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With which medical condition would a nurse expect the health care provider to reduce the dosage of ranitidine due to potential accumulation of the drug?
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Which outcome is anticipated as a result of histamine2 receptor blockers obstructing histamine2 receptors in the parietal cells in the stomach?
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Pharma 2 BSN315-17
Week 1-15
| Question | Answer |
|---|---|
| With which medical condition would a nurse expect the health care provider to reduce the dosage of ranitidine due to potential accumulation of the drug? | Kidney disease |
| Which outcome is anticipated as a result of histamine2 receptor blockers obstructing histamine2 receptors in the parietal cells in the stomach? | Decrease in hydrogen ions and gastric acid |
| Which comparison between cimetidine and ranitidine is accurate? | Ranitidine is more potent than cimetidine. |
| Which patients would a nurse determine will likely receive a dosage reduction in cimetidine for gastroesophageal reflux disease? | A 71-year-old patient with hypertension A 58-year-old patient with chronic kidney disease |
| Which patients would a nurse recommend against use of ranitidine? | A patient who is breastfeeding A patient who is in her second trimester of pregnancy |
| Which effect would a nurse anticipate may occur if a patient with warfarin is given cimetidine? | Increased anticoagulant effect |
| Which teaching point will a nurse share with a 63-year-old male patient who has been prescribed ranitidine for gastroesophageal reflux disease (GERD)? | Ranitidine should be separated from any other drugs the patient may be taking by at least 1 hour. |
| Which monitoring parameters would a nurse ensure are evaluated when a 73-year-old patient who is newly prescribed cimetidine returns for a follow-up? | Lung sounds Liver function Renal function Mental status change |
| Which statement by the nursing student about the mechanism of action of proton pump inhibitors (PPIs) requires further intervention? | “PPIs work by blocking histamine2 receptors, which reduces gastric acid secretion.” |
| In which time frame would a patient expect to experience effects from esomeprazole? | 1 hour |
| Which statement regarding the pharmacodynamic profile of omeprazole is accurate? | The elimination half-life of omeprazole is 0.5 to 1 hour. |
| Which medical conditions would a nurse recognize that oral esomeprazole may be used to treat? | Gastroesophageal reflux disease (GERD) Duodenal ulcers Nonsteroidal antiinflammatory drug (NSAID)-induced ulcers Zollinger-Ellison syndrome |
| Which patients would a nurse determine require cautious use of or avoidance of esomeprazole? | A 70-year-old Asian patient with hypertension A 73-year-old Caucasian patient with osteoporosis A 29-year-old Hispanic patient who is breastfeeding A 54-year-old Caucasian patient with alcoholic cirrhosis |
| Which outcome would a nurse anticipate from the drug interaction that may occur in a patient who is receiving diazepam and has been newly prescribed omeprazole? | Increase in serum concentration of diazepam |
| A patient who is receiving omeprazole has been prescribed clopidogrel following stent placement. Which outcome does a nurse alert the health care provider about resulting from the drug interaction? | Decrease in activation of clopidogrel |
| A 93-year-old patient with gastroesophageal reflux disease (GERD) is prescribed esomeprazole. The patient is immobile in a skilled nursing facility, is frail, and experienced a stroke a year ago. Which adverse effects | Dementia Pneumonia Osteoporosis Hip or vertebral fracture |
| Which statement by the nursing student in regard to the pharmacokinetic parameters of calcium carbonate requires further intervention? | “The solubility of calcium is decreased in an acidic environment.” |
| Which statement about the classification of antacids is accurate? | Aluminum hydroxide is a non-systemic antacid that can cause constipation. |
| Which time frame can a nurse expect aluminum hydroxide to reach its peak concentration? | 30 minutes |
| Which phrases accurately describe the mechanisms of action exerted by antacids? | Rasie gastric pH Neutralize stomach acidity Lower pepsin activity |
| Which outcome would a nurse anticipate might occur when magnesium hydroxide is administered with phenytoin? | Decreased absorption and efficacy of phenytoin |
| Which effect would a nurse monitor for in a patient who is receiving glipizide, a sulfonylurea, and aluminum hydroxide? | Hypoglycemia |
| Which patients would a nurse determine have precautions to treatment with calcium carbonate? | a patient with hypoparathyroid disease a patient with real dysfunction on dialysis |
| A nurse is caring for a patient who takes calcium carbonate and was recently prescribed ciprofloxacin, a quinolone, for a urinary tract infection. Which teaching point would the nurse share with this patient about administration of these drugs? | Take calcium carbonate 1 to 2 hours after ciprofloxacin. |
| A patient who takes an antacid frequently for persistent heartburn presents with confusion and extreme muscle weakness. The patient is also having difficulty speaking. Which antacid would a nurse suspect this patient may have been receiving in excess? | Aluminum hydroxide |
| Which antiemetic can a nurse anticipate having the longest duration of action? | Scopolamine |
| Which antiemetic is excreted in urine, feces, and bile? | Dronabinol |
| Which statement regarding the pharmacodynamic parameters of intravenous (IV) ondansetron is accurate? | Its elimination half-life is 3 to 5 hours. |
| Which time frame can a nurse expect dexamethasone to reach its peak concentration? | 5 to 10 minutes |
| Which statement regarding the pharmacokinetic parameters of aprepitant is accurate? | The drug undergoes metabolism mostly by CYP3A4. |
| Which phrase describes how ondansetron works to treat nausea and vomiting? | Blocks the serotonin receptors in the chemoreceptor trigger zone and vagal nerve terminals in the gastrointestinal (GI) tract |
| Which patients would a nurse determine cannot safely receive therapy with promethazine? | A 1-year-old child with profuse vomiting A 31-year-old patient who is breastfeeding |
| A nurse is caring for a patient who will be using a scopolamine patch for motion sickness. In addition to scopolamine, the patient is also taking diphenhydramine, an antihistamine, as needed for allergies. requires further intervention | “I will apply the patch to my upper arm.” |
| Which effect would a nurse anticipate might occur from the drug interaction between dronabinol and warfarin? | Increase in warfarin concentration |
| Which electrolyte abnormality would a nurse monitor for in a patient receiving dexamethasone as an antiemetic who is also receiving furosemide, a loop diuretic? | Hypokalemia |
| Which frequency would a nurse anticipate seeing promethazine prescribed for a patient with nausea and vomiting? | every 4-6 hours |
| Which explanation would a nurse provide a patient about the avoidance of alcohol while taking promethazine? | The combination may cause excessive central nervous system (CNS) effects such as sedation. |
| Which patient has an indication to safely receive misoprostol? | A patient with rheumatoid arthritis who is taking NSAIDs |
| Which phrase describes the mechanism of action of sucralfate? | Inhibition of pepsin |
| Which time frame would a patient expect the effects of oral metoclopramide to last? | 3 to 4 hours |
| Which statement is accurate regarding the pharmacokinetics of sucralfate? | The drug is excreted in the urine. |
| Which time frame describes misoprostol’s elimination half-life? | 20 to 40 minutes |
| Which patients can safely receive misoprostol? | A patient with epilepsy A patient with alcoholism A patient with Parkinson disease A patient with pheochromocytoma |
| Which patient parameters would a nurse ensure are documented before administration of sucralfate? | B. Urine output E. Gastrointestinal (GI) pain |
| Which patient parameter would a nurse ensure has been determined in a 25-year-old female patient receiving misoprostol for prevention of nonsteroidal antiinflammatory drug (NSAID)–induced ulcers? | Pregnancy test |
| A nurse is caring for patient who is taking levothyroxine and has been prescribed sucralfate. Which outcome would the nurse anticipate will occur from this drug interaction? | Increased dosage of levothyroxine |
| Which patient parameters would a nurse ensure are monitored in a patient receiving metoclopramide? | A. Heart rate B. Temperature D. Blood pressure (BP) E. Unusual facial or tongue movements |
| Which statement made by a lactating female patient regarding misoprostol therapy requires further intervention? | "I should take magnesium-containing antacids to help with any stomach issues from misoprostol." |
| Which teaching points would be shared by a nurse with a patient who is receiving metoclopramide as orally disintegrating tablets? | Continue taking metoclopramide, even upon feeling better. Avoid driving or other hazardous activities until stabilized on the medication. medication on the tongue, allowing it to dissolve before swallowing. Avoid alcohol this can increase sedation. |
| Which phrase describes a correct therapeutic goal for treatment of Parkinson’s disease? | Improve the patient’s ability to carry out activities of daily living |
| Which statement about carbidopa-levodopa is accurate? | Carbidopa-levodopa should not be stopped abruptly. |
| Which statement about the mechanism of action of carbidopa is accurate? | Carbidopa has no therapeutic effect on its own. |
| A nurse administers oral carbidopa-levodopa to a patient who has tremors caused by Parkinson’s disease. The nurse would expect to see the medication effect in which time frame? | 5 hours |
| Which statement is accurate about the pharmacodynamics of topical rivastigmine? | Onset of action is 0.5 to 1 hour. |
| Which description of the therapeutic effect of rivastigmine is accurate? | Improves memory |
| Rivastigmine must be used with caution in patients with which condition? | Asthma |
| A nurse is evaluating the effectiveness of a patient’s drug regimen for Alzheimer’s disease. Which assessment finding by the nurse would indicate that the drug is effective? | Improvement in mental status |
| A patient has been taking carbidopa-levodopa for many years. During assessment, the nurse finds that the patient presents with hand tremors, drooling, and a mask-like facial expression. Which action would the nurse anticipate incorporating into the | Increase in medication dosage |
| Which foods would the nurse instruct a patient who is taking selegiline to avoid? | Aged cheeses Red wine Bananas |
| The nurse is providing education to a patient taking carbidopa-levodopa. Which statement by the nurse correctly explains why the patient should take this medication with low-protein foods? | "High-protein foods interfere with transportation of this medication to the central nervous system." |
| A patient taking an antihypertensive drug and carbidopa-levodopa tells the nurse that he or she is applying for a job that involves operating heavy machinery. Which information would the nurse share with the patient? | "These medications together may increase your risk for hypotension, so you will need to use caution when operating heavy machinery." |
| Which instruction is most important for the nurse to include when teaching a patient who has been prescribed sustained-released carbidopa-levodopa? | "Watch for adverse effects like dizziness and drowsiness." |
| Which statement related to carbidopa-levodopa and symptoms of dyskinesia would the nurse include in patient teaching? | "It may take weeks or months before your symptoms are controlled." |
| The nurse is preparing to administer rivastigmine to a patient. The prescription states to administer 8 mg b.i.d. The pharmacy sends four 2-mg tablets for the morning dose. Which action would the nurse take? | Call the health care provider for a prescription change. |
| Which effect may occur when theophylline and rivastigmine are administered together? | Increased risk for theophylline toxicity |
| Which factor in a patient’s health history is most important for the nurse to consider with regard to treatment for Alzheimer’s disease using rivastigmine? | Liver disease |
| A family member states, “My father complains of an upset stomach after taking rivastigmine.” Which response by the nurse is appropriate? | “Make sure he takes the medication with food.” |
| To evaluate the effectiveness of dopaminergic agents, the nurse would assess for which condition? | Improvement in balance |
| A patient with complex partial seizures is prescribed phenytoin to control recurrent seizures, but the patient reports being reluctant to take the drug long term because of its side effects. Which information would the nurse provide this patient? | “Ask your health care provider about the possibility of using a different class of antiseizure medication.” because of side effects causing adherence to regimen issue |
