HES 005 Nursing Pharmacology P3 Examination 2024-2025 PDF

# HES 005 - NURSING PHARMACOLOGY ## FIRST SEMESTER SY 2024-2025 ### P3 EXAMINATION **God Bless!** **(Analyzing)** 1. ACE inhibitors work on the renin-angiotensin system to prevent the conversion of angiotensin I to angiotensin II. Because blocking occurs in the cells in the lung, which is usually...

# HES 005 - NURSING PHARMACOLOGY ## FIRST SEMESTER SY 2024-2025 ### P3 EXAMINATION **God Bless!** **(Analyzing)** 1. ACE inhibitors work on the renin-angiotensin system to prevent the conversion of angiotensin I to angiotensin II. Because blocking occurs in the cells in the lung, which is usually the site of this conversion, the use of ACE inhibitors often results in: A. spontaneous pneumothorax. B. pneumonia. C. unrelenting cough. D. respiratory depression. **Rationale:** ACE inhibitors can cause a persistent, dry cough in some patients. This occurs because ACE inhibitors block the breakdown of bradykinin, a substance that can accumulate in the lungs and lead to coughing. **(Understanding)** 2. A patient who is hypertensive becomes pregnant. The drug of choice for this patient is A. an angiotensin II receptor blocker. B. an ACE inhibitor. C. a diuretic. D. a calcium-channel blocker. **Rationale:** Calcium-channel blockers are often considered safer for managing hypertension in pregnant women compared to ACE inhibitors or angiotensin II receptor blockers, which are contraindicated in pregnancy due to the risk of fetal harm. Diuretics are generally avoided unless absolutely necessary during pregnancy due to potential effects on blood volume and electrolyte balance. For a pregnant patient with hypertension, the drug of choice is generally alpha-2 adrenergic agonists, specifically methyldopa, rather than a calcium channel blocker. **(Understanding)** 3. ACE inhibitors and other vasodilators are used in the early treatment of HF. They act to A. cause loss of volume. B. increase arterial pressure and perfusion. C. cause pooling of the blood and decreased venous return to the heart. D. increase the release of aldosterone and improve fluid balance. **Rationale:** ACE inhibitors and other vasodilators help treat heart failure by reducing peripheral resistance (vasodilation), which decreases the workload on the heart. This leads to reduced venous return (preload) and decreased afterload, improving overall cardiac function in heart failure. They do not directly cause volume loss or increase aldosterone release. **Scenario:** A 52-year-old patient presents to the clinic with complaints of frequent headaches, dizziness, and palpitations. The patient's blood pressure is consistently high at 180/110 mmHg despite being on antihypertensive medications for several months. Upon further investigation, it is discovered that the patient has an underlying adrenal tumor. **(Remembering)** 4. What type of hypertension the patient is most likely experiencing? A. Essential Hypertension B. Secondary Hypertension C. Primary Hypertension D. The patient's blood pressure is normal **Rationale:** Secondary hypertension is characterized by elevated blood pressure due to a known cause. **(Remembering)** 5. The following are the major classes of antihypertensive drugs that acts at the vasomotor center of the brain, EXCEPT: A. Methyldopa B. Clonidine C. Propanolol D. Guanfacine **Rationale:** All options are correct, except for Propanolol which acts at the Beta receptors in the heart. **(Understanding)** 6. Which of the following is a key difference between primary and secondary hypertension? A. Primary hypertension is caused by an identifiable condition, while secondary hypertension has no known cause. B. Primary hypertension is more common in younger patients, while secondary hypertension occurs mostly in the elderly. C. Secondary hypertension has a known underlying cause, whereas primary hypertension does not. D. Secondary hypertension is easily controlled with medication, while primary hypertension requires surgery. **Rationale** Secondary hypertension is caused by an identifiable and often treatable underlying condition, such as adrenal gland tumors, kidney disease, or hormonal imbalances, whereas primary hypertension does not have a specific cause. **(Analyzing)** 7. A patient is experiencing tachycardia due to increased sympathetic stimulation. Which class of antiarrhythmic would be most appropriate to analyze for its effectiveness in controlling the heart rate? A. Class I (Sodium Channel Blockers) B. Class II (Beta-blockers) C. Class III (Potassium Channel Blockers) D. Class IV (Calcium Channel Blockers) **Rationale:** Beta-blockers