NU 115 Final Exam Questions - PDF

Chapter 02: Pharmacologic Principles Lilley: Pharmacology and the Nursing Process, 10th Edition MULTIPLE CHOICE 1. 2. 3. The patient is receiving two different drugs. At current dosages and dosage forms, both drugs have the same concentration of the active ingredient. Which term is used to identify...

Chapter 02: Pharmacologic Principles Lilley: Pharmacology and the Nursing Process, 10th Edition MULTIPLE CHOICE 1. 2. 3. The patient is receiving two different drugs. At current dosages and dosage forms, both drugs have the same concentration of the active ingredient. Which term is used to identify this principle? a. Bioequivalent b. Synergistic c. Prodrugs d. Steady state ANS: A Two drugs absorbed into the circulation in the same amount (in specific dosage forms) have the same bioavailability; thus, they are bioequivalent. A drug‘s steady state is the physiologic state in which the amount of drug removed via elimination is equal to the amount of drug absorbed from each dose. The term synergistic refers to two drugs, given together, with a resulting effect that is greater than the sum of the effects of each drug given alone. A prodrug is an inactive drug dosage form that is converted to an active metabolite by various biochemical reactions once it is inside the body. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies When given an intravenous medication, the patient says to the nurse, ―I usually take pills. Why does this medication have to be given in the arm?‖ What is the nurse‘s best answer? a.―The medication will cause fewer adverse effects when given intravenously.‖ b.―The intravenous medication will have delayed absorption into the body‘s tissues.‖ c.―The action of the medication will begin sooner when given intravenously.‖ d.―There is a lower chance of allergic reactions when drugs are given intravenously.‖ ANS: C An intravenous (IV) injection provides the fastest route of absorption. The IV route does not affect the number of adverse effects, nor does it cause delayed tissue absorption (it results in faster absorption). The IV route does not affect the number of allergic reactions. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies The nurse is administering parenteral drugs. Which statement is true regarding parenteral drugs? a. b. c. d. Parenteral drugs bypass the first-pass effect. Absorption of parenteral drugs is affected by reduced blood flow to the stomach. Absorption of parenteral drugs is faster when the stomach is empty. Parenteral drugs exert their effects while circulating in the bloodstream. If you need any other Test Banks or eTextbooks contact us: [email protected] 4. 5. 6. ANS: A Drugs given by the parenteral route bypass the first-pass effect. Reduced blood flow to the stomach and the presence of food in the stomach apply to enteral drugs (taken orally), not to parenteral drugs. Parenteral drugs must be absorbed into cells and tissues from the circulation before they can exert their effects; they do not exert their effects while circulating in the bloodstream. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: General MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies When monitoring the patient receiving an intravenous infusion to reduce blood pressure, the nurse notes that the patient‘s blood pressure is extremely low, and the patient is lethargic and difficult to awaken. This would be classified as which type of adverse drug reaction? a. Adverse effect b. Allergic reaction c. Idiosyncratic reaction d. Pharmacologic reaction ANS: D A pharmacologic reaction is an extension of a drug‘s normal effects in the body. In this case, the antihypertensive drug lowered the patient‘s blood pressure levels too much. The other options do not describe a pharmacologic reaction. An adverse effect is a predictable, well-known adverse drug reaction that results in minor or no changes in patient management. An allergic reaction (also known as a hypersensitivity reaction) involves the patient‘s immune system. An idiosyncratic reaction is unexpected and is defined as a genetically determined abnormal response to normal dosages of a drug. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: General MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies The nurse is reviewing pharmacology terms for a group of newly graduated nurses. Which sentence defines a drug‘s half-life? a. The time it takes for the drug to cause half of its therapeutic response b. The time it takes for one half of the original amount of a drug to reach the target cells c. The time it takes for one half of the original amount of a drug to be removed from the body d. The time it takes for one half of the original amount of a drug to be absorbed into the circulation ANS: C A drug‘s half-life is the time it takes for one half of the original amount of a drug to be removed from the body. It is a measure of the rate at which drugs are removed from the body. The other options are incorrect definitions of half-life. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: General MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies When administering drugs, the nurse remembers that the duration of action of a drug is defined as which of these? a. b. The time it takes for a drug to elicit a therapeutic response The amount of time needed to remove a drug from circulation If you need any other Test Banks or eTextbooks contact us: [email protected] 7. 8. 9. c. d. The time it takes for a drug to achieve its maximum therapeutic response The time period at which a drug‘s concentration is sufficient to cause a therapeutic response ANS: D Duration of action is the time during which drug‘s concentration is sufficient to elicit a therapeutic response. The other options do not define duration of action. A drug‘s onset of action is the time it takes for the drug to elicit a therapeutic response. A drug‘s peak effect is the time it takes for the drug to reach its maximum therapeutic response. Elimination is the length of time it takes to remove a drug from circulation. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: General MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies When reviewing the mechanism of action of a specific drug, the nurse reads that the drug works by selective enzyme interaction. Which of these processes describes selective enzyme interaction? a. b. c. The drug alters cell membrane permeability. The drug‘s effectiveness within the cell walls of the target tissue is enhanced. The drug is attracted to a receptor on the cell wall, preventing an enzyme from binding to that receptor. d. The drug binds to an enzyme molecule and inhibits or enhances the enzyme‘s action with the normal target cell. ANS: D With selective enzyme interaction, the drug attracts the enzymes to bind with the drug instead of allowing the enzymes to bind with their normal target cells. As a result, the target cells are protected from the action of the enzymes. This results in a drug effect. The actions described in the other options do not occur with selective enzyme interactions. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: General MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies When administering a new medication to a patient, the nurse reads that it is highly protein bound. Assuming that the patient‘s albumin levels are normal, the nurse would expect which result, as compared to a medication, that is not highly protein bound? a. b. c. d. Renal excretion will be faster. The drug will be metabolized quickly. The duration of action of the medication will be shorter. The duration of action of the medication will be longer. ANS: D Drugs that are bound to plasma proteins are characterized by longer duration of action. Protein binding does not make renal excretion faster, does not speed up drug metabolism, and does not cause the duration of action to be shorter. DIF: Cognitive Level: Applying (Application) MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Nursing Process: Planning The patient is experiencing chest pain and needs to take a buccal form of nitroglycerin. Where does the nurse instruct the patient to place the tablet? a. Under the tongue If you need any other Test Banks or eTextbooks contact us: [email protected] 10. 11. 12. b. c. d. On top of the tongue At the back of the throat In the space between the cheek and the gum ANS: D Drugs administered via the buccal route are placed in the space between the cheek and the gum. Drugs administered via the sublingual route are placed under the tongue. The other options are incorrect. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies The nurse is administering medications to the patient who is in renal failure resulting from end-stage renal disease. The nurse is aware that patients with kidney failure would most likely have problems with which pharmacokinetic phase? a. Absorption b. Distribution c. Metabolism d. Excretion ANS: D The kidneys are the organs that are most responsible for drug excretion. Renal function does not affect the absorption and distribution of a drug. Renal function may affect metabolism of drugs to a small extent. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies A patient who has advanced cancer is receiving opioid medications around the clock to keep him comfortable as he nears the end of his life. Which term best describes this type of therapy? a. Palliative therapy b. Maintenance therapy c. Empiric therapy d. Supplemental therapy ANS: A The goal of palliative therapy is to make the patient as comfortable as possible. It is typically used in the end stages of illnesses when all attempts at curative therapy have failed. Maintenance therapy is used for the treatment of chronic illnesses such as hypertension. Empiric therapy is based on clinical probabilities and involves drug administration when a certain pathologic condition has an uncertain but high likelihood of occurrence based on the patient‘s initial presenting symptoms. Supplemental therapy (or replacement therapy) supplies the body with a substance needed to maintain normal function. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies The patient is stating that he has a headache and asks the nurse which over-the-counter medication form would work the fastest to help reduce the pain. Which medication form will If you need any other Test Banks or eTextbooks contact us: [email protected] 13. the nurse suggest? a. A capsule b. A tablet c. A powder d. An enteric-coated tablet ANS: C Of the types of oral medications listed, the powder form would be absorbed the fastest, thus having a faster onset. The tablet, the capsule, and, finally, the enteric-coated tablet would be absorbed next, in that order. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies The nurse will be injecting a drug into the superficial skin layers immediately underneath the epidermal layer of skin. Which route does this describe? a. Intradermal b. Subcutaneous c. Intramuscular d. Transdermal ANS: A Injections under the more superficial skin layers immediately underneath the epidermal layer of skin and into the dermal layer are known as intradermal injections. Injections into the fatty subcutaneous tissue under the dermal layer of skin are referred to as subcutaneous injections. Injections into the muscle beneath the subcutaneous fatty tissue are referred to as intramuscular injections. Transdermal drugs are applied to the skin via an adhesive patch. DIF: Cognitive Level: Remembering (Knowledge) TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies MULTIPLE RESPONSE 1. Which drugs would be affected by the first-pass effect when administered? (Select all that apply.) a. Morphine given by IV push injection b. Sublingual nitroglycerin tablet c. Diphenhydramine elixir d. Levothyroxine (Synthroid) tablet e. Transdermal nicotine patches f. Esomeprazole capsule g. Penicillin given by IV piggyback infusion ANS: C, D, F Orally administered drugs (elixirs, tablets, and capsules) undergo the first-pass effect, because they are metabolized in the liver after being absorbed into the portal circulation from the small intestine. IV medications (IV push and IV piggyback) enter the bloodstream directly and do not go directly to the liver. Sublingual tablets and transdermal patches also enter the bloodstream without going directly to the liver, thus avoiding the first-pass effect. If you need any other Test Banks or eTextbooks contact us: [email protected] DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: General MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies COMPLETION 1. A drug dose that delivers 10 mg has a half-life of 5 hours. Identify how much drug will remain in the body after one half-life. ANS: 5 mg A drug‘s half-life is the time required for one half of an administered dose of a drug to be eliminated by the body, or the time it takes for the blood level of a drug to be reduced by 50%. Therefore, one half of 10 mg equals 5 mg. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies Chapter 09: Photo Atlas of Drug Administration Lilley: Pharmacology and the Nursing Process, 10th Edition MULTIPLE CHOICE 1. Before administering any medication, what is the nurse‘s priority action regarding patient safety? a. Verifying orders with another nurse b. Documenting the medications given c. Counting medications in the medication cart drawers d. Checking the patient‘s identification using two identifiers ANS: D Verifying the patient‘s identity, using two identifiers, before administering any medication is essential for the patient‘s safety and reflects checking one of the ―Nine Rights‖ of medication administration. Documentation is done after the medications are given. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control 2. The nurse is giving an intradermal (ID) injection and will choose which syringe for this injection? a. b. c. d. PRIMEXAM.COM If you need any other Test Banks or eTextbooks contact us: [email protected] 3. 4. ANS: B The proper size syringe for ID injection is a 1-mL tuberculin. The other syringes pictured are incorrect. Insulin syringes (marked in units) are not used for intradermal injections. DIF: Cognitive Level: Analyzing (Analysis) TOP: Nursing Process: Planning MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control A patient is to receive a penicillin intramuscular (IM) injection in the ventrogluteal site. The nurse will use which angle for the needle insertion? a. 15 degrees b. 45 degrees c. 60 degrees d. 90 degrees ANS: D The proper angle for IM injections is 90 degrees. The other angles are incorrect. DIF: Cognitive Level: Remembering (Knowledge) TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies When administering medication by IV bolus (push), the nurse will occlude the IV line by which method? a. b. c. d. Injecting the bolus without pinching the tubing Pinching the tubing just above the injection port Pinching the tubing just below the injection port Pinching the tubing just above the drip chamber of the infusion set If you need any other Test Banks or eTextbooks contact us: [email protected] 5. 6. ANS: B Before a medication is injected by IV push, the IV line is occluded by pinching the tubing just above the injection port. The other locations are incorrect. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies The nurse has an order to administer an intramuscular (IM) immunization to a 2-month-old child. Which site is considered the best choice for this injection? a. Deltoid b. Dorsogluteal c. Ventrogluteal d. Vastus lateralis ANS: D The vastus lateralis is the preferred site of injection of drugs such as immunizations for infants. The other sites are not appropriate for infants. The ventrogluteal site is the preferred site for adults and children. The deltoid site is used only for the administration of immunizations to toddlers, older children, and adults (not infants) and only for small volumes of medication. The dorsogluteal site is no longer recommended because of the possibility of nerve injury. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies The nurse needs to administer insulin subcutaneously to an obese patient. Which is the proper technique for this injection? a. Using the Z-track method b. c. Inserting the needle at a 5- to 15-degree angle until resistance is felt Pinching the skin at the injection site, and then inserting the needle to below the tissue fold at a 90-degree angle d. Spreading the skin tightly over the injection site, inserting the needle, and then If you need any other Test Banks or eTextbooks contact us: [email protected] 7. 8. releasing the skin ANS: C The proper technique for a subcutaneous injection for an obese patient is to pinch the skin at the injection site and inject the needle to below the skin fold at a 90-degree angle. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies The nurse will plan to use the Z-track method of intramuscular (IM) injections for which situation? a. b. c. d. The medication is known to be irritating to tissues. The patient is emaciated and has very little muscle mass. The medication must be absorbed quickly into the tissues. The patient is obese and has a deep fat layer below the muscle mass. ANS: A The Z-track method is used for medications known to irritate tissues or for medications that are painful or cause stains to the tissues. It also prevents the deposit of medication into more sensitive subcutaneous tissues. The other options are not appropriate situations for the Z-track method. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential After administering an intradermal (ID) injection for a skin test, the nurse notices a small bleb at the injection site. Which of these is the best action for the nurse to take at this time? a. Apply heat. b. Massage the area. c. Do nothing. d. Report the bleb to the physician. If you need any other Test Banks or eTextbooks contact us: [email protected] 9. 10. ANS: C The formation of a small bleb is expected after an ID injection for skin testing. The other actions are not appropriate. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies The nurse is administering an IV push medication through an IV lock. After injecting the medication, which action will be taken next? a. Flushing the lock b. Regulating the IV flow c. Clamping the tubing for 10 minutes d. Holding the patient‘s arm up to improve blood flow ANS: A IV locks are to be flushed before and after each use; either heparin or saline flush is used, depending on the individual facility‘s policy. The other actions are not appropriate. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies When adding medications to a bag of intravenous (IV) fluid, the nurse will use which method to mix the solution? a. b. c. d. Shaking the bag or bottle vigorously Turning the bag or bottle gently from side to side Inverting the bag or bottle one time after injecting the medication Allowing the IV solution to stand for 10 minutes to enhance even distribution of medication If you need any other Test Banks or eTextbooks contact us: [email protected] 11. 12. ANS: B When medications are added to IV fluid containers, the medication and the IV solution are mixed by holding the bag or bottle and turning it end-to-end, mixing it gently. Shaking vigorously is not appropriate; inverting the bag just once or simply allowing the bag to stand for 10 minutes may not be sufficient to mix the medication into the fluid. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies The nurse is measuring 4 mL of a liquid cough elixir for a child. Which method is most appropriate? a. b. c. d. Using a teaspoon to measure and administer Holding the medication cup at eye level and filling it to the desired level Withdrawing the elixir from the container using a syringe without a needle attached Withdrawing the elixir from the container using a calibrated oral syringe ANS: D Small doses of liquid medications must be withdrawn using a calibrated oral syringe. A hypodermic syringe or a syringe with a needle or syringe cap must not be used. If hypodermic syringes are used, the drug may be inadvertently given parenterally, or the syringe cap or needle, if not removed from the syringe, may become dislodged and accidentally aspirated by the patient when the syringe plunger is pressed. The other methods are not accurate for small volumes. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies While the nurse is assisting a patient in taking his medications, the medication cup falls to the If you need any other Test Banks or eTextbooks contact us: [email protected] 13. 14. floor, spilling the tablets. What is the nurse‘s best action at this time? a. b. c. d. Discarding the medications and repeating preparation Asking the patient if he will take the medications Waiting until the next dose time, and then giving the medications Retrieving the medications and administering them to avoid waste ANS: A Medications that fall to the floor must be discarded, and the procedure must be repeated with new medications. The other actions are not appropriate. DIF: Cognitive Level: Analyzing (Analysis) TOP: Nursing Process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control When giving a buccal medication to a patient, which action by the nurse is appropriate? a. b. c. d. Encouraging the patient to swallow, if necessary Administering water after the medication has been given Placing the medication between the upper or lower molar teeth and the cheek Placing the tablet under the patient‘s tongue and allowing it to dissolve completely ANS: C Buccal medications are properly administered between the upper or lower molar teeth and the cheek. Remind the patient not to swallow the tablet, and do not administer with water. Medications given under the tongue are sublingually administered. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies The nurse is giving liquid medications through a percutaneous endoscopic gastrostomy (PEG) tube. Which technique is correct? a. Administering the medications using a 3-mL medication syringe If you need any other Test Banks or eTextbooks contact us: [email protected] b. c. d. Applying firm pressure on the syringe‘s piston to infuse the medication Flushing the tubing with 30 mL of saline after the medication has been given Using the barrel of the syringe, allowing the medication to flow via gravity into the tube ANS: D For PEG tubes (and nasogastric tubes), medications are poured into the barrel of the syringe with the piston removed, and the medication is allowed to flow via gravity into the tube. Fluid must never be forced into the tube. The tubing is to be flushed with 30 mL of tap water (not saline) to ensure that the medication is cleared from the tube after the medication has been given. A 3-mL syringe is too small for this procedure. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 15. The nurse is about to give a rectal suppository to a patient. Which technique would facilitate the administration and absorption of the rectal suppository? a. b. c. Having the patient lie on the right side, unless contraindicated Having the patient hold his or her breath during insertion of the medication Lubricating the suppository with a small amount of petroleum-based lubricant before insertion d. Encouraging the patient to lie on the left side for 15 to 20 minutes after insertion ANS: D Position the patient on the left side for rectal suppository insertion. The suppository is then lubricated with a small amount of water-soluble lubricant, not petroleum-based substances. The patient is told to take a deep breath and exhale through the mouth during insertion. Then, the patient needs to remain lying on the left side for 15 to 20 minutes to allow absorption of the drug. DIF: Cognitive Level: Applying (Application) If you need any other Test Banks or eTextbooks contact us: [email protected] 16. 17. TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies A patient is receiving eyedrops that contain a beta-blocker medication. The nurse will use what method to reduce systemic effects after administering the eyedrops? a. b. c. Wiping off excess liquid immediately after instilling the drops Having the patient close the eye tightly after the drops are instilled Having the patient try to keep the eye open for 30 seconds after the drops are instilled d. Applying gentle pressure to the patient‘s nasolacrimal duct for 30 to 60 seconds after instilling the drops ANS: D When administering ophthalmic drugs that may cause systemic effects, one‘s finger should be protected by a clean tissue or glove and gentle pressure applied to the patient‘s nasolacrimal duct for 30 to 60 seconds. The other actions are not appropriate. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies A 2-year-old child is to receive eardrops. The nurse is teaching the parent about giving the eardrops. Which statement reflects the proper technique for administering eardrops to this child? a. b. c. d. Administer the drops without pulling on the ear lobe. Straighten the ear canal by pulling the lobe upward and back. Straighten the ear canal by pulling the pinna down and back. Straighten the ear canal by pulling the pinna upward and outward. ANS: C If you need any other Test Banks or eTextbooks contact us: [email protected] 18. 19. In an infant or a child younger than 3 years of age, the ear canal is straightened by pulling the pinna down and back. In adults, the pinna is pulled up and outward. Pulling the lobe and administering eardrops without pulling on the ear lobe are not appropriate actions. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies A patient with asthma is to begin medication therapy using a metered-dose inhaler. What is an important reminder to include during teaching sessions with the patient? a. b. c. d. Repeat subsequent puffs, if ordered, after 5 minutes. Inhale slowly while pressing down to release the medication. Inhale quickly while pressing down to release the medication. Administer the inhaler while holding it 3 to 4 inches away from the mouth. ANS: B Position the inhaler to an open mouth, with the inhaler 1 to 2 inches away from the mouth, or attach a spacer to the mouthpiece of the inhaler, or place the mouthpiece in the mouth. To administer, press down on the inhaler to release the medication while inhaling slowly. Wait 1 to 2 minutes between puffs if a second puff of the same medication has been ordered. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies When giving parenteral medications, the nurse will use Standard Precautions, which include what action? a. b. c. d. Bending the needle to prevent reuse Recapping needles to prevent needle sticks Discarding all syringes and needles in the trash can Discarding all syringes and needles in a puncture-resistant container If you need any other Test Banks or eTextbooks contact us: [email protected] 20. 21. ANS: D Standard Precautions include wearing clean gloves when there is potential exposure to a patient‘s blood or other body fluids; never recapping needles; never bending needles or syringes; and discarding all disposable syringes and needles in the appropriate puncture-resistant container. DIF: Cognitive Level: Remembering (Knowledge) TOP: Nursing Process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control A patient says he prefers to chew rather than swallow his pills. One of the pills has the abbreviation SR behind the name of the medication. The nurse needs to remember which correct instruction regarding how to give this medication? a. Break the tablet into halves or quarters. b. Dissolve the tablet in a small amount of water before giving it. c. Do not crush or break the tablet before administration. d. Crush the tablet as needed to ease administration. ANS: C Sustained-release (SR) and enteric-coated tablets or capsules are forms of medications that must not be crushed before administration so as to protect the gastrointestinal lining or the medication itself. Do not break, dissolve, or crush these tablets before administering. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control When administering nasal spray, which instruction by the nurse is appropriate? a. b. c. ―You will need to blow your nose before I give this medication.‖ ―You will need to blow your nose after I give this medication.‖ ―When I give this medication, you will need to hold your breath.‖ If you need any other Test Banks or eTextbooks contact us: [email protected] d. ―You need to sit up for 5 minutes after you receive the nasal spray.‖ ANS: A Clear the nasal passages before receiving nasal spray. Blowing one‘s nose after receiving the medication will remove the medication from the nasal passages. The patient will receive the spray while inhaling through the open nostril and needs to remain in a supine position for 5 minutes afterward. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies MULTIPLE RESPONSE 1. The nurse is preparing to give an aqueous intramuscular (IM) injection to an average-sized adult. Which actions are appropriate? (Select all that apply.) a. b. c. d. e. f. Choose a 26- or 27-gauge, 1/4- to 1/2-inch needle. Choose a 20- to 25-gauge, 1- to 1 1/2-inch needle. Choose the dorsogluteal site, the preferred site for IM injections for adults. Insert the needle at a 45-degree angle. Insert the needle at a 90-degree angle. Before injecting the medication, withdraw the plunger to check for blood return. ANS: B, E, F In general, aqueous medications can be given with a 20- to 25-gauge needle, and average needle lengths for adults range from 1 to 1 1/2 inches. Insert the needle at a 90-degree angle. Checking for blood return is also part of the technique for IM injections to prevent inadvertent administration into the bloodstream. The ventrogluteal site is the preferred site for IM injections in adults. The dorsogluteal site is to be avoided because of proximity to nerves and blood vessels. If you need any other Test Banks or eTextbooks contact us: [email protected] DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies COMPLETION 1. A patient is to receive hydromorphone 1.5 mg IV push now. The medication comes in a prefilled syringe, 2 mg/mL. Identify how many milliliters the nurse will administer for this dose. ANS: 0.75 mL 2 mg:1 mL::1.5 mg:x mL (2 x) = (1 1.5); 2x = 1.5; x = 0.75; administer 0.75 mL. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies Chapter 07: Over-the-Counter Drugs and Herbal and Dietary Supplements Lilley: Pharmacology and the Nursing Process, 10th Edition MULTIPLE CHOICE 1. A 25-year-old woman is visiting the prenatal clinic and shares with the nurse her desire to go ―natural‖ with her pregnancy. She shows the nurse a list of herbal remedies that she wants to buy so that she can ―avoid taking any drugs.‖ Which statement by the nurse is correct? a. ―Most herbal remedies are not harmful and are safe for use during pregnancy.‖ b. c. d. ―Please read each label carefully before use to check for cautionary warnings.‖ ―Keep in mind that products from different manufacturers are required to contain consistent amounts of the herbal products.‖ ―It‘s important to remember that herbal remedies do not have proven safety ratings for pregnant women.‖ ANS: D The fact that a drug is an herbal or a dietary supplement does not mean that it can be safely administered to children, infants, or pregnant or lactating women. Many herbal products have not been tested for safety during pregnancy. Simply reading the labels may not provide enough information for use during pregnancy. Last, manufacturers of herbal products are not required to guarantee the reliability of the contents. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Implementation MSC: NCLEX: Health Promotion and Maintenance 2. The nurse is giving a lecture about current U.S. laws and regulations of herbal products. According to the United States Dietary Supplement and Health Education Act of 1994, which statement is true? If you need any other Test Banks or eTextbooks contact us: [email protected] a. b. c. d. Medicinal herbs are viewed as dietary supplements. Herbal remedies are held to the same standards as drugs. Producers of herbal products must prove therapeutic efficacy. Herbal remedies are protected by patent laws. ANS: A Current U.S. laws view herbal products as dietary supplements and do not hold them to the same efficacy standards as drugs. The other options do not correctly reflect current U.S. laws regarding herbal supplements. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: General MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 3. The patient wants to take the herbal product kava to help him rest at night. The nurse would be concerned about potential interactions if he is taking a medication from which class of drugs? a. Digitalis b. Anticoagulants c. Sedatives d. Immunosuppressants ANS: C Kava may cause increased central nervous system depression if used with sedatives. Digitalis, anticoagulants, and immunosuppressants do not have interactions with kava. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential If you need any other Test Banks or eTextbooks contact us: [email protected] 4. 5. The patient has been taking an over-the-counter (OTC) acid-reducing drug because he has had ―stomach problems‖ for several months. He tells the nurse that the medicine helps as long as he takes it, but once he stops it, the symptoms return. Which statement by the nurse is the best advice for this patient? a. b. ―The over-the-counter drug has helped you, so you should continue to take it.‖ ―The over-the-counter dosage may not be strong enough. You should be taking prescription-strength for best effects.‖ c. ―For best results, you need to watch what you eat in addition to taking this drug.‖ d. ―Using this drug may relieve your symptoms, but it does not address the cause. Please make an appointment with your health care provider.