| The nurse is caring for a patient who is experiencing excessive drowsiness caused by phenytoin. The health care provider withholds the drug and prescribes a serum drug level test. For which length of time will the nurse monitor the patient for drowsiness? | 24 to 42 hours |
| Which condition is most likely to require lower dosing and closer monitoring to prevent drug toxicity in a patient taking phenytoin? | Hepatitis |
| A patient who has a seizure disorder has begun taking phenytoin. To ensure effectiveness of the drug, which laboratory value will the nurse monitor? | Serum drug levels |
| The nurse is performing an admission assessment on a patient who will receive intravenous phenytoin. The patient reports a history of a “slow heart rate.” Which action by the nurse is appropriate? | Request an electrocardiogram (ECG). |
| A patient prescribed phenytoin reports using over-the-counter medications to treat acid reflux. Which response by the nurse is correct? | “Use an antacid that does not contain calcium.” calcium binds to it reducing therapeutic effect by decreasing absorption |
| A patient who has type 2 diabetes mellitus (DM) will begin taking phenytoin to treat seizures. Which ongoing assessment will the nurse complete on this patient? | Close monitoring of serum glucose Phenytoin can lead to increased serum glucose levels; this needs to be monitored closely in patients with type 2 DM. |
| The nurse is preparing to administer a dose of intravenous phenytoin to a patient and notes that the patient’s serum phenytoin level is 25 mcg/mL. Which action would the nurse take? | Hold the dose and notify the health care provider. The therapeutic serum level of phenytoin is 10 to 20 mcg/mL. |
| At the beginning of a shift, the nurse assesses a 65-year-old patient who is receiving intravenous (IV) phenytoin and notes that the pump is programmed to deliver 50 mg/minute. Which action would the nurse take? | Stop the IV. Notify the health care provider. Assess the patient’s blood pressure and heart rate.The maximum rate for IV phenytoin is 50 mg/minute for adults, but not more than 20 mg/minute for older adults |
| An older adult patient who weighs 70 kg is in status epilepticus. Which dose is an appropriate loading dose of phenytoin for this patient? | 1400 mg The loading dose of phenytoin is 15 to 20 mg/kg IV given as a single dose. A patient weighing 70 kg would get a loading dose of 1400 mg (20 mg x 70 kg). |
| A patient who has been taking phenytoin for several years reports stopping the drug the day before admission to the hospital. Which condition is most important for the nurse to monitor for in this patient? | Status epilepticus |
| A patient who is taking oral phenytoin reports experiencing heartburn and gastrointestinal (GI) upset. Which recommendation will the nurse provide to the patient? | Take the medication with food. |
| A patient calls the clinic 1 week after beginning therapy with phenytoin to report urine that is pinkish red. How would the nurse respond? | Reassure the patient that this is a harmless side effect of phenytoin. |
| The nurse would teach a patient with diabetes who is taking phenytoin to monitor for which condition? | Phenytoin can cause increased serum glucose, so this patient should monitor for hyperglycemia. |
| The nurse is teaching a patient about the administration of phenytoin and instructs the patient to perform which action in case of a rash? | Some patients may develop Stevens-Johnson syndrome, which may present with a rash. This is a serious and potentially fatal adverse effect and should be immediately reported to the health care provider. |
| A nurse would instruct patients taking phenytoin to report which side effects? | Fever Dizziness Bleeding gums |
| For which primary purpose does an individual take an opioid drug that has been prescribed by a health care provider? | Pain control |
| Which assessment finding would the nurse anticipate for a patient who has a blood alcohol content of 0.10%? | Impaired judgment with poor coordination |
| Which drugs are considered to be Z-drugs? | Eszopiclone Zaleplon Zolpidem |
| For which desired effects does a person misuse a Z-drug? | Induce a sense of calm Achieve muscle relaxation Decrease anxiety Facilitate sedation |
| The nurse is caring for a patient who has misused substances and whose temperature is 95°F. Which substance does the nurse anticipate the patient has consumed? | Alcohol |
| The oncoming nurse receives report and will be caring for a patient who has stimulant toxicity. Which assessment findings would the nurse anticipate? | Diaphoresis Hyperthermia Tachycardia Extreme agitation Psychosis |
| The nurse is caring for a patient who has been diagnosed with oxycodone overdose. In addition to expected assessment findings, for which additional sign of toxicity would the nurse monitor? | Prolonged QT interval |
| Which assessment findings does the nurse anticipate in a patient diagnosed with benzodiazepine toxicity? | Coma Central nervous system depression Respiratory depression |
| A patient asks the nurse how disulfiram works. What is the correct nursing response? | “If alcohol is ingested, acetaldehyde accumulates to toxic levels, producing unpleasant effects.” |
| Based on what the nurse understands about the pharmacokinetics and pharmacodynamics of oral naltrexone, which instruction regarding dosing would be included in patient teaching? | Take the prescribed dose at the same time each day. |
| The nurse is caring for a patient taking disulfiram who consumed alcohol before admission. Which assessment finding requires immediate nursing intervention? | Respiratory rate 10 breaths per minute |
| Which patient statement regarding disulfiram reflects that nursing teaching has been effective? | "When taking this medication, I cannot consume alcohol." |
| Which teaching would a nurse provide if a patient experiences edema, erythema, and pruritis around the injection site after a dose of intramuscular naltrexone? | Notify the health care provider. |
| Which substances would the nurse teach a patient taking disulfiram to avoid? | beer vinegar cough syrup colonge cold remedies |
| Which substances will the nurse teach the patient about that may cause adverse reactions with disulfiram? | st johns wort warfarin isoniazid |
| Which teaching will the nurse include about the effects of drinking alcohol while taking disulfiram? | "Symptoms can occur with as little as 7 mL of alcohol." |
| In which way does buspirone differ from other anxiolytics? | It is not a central nervous system (CNS) depressant. |
| Which laboratory value(s) would the nurse follow for a patient who has been taking buspirone regularly? | Alanine transaminase (ALT) and aspartate transaminase (AST) |
| A patient is having an acute anxiety attack because of the anticipation of surgery the following day. The health care provider prescribes buspirone. Which nursing action is appropriate? | Hold the medication and verify the prescription with the health care provider. Its not an PRN med it takes time |
| Which patient who would benefit from buspirone does the nurse discuss with the health care provider? | Which patient who would benefit from buspirone does the nurse discuss with the health care provider? because it has no abuse potential |
| A patient taking buspirone uses the call light after breakfast to report feeling “really spacey.” Which nursing response is appropriate? | Asking "Did you drink grapefruit juice with breakfast?" is appropriate because buspirone has an interaction with grapefruit juice that can lead to toxicity. Elevated levels of buspirone may cause drowsiness and subjective effects (dysphoria, feelin |
| The health care provider prescribes ketoconazole for a patient. Before administration of the new medication, the patient’s family brings in an updated medication list that includes buspirone. Which action should the nurse take? | Hold the ketoconazole and notify the health care provider. The patient should not receive ketoconazole with buspirone because of the risk for buspirone toxicity |
| The nurse notes in the medical administration record (MAR) that a nurse from the previous shift administered buspirone to a patient who is also taking a monoamine oxidase inhibitor (MAOI). Which actions would the nurse take? | Perform a focused assessment on the patient. Contact the health care provider. The nurse recognizes that buspirone and MAOIs should not be given together because of the risk for hypertension |
| Before administering buspirone to a patient, the nurse provides teaching. Which patient statement demonstrates that teaching has been effective? | “This medication may make me dizzy; I will call for assistance when walking to the bathroom.” |
| Buspirone is contraindicated for which patients? | Patients with a known drug allergy |
| Which information would the nurse teach a patient about how aripiprazole affects dopamine? | Exerts a moderate block of dopamine receptors |
| The health care provider indicates that a first-generation antipsychotic will be prescribed for a patient with psychosis. Which drugs would the nurse anticipate may be prescribed? | Fluphenazine Haloperidol |
| In addition to schizophrenia, aripiprazole is commonly used for which indications? | Bipolar mania Major depressive disorder Irritability associated with autism spectrum disorder |
| In which substances is aripiprazole excreted? | Feces A small amount of aripiprazole is excreted in the feces. Urine Aripiprazole is mostly excreted in the urine. |
| Which side effect would the nurse assess for in a patient taking aripiprazole who nearly falls after standing up? | Orthostatic hypotension |
| For which patient would the nurse question a prescription for aripiprazole? | Patient who drinks alcohol Taking a second-generation antipsychotic (SGA) may cause hypotension or central nervous system depression; the nurse would question a prescription for aripiprazole in a patient who drinks alcohol. |
| Which laboratory result(s) would a nurse monitor for a patient taking an atypical antipsychotic drug? | Serum glucose, cholesterol, and triglycerides |
| The nurse would assess for which finding in a patient taking fluphenazine who reports tremors and neck spasms? | Extrapyramidal symptoms Fluphenazine has a high incidence of extrapyramidal symptoms, which may manifest with parkinsonian symptoms (tremors) and acute dystonia (neck spasms). |
| The nurse would explain to a patient that fluphenazine is incompatible with which beverage? | Apple juice Pectinates (apple juice), tea (tannics), and caffeine found in colas and coffee may be incompatible with fluphenazine and should be avoided. |
| A patient with schizophrenia says, “I quit taking an antipsychotic because it makes me feel bad.” Which nursing response is the priority? | “Tell me more about the symptoms you experienced.” |
| Which phrase describes the mechanism of action of duloxetine? | Inhibits reuptake of serotonin and norepinephrine |
| In which area of the body is the majority of lithium absorbed? | Gastrointestinal (GI) tract |
| The nurse is caring for a patient who started lithium therapy 6 weeks ago. The patient states, “This medication is not helping me.” Which nursing responses are appropriate? | B. "The medication should be working by now; let's contact the health care provider." C. "Your medication regimen likely needs to be adjusted." |
| The nurse is caring for a patient with a history of bipolar disorder and mania who has been nonadherent to medication therapy in the past. Which medication would the nurse anticipate will be prescribed by the health care provider? | Lithium |
| The nurse notes a patient’s lithium level as 0.1 mEq/L. Which prescription from the health care provider would the nurse anticipate receiving? | Increase in lithium dose |
| Which teaching would the nurse provide to a patient who has just been prescribed a selective serotonin reuptake inhibitor (SSRI)? | “Do not abruptly stop taking the medication.” |
| The telehealth nurse receives a call from a spouse who reports that the patient started sertraline 2 days ago and is now confused, anxious, sweating, and feverish. Which nursing response is appropriate? | “Take your spouse to the emergency department.” |
| Which effect is the priority for the nurse to educate a patient about who is newly prescribed duloxetine? | Suicidal ideation |
| A patient with bipolar disorder taking lithium reports still experiencing manic episodes. Which request would the nurse make to the health care provider? | Order a lithium level. |
| Which education would the nurse include when teaching a patient who has just been prescribed a selective serotonin reuptake inhibitor (SSRI)? | “Do not operate automobiles or machinery when beginning to take this medication.” |
| The nurse is teaching a patient about dietary restrictions related to lithium. Which response by the patient indicates that the patient understands the teaching? | “I will monitor my sodium intake.” |
