feelings about drug therapy as evidenced by statements such as ―I’m upset about having to give myself shots‖ D. Anxiety related to new drug therapy as evidenced by statements such as ―I’m upset about having to give myself shots‖ ANS: D 2. A patient is to receive oral digoxin (Lanoxin) daily; however, because he is unable to swallow, he cannot take it orally, as ordered. What type of problem does this represent? A. ―Right time‖ problem B. ―Right dose‖ problem C. ―Right route‖ problem D. ―Right medication‖ problem ANS: C 3. The nurse has been monitoring a patient’s progress on a new drug regimen since the first dose and documenting signs of possible adverse effects. This example illustrates which phase of the nursing process? A. Planning B. Evaluation C. Implementation D. Nursing diagnosis ANS: B 4. The nurse is assigned to a patient who is newly diagnosed with type 1 diabetes mellitus. Which statement best illustrates an outcome criterion for this patient? A. The patient will follow instructions. B. The patient will not experience complications. C. The patient will adhere to the new insulin treatment regimen. D. The patient will demonstrate safe insulin self-administration technique. ANS: D 5. Which activity best reflects the implementation phase of the nursing process for a patient who is newly diagnosed with type 1 diabetes mellitus? A. Providing education regarding self-injection technique B. Setting goals and outcome criteria with the patient’s input C. D. Recording a drug history regarding over-the-counter medications used at home Formulating nursing diagnoses regarding knowledge deficit related to new treatment regimen ANS: A 3 6. The medication order reads, ―Give ondansetron 24 mg, 30 minutes before beginning chemotherapy to prevent nausea.‖ The nurse notes that the route is missing from the order. What is the nurse’s best action? A. Giving the medication intravenously because it is for nausea prevention B. Giving the medication orally because the tablets are available in 24 mg doses C. Contacting the prescriber to clarify the route of the medication ordered D. Holding the medication until the prescriber returns to clarify the order ANS: C 7. When the nurse considers the timing of a drug dose, which of the factors listed below is appropriate to consider when deciding when to give a drug? A. The patient’s ability to swallow B. The patient’s weight C. The patient’s last meal D. The patient’s allergies ANS: C MULTIPLE RESPONSE 1. When giving medications, the nurse will follow the rights of medication administration, which include what rights? Select all that apply. A. Right drug B. Right route C. Right dose D. Right time E. Right patient F. Right documentation ANS: A, B, C, D, E, F OTHER 1. Place the phases of the nursing process in the correct order, with 1 as the first phase and 5 as the last phase. 1. Evaluation 2. Nursing Diagnoses 3. Assessment 4. Implementation 5. Planning ANS: 3, 2, 5, 4, 1 4 Chapter 02 Pharmacologic Principles MULTIPLE CHOICE 1. A patient is receiving two different drugs. At current dosages and dosage forms, both drugs are absorbed into the circulation in identical amounts. Thus, because they have the same absorption rates, they are A. in a steady state. B. synergistic. C. compatible. D. bioequivalent. ANS: D 2. When given an intravenous (IV) medication, the patient says to the nurse, ―I usually take pills. Why does this medication have to be given in the arm?‖ What is the nurse’s best answer? A. ―The medication will cause fewer adverse effects when given intravenously.‖ B. ―The IV medication will be absorbed slowly into the tissues over time.‖ C. ―The action of the medication will begin sooner when given intravenously.‖ D. ―There is a lower chance of allergic reactions when drugs are given IV.‖ ANS: C 3. The nurse is administering parenteral drugs. Which statement is true regarding parenteral drugs? A. Parenteral drugs bypass the first-pass effect. B. Absorption of parenteral drugs is affected by reduced blood flow to the stomach. C. Absorption of parenteral drugs is altered by the presence of food in the stomach. D. Parenteral drugs exert their effects while circulating in the bloodstream. ANS: A 4. When monitoring a patient on an insulin drip to reduce blood glucose levels, the nurse notes that the patient’s glucose level is extremely low, and the patient is lethargic and difficult to awaken. This would be classified as which type of adverse drug reaction? A. An adverse effect B. An allergic reaction C. An idiosyncratic reaction D. A pharmacologic reaction ANS: D 5. When reviewing pharmacology terms for a group of newly graduated nurses, the nurse explains that a drug’s half-life is the time it takes for A. the drug to elicit half of its therapeutic response. B. one half of the original amount of a drug to reach the target cells. C. one half of the original amount of a drug to be removed from the body. D. one half of the original amount of a drug to be absorbed into the circulation. ANS: C 5 6. When administering drugs, the nurse remembers that the duration of action of a drug is defined as the time it takes A. for a drug to elicit a therapeutic response. B. for a drug to achieve its maximum therapeutic response. C. to remove a drug from circulation. D. for a drug’s concentration to be sufficient to cause a therapeutic response. ANS: D 7. When reviewing the mechanism of action of a specific drug, the nurse reads that the drug works by selective enzyme interaction. This process occurs when the drug A. alters cell membrane permeability. B. is attracted to a receptor on the cell wall, preventing an enzyme from binding to that receptor. C. enhances its effectiveness within the cell walls of the target tissue. D. attracts enzymes to bind with it instead of the enzymes’ normal target cells, blocking the action of the enzymes. ANS: D 8. When administering a new medication to a patient, the nurse reads that it is highly proteinbound. The nurse should expect which result? A. Renal excretion will take longer. B. The length of time for drug metabolism will be shorter. C. The duration of action of the medication will be longer. D. The duration of action of the medication will be shorter. ANS: C 9. A patient is experiencing chest pain and needs to take a sublingual form of nitroglycerin. Where does the nurse instruct the patient to place the tablet? A. Under the tongue B. In the space between the cheek and the gum inside the mouth C. At the back of the throat for easy swallowing D. On a nonhairy area of the chest ANS: A 10. The nurse is administering medications to a patient who is in liver failure resulting from endstage cirrhosis. The nurse is aware that patients with liver failure would most likely have problems with which pharmacokinetic phase? A. Absorption B. Distribution C. Metabolism D. Excretion ANS: C 11. A patient who has advanced cancer is receiving opioid medications around the clock to keep him comfortable as he nears the end of his life. Which term best describes this type of therapy? 