NURS 6521 ADVANCED PHARMACOLOGY FINAL EXAM

NURS 6521 ADVANCED PHARMACOLOGY FINAL EXAM Question 1: A 59-year-old man with a recent history of erectile dysfunction has been assessed and prescribed sildenafil (Viagra). When providing patient education to this man, the nurse should tell him which of the following? Answer: "You might find that your face becomes flushed, or you get a headache after taking Viagra." - Question 2: A patient takes etoposide for a testicular tumor refractory treatment. The nursing assessment reveals that he is also taking warfarin. The nurse must carefully monitor which of the following? - ANSWERAnswer: Elevated prothrombin time - Question 3: A man is prescribed ciprofloxacin to treat a sexually transmitted infection. The nurse will instruct the patient - Answer: to complete the entire course of drug therapy. – Question 4: Drugs have a valid medical use but a high potential for psychological and physiologic abuse. In an emergency, a Schedule II drug may be prescribed by telephone if a written prescription cannot be provided at the time. However, a written prescription must be provided within 72 hours with the words authorization for emergency dispensing written on the prescription. These prescriptions cannot be refilled. A new prescription must be written each time. Examples include certain amphetamines and barbiturates. These are scheduled drugs - ANSWERAnswer: Schedule II Question 5: A 16-year-old boy has been prescribed cromolyn sodium nasal spray to treat a nasal allergy. To maximize the drug's therapeutic effects, which of the following will the nurse include in instructions to the patient? Answer: Take the drug for one whole week before coming in contact with allergensQuestion 6: A woman is receiving magnesium sulfate for intrapartum eclampsia. The patient is sweating, and her BP is 88/50. The serum magnesium level is 10 mg/dL. The nurse will interpret these manifestations as Answer: Magnesium Sulfate toxicity. - Question 7: A patient with a recent diagnosis of chronic myelogenous leukemia (CML) discusses treatment options with his care team. What aspect of the patient's condition would contraindicate the use of cyclophosphamide to treat leukemia? Answer: The patient's bone marrow function is significantly depressed. – Question 8: After six months of unsuccessfully trying to conceive, a 31 year-old woman and her husband have sought a referral to a fertility specialist to explore their options. A nurse at the clinic should recognize that the woman may benefit from - Answer: clomiphene. Question 9: A 34-year-old male has been diagnosed with TB and will be started on INH therapy. The medication history reveals that he currently takes antacids regularly. The nurse will instruct the patient:Answer: to take antacids not less than 1 hour before or 2 hours after taking INH. Question 10: A Nurse Practitioner working in a cancer center is preparing to administer medication to a 5-year-old child. The nurse will calculate the drug dosage by using Answer: Body Surface Area Question 11: An older adult woman has been diagnosed with acute lymphoblastic leukemia (ALL), and her care team has identified potential benefits of imatinib. Which of the following characteristics of this patient's current health status may preclude the use of imatinib? - Answer: The patient has chronic heart failure resulting in significant peripheral edema Question 12: A male patient is trying to decide if he should use finasteride (Proscar) to treat benign prostatic hypertrophy (BPH). When providing information about the drug, the nurse will include which of the following as a risk associated with finasteride therapy? Answer: Prostatic neoplasia Question 13: A Nurse Practitioner will instruct a patient taking allopurinol to take each doseAnswer: After a meal. Question 14: A patient has acquired primary hypogonadism and was prescribed testosterone transdermal (Androderm) patches. When educating the patient on administering the drug, the nurse will instruct him to Answer: place the patch on the back, abdomen, upper arms, or thighs. - Question 15: A 66-year-old woman has experienced a significant decline in her quality of life due to worsening rheumatoid arthritis. Her physician has prescribed etanercept and the APRN is responsible for facilitating this new aspect of the patient's drug regimen involving the administration of Answer: weekly subcutaneous injections - Question 16: A 54-year-old woman with a history of osteoporosis has been prescribed ciprofloxacin for recurrent cystitis. Because of the patient's history, the nurse would be sure to discuss the use of - Answer: food containing iron or calcium with the woman. Question 17: A Nurse Practitioner has questioned why a patient's physician has prescribed a narrow-spectrum antibiotic rather than a broad-spectrum drug to treat a patient's infection. Which of thefollowing facts provides the best rationale for using narrow-spectrum antibiotics whenever possible? - ANSWERAnswer: The use of broad-spectrum antibiotics can create a risk for a superinfection. - ANSWERQuestion 18: A 3-year-old boy has developed otitis media and requires antibiotics. In order to increase the chance that the boy will take his prescribed medication, the nurse should - ANSWERAnswer: offer a choice between liquid and chewable medications, if possible. - ANSWERQuestion 19: Which of the following would a Nurse Practitioner assess for in a patient taking polymyxin B systemically? - ANSWERAnswer: Nephrotoxicity and hepatotoxicity - ANSWERQuestion 20: A woman is receiving prolonged drug therapy during her complicated pregnancy, and it may pose a risk to both the mother and the fetus. The primary care physician has made dosage adjustments to minimize adverse effects and prevent toxicity; The RN should ensure that - ANSWERAnswer: Drug serum levels are being monitored. - ANSWERQuestion 21: A female patient is taking oral cyclophosphamide therapy for breast cancer. Because of possible adverse effects of the drug, the nurse will instruct the patient to do which of the following? - ANSWERAnswer: Drink alot of water - ANSWERQuestion 22: A pregnant patient with diabetes has been admitted to the hospital to begin labor. Since the patient has diabetes, the physician has decided to use oxytocin (Pitocin) to initiate labor contractions. When talking to the patient about the adverse effects of the drug, the nurse should understand that the most common adverse effects of the drug include - ANSWERAnswer: uterine tachysystole. - ANSWERQuestion 23: A nurse practitioner has been assigned to a 55-year-old woman who has a malignant brain tumor. The patient is receiving her first dose of carmustine. It will be critical for the nurse to observe for which of the following? - ANSWERAnswer: Respiratory difficulty - ANSWERQuestion 24: A patient has been admitted to the critical care unit with a diagnosis of peritonitis that has necessitated treatment with gentamicin. As a result, the care team should be cautious when concurrently administering other medications that may cause - ANSWERAnswer: ototoxicity or nephrotoxicity - ANSWERQuestion 25: A 66-year-old man has made an appointment with his primary care provider to discuss his recent erectile dysfunction (ED) and requested a prescription for tadalafil (Cialis) based on television commercials. What characteristic of this patient would most likely contraindicate the use of tadalafil for his ED? - ANSWERAnswer: The patient has unstable angina and uses a nitroglycerin patch - ANSWERQuestion 26: A 29-year-old woman who is morbidly obese has recently begun a comprehensive, medically-supervised program of weight reduction. Prior to adding dextroamphetamine (Dexedrine) to her regimen, the patient should be questioned about her intake of - ANSWERAnswer: Caffeine - ANSWERQuestion 27: A 68-year-old man is being treated for benign prostatic hypertrophy (BPH) and began treatment with finasteride (Proscar) 3 months ago. When planning the care of this patient, what desired outcome should the nurse prioritize? - ANSWERAnswer: The patient will experience complete bladder emptying - ANSWERQuestion 28: A Nurse Practitioner is to use a single-dose 1 mL vial to administer 0.5 mL of epoetin alfa to a 39-year-old woman who is being treated for chemotherapy-induced anemia. Which of the following will the nurse do with the unused portion of the drug? - ANSWERAnswer: Discard the unused portion of the drug. - ANSWERQuestion 29: A 36-year-old woman with a history of dysmenorrhea has begun treatment with progesterone, which she will be received by the intramuscular route. The nurse participating in the woman's care should prioritize which of the following potential nursing diagnoses? - ANSWERAnswer: Risk for Injury related to loss of vision or thrombotic events - ANSWERQuestion 30: A 33-year-old man has developed acute gouty arthritis. He has been prescribed colchicine. When developing a care plan for this patient, which factor will be most important for the nurse to consider? - ANSWERAnswer: Dietary habits - ANSWERQuestion 31: A Nurse Practitioner is obtaining baseline physical data from a 7-year-old patient who is to be started on dextroamphetamine for ADHD. After obtaining vital signs, height, and weight, the nurse will prepare the patient for an - ANSWERAnswer: electrocardiogram (ECG). - ANSWERQuestion 32: Mr. Lepp is a 63-year-old man diagnosed with colon cancer several weeks ago and is scheduled to begin chemotherapy. He reports to the nurse that he read about the need for erythropoietin in an online forum for cancer patients and wants to explore the use of epoetin alfa with his oncologist. Which of the following facts should underlie the nurse's response to Mr. Lepp? - ANSWERAnswer: The potential benefits of epoetin alfa must be weighed carefully against the potential adverse effects in cancer patients - ANSWERQuestion 33: A Nurse Practitioner has completed a medication reconciliation of a patient admitted following a motor vehicle accident. Rituximab is among the many drugs the patient has received in the previous year. The nurse would be justified in suspecting the patient may have received treatment for the following diseases. - ANSWERAnswer: Non-Hodgkin's lymphoma - ANSWERQuestion 34: An oncology nurse is aware of the risk for injury related to the preparation, transportation, and administration of chemotherapeutic agents. In order to reduce these risks, the nurse should take the following actions? - ANSWERAnswer: Prime the IV tubing with an approved IV solution rather than the drug itself. - ANSWERQuestion 35: A patient is receiving long-term clindamycin therapy for a life-threatening infection. The nurse will begin by monitoring this drug therapy by obtaining - ANSWERAnswer: a baseline CBC - ANSWERQuestion 36: A 45-year-old woman with acute leukemia will begin chemotherapy with vincristine. The nurse is aware that vincristine must always be administered. - ANSWERAnswer: through a central line. - ANSWERQuestion 37: A patient takes rifampin (Rifadin) for active TB. When discussing this drug with the patient, the nurse should stress that - ANSWERAnswer: body fluids such as urine, saliva, tears, and sputum may become discolored. - ANSWERQuestion 38: A 30-year-old woman in the first trimester of pregnancy has presented to her primary care provider with a 4-day history of a reddened, itchy left eye crusted with a purulent exudate. The clinician suspects a bacterial, rather than viral, etiology. How will the patient'spregnancy affect the potential use of ciprofloxacin to treat her conjunctivitis? - ANSWERAnswer: The use of ciprofloxacin is contraindicated in pregnancy. - ANSWERQuestion 39: A male patient is taking finasteride for BPH. Which of the following will the nurse evaluate at each clinic visit? - ANSWERAnswer: Urinary elimination patterns - ANSWERQuestion 40: A 62-year-old patient taking tamoxifen exhibits increased bone and tumor pain and a local disease flare. The nurse interprets this as an indication of which of the following? - ANSWERAnswer: The tumor is responding to treatment. - ANSWERQuestion 41: A nurse practitioner orders a single dose of 2 g Metronidazole orally. How many milligrams will the patient receive in one dose? Answer: 2000 mg - ANSWERQuestion 42: A 56-year-old woman will soon begin treating her overactive bladder with tolterodine (Detrol). What patient teaching should the nurse provide to this woman? - ANSWERAnswer: "You might find that you get a dry mouth or a headache from this drug, but this does not mean it has to be discontinued." - ANSWERQuestion 43: A patient is seen in the emergency department for a sprained ankle and is given a drug to relieve pain. When a second dose of the pain medication is given, the patient develops redness of the skin, itching, and swelling at the injection site of the drug. The most likely cause of this response is: - ANSWERAnswer: an allergic response. - ANSWERQuestion 44: A 29-year-old pregnant patient is extremely upset about taking medication for a pre-existing medical condition. She is consumed with fear that her baby will be born with a physical deformity or a congenital anomaly but knows that she has to take the medication. She constantly talks about this and is unable to sleep most nights. Which of the following is the most appropriate nursing diagnosis for this patient? Answer: Anxiety related to the perceived danger of drug therapy to a fetus or infant. - ANSWERQuestion 45: A 15-year-old boy who has been taking dextroamphetamine to treat ADHD has been experiencing a depressed mood and a sense of hopelessness. He confides in the school nurse that he has begun taking his stepfather's antidepressant to improve his mood. After immediately phoning the boy's stepfather, the nurse learns that the drug in question is phenelzine (Nardil), a monoamine oxidase inhibitor (MAOI). The nurse should recognize that this combination of drugs creates a severe risk of a health problems? - ANSWERAnswer: hypertensive crisis - ANSWERQuestion 46: A patient has been admitted to the hospital's critical care unit with bacterial septicemia that has failed to respond to initial antibiotic treatment. The patient's most recent blood cultures reveal the presence of methicillin-resistant Staphylococcus aureus (MRSA). The nurse will anticipate that this patient will likely require intravenous administration of what antibiotic? - ANSWERAnswer: vancomycin - ANSWERQuestion 47: A 73-year-old woman has osteoporosis and is prescribed alendronate. She takes calcium and vitamin D supplements, drinks lots of water, and has just quit smoking. The nurse should advise the patient. - ANSWERAnswer: perform light-weight exercises and go for walks. - ANSWERQuestion 48: A Nurse Practitioner is performing patient education for a woman who has just been prescribed bisphosphonate. Which of the following diagnostic and history findings would have prompted the woman's care provider to prescribe a bisphosphonate? - ANSWERAnswer: Low bone density and a family history of osteoporosis - ANSWERQuestion 49: A nurse practitioner provides patient education to a 50- year-old woman taking methotrexate (MTX) for breast cancer. The nurse will instruct the patient to avoid the following drugs. - ANSWERAnswer: Salicylates - ANSWERQuestion 50: A Nurse Practitioner is caring for a patient at 28 weeks gestation and is receiving terbutaline (Brethine) to control preterm labor. Which of the following assessment parameters should the nurse prioritize? - ANSWERAnswer: Fetal Heart Rate (FHR) - ANSWERQuestion 51: A Nurse Practitioner educator who coordinates the staff education in an oncology unit conducts an in-service on targeted therapies. What potential benefit of targeted therapies should the nurse highlight in this education session? - ANSWERAnswer: Targeted therapies have the potential to damage cancerous cells while