| Which dietary recommendations would the nurse make to the patient who is taking lithium? | A. Decrease intake of coffee. C. Stabilize intake of salt. |
| The nurse is caring for a patient who has a new prescription for sertraline. The patient states, “I am so glad I can take this medication while I am trying to get pregnant.” Which nursing response is appropriate? | “There may be risks to the newborn infant. Let’s talk with your health care provider.” |
| Which phrase describes the mechanism of action of atypical antidepressants? | Varies with the medication |
| The Food and Drug Administration (FDA) has approved selective serotonin reuptake inhibitors (SSRIs) to treat which conditions? | A. Major depressive disorder B. Obsessive-compulsive disorder C. Panic disorder E. Posttraumatic stress disorder F. Premenstrual dysphoric disorder |
| A patient who is taking an atypical antidepressant for the first time says, “I’m glad this will start to work quickly.” Which response would the nurse provide? | “You should feel some relief in 1 to 2 weeks and the full effect in about 2 months.” |
| A patient taking long-term amphetamines is ready to be weaned off of the medication. Which information is most important for the nurse to provide the patient about medication discontinuation? | Abrupt discontinuation can cause depression. |
| Which information would the nurse emphasize when educating a patient about anorexiants for weight loss? | A nutritious diet is one of the most important components to weight loss. |
| Amphetamines should be prescribed for short-term use because of which potential effect? | Amphetamines have a high potential for tolerance. |
| Which use of analeptics is appropriate? | Stimulation of respirations |
| Parents report they are giving their child methylphenidate at breakfast and at dinnertime for the treatment of attention-deficit/hyperactivity disorder (ADHD). Which education would the nurse provide regarding this dosing schedule? | “Give methylphenidate at least 6 hours before bedtime because it may cause insomnia.” |
| Which assessments would the nurse conduct before initiating methylphenidate for a child? | Height Weight Growth |
| A patient ran out of methylphenidate 8 days ago. Which symptoms would the nurse assess for in this patient? | Nausea Vomiting Headache |
| Which interaction would the nurse monitor for in a patient who is taking methylphenidate concurrently with antihypertensives? | Methylphenidate may reduce the effect of antihypertensives. |
| A patient who routinely takes methylphenidate asks the nurse if pseudoephedrine can be taken to help treat a sinus infection. Which response by the nurse is appropriate? | “Pseudoephedrine taken with methylphenidate increases the stimulatory effects of irritability, nervousness, tremors, and insomnia.” |
| Which assessments would the nurse perform when evaluating methylphenidate therapy? | Vital signs Attention level Level of hyperactivity Presence of side effects |
| The nurse explains to the patient that tremors and increased heart rate are possible side effects of central nervous system (CNS) stimulants. Which information would the nurse provide the patient regarding these side effects? | “Report these side effects to the health care provider.” |
| A nursing mother asks to take an anorexiant to assist with weight loss. Which education would the nurse provide to this patient? | "Nursing mothers should avoid central nervous system stimulants because these drugs are excreted in breast milk." |
| Which strategy is appropriate for a patient taking a central nervous system (CNS) stimulant to use to monitor for weight loss? | Weigh twice a week. |
| Which statement describes the rationale for providing calorie-dense meals to a child taking a central nervous system (CNS) stimulant? | CNS stimulants may have anorexic effects. |
| The nurse would monitor which laboratory values for a patient taking cyclobenzaprine? | Liver function tests |
| The nurse understands that excretion of cyclobenzaprine occurs via which organ system? | Kidneys |
| Which nursing assessments are important for a patient prescribed cyclobenzaprine? | Level of consciousness Breathing Blood pressure |
| Which method would the nurse use to administer cyclobenzaprine to facilitate the greatest amount of absorption? | Administer on an empty stomach |
| Use of muscle relaxants is contraindicated in patients with which condition? | Hepatic disease |
| A patient who has been taking 5 mg of oral cyclobenzaprine PO tid for 6 weeks asks for a renewal of the prescription. Which information is of concern to the nurse? | Length of time patient has been on medication |
| The nurse educates a patient to avoid which drugs while taking muscle relaxants? | Alcohol Kava kava Valerian |
| Which side effects of muscle relaxants would the nurse educate a patient about? | Headache Nausea Muscle weakness |
| Which instruction would the nurse provide a patient taking cyclobenzaprine to avoid dizziness and fainting? | Stand slowly from a sitting position Maintain adequate hydration |
| A patient is complaining of gastrointestinal symptoms when taking a prescribed muscle relaxant. The nurse would recommend which beverage to help alleviate these symptoms? | Milk |
| A nurse is providing discharge teaching to a patient prescribed cyclobenzaprine. Which statement would be appropriate to include in the teaching? | "Notify your health care provider if you think you might be pregnant." |
| The nurse will teach the patient that cyclobenzaprine can relieve which symptoms? | Muscle stiffness Localized muscle spasms Pain with range of motion |
| For which reason should a patient taking cyclobenzaprine report adverse effects to the health care provider? | To prevent respiratory depression |
| The nurse teaches a patient that a muscle relaxant should not be abruptly stopped based on which rationale? | To avoid rebound spasms |
| A patient has been prescribed a skeletal muscle relaxant and asks the nurse, “Why was I told not to drive or participate in activities that require mental alertness while taking this drug?” Which response by the nurse is appropriate? | “Sedation is a common side effect of skeletal muscle relaxants.” |
| A patient who has received an intravenous (IV) dose of midazolam will be switched to oral (PO) formulation. Which adjustment in dosing does the nurse anticipate? | Higher PO dose |
| Which medication would the nurse instruct an otherwise healthy patient to avoid while taking midazolam? | Morphine |
| The nurse administered midazolam intravenously. Which assessment, if noted by the nurse, would require immediate intervention? | Cough - may be indicative of bronchospasm, which is an adverse effect of midazolam. The nurse should intervene to ensure the patient's airway is not compromised. |
| Which assessment finding would require the nurse to hold the prescribed midazolam? | Blood pressure 90/60 mm Hg |
| Which nursing assessments, if applicable, must be completed before the administration of midazolam? | Allergy history Medication history Blood pressure Pregnancy test |
| Which disease-modifying antirheumatic drug (DMARD) is beneficial in rheumatoid arthritis (RA) by inhibiting the enzyme Janus kinase? | Tofacitinib |
| Which disease-modifying antirheumatic drug (DMARD) requires a “washout” if it needs to be quickly removed from the body? | Leflunomide |
| Which disease-modifying antirheumatic drug (DMARD) may be given orally, subcutaneously, or intramuscularly? | Methotrexate |
| Which disease-modifying antirheumatic drug’s (DMARD’s) metabolism occurs through CYP3A4 and is subject to drug interactions involving this isoenzyme? | Tofacitinib |
| A nurse is caring for a patient diagnosed with rheumatoid arthritis (RA) who has been prescribed leflunomide 100 mg PO daily for 3 days then 10 mg PO daily. Before the patient begins leflunomide, which baseline parameters would the nurse assess? | Blood cell counts Blood pressure Liver function tests Purified protein derivative (PPD) test |
| Which patients diagnosed with rheumatoid arthritis (RA) would a nurse determine can safely receive therapy with methotrexate? | A 49-year-old patient with hypertension A 56-year-old patient with dyslipidemia |
| A nurse is caring for a patient with rheumatoid arthritis (RA) who is prescribed leflunomide. The patient is currently taking metformin and pioglitazone for type 2 diabetes, lisinopril for hypertension, and simvastatin for dyslipidemia. interact with- | Pioglitazone |
| A patient who was diagnosed with rheumatoid arthritis (RA) 7 years ago is currently managed with weekly oral methotrexate, hydroxychloroqu | "Inject abatacept into the abdomen, thighs, or upper arm." "Rotate injection sites, avoiding areas that are bruised, hard, or red." "You may experience changes in blood pressure, injection site reactions, headaches, and dizziness with abatacept." |
| Which patient would a nurse determine cannot safely receive therapy with leflunomide? | A 49-year-old patient with end-stage liver disease |
| A nurse is caring for a patient prescribed tofacitinib extended-release 11 mg PO daily who is also receiving methotrexate, HCTZ, and ethinyl estradiol/levonorgestrel. Which teaching point would the nurse provide to the patient about administration? | It cannot be crushed or chewed. |
| A patient with rheumatoid arthritis (RA) asks the nurse why he or she was told to take folic acid with methotrexate. Which rationale would the nurse provide? | To reduce gastrointestinal and hepatic toxicity |
| A nurse is caring for a patient with rheumatoid arthritis who has been prescribed abatacept. Which drug-drug product can be safely administered to a patient who is receiving abatacept? | Methotrexate |
| Match the disease-modifying antirheumatic drug (DMARD) to its associated drug class. | T-cell costimulation modulator: Abatacept Tumor necrosis factor (TNF)-α antagonist:Etanercept Dihydroorotate dehydrogenase inhibitor: Leflunomide Janus kinase inhibitor: Baricitinib |
| A nurse is preparing to administer heparin intravenously (IV) to a patient who was admitted with an acute pulmonary embolus. Which response by the nurse is appropriate when the patient asks why the drug is given IV rather than orally? | Heparin is poorly absorbed by the gastrointestinal (GI) tract. |
| A patient was started on intravenous (IV) heparin at 1200 pm. When will the nurse assess the activated thromboplastin time (aPTT)? | 1800 |
| For which patient would the nurse anticipate administering heparin? | Patient diagnosed with atrial fibrillation |
| The nurse is preparing to administer heparin intravenously (IV). Which response by the nurse would be appropriate when the patient asks when the medication will start working? | “Heparin will start working in about 5 to 10 minutes.” |
| The nurse is preparing to administer unfractionated heparin to three patients. Which patient would the nurse be most concerned about when administering heparin? | Patient with activated thromboplastin time (aPTT) value of 98 seconds |
| A patient who was started on continuous intravenous heparin for a pulmonary embolus complains of “a lot of bruises” and “pink urine.” Laboratory values show that platelets have decreased from 225,000 mm3 to 75,000 mm | Heparin-induced thrombocytopenia (HIT) from heparin |
| A nurse is preparing to administer enoxaparin, a heparin derivative. Which action by the nurse demonstrates the correct technique for administering the medication? | Administer the drug at least 2 inches from the umbilicus. |
| A patient has been receiving subcutaneous heparin every 12 hours. The patient is scheduled to have a lumbar puncture at 0900. Which action is the nurse’s priority? | Notify the health care provider the patient is receiving heparin. |
| Which teaching is appropriate for a patient being discharged with a prescription for subcutaneous heparin? | Shave with an electric razor. |
| A patient on subcutaneous anticoagulant calls the clinic about a cut received on the hand. Which initial action would the nurse tell the patient to take? | Apply direct pressure to the cut for 5 to 10 minutes. |
| For which reasons would the nurse monitor older adults taking heparin more closely for bleeding? | -Capillary walls are more fragile. -Skin is thinner |
| A patient who recently started taking warfarin asks the nurse why laboratory work needs to be obtained every 3 to 4 days. Which response would the nurse provide? | “To ensure adequate dosing of warfarin, the INR needs to be checked every 3 to 4 days.” |
| A patient who has been taking warfarin for chronic atrial fibrillation was advised by a friend to consume a low-protein diet. Which change in warfarin dosage would the nurse anticipate? | Decrease. Rational: Warfarin is 99% bound to protein. With a low-protein diet, less protein will be available for warfarin to bind with, which can increase the bioavailability of warfarin and require a decrease in warfarin dosage. |