work by blocking the effects of adrenaline, thus reducing heart rate and helping manage tachycardia caused by sympathetic stimulation. **(Evaluating)** 8. In evaluating a patient who has been prescribed a calcium channel blocker for atrial fibrillation, which of the following considerations should the nurse prioritize? A. Monitor for bradycardia and hypotension B. Assess for signs of hyperkalemia C. Ensure the patient has adequate fluid intake D. Watch for increased heart rate **Rationale:** Calcium channel blockers can lower heart rate and blood pressure, so it's essential to monitor for these effects to ensure patient safety. **(Applying)** 9. A nurse educates a patient about the use of digoxin as an antiarrhythmic agent. What mechanism of action should the nurse explain? A. It blocks beta-adrenergic receptors. B. It inhibits sodium and potassium ATPase. C. It enhances calcium entry during depolarization. D. It blocks potassium channels, leading to a prolonged refractory period. **Rationale:** Digoxin increases the force of myocardial contractions by increasing intracellular calcium levels, which is crucial for treating certain types of arrhythmias. **(Remembering)** 10. A patient experiencing ventricular tachycardia can be treated with various antiarrhythmic medications. Which of the following drugs is not typically used to affect ventricular rhythms? A. Lidocaine B. Amiodarone C. Procainamide D. Adenosine **Rationale:** Adenosine is primarily used to treat supraventricular tachycardia and is not effective for ventricular tachycardia, unlike the other options listed. **(Understanding)** 11. What is the primary mechanism by which bile acid sequestrants lower cholesterol levels? A. They increase the excretion of cholesterol in urine. B. They bind to bile acids in the intestine. C. They inhibit cholesterol synthesis in the liver. D. They enhance triglyceride metabolism. **Rationale:** They bind to bile acids in the intestine, preventing their reabsorption. Bile acid sequestrants lower cholesterol by binding bile acids, which leads to increased cholesterol conversion to bile acids and subsequently lower cholesterol levels. **Scenario:** A 50-year-old Male Patient presents for a routine check-up. His lipid panel shows a total cholesterol level of 250 mg/dL, with an LDL cholesterol level of 160 mg/dL. After discussing his lifestyle and risks, the doctor prescribes atorvastatin to help lower his cholesterol levels. **(Analyzing)** 12. After complying the prescribed medication, patient reports muscle pain and weakness. What should the nurse consider as a potential side effect of this medication? A. Rhabdomyolysis B. Gastrointestinal bleeding C. Hypertension D. Hyperglycemia **Rationale:** Muscle pain and weakness can be indicative of rhabdomyolysis, a serious side effect associated with statin use. **(Remembering)** 13. When is the best time for a patient to take atorvastatin? A. In the morning, with breakfast B. In the evening, before bed C. At noon, with lunch D. Whenever the patient remembers **Rationale:** Statins are most effective when taken in the evening, as cholesterol synthesis in the liver is highest at night. **(Understanding)** 14. Which of the following parameters should a nurse monitor in a patient taking statins? A. Blood glucose levels B. Thyroid function tests C. Electrolyte levels D. Liver enzyme levels and muscle pain **Rationale:** It is important to monitor liver enzymes due to the risk of hepatotoxicity and to assess for muscle pain, which may indicate rhabdomyolysis. **Scenario:** A 62-year-old Female Patient presents to the emergency department with sudden onset of left-sided weakness and difficulty speaking. A CT scan reveals an ischemic stroke. The doctor orders a thrombolytic agent to be administered STAT. **(Analyzing)** 15. Which of the following factors would most influence the decision to use this medication? A. The patient's age B. The time elapsed since symptom onset C. The patient's history of hypertension D. The presence of hyperlipidemia **Rationale:** Thrombolytic agents are most effective when administered within a specific time frame after the onset of symptoms (usually within 3 to 4.5 hours for ischemic stroke). Delayed administration can increase the risk of complications. **(Evaluating)** 16. After administering a thrombolytic agent, which assessment finding would require immediate intervention by the nurse? A. Minor bruising at the injection site B. Improvement in neurological function C. Sudden onset of severe headache D. Increased heart rate **Rationale:** A sudden severe headache could