6 A. Palliative therapy B. Maintenance therapy C. Acute therapy D. Supplemental therapy ANS: A 12. The nurse gave a sleeping pill to an elderly patient at bedtime. Two hours later, the patient is irritable and restless and unable to sleep. The nurse recognizes that the patient’s response is reflective of which reaction? A. Allergic reaction B. Mutagenic effect C. Idiosyncratic reaction D. Teratogenic reaction ANS: C MULTIPLE RESPONSE 1. Of the drugs listed below, which would be affected by the first-pass effect? Select all that apply. A. morphine infusion through a patient-controlled analgesia pump B. nitroglycerin sublingual tablets C. diphenhydramine (Benadryl) elixir D. levothyroxine (Synthroid) tablets E. Transdermal nicotine patches F. nifedipine (Procardia) capsules G. penicillin given by IV piggyback infusion ANS: C, D, F 7 Chapter 03 Life Span Considerations MULTIPLE CHOICE 1. Drug transfer to the fetus is more likely during the last trimester of pregnancy for which reason? A. Decreased fetal surface area B. Increased placental surface area C. Enhanced placental blood flow D. Increased amount of protein-bound drug in maternal circulation ANS: C 2. The nurse is monitoring a 22-year-old patient who is in the 26th week of pregnancy and has developed gestational diabetes and pneumonia. She is given medications that pose a possible fetal risk, but the potential benefits may warrant the use of the medications in her situation. The nurse recognizes that these medications are in which U.S. Food and Drug Administration (FDA) pregnancy safety category? A. Category B B. Category C C. Category D D. Category X ANS: C 3. When discussing dosage calculation for pediatric patients with a clinical pharmacist, the nurse notes that which type of dosage calculation is used most commonly in pediatric calculations? A. West nomogram B. Clark rule C. Height-to-weight ratio D. Mg/kg formula ANS: D 4. The nurse is assessing a newly admitted 83-year-old patient and determines that the patient is experiencing polypharmacy. Which statement most accurately illustrates polypharmacy? A. The patient has lower risk for drug interactions. B. The patient takes one medication for an illness several times a day. C. The patient risks problems only if over-the-counter medications are also taken. D. The patient takes multiple medications for several different illnesses. ANS: D 5. The nurse is aware that confusion, forgetfulness, and increased risk for falls are common responses of an elderly patient who is taking which type of drug? A. Laxatives B. Anticoagulants C. Sedatives D. Diuretics ANS: C 8 6. For accurate medication administration to pediatric patients, the nurse must take into account which criteria? A. Weight and organ maturity B. Renal output and weight C. Weight, body temperature, and age D. Height and age ANS: A 7. It is not uncommon for an elderly patient to experience a reduction in the stomach’s ability to produce hydrochloric acid. This change may result in which effect? A. Delayed gastric emptying B. An increase in gastric acidity C. Decreased intestinal absorption of medications D. Altered absorption of weakly acidic drugs such as aspirin ANS: D 8. The nurse is administering drugs to neonates and should consider which factor that may contribute to drug toxicity? A. The lungs are immature. B. The kidneys are small. C. The liver is not fully developed. D. Excretion of the drug occurs quickly. ANS: C 9. An 83-year-old woman has been given a thiazide diuretic to treat mild heart failure. She and her daughter should be told to watch for which problems? A. Constipation and anorexia B. Fatigue and dehydration C. Daytime sedation and lethargy D. Edema, nausea, and blurred vision ANS: B 10. An elderly patient with a new diagnosis of hypertension will be receiving a new prescription for an antihypertensive drug. The nurse expects which type of dosing to occur with this drug therapy? A. Drug therapy will be based on the patient’s weight. B. Drug therapy will be based on the patient’s age. C. The patient will receive the maximum dose that is expected to reduce the blood pressure. D. The patient will receive the lowest possible dose at first, and then the dose will be adjusted as needed. ANS: D 11. The nurse is trying to give a liquid medication to a -year-old child and notes that the medication has a strong taste. Which technique is the best way for the nurse to give the medication to this child? 9 A. Give the medication with spoonfuls of sherbet. B. Add the medication to the child’s bottle. C. Tell the child you have candy for him. D. Add the medication to a cup of milk. ANS: A MULTIPLE RESPONSE 1. Which statements are true regarding pediatric patients and pharmacokinetics? Select all that apply. A. The levels of microsomal enzymes are decreased. B. Perfusion to the kidneys may be decreased and may result in reduced renal functio C. First-pass elimination is increased because of higher portal circulation. D. First-pass elimination is reduced because of the immaturity of the liver. E. Total body water content is much less than in adults. F. Gastric emptying is slowed because of slow or irregular peristalsis. G. Gastric emptying is more rapid because of increased peristaltic activity. ANS: A, B, D, F 2. Which statements are true regarding the elderly and pharmacokinetics? Select all that apply. A. The levels of microsomal enzymes are decreased. B. Fat content is increased because of decreased lean body mass. C. Fat content is decreased because of increased lean body mass. D. The number of intact nephrons is increased. E. The number of intact nephrons is decreased. F. Gastric pH is less acidic. G. Gastric pH is more acidic. ANS: A, B, E, F OTHER 1. A newborn infant needs a dose of acetaminophen. The order reads, ―Give acetaminophen, infant oral solution, 10 mg/kg/dose, every 4 hours as needed.‖ The infant weighs 7.8 pounds. How many milligrams will this infant receive per dose? Round to the nearest tenth. ANS: 35 mg 10 Chapter 04 Cultural, Legal, and Ethical Considerations MULTIPLE CHOICE 1. During the development of a new drug, which would be included in the study by the researcher to prevent any bias or unrealistic expectations of the new drug’s usefulness? A. A placebo B. FDA approval C. Informed consent D. Efficacy information ANS: A 2. A member of an investigational drug study team is working with healthy volunteers whose participation will help to determine the optimal dosage range and pharmacokinetics of the drug. The team member is participating in what type of study? A. Phase I B. Phase II C. Phase III D. Phase IV ANS: A 3. During discharge patient-teaching, the nurse reviews prescriptions with a patient. Which statement is correct about refills for an analgesic that is classified as Schedule C-III? A. No prescription refills are permitted. B. Refills are allowed only by written prescription. C. The patient may have no more than 5 refills in a 6-month period. D. The patient may have no more than 6 refills in a 12-month period. ANS: C 4. A patient has been selected as a potential recipient of an experimental drug for heart failure. The nurse knows that when informed consent has been obtained, it indicates that the patient A. has been informed of the possible benefits of the new therapy. B. will be informed of the details of the study as the research continues. C. will not be sure to receive the actual drug during the experiment. D. has had the study’s purpose, procedures, and the risks involved explained to him. ANS: D 5. For which cultural group must the health care provider respect the value placed on harmony with nature and the belief that disease is the result ill spirits? A. Hispanics B. Asian Americans C. Native Americans D. African Americans ANS: C 11 6. The nurse is assessing an elderly Hispanic woman who is being treated for hypertension. During the assessment, what is important for the nurse to remember about cultural aspects? A. The patient should be discouraged from using folk remedies and rituals. B. The nurse should expect the patient to value protective bracelets and ―root workers‖ as healers. C. The nurse should remember that the balance among body, mind, and environment would be important for this patient’s health beliefs. D. The nurse’s assessment should include information regarding religious practices and beliefs regarding medication, treatment, and healing. ANS: D 7. When reviewing the various schedules of controlled drugs, the nurse knows that which description correctly describes Schedule II drugs? A. Drugs with high potential for abuse that have accepted medical use B. Drugs with high potential for abuse that do not have accepted medical use C. Medically accepted drugs that may cause moderate physical or psychologic dependence