Pharmacology & The Nursing Process 8th Edition, Lilley Test Bank

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Test Bank For Pharmacology & The Nursing Process 8th Edition, Lilley. Note: This is not a text book. Description: ISBN-13: 978-0323358286, ISBN-10: 0323358284.

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Test Bank Pharmacology Nursing Process 8th Edition, Lilley

Chapter 01: The Nursing Process and Drug Therapy
1. The nurse is writing a nursing diagnosis for a plan of care for a patient who has been newly diagnosed with type 2 diabetes. Which statement reflects the correct format for a nursing diagnosis?
a. Anxiety
b. Anxiety related to new drug therapy
c. Anxiety related to anxious feelings about drug therapy, as evidenced by statements such as “I’m upset about having to test my blood sugars.”
d. Anxiety related to new drug therapy, as evidenced by statements such as “I’m upset about having to test my blood sugars.”
2. The patient is to receive oral guaifenesin (Mucinex) twice a day. Today, the nurse was busy and gave the medication 2 hours after the scheduled dose was due. What type of problem does this represent?
a. “Right time”
b. “Right dose”
c. “Right route”
d. “Right medication”
3. The nurse has been monitoring the patient’s progress on a new drug regimen since the first dose and documenting the patient’s therapeutic response to the medication. Which phase of the nursing process do these actions illustrate?
a. Nursing diagnosis
b. Planning
c. Implementation
d. Evaluation
4. The nurse is assigned to a patient who is newly diagnosed with type 1 diabetes mellitus. Which statement best illustrates an outcome criterion for this patient?
a. The patient will follow instructions.
b. The patient will not experience complications.
c. The patient will adhere to the new insulin treatment regimen.
d. The patient will demonstrate correct blood glucose testing technique.
5. Which activity best reflects the implementation phase of the nursing process for the patient who is newly diagnosed with hypertension?
a. Providing education on keeping a journal of blood pressure readings
b. Setting goals and outcome criteria with the patient’s input
c. Recording a drug history regarding over-the-counter medications used at home
d. Formulating nursing diagnoses regarding deficient knowledge related to the new treatment regimen
6. The medication order reads, “Give ondmscetron (Zofran) 4 mg, 30 minutes before beginning chemotherapy to prevent nausea.” The nurse notes that the route is missing from the order. What is the nurse’s best action?
a. Give the medication intravenously because the patient might vomit.
b. Give the medication orally because the tablets are available in 4-mg doses.
c. Contact the prescriber to clarify the route of the medication ordered.
d. Hold the medication until the prescriber returns to make rounds.
7. When the nurse considers the timing of a drug dose, which factor is appropriate to consider when deciding when to give a drug?
a. The patient’s ability to swallow
b. The patient’s height
c. The patient’s last meal
d. The patient’s allergies
8. The nurse is performing an assessment of a newly admitted patient. Which is an example of subjective data?
a. Blood pressure 158/96 mm Hg
b. Weight 255 pounds
c. The patient reports that he uses the herbal product ginkgo.
d. The patient’s laboratory work includes a complete blood count and urinalysis.
Chapter 02: Pharmacologic Principles
1. The patient is receiving two different drugs. At current dosages and dosage forms, both drugs are absorbed into the circulation in identical amounts. Which term is used to identify this principle?
a. Bioequivalent
b. Synergistic
c. Prodrugs
d. Steady state
2. When given an intravenous medication, the patient says to the nurse, “I usually take pills. Why does this medication have to be given in the arm?” What is the nurse’s best answer?
a. “The medication will cause fewer adverse effects when given intravenously.”
b. “The intravenous medication will have delayed absorption into the body’s tissues.”
c. “The action of the medication will begin sooner when given intravenously.”
d. “There is a lower chance of allergic reactions when drugs are given intravenously.”