indicate a hemorrhagic complication, such as a hemorrhagic stroke, which requires immediate medical intervention. **Scenario:** A 50-year-old female obese patient recently started on heparin for Deep Vein Thrombosis (DVT) treatment, and being transitioned to warfarin for long-term anticoagulation. **(Understanding)** 17. What is the primary mechanism of action of heparin? A. It inhibits vitamin K activity. B. It promotes platelet aggregation. C. It increases the production of clotting factors. D. It inactivates thrombin and factor Xa. **Rationale:** Heparin works by binding to antithrombin III, enhancing its ability to inactivate thrombin and factor Xa, thereby preventing clot formation. **(Analyzing)** 18. The patient reports experiencing minor bruising since starting heparin. What is the best nursing response? A. "This is a serious side effect; we need to stop the medication immediately." B. "Bruising can be common with heparin; let's monitor it closely." C. "You should apply heat to the bruised areas." D. "You should take more vitamin K to counteract this effect." **Rationale:** Minor bruising is a known side effect of anticoagulants like heparin, but it should be monitored for severity or any signs of bleeding. **(Understanding)** 19. Why are heparin and warfarin often administered together during the initial treatment of conditions like DVT? A. To reduce the risk of thrombus formation by using two different classes of anticoagulants. B. To minimize side effects associated with either medication. C. To provide a continuous infusion of anticoagulation. D. To allow for the rapid action of heparin while warfarin reaches therapeutic levels. **Rationale:** Heparin provides immediate anticoagulation, while warfarin is being titrated to achieve a therapeutic INR level, ensuring that the patient is adequately protected from clot formation during the transition. **(Applying)** 20. After educating a patient about the side effects of warfarin, which of the following statements made by the patient indicates the need for further intervention? A. "I can continue taking aspirin while on warfarin." B. "I understand that I need to watch for any unusual bruising or bleeding." C. "I will inform my doctor if I notice any blood in my urine." D. "I know that I should avoid foods high in vitamin K." **Rationale:** This statement indicates a misunderstanding, as combining aspirin with warfarin can significantly increase the risk of bleeding. The patient should be educated on the potential interactions and advised to consult their healthcare provider before taking any additional medications. **(Applying)** 21. If Patient's INR is found to be significantly elevated, what action should the nurse prepare for? A. Administer vitamin K as ordered. B. Increase the warfarin dose. C. Administer Protamine Sulfate as ordered. D. Schedule a follow-up in one month. **Rationale:** Vitamin K is the antidote for warfarin and may be administered to reverse its effects in cases of elevated INR and risk of bleeding. **(Analyzing)** 22. During follow-up visit, which finding would be most concerning related to her anticoagulant therapy? A. Mild headache B. New onset of hematuria C. Weight gain of 2 pounds D. Occasional dizziness **Rationale:** Hematuria (blood in urine) is a potential sign of bleeding and is a serious concern for a patient on anticoagulant therapy. **(Remembering):** 23. Which of the following is an erythropoiesis-stimulating agent? A. Folic Acid B. Ferrous sulfate C. Epoetin alfa D. Vitamin B12 **Rationale:** Epoetin alfa is used to stimulate the production of red blood cells, while the other options do not have this function. **(Understanding):** 24. Erythropoiesis-stimulating agents work by: A. Increasing platelet production B. Stimulating bone marrow to produce red blood cells C. Enhancing oxygen-carrying capacity of white blood cells D. Reducing the need for blood transfusions by promoting leukocyte formation **Rationale:** These agents specifically stimulate red blood cell production in response to signals like low oxygen levels or anemia. **(Remembering):** 25. Which of the following is a common iron supplement used to treat iron deficiency anemia? A. Epoetin alfa B. Folic acid C. Cyanocobalamin D. Ferrous sulfate. **Rationale:** Ferrous sulfate is the most widely used oral iron supplement for iron deficiency anemia. **(Understanding):** 26. Iron supplements are prescribed to a patient with Iron deficiency anemia. The nurse knows the main action of iron supplements is to: A. Stimulate bone marrow to produce white blood cells B. Increase oxygen-carrying capacity