leaving normal body cells less affected. - ANSWERQuestion 52: Laboratory testing has confirmed that a patient has chloroquine-resistant malaria, and the patient's physician has prescribed quinine and an adjunctive drug. The nurse should question the physician's order if the patient has a history of - ANSWERAnswer: cardiac arrhythmias. - ANSWERQuestion 53: When planning care for a patient receiving filgrastim (Neupogen) for a non-myeloid malignancy, the nurse should formulate the following patient outcomes? (Select all that apply.) - ANSWERAnswer: The patient will not develop an infection; The patient will not experience bone pain; The patient will be able to self-administer filgrastim at home. The patient will not develop febrile neutropenia. - ANSWERQuestion 54: A 67-year-old man treated for prostate cancer is taking epoetin alfa. The nurse will instruct the patient to - ANSWERAnswer: schedule an appointment to measure hemoglobin twice a week for at least 2 to 6 weeks. - ANSWERQuestion 55: A 12-year-old boy is being discharged from the hospital after major surgery. The boy will be taking two medications at home for an extended period. The nurse who is discharging the patient should provide teaching medication specifically - ANSWERAnswer: to both the boy and his mother regarding all medication issued. - ANSWERQuestion 56: A Nurse Practitioner reviews the pre-pregnancy medication regimen of a patient who has just had a positive pregnancy test. Thenurse should be aware of the following changes in pharmacokinetics that accompany pregnancy? - ANSWERAnswer: Increased drug distribution resulting from hemodynamic changes - ANSWERQuestion 57: A patient will begin taking tobramycin (Nebcin) for nosocomial infection. Which of the following assessments should the nurse prioritize? - ANSWERAnswer: The peak and trough blood levels. - ANSWERQuestion 58: A Nurse Practitioner is assigned to a patient at 32 weeks gestation and is receiving terbutaline (Brethine) IV for 24 hours to control preterm labor. Which of the following nursing actions will the nurse take to decrease the risk of hypotension and promote circulation to the fetus? - ANSWERAnswer: Instruct the patient to lie on her left side during the infusion - ANSWERQuestion 59: A patient takes flavoxate hydrochloride (Urispas) to help control an overactive bladder. On a follow-up visit to the clinic, the nurse will question the patient about which of the following? - ANSWERAnswer: Dental hygiene practices - ANSWERQuestion 60: A 60-year-old patient experienced sudden chest pain and shortness of breath and was subsequently diagnosed with a pulmonary embolism in the emergency department. The patient has been started an intravenous heparin infusion. How does this drug achieve a therapeutic effect? - ANSWERAnswer: By inactivating clotting factors and thus stopping the coagulation cascade - ANSWERQuestion 61: A Nurse Practitioner who provides care in a pediatric hospital unit is aware that the potential for harm due to drug errors is higher among infants and children than in adults. This fact is primarily due to - ANSWERAnswer: immature liver and kidney function in infants and children. - ANSWERQuestion 62: A Nurse Practitioner is providing patient education to a 13- year-old girl who was just diagnosed with type 1 diabetes mellitus. Which of the following statements by the patient will alert the nurse that special instructions regarding insulin are necessary? - ANSWERAnswer: "I am on the middle school track team." - ANSWERQuestion 63: A nurse practitioner explains to a pregnant 21-year-old college student why she cannot continue taking ibuprofen (Advil) for herheadaches. The nurse draws a picture depicting drug molecules crossing the placental membrane and entering the fetal circulation. The nurse tells the patient that the main reason this happens is because - ANSWERAnswer: drugs compete with pregnancy hormones for albumin binding sites. - ANSWERQuestion 64: During ongoing assessment of a patient receiving 5-FU therapy, the nurse finds the patient's platelet count to be 92,000 cells/mm3. The nurse should do which of the following? - ANSWERAnswer: Consult the prescriber for discontinuation of the drug. - ANSWERQuestion 65: A nurse practitioner works with a 16-year-old pregnant teen and assesses for behavior that may put the baby at risk. The most important assessment the nurse can make is - ANSWERAnswer: whether the pregnant woman uses illegal substances. - ANSWERQuestion 66: A patient will soon begin targeted therapy as a component of her treatment plan for chronic leukemia. The nurse is conducting health education about this new aspect of the patient's drug regimen and the patient has asked about the potential side effects of treatment. How should the nurse best respond? - ANSWERAnswer: "Both classes of drugs have adverse effects, but targeted therapies tend to have less of an effect on healthy body cells." - ANSWERQuestion 67: A 20-year-old female patient is receiving topical clindamycin for acne vulgaris. She develops a rash and urticaria along with severe itching where the medication is applied. The nurse will formulate which of the following nursing diagnoses for the patient? - ANSWERAnswer: Risk for Injury related to allergic reactions - ANSWERQuestion 68: A 19-year-old patient reports to a clinic with vaginal discharge with a foul odor. A microscopic exam reveals trichomonas vaginalis. The nurse practitioner is aware that - ANSWERAnswer: asymptomatic women are diagnosed with trichomoniasis by a routine pap smear. - ANSWERQuestion 69: A Nurse Practitioner is having difficulty administering a bitter drug to a 5-year-old child. The nurse should - ANSWERAnswer: offer the child a flavored ice chip or ice pop prior to administering the drug. - ANSWERQuestion 70: A school nurse has been teaching high school students about the risks associated with marijuana use. However, the nurse hasbeen met with considerable skepticism on the part of students, most of whom believe that marijuana is a benign drug. Which of the following teaching points should the nurse provide? - ANSWERAnswer: "Smoking marijuana is just as bad, or worse, for your lungs as smoking cigarettes." - ANSWERQuestion 71: A 6-month-old child has developed skin irritation due to an allergic reaction. He has been prescribed a topical skin ointment. The nurse will consider which of the following before administering the drug? - ANSWERAnswer: That the infant's skin has greater permeability than that of an adult. - ANSWERQuestion 72: A Nurse Practitioner works at a weight management clinic. To which of the following overweight patients could the nurse safely administer dextroamphetamine? - ANSWERAnswer: A 48-year-old Caucasian man who has adult onset diabetes. - ANSWERQuestion 73: Morphine has been prescribed for a 28-year-old man with severe pain due to a back injury. The nurse will advise the patient to avoid - ANSWERAnswer: alcohol. - ANSWERQuestion 74: An immunocompromised 7-year-old child, recently discharged home with a peripherally-inserted central line (PICC line) for home antibiotic therapy; He has now been brought to the emergency department by his mother and father with signs and symptoms of line sepsis. Upon questioning, the mother states that she has been removing the PICC dressing daily and washing the site with warm water and a cloth. What nursing diagnosis is most appropriate in this situation? - ANSWERAnswer: Ineffective Family Therapeutic Regimen Management - ANSWERQuestion 75: A 20-year-old woman has been prescribed estrogen. As with all women taking estrogen, the nurse will carefully monitor the patient for which of the following? - ANSWERAnswer: Cardiovascular complications - ANSWERQuestion 76: A 5-year-old boy needs an IM injection. The least painful and most effective injection site would be the - ANSWERAnswer: ventrogluteal muscle. - ANSWERQuestion 77: Alendronate (Fosamax) is prescribed for a 67-year-old