3. The nurse is administering parenteral drugs. Which statement is true regarding parenteral drugs?
a. Parenteral drugs bypass the first-pass effect.
b. Absorption of parenteral drugs is affected by reduced blood flow to the stomach.
c. Absorption of parenteral drugs is faster when the stomach is empty.
d. Parenteral drugs exert their effects while circulating in the bloodstream.
4. When monitoring the patient receiving an intravenous infusion to reduce blood pressure, the nurse notes that the patient’s blood pressure is extremely low, and the patient is lethargic and difficult to awaken. This would be classified as which type of adverse drug reaction?
a. Adverse effect
b. Allergic reaction
c. Idiosyncratic reaction
d. Pharmacologic reaction
5. The nurse is reviewing pharmacology terms for a group of newly graduated nurses. Which sentence defines a drug’s half-life?
a. The time it takes for the drug to cause half of its therapeutic response
b. The time it takes for one half of the original amount of a drug to reach the target cells
c. The time it takes for one half of the original amount of a drug to be removed from the body
d. The time it takes for one half of the original amount of a drug to be absorbed into the circulation
6. When administering drugs, the nurse remembers that the duration of action of a drug is defined as which of these?
a. The time it takes for a drug to elicit a therapeutic response
b. The amount of time needed to remove a drug from circulation
c. The time it takes for a drug to achieve its maximum therapeutic response
d. The time period at which a drug’s concentration is sufficient to cause a therapeutic response
7. When reviewing the mechanism of action of a specific drug, the nurse reads that the drug works by selective enzyme interaction. Which of these processes describes selective enzyme interaction?
a. The drug alters cell membrane permeability.
b. The drug’s effectiveness within the cell walls of the target tissue is enhanced.
c. The drug is attracted to a receptor on the cell wall, preventing an enzyme from binding to that receptor.
d. The drug binds to an enzyme molecule and inhibits or enhances the enzyme’s action with the normal target cell.
8. When administering a new medication to a patient, the nurse reads that it is highly protein bound. Assuming that the patient’s albumin levels are normal, the nurse would expect which result, as compared to a medication that is not highly protein bound?
a. Renal excretion will be faster.
b. The drug will be metabolized quickly.
c. The duration of action of the medication will be shorter.
d. The duration of action of the medication will be longer.
9. The patient is experiencing chest pain and needs to take a sublingual form of nitroglycerin. Where does the nurse instruct the patient to place the tablet?
a. Under the tongue
b. On top of the tongue
c. At the back of the throat
d. In the space between the cheek and the gum
10. The nurse is administering medications to the patient who is in renal failure resulting from end-stage renal disease. The nurse is aware that patients with kidney failure would most likely have problems with which pharmacokinetic phase?
a. Absorption
b. Distribution
c. Metabolism
d. Excretion
Chapter 03: Lifespan Considerations
1. Drug transfer to the fetus is more likely during the last trimester of pregnancy for which reason?
a. Decreased fetal surface area
b. Increased placental surface area
c. Enhanced blood flow to the fetus
d. Increased amount of protein-bound drug in maternal circulation
2. The nurse is monitoring a patient who is in the 26th week of pregnancy and has developed gestational diabetes and pneumonia. She is given medications that pose a possible fetal risk, but the potential benefits may warrant the use of the medications in her situation. The nurse recognizes that these medications are in which U.S. Food and Drug Administration pregnancy safety category?
a. Category X
b. Category B
c. Category C
d. Category D
3. When discussing dosage calculation for pediatric patients with a clinical pharmacist, the nurse notes that which type of dosage calculation is used most commonly in pediatric calculations?
a. West nomogram
b. Clark rule
c. Height-to-weight ratio
d. Milligram per kilogram of body weight formula
4. The nurse is assessing a newly admitted 83-year-old patient and determines that the patient is experiencing polypharmacy. Which statement most accurately illustrates polypharmacy?
a. The patient is experiencing multiple illnesses.
b. The patient uses one medication for an illness several times per day.
c. The patient uses over-the-counter drugs for an illness.
d. The patient uses multiple medications simultaneously.