by increasing Hgb C. Decrease red blood cell destruction D. Promote vitamin B12 absorption in the intestines **Rationale:** Iron is essential for hemoglobin production, which enhances the blood's oxygen-carrying capacity. **(Applying)** 27. A patient reports dark stools after starting ferrous sulfate. What should the nurse teach the patient? A. "You need to stop taking the medication immediately." B. "This indicates an allergic reaction to the drug." C. "You should take the medication with milk to reduce this effect." D. "This is a normal side effect of iron supplements." **Rationale:** Dark stools are a common and expected side effect of oral iron supplementation. **(Remembering)** 28. In cases of folic acid deficiency, red blood cells can become large and immature, leading to ineffective oxygen transport. What type of anemia is described? A. Aplastic anemia B. Iron deficiency anemia C. Hemolytic anemia D. Megaloblastic anemia **Rationale:** Megaloblastic anemia occurs when there is a deficiency in folic acid or vitamin B12, leading to the production of abnormally large and immature red blood cells (megaloblasts). These cells are less efficient in transporting oxygen throughout the body. **(Remembering):** 29. Which of the following drugs is used to treat megaloblastic anemia caused by vitamin B12 deficiency? A. Ferrous sulfate B. Epoetin alfa C. Cyanocobalamin D. Folic acid **Rationale:** Cyanocobalamin (vitamin B12) is used to treat vitamin B12 deficiency, which can cause megaloblastic anemia. **(Analyzing):** 30. A patient with megaloblastic anemia is prescribed both folic acid and vitamin B12. The nurse understands this combination is used because: A. Folic acid alone can mask vitamin B12 deficiency B. Folic acid enhances the absorption of vitamin B12 C. Vitamin B12 increases the effectiveness of folic acid D. They are needed to treat iron deficiency anemia **Rationale:** Folic acid can correct anemia, but without vitamin B12, neurological damage can progress undetected. **(Applying):** 31. A 12-year-old patient with sickle cell anemia is being started on hydroxyurea. What lab value should the nurse monitor closely while the patient is on this medication? A. Serum calcium B. White blood cell count C. Platelet count D. Hemoglobin level **Rationale:** Hydroxyurea can cause bone marrow suppression, leading to leukopenia, so the white blood cell count needs close monitoring. **(Evaluating):** 32. A nurse is evaluating a patient's response to iron therapy. Which of the following indicates effective treatment of iron deficiency anemia? A. Increased appetite and weight gain B. Decreased oxygen saturation C. Increased hemoglobin and hematocrit levels D. Reduced need for blood transfusions **Rationale:** Successful iron therapy is reflected by improved hemoglobin and hematocrit, showing better oxygen-carrying capacity. **Case Scenario:** Nurse Gian is caring for Jasmine, a 60-year-old woman admitted with symptoms of shortness of breath, swollen ankles, and increased fatigue. Jasmine has a history of hypertension and was recently diagnosed with heart failure. She has been prescribed a combination of diuretics, including furosemide (Lasix) and spironolactone (Aldactone), to help manage her symptoms. **Easy: Remembering (5 Questions)** 33. Which class of diuretic is furosemide (Lasix)? A. Thiazide diuretic B. Loop diuretic C. Potassium-sparing diuretic D. Osmotic diuretic 34. What is the main function of diuretics in managing heart failure? A. Increasing heart rate B. Reducing fluid overload C. Increasing blood sugar levels D. Promoting blood clotting **Rationale:** Diuretics are primarily used in heart failure to reduce fluid overload, which alleviates symptoms such as shortness of breath and edema. 35. Which electrolyte imbalance is Jasmine at risk for due to her furosemide therapy? A. Hypernatremia B. Hyperkalemia C. Hypokalemia D. Hypercalcemia **Rationale:** Furosemide can cause potassium depletion, leading to hypokalemia, as it increases the excretion of potassium in the urine. 36. Which symptom is most likely associated with edema in heart failure? A. Excessive urination B. Swelling of the ankles C. Increased appetite D. Weight loss **Rationale:** Edema in heart failure often presents as swelling in the extremities, particularly the ankles, due to fluid accumulation. 