postmenopausal woman. In order to help prevent gastrointestinal distress, the nurse will advise the patient to - ANSWERAnswer: stand or sit upright for at least 30 minutes after taking alendronate. - ANSWERQuestion 78: A male patient is experiencing climacteric symptoms secondary to androgen deficiency. His physician has prescribed testosterone. The nursing assessment reveals that the patient has had a myocardial infarction. The combination of testosterone therapy and a history of myocardial infarction would place that patient at a significantly higher risk of - ANSWERAnswer: Heart Attack - ANSWERQuestion 79: A Nurse Practitioner is instructing a 19-year-old female patient on the use of fluconazole for candida vaginitis. A teaching priority will be to - ANSWERAnswer: use an alternative form of birth control, if taking an oral contraceptive. - ANSWERQuestion 80: A postmenopausal patient is prescribed bisphosphonates to treat osteoporosis. The nurse will instruct the patient to take the drug Answer: first thing in the morning. - ANSWERQuestion 81: A man has a demonstrated history of androgen deficiency and the consequences of this health problem include an inability tomaintain an erection. Which of the following medications would best address this patient's erectile dysfunction (ED)? - ANSWERAnswer: Exogenous testosterone - ANSWERQuestion 82: A Nurse Practitioner is caring for a patient with cancer who has been prescribed dronabinol (Marinol) to help reduce nausea and vomiting from chemotherapy. The nurse will inform the patient that he or she is taking an oral form of - ANSWERAnswer: marijuana. - ANSWERQuestion 83: Which of the following patients will be at the greatest risk for anemia and would be the most likely candidate for epoetin alfa therapy? - ANSWERAnswer: A 62-year-old male with cancer - ANSWERQuestion 84: A woman who is in the second trimester of her first pregnancy has been experiencing frequent headaches and has sought advice from her nurse practitioner about safe treatment options. What analgesic can the nurse most safely recommend? - ANSWERAnswer: Acetaminophen - ANSWERQuestion 85: A pregnant patient asks the Nurse Practitioner what overthe-counter medication she can take for recurring headaches. The nurse should recommend - ANSWERAnswer: tylenol - ANSWERQuestion 86: An immunocompromised cancer patient has developed cryptococcal meningitis and been admitted to the intensive care unit for treatment with amphotericin B. How should the nurse most safely administer this drug? - ANSWERAnswer: Infuse the drug over 2 to 4 hours into a central line using an infusion pump - ANSWERQuestion 87: A 38-year-old pregnant patient admits to the Nurse Practitioner that she is an alcoholic and has been consuming alcohol during her pregnancy. The nurse knows that using alcohol during pregnancy may result in a child who presents with - ANSWERAnswer: mircocehpaly - ANSWERQuestion 88: A patient with AIDS has developed a number of secondary infections in recent weeks, including Kaposi's sarcoma. As a result of this most recent diagnosis, his care team has opted to begin treatment with interferon alfa-2a. The nurse is aware that this drug will address the etiology of Kaposi sarcoma by - ANSWERAnswer: inhibiting tumor growth by enhancing inflammation. - ANSWERQuestion 89: A 7-year-old child has been taking tetracycline for a bacterial infection. The nurse will be sure to inform the parents that this drug could cause - ANSWERAnswer: staining of permanent teeth. - ANSWERQuestion 90: A patient has completed 4 weeks of treatment with epoetin alfa. Which of the following assessment findings would most strongly indicate that treatment has been effective? - ANSWERAnswer: The patient's hemoglobin level is 11 g/dL. - ANSWERQuestion 91: The clinical nurse educator who oversees the emergency department in a children's hospital has launched an awareness program aimed at reducing drug errors. What measure addresses the most common cause of incorrect doses in the care of infants and children? - ANSWERAnswer: Having nurses check their math calculations with a colleague before administering a drug. - ANSWERQuestion 92: A 20-year-old woman will soon begin taking oral contraceptives for the first time. What advice should the nurse provide to this patient? - ANSWERAnswer: "Make sure to seek care quickly if you experience bad headaches, calf pain, or changes in vision." - ANSWERQuestion 93: A 45-year-old female patient is prescribed ciprofloxacin to treat a bronchial infection. A nursing assessment revealed that she started taking daily vitamin supplements about 2 years ago. To maximize the therapeutic effects of the ciprofloxacin therapy, the nurse should advise the patient to - ANSWERAnswer: take the vitamins at least 2 hours before or after taking ciprofloxacin. - ANSWERQuestion 94: A male patient is receiving heparin by continuous intravenous infusion. The nurse will instruct the patient and family members to report which of the following should it occur? - ANSWERAnswer: presence of blood in urine or stools - ANSWERQuestion 95: A patient with non-Hodgkin's lymphoma (NHL) will be starting a course of doxorubicin shortly. When planning this patient's care, what nursing diagnosis should the nurse prioritize? - ANSWERAnswer: Risk for infection related to suppressed bone marrow function. - ANSWERQuestion 96: A 65-year-old woman has an advanced form of rheumatoid arthritis. Her treatment includes a regular dosage of methotrexate. The APRN will advise her to take which of the following vitamin supplements while taking the drug? - ANSWERAnswer: Vitamin B. - ANSWERQuestion 97: A 46-year-old man is receiving a quinupristin/dalfopristin IV infusion for a life threatening infection. Which of the following would be most important for the nurse to monitor? - ANSWERAnswer: Infiltration, edema, or phlebitis at the infusion site. - ANSWERQuestion 98: A 51-year-old female patient has been receiving doxorubicin (Adriamycin) for metastatic breast cancer. Her medical record indicates she has cardiomyopathy, and a cumulative dose of 300 mg/m2 of doxorubicin. Which of the following measures would help limit the severity of the cardiomyopathy in this patient? - ANSWERAnswer: The use of dexrazoxane in conjunction with doxorubicin - ANSWERQuestion 99: The Nurse Practitioner has established peripheral IV access and begun an infusion of magnesium sulfate on a 29-year-old antepartum patient who is 35 weeks pregnant. Which of the followingassessment findings most likely prompted the patient's physician to order magnesium sulfate for this patient? - ANSWERAnswer: Systolic blood pressure readings in excess of 190 mmHg - ANSWERQuestion 100: A Nurse Practitioner is explaining the use of acyclovir therapy to a 72-year-old man. Nephrotoxicity is discussed as a major adverse effect in older patients. To minimize the risk of the patient developing this adverse effect, the nurse will advise him to - ANSWERAnswer: stay well hydrated by drinking at least eight 8-oz glasses of water daily. - ANSWERA nurse is caring for an infant after a surgical procedure. After ensuring that the ordered dose is appropriate for the infant's age and weight, the nurse administers a narcotic analgesic intravenously. When assessing the infant 15 minutes later, the nurse notes respirations of 22 breaths/minute and a heart rate of 110 beats/minute. The infant is asleep in the parent's arms and does not awaken when vital signs are assessed. The nurse understands that these findings are the result of: - ANSWER- immaturity of the blood-brain barrier in the infant. A child will receive 750 mg of an antibiotic for 10 days. The child attends day care. The drug may be dosed in several ways and is available in two concentrations. Which dosing regimen will the nurse discuss with the child's provider? - ANSWER- 500 mg/5 mL to 375 mg PO twice dailyParents ask the nurse why an over-the-counter cough suppressant with