5. The nurse is aware that confusion, forgetfulness, and increased risk for falls are common responses in an elderly patient who is taking which type of drug?
a. Laxatives
b. Anticoagulants
c. Sedatives
d. Antidepressants
6. For accurate medication administration to pediatric patients, the nurse must take into account which criteria?
a. Organ maturity
b. Renal output
c. Body temperature
d. Height
7. The nurse recognizes that it is not uncommon for an elderly patient to experience a reduction in the stomach’s ability to produce hydrochloric acid. This change may result in which effect?
a. Delayed gastric emptying
b. Increased gastric acidity
c. Decreased intestinal absorption of medications
d. Altered absorption of weakly acidic drugs
8. The nurse is administering drugs to neonates and will consider which factor may contribute the most to drug toxicity?
a. The lungs are immature.
b. The kidneys are small.
c. The liver is not fully developed.
d. Excretion of the drug occurs quickly.
9. An 83-year-old woman has been given a thiazide diuretic to treat mild heart failure. She and her daughter should be told to watch for which problems?
a. Constipation and anorexia
b. Fatigue, leg cramps, and dehydration
c. Daytime sedation and lethargy
d. Edema, nausea, and blurred vision
10. An elderly patient with a new diagnosis of hypertension will be receiving a new prescription for an antihypertensive drug. The nurse expects which type of dosing to occur with this drug therapy?
a. Drug therapy will be based on the patient’s weight.
b. Drug therapy will be based on the patient’s age.
c. The patient will receive the maximum dose that is expected to reduce the blood pressure.
d. The patient will receive the lowest possible dose at first, and then the dose will be increased as needed.
Chapter 04: Cultural, Legal, and Ethical Considerations
1. During the development of a new drug, which would be included in the study by the researcher to prevent any bias or unrealistic expectations of the new drug’s usefulness?
a. A placebo
b. FDA approval
c. Informed consent
d. Safety information
2. A member of an investigational drug study team is working with healthy volunteers whose participation will help to determine the optimal dosage range and pharmacokinetics of the drug. The team member is participating in what type of study?
a. Phase I
b. Phase II
c. Phase III
d. Phase IV
3. During discharge patient teaching, the nurse reviews prescriptions with a patient. Which statement is correct about refills for an analgesic that is classified as Schedule C-III?
a. No prescription refills are permitted.
b. Refills are allowed only by written prescription.
c. The patient may have no more than five refills in a 6-month period.
d. Written prescriptions expire in 12 months.
4. A patient has been selected as a potential recipient of an experimental drug for heart failure. The nurse knows that when informed consent has been obtained, it indicates which of these?
a. The patient has been informed of the possible benefits of the new therapy.
b. The patient will be informed of the details of the study as the research continues.
c. The patient will receive the actual drug during the experiment.
d. The patient has had the study’s purpose, procedures, and the risks involved explained to him.
5. For which cultural group must the health care provider respect the value placed on preserving harmony with nature and the belief that disease is a result of ill spirits?
a. Hispanics
b. Asian Americans
c. Native Americans
d. African Americans
6. The nurse is assessing an elderly Hispanic woman who is being treated for hypertension. During the assessment, what is important for the nurse to remember about cultural aspects?
a. The patient should be discouraged from using folk remedies and rituals.
b. The nurse will expect the patient to value protective bracelets and “root workers” as healers.
c. The nurse will remember that the balance among body, mind, and environment is important for this patient’s health beliefs.
d. The nurse’s assessment needs to include gathering information regarding religious practices and beliefs regarding medication, treatment, and healing.