37. How does spironolactone help manage potassium levels in patients on loop diuretics? A. It increases sodium reabsorption B. It retains potassium while excreting sodium C. It inhibits insulin release D. It decreases chloride excretion **Rationale:** Spironolactone is a potassium-sparing diuretic that helps retain potassium while promoting sodium excretion, counteracting the potassium loss from loop diuretics like furosemide. **Easy: Understanding (5 Questions)** 38. Jasmine is experiencing low potassium levels. Which intervention should Nurse Gian implement first? A. Administer potassium chloride as prescribed B. Restrict fluid intake C. Increase sodium intake D. Administer an antihypertensive **Rationale:** The immediate response to low potassium levels (hypokalemia) is to administer potassium supplements as prescribed to restore electrolyte balance. 39. Nurse Gian is explaining to Jasmine the reason for her diuretic therapy. Which statement best describes the role of spironolactone in her treatment plan? A. "It helps your heart pump more blood." B. "It retains potassium while removing excess fluid." C. "It reduces blood sugar levels." D. "It causes calcium to be reabsorbed." **Rationale:** This statement accurately describes the dual function of spironolactone in promoting fluid removal while conserving potassium. 40. Which of the following symptoms would indicate to Nurse Gian that Jasmine may be experiencing dehydration due to diuretic therapy? A. Increased urine output B. Dry mouth and dizziness C. Increased appetite D. Bradycardia **Rationale:** Symptoms like dry mouth and dizziness are indicative of dehydration, a potential side effect of diuretic therapy. 41. Why might Nurse Gian encourage Jasmine to avoid using NSAIDs while on diuretics? A. They reduce the effectiveness of diuretics B. They cause excessive potassium retention C. They increase diuretic potency D. They lead to dehydration **Rationale:** NSAIDs can interfere with renal blood flow and decrease the efficacy of diuretics, leading to potential fluid retention. 42. Jasmine asks Nurse Gian why she needs to weigh herself daily. What is the best response by Nurse Gian? A. "It helps to monitor your blood sugar levels." B. "It helps to monitor fluid balance and detect fluid retention early." C. "It helps to evaluate your kidney function." D. "It helps to determine if your blood pressure is controlled." **Rationale:** Daily weights are crucial for monitoring fluid balance, helping to identify changes in fluid status that could indicate worsening heart failure. **Moderate: Applying (4 Questions)** 43. Jasmine reports feeling weak and experiencing muscle cramps. Nurse Gian suspects hypokalemia. Which action should be prioritized? A. Administer a calcium supplement B. Administer a prescribed potassium supplement C. Restrict fluid intake D. Increase sodium intake **Rationale:** Given the suspicion of hypokalemia, administering a potassium supplement is the priority action to address the deficiency and alleviate symptoms. 44. Nurse Gian monitors Jasmine's blood pressure and notes that it remains elevated despite diuretic therapy. Which underlying mechanism may contribute to this? A. Excessive sodium retention B. Decreased fluid retention C. Reduced blood volume D. Hyperkalemia **Rationale:** If sodium retention occurs despite diuretic therapy, it can lead to increased blood pressure, as sodium attracts water into the bloodstream, raising volume and pressure. 45. Jasmine is experiencing edema despite taking hydrochlorothiazide. Nurse Gian decides to administer furosemide. What is the expected outcome of this intervention? A. Increased blood glucose B. Decreased edema and increased urine output C. Decreased urine output D. Increased blood pressure **Rationale:** Furosemide is effective at reducing edema and promoting diuresis, which would lead to decreased fluid retention and increased urine output. 46. Jasmine has a history of liver disease. Which mechanism explains her increased risk for developing edema? A. Increased production of plasma proteins B. Reduced production of plasma proteins leading to decreased oncotic pressure C. Enhanced filtration rate D. Increased bile production **Rationale:** Liver disease can reduce the synthesis of plasma proteins, leading to decreased oncotic pressure and fluid accumulation in tissues, resulting in edema. **Moderate: Analyzing (3 Questions)** 47. Jasmine's blood pressure remains elevated, and Nurse Gian suspects an issue with the renin-angiotensin-aldosterone system (RAAS). Which finding would support this suspicion? A. Decreased aldosterone secretion B. Increased sodium and water retention C. Decreased renin production D. Increased potassium excretion **Rationale:** An active RAAS leads to sodium and water retention, which would contribute to elevated blood pressure, supporting the suspicion of RAAS dysfunction. 48. Jasmine has been prescribed acetazolamide (Diamox) for her glaucoma. Which adverse effect should Nurse Gian closely monitor for? A. Hypokalemia and metabolic acidosis B. Hyperglycemia and hypotension C. Hypernatremia and dehydration D. Hypertension and dizziness **Rationale:** Acetazolamide can lead to increased bicarbonate excretion, resulting in metabolic acidosis and hypokalemia, necessitating monitoring of these electrolyte levels. 49. Jasmine's condition requires rapid fluid removal due to acute pulmonary edema. Which diuretic should Nurse Gian prepare to administer? A. Hydrochlorothiazide B. Spironolactone C. Furosemide D. Mannitol **Rationale:** Furosemide is the preferred choice for rapid fluid removal in cases of acute pulmonary edema due to its potency and quick onset of action. **Difficult: Evaluating (3 Questions)** 50. Nurse Gian is assessing Jasmine's medication profile. Jasmine is taking spironolactone in combination with furosemide. Which laboratory value would indicate an adverse effect of spironolactone? A. Potassium: 5.8 mEq/L B. Sodium: 135 mEq/L C. Chloride: 100 mEq/L D. Calcium: 9.5 mg/dL **Rationale:** A potassium level of 5.8 mEq/L indicates hyperkalemia, a potential adverse effect of spironolactone, especially in combination with other medications. 51. Nurse Gian notes that Jasmine has become increasingly confused and reports a headache. Which diuretic-related complication should be suspected? A. Hypokalemia B. Ototoxicity C. Hyponatremia D. Hyperglycemia **Rationale:** Confusion and headache can be symptoms of hyponatremia, which can occur as a complication of diuretic therapy due to excessive sodium loss. 52. Jasmine is at risk for dehydration due to diuretic therapy. Which assessment finding would indicate that Jasmine is becoming dehydrated? A. Decreased urine output and dry mucous membranes B. Increased heart rate and hypertension C. Increased weight gain and edema D. Normal skin turgor and blood pressure **Rationale:** Decreased urine output and dry mucous membranes are classic signs of dehydration, particularly in patients undergoing diuretic therapy. 53. What category of medications is utilized to inhibit histamine at the H1 receptor locations, diminishing the symptoms of allergic rhinitis and colds? REMEMBERING QUESTION A. Antihistamines B. Antitussives C. Bronchodilator D. Decongestants **Rationale:** Antihistamines block the effects of histamine at H1 receptor sites, reducing allergic symptoms like rhinitis. 54. What is the mechanism of action of expectorants for therapeutic purposes? REMEMBERING QUESTION A. Inhibit the urge to cough B. Thinning and diluting respiratory fluids C. Narrow blood vessels in the nose D. Block the receptors of histamine **Rationale:** Expectorants are medications that help clear mucus from the airways. Their primary mechanism of action involves thinning and diluting respiratory secretions, which makes it easier to cough up phlegm and clear congestion from the respiratory tract. By reducing the viscosity of mucus, expectorants facilitate mucus clearance and improve overall respiratory function. This is particularly beneficial in conditions like bronchitis, pneumonia, and other respiratory infections where excessive mucus production is present. **Scenario:** You work as a nurse at a respiratory clinic where patients often visit with different issues related to coughing. A woman, 40, goes to the clinic and mentions a dry cough that has been bothering her for a few days. She notes that the cough is dry and worsening during the night, making it hard for her to get a good night's rest. You discuss treatment options with the physician after evaluating her symptoms, and the physician recommends using an antitussive. 55. What is the reason an antitussive could be suggested for a dry cough? Understanding Questions A. To increase mucus production B. To suppress the cough reflex C. To treat bacterial infection D. To reduce inflammation **Rationale:** Antitussives are used to suppress the cough reflex, especially for non-productive coughs. 56. If the antitussive does not work, what should be the next appropriate course of action in treatment? Applying Questions A. Increase dosage B. Refer to a specialist C. Switch to an expectorant D. Monitor symptoms for 1 week **Rationale:** If the treatment is ineffective, referring to a specialist may be warranted for further evaluation. 57. What nursing diagnosis should be considered a priority for this patient? Analyzing Questions A. Impaired gas exchange B. Ineffective airway clearance C. Risk for infection D. Disturbed sleep pattern **Rationale:** The patient's dry cough is affecting her ability to sleep, making this diagnosis a priority. 