sedative side effects is not recommended for infants. Which response by the nurse is correct? - ANSWER- "Infants are more susceptible to central nervous system effects than are adults." A nurse caring for a 5-year-old child notes that the child has discoloration of several teeth. When taking a medication history, the nurse will ask about which group of medications? - ANSWERTetracyclines An infant has allergies and often develops a pruritic rash when exposed to allergens. The infant's parents ask the nurse about using a topical antihistamine. What should the nurse tell them? - ANSWER- Applying an antihistamine to the skin can cause toxicity in this age group. An infant is receiving a medication that has a narrow therapeutic range. The nurse reviews the medication information and learns that the drug is excreted by the kidneys. When giving the medication, the nurse will assess the infant for: - ANSWER- signs of drug toxicity. A pediatric nurse is teaching nursing students to calculate medication doses for children using a formula based on body surface area. Which statement by a nursing student indicates understanding of the teaching? - ANSWER- "This formula helps approximate the first dose; other doses should be based on clinical observations."A pediatric nurse is teaching nursing students about medication administration in children. Which statement by a student indicates an understanding of the teaching? - ANSWER- "Drugs effective in adults may not work in children, even if the dose is proportional for weight and size." A nurse is teaching nursing students about pediatric medication administration. What will the nurse include when discussing pediatric drug research? - ANSWER- Studies showed a significant percentage of unanticipated and potentially lethal side effects in children. A prescriber has ordered medication for a newborn. The medication is eliminated primarily by hepatic metabolism. The nurse expects the prescriber to: - ANSWER- order a dose that is lower than an adult dose. The parents of a child with asthma ask the nurse why their child can not use oral corticosteroids more often, because they are so effective. The nurse will offer which information that is true for children? - ANSWERChronic steroid use can inhibit growth. A patient with schizophrenia receives a dose of risperidone [Risperdal Consta] IM. The nurse teaching this patient about this medication will make which statement? - ANSWER- "You will need to take an oral antipsychotic drug for 3 weeks." A patient with schizophrenia shows suicidal behaviors, and the provider orders clozapine [Clozaril]. The nurse teaches the family about the medication and its side effects. Which statement by a family memberindicates a need for further teaching about this drug? - ANSWER- "If the ANC is less than 3000, the drug will be discontinued permanently." A patient in whom drug therapy has failed several times in the past is readmitted to a hospital to begin therapy for schizophrenia. What will the nurse do to help improve adherence? - ANSWER- Teach the patient about drug side effects and how to manage them. A nurse provides teaching for a patient about to begin taking an FGA drug for schizophrenia. Which statement by the patient indicates a need for further teaching about side effects of these drugs? - ANSWER- "Dry mouth and constipation are uncommon with this medication." A patient taking an FGA medication develops severe parkinsonism and is treated with amantadine [Symmetrel]. The amantadine is withdrawn 2 months later, and the parkinsonism returns. The nurse will expect the provider to: - ANSWER- try a second-generation antipsychotic (SGA). What are negative symptoms of schizophrenia? Select all that apply. - ANSWER- Poor judgment Poor self-care Poverty of speech A patient is taking an FGA for schizophrenia. The nurse notes that the patient has trouble speaking and chewing and observes slow, wormlikemovements of the patient's tongue. The nurse recognizes which adverse effect in this patient? - ANSWER- Tardive dyskinesiaA nurse and a nursing student are discussing the plan of care for a patient with schizophrenia. The patient, who has been taking a highpotency FGA for 2 months, has become restless and constantly needs to be in motion. Which statement by the student indicates a need for further education? - ANSWER- "Because this may be an exacerbation of psychosis, the provider may increase the dose of the FGA." A patient who is taking a first-generation antipsychotic (FGA) drug for schizophrenia comes to the clinic for evaluation. The nurse observes that the patient has a shuffling gait and mild tremors. The nurse will ask the patient's provider about which course of action? - ANSWER- Giving an anticholinergic medication A patient with schizophrenia has been taking an oral FGA for 1 week. The patient has been taking the drug daily in two divided doses. The individual complains of daytime drowsiness. The patient's family reports a decrease in the person's hostility and anxiety but states that the patient remains antisocial with disordered thinking. What will the nurse tell the patient and the family? - ANSWER- Some symptoms take months to improve. A patient with schizophrenia has been taking an antipsychotic drug for several days. The nurse enters the patient's room to administer a dose of haloperidol [Haldol] and finds the patient having facial spasms. The patient's head is thrust back, and the patient is unable to speak. What will the nurse do? - ANSWER- Request an order to give diphenhydramine.A parent reports being afraid that a child may have schizophrenia because of disorganized speech and asocial behaviors. The nurse will tell this parent that which of the following must also be present to make a diagnosis? Select all that apply. - ANSWER- A decrease in self-care, job, or school function A 1-month duration of active phase symptoms Continuous signs of disturbance for longer than 6 months Which side effects are more common in second-generation antipsychotic medications than in first-generation antipsychotic medications? Select all that apply. - ANSWER- Agranulocytosis Anticholinergic effects Metabolism by CYP3A4 A nurse in a mental health hospital finds a patient with schizophrenia who takes haloperidol [Haldol] lying rigid in bed with a temperature of 41.3°C. A cardiac monitor shows cardiac dysrhythmias. What will be included in the treatment of this patient? Select all that apply. - ANSWER- Dantrolene Intravenous fluids Withdrawal of haloperidol A patient who has diabetes mellitus is diagnosed with schizophrenia and the provider orders thioridazine. The patient asks the nurse why the provider has not ordered olanzapine [Zyprexa], which the patient has seen advertised on television. Which response by the nurse is the most important reason that this patient is not receiving olanzapine? -ANSWER- "Olanzapine causes more metabolic side effects than thioridazine." A patient who has been taking a monoamine oxidase inhibitor (MAOI) for depression for several months tells the provider that the medication has not helped with symptoms. The provider plans to switch the patient to an SSRI. The nurse will teach this patient to: - ANSWER- stop taking the MAOI 2 weeks before starting the SSRI. A young adult patient has been taking an antidepressant medication for several weeks and reports having increased thoughts of suicide. The nurse questions further and learns that the patient has attempted suicide more than once in the past. The patient identifies a concrete plan for committing suicide. The nurse will contact the provider to discuss: - ANSWER- hospitalizing the patient for closer monitoring. An older adult patient who is to begin taking imipramine [Tofranil] asks the nurse when the drug should be taken. The nurse will instruct the patient to: - ANSWER- divide the daily dose into two equal doses 12 hours apart. A patient has been taking an SSRI antidepressant for major