D. Medically accepted drugs with very limited potential for causing mild physical or psychologic dependence ANS: A 8. The nurse is reviewing facts about pharmacology. The term legend drug refers to which item? A. Over-the-counter drugs B. Prescription drugs C. Orphan drugs D. Herbal products ANS: B 9. Nurses have the ethical responsibility to tell the truth to their patients. What is this principle known as? A. Justice B. Veracity C. Beneficence D. Nonmaleficence ANS: B 10. The nurse is performing an admission assessment. Which findings would reflect a component of a cultural assessment? A. The patient uses aspirin as needed for pain. B. The patient has a history of hypertension. C. The patient is allergic to shellfish. D. The patient does not eat pork products for religious reasons. ANS: D 12 MULTIPLE RESPONSE 1. Which factors contribute to drug polymorphism? Select all that apply. A. The number of drugs ordered by the physician B. Inherited factors C. The patient’s diet and nutrition status D. Different dosage forms of the same drug E. The patient’s values and beliefs F. The patient’s drug history G. The various available forms of a drug ANS: B, C, E 13 Chapter 05 Gene Therapy and Pharmacogenetics MULTIPLE CHOICE 1. Which is the most important compound that transfers genes from parents to offspring? A. Chromatin B. DNA C. Alleles D. RNA ANS: B 2. Which drug is manufactured as a result of indirect gene therapy? A. Vitamin K B. Warfarin C. Human insulin D. Heparin ANS: C 3. The nurse is discussing gene therapy in a continuing education class. Which is the best definition of eugenics? A. Using gene therapy to prevent disease B. Developing new drugs based on gene therapy C. Intentional selection, before birth, of genotypes that are considered more desirable than others D. The determination of genetic factors that influence a person’s response to medications ANS: C 4. The main purpose of the Human Genome Project is to A. study genetic diseases. B. study genetic traits in humans. C. discover new genetic diseases. D. describe the entire genome of a human being. ANS: D 5. A patient has just been told that she has the genetic markers for a severe type of breast cancer. After the patient meets with the physician, the patient’s daughter asks the nurse, ―What did the doctor tell my mother? She seems upset.‖ What is the nurse’s best answer? A. ―I’m sorry but I’m not allowed to discuss that.‖ B. ―The physician will discuss this with you.‖ C. ―It seems that your mother has the genetic markers for a type of breast cancer.‖ D. ―This is information that your mother will need to discuss with you.‖ ANS: D 14 MULTIPLE RESPONSE 1. The nurse is performing an assessment of a patient. Which assessment findings may indicate a higher risk for genetic disorders? Select all that apply. A. The patient’s father was diagnosed with heart disease at age 60. B. The patient’s mother was diagnosed with breast cancer at age 33. C. The patient’s grandfather died of a cerebral vascular accident at age 78. D. The patient’s sister has a history of both renal cancer and lung cancer. E. The patient has two uncles and a grandparent who have been diagnosed with Alzheimer disease. ANS: B, D, E 15 Chapter 06 Medication Errors: Preventing and Responding MULTIPLE CHOICE 1. Which situation is an example of a medication error? A. A patient refuses her morning medications. B. A patient receives a double dose of a medication because the nurse did not cut the pill in half. C. A patient develops hives after having started an IV antibiotic 24 hours earlier. D. A patient complains of severe pain still present 60 minutes after a pain medication was given. ANS: B 2. The nurse is transcribing a verbal medication order. Which is the proper notation of the dose of the drug ordered? A. Digoxin .125 mg B. Digoxin .1250 mg C. Digoxin 0.125 mg D. Digoxin 0.1250 mg ANS: C 3. When given a scheduled morning medication, the patient states, ―I haven’t seen that pill before. Are you sure it’s correct?‖ The nurse checks the medication administration record and verifies that it is listed. Which is the nurse’s best response to the patient? A. ―It’s listed here on the medication sheet, so you should take it.‖ B. ―Go ahead and take it, and then I’ll check with your doctor about it.‖ C. ―It wouldn’t be listed here if it were not ordered for you!‖ D. ―I’ll check on the order first before you take it.‖ ANS: D 4. The prescriber has written admission orders, and the nurse is transcribing them. The nurse is having difficulty transcribing one order because of the prescriber’s handwriting. Which is the best action for the nurse to take at this time? A. Ask a colleague what the order says. B. Contact the prescriber to clarify the order. C. Wait until the prescriber makes rounds again to clarify the order. D. Ask the patient what medications he takes at home. ANS: B MULTIPLE RESPONSE 1. The nurse can prevent medication errors by following which principles? Select all that apply. A. Assess for allergies after giving medications. B. Use two patient identifiers before giving medications. C. Do not give a medication that another nurse has drawn up in a syringe. 16 D. Minimize the use of verbal and telephone orders. E. Use trade names instead of generic names to avoid confusion. ANS: B, C, D OTHER 1. Levothyroxine is available in 88-mcg tablet form. Convert this dose to milligram strength. Do not round. ANS: 0.088 mg 17 Chapter 07 Patient Education and Drug Therapy MULTIPLE CHOICE 1. Which nursing diagnosis is appropriate for a patient who has just received a prescription for a new medication? A. Noncompliance related to a new drug therapy B. Ineffective health maintenance related to new drug therapy C. Lack of knowledge regarding newly prescribed drug therapy D. Deficient knowledge related to newly prescribed drug therapy ANS: D 2. The nurse is developing a care plan for a patient who will be self-administering insulin injections. Which statement reflects a measurable goal? A. The patient will know about insulin injections. B. The patient will understand the principles of insulin preparation. C. The patient will demonstrate the proper technique of mixing insulin. D. The patient will comprehend the proper technique of preparing insulin. ANS: C 3. During a nursing assessment, which question by the nurse allows for greater clarification and additional discussion with the patient? A. ―Are you allergic to penicillin?‖ B. ―What medications do you take?‖ C. ―Have you had a reaction to this drug?‖ D. ―Are you taking this medication with meals?‖ ANS: B 4. The nurse is setting up a teaching session with an 85-year-old patient who will be going home on anticoagulant therapy. Which education strategy would reflect consideration of the changes resulting from aging that exist with this patient? A. Show a colorful video about anticoagulation therapy. B. Present all the information in one session just before discharge. C. Give the patient pamphlets about the medications to read at home. D. Develop large-print handouts that reflect the verbal information presented. ANS: D 5. When the nurse teaches a manual skill such as self-injection of insulin to a patient, what is the best way to set up the teaching/learning session? A. Provide written pamphlets for instruction. B. Show a video and allow the patient to practice as needed on his own. C. Verbally explain the procedure and provide written handouts for reinforcement. D. After demonstrating the procedure, allow the patient to do several return demonstrations. ANS: D 18 6. A patient with a new prescription for a diuretic has just reviewed with the nurse how to include more potassium in her diet. This reflects learning in which domain? A. Physical B. Affective C. Cognitive D. Psychomotor ANS: C 7. During an admission assessment, the nurse discovers that a patient does not speak English. Which is considered the ideal resource