58.A nonproductive cough patient has been given a prescription for dextromethorphan. What nursing education is crucial for this patient. Applying Questions A. Drink more fluids B. Make sure to consume the medication while eating. C. Refrain from driving or using heavy machinery. D. Bite the tablet thoroughly prior to swallowing. **Rationale:** Dextromethorphan, a nonopioid antitussive, can cause drowsiness and sedation. Patients should be advised not to drive or operate machinery until they know how the drug affects them. 59. Following one week of guaifenesin use, a bronchitis patient notes a decrease in cough severity and an easier expulsion of mucus. What is the appropriate way for the nurse to understand this discovery? Evaluating A. The guaifenesin is not working and should be stopped. B. The individual might have to change to a cough suppressant medication. C. The medicine is performing as anticipated in thinning out the mucus. D. The patient should boost their fluid consumption in order to improve effectiveness. **Rationale:** Guaifenesin works by thinning and loosening mucus, making it easier to expel. This is a sign of the medication's effectiveness. 60. What is the mechanism of action of H1 antihistamines in the prevention of allergic reactions? Understanding A. Blocking of histamine from binding to its receptor occurs. B. By encouraging the release of histamine C. By decomposing histamine. D. When acetylcholine receptors are inhibited **Rationale:** Nasal steroids reduce inflammation, leading to decreased nasal congestion. 61. How do nasal steroids impact the respiratory system? Understanding A. Enhance the production of mucus B. Widen the bronchial tubes C. Inhibit the coughing instinct D. Reduce swelling in the nasal passages **Rationale:** Nasal steroids reduce inflammation, leading to decreased nasal congestion. 62. What is a typical adverse reaction of antihistamines? Remembering A. Rapid heart rate B. Inducing a state of calmness or drowsiness. C. High blood pressure D. Sweating is the act of perspiring. **Rationale:** Sedation is a well-known side effect of many traditional antihistamines. 63. A patient with a chronic productive cough is asking for a cough suppressant. What is the optimal nursing reaction? Applying A. Prescribe codeine B. Recommend a nasal decongestant C. Do not recommend antitussives for coughs that bring up mucus. D. Provide guaifenesin option **Rationale:** Antitussives should not be used in productive coughs as they can prevent mucus clearance. 64. A patient is experiencing worsening congestion after using oxymetazoline nasal spray for 10 days. What is the biological reason behind this side effect? ANALYZING A. Heightened histamine secretion B. Decrease in the production of mucus. C. Continued narrowing of blood vessels results in increased congestion D. Unnecessary accumulation of fluids **Rationale:** Prolonged vasoconstriction from overuse of decongestants leads to rebound congestion due to the blood vessels' inability to remain constricted. **Scenario:** A 45-year-old man sees his primary care doctor about a continuous dry cough he has had for two weeks. He characterizes the cough as unproductive and mentions that it intensifies at night, affecting his ability to sleep. Upon reviewing the patient's symptoms and medical background, the doctor recommends benzonatate, an antitussive drug, to assist in controlling the cough. The doctor clarifies the reason for the medication and gives guidance on its proper administration. 65. What is the primary action of benzonatate? Remembering A. In order to enhance the production of mucus B. To control the urge to cough C. For the purpose of curing bacterial infections D. In order to alleviate the tightness in the chest. **Rationale:** Benzonatate is a non-narcotic cough suppressant that works primarily by acting on the respiratory system. Benzonatate is primarily used to suppress the cough reflex in the brain. 66. What is the mechanism of action of benzonatate in the body? Understanding A. By elevating secretions in the airways B. By causing a numbing sensation in the throat and lungs C. Inflammation can be reduced. D. By easing the muscles surrounding the bronchi **Rationale:** Benzonatate works by numbing the throat and lungs, which helps suppress the cough reflex. 