‖ ANS: D The use of OTC drugs may postpone effective management of chronic disease states and may delay treatment of serious or life-threatening disorders because these drugs may relieve symptoms without necessarily addressing the cause of the disorder. The other options do not address the need to investigate the cause of the symptoms and are incorrect. DIF: Cognitive Level: Applying (Application) Planning MSC: NCLEX: Safe and Effective Care Environment: Management of Care TOP: Nursing Process: During an assessment, the patient tells the nurse that he takes a garlic supplement for its cardiovascular benefits. Which drug or drug class, if taken, would have a potential interaction with the garlic? a. Acetaminophen (Tylenol) b. Insulin c. Antilipemic drugs d. Sedatives ANS: B If you need any other Test Banks or eTextbooks contact us: [email protected] 6. 7. The use of garlic may interfere with hypoglycemic drugs. The other options are incorrect because acetaminophen, antilipemic drugs, and sedatives do not have interactions with garlic. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential A patient calls the clinic to ask about taking cranberry dietary supplement capsules because a friend recommended them. The nurse will discuss which possible concern when a patient is taking cranberry supplements? a. b. It may increase the risk for bleeding if the patient is taking anticoagulants. It may increase the risk of toxicity of some psychotherapeutic drugs. c. d. It may reduce elimination of drugs that are excreted by the kidneys. Cranberry may increase the intensity and duration of effects of caffeine. ANS: C The use of cranberry decreases the elimination of many drugs that are renally excreted. The other concerns do not occur with cranberry supplements. DIF: Cognitive Level: Applying (Application) Planning MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential TOP: Nursing Process: A patient wants to take the herb gingko to help his memory. The nurse reviews his current medication list and would be concerned about potential interactions if he is taking a medication from which class of drugs? a. Digitalis b. Antiplatelet drugs c. Sedatives d. Immunosuppressants ANS: B If you need any other Test Banks or eTextbooks contact us: [email protected] The use of gingko increases the risk of bleeding with antiplatelet drugs (aspirin, clopidogrel) and anticoagulants (warfarin, heparin). The other concerns do not occur with gingko supplements. DIF: Cognitive Level: Applying (Application) Planning MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential TOP: Nursing Process: MULTIPLE RESPONSE 1. The nurse is conducting a class for senior citizens about the use of over-the-counter (OTC) drugs. Which statements are true regarding the use of OTC drugs? (Select all that apply.) a. b. c. d. e. Use of OTC drugs may delay treatment of serious ailments. Drug interactions with OTC medications are rare. OTC drugs may relieve symptoms without addressing the cause of the problem. OTC drugs are indicated for long-term treatment of conditions. Patients may misunderstand product labels and use the drugs improperly. ANS: A, C, E It is true that use of OTC drugs may delay treatment of serious ailments; OTC drugs may relieve symptoms without addressing the cause of the problem, and patients may misunderstand product labels and use the drugs improperly. These statements should be included when teaching patients about their use. In contrast, drug interactions with OTC medications are not rare and may indeed occur with prescription medications and other OTC drugs. Normally, OTC drugs are intended for short-term treatment of minor ailments. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 2. The nurse is reviewing the criteria for over-the-counter drugs. Which criteria for over-the-counter status in the United States are accurate? (Select all that apply.) If you need any other Test Banks or eTextbooks contact us: [email protected] a. b. c. d. e. The drug must be easy to use. The drug must have a low therapeutic index. The consumer must be able to monitor the drug‘s effectiveness. The drug must have a low potential for abuse. The drug must not have any interactions with other drugs. ANS: A, C, D In the United States, criteria for over-the-counter status include the drug being easy to use, the drug having a low potential for abuse, and the consumer must be able to monitor the drug‘s effectiveness for the condition. The drug must have a high therapeutic index (not a low one), and the drug must have limited interactions with other drugs. DIF: Cognitive Level: Applying (Application) General TOP: Nursing Process: MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies COMPLETION 1. A patient with a PEG tube is to receive ferrous sulfate, 75 mg per the tube, daily. The medication is available as an elixir, 220 mg/5 mL. How many milliliters will the patient receive per dose? Record your answer using one decimal place. ANS: 1.7 mL 220 mg:5 mL::75 mg:x mL (220 mL/dose. x) = (5 75); 220x = 375; x = 1.704 which rounds to 1.7 Chapter 03: Lifespan Considerations Lilley: Pharmacology and the Nursing Process, 10th Edition MULTIPLE CHOICE 1. 2. 3. Drug transfer to the fetus is more likely during the last trimester of pregnancy for which reason? a. Decreased fetal surface area b. Increased placental surface area c. Enhanced blood flow to the fetus d. Increased amount of protein-bound drug in maternal circulation ANS: C Drug transfer to the fetus is more likely during the last trimester of pregnancy as a result of enhanced blood flow to the fetus. The other options are incorrect. Increased fetal surface area, not decreased, is a factor that affects drug transfer to the fetus. The placenta‘s surface area does not increase during this time. Drug transfer is increased because of an increased amount of free drug, not protein-bound drug, in the mother‘s circulation. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: General MSC: NCLEX: Health Promotion and Maintenance The nurse is monitoring a patient who is in the 26th week of pregnancy and has developed gestational diabetes and pneumonia. She is given medications that pose a possible fetal risk, but the potential benefits may warrant the use of the medications in her situation. The nurse recognizes that these medications are in which U.S. Food and Drug Administration pregnancy safety category? a. Category A b. Category B c. Category C d. Category D ANS: D Pregnancy category D fits the description given. Category A indicates no risk to the human fetus; Category B indicates no risk to animal fetus; information for humans is not available. Category C indicates adverse effects reported in animal fetus; information for humans is not available. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control When discussing dosage calculation for pediatric patients with a clinical pharmacist, the nurse notes that which type of dosage calculation is used most commonly in pediatric calculations? a. West nomogram b. Clark rule c. Height-to-weight ratio d. Milligram per kilogram of body weight formula ANS: D The milligram per kilogram formula, based on body weight, is the most common method of If you need any other Test Banks or eTextbooks contact us: [email protected] 4. 5. 6. calculating doses for pediatric patients. Height-to-weight ratio is not used. The other options are available methods but are not the most commonly used. DIF: Cognitive Level: Remembering (Knowledge) TOP: Nursing Process: Implementation MSC: NCLEX: Health Promotion and Maintenance The nurse is assessing a newly admitted 83-year-old patient and determines that the patient is experiencing polypharmacy. Which statement most accurately illustrates polypharmacy? a. b. c. d. The patient is experiencing multiple illnesses. The patient uses one medication for an illness several times per day. The patient uses over-the-counter drugs for an illness. The patient uses multiple medications simultaneously. ANS: D Polypharmacy usually occurs when a patient has several illnesses and takes medications for each of them, possibly prescribed by different specialists who may be unaware of other treatments the patient is undergoing. The other options are incorrect. Polypharmacy addresses the medications taken, not just the illnesses. Polypharmacy means the patient is taking several different medications, not just one, and can include prescription drugs, over-the-counter medications, and herbal products. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies The nurse is aware that confusion, forgetfulness, and increased risk for falls are common responses in an elderly patient who is taking which type of drug? a. Laxatives b. Anticoagulants c. Sedatives d. Antidepressants ANS: C Sedatives and hypnotics often cause confusion, daytime sedation, ataxia, lethargy, forgetfulness, and increased risk for falls in the elderly. Laxatives, anticoagulants, and antidepressants may cause adverse effects in the elderly, but not the ones specified in the question. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control For accurate medication administration to pediatric patients, the nurse must consider which of these factors? a. Organ maturity b. Renal output c. Body temperature d. Height ANS: A To administer medications to pediatric patients accurately, one must take into account organ maturity, body surface area, age, and weight. The other options are incorrect; renal output and body temperature are not considerations, and height alone is not sufficient. If you need any other Test Banks or eTextbooks contact us: [email protected] 7. 8. 9. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: Implementation MSC: NCLEX: Health Promotion and Maintenance The nurse recognizes that an elderly patient may experience a reduction in the stomach‘s ability to produce hydrochloric acid. This change may result in which effect? a. Delayed gastric emptying b. Increased gastric acidity c. Decreased gastrointestinal motility d. Altered absorption of some drugs ANS: D Reduction in the stomach‘s ability to produce hydrochloric acid is an aging-related change that results in a decrease in gastric acidity and may alter the absorption of some drugs. The other options are not results of reduced hydrochloric acid production. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Assessment MSC: NCLEX: Health Promotion and Maintenance The nurse is administering drugs to neonates and will consider which factor may contribute the most to drug toxicity? a. The lungs are immature. b. The kidneys are small. c. The liver is not fully developed. d. Excretion of the drug occurs quickly. ANS: C A neonate‘s liver is not fully developed and cannot detoxify many drugs. The other options are incorrect. The lungs and kidneys do not play major roles in drug metabolism. Renal excretion is slow, not fast, because of organ immaturity, but this is not the factor that contributes the most to drug toxicity. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: Planning dosage has been double-checked and updated MSC: NCLEX: Health Promotion and Maintenance An 83-year-old woman has been given a thiazide diuretic to treat heart failure. She and her caregiver should be told to watch for which problems? a. Constipation and anorexia b. Fatigue, leg cramps, and dehydration c. Daytime sedation and lethargy d. Edema, nausea, and blurred vision ANS: B Electrolyte imbalance, leg cramps, fatigue, and dehydration are common complications when thiazide diuretics are given to elderly patients. The other options do not describe complications that occur when these drugs are given to the elderly. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies If you need any other Test Banks or eTextbooks contact us: [email protected] 10. 11. 12. An elderly patient with a new diagnosis of hypertension will be receiving a new prescription for an antihypertensive drug. The nurse expects which type of dosing to occur with this drug therapy? a. Drug therapy will be based on the patient‘s weight. b. Drug therapy will be based on the patient‘s age. c. The patient will receive the maximum dose that is expected to reduce the blood pressure. d. The patient will receive the lowest possible dose at first, and then the dose will be increased as needed. ANS: D As a general rule, dosing for elderly patients should follow the admonition, ―Start low, and go slow,‖ which means to start with the lowest possible dose (often less than an average adult dose) and increase the dose slowly, if needed, based on patient response. The other responses are incorrect. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies The nurse is trying to give a liquid medication to a 2 1/2-year-old child and notes that the medication has a strong taste. Which technique is the best way for the nurse to give the medication to this child? a. b. c. d. Give the medication with a spoonful of ice cream. Add the medication to the child‘s bottle. Tell the child you have candy for him. Add the medication to a cup of milk. ANS: A Ice cream or another nonessential food disguises the taste of the medication. The other options are incorrect. If the child does not drink the entire contents of the bottle, medication is wasted and the full dose is not administered. Using the word candy with drugs may lead to the child thinking that drugs are actually candy. If the medication is mixed with a cup of milk, the child may not drink the entire cup of milk, and the distasteful drug may cause the child to refuse milk in the future. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies The nurse is preparing to give an injection to a 4-year-old child. Which intervention is age appropriate for this child? a. b. c. Give the injection without any advanced preparation. Give the injection, and then explain the reason for the procedure afterward. Offer a brief, concrete explanation of the procedure at the patient‘s level and with the parent or caregiver present. d. Prepare the child in advance with details about the procedure without the parent or caregiver present. ANS: C If you need any other Test Banks or eTextbooks contact us: [email protected] For a 4-year-old child, offering a brief, concrete explanation about a procedure just beforehand, with the parent or caregiver present, is appropriate. The other options are incorrect for any age group. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity MULTIPLE RESPONSE 1. Which statements are true regarding pediatric patients and pharmacokinetics? (Select all that apply.) a. The levels of microsomal enzymes are decreased. b. Perfusion to the kidneys may be decreased and may result in reduced renal function. c. d. e. f. g. First-pass elimination is increased because of higher portal circulation. First-pass elimination is reduced because of the immaturity of the liver. Total body water content is much less than in adults. Gastric emptying is slowed because of slow or irregular peristalsis. Gastric emptying is more rapid because of increased peristaltic activity. ANS: A, B, D, F In children, first-pass elimination by the liver is reduced because of the immaturity of the liver, and microsomal enzymes are decreased. In addition, gastric emptying is reduced because of slow or irregular peristalsis. Perfusion to the kidneys may be decreased, resulting in reduced renal function. The other options are incorrect. In addition, remember that total body water content is greater in children than in adults. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Assessment MSC: NCLEX: Health Promotion and Maintenance 2. Which statements are true regarding the elderly and pharmacokinetics? (Select all that apply.) a. b. c. d. e. f. g. The levels of microsomal enzymes are decreased. Fat content is increased because of decreased lean body mass. Fat content is decreased because of increased lean body mass. The number of intact nephrons is increased. The number of intact nephrons is decreased. Gastric pH is less acidic. Gastric pH is more acidic. ANS: A, B, E, F In the elderly, levels of microsomal enzymes are decreased because the aging liver is less able to produce them; fat content is increased because of decreased lean body mass; the number of intact nephrons is decreased as the result of aging; and gastric pH is less acidic because of a gradual reduction of the production of hydrochloric acid. The other options are incorrect statements. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Assessment MSC: NCLEX: Health Promotion and Maintenance COMPLETION If you need any other Test Banks or eTextbooks contact us: [email protected] 1. A 7-year-old child will be receiving amoxicillin (Amoxil) 50 mg/kg/day in two divided doses. The child weighs 55 pounds. The medication, once reconstituted, is available as an oral suspension of 125 mg/5 mL. Identify how many milliliters will the child receive per dose. ANS: 25 mL per dose Convert pounds to kilograms: 55 pounds = 25 kg. 25 kg 50 mg/kg/day = 1250 mg/day. To get the amount per dose, divide 1250 by 2, which equals 625 mg/dose. To calculate the milliliters: 125 mg:5 mL:: 625 mg:x mL. (125 x) = (5 625); 125x = 3125; x = 25 mL/dose. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies Chapter 12: Central Nervous System Depressants and Muscle Relaxants Lilley: Pharmacology and the Nursing Process, 10th Edition MULTIPLE CHOICE 1. 2. 3. A patient who has received some traumatic news is panicking and asks for some medication to help settle down. The nurse anticipates giving which drug that is most appropriate for this situation? a. Diazepam b. Zolpidem c. Phenobarbital d. Cyclobenzaprine ANS: A Benzodiazepines such as diazepam are used as anxiolytics, or sedatives. Zolpidem is used as a hypnotic for sleep. Phenobarbital is not used as an anxiolytic but is used for seizure control. Cyclobenzaprine is a muscle relaxant and is not used to reduce anxiety. DIF: Cognitive Level: Applying (Application) MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Nursing Process: Planning A patient has been taking phenobarbital for 2 weeks as part of his therapy for epilepsy. He tells the nurse that he feels tense and that ―the least little thing‖ bothers him now. Which is the correct explanation for this problem? a. b. c. These are adverse effects that usually subside after a few weeks. The drug must be stopped immediately because of possible adverse effects. This drug causes the rapid eye movement (REM) sleep period to increase, resulting in nightmares and restlessness. d. This drug causes deprivation of REM sleep and may cause the inability to deal with normal stress. ANS: D Barbiturates such as phenobarbital deprive people of REM sleep, which can result in agitation. Rebound phenomenon occurs when the drug is stopped (not during therapy), and the proportion of REM sleep increases, sometimes resulting in nightmares. The other options are incorrect. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity: Basic Care and Comfort A man who has been taking phenobarbital for 1 week is found very lethargic and unable to walk after eating out for dinner. His wife states that he has no other prescriptions and that he did not take an overdose—the correct number of pills is in the bottle. The nurse suspects that which of these may have happened? a. He took a multivitamin. b. c. d. He drank a glass of wine. He took a dose of aspirin. He developed an allergy to the drug. ANS: B If you need any other Test Banks or eTextbooks contact us: [email protected] 4. 5. 6. Alcohol has an additive effect when combined with barbiturates and causes central nervous system (CNS) depression. Multivitamins and aspirin do not interact with barbiturates, and this situation does not illustrate an allergic reaction. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies A patient has been taking suvorexant for intermittent insomnia. She calls the nurse to say that when she takes it, she sleeps well, but the next day she feels ―so tired.‖ Which explanation by the nurse is correct? a. b. c. d. ―Long-term use of this drug results in a sedative effect.‖ ―If you take the drug every night, this hangover effect will be reduced.‖ ―These drugs affect the sleep cycle, resulting in daytime sleepiness.‖ ―These drugs increase the activity of the central nervous system, making you tired the next day.‖ ANS: C Use of suvorexant result in daytime sleepiness. The other statements are incorrect. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation A patient is taking flurazepam three to four nights a week for sleeplessness. She is concerned that she cannot get to sleep without taking the medication. What nonpharmacologic measures should the nurse suggest to promote sleep for this patient? a. Providing a quiet environment b. Exercising before bedtime to become tired c. Consuming heavy meals in the evening to promote sleepiness d. Drinking hot tea or coffee just before bedtime ANS: A Nonpharmacologic approaches to induce sleep include providing a quiet environment, avoiding heavy exercise before bedtime, avoiding heavy meals late in the evening, and drinking warm decaffeinated drinks, such as warm milk, before bedtime. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Basic Care and Comfort A patient is brought to the emergency department for treatment of a suspected overdose. The patient was found with an empty prescription bottle of a barbiturate by his bedside. He is lethargic and barely breathing. The nurse would expect which immediate intervention? a. Starting an intravenous infusion of diluted bicarbonate solution b. Administering medications to increase blood pressure c. Implementing measures to maintain the airway and support respirations d. Administrating naloxone (Narcan) as an antagonist ANS: C There are no antagonists/antidotes for barbiturates. Treatment supports respirations and maintains the airway. The other interventions are not appropriate. If you need any other Test Banks or eTextbooks contact us: [email protected] 7. 8. 9. 10. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies Ramelteon is prescribed for a patient with insomnia. The nurse checks the patient‘s medical history, knowing that this medication is contraindicated in which disorder? a. Coronary artery disease b. Renal insufficiency c. Liver disease d. Anemia ANS: C contraindications. Ramelteon is contraindicated in cases of severe liver dysfunction. The other conditions are not DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies The nurse notes in the patient‘s medication history that the patient is taking cyclobenzaprine. Based on this finding, the nurse interprets that the patient has which disorder? a. A musculoskeletal injury b. Insomnia c. Epilepsy d. Agitation ANS: A Cyclobenzaprine is the muscle relaxant most commonly used to reduce spasms following musculoskeletal injuries. It is not appropriate for insomnia, epilepsy, or agitation. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies A patient has experienced insomnia for months, and the physician has prescribed a medication to help with this problem. The nurse expects which drug to be used for long-term treatment of insomnia? a. Secobarbital, a barbiturate b. Diazepam, a benzodiazepine c. Midazolam, a benzodiazepine d. Eszopiclone, a nonbenzodiazepine sleep aid ANS: D Eszopiclone is one of the newest prescription hypnotics to be approved for long-term use in treatment of insomnia. Barbiturates and benzodiazepines are not appropriate for long-term treatment of insomnia; midazolam is used for procedural (moderate) sedation. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies A patient tells the nurse that he likes to drink kava herbal tea to help him relax. Which statement by the patient indicates that additional teaching about this herbal product is needed? If you need any other Test Banks or eTextbooks contact us: [email protected] a. b. c. d. ―I will not drink wine with the kava tea.‖ ―If I notice my skin turning yellow, I will stop taking the tea.‖ ―I will not take sleeping pills if I have this tea in the evening.‖ ―I will be able to drive my car after drinking this tea.‖ ANS: D Patients should not drive after drinking this tea because it may cause sedation. Kava tea may cause skin discoloration (with long-term use). In addition, it must not be taken with alcohol, barbiturates, and psychoactive drugs. DIF: Cognitive Level: Applying (Application) MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential TOP: Nursing Process: Evaluation MULTIPLE RESPONSE 1. 2. The nurse is preparing to administer a barbiturate. Which conditions or disorders would be a contraindication to the use of these drugs? (Select all that apply.) a. Gout b. Pregnancy c. Epilepsy d. Severe chronic obstructive pulmonary disease e. Severe liver disease f. Diabetes mellitus ANS: B, D, E Contraindications to barbiturates include pregnancy, significant respiratory difficulties, and severe liver or renal disease. The other disorders are not contraindications. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies The barbiturate phenobarbital is prescribed for a patient with epilepsy. While assessing the patient‘s current medications, the nurse recognizes that interactions may occur with which drugs? (Select all that apply.) a. Antihistamines b. Opioids c. Diuretics d. Anticoagulants e. Oral contraceptives f. Insulin ANS: A, B, D, E The co-administration of barbiturates and alcohol, antihistamines, benzodiazepines, opioids, and tranquilizers may result in additive CNS depression. Co-administration of anticoagulants and barbiturates can result in decreased anticoagulation response and possible clot formation. Co-administration of barbiturates and oral contraceptives can result in accelerated metabolism of the contraceptive drug and possible unintended pregnancy. There are no interactions with diuretics and insulin. DIF: Cognitive Level: Understanding (Comprehension) If you need any other Test Banks or eTextbooks contact us: [email protected] TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological Therapies COMPLETION 1. A patient is about to receive pentobarbital 100 mg IV as preoperative sedation. The medication is available in a concentration of 50 mg/mL. How many milliliters will the patient receive for this dose? ANS: 2 mL 50 mg:1 mL::100 mg:x mL (50 x) = (1 100); 50x = 100; x = 2 mL. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies Chapter 10: Analgesic Drugs Lilley: Pharmacology and the Nursing Process, 10th Edition MULTIPLE CHOICE 1. A patient was diagnosed with pancreatic cancer last month, and has complained of a dull ache in the abdomen for the past 4 months. This pain has been gradually increasing, and the pain relievers taken at home are no longer effective. What type of pain is the patient experiencing? a. Acute pain b. Chronic pain c. Somatic pain d. Neuropathic pain ANS: B Chronic pain is associated with cancer and is characterized by slow onset, long duration, and dull, persistent aching. The patient‘s symptoms are not characteristics of acute pain, somatic pain, or neuropathic pain. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Basic Care and Comfort 2. A 16-year-old field hockey player fell and twisted her ankle during a game. The nurse will expect to administer which type of analgesic? a. b. c. d. Synthetic opioid, such as meperidine Opium alkaloid, such as morphine sulfate Opioid antagonist, such as naloxone HCL Nonopioid analgesics, such as indomethacin ANS: D If you need any other Test Banks or eTextbooks contact us: [email protected] 3. 4. Somatic pain, which originates from skeletal muscles, ligaments, and joints, usually responds to nonopioid analgesics such as nonsteroidal anti-inflammatory drugs (NSAIDs). The other options are not the best choices for somatic pain. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Basic Care and Comfort A patient had abdominal surgery this morning. The patient is groggy but complaining of severe pain around the incision. What is the most important assessment data to consider before the nurse administers a dose of morphine sulfate to the patient? a. The patient‘s pulse rate b. The patient‘s respiratory rate c. d. ANS: B The appearance of the incision The date of the patient‘s last bowel movement One of the most serious adverse effects of opioids is respiratory depression. The nurse must assess the patient‘s respiratory rate before administering an opioid. The other options are incorrect. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential A 78-year-old patient is in the recovery room after having a lengthy surgery on his hip. As he is gradually awakening, he requests pain medication. Within 10 minutes after receiving a dose of morphine sulfate, he is very lethargic and his respirations are shallow, with a rate of 7 breaths/minute. The nurse prepares for which priority action at this time? a. b. Assessment of the patient‘s pain level Immediate intubation and artificial ventilation c. Administration of naloxone (Narcan) d. Close observation of signs of opioid tolerance If you need any other Test Banks or eTextbooks contact us: [email protected] 5. 6. ANS: C Naloxone, an opioid-reversal agent, is used to reverse the effects of acute opioid overdose and is the drug of choice for reversal of opioid-induced respiratory depression. This situation is describing an opioid overdose, not opioid tolerance. Intubation and artificial ventilation are not appropriate because the patient is still breathing at 7 breaths/min. It would be inappropriate to assess the patient‘s level of pain. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies A patient will be discharged with a 1-week supply of an opioid analgesic for pain management after abdominal surgery. The nurse will include which information in the teaching plan? a. How to prevent dehydration due to diarrhea b. The importance of taking the drug only when the pain becomes severe c. How to prevent constipation d. The importance of taking the drug on an empty stomach ANS: C Gastrointestinal (GI) adverse effects, such as nausea, vomiting, and constipation, are the most common adverse effects associated with opioid analgesics. Physical dependence usually occurs in patients undergoing long-term treatment. Diarrhea is not an effect of opioid analgesics. Taking the dose with food may help minimize GI upset. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential A patient has been treated for lung cancer for 3 years. Over the past few months, the patient has noticed that the opioid analgesic is not helping as much as it had previously and more If you need any other Test Banks or eTextbooks contact us: [email protected] 7. medication is needed for the same pain relief. The nurse is aware that this patient is experiencing which of these? a. Opioid addiction b. Opioid tolerance c. Opioid toxicity d. Opioid abstinence syndrome ANS: B Opioid tolerance is a common physiologic result of long-term opioid use. Patients with opioid tolerance require larger doses of the opioid agent to maintain the same level of analgesia. This situation does not describe toxicity (overdose), addiction, or abstinence syndrome (withdrawal). DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies A 38-year-old man has come into the urgent care center with severe hip pain after falling from a ladder at work. He says he has taken several pain pills over the past few hours but cannot remember how many he has taken. He hands the nurse an empty bottle of acetaminophen (Tylenol). The nurse is aware that the most serious toxic effect of acute acetaminophen overdose is which condition? a. Tachycardia b. Central nervous system depression c. Hepatic necrosis d. Nephropathy ANS: C Hepatic necrosis is the most serious acute toxic effect of an acute overdose of acetaminophen. The other options are incorrect. If you need any other Test Banks or eTextbooks contact us: [email protected] 8. 9. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control A 57-year-old woman being treated for end-stage breast cancer has been using a transdermal opioid analgesic as part of the management of pain. Lately, she has been experiencing breakthrough pain. The nurse expects this type of pain to be managed by which of these interventions? a. Administering NSAIDs b. Administering an immediate-release opioid c. Changing the opioid route to the rectal route d. Making no changes to the current therapy ANS: B If a patient is taking long-acting opioid analgesics, breakthrough pain must be treated with an immediate-release dosage form that is given between scheduled doses of the long-acting opioid. The other options are not appropriate actions. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies The nurse is reviewing herbal therapies. Which is a common use of the herb feverfew? a. Muscle aches b. Menstrual cramps c. Joint pain d. Incision pain after surgery ANS: B Feverfew is commonly used for migraine headaches, menstrual problems, arthritis, and fever. If you need any other Test Banks or eTextbooks contact us: [email protected] 10. 11. Possible adverse effects include muscle stiffness and muscle and joint pain. DIF: Cognitive Level: Remembering (Knowledge) TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies A patient is to receive acetylcysteine as part of the treatment for an acetaminophen overdose. Which action by the nurse is appropriate when giving this medication? a. b. c. d. Giving the medication undiluted for full effect Avoiding the use of a straw when giving this medication Disguising the flavor with soda or flavored water Preparing to give this medication via a nebulizer ANS: C Acetylcysteine has the flavor of rotten eggs and so is better tolerated if it is diluted and disguised by mixing with a drink such as cola or flavored water to help increase its palatability. The use of a straw helps to minimize contact with the mucous membranes of the mouth and is recommended. The nebulizer form of this medication is used for certain types of pneumonia, not for acetaminophen overdose. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies A patient is receiving gabapentin (Neurontin), an anticonvulsant, but has no history of seizures. The nurse expects that the patient is receiving this drug for which condition? a. Inflammation pain b. Pain associated with peripheral neuropathy c. Depression associated with chronic pain d. Prevention of seizures ANS: B If you need any other Test Banks or eTextbooks contact us: [email protected] 12. 13. Anticonvulsants are often used as adjuvants for treatment of neuropathic pain to enhance analgesic efficacy. The other indications listed are not correct. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies The nurse is assessing a patient who has been admitted to the emergency department for a possible opioid overdose. Which assessment finding is characteristic of an opioid drug overdose? a. Dilated pupils b. Restlessness c. Respiration rate of 6 breaths/min d. Heart rate of 55 beats/min ANS: C The most serious adverse effect of opioid use is CNS depression, which may lead to respiratory depression. Pinpoint pupils, not dilated pupils, are seen. Restlessness and a heart rate of 55 beats/min are not indications of an opioid overdose. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies The drug nalbuphine is an agonist-antagonist (partial agonist). The nurse understands that which is a characteristic of partial agonists? a. They have anti-inflammatory effects. b. They are given to reverse the effects of opiates. c. d. They have a higher potency than agonists. They have a lower dependency potential than agonists. ANS: D If you need any other Test Banks or eTextbooks contact us: [email protected] 14. 15. Partial agonists such as nalbuphine are similar to the opioid agonists in terms of their therapeutic indications; however, they have a lower risk of misuse and addiction. They do not have anti-inflammatory effects, nor are they given to reverse the effects of opiates. They do not have a higher potency than agonists. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies The nurse is assessing a patient for contraindications to drug therapy with acetaminophen (Tylenol). Which patient should not receive acetaminophen? a. A patient with a fever of 101°F (38.3°C) b. A patient who is complaining of a mild headache c. A patient with a history of liver disease d. A patient with a history of peptic ulcer disease ANS: C Liver disease is a contraindication to the use of acetaminophen. Fever and mild headache are both possible indications for the medication. Having a history of peptic ulcer disease is not a contraindication. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies A patient arrives at the urgent care center complaining of leg pain after a fall when rock climbing. The radiographs show no broken bones, but he has a large bruise on his thigh. The patient says he drives a truck and does not want to take anything strong because he needs to stay awake. Which statement by the nurse is most appropriate? a. ―It would be best for you not to take anything if you are planning to drive your truck.‖ b. ―We will discuss with your doctor about taking an opioid because that would work best for your pain.‖ c. ―You can take acetaminophen, also known as Tylenol, for pain, but no more than 1000 mg per day.‖ d. ―You can take acetaminophen, also known as Tylenol, for pain, but no more than 3000 mg/day.‖ ANS: D Acetaminophen is indicated for mild-to-moderate pain and does not cause drowsiness, as an opioid would. Currently, the maximum daily amount of acetaminophen is 3000 mg/day. The 1000-mg amount per day is too low. Telling the patient not to take any pain medications is incorrect. DIF: Cognitive Level: Applying (Application) MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Nursing Process: Planning If you need any other Test Banks or eTextbooks contact us: [email protected] 16. A patient is suffering from tendonitis of the knee. The nurse is reviewing the patient‘s medication administration record and recognizes that which adjuvant medication is most appropriate for this type of pain? a. Antidepressant b. Anticonvulsant c. Corticosteroid d. Local anesthesia ANS: C Corticosteroids have an anti-inflammatory effect, which may help to reduce pain. The other medications do not have anti-inflammatory properties. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies MULTIPLE RESPONSE 1. The opioid Vicodin (acetaminophen/hydrocodone) is prescribed for a patient who has had surgery. The nurse informs the patient that which common adverse effects can occur with this medication? (Select all that apply.) a. Diarrhea b. Constipation c. Lightheadedness d. Nervousness e. Urinary retention f. Itching ANS: B, C, E, F Constipation (not diarrhea), lightheadedness (not nervousness), urinary retention, and itching are some of the common adverse effects that the patient may experience while taking opioids such as Vicodin. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological Therapies COMPLETION 1. A patient is to receive methadone 2.5 mg intramuscularly (IM) now. The medication is available in a concentration of 10 mg/mL. Identify how many milliliters of methadone will be drawn up for this dose. ANS: 0.25 mL 10 mg:1 mL::2.5 mg:x mL (10 x) = (2 2.5); 10x = 2.5; x = 0.25 mg. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies Chapter 13: Central Nervous System Stimulants and Related Drugs Lilley: Pharmacology and the Nursing Process, 10th Edition MULTIPLE CHOICE 1. 2. 3. A patient is receiving instructions regarding the use of caffeine. The nurse shares that caffeine should be used with caution if which of these conditions is present? a. A history of peptic ulcers b. Migraine headaches c. Asthma d. A history of kidney stones ANS: A Caffeine should be used with caution by patients who have histories of peptic ulcers or cardiac dysrhythmias or who have recently had myocardial infarctions. The other conditions are not contraindications to the use of caffeine. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies A patient who started taking orlistat 1 month ago calls the clinic to report some ―embarrassing‖ adverse effects. She tells the nurse that she has had episodes of ―not being able to control my bowel movements.‖ Which statement is true about this situation? a. These are expected adverse effects that will eventually diminish. b. The patient will need to stop this drug immediately if these adverse effects are occurring. c. d. The patient will need to increase her fat intake to prevent these adverse effects. The patient will need to restrict fat intake to less than 30% of total calories to help reduce these adverse effects. ANS: D Restricting dietary intake of fat to less than 30% of total calories can help reduce some of the GI adverse effects, which include oily spotting, flatulence, and fecal incontinence. The other options are incorrect. DIF: Cognitive Level: Applying (Application) MSC: NCLEX: Physiological Integrity: Physiological Adaptation TOP: Nursing Process: Evaluation A 6-year-old boy has been started on an extended-release form of methylphenidate hydrochloride for the treatment of attention deficit hyperactivity disorder (ADHD). During a follow-up visit, his mother tells the nurse that she has been giving the medication at bedtime so that it will be ―in his system‖ when he goes to school the next morning. What is the nurse‘s appropriate evaluation of the mother‘s actions? a. She is giving him the medication dosage appropriately. b. The medication should not be taken until he is at school. c. The medication should be taken with meals for optimal absorption. d. The medication should be given 4 to 6 hours before bedtime to diminish insomnia. ANS: D Central nervous system stimulants should be taken 4 to 6 hours before bedtime to decrease If you need any other Test Banks or eTextbooks contact us: [email protected] 4. 5. 6. 7. insomnia. Generally speaking, once-a-day dosing is used with extended-release or long-acting preparations. These formulations eliminate the need to take this medication at school. DIF: Cognitive Level: Applying (Application) MSC: NCLEX: Physiological Integrity: Physiological Adaptation TOP: Nursing Process: Evaluation A 22-year-old nursing student has been taking caffeine tablets for the past few weeks to ―make it through‖ the end of the semester and exam week. She is in the university clinic today because she is ―exhausted.‖ What human needs statement may be appropriate for her? a. Altered oxygenation need b. Altered physical activity c. Altered need for sleep d. Altered food intake ANS: C Caffeine, is a central nervous system stimulant that can be used to increase mental alertness. It is available in OTC forms such as NoDoz. Restlessness, anxiety, and insomnia are common adverse effects. Thus, altered need for sleep is the most appropriate human needs statement of those listed. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation A 10-year-old patient will be started on methylphenidate hydrochloride therapy. The nurse will perform which essential baseline assessment before this drug is started? a. Eye examination b. Height and weight c. Liver function studies d. Hearing test ANS: B Assessment of baseline height and weight is important before beginning methylphenidate therapy because it may cause a temporary slowing of growth in prepubertal children. The other studies are not as essential at this time. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies When evaluating a patient who is taking orlistat, which is an intended therapeutic effect? a. Increased wakefulness b. Increased appetite c. Decreased weight d. Decreased hyperactivity ANS: C are incorrect. Orlistat is a nonstimulant drug that is used as part of a weight loss program. The other options DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies The nurse is teaching a patient how to self-administer triptan injections for migraine If you need any other Test Banks or eTextbooks contact us: [email protected] headaches. Which statement by the patient indicates that he needs further teaching? a. ―I will take this medication regularly to prevent a migraine headache from occurring.‖ b. c. d. ―I will take this medication when I feel a migraine headache starting.‖ ―This medication will not reduce the number of migraines I will have.‖ ―I will keep a journal to record the headaches I have and how the injections are working.‖ ANS: A Although they may be taken during aura symptoms by patients who have auras with their headaches, these drugs are not indicated for preventive migraine therapy. The medication is intended to relieve the migraine and not to prevent it or to reduce the number of attacks. The triptans do not reduce the number of migraines a person will have. Journal recordings of headaches and the patient‘s responses to the medication are helpful. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies MULTIPLE RESPONSE 1. The nurse is reviewing the use of central nervous system stimulants. Which of these are indications for this class of drugs? (Select all that apply.) a. Narcolepsy b. Depression c. Panic attacks d. Neonatal apnea e. Attention deficit hyperactivity disorder (ADHD) f. Appetite suppression g. Migraine headaches ANS: A, D, E, F, G Central nervous system stimulants can be used for narcolepsy, neonatal apnea, ADHD, migraine headaches, and appetite suppression in the treatment of obesity. They are not used for depression and panic attacks. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 2. A patient has a new prescription for phentermine as part of the treatment for weight loss. Which information will the nurse include when teaching this patient about a stimulant such as phentermine? (Select all that apply.) a. b. c. d. e. Take this medication after meals. Take this medication in the morning. This drug is taken along with supervised exercise and suitable diet. Use mouth rinses, sugarless gum, or hard candies to minimize dry mouth. Avoid foods that contain caffeine, such as coffee, tea, and colas. ANS: B, C, D, E This drug should be taken in the morning to avoid interference with sleep, and the patient should also be on a supervised exercise and dietary regime. Caffeine-containing products If you need any other Test Banks or eTextbooks contact us: [email protected] 3. should be avoided because of possible additional stimulation. Dry mouth can be minimized by the use of mouth rinses, sugarless gum, or hard candy. The other option is incorrect. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies A patient has just received an injection of onabotulinumtoxin A. The nurse will monitor for which adverse effects? (Select all that apply.) a. Insomnia b. Dysphagia c. Weight gain d. GI upset e. Difficulty breathing ANS: B, E Onabotulinumtoxin A (Botox) is given by injection (by a healthcare provider) 12 weeks. Botox has a Black Box Warning regarding spread of the toxin beyond the site of injection which can result in dysphagia and breathing difficulties. The other answers are not correct. DIF: Cognitive Level: Applying (Application) MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Nursing Process: Evaluation COMPLETION 1. The order reads, ―Give atomoxetine 0.5 mg/kg/day once daily in the morning before school.‖ The child weighs 88 pounds. Identify how many milligrams will be administered per dose. ANS: 20 mg 88 pounds ÷ 2.2 = 40 kg. 0.5 mg/kg/day 40 kg = 20 mg/dose. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies Chapter 14: Antiepileptic Drugs Lilley: Pharmacology and the Nursing Process, 10th Edition MULTIPLE CHOICE 1. 2. 3. The nurse is reviewing the dosage schedule for several different antiepileptic drugs (AEDs). Which antiepileptic drug allows for once-a-day dosing? a. Levetiracetam b. Phenobarbital c. Valproic acid d. Gabapentin ANS: B Phenobarbital has the longest half-life of all standard AEDs, including those listed in the other options; therefore, it allows for once-a-day dosing. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies The nurse has given medication instructions to a patient receiving phenytoin. Which statement by the patient indicates that the patient has an adequate understanding of the instructions? a. b. c. d. ―I will need to take extra care of my teeth and gums while on this medication.‖ ―I can go out for a beer while on this medication.‖ ―I can skip doses if the side effects bother me.‖ ―I will be able to stop taking this drug once the seizures stop.‖ ANS: A Thorough dental care is necessary to prevent gingival hypertrophy during therapy with phenytoin. Alcohol and other central nervous system depressants may cause severe sedation. Consistent dosing is important to maintain therapeutic drug levels. Therapy with AEDs usually must continue for life and must not be stopped once seizures stop. DIF: Cognitive Level: Analyzing (Analysis) MSC: NCLEX: Safe and Effective Care Environment: Management of Care TOP: Nursing Process: Evaluation When teaching a patient about taking a newly prescribed antiepileptic drug (AED) at home, the nurse will include which instruction? a. b. c. d. ―Driving is allowed after 2 weeks of therapy.‖ ―If seizures recur, take a double dose of the medication.‖ ―Antacids can be taken with the AED to reduce gastrointestinal adverse effects.‖ ―Take the drug at the same time every day.‖ ANS: D Consistent dosing, taken regularly at the same time of day, at the recommended dose, and with meals to reduce the common gastrointestinal adverse effects, is the key to successful management of seizures when taking AEDs. The other options are not correct statements. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Implementation If you need any other Test Banks or eTextbooks contact us: [email protected] 4. 5. 6. MSC: NCLEX: Safe and Effective Care Environment: Management of Care A patient has a 9-year history of a seizure disorder that has been managed well with oral phenytoin therapy. He is to be NPO (consume nothing by mouth) for surgery in the morning. What will the nurse do about his morning dose of phenytoin? a. b. c. d. Give the same dose intravenously. Give the morning dose with a small sip of water. Contact the prescriber for another dosage form of the medication. Notify the operating room that the medication has been withheld. ANS: C If there are any questions about the medication order or the medication prescribed, contact the prescriber immediately for clarification and for an order of the appropriate dose form of the medication. Do not change the route without the prescriber‘s order. There is an increased risk of seizure activity if one or more doses of the AED are missed. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies The nurse is monitoring a patient who has been taking carbamazepine for 2 months. Which effects would indicate that autoinduction has started to occur? a. b. c. d. The drug levels for carbamazepine are higher than expected. The drug levels for carbamazepine are lower than expected. The patient is experiencing fewer seizures. The patient is experiencing toxic effects from the drug. ANS: B With carbamazepine, autoinduction occurs and leads to lower than expected drug concentrations. Therefore, the dosage may have to be adjusted with time. The other options are incorrect. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies The nurse is giving an intravenous dose of phenytoin. Which action is correct when administering this drug? a. b. c. d. Give the dose as a fast intravenous (IV) bolus. Mix the drug with normal saline, and give it as a slow IV push. Mix the drug with dextrose (D5W), and give it as a slow IV push. Mix the drug with any available solution as long as the administration rate is correct. ANS: B Intravenous phenytoin is given only with normal saline solution to prevent precipitation formation caused by incompatibilities. The IV push dose must be given slowly (not exceeding 50 mg/min in adults), and the patient must be monitored for bradycardia and decreased blood pressure. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies If you need any other Test Banks or eTextbooks contact us: [email protected] 7. 8. 9. 10. The U.S. Food and Drug Administration has issued a warning for users of antiepileptic drugs. Based on this report, the nurse will monitor for which potential problems with this class of drugs? a. Increased risk of suicidal thoughts and behaviors b. Signs of bone marrow depression c. Indications of drug addiction and dependency d. Increased risk of cardiovascular events, such as strokes ANS: A The U.S. Food and Drug Administration (FDA) has required black box warnings on all antiepileptic drugs regarding the risk of suicidal thoughts and behaviors. Patients being treated with antiepileptic drugs for any indication need to be monitored for the emergence or worsening of depression, suicidal thoughts or behavior, or any unusual changes in mood or behavior. The other options are incorrect. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies A patient is experiencing status epilepticus. The nurse prepares to give which drug of choice for the treatment of this condition? a. Diazepam b. Midazolam c. Valproic acid d. Carbamazepine ANS: A Diazepam and lorazepam are considered by many to be the drugs of choice for status epilepticus. Other drugs that are used are listed in Table 14-3 and do not include the drugs listed in the other options. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies Phenytoin has a narrow therapeutic index. The nurse recognizes that this characteristic indicates which of these? a. b. c. d. The safe and the toxic plasma levels of the drug are very close to each other. The phenytoin has a low chance of being effective. There is no difference between safe and toxic plasma levels. A very small dosage can result in the desired therapeutic effect. ANS: A Having a ―narrow therapeutic index‖ means that there is a small difference between safe and toxic drug levels. These drugs require monitoring of therapeutic plasma levels. The other options are incorrect. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies A patient has been taking an AED for several years as part of his treatment for seizures. His wife has called because he ran out of medication this morning and wonders if he can go without it for a few days until she has a chance to go to the drugstore. What is the nurse‘s best If you need any other Test Banks or eTextbooks contact us: [email protected] 11. 12. response? a. ―He is taking another antiepileptic drug, so he can go without the medication for a week.‖ b. ―Stopping this medication abruptly may cause withdrawal seizures. A refill is needed right away.‖ c. ―He can temporarily increase the dosage of his other antiseizure medications until you get the refill.‖ d. ―He can stop all medications because he has been treated for several years now.‖ ANS: B Abrupt discontinuation of antiepileptic drugs can lead to withdrawal seizures. The other options are incorrect. The nurse cannot change the dose or stop the medication without a prescriber‘s order. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies During a routine appointment, a patient with a history of seizures is found to have a phenytoin level of 18 mcg/mL. What concern will the nurse have, if any? a. The patient is at risk for seizures because the drug level is not at a therapeutic level. b. The patient‘s seizures should be under control because this is a therapeutic drug level. c. The patient‘s seizures should be under control if she is also taking a second antiepileptic drug. d. The drug level is at a toxic level, and the dosage needs to be reduced. ANS: B Therapeutic drug levels for phenytoin are usually 10 to 20 mcg/mL (see Table 14-6). The other options are incorrect. DIF: Cognitive Level: Analyzing (Analysis) MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential TOP: Nursing Process: Evaluation A patient is taking gabapentin, and the nurse notes that there is no history of seizures on his medical record. What is the best possible rationale for this medication order? a. b. c. d. The medication is used for the treatment of neuropathic pain. The medication is helpful for the treatment of multiple sclerosis. The medication is used to reduce the symptoms of Parkinson‘s disease. The medical record is missing the correct information about the patient‘s history of seizures. ANS: A Gabapentin is commonly used to treat neuropathic pain. The other options are incorrect. DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: Assessment MSC: NCLEX: Physiologi