| A patient with a mechanical heart valve has been taking warfarin. The patient tells the nurse that vegetables and fruits have been added to the diet. Which effect will most likely occur with the increase in fruit and vegetable intake? | INR will decrease. Rational: Fruits and vegetables can contain vitamin K-rich food. Vitamin K promotes the production of clotting factors, which increases the risk for blood clots. |
| Heparin and warfarin are started simultaneously in a patient who is diagnosed with a deep vein thrombosis. The nurse would anticipate that the heparin will most likely be discontinued at which time? | 3 days after being on Warfain. Rational: Warfarin peaks in 1.5 to 3 days of starting warfarin. Heparin is administered as a bridge until the international normalized ratio (INR) becomes therapeutic, which usually takes 3 to 4 days. |
| The nurse is preparing to administer dabigatran. Dabigatran would be most appropriate for a patient with which medical condition? | Hepatic Dysfunction Rational: Dabigatran is not metabolized by the hepatic enzyme system; therefore a patient with hepatic dysfunction can receive dabigatran. |
| The nurse is preparing warfarin for several patients. For which patient would the nurse be most concerned in administering warfarin? | An alcoholic patient with liver disease Rational: Warfarin is contraindicated in alcoholic patients with liver disease. Alcohol and liver disease disrupt hepatic synthesis of clotting factors, which increases the risk for bleeding. |
| While obtaining a medical history, the nurse finds that the patient taking warfarin eats a spinach salad for lunch every day. Which teaching point would the nurse provide for this patient? | "The salad may decrease warfarin's effectiveness." Rational: Foods high in vitamin K, such as green, leafy vegetables found in salads, can decrease the effectiveness of warfarin, |
| The patient continues to bleed after receiving vitamin K for warfarin toxicity. The nurse anticipates administering which product to a patient who is not responding to vitamin K? | Fresh frozen Plasma Rational: Fresh-frozen plasma can be given to patients who are actively bleeding and are unresponsive to vitamin K or need to rapidly increase clotting factors. |
| A patient is admitted for bleeding caused by an overdose of dabigatran. Which drug will the nurse anticipate administering? | Idarucizumab Rational: Idarucizumab is the antidote to reverse the effects of dabigatran. |
| A patient taking dabigatran complains of dyspepsia. Which instruction would the nurse provide to the patient? | "Take the drug with food." Rational: If gastrointestinal distress, such as dyspepsia, occurs, dabigatran can be taken with food to decrease the distress. |
| Warfarin is appropriate for patients with which conditions? | -DVT -Mechanical Heart valve -PE -Thromboebolic Stroke |
| Which phrases describe reported benefits of prescribing novel oral anticoagulants (NOACs) instead of warfarin? | -Frequent laboratory monitoring is not required for NOACs. -Genetics do not alter the effectiveness of NOACs. -Comorbid conditions do not affect the effectiveness of NOACs. -Diet does not affect the effectiveness of NOACs. |
| Which discharge teaching is appropriate to give a patient who has been prescribed warfarin? | -"Obtain emergency care if you do not stop bleeding within 5 to 10 minutes." -"Check with your health care provider before taking any new medications, including over-the-counter medications and herbals." -"Notify provider if you will be using tobacco |
| A nurse is preparing to administer clopidogrel and aspirin to a patient who has an altered CYP2C19 gene. Which action would the nurse take? | Notify the health care provider. Patients with an altered CYP2C19 gene are poor metabolizers of clopidogrel, which places them at higher risk for complications; |
| A nurse is preparing to administer clopidogrel to a patient who has previously complained of dyspepsia 2 hours after taking the drug. Which action would the nurse take? | Administer the drug with a small amount of food. Clopidogrel is rapidly absorbed with or without food. Common side effects include gastrointestinal (GI) distress. |
| A patient is prescribed clopidogrel and aspirin at 9:00 a.m. Which action would the nurse take? | Administer both drugs at 9:00 a.m. Antiplatelet effects of clopidogrel and aspirin are more effective when administered together than if used separately. |
| Routine medications were prescribed to resume for a patient who returned from major knee surgery 1 hour ago. The nurse is preparing to administer these medications, including clopidogrel. Which action would the nurse take? | Administer the clopidogrel. Surgery is not a contraindication for clopidogrel. The nurse should administer the drug but closely monitor for any evidence of bleeding at the surgical site. |
| The nurse is providing teaching education to a patient who is being discharged with prescriptions for clopidogrel and aspirin. The patient tells the nurse that fresh garlic is used to season many of the foods eaten. Which response would the nurse make? | "Avoid garlic. It can increase chance of bleeding." Garlic can enhance the effects of antiplatelet activities of clopidogrel and aspirin. The risk for bleeding is increased. |
| A patient states that clopidogrel is causing an upset stomach. Which instruction would the nurse provide? | Take the clopidogrel with food." |
| A patient is started on clopidogrel and reports hematuria to the nurse before receiving the morning dose. The nurse has placed a call to the health care provider and is waiting for a response. Which action would the nurse take next? | Administer the medication. When signs of complications such as bleeding occur, the patient should continue taking clopidogrel until the health care provider instructs the patient to stop taking the medication. |
| A patient is on the tenth day of a clopidogrel regimen and presents with a temperature of 102.1oF and total urine output of 200 mL over 24 hours. The patient is disoriented. Which adverse effect would the nurse suspect? | Thrombotic thrombocytopenia purpura (TTP) reaction TTP is a condition characterized by thrombocytopenia, neurologic symptoms, and fever. Most cases occur during the first 2 weeks of treatment and require urgent treatment. |
| A nurse is preparing clopidogrel for several patients. Patients with which conditions should receive the drug? | Prevention of thrombosis Acute coronary syndrome Coronary artery stents Clopidogrel is contraindicated in patients with hemorrhagic stroke. Clopidogrel will increase bleeding. |
| How many days does it take for platelet aggregation to return to baseline once clopidogrel is discontinued? days | 5 days |
| A nurse is preparing to administer alteplase. The nurse would gather equipment knowing that alteplase would be administered by which route? | Intravenously (IV) |
| A patient who was found unconscious was found to have a large, acute pulmonary embolism and was given alteplase. The patient’s family asks the nurse why alteplase was given rather than warfarin. Which response would the nurse make? | “Alteplase is a thrombolytic that is used to dissolve large clots to restore circulation. Warfarin only prevents clots from forming.” |
| A patient with healing stab wounds to the arms and legs is brought to the emergency department with complaints of chest pain. The patient was diagnosed with acute myocardial infarction, and alteplase was prescribed. monitor for? | Bleeding |
| A patient on thrombolytic therapy experiences severe bleeding. The nurse anticipates the administration of which medication? | Aminocoproic acid |
| A patient who has a pulmonary embolism is prescribed alteplase. The review of the patient history reveals an ischemic stroke 4 months ago. Which action would the nurse take? | Notify the health care provider. |
| Which adverse effects would the nurse teach the patient to report during thrombolytic therapy? | -Rapid heartbeat -Rashes -Lightheadedness -Dizziness |
| A patient is being discharged 2 days after being treated with alteplase for acute myocardial infarction (MI). Which statement made by the patient indicates a need for additional teaching? | "I will need to continue to shave with an electric razor." |
| The nurse is teaching a class on angiotensin receptor blockers (ARBs). What would the nurse include in the teaching? | ARBs lower blood pressure by preventing vasoconstriction, ARBs prevent angiotensin II from stimulating release of aldosterone, ARBs prevent angiotensin II from inducing structural changes to heart, ARBs are well absorbed, Valsartan crosses placenta cause |
| The nurse administered a dose of lisinopril at 0800, and the patient’s blood pressure was 189/96 mm Hg. Based on the pharmacodynamics of the drug, at which time would the nurse anticipate the greatest reduction in blood pressure? | 1400 At 1400, the nurse would anticipate peak effects of the drug, as this is 6 hours after administration, and the peak effect occurs within 6 to 8 hours. |
| A patient who is prescribed lisinopril asks the nurse, “Will this drug help the swelling in my legs?” Which nursing response is appropriate? | “Lisinopril may help the edema from progressing, as this drug suppresses aldosterone, which promotes sodium and water excretion.” |
| The nurse is completing discharge teaching, which includes the direction, “Do not stop the angiotensin-converting enzyme (ACE) inhibitor abruptly.” Which effect would the nurse tell the patient to expect if the medication were stopped suddenly? | Dramatic increase in blood pressure |
| For which patients is the use of an angiotensin-converting enzyme (ACE) inhibitor contraindicated? | 32-year-old female patient who is 4 months pregnant, 62-year-old male patient with a history of renal artery stenosis, 29-year-old female patient with a potassium level of 5.2 mEq/L, |
| The nurse is providing education to a patient who is being discharged on valsartan. Which patient responses indicate that more education is required? | Which one of those medications is for my blood pressure?","I have to take it with food or it won’t work.""I take it only when my blood pressure is over 180/80 mm Hg." |
| A patient who is hospitalized following a planned orthopedic surgery has been taking a routine dose of lisinopril since the operative day. Which action will the nurse take when a sudden onset of facial swelling is noted? | Prepare to administer epinephrine subcutaneously. |
| The nurse is teaching a course on calcium channel blockers. Which description of the mechanism of action will the nurse provide? | Calcium channel blockers prevent contraction of smooth muscle and allow dilation of the coronary arteries. |
| The nurse administers a prescribed dose of intravenous verapamil to a patient with a baseline blood pressure (BP) of 210/110 mm Hg at 0800. Which BP reading would the nurse expect to see 15 minutes after administration? | The BP will start to increase, returning to baseline within 10 to 20 minutes. |
| The nurse is teaching about nondihydropyridine calcium channel blockers. Which medication would the nurse include? | Diltiazem |
| The nurse is caring for a patient who is receiving prescribed digoxin and diltiazem. Which assessment data alerts the nurse to a potential interaction? | Irregular heart rate |
| A patient taking a newly prescribed calcium channel blocker states, “I can’t seem to get my shoes to fit. My feet feel puffy.” Which nursing response is appropriate? | "I will contact the healthcare provider, you may need a diuretic" |
| Which teaching would the nurse include for a patient who is being discharged home from an acute care setting on a calcium channel blocker? | "Record each angina attack in a journal." "Assess your heart rate before taking your medication." "Do not chew or crush the sustained-release medication." "keep a daily record of your blood pressure" |
| A patient who is taking sustained-release diltiazem is having difficulty swallowing the medication. What teaching is appropriate? | "try taking the medication whole in applesauce or pudding" |
| Which statements about the pharmacodynamic and pharmacokinetic of digoxin toxicity are correct? | Toxicity can occur easily due to the narrow therapeutic range of digoxin. half-life and duration of digoxin are very long. Digoxin increases myocardial contraction, which increases cardiac output. Oral digoxin begins to work in 30 minutes to 2 hours. |
| The nurse is administering an intravenous (IV) dose of digoxin at 1130. At which time would the nurse anticipate the onset of the drug? | 1140 The nurse would anticipate the onset at 1140 because the onset of IV digoxin is 5 to 30 minutes. |
| A patient who is taking digoxin states, “I take this medication for my high blood pressure.” How would the nurse respond to educate the patient? | "Digoxin is used for heart failure and atrial fibrillation." This statement informs the patient that digoxin is used for either heart failure or atrial fibrillation. It is not used in the treatment of hypertension. |