67. What is the most effective way for the nurse to evaluate the patient's comprehension of benzonatate administration? Evaluating A. By inquiring about the patient's understanding of the dosing regimen. B. Solely through offering written directions C. By watching the patient consume the medication D. Through reviewing the patient's medical documents **Rationale:** To effectively evaluate a patient's comprehension of medication administration, especially for benzonatate (a cough suppressant), it is essential to directly engage with the patient and assess their understanding. Asking the patient to explain reinforces understanding and retention of instructions. 68. In an educational session, a nurse discusses how corticosteroids work. What ought she incorporate? Understanding A. Their mechanism of action involves widening air passages. B. They inhibit the immune system and decrease swelling. C. They enhance the production of mucus. D. They do not impact inflammation. **Rationale:** Corticosteroids are a class of medications that have potent anti-inflammatory and immunosuppressive properties. They are commonly used in various conditions, including asthma, allergies, autoimmune diseases, and inflammatory disorders. 69. A bronchodilator and a corticosteroid are prescribed for a patient with asthma. The patient inquires about the appropriate timing for each medication. What is the most suitable reply for the nurse? Applying A. Administer the bronchodilator following the corticosteroid. B. Administer both medications simultaneously. C. Administer the bronchodilator before the corticosteroid. D. Only use the corticosteroid when experiencing asthma attacks. **Rationale:** Administering the bronchodilator first opens the airways, allowing the corticosteroid to work more effectively. In the management of asthma, the timing of medication administration can significantly impact treatment effectiveness. Bronchodilators, especially short-acting beta-agonists (SABAs) such as albuterol, are used to quickly relax and open the airways, providing rapid relief from asthma symptoms. Corticosteroids, on the other hand, work to reduce inflammation in the airways and have a longer-term effect on controlling asthma. 70. Following the bronchodilator administration, the nurse observes that the patient's heart rate has increased. What is the next step for the nurse to take? Analyzing A. Record the discovery and maintain ongoing observation. B. Give a beta-blocker. C. Reach out to the healthcare provider for additional assessment. D. Provide assurance to the patient that this is a regular occurrence. **Rationale:** Significant tachycardia following bronchodilator use should be evaluated by a healthcare provider, especially if it is concerning for the patient. 71. What should be the nurse's main focus when considering how effective acetylcysteine is for a patient with chronic bronchitis? Evaluating A. Reduction in oxygen saturation. B. Heightened production of mucus C. Better breath sounds and less coughing D. Elevated breathing frequency **Rationale:** When evaluating the effectiveness of acetylcysteine in a patient with chronic bronchitis, the primary focus should be on improvements in respiratory symptoms and lung function. Acetylcysteine is a mucolytic agent that works by breaking down and thinning mucus, making it easier to expectorate. Effective treatment should lead to improved lung function and decreased mucus retention. 72. A patient presents with chronic heartburn and is diagnosed with GERD. Which class of medication would likely be prescribed to manage this condition? (APPLYING) A. Antacids B. H2 antagonists C. Laxatives D. Antidiarrheal agents **Rationale:** In the management of Gastroesophageal Reflux Disease (GERD), H2 antagonists are a common choice. These medications, such as ranitidine and famotidine, work by blocking histamine H2 receptors in the stomach, which decreases gastric acid secretion. By reducing acid production, H2 antagonists help alleviate symptoms of heartburn and prevent damage to the esophagus caused by acid reflux. 73. A patient develops a peptic ulcer after prolonged use of NSAIDs. What would be an appropriate nursing intervention? ANALYZING A. Administer a high-fiber diet B. Educate on the importance of hydration C. Encourage the patient to continue NSAID use with food D. Discuss the use of proton pump inhibitors **Rationale:** Proton pump inhibitors (PPIs) are a class of medications commonly prescribed to reduce gastric acid production, thereby promoting healing of peptic ulcers and providing relief from ulcer-related symptoms. When a patient develops a peptic ulcer, especially due to the prolonged use of nonsteroidal anti-inflammatory drugs (NSAIDs), it is crucial to address both the management of the ulcer and the prevention of further complications. 74