for translation? A. The nurse should speak to the patient in the patient’s native language. B. The nurse should speak to a translator from the patient’s family. C. The nurse should speak to an adult friend of the family. D. The nurse should use prewritten note cards that include both English and the patient’s language. ANS: A 8. The nurse is teaching a 16-year-old newly diagnosed diabetic about blood glucose monitoring and the importance of regulating glucose intake. When developing a teaching plan for this teenager, which of Erikson’s stages of development should the nurse consider? A. Trust versus mistrust B. Intimacy versus isolation C. Industry versus inferiority D. Identity versus role confusion ANS: D 9. A 60-year-old patient is on several new medications and expresses worry that she will forget to take her pills. Which action by the nurse would be most helpful in this situation? A. Teaching effective coping strategies B. Reducing the number of drugs prescribed C. Assuring her that she will not forget once she is accustomed to the routine D. Assisting her with obtaining and learning to use a calendar or pill container ANS: D MULTIPLE RESPONSE 1. Which are appropriate considerations when the nurse is assessing the learning needs of a patient? Select all that apply. A. Cultural background. B. Social support C. Level of education D. Readiness to learn E. Health beliefs ANS: A, B, C, D, E 19 Chapter 08 Over-the-Counter Drugs and Herbal and Dietary Supplements MULTIPLE CHOICE 1. A 25-year-old woman is visiting the prenatal clinic today and shares with the nurse her desire to go ―natural‖ with her pregnancy. She shows the nurse a list of herbal remedies that she wants to buy so that she can ―avoid taking any drugs.‖ Which statement by the nurse is correct? A. ―Most herbal remedies are nontoxic and safe for use during pregnancy.‖ B. ―Please read the labels carefully before use to check for cautionary warnings.‖ C. ―Keep in mind that products from different manufacturers are required to contain consistent amounts of the herbal products.‖ D. ―It’s important to remember that herbal remedies do not have proven safety ratings for pregnant women.‖ ANS: D 2. The patient is asking the nurse about current U.S. laws and regulations of herbal products. Which statement is true? A. Medicinal herbs are viewed as dietary supplements. B. Herbal remedies are held to the same standards as drugs. C. Producers of herbal products must prove therapeutic efficacy. D. Herbal remedies are protected by patent laws. ANS: A 3. A patient wants to take the herb valerian to help himself rest at night. The nurse would be concerned about potential interactions if he is taking which drugs? A. Digitalis B. Anticoagulants C. Sedatives D. Immunosuppressants ANS: C 4. A patient has been taking an over-the-counter (OTC) acid-reducing drug because he has had ―stomach problems‖ for several months. He tells the nurse that the medicine helps as long as he takes it, but once he stops it, the symptoms return. Which statement by the nurse is the best advice for this patient? A. ―The over-the-counter drug has helped you, so you should continue to take it.‖ B. ―The over-the-counter dosage may not be strong enough. You should be taking prescription-strength for best effects.‖ C. ―For best results, you need to watch what you eat in addition to taking this drug.‖ D. ―Using this drug may relieve your symptoms, but it does not address the cause. You should be seen by your health care provider.‖ ANS: D 20 5. During an assessment, a patient tells the nurse that he eats large amounts of garlic for its cardiovascular benefits. Which drug or drug classes, if taken, would have a potential interaction with the garlic? A. Acetaminophen (Tylenol) B. Insulin C. Antilipemic drugs D. Sedatives ANS: B 6. A patient calls the clinic to ask about taking cranberry dietary supplement capsules because a friend recommended them. The nurse will discuss which possible concern when a patient is taking cranberry supplements? A. It may increase the risk for bleeding if the patient is taking anticoagulants. B. It may increase the risk of toxicity of some psychotherapeutic drugs. C. It may reduce elimination of drugs that are excreted by the kidneys. D. Cranberry may increase the intensity and duration of effects of caffeine. ANS: C MULTIPLE RESPONSE 1. The nurse is conducting a class for senior citizens about the use of over-the-counter (OTC) drugs. Which statements are true regarding the use of OTC drugs? Select all that apply. A. Use of OTC drugs may delay treatment of serious ailments. B. Drug interactions with OTC medications are rare. C. OTC drugs may relieve symptoms without addressing the cause of the problem. D. OTC drugs are indicated for long-term treatment of conditions. E. Patients may misunderstand product labels and misuse the drugs. ANS: A, C, E 21 Chapter 09 Substance Abuse MULTIPLE CHOICE 1. A 38-year-old man stopped smoking 6 months ago. He tells the nurse that he still feels strong cigarette cravings and wonders if he is ever going to feel ―normal‖ again. Which statement by the nurse is correct? A. ―These cravings will never stop.‖ B. ―These cravings may persist for months to years.‖ C. ―The cravings tell us that you are still using nicotine.‖ D. ―The cravings indicate that you are about to experience nicotine withdrawal.‖ ANS: B 2. A patient in a rehabilitation center is beginning to experience opioid withdrawal symptoms. The nurse should prepare to administer which drug as part of the treatment? A. diazepam (Valium) B. Methadone C. disulfiram (Antabuse) D. bupropion (Zyban) ANS: B 3. A patient has been taking naltrexone (ReVia) as part of the treatment for addiction to heroin. The nurse expects that the naltrexone will have which therapeutic effect for this patient? A. Naltrexone prevents the cravings for opioid drugs. B. Naltrexone works as a safer substitute for the heroin until the patient completes withdrawal. C. The patient will experience flushing, sweating, and severe nausea if he takes heroin while on naltrexone. D. If opioid drugs are used while taking naltrexone, euphoria is not produced; thus, the drug’s effects are lost. ANS: D 4. The nurse is presenting a substance-abuse lecture for teenage girls and is asked about ―roofies.‖ The nurse recognizes that this is the slang term for what substance? A. cocaine B. flunitrazepam C. secobarbital D. methamphetamine ANS: B 5. A 29-year-old male is admitted to the intensive care unit with the following symptoms: restlessness, hyperactive reflexes, talkativeness, confusion and periods of panic, tachycardia, and fever. The nurse suspects that he may be experiencing the effects of taking which substance? A. Opiates 22 B. Alcohol C. Stimulants D. Depressants ANS: C 6. When admitting a patient with a suspected diagnosis of chronic alcohol use, the nurse should keep in mind that chronic use of alcohol might result in which condition? A. Renal failure B. Stroke C. Korsakoff psychosis D. Alzheimer’s disease ANS: C 7. A patient is being treated for ethanol alcohol abuse in a rehabilitation center. The nurse should include which information when teaching him about disulfiram (Antabuse) therapy? A. He should not smoke cigarettes while on this drug. B. He needs to know about the common over-the-counter substances that contain alcohol. C. This drug will cause the same effects as the alcohol did, without the euphoric effects. D. Mouthwashes and cough medicines that contain alcohol are safe because they are used in small amounts. ANS: B 8. The nurse is conducting a smoking-cessation program. Which statement regarding drugs used in cigarette–smoking-cessation programs is true? A. Rapid chewing of the nicotine gum releases an immediate dose of nicotine. B. Quick relief from withdrawal symptoms is most easily achieved by using a transdermal patch. C. Treatment compliance is higher with use of the gum rather than the transdermal patch. D. The nicotine gum can be used only up to six times a day. ANS: A 9. A nurse is providing teaching for a patient who will be taking varenicline (Chantix) as part of a smoking-cessation program. Which teaching point is appropriate for a patient taking this medication? A. This drug is available as a chewing gum that can be taken to reduce cravings. B. Be careful when driving because drowsiness may be a problem. C. There have been very few adverse effects reported for this drug. D. Avoid caffeine while on this drug. ANS: B MULTIPLE RESPONSE 1. During a party, a guest who is on disulfiram (Antabuse) therapy drinks a half glass of wine. The party guest will quickly experience which symptoms? Select all that apply. A. Euphoria 23 B. Vomiting C. Diarrhea D. Pallor E. Flushed skin F. Sweating ANS: B, E, F 24 Chapter 10 Photo Atlas of Drug Administration MULTIPLE CHOICE 1. Before administering any medication, which action by the nurse is most important regarding patient safety? A. Verifying orders with another nurse B. Documenting the medications given C. Counting medications in the medication cart drawers D. Checking the patient’s identification and allergies ANS: D 2. The nurse is giving an intradermal (ID) injection and should choose which size syringe for this injection? A. 3-mL syringe B. 1-mL tuberculin C. 2-mL tuberculin D. 2- to 3-mL for adults and 1- to 2-mL for children ANS: B 3. A patient is to receive a penicillin intramuscular (IM) injection in the ventrogluteal site. The nurse remembers that the proper angle for needle insertion is degrees. B. 45 C. 60 D. 90 ANS: D 4. When administering medication by IV bolus (push), the nurse should occlude the IV line by which method? A. Pinching the tubing just below the injection port B. Pinching the tubing just above the injection port C. Pinching the tubing just below the drip chamber of the infusion set D. Not pinching the IV tubing at all ANS: B 5. The nurse has an order to administer an IM immunization to a 2-month-old child. Which site is the best choice for this injection? A. Deltoid B. Dorsogluteal C. Ventrogluteal D. Vastus lateralis ANS: D 6. The nurse needs to administer insulin subcutaneously (subcut) to an obese patient. The proper technique for this injection includes 25 A. using the Z-track method. B. inserting the needle at a 5- to 15-degree angle until resistance is felt. C. pinching the skin at the injection site and inserting the needle to below the tissue fold. D. spreading the skin tightly over the injection site, inserting the needle, then releasing the skin. ANS: C 7. The nurse will plan to use the Z-track method of IM injections when the A. medication is known to be irritating to tissues. B. patient is emaciated and has very little muscle mass. C. medication must be absorbed quickly into the tissues. D. patient is obese and has a deep fat layer below the muscle mass. ANS: A 8. After administering an intradermal (ID) injection for a skin test, the nurse notices a small bleb at the injection site. The best action for the nurse to take at this time is to A. apply heat. B. massage the area. C. report the bleb to the physician. D. do nothing. ANS: D 9. The nurse is administering an IV push medication through an IV lock. After injecting the medication, which action will be taken next? A. Flushing the lock B. Regulating the IV flow C. Clamping the tubing for 10 minutes D. Holding the patient’s arm up to improve blood flow ANS: A 10. When adding medications to a bag of IV fluid, the nurse will use which method to mix the solution? A. Shaking the bag or bottle vigorously B. Shaking the bag or bottle gently C. Inverting the bag or bottle just once after injecting the medication D. Allowing the IV solution to stand for 10 minutes to enhance even distribution of medication ANS: B 11. The nurse is measuring 4 mL of a liquid cough elixir for a child. Which method is most appropriate? A. Using a teaspoon to measure and administer B. Holding the medication cup at eye level and filling it to the desired level C. Withdrawing the elixir from the container using a syringe without a needle attached 26 D. Withdrawing the elixir from the container using a calibrated oral syringe ANS: D 12. While the nurse is assisting a patient in taking his medications, the medication cup falls to the floor, spilling the contents. What is the nurse’s best action? A. Discarding the medications and repeating preparation B. Documenting that the patient refused the medications C. Waiting until the next dose time, then giving the medications D. Retrieving the medications and administering them to avoid waste ANS: A 13. When giving a buccal medication to a patient, which action by the nurse is appropriate? A. Encouraging the patient to swallow if necessary B. Administering water after the medication has been given C. Placing the medication between the upper or lower molar teeth and the cheek D. Placing the tablet under the patient’s tongue and allowing it to dissolve completely ANS: C 14. The nurse is giving medications through a percutaneous endoscopic gastrostomy (PEG) tube. Which technique is correct? A. Administering the medications using a 3-mL medication syringe B. Applying firm pressure on the syringe’s piston to infuse the medication C. Flushing the tubing with 30 mL of saline after the medication has been given D. Using the barrel of the syringe, allowing the fluid to flow via gravity into the tube ANS: D 15. The nurse is about to give a rectal suppository to a patient. Which technique would facilitate the administration of the rectal suppository? A. Having the patient lie on his or her right side, unless contraindicated B. Having the patient hold his or her breath during insertion of the medication C. Lubricating the suppository with a small amount of petroleum-based lubricant D. Encouraging the patient to lie on his or her left side for 15 to 20 minutes after insertion ANS: D 16. A patient is receiving eye drops that contain a beta-blocker medication. The nurse will use what method to reduce systemic effects after administering the eye drops? A. Wiping off excess liquid immediately after instilling the drops B. Having the patient close the eye tightly after the drops have been instilled C. Having the patient close the eye, then move the eye around to help distribute the medication D. Applying gentle pressure to the patient’s nasolacrimal duct for 30 to 60 seconds after instilling the drops ANS: D 27 17. A 2-year-old child is to receive eardrops. The nurse is teaching the parent about giving the eardrops. Which statement reflects the proper technique for administering eardrops to this child? A. Administer the drops without altering the ear canal’s direction. B. Straighten the ear canal by pulling the lobe upward and back. C. Straighten the ear canal by pulling the pinna down and back. D. Straighten the ear canal by pulling the pinna upward and outward. ANS: C 18. A patient with asthma is to begin medication therapy using a metered-dose inhaler. What is an important reminder to include during teaching sessions with the patient? A. Repeat subsequent puffs, if ordered, after 5 minutes. B. Inhale slowly while pressing down to release the medication. C. Inhale quickly while pressing down to release the medication. D. Administer the inhaler while holding it 3 to 4 inches away from the mouth. ANS: B 19. When giving medications, the nurse should use Standard Precautions, such as A. bending the syringe to prevent reuse. B. recapping needles to prevent needlesticks. C. discarding all syringes and needles in the trash can. D. discarding all syringes and needles in a puncture-resistant container. ANS: D 20. A patient says he prefers to chew rather than swallow his pills. One of the pills has the abbreviation SR behind the name of the medication. The nurse needs to remember that which instruction is correct regarding how to give this medication? A. Break the tablet into halves or quarters. B. Dissolve the tablet in a small amount of water before giving it. C. The tablet should not be crushed or broken before administration. D. Use a mortar and pestle to crush the tablet as needed to ease administration. ANS: C 21. When administering nasal spray, which instruction by the nurse is appropriate? A. ―You will need to blow your nose before I give this medication.