| The nurse is assessing a patient with a new prescription for digoxin. Which assessment data are contraindications or cautions for digoxin therapy? | History of ventricular tachycardia such as ventricular tachycardia, are contraindications for digoxin therapy. Potassium 3.1 mEq/L used with caution in patients who are hypokalemic (3.1 mEq/L is a low potassium level). History of renal failure |
| Which patient assessment findings would the nurse associate with potential digoxin toxicity? | Reports of blurry vision Reports of halos around objects Disoriented to person, place, and time Vomiting |
| The nurse is conducting teaching for a patient who is being discharged on digoxin. What patient statement indicates the need for further teaching? | My weight will likely go up and down." This statement, that the patient's weight will likely go up and down, requires further education. With heart failure, the patient should not have an increase in weight that would be indication of HF |
| The patient with which medical condition will most likely benefit from lidocaine administered intravenously? | Acute ventricular tachycardia Lidocaine administered intravenously is indicated for patients with ventricular dysrhythmias, such as acute ventricular tachycardia. |
| The nurse will monitor for which therapeutic effect while administering quinidine? | Decreased heart rate Quinidine, a Class IA antidysrhythmic drug, slows the conduction rate and prolongs repolarization, which decreases heart rate such as in atrial fibrillation with rapid ventricular response |
| Which time frame after administration of flecainide would the nurse expect the onset of action to occur? | 3 hours Flecainide's onset is 3 hours. |
| Before administering quinidine, the nurse would assess the patient for which contraindication? | Complete heart block Complete heart block is a contraindication for administration of quinidine. |
| Which symptom, if reported by a patient recently started on quinidine, would the nurse find most concerning? | Shortness of breath Shortness of breath following initiation of quinidine therapy may be a symptom of a pulmonary embolus. |
| A nurse is preparing quinidine to administer to a patient with ventricular dysrhythmia. Which dose of quinidine would cause the nurse to notify the health care provider before administering? | 100mg every 4 hrs usual dose is 324 to 648 every 8-12 hrs |
| A patient with a ventricular dysrhythmia is to receive lidocaine. The health care provider prescribes a lidocaine bolus at 250 mg, which may be repeated in 5 minutes. This is to be followed by a maintenance lidocaine drip at 2 mg/minute for 24 hour | Bolus dose of 250 mg |
| Before the administration of quinidine, the nurse will review the patient’s medication list for which other drugs that can prolong the QT interval? | Fluoxetine Ciprofloxacin Flecainide Ondansetron |
| A patient with ventricular tachycardia and a pulse is to receive lidocaine. Before administering lidocaine the nurse will assess for which contraindications to lidocaine? | First-degree atrioventricular block Second-degree Mobitz I atrioventricular block Wolff-Parkinson-White (WPW) syndrome |
| While administering lidocaine, the nurse will monitor for which adverse drug effect? | Seizure Seizure is an adverse drug effect of lidocaine. |
| A nurse administering flecainide to a patient with sustained ventricular tachycardia will monitor the patient for which adverse drug effect? | Angioedema Angioedema is an adverse drug effect of flecainide. Other adverse drug effects include worsening of arrhythmia, heart failure, seizures, and pulmonary toxicity. |
| A patient who is prescribed quinidine, a Class I antidysrhythmic drug, tells the nurse that “long, hot baths are enjoyable at the end of a long work day.” Which teaching will the nurse provide to the patient regarding long, hot baths? | because quinidine can lower the blood pressure. Quinidine, while an antidysrhythmic drug, can also lower blood pressure. Long, hot baths promote vasodilation, which can worsen hypotension. |
| A patient is being discharged on extended-release (ER) metoprolol. Which statement by the patient indicates an understanding of metoprolol ER? | “I should take the drug whole.” |
| Teaching is provided to a patient who is prescribed metoprolol after a myocardial infarction. Which response by the patient indicates a need for additional teaching? | "I do not need to check my heart rate before taking the drug." Metoprolol is a beta blocker and can lower the heart rate. This patient requires additional teaching. |
| In which division of the nervous system are catecholamines blocked by metoprolol, resulting in drowsiness? | Sympathetic nervous system |
| The nurse reports which assessment finding as contributing to the cardioprotective effect in a patient receiving metoprolol? | The heart rate decreased from 130 to 98 beats/min. Metoprolol slows the conduction through the atrioventricular node, thereby decreasing the heart rate. |
| The patient refuses to take metoprolol because of its effects on the lungs. The nurse explains that metoprolol will not affect the lungs because it affects which type of cell receptors? | Beta 1 |
| The nurse administers propranolol intravenously at 0900. At which time will the nurse start assessing for its therapeutic effects? | 0905 The onset for propranolol administered intravenously occurs within 2 minutes. Therefore the nurse would assess its effects around 0905. |
| Propranolol is prescribed to a patient for heart failure. Which assessment finding would concern the nurse? | Wheezing Propranolol, a nonselective beta blocker, can cause bronchoconstriction. Wheezing is an indication of bronchoconstriction. |
| A nurse is preparing to administer a beta blocker to a patient who has the following vital signs: blood pressure 118/68 mm Hg; heart rate 54 beats/min; and respiratory rate 14 breaths/minute. Which action would the nurse take? | Hold the medication. Beta blockers lower heart rate and blood pressure. A heart rate of 54 beats/min is bradycardic. The nurse should hold the drug and then call the health care provider for further action. |
| A nurse is assessing a patient who has been taking metoprolol. Which assessment finding would be most concerning? | Weight gain of 4lbs in 24 hours Metoprolol decreases the force of ventricular contraction, which can worsen preexisting heart failure. A weight gain of 4 lb within 24 hours is indicative of fluid retention. |
| Which nursing assessment would be of highest priority when administering a beta blocker? | Heart rate |
| A patient who is prescribed propranolol complains of swelling to the feet. Which action would the nurse take? | Hold the propranolol. Swelling of the feet could be an indication of heart failure. Propranolol can cause heart failure by blocking beta1 receptors. Heart failure is a contraindication for propranolol; therefore hold the medicine call HCP |
| A patient taking propranolol complains of dizziness when getting out of bed. Which action would the nurse take first? | Obtain blood pressure and heart rate. Propranolol has a negative chronotropic property to the heart and reduces the workload of the heart. Bradycardia and hypotension can occur. |
| A patient asks the nurse why dronedarone needs to be taken with food. The nurse responds knowing that bioavailability of dronedarone is at which level without food? | 4% |
| Which condition will the nurse suspect for a patient who is prescribed amiodarone? | Ventricular tachycardia Amiodarone is indicated for life-threatening ventricular dysrhythmias, such as ventricular tachycardia. Amiodarone has properties of Class I to IV antidysrhythmic drugs |
| A patient with new onset atrial fibrillation asks the nurse how dronedarone will help with the heart. The nurse answers knowing that dronedarone has which mechanism of action? | Blocks potassium channels Dronedarone primarily blocks potassium channels. It can also block sodium and calcium channels and beta-adrenergic receptors. |
| A nurse reviews the cardiac monitor on a patient who is receiving dronedarone for paroxysmal atrial fibrillation. Which cardiac dysrhythmia would most alarm the nurse? | A nurse reviews the cardiac monitor on a patient who is receiving dronedarone for paroxysmal atrial fibrillation. Which cardiac dysrhythmia would most alarm the nurse? |
| Which action related to drug administration will a nurse expect to take for a patient with unstable ventricular tachycardia? | Administer initial intravenous dose of amiodarone over 10 minutes. For ventricular tachycardia, amiodarone intravenous bolus is to be administered over 10 minutes at 15 mg/min. |
| The nurse is preparing to administer a maintenance dose of amiodarone. Which dose would the nurse administer? | Amiodarone 400 mg daily Once arrhythmia has been controlled, amiodarone is lowered to 400 mg once daily. |
| Which teaching is appropriate for a patient receiving oral amiodarone? | Avoid prolonged sun exposure. Patients on amiodarone should avoid prolonged sun exposure and wear sunscreen when out in the sun. |
| A patient who was prescribed amiodarone is concerned about developing heart failure. Which clinical manifestations would the nurse instruct the patient to report that are indicative of heart failure? | Weight Gain Swelling Difficulty Breathing |
| A patient is prescribed to receive an initial dose of amiodarone 800 mg and a maintenance dose of warfarin 8 mg. Which action would the nurse expect when notifying the health care provider about the order? | Decrease the dose of warfarin. Amiodarone can increase the level of warfarin. The dose of warfarin may need to be decreased. |
| Which statements made by the patient indicate a need for more teaching about dronedarone? | "I can take this without regard to food." "If I forget to take a dose, I can double it." "It is normal to develop swelling to the feet." |
| A patient is receiving amiodarone. During patient teaching, the nurse will explain the importance of drug toxicity knowing amiodarone accumulates in which organs? | Lungs & Liver |
| A nurse administered diltiazem intravenously at 0900. At which time will the nurse assess the patient for therapeutic effects of diltiazem? | 905 |
| A nurse would question a prescription for verapamil in a patient diagnosed with which condition? | Heart failure |
| The nurse is assessing a patient who is taking verapamil for atrial fibrillation and notes 1+ edema to the ankles and feet. Which action would the nurse take? | Assess the patient for heart failure. |
| Before administering diltiazem, the nurse observes the patient’s pulse at 54 beats/min on the cardiac monitor. Which action will the nurse take next? | Hold the drug. |
| Which instruction will the nurse provide on avoiding side effects related to diltiazem? | Increase dietary fiber |
| A health care provider prescribes diltiazem 10 mg intravenous push for persistent atrial fibrillation with a ventricular rate of 115 beats/min. While preparing the diltiazem, the nurse notices the patient is on digoxin 0.125 mg and metoprolol 25 mg. | Hold the diltiazem. The nurse would hold the diltiazem until the prescription can be clarified with the health care provider. Giving diltiazem to a patient who is already taking digoxin and metoprolol could suppress the cardiac function |
| A patient who is being discharged on diltiazem tells the nurse that cooking with herbs and taking supplements has improved the patient’s physical stamina. Which response by the nurse is appropriate? | "Certain supplements can alter the therapeutic effects of diltiazem." The nurse would provide teaching on drug-drug, drug-herb, and drug-food interactions. Grapefruit juice, ginkgo, ginseng, hawthorn, and St. John's wort |
| A patient who is receiving verapamil asks the nurse how the drug helps the heart. The nurse responds knowing that verapamil has which mechanisms of action? | Slowing of sinoatrial (SA) node automaticity Delay of AV nodal conduction Reduction of myocardial contractility |
| A patient with atrial fibrillation is being discharged on verapamil. Which symptoms will the nurse instruct the patient to report to the health care provider? | Weight gain Dyspnea Swelling to feet and ankles |
| The nurse is preparing to administer a loading dose of digoxin to a patient in atrial fibrillation with a heart rate of 130 beats/minute. Which statement describes the rationale for the loading dose? | Achieve therapeutic effect of Digoxin more quickly |
| A nurse would anticipate that which dysrhythmia will likely develop when adenosine is administered? | Asystole The nurse would anticipate asystole when administering adenosine. Asystole is rarely sustained and is resolved quickly. |
| A patient remains in supraventricular tachycardia after administration of adenosine 6 mg. Which action would the nurse anticipate taking? | Administer adenosine 12 mg in 1 to 2 minutes after the previous dose. |
| A patient is being treated with digoxin for atrial fibrillation. Which finding would concern the nurse? | Development of second-degree block Digoxin prolongs the PR interval as a result of the slowed atrioventricular (AV) conduction. Development of second-degree block is a contraindication for digoxin. |