depression and reports having headaches and jaw pain. What will the nurse tell the patient? - ANSWER- Discuss these symptoms with a dentist. A neonate is born to a patient who reports taking venlafaxine [Effexor XR]. The nurse caring for the infant will observe the infant for: - ANSWER- irritability, tremor, and respiratory distress.A patient is brought to the emergency department after taking a handful of TCA pills. The nurse will expect to provide what when caring for this patient? Select all that apply. - ANSWER- Cardiac monitoring Cholinesterase inhibitors Gastric lavage and activated charcoal A patient is diagnosed with major depression with severe symptoms and begins taking an antidepressant medication. Three weeks after beginning therapy, the patient tells the nurse that the drug is not working. The nurse will counsel this patient to ask the provider about: - ANSWER- using nondrug therapies to augment the medication. Which patients are candidates for MAOIs? Select all that apply. - ANSWER- Patients who have not responded to SSRIs and TCAs Patients with atypical depression Patients with bulimia nervosa A patient whose spouse has died recently reports feeling down most of every day for the past 2 months. On further questioning, the nurse learns that the patient has quit participating in church and social activities, has difficulty falling asleep, and has lost 5 pounds. The patient reports feeling tired and confused all the time but does not have suicidal thoughts. What does the nurse suspect? - ANSWER- Major depressionA patient taking an MAOI is seen in the clinic with a blood pressure of 170/96 mm Hg. What will the nurse ask this patient? - ANSWER- To list all foods eaten that day A patient taking fluoxetine [Prozac] complains of decreased sexual interest. A prescriber orders a "drug holiday." What teaching by the nurse would best describe a drug holiday? - ANSWER- "Don't take the medication on Friday and Saturday." A patient with bipolar disorder who wants to minimize the need for drug therapy asks the nurse what else can be done to treat the disorder. The nurse will recommend which measures? Select all that apply. - ANSWER- Psychotherapy Regular sleep and exercise Using a chart to monitor mood changes A patient with bipolar disorder who is taking divalproex sodium [Valproate] has just been admitted to the hospital. During the admission assessment, the patient tells the nurse about recent suicidal ideation. The nurse observes several areas of bruising over soft tissue areas and notes a weight gain of 10 pounds since the last admission 1 year ago. What will the nurse do? - ANSWER- Contact the provider to report these findings. A patient with bipolar disorder takes lamotrigine [Lamictal]. Which statement by the patient would prompt the nurse to hold the drug and notify the prescriber for further assessment? - ANSWER- "I've broken out in a rash on my chest and back."A patient who has recently begun taking carbamazepine [Equetro] for bipolar disorder reports having vertigo and headaches. Which action by the nurse is appropriate? - ANSWER- Reassure the patient that these effects occur early in treatment and will resolve over time. A patient is admitted to a hospital for treatment for first-time symptoms of mania and is exhibiting euphoric mania. Which medication will the provider order? - ANSWER- Lithium [Lithobid] A patient with bipolar disorder has been taking lithium [Lithobid] for several years. The patient has developed a goiter, and serum tests reveal hypothyroidism. What will the nurse expect the provider to order for this patient? - ANSWER- Administration of levothyroxine A nurse is preparing to administer medications to a hospitalized patient who has been taking lithium [Lithobid] for 3 days. The patient is complaining of mild nausea and abdominal bloating. The patient's lithium level is 0.8 mEq/L. What will the nurse do? - ANSWERAdminister the dose and tell the patient that the side effects are temporary. A patient recently was diagnosed with bipolar disorder. The patient, who has a history of seasonal allergies, is an athlete who participates in track. The nurse is teaching the patient about lithium [Lithobid], which the prescriber has just ordered. Which statement by the patient indicates the need for further teaching? - ANSWER- "I can continue to use ibuprofen as needed for muscle pain."A patient with bipolar disorder is admitted to the hospital. The patient has been taking lithium [Lithobid] for several years and has not been evaluated by a provider for over a year. Besides obtaining a lithium level, the nurse caring for this patient will anticipate orders for which laboratory tests? Select all that apply. - ANSWER- Calcium level Renal function tests Thyroid function tests The spouse of a patient with bipolar disorder (BPD) tells the nurse that the patient will not stay on the lithium ordered by the provider longer than 1 or 2 months at a time. The nurse understands that adherence to medication regimens in patients with BPD is problematic and will tell the spouse: - ANSWER- "During manic episodes, many patients don't see the benefit of prophylactic medications." A patient with bipolar disorder has frequent manic episodes alternating with depressive episodes. The prescriber orders risperidone [Risperdal] in addition to the lithium [Lithobid] that the patient is already taking. The patient asks the nurse why another drug is needed. The nurse will tell the patient that the risperidone is used to: - ANSWER- help control symptoms during manic episodes. A patient with a new-onset seizure disorder receives a prescription for phenobarbital. The patient reports being concerned about the sedative side effects of this drug. Which response by the nurse is correct? - ANSWER- "Phenobarbital doses for seizures are nonsedating."A patient who travels frequently for business reports occasional instances of being unable to fall asleep. The patient tells the nurse that job demands require staying up late and then getting up early for meetings. The nurse expects that the provider will prescribe which medication for this patient? - ANSWER- Zaleplon [Sonata] A patient who is experiencing alcohol withdrawal is given a benzodiazepine. The nurse understands that this drug is effective because: - ANSWER- the patient has a cross-dependence to the benzodiazepine. A patient in the emergency department is given intravenous diazepam [Valium] for seizures. When the seizures stop, the nurse notes that the patient is lethargic and confused and has a respiratory rate of 10 breaths/minute. The nurse will expect to administer which of the following? - ANSWER- Respiratory support A patient who has been using secobarbital for several months to treat insomnia tells the nurse that the prescriber has said the prescription will be changed to temazepam [Restoril] because it is safer. The patient asks why this agent is safer. The nurse is correct in telling the patient that temazepam: - ANSWER- potentiates endogenous gamma-aminobutyric acid (GABA) producing a finite CNS depression. A hospitalized patient who is given one dose of flurazepam continues to show drowsiness the next day. A nursing student asks the nurse the reason for this, because the drug's half-life is only 2 to 3 hours. Which response by the nurse is correct? - ANSWER- "When this drug is metabolized, the resulting compound has longer-lasting effects."A patient takes temazepam [Restoril] for insomnia. The patient tells the nurse that a recent telephone bill lists several calls to friends that the patient does not remember making. What will the nurse do? - ANSWER- Ask the patient about any alcohol consumption in conjunction with the benzodiazepine. A nurse is discussing the use of benzodiazepines as sedative-hypnotic agents with a group of nursing students. A student asks about the actions of these drugs in the central nervous system. The nurse makes which correct