‖ B. ―You will need to blow your nose after I give this medication.‖ C. ―When I give this medication, you will need to hold your breath.‖ D. ―You should sit up for 5 minutes after you receive the nasal spray.‖ ANS: A 28 MULTIPLE RESPONSE 1. The nurse is preparing to give an IM injection to an average-sized adult. Which actions are appropriate? Select all that apply. A. Choose a 26- or 27-gauge, - to -inch needle. B. Choose a 22- to 27-gauge, 1- to -inch needle. C. Choose the ventrogluteal site, the preferred site for IM injections. D. Insert the needle at a 45-degree angle. E. Insert the needle at a 90-degree angle. F. Before injecting the medication, withdraw the plunger to check for blood return. ANS: B, C, E, F 29 Chapter 11 Analgesic Drugs MULTIPLE CHOICE 1. A patient was diagnosed with pancreatic cancer last month, and she has complained of a dull ache in her abdomen for the past 4 months. This pain has been gradually increasing, and the pain relievers she has taken at home are no longer effective. What type of pain is she experiencing? A. Acute pain B. Chronic pain C. Somatic pain D. Superficial pain ANS: B 2. An 18-year-old basketball player fell and twisted his ankle during a game. The nurse will expect to administer which type of analgesic? A. Synthetic opioid, such as meperidine B. Opium alkaloid, such as morphine sulfate C. Opioid antagonist, such as naloxone HCL D. Nonopioid analgesic, such as indomethacin ANS: D 3. A patient is recovering from abdominal surgery, which he had this morning. He is groggy but complaining of severe pain around his incision. What is the most important thing for the nurse to consider during an assessment before administering a dose of morphine sulfate to the patient? A. His temperature B. His respiration rate C. The appearance of the incision D. The date of his last bowel movement ANS: B 4. A 78-year-old patient is in the recovery room after having a lengthy surgery on his hip. As he is gradually awakening, he requests pain medication. Within 10 minutes after receiving a dose of morphine sulfate, he is very lethargic and his respirations are shallow, with a rate of 9 per minute. The nurse prepares for which action at this time? A. Close observation of signs of opioid tolerance B. Immediate intubation and artificial ventilation C. Administration of naloxone (Narcan), an opioid reversal agent D. Administration of an agonist opioid such as fentanyl ANS: C 5. A patient will be discharged with a 1-week supply of an opioid analgesic for pain management after abdominal surgery. The nurse should include which information in the teaching plan? A. Management of diarrhea 30 B. Drug addiction programs C. Prevention of constipation D. Dehydration due to polyuria ANS: C 6. A patient has been treated for lung cancer for 3 years. Over the past few months, she has noticed that the opioid analgesic she has been taking is not helping as much as it had previously and says she needs to take more medication for the same pain relief. The nurse is aware that this patient is experiencing opioid A. toxicity. B. addiction. C. tolerance. D. abstinence syndrome. ANS: C 7. A 38-year-old man has come into the urgent care center with severe hip pain after falling from a ladder at work. He says he has taken several pain pills over the past few hours but cannot remember how many he has taken. He hands the nurse an empty bottle of acetaminophen (Tylenol). The nurse is aware that the most serious toxic effect of acute acetaminophen overdose is A. tachycardia. B. depression of the central nervous system. C. hepatic necrosis. D. nephropathy. ANS: C 8. A 57-year-old woman being treated for end-stage breast cancer has been using a transdermal opioid analgesic as part of the management of pain. Lately, she has been experiencing breakthrough pain. The nurse should expect this type of pain to be managed by A. administering NSAIDs. B. administering an immediate-release opioid. C. changing the opioid route to the rectal route. D. not changing the current therapy. ANS: B 9. The nurse is reviewing herbal therapies. Which is a common use of the herb feverfew? A. Muscle aches B. Migraine headaches C. Leg cramps D. Incision pain after surgery ANS: B 10. A patient is to receive acetylcysteine (Mucomyst) as part of the treatment for an acetaminophen (Tylenol) overdose. Which action by the nurse is appropriate when giving this medication? 31 A. Giving the medication undiluted for full effect B. Avoiding use of a straw when giving this medication C. Disguising the flavor with soda or flavored water D. Preparing to give this medication via a nebulizer ANS: C 11. A patient is receiving an anticonvulsant but has no history of seizures. The nurse suspects that the patient is receiving this drug for which condition? A. Pain associated with peripheral neuropathy B. Inflammation pain C. Depression associated with chronic pain D. Prevention of possible seizures ANS: A MULTIPLE RESPONSE 1. Vicodin (acetaminophen/hydrocodone) is prescribed for a patient who has had surgery. The nurse informs the patient that which common adverse effects can occur with this medication? Select all that apply. A. Diarrhea B. Constipation C. Lightheadedness D. Nervousness E. Urinary retention F. Itching ANS: B, C, E, F OTHER 1. A patient is to receive codeine, 40 mg subcutaneously, every 6 hours as needed for pain. The solution is available in a concentration of 30 mg/mL. How many milliliters of codeine will be drawn up for this dose? Round to the nearest tenth. ANS: 1.3 mL 32 Chapter 12 General and Local Anesthetics MULTIPLE CHOICE 1. During a fishing trip, a patient pierced his finger with a large fishhook. He is now in the emergency department to have it removed. The nurse anticipates which type of anesthesia will be used for this procedure? A. Topical benzocaine spray on the area B. Spinal anesthesia with mepivacaine C. Topical prilocaine (EMLA) cream around the site D. Infiltration of the puncture wound with lidocaine ANS: D 2. A patient is to receive local anesthesia for removal of a lymph node from his groin. The physician asks for a solution of premixed lidocaine and epinephrine. The nurse knows that the epinephrine is used because A. it prevents an anaphylactic reaction from occurring. B. the anesthetic enhances the effect of the epinephrine. C. epinephrine contributes to a balanced anesthetic state. D. it keeps the anesthetic at its local site of action and decreases incisional bleeding. ANS: D 3. During the postoperative recovery period, what is the nurse’s immediate main concern? A. Pupil responses B. Return to sensation C. Level of consciousness D. Airway, breathing, and circulation ANS: D 4. While monitoring a patient who had surgery under general anesthesia 2 hours ago, the nurse notes a sudden elevation in body temperature. This finding may be an indication of which problem? A. Tachyphylaxis B. Postoperative infection C. Malignant hypertension D. Malignant hyperthermia ANS: D 5. When assessing patients in the preoperative area, the nurse knows that which patient is at a higher risk for an altered response to anesthesia? A. The 30-year-old who has never had surgery before B. The 45-year-old who stopped smoking 10 years ago C. The 20-year-old who is to have a lymph node removed D. The 78-year-old who is to have gallbladder removal ANS: D 33 6. A patient is undergoing abdominal surgery and has been anesthetized for 3 hours. Which of the following nursing