| A nurse is reviewing laboratory results on a patient who is taking oral digoxin. Which electrolyte imbalance would the nurse associate with digoxin toxicity? | Hypokalemia Hypokalemia enhances the risk of cardiotoxicity caused by digoxin. |
| A patient’s rhythm is now asystole after receiving adenosine. Which action would the nurse take? | Monitor the patient Asystole is common for a few seconds after receiving adenosine. While the patient should still be closely monitored, no treatment is required as a result of the short half-life of the drug. |
| A patient who has been taking digoxin for several months is now complaining about changes to vision. Which action would the nurse take? | Further inquire about the vision changes. Vision changes may be normal in this patient, but digoxin can alter vision, such as seeing green, yellow, or purple halos. Therefore the nurse should inquire about the vision changes. |
| A patient with a history of heart failure is taking both a diuretic and digoxin. Which substance would the nurse anticipate administering to this patient? | Potassium Supplement Diuretics can cause potassium loss, increasing the risk of digitalis toxicity. Potassium supplements may be needed. |
| Digoxin is prescribed to a patient who has been taking verapamil for hypertension. Which dosing change would the nurse anticipate seeing in the prescription? | A reduction in digoxin dose by 50% Verapamil decreases digoxin clearance, thereby increasing the effects of digoxin. The dose of digoxin should be decreased by 50%. |
| Before administering digoxin, the nurse would conduct a thorough assessment, knowing that digoxin accumulates the highest in which areas of the body? | Kidney Intestine Heart Skeletel Muscle Digoxin accumulates mostly in the heart, kidneys, intestine, liver, stomach, and skeletal muscle. |
| A nurse is preparing to administer adenosine through an established intravenous site with intravenous fluids infusing. Which intravenous fluids would the nurse accept as compatible with adenosine? | 0.9% NaCl (normal saline) is compatible with adenosine. D5W is compatible with adenosine. Ringer's lactate is compatible with adenosine. |
| Regular insulin is administered at 0730. At which time would the nurse anticipate the insulin to start acting? | 0800 |
| Glargine insulin is administered at bedtime (2100). When should the peak of action be expected for this medication? | Because it is a basal insulin, is considered “peakless.” |
| A nurse administering neutral protamine Hagedorn (NPH) insulin would expect peak effect to occur in which time frame? | 6 to 12 hours |
| A nurse is administering glargine insulin to a patient. Which time frame describes the onset of action of this medication? | 1 to 2 hours |
| After taking metformin at 0800, in which time frame should the patient expect to take another dose? | Within 24 hours |
| Which phrase describes the unique action of empagliflozin, an SGLT2 inhibitor used for type II diabetes? | Promotes glucose excretion through the urine |
| Which action of sulfonylurea drugs lowers the elevated blood glucose levels in patient with type II diabetes? | Stimulates release of insulin from pancreas |
| A home health nurse is visiting a patient who uses prefilled insulin syringes. Which instruction would the nurse provide regarding the storage of the insulin syringes? | Store insulin syringes in refrigerator with needles pointing up. |
| A nurse is treating an unconscious adult who is covered in sweat. The person has a history of diabetes. A blood glucose of 20 mg/dL is obtained. Which substance would the nurse administer? | Glucagon injection Glucagon should be administered to patients who are unconscious or unable to swallow. |
| A patient with type 1 diabetes has a scheduled dose of insulin due. Which action would the nurse take when the fingerstick glucose monitor reads 50 mg/dL? | Hold scheduled dose and give fruit juice. |
| A patient taking insulin has a new prescription for hydrochlorothiazide, a thiazide diuretic to treat hypertension. Which statement by the patient indicates a need for additional teaching about the interactions between the two medications? | "My insulin dose may need to be decreased." Thiazide diuretics increase blood sugar, so the insulin dose would need to be increased, not decreased. |
| A patient with type 1 diabetes, who has been admitted to the hospital for infection, has been taking regular insulin for about 3 months. Which statement made by the patient indicates a need for additional teaching? | "My insulin needs will be decreased." Blood glucose levels can be elevated during stressful times, such as during an infection. Insulin doses may need to be increased for a period of time. |
| There is a clinical protocol to hold metformin for 48 hours before and after tests that require intravenous contrast dye. Which statement explains why metformin would be held? | Contrast dye can cause kidney dysfunction, which is a metformin contraindication. |
| Following administration of a nonantidiabetic drug, the patient develops new responses. Which response indicates an urgent need for nursing intervention? | The presence of itching and rash Itching and rash may indicate a hypersensitivity reaction to the medication and a potential anaphylaxis reaction. The patient with these symptoms would be given the highest priority. |
| A patient diagnosed with type 2 diabetes states, “I did not eat breakfast, but I made sure to take my repaglinide.” Which response by the nurse is appropriate? | "Skipping meals can cause your blood glucose to drop." Repaglinide regulates blood glucose, which could drop if the drug is taken without a meal |
| A patient presents to the emergency department reporting heart palpitations. The patient is flushed, smells of alcohol, and is taking glyburide, a sulfonylurea. Which situation might the nurse suspect based on this clinical presentation? | The alcohol is reacting with the glyburide. |
| A patient taking metformin for type II diabetes is prescribed prednisone for a respiratory infection. Which action would the nurse anticipate? | Increase metformin dosage during prednisone therapy. Prednisone is a corticosteroid that increases glucose blood levels. |
| Which statement accurately describes the glucocorticoid that is secreted from the adrenal cortex along with its effect in the body? | Cortisol, which impacts carbohydrate metabolism |
| Which statements accurately describe the actions glucocorticoids exert in the inflammatory process? | Stimulation of erythroid Reduction of interleukin-1 release from white blood cells Promotion protein metabolism, glycogen production, and fat red Stabilization of lysosomal cell membranes to reduce capillary permeability and leukocyte migration |
| Which statement about fludrocortisone is accurate? | Fludrocortisone possesses both mineralocorticoid and glucocorticoid activity. |
| Which patients does a nurse determine cannot safely receive prednisone? | A 33-year-old patient with active tuberculosis A 78-year-old patient with cataracts |
| A patient has been prescribed prednisone 10 mg PO daily for worsening systemic lupus erythematous (SLE). The patient is also on hydroxychloroquine (for SLE) and warfarin (for venous thromboembolism). | The prednisone will interact with warfarin, increasing the effects of warfarin. |
| A nurse instructs a patient with rheumatoid arthritis who was prescribed prednisone 20 mg PO daily. Which statements by the patient indicate that patient teaching was effective? | have a diet rich in vitamin D and calcium to reduce my risk for osteoporosis.” make sure to take the prednisone with food to avoid an upset stomach.” experience side effects and adverse effects such as insomnia, weight gain, and mood swings.” |
| Which side/adverse effects and/or laboratory results would a nurse monitor for while a patient is receiving fludrocortisone? | Swelling in the extremities Increased blood sugars Hypertension Decreased bone mineral density |
| A nurse is providing care to a patient with chronic kidney disease (CKD) who has been prescribed methylprednisolone. Which statement describes the appropriate nursing action for this patient and the rationale for this action? | The nurse should monitor for side effects because methylprednisolone is renally excreted. |
| Which categories can be used for classifying glucocorticoids? | Duration of action Route of administration Natural versus synthetic analog Potential for sodium and water retention |
| Which parameters would be assessed in a patient who has been prescribed prednisone? | Vital signs Glucose levels Potassium levels Presence of preexisting edema Skin color, turgor, and temperature |
| Which action enhances the effectiveness of levothyroxine for the patient with hypothyroidism? | Using levothyroxine at a consistent time each day |
| Which description regarding the action of methimazole, a drug prescribed for hyperthyroidism, is accurate? | Blocks thyroid hormone synthesis |
| Which action facilitates cinacalcet absorption? | Giving with meals |
| Which phrase describes the goal of cinacalcet drug therapy? | Decrease and normalize calcium levels. |
| A patient newly diagnosed with hyperthyroidism is pregnant. Which antithyroid drug should be used during first trimester? | Propylthiouracil (PTU) |
| A nurse is preparing to administer levothyroxine. Which finding would require further assessment? | Heart rate of 110 beats/min |
| A patient with diabetes is prescribed levothyroxine for hypothyroidism. Which action from the health care provider should the nurse anticipate occurring for this patient? | An increase in the patients dose of insulin |
| In which time frame should patients expect full therapeutic response from levothyroxine? | 3 to 4 weeks |
| A patient has a new prescription for propylthiouracil. Which instructions are important in relation to drug therapy? | -"Stopping the drug suddenly is not recommended." -"Take antithyroid drugs with meals." -"This drug should not take amiodarone with the prescribed drug." -"Report a slow heart rate of below 60 beats per minute." |
| The nurse teaches the patient taking methimazole to report which symptom to the primary health care provider immediately? | Sore throat |
| Which should be included in the discharge instructions for a patient taking levothyroxine? | “You will need to have lab work done periodically.” |
| A patient has a new prescription for calcitriol. Which pre-administration assessment would the nurse complete? | Survey the current serum calcium level. |
| An older female patient admitted to the hospital with fatigue, weight loss, and lack of appetite states that she has not been taking the prescribed calcitriol. Her serum calcium level 8.3 mg/day. Which focused assessment should the nurse complete? | Observe for hand spasms when taking the blood pressure |
| Which rationale would the nurse provide for limiting high-fat foods in a patient prescribed cinacalcet for hyperparathyroidism? | The drug effects are increased with high-fat foods. |
| Which phrase indicates therapeutic effectiveness of cinacalcet prescribed for hyperparathyroidism? | Down trending of calcium blood levels toward normal |
| Hydrocortisone is a synthetic steroid with a structure identical to which hormone? | Cortisol |
| The nurse is administering pasiriotide to a patient with Cushing’s disease secondary to a pituitary tumor. Which phrase describes the rationale for using this drug? | To block production of adrenocorticotropic hormone (ACTH) |
| A patient is admitted to the emergency department with acute adrenal crisis. Which drug would the nurse anticipate administering? | Hydrocortisone |
| When teaching a patient about the most common side effects of hydrocortisone, which information would the nurse include? | Heartburn or indigestion Insomnia and mood swings Delayed wound healing |
| Which concerns would the nurse address when teaching patients about long-term hydrocortisone therapy for Addison’s disease? | Potential infections Drug interactions Medication compliance |
| A female patient with Addison’s disease has started taking fludrocortisone in addition to hydrocortisone. She calls the clinical nurse to report feet swelling and a headache. Which action should the nurse take? | Instruct the patient to come to the clinic for further evaluation. |
| A patient with Addison’s disease is upset about weight gain and wants to stop taking hydrocortisone and fludrocortisone. Which response would the nurse make? | “If you stop taking the medications, you may have severe side effects.” |
| Which foods would the nurse advise patients on long-term fludrocortisone for Addison’s disease to include in their diet? | Foods rich in potassium |
| Hydrocortisone is prescribed to a patient newly diagnosed with Addison’s disease. When reviewing current medications taken by the patient, the nurse is aware that hydrocortisone could increase the action of which drugs? | Ibuprofen, a nonsteroidal antiinflammatory drug, for pain Metformin, an antidiabetic drug Furosemide, a loop diuretic |