statement? - ANSWER- "Benzodiazepines affect the hippocampus and the cerebral cortex to cause anterograde amnesia." A patient who has been taking alprazolam [Xanax] to treat generalized anxiety disorder (GAD) reports recently stopping the medication after symptoms have improved but reports having feelings of panic and paranoia. Which initial action by the nurse is correct? - ANSWER- Ask the patient if the medication was stopped abruptly. A patient is diagnosed with anxiety after describing symptoms of tension, poor concentration, and difficulty sleeping that have persisted for over 6 months. Which medication will the nurse expect the provider to order for this patient? - ANSWER- Buspirone [Buspar] A nurse is preparing a patient who will stop taking lorazepam [Ativan] for anxiety and begin taking buspirone [Buspar]. Which statement by the patient indicates a need for further teaching? - ANSWER- "I should stop taking the Ativan when I start taking the Buspar."A patient reports having occasional periods of tremors, palpitations, nausea, and a sense of fear, which usually dissipate within 30 minutes. To treat this condition, the nurse anticipates the provider will prescribe a drug in which drug class? - ANSWER- Selective serotonin reuptake inhibitors Selective serotonin reuptake inhibitors are known to be effective for which disorders? Select all that apply. - ANSWER- Generalized anxiety disorder (GAD) Obsessive-compulsive disorder Panic disorder Social anxiety disorder uring an admission history, a patient reports a frequent need to return to a room multiple times to make sure an iron or other appliance is unplugged. What does the nurse understand about this patient's behavior? - ANSWER- It helps the patient reduce anxiety about causing a fire. A patient describes feelings of anxiety and fear when speaking in front of an audience and is having difficulty at work because of an inability to present information at meetings three or four times each year. The patient is reluctant to take long-term medications. The nurse will expect the provider to order which treatment? - ANSWER- Alprazolam [Xanax] as neededA patient who has obsessive-compulsive disorder (OCD) has been undergoing behavioral therapy but continues to exhibit symptoms that interfere with daily life. Which intervention will the nurse expect the provider to order for this patient? - ANSWER- Fluoxetine [Paxil] A nurse is performing an admission assessment on a patient. The patient reports taking alprazolam [Xanax] for "nerves." The nurse knows that this patient is most likely being treated for which condition? - ANSWER- Generalized anxiety disorder An agitated, extremely anxious patient is brought to the emergency department. The prescriber orders a benzodiazepine. The nurse understands that benzodiazepines are used in this clinical situation based on which principle? - ANSWER- Benzodiazepines have a rapid onset of action. A child will begin taking methylphenidate [Ritalin] for attentiondeficit/hyperactivity disorder. Important baseline information about this patient will include: - ANSWER- height and weight. A child has been taking SD methylphenidate [Ritalin], 10 mg at 0800 and 1200 and 5 mg at 1600, for 2 months. The parents tell the nurse that the child sometimes misses the noon dose while at school. The child's appetite is normal. The teacher has reported a slight improvement in hyperactivity and impulsivity. What will the nurse do? - ANSWER- Ask the prescriber whether this child could be given methylphenidate [Concerta].An adult patient will begin taking atomoxetine [Strattera] for attentiondeficit/hyperactivity disorder. What will the nurse teach this patient? - ANSWER- Therapeutic effects may not be felt for 1 to 3 weeks after beginning therapy. A child is diagnosed with attention-deficit/hyperactivity disorder (ADHD). The prescriber orders a central nervous system stimulant. Which statement by the child's parent indicates a need for further teaching? - ANSWER- "This drug will make him less impulsive while he's at school." A university student who is agitated and restless and has tremors is brought to the emergency department. The patient's heart rate is 110 beats/minute, the respiratory rate is 18 breaths/minute, and the blood pressure is 160/95 mm Hg. The patient reports using concentrated energy drinks to stay awake during finals. This patient is at risk of having: - ANSWER- Seizures A patient who is morbidly obese is admitted for treatment. The prescriber orders lisdexamfetamine [Vyvanse]. The nurse will be concerned if this patient shows signs of: - ANSWER- dyspnea. 234. A nurse is providing education to a group of patients regarding amphetamines. To evaluate the group's understanding, the nurse asks a participant what effects amphetamines would have on her. The participant shows that she understands the effects of these drugs if she gives which answers? Select all that apply. - ANSWER- "Amphetamines suppress the perception of pain." "Amphetamines increase the heart rate.""Amphetamines elevate mood." A nurse working the night shift begins taking modafinil [Alertec]. The nurse is telling a coworker about the medication. Which statement is correct? - ANSWER- "It will not interfere with my normal sleep." A nurse is teaching the parents of a child who has attentiondeficit/hyperactivity disorder about methylphenidate [Concerta]. Which statement by the child's parents indicates understanding of the teaching? - ANSWER- "The tablet needs to be swallowed whole, not crushed or chewed." A young adult begins taking clonidine [Kapvay] to treat ADHD symptoms after suffering anorexia with methylphenidate [Ritalin]. What will the nurse include when teaching this patient about taking clonidine? - ANSWER- "Avoid consuming alcohol while taking this medication." A parent thinks a school-aged child has ADHD. The nurse asks the parent to describe the child's behaviors. Which behaviors are characteristic of ADHD? Select all that apply. - ANSWERHyperactivity Inattention Impulsivity A patient has been receiving heparin while in the hospital to treat deep vein thromboses and will be discharged home with a prescription for enoxaparin [Lovenox]. The nurse provides teaching for the nursingstudent who asks about the advantages of enoxaparin over heparin. Which statement by the student indicates a need for further teaching? - ANSWER- "Enoxaparin is more cost-effective than heparin." A patient is receiving heparin postoperatively to prevent deep vein thrombosis. The nurse notes that the patient has a blood pressure of 90/50 mm Hg and a heart rate of 98 beats/minute. The patient's most recent aPTT is greater than 90 seconds. The patient reports lumbar pain. The nurse will request an order for: - ANSWER- protamine sulfate. A nursing student who is preparing to care for a postoperative patient with deep vein thrombosis asks the nurse why the patient must take heparin rather than warfarin. Which response by the nurse is correct? - ANSWER- "The onset of warfarin is delayed." A postoperative patient reports pain in the left lower extremity. The nurse notes swelling in the lower leg, which feels warm to the touch. The nurse will anticipate giving which medication? - ANSWEREnoxaparin [Lovenox] A patient who is taking warfarin [Coumadin] has just vomited blood. The nurse notifies the provider, who orders laboratory work revealing a PT of 42 seconds and an INR of 3.5. The nurse will expect to administer: - ANSWER- phytonadione (vitamin K1) 1 mg IV over 1 hour. A patient is admitted to the emergency department with chest pain. An electrocardiogram shows changes consistent with an evolving myocardial infarction. The patient's cardiac enzymes are pending. Thenurse caring for this patient will expect to: - ANSWER- give alteplase [Activase] within 2 hours. A patient who takes warfarin for atrial fibrillation undergoes hip replacement surgery. On the second postoperative day, the nurse assesses the patient and