diagnoses would be appropriate for this patient? A. Anxiety related to the use of an anesthetic B. Risk for injury related to increased sensorium from general anesthesia C. Decreased cardiac output related to systemic effects of local anesthesia D. Impaired gas exchange related to central nervous system depression produced by general anesthesia ANS: D 7. When administering a neuromuscular blocking drug such as pancuronium, the nurse needs to remember which principle? A. It can be used instead of general anesthesia during surgery. B. Only skeletal muscles are paralyzed; respiratory muscles remain functional. C. It causes sedation and pain relief while allowing for lower doses of anesthetics. D. Patients will require artificial mechanical ventilation because of paralyzed respiratory muscles. ANS: D 8. A patient has been given succinylcholine after a severe injury that necessitated controlled ventilation. The physician now wants to reverse the paralysis. The nurse would expect to use which drug to reverse the succinylcholine? A. valium B. caffeine C. neostigmine D. vecuronium ANS: C 9. A patient is being prepared for an oral endoscopy, and the nurse anesthetist reminds him that he will be awake during the procedure but probably will not remember it. What type of anesthetic technique is used in this situation? A. Twilight sleep B. Moderate sedation C. Adjunctive anesthesia D. Spinal anesthesia ANS: B 10. During the immediate postoperative period, the Post Anesthesia Care Unit nurse is assessing a patient who had hip surgery. The patient is experiencing tachycardia, tachypnea, and The nurse will prepare for what immediate treatment? A. naltrexone hydrochloride (Narcan) injection, an opioid reversal drug B. dantrolene (Dantrium) injection, a skeletal muscle relaxant C. Anticholinesterase drugs, such as neostigmine D. Cardiopulmonary resuscitation (CPR) and intubation ANS: B 34 MATCHING When a neuromuscular blocking drug is given, the effects occur in a certain order. Put the drug effects in the proper order as indicated, using the choices A through C listed below. A. Cessation of respirations due to paralysis of diaphragm and intercostal muscles B. Total flaccid paralysis C. Weakness ANS: C B A 35 Chapter 13 Central Nervous System Depressants and Muscle Relaxants MULTIPLE CHOICE 1. A patient who has received some traumatic news is panicking and will be receiving medication. The nurse anticipates giving which type of drug that is most appropriate for this situation? A. diazepam (Valium) B. zolpidem (Ambien) C. phenobarbital D. cyclobenzaprine (Flexeril) ANS: A 2. A patient has been taking phenobarbital for 2 weeks as part of his therapy for epilepsy. He says that he feels tense and that ―the least little thing‖ bothers him now. The nurse should explain to him which of the following? A. These adverse effects usually subside after a few weeks. B. The drug should be stopped immediately because of possible adverse effects. C. This drug causes the rapid eye movement (REM) sleep period to increase, resulting in nightmares and restlessness. D. This drug causes deprivation of REM sleep and may cause the inability to deal with normal stress. ANS: D 3. A 50-year-old man who has been taking phenobarbital for 1 week is found unresponsive. His wife states that he has no other prescriptions and that he did not take an overdose —the correct number of pills is in the bottle. The nurse suspects that which of the following may have happened? A. He took a multivitamin. B. He drank a glass of wine. C. He took a dose of aspirin. D. He developed an allergy to the drug. ANS: B 4. A patient has been taking temazepam for intermittent insomnia. She calls the nurse to say that when she takes it, she sleeps well, but the next day she feels ―so tired.‖ Which explanation by the nurse is correct? A. ―Long-term use of this drug results in a sedative effect.‖ B. ―If you take the drug every night, this hangover effect will be reduced.‖ C. ―These drugs affect the sleep cycle, resulting in a hangover effect.‖ D. ―These drugs increase the activity of the central nervous system (CNS), making you tired the next day.‖ ANS: C 36 5. A patient is recovering from a minor automobile accident that occurred 1 week ago. He is taking cyclobenzaprine (Flexeril) for muscular pain and goes to physical therapy three times a week. Which nursing diagnosis would be appropriate for him? A. Risk for falls related to decreased sensorium B. Risk for addiction related to psychologic dependency C. Excess fluid volume related to potential adverse effects D. Disturbed sleep pattern related to the drug’s interference with REM sleep ANS: A 6. A patient is taking flurazepam (Dalmane) 3 to 4 nights a week for sleeplessness. She is concerned that she cannot get to sleep without taking the medication. What nonpharmacologic measures should the nurse suggest to promote sleep for this patient? A. Trying to establish set sleep patterns B. Exercising before bedtime to become tired C. Consuming heavy meals in the evening to promote sleepiness D. Drinking warm beverages, such as tea or coffee, just before bedtime ANS: A 7. A patient is brought to the emergency department for treatment of an acute overdose of a barbiturate. The nurse would expect which intervention? A. Starting an intravenous infusion of diluted bicarbonate solution B. Administering medications to decrease blood pressure C. Implementing measures to maintain the airway and support respirations D. Administrating naloxone (Narcan) as an antagonist ANS: C 8. Ramelteon (Rozerem) is prescribed for a patient with insomnia. The nurse checks the patient’s medical history, knowing that this medication is contraindicated in which disorder? A. Coronary artery disease B. Renal insufficiency C. Liver disease D. Anemia ANS: C 9. The nurse notes in the patient’s medication history that the patient is taking cyclobenzaprine (Flexeril). Based on this finding, the nurse interprets that the patient has which disorder? A. A musculoskeletal injury. B. Insomnia C. Epilepsy D. Relief of agitation ANS: A 10. A patient has experienced insomnia for months, and the physician has prescribed a medication to help with this problem. The nurse expects which drug to be used for long-term treatment of insomnia? 37 A. secobarbital (Seconal) B. flurazepam (Dalmane) C. midazolam (Versed) D. eszopiclone (Lunesta) ANS: D MULTIPLE RESPONSE 1. The nurse is preparing to administer a barbiturate. Which conditions or disorders would be a contraindication to the use of these drugs? Select all that apply. A. Gout B. Pregnancy C. Epilepsy D. Severe chronic obstructive pulmonary disease E. Peripheral vascular disease F. Current use of an opioid analgesic ANS: B, D, F 2. The barbiturate phenobarbital is prescribed for a patient with epilepsy. While assessing the patient’s current medications, the nurse recognizes that interactions may occur with which drugs? Select all that apply. A. Antihistamines B. Opioids C. Diuretics D. Anticoagulants E. Oral contraceptives F. Insulin ANS: A, B, D, E 38 Chapter 14 Central Nervous System Stimulants and Related Drugs MULTIPLE CHOICE 1. A patient is receiving instructions regarding dietary sources of caffeine. The nurse shares that caffeine should be used with caution if which of these conditions is present? A. A history of peptic ulcers B. Migraine headaches C. Asthma D. A history of kidney stones ANS: A 2. A patient has a new prescription for sibutramine (Meridia) as part of the treatment for weight loss. Which information will the nurse include when teaching this patient about a stimulant such as sibutramine? A. This medication should be taken after meals to enhance the effect. B. Taking one glass of wine at night will counteract the stimulant effects and allow sleep. C. Missed doses should be taken with the next meal to maintain sufficient blood levels of the medication. D. Other sources of central nervous system stimulants, such as coffee, tea, and colas, should be avoided while on this medication. ANS: D 3. A 6-year-old boy has been started on an extended-release form of methylphenidate hydrochloride (Ritalin) for the treatment of attention deficit hyperactivity disorder (ADHD). During a follow-up visit, his mother tells the nurse that she has been giving the medication at bedtime so that it will be ―in his system‖ when he goes to school the next morning. What will the nurse tell her? A. She is giving him the medication dosage appropriately. B. The medication should not be taken until he is at school. C. The medication should be taken with meals for optimal absorption. D. The medication should be given 4 to 6 hours before bedtime to diminish the insomnia it causes. ANS: D 4. A 22-year-old nursing student has been taking NoDoz (caffeine) tablets for the past few weeks to ―make it through‖ the end of the semester and exam week. She is in the university clinic today because she is ―exhausted.