| In addition to treating primary growth failure, somatropin has therapeutic uses in which situations? | Growth failure caused by chronic renal failure Cachexia or wasting with AIDS Growth enhancement in children with Turner syndrome |
| Which phrase describes the action of desmopressin? | Increases water reabsorption in kidney collecting ducts |
| The nurse administers intravenous desmopressin at 0730. During which time frame would the nurse anticipate giving another dosage of this drug? | 1530 to 1930 |
| Which phase describes the action of octreotide drug therapy? | Inhibits growth hormone release |
| Which phrase describes the therapeutic goal in using octreotide to treat acromegaly? | To control acromegaly symptoms |
| Octreotide should be used with caution in patients with which disorders? | Heart failure Hepatic impairment Chronic kidney disease |
| A child is receiving somatropin for growth failure. During follow-up visits, which data would the nurse monitor? | Serial changes in height and weight chart Presence of antirecombinant human growth hormone (anti-rhGH) antibodies Thyroid levels for hypothyroidism Side effects of therapy reported by family. |
| Octreotide is prescribed to a patient newly diagnosed with acromegaly. When reviewing current medications taken by the patient, the nurse is aware that octreotide could decrease the action of which drugs? | Metformin, a non-insulin antidiabetic drug |
| In the pediatric clinic, a child is receiving growth hormone (GH). The adolescent sibling asks about receiving the same medication. He would like to play basketball but is too short. How should the nurse respond? | “You have stopped growing and can’t take growth hormone.” |
| The spouse of a patient receiving desmopressin calls the clinic to report that her husband is not feeling well and is nauseated and confused. Which action would the nurse take? | Instruct the spouse to bring the patient to the clinic for further evaluation. |
| Which statements regarding the pharmacokinetic parameters of medroxyprogesterone acetate is accurate? | Food increases the drug’s bioavailability. Medroxyprogesterone acetate is 90% protein bound. The drug undergoes hepatic metabolism involving hydroxylation and conjugation. |
| Which formulation of testosterone has the longest elimination half-life? | Intramuscular testosterone cypionate |
| Which phrases accurately describe the mechanism of action and roles of medroxyprogesterone acetate in hormone replacement therapy? | Protects against endometrial proliferation, which can cause cancer Causes a transition in the endometrium from the proliferative to the secretory phase |
| Which time frame describes when oral conjugated equine estrogens (CEE) should reach the peak plasma concentration? | 6 to 10 hours |
| Which drugs are type 5 phosphodiesterase (PDE5) inhibitors used to treat erectile dysfunction (ED)? | Avanafil Sildenafil Tadalafil Vardenafil |
| Which statements accurately describe what occurs normally within the body during an erection? | nonerect arterial blood flow into is equal to venous outflow Acetylcholine ^ the production of nitric oxide from endothelial cells. Nitric oxide activates guanine cyclase, produces cyclic guanosine monophosphate. Cyclic guanosine monophosphate |
| In which time frame can a patient expect sildenafil to begin working? | 30 to 60 minutes |
| Which statement by the nursing student about benign prostatic hyperplasia (BPH) and erectile dysfunction (ED) therapy requires further intervention? | Sildenafil is a 5-alpha-reductase inhibitor that causes smooth muscle constriction, allowing increased blood flow into the penis. |
| Which statement about the pharmacokinetic parameters of finasteride is accurate? | Finasteride is excreted in both the urine and the feces. |
| Which mechanism of action describes how pseudoephedrine works to treat stress urinary incontinence? | Alpha1-adrenergic agonism |
| Which statements regarding the pharmacokinetic parameters of oxybutynin are accurate? | Gels and patches allow for passive diffusion of oxybutynin across the skin. widely distributed in tissues. hepatically metabolized, with most CYP3A4. A small amount of the administered oxybutynin dose is excreted in the urine. |
| Which statement regarding the pharmacodynamics and pharmacokinetics of mirabegron is accurate? | Mirabegron undergoes extensive metabolism that involves CYP2D6 and CYP3A4. |
| Which patient parameters would a nurse ensure are assessed before a female patient begins therapy with oral conjugated equine estrogens and medroxyprogesterone acetate for menopausal symptoms? | Smoking status Complete gynecologic history, including if she has an intact uterus History of or current thromboembolism Patient and family history of hormone-sensitive cancers |
| Which patient education points are important for a nurse to share with a patient who has been prescribed buccal testosterone 30 mg twice daily? | The old tablet should be removed before applying a new one. It may take the drug about 30 seconds for the drug to be applied. The tablet should be placed above the incisor tooth, adhering to the gum. |
| Which teaching points would the nurse share with a patient who had a hysterectomy and is newly prescribed conjugated equine estrogen (CEE)? | The patient may experience depressive symptoms or mood changes with CEE therapy. CEE increases the risk for deep vein thrombosis and stroke and should be used for the shortest amount of time. |
| Which patient education points would the nurse share with a patient who has been prescribed sildenafil for erectile dysfunction? | The drug will not work without adequate sexual stimulation. The drug should be administered about an hour before sexual activities. The patient should report any dizziness, chest pain, or blood pressure changes to the health care provider. |
| A nurse is providing care to a patient with benign prostatic hyperplasia and erectile dysfunction who is receiving both sildenafil and tamsulosin. Which potential outcome may result from the two drugs being taken together? | Hypotension |
| A patient with hyperthyroidism, prostate cancer, type 2 diabetes mellitus, and status post myocardial infarction 9 months ago is in clinic to see if he is able to receive sildenafil for erectile dysfunction. | Status post myocardial infarction |
| Which patients would a nurse determine cannot safely receive therapy with duloxetine for stress urinary incontinence? | A patient with alcoholism A patient with hepatitis B |
| A patient with stress urinary incontinence is prescribed duloxetine 40 mg PO BID. The patient also takes paroxetine (for depression), ibuprofen (for osteoarthritis), lisinopril (for hypertension), atorvastatin (for dyslipidemia), and famotid | Ibuprofen due to an increased risk for bleeding Paroxetine due to an increased risk for serotonin syndrome |
| Which patient teaching points would a nurse to share with a female patient prescribed pseudoephedrine for stress urinary incontinence? | Advise the patient to check her blood pressure at home. The drug should be taken as prescribed, not taking more or less than what was prescribed. The patient should avoid taking the drug late in the day or early evening because it may cause jit |
| Which counseling point would a nurse share with a patient who has been newly prescribed oxybutynin 10% gel 1 sachet once daily? | Smoking should not occur when applying topical oxybutynin. |
| Which patient parameter would a nurse closely monitor in a patient who is taking mirabegron? | Blood pressure |
| Which patient education point would a nurse share with a patient who has been newly prescribed tamsulosin for benign prostatic hyperplasia? | Do not crush, chew, or cut open the capsules. |
| Which statement accurately describes the pharmacokinetic parameters for levonorgestrel used as emergency contraception? | Levonorgestrel is excreted in both urine and feces. |
| Which hormonal contraceptive has the longest elimination half-life? | Medroxyprogesterone acetate injection (Depo Provera®) |
| Which effects are advantages to the use of nonoral combined hormonal contraceptives (CHCs) over oral CHC? | Reduced drug interaction potential Rapidly achieved serum hormone levels Decreased fluctuations of hormone levels in blood |
| Which advantages are associated with the use of progestin-only products (POPs) compared with combined hormonal contraceptives (CHCs)? | Relative safety of contraception Reversibility of contraception, except the depot POP |
| A 29-year-old woman with hypertension had unprotected sexual intercourse about 36 hours ago. Which statement accurately explains whether this patient is a candidate for emergency contraception? | She is a candidate for emergency contraception because it may be taken within 72 hours of unprotected sexual intercourse. |
| Which patients does a nurse determine cannot safely receive treatment with the ethinyl estradiol plus etonogestrel vaginal ring (NuvaRing®)? | A 36 year old with hepatitis A A 37 year old with complicated mitral valve prolapse A 36 year old who smokes one pack of cigarettes per day |
| A female patient has been taking ethinyl estradiol plus norgestimate tablets (Ortho Tri-Cyclen®) for contraception. She was recently prescribed r | Switch to another form of contraception. Increase the estrogen dosage in the combined hormonal contraception (CHC). monitor for breakthrough bleeding, indicate lack of CHC effect. second form of contraception, condom while receiving rifampin. |
| Which teaching points would a nurse share with a patient newly prescribed the ethinyl estradiol plus etonogestrel vaginal ring (NuvaRing®) who has never received hormonal contraception before? | If it is expelled during treatment weeks, washed and reinserted. vaginally insert the ring between day 1 and day 5 of the menstrual cycle, even The ring should be replaced every 3 weeks, re If the ring is expelled for more than 3 hours during we |
| Which potential symptoms resulting from treatment with a combined hormonal contraception (CHC) would a nurse teach a patient to report immediately to the health care provider? | Severe abdominal pain Chest pain or shortness of breath Severe leg pain or swelling in the calf or thigh Severe headaches, dizziness, speech difficulties Eye disorders such as blurry vision or loss of vision |
| Which statement by the nursing student about the administration of norethindrone tablets (Micronor®) requires correction and further education? | If the postpartum patient is fully breastfeeding, she may begin using norethindrone tablets within 3 weeks of delivery. |
| Which teaching points would a nurse share with a patient newly prescribed the ethinyl estradiol plus norelgestromin patch (Ortho Evra®) who is switching from an oral combined hormonal contraception (CHC)? | Before applying, the patient should ensure the skin is dry a Apply the patch on the first day of the menstrual cycle whe If the patch comes off and has not been off for more than 24 ho If the patch comes off and remains off for more than 24 hours, a |
| Which teaching points would a nurse share with a patient who is taking levonorgestrel 0.75 mg PO BID for two doses for emergency contraception? | second dose within 12 hours of the first Once implantation occurs, emergency contraception is not effective. does not protect against STI Nausea, vomiting, and heavier menstruation may occur with emergency contraception. |
| Which description of clomiphene citrate’s mechanism of action is accurate? | Inhibits estrogen receptors in the hypothalamus and pituitary gland to secrete more FSH and LH to stimulate ovulation |
| Which statement about the pharmacokinetic parameters of testosterone is accurate? | Testosterone undergoes hepatic metabolism and beta-oxidation. |
| Which statements about the therapeutic use and pharmacodynamic parameters of clomiphene citrate are accurate? | The drug's elimination half-life is 5 to 7 days. Clomiphene citrate's durat action is 30 days. women with persistent ovulatory dysfunction to stimulate ovulation. When administered to women with polycystic ovary syndrome ( ovulation is increased. |
| Which time frame represents the anticipated elimination half-life of most testosterone products? | 10 to 100 minutes |
| A nurse is caring for a patient who has been prescribed oral methyltestosterone therapy for infertility. This patient also takes warfarin and lisinopril. Which outcome and intervention are recommended to manage a potential drug interac | Methyltestosterone may increase the effects of warfarin; decrease the dosage of warfarin. |
| Which teaching points would a nurse share with a patient who has diabetes and is initiated on a gel formulation of testosterone? | transferred to others if is not completely dry. not abruptly discontinue therapy with testosterone. monitor weight and report any weight gain of more than 5 lbs in a week. testosterone levels monitored within 2 to 4 weeks after starting the drug. |
| A nurse is caring for a patient who has been prescribed clomiphene citrate for infertility. The patient also takes methyldopa for hypertension. Which outcome would a nurse anticipate may come from the drug interaction between methyldopa and clomiph | Impaired fertility due to an increase in prolactin |
| Which administration considerations would be given to a nurse who is caring for a patient initiated on clomiphene citrate? | taken with or without food. max sequential cycles of clomiphene citrate is three. 50 mg once daily and may be increased by 50 mg/day for a second course if ovulation does not occur. occurs within 5 to 10 days after the last dose, |
| Which patient parameters would a nurse inquire about when a patient returns to have his testosterone levels monitored? | Weight changes Mood alterations blood glucose readings blood pressure chanfes |
| For which patient would oseltamivir be appropriate in the treatment of influenza? | 6-year-old patient who has been sick for 36 hours Oseltamivir is approved for persons 1 year old and older and should be started within 48 hours of influenza symptoms. |
| Which statement is correct about the action of oseltamivir? | Prevents the replication of the virus |
| A nurse is preparing to administer non-HIV antivirals for influenza. Which prescription would the nurse clarify before administering the antivirals? | Amantadine to a patient with influenza type B Amantadine is only effective against influenza type A, not influenza type B. The nurse should notify the health care provider about the prescription. |
| For which reason should patients increase their oral fluid intake while on antivirals? | Antivirals are excreted in urine. |
| The nurse is preparing to administer antiretroviral drugs to a patient diagnosed with HIV. How many different types of antiretroviral drugs will the nurse anticipate in administering to the patient? | Three The standard ART includes three or four antiretroviral drugs, with or without pharmacokinetic enhancer. |
| For which reason should darunavir be taken with food? | Food increases the bioavailability of darunavir. |
| Which drugs are indicated for patients with HIV? | Efavirenz Abacavir Maraviroc |
| Which antiretrovirals have a protein binding of 80% or more? | Efavirenz Raltegravir Darunavir Enfuvirtide |
| A patient with which condition cannot safely receive ribavirin? | Autoimmune hepatitis A patient with an autoimmune hepatitis should not receive ribavirin. |
| A child with respiratory syncytial virus (RSV) is receiving aerosolized ribavirin. Which action would the nurse take first when the child’s respiratory function declines during treatment? | Discontinue the treatment. Caution is advised in administering aerosolized ribavirin if respiratory function suddenly declines during treatment. The nurse should withdraw the treatment immediately and provide respiratory support. notify HP |
| A patient who is prescribed oseltamivir is to receive an influenza vaccine with live attenuated virus. Which instruction by the nurse is appropriate? | “Get the vaccine after you have stopped oseltamivir for at least 2 days.” |
| A patient, who has been on lamivudine for hepatitis B, was prescribed sulfamethoxazole-trimethoprim (SMX-TMP) for a urinary tract infection (UTI). The nurse notifies the health care provider because of which drug-drug interaction? | SMX-TMP can increase the levels of lamivudine, which can increase the risk for adverse reactions, such as hepatoxicity and exacerbation of hepatitis B. |
| Acyclovir was prescribed to a patient with a history of seizures that have been controlled with phenytoin. Which action by the health care provider would the nurse anticipate because of the drug-drug interaction? | Increase the phenytoin dose. Acyclovir can decrease the effects of phenytoin. To maintain therapeutic phenytoin serum level, phenytoin may need to be increased. |
| Which statement by the patient indicates an accurate understanding of abacavir? | “I need to avoid all alcohol, including over-the-counter liquid drug preparations.” |
| A patient, who recently started antiretroviral therapy (ART) for HIV infection, asks the nurse why a strict routine for taking the drugs is important. Which reason would the nurse provide? | “Strict drug adherence is important in preventing drug-resistant strains.” |
| A nurse preparing to administer abacavir notes the patient has mild renal impairment. Which action would the nurse anticipate taking? | Administer abacavir. No adjustment is needed with renal impairment; therefore the nurse should administer the dose of abacavir. |
| A patient who has difficulty swallowing solids is prescribed darunavir tablets. Which action by the nurse is correct? | Notify the health care provider to change the prescription to an oral solution. Darunavir is available in oral solution for patients who are unable to swallow pills. |
| The nurse is educating a patient about the side and adverse effects of antiretroviral drugs. Which side effects will the nurse tell the patient are common? | Nausea Vomiting Myalgia Fatigue |
| Match the chemotherapeutic drug to its class. | Antimetabolites-Fluorouracil Plant alkaloids-Vincristine Antitumor antibiotics-Doxorubicin Alkylating drugs-Cyclophosphamide |
| In which phase of the cell cycle do most antimetabolites affect cells? | S phase |
| A patient with multiple myeloma received cyclophosphamide at 0900. Which time would the nurse expect the drug to peak? | 1100 |
| Which statements describe the benefits of treating cancer cells with a combination of different classes of chemotherapeutic drugs? | Therapeutic effect in all phases of cancer cells is increased. Development of drug resistance is decreased. Destruction of cancer cells is increased. |
| A patient receiving vincristine asks why it must be given intravenously. Which response would the nurse provide to the patient? | Oral administration has a low absorption rate." |
| Which statement made by the patient indicates a need for further teaching regarding doxorubicin, an antitumor antibiotic? | “I do not have to worry about infection because the drug is an antibiotic.” |
| A patient is prescribed vincristine for Hodgkin’s lymphoma. On further questioning, the nurse discovers the patient has plant allergies, specifically to periwinkle. Which action would the nurse take? | Notify the health care provider. |
| A nurse is disposing of urine from a patient who is receiving chemotherapeutic drugs. Which action would the nurse take to decrease the risk for occupational exposure? | Apply a face shield. |
| Oral cyclophosphamide 700 mg is prescribed to a patient weighing 125 pounds. Which action would the nurse take first? | Hold the drug. |
| A patient diagnosed with metastatic pancreatic cancer is prescribed fluorouracil as part of a combination regimen with oxaliplatin, leucovorin, and irinotecan. Which treatment cycle would the nurse expect fluorouracil to be repeated? | Every 2 weeks |
| The nurse preparing to administer chemotherapeutic drugs notes the patient has had a significant drop in neutrophils. The nurse would anticipate administering which product into the patient’s plan of care? | Colony-stimulating factors (CSFs) |
| A patient receiving chemotherapeutic drugs complains of mouth lesions and inability to eat or swallow. The nurse notes the patient has opioid analgesic, topical anesthetic, antiemetic, and sedative prescribed. Which | Topical anesthetic |
| A nurse provides teaching to a male patient receiving chemotherapeutic drugs. Which statements made by the patient indicate an understanding of potential side effects of chemotherapeutic drugs? | "I will use a soft toothbrush to brush my teeth." "I may need to take stool softeners to avoid constipation." "I will bank some of my sperm so I still have the option of having children in the future." |
| Block communication pathway Kinase inhibitors Prevent the degrading of proteins Proteasome inhibitors | Assist the immune system Monoclonal antibodies Inhibit formation of new blood vessels Angiogenesis inhibitors |
| A patient receiving erlotinib asks why it is important to prevent the formation of blood vessels. Which response would the nurse provide? | “Blood vessels allow cancer cells travel to distant sites.” |
| A patient diagnosed with leukemia is to receive imatinib. Before initiating imatinib, the nurse would ensure the patient is positive for which chromosomal abnormality? | Ph+ |
| A patient whose diet consists of fried foods is prescribed sorafenib. Which information on the drug-food interactions would the nurse provide to the patient? | High-fat foods decrease the bioavailability of sorafenib. |
| A patient who has been on sorafenib for advanced renal cancer started taking St. John’s wort for depression. Which effects would the nurse assess as a result of the drug-herbal interaction? | Increased proliferation of cancer cells |
| A patient is prescribed erlotinib and gemcitabine for pancreatic cancer. Which information would the nurse provide regarding the risk for infection? | Risk for infection will increase. |
| A patient is prescribed temsirolimus for advanced renal cell cancer. Before the administration of temsirolimus, which substance would the nurse most likely administer? | Antihistamine |
| A patient is prescribed rituximab for chronic lymphocytic leukemia. Which condition would the nurse teach the patient to seek immediate medical care? | Chest pain |
| A patient receiving targeted antineoplastic drug reports not wanting to eat at mealtimes. Which action would the nurse take first? | Determine the reason for not wanting to eat. |
| Which targeted antineoplastic drugs would most likely interact with St. John’s wort? | Erlotinib Sorafenib Bortezomib Temsirolimus |
| Bortezomib is prescribed to a patient who is on prednisone, a hepatic inhibitor. Which change to the dose of bortezomib would the nurse expect? | Decreased dose of bortezomib |
| Which biologic response modifier is expected to stimulate the production of bone marrow cells and to shorten the recovery time after bone marrow transplantation? | Colony-stimulating factors |
| Which phrases are accurate descriptions of the role of interferons? | Inhibit division and replication of tumor cell Produced in the body by activated T cells and other cells during viral replication Assist cells by producing enzymes that block viral replication and stop viral entry into healthy cells |
| Which biologic response modifiers (BRMs) are proteins that are made by cells in the body’s immune system? | Colony-stimulating factor Interferons Interleukin Keratinocyte growth factors |
| Which IFN-alfa products are used for the management of chronic hepatitis C? | IFN-alfa-2a IFN-alfa-2b Peginterferon alfa-2a Peginterferon alfa-2b |
| Which disease state would interferon-β products be used to manage? | Multiple sclerosis |
| Which IFN-alfa product is expected to have the longest elimination half-life? | Peginterferon alfa-2b |
| Which drug is administered to promote proliferation, differentiation, and migration of epithelial cells? | Palifermin |
| Which statement regarding the pharmacokinetic profile of aldesleukin is accurate? | The drug is distributed through the extracellular space. |
| Which drug is used in metastatic renal cell carcinoma and metastatic melanoma to enhance lymphocytic production and cytotoxicity? | Aldesleukin |
| Which baseline assessments would a nurse ensure have occurred before administering filgrastim therapy to a patient? | Bowel sounds and patterns Cardiovascular assessment, including blood pressure, heart rate, edema, and heart sounds White blood cell count |
| A nurse teaches a patient about the administration of newly prescribed aldesleukin. Which statements by the patient indicate need for further intervention? | My vision might change when I am receiving aldesleukin. I will inject the drug into my abdomen or the back of my arm." Aldesleukin may change the way I taste food and discolor my tongue." |
| Which patient does a nurse determine cannot safely receive therapy with interferon-α-2b? | A 57-year-old patient with alcoholic cirrhosis |
| Which instructions would a nurse follow when administering palifermin to a patient receiving intravenous (IV) chemotherapy? | The patient's IV line should be flushed if any heparin is present before administering palifermin. The drug product should be protected from light when not being administered. The nurse should wait at least 24 hours after chemotherapy befor |
| Which rationale does a nurse provide a health care provider regarding a potential drug interaction in a patient who has been prescribed aldesleukin and is currently on atenolol and lithium? | The combination of aldesleukin and atenolol can increase the patient’s risk for hypotension. |
| A nurse counsels a patient receiving aldesleukin to report any significant weight gain; sudden onset of swelling in the arms, legs, and other body parts; nasal congestion; weakness; fatigue; and nausea. These symptoms would be suggestiv | Capillary leak syndrome |
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iobraztsov