notes an oxygen saturation of 83%, pleuritic chest pain, shortness of breath, and hemoptysis. The nurse will contact the provider to report possible and request an order for - ANSWER- pulmonary embolism; heparin A patient with atrial fibrillation is receiving warfarin [Coumadin]. The nurse notes that the patient's INR is 2.7. Before giving the next dose of warfarin, the nurse will notify the provider and: - ANSWER- administer the dose as ordered. A postoperative patient will begin anticoagulant therapy with rivaroxaban [Xarelto] after knee replacement surgery. The nurse performs a history and learns that the patient is taking erythromycin. The patient's creatinine clearance is 50 mL/minute. The nurse will: - ANSWER- notify the provider to discuss changing the patient's antibiotic. A patient who is taking clopidogrel [Plavix] calls the nurse to report black, tarry stools and coffee-ground emesis. The nurse will tell the patient to: - ANSWER- continue taking the clopidogrel until talking to the provider.A patient has been taking warfarin [Coumadin] for atrial fibrillation. The provider has ordered dabigatran etexilate [Pradaxa] to replace the warfarin. The nurse teaches the patient about the change in drug regimen. Which statement by the patient indicates understanding of the teaching? - ANSWER- "I will stop taking the warfarin and will start taking the dabigatran when my INR is less than 2." A 50-year-old female patient asks a nurse about taking aspirin to prevent heart disease. The patient does not have a history of myocardial infarction. Her cholesterol and blood pressure are normal, and she does not smoke. What will the nurse tell the patient? - ANSWER- There is most likely no protective benefit for patients her age. A patient who takes warfarin [Coumadin] is brought to the emergency department after accidentally taking too much warfarin. The patient's heart rate is 78 beats/minute and the blood pressure is 120/80 mm Hg. A dipstick urinalysis is normal. The patient does not have any obvious hematoma or petechiae and does not complain of pain. The nurse will anticipate an order for: - ANSWER- a PT and an INR. A nurse caring for a patient receiving heparin therapy notes that the patient has a heart rate of 98 beats/minute and a blood pressure of 110/72 mm Hg. The patient's fingertips are purplish in color. A stat CBC shows a platelet count of less than 100,000 mm3. The nurse will: - ANSWER- discontinue the heparin and notify the provider. A patient will begin taking dabigatran etexilate [Pradaxa] to prevent stroke. The nurse will include which statement when teaching thispatient? - ANSWER- It is important not to crush, chew, or open capsules of dabigatran. A patient is admitted to the hospital with unstable angina and will undergo a percutaneous coronary intervention. Which drug regimen will the nurse expect to administer to prevent thrombosis in this patient? - ANSWER- Aspirin, heparin, abciximab [ReoPro] A patient who has taken warfarin [Coumadin] for a year begins taking carbamazepine. The nurse will anticipate an order to: - ANSWERincrease the dose of warfarin. A nurse has just received an order for tenecteplase [TNKase] for a patient experiencing an acute myocardial infarction. The nurse should administer this drug: - ANSWER- by bolus injection A nurse is taking a medication history on a newly admitted patient. The patient reports taking folic acid and vitamin B12. The nurse notifies the provider because of the concern that folic acid can: - ANSWER- mask the signs of vitamin B12 deficiency. A nurse is caring for a patient after hip replacement surgery. The patient has been receiving iron replacement therapy for 2 days. The nurse notes that the patient's stools appear black. The patient is pale and complains of feeling tired. The patient's heart rate is 98 beats/minute, respirations are 20 breaths/minute, and the blood pressure is 100/50 mm Hg. The nurse will contact the provider to: - ANSWER- request a hemoglobin and hematocrit (H&H).A 12-year-old female patient is admitted to the hospital before sinus surgery. The nurse preparing to care for this patient notes that the admission hemoglobin is 10.2 gm/dL, and the hematocrit is 32%. The nurse will ask the child's parents which question about their daughter? - ANSWER- "Has she begun menstruating?" A patient with renal failure is undergoing chronic hemodialysis. The patient's hemoglobin is 10.6 gm/dL. The provider orders sodium-ferric gluconate complex (SFGC [Ferrlecit]). What will the nurse expect to do? - ANSWER- Administer the drug intravenously with erythropoietin. A patient tells a nurse that she is thinking about getting pregnant and asks about nutritional supplements. What will the nurse recommend? - ANSWER- 400 to 800 mg of folic acid per day A patient who has recently immigrated to the United States from an impoverished country appears malnourished. The patient's folic acid levels are low, and the vitamin B12 levels are normal. The nurse expects this patient's treatment to include: - ANSWER- a diet high in folic acid. A patient is admitted to the hospital. The patient's initial laboratory results reveal megaloblastic anemia. The patient complains of tingling of the hands and appears confused. The nurse suspects what in this patient? - ANSWER- Vitamin B12 deficiency A nurse is reviewing a patient's most recent blood count and notes that the patient has a hemoglobin of 9.6 gm/dL and a hematocrit of 33%. Thenurse will notify the provider and will expect initial treatment to include: - ANSWER- determining the cause of the anemia. What are the indications for administration of a parenteral iron preparation? Select all that apply. Blood loss of 750 mL/week - ANSWER- Blood loss of 750 mL/week Celiac disease with anemia Intestinal disease impairing absorption A patient was given a 30-day supply of Feosol and has been taking the drug for 4 weeks for iron deficiency anemia. The patient's initial hemoglobin was 8.9 gm/dL. The nurse notes that the hemoglobin has risen to 9.7 gm/dL. What will the nurse ask the patient about? - ANSWER- Whether the prescription needs to be refilled The patient with which of the following is most at risk for folic acid deficiency? - ANSWER- Alcoholism A patient is receiving oral iron for iron deficiency anemia. Which antibiotic drug, taken concurrently with iron, would most concern the nurse? - ANSWER- Tetracycline A patient with vitamin B12 deficiency is admitted with symptoms of hypoxia, anemia, numbness of hands and feet, and oral stomatitis. The nurse expects the prescriber to order which of the following therapies? - ANSWER- IM cyanocobalamin and folic acidA patient who has been prescribed oral ferrous sulfate reports taking extra doses for the past few months. The patient's serum iron level is 560 mcg/dL. What will the nurse expect the provider to order for this patient? - ANSWER- oral deferasirox [Exjade]Giving parenteral deferoxamine [Desferal] A patient is diagnosed with moderate vitamin B12 deficiency. The nurse reviews the laboratory work and notes that the plasma B12 is low; also, a Schilling test reveals B12 malabsorption. The provider orders oral cyanocobalamin 500 mcg/day. The nurse will contact the provider to: - ANSWER- suggest an increased dose. A postmenopausal patient who has had a hysterectomy and who has a family history of coronary heart disease reports experiencing vaginal dryness and pain with intercourse but tells the nurse that she does not want to take hormones because she is afraid of adverse effects. The nurse will suggest that the woman ask her provider about: - ANSWERPremarin vaginal. A 50-year-old postmenopausal patient who has had a hysterectomy has moderate to severe vasomotor symptoms and is discussing estrogen therapy (ET) with the nurse. The patient is concerned about adverse effects of ET. The nurse will tell her that: - ANSWER- transdermal preparations have fewer side effects. A patient who will beg