‖ What nursing diagnosis may be appropriate for her? A. Noncompliance B. Impaired physical mobility C. Sleep deprivation D. Imbalanced nutrition: less than body requirements ANS: C 39 5. An ergot alkaloid is prescribed for a patient who is having frequent migraine headaches. The nurse provides information to the patient about the medication and tells the patient to contact the prescriber if which problem occurs? A. Nervousness B. Dizziness C. Chest pain D. Nausea and vomiting ANS: C 6. A 10-year-old will be started on methylphenidate hydrochloride (Ritalin) therapy. The nurse will perform which essential baseline assessment before this drug is started? A. Eye examination B. Height and weight C. Liver studies D. Cognitive function ANS: B 7. Before a patient receives triptans for the treatment of migraines, the nurse will assess for the presence of which condition? A. Hypotension B. Renal disease C. Liver damage D. Coronary artery disease ANS: D 8. When evaluating a patient who is taking sibutramine (Meridia), which is an intended therapeutic effect? A. Increased wakefulness B. Increased appetite C. Suppressed appetite D. Decreased hyperactivity ANS: C 9. The nurse is teaching a patient how to self-administer triptan injections for migraine headaches. Which statement by the patient indicates that he needs further teaching? A. ―I will take this medication to prevent a migraine headache from occurring.‖ B. ―I will take this medication when I feel a migraine headache starting.‖ C. ―This medication does not reduce the number of migraines I will have.‖ D. ―I will keep a journal to record the headaches I have and how the injections are working.‖ ANS: A 40 MULTIPLE RESPONSE 1. Which are indications for a central nervous system stimulant? Select all that apply. A. Narcolepsy B. Depression C. Panic attacks D. Neonatal apnea E. Attention deficit hyperactivity disorder F. Appetite suppression ANS: A, D, E, F OTHER 1. The order reads: Give atomoxetine (Strattera) 0.5 mg/kg/day once daily in the morning before school. The child weighs 88 pounds. How many milligrams will be administered per dose? ANS: 20 mg 41 Chapter 15 Antiepileptic Drugs MULTIPLE CHOICE 1. The nurse is reviewing the dosage schedule for several different antiepileptic drugs (AEDs). Which antiepileptic drug allows for once-a-day dosing? A. tiagabine (Gabitril) B. phenobarbital (Solfoton) C. valproic acid (Depakote) D. rabapentin (Neurontin) ANS: B 2. The nurse has given medication instructions to a patient receiving phenytoin (Dilantin). Which statement by the patient will lead the nurse to determine that the patient has an adequate understanding? A. ―I will need to take extra care of my teeth and gums while on this medication.‖ B. ―I can go out for beer while on this medication.‖ C. ―I can skip doses if the adverse effects bother me.‖ D. ―I will be able to stop taking this drug once the seizures stop.‖ ANS: A 3. When teaching a patient about taking a newly prescribed AED at home, the nurse should include which instruction? A. Driving will be allowed after 2 weeks of therapy. B. If seizures recur, take a double dose of the medication. C. Antacids can be taken with the AED to reduce gastrointestinal adverse effects. D. Regular, consistent dosing is important for successful treatment. ANS: D 4. A patient has a 9-year history of a seizure disorder that has been managed well with oral phenytoin (Dilantin) therapy. He is to be NPO (consume nothing by mouth for surgery in the morning. What will the nurse do about his morning dose of phenytoin? A. Give the same dose intravenously. B. Give him the morning dose with a small sip of water. C. Contact the prescriber for another dosage form of the medication. D. Notify the operating room that the medication has been withheld. ANS: C 5. A patient has been taking carbamazepine (Tegretol) for several months and is worried because the physician has increased the dose twice since the beginning of therapy. What explanation by the nurse is correct? A. The initial dose was not sufficient to prevent seizures. B. A process known as autoinduction results in lower-than-expected drug concentrations. 42 C. The seizures are difficult to manage, and increased doses are needed to control them. D. The patient was forgetting to take the medication as prescribed, which led to a need for increased dosage. ANS: B 6. The nurse is giving an intravenous dose of phenytoin (Dilantin). Which action will the nurse perform to administer the drug? A. Give the dose as a fast intravenous (IV) bolus. B. Mix the drug with normal saline and give it as an IV piggyback. C. Mix the drug with dextrose (D5W) and give it as an IV piggyback. D. Mix the drug with any available solution as long as the drip rate is correct. ANS: B 7. The regular-release capsule dosage form of topiramate (Topamax) is prescribed for a patient, and the nurse provides information to the patient about the medication. What does the nurse instruct the patient? A. ―Do not chew, crush, or break the capsule.‖ B. ―Take the medication on an empty stomach.‖ C. ―The capsule may be opened and sprinkled on a teaspoon of soft food.‖ D. ―If adverse effects are too severe, a dose may be skipped.‖ ANS: C 8. A patient is experiencing status epilepticus. The nurse prepares to give which drug of choice for the treatment of this condition? A. diazepam (Valium) B. midazolam (Versed) C. valproic acid (Depakote) D. carbamazepine (Tegretol) ANS: A 9. Phenytoin (Dilantin) has a narrow therapeutic index. The nurse recognizes that this characteristic means that A. the safe and the toxic plasma levels of the drug are very close to each other. B. phenytoin has a slim chance of being effective. C. there is no difference between safe and toxic plasma levels. D. a very small dosage can result in the desired therapeutic effect. ANS: A 10. A patient has been taking an AED for several years as part of his treatment for partial seizures. His wife has called because he ran out of medication this morning and wonders if he can go without it for a week until she has a chance to go to the drugstore. What is the nurse’s best response? A. ―He is taking another antiepileptic drug, so he can go without the medication for a week.‖ 43 B. ―Stopping this medication abruptly may cause withdrawal seizures. A refill is needed right away.‖ C. ―He should temporarily increase the dosage of his other antiseizure medications.‖ D. ―He can probably stop all medication because he has been treated for several years now.‖ ANS: B 11. During a routine appointment, a patient with a history of seizures is found to have a phenytoin (Dilantin) level of 18 mcg/mL. What concern should the nurse have, if any? A. The patient is at risk for seizures because the drug level is not at a therapeutic level. B. The patient’s seizures should be under control because this is a therapeutic drug level. C. The patient’s seizures should be u