7. When reviewing the various schedules of controlled drugs, the nurse knows that which description correctly describes Schedule II drugs?
a. Drugs with high potential for abuse that have accepted medical use
b. Drugs with high potential for abuse that do not have accepted medical use
c. Medically accepted drugs that may cause moderate physical or psychologic dependence
d. Medically accepted drugs with limited potential for causing physical or psychologic dependence
8. The nurse is reviewing facts about pharmacology for a review course. The term legend drug refers to which item?
a. Over-the-counter drugs
b. Prescription drugs
c. Orphan drugs
d. Older drugs
9. Nurses have the ethical responsibility to tell the truth to their patients. What is this principle known as?
a. Justice
b. Veracity
c. Beneficence
d. Autonomy
10. A patient is undergoing major surgery and asks the nurse about a living will. He states, “I don’t want anybody else making decisions for me. And I don’t want to prolong my life.” The patient is demonstrating which ethical term?
a. Autonomy
b. Beneficence
c. Justice
d. Veracity
Chapter 05: Medication Errors: Preventing and Responding
1. The nurse is reviewing medication errors. Which situation is an example of a medication error?
a. A patient refuses her morning medications.
b. A patient receives a double dose of a medication because the nurse did not cut the pill in half.
c. A patient develops hives after having started an IV antibiotic 24 hours earlier.
d. A patient complains of severe pain still present 60 minutes after a pain medication was given.
2. The nurse is reviewing a list of verbal medication orders. Which is the proper notation of the dose of the drug ordered?
a. Digoxin .125 mg
b. Digoxin .1250 mg
c. Digoxin 0.125 mg
d. Digoxin 0.1250 mg
3. When given a scheduled morning medication, the patient states, “I haven’t seen that pill before. Are you sure it’s correct?” The nurse checks the medication administration record and verifies that it is listed. Which is the nurse’s best response?
a. “It’s listed here on the medication sheet, so you should take it.”
b. “Go ahead and take it, and then I’ll check with your doctor about it.”
c. “It wouldn’t be listed here if it were not ordered for you!”
d. “Let me check on the order first before you take it.”
4. During a period of time when the computerized medication order system was down, the prescriber wrote admission orders, and the nurse is transcribing them. The nurse is having difficulty transcribing one order because of the prescriber’s handwriting. Which is the best action for the nurse to take at this time?
a. Ask a colleague what the order says.
b. Contact the prescriber to clarify the order.
c. Wait until the prescriber makes rounds again to clarify the order.
d. Ask the patient what medications he takes at home.
5. When taking a telephone order for a medication, which action by the nurse is most appropriate?
a. Verify the order with the charge nurse.
b. Call back the prescriber to review the order.
c. Repeat the order to the prescriber before hanging up the telephone.
d. Ask the pharmacist to double-check the order.
Chapter 06: Patient Education and Drug Therapy
1. Which nursing diagnosis is appropriate for the patient who has just received a prescription for a new medication?
a. Noncompliance related to new drug therapy
b. Impaired memory related to new drug therapy
c. Lack of knowledge regarding newly prescribed drug therapy
d. Deficient knowledge related to newly prescribed drug therapy
2. The nurse is developing a care plan for a patient who will be self-administering insulin injections. Which statement reflects a measurable outcome?
a. The patient will know about self-administration of insulin injections.
b. The patient will understand the principles of self-administration of insulin injections.
c. The patient will demonstrate the proper technique of self-administering insulin injections.
d. The patient will comprehend the proper technique of self-administering insulin injections.
3. During a nursing assessment, which question by the nurse allows for greater clarification and additional discussion with the patient?
a. “Are you allergic to penicillin?”
b. “What medications do you take?”
c. “Have you had a reaction to this drug?”
d. “Are you taking this medication with meals?”
4. The nurse is setting up a teaching session with an 85-year-old patient who will be going home on anticoagulant therapy. Which educational strategy would reflect consideration of the age-related changes that may exist with this patient?
a. Show a video about anticoagulation therapy.
b. Present all the information in one session just before discharge.
c. Give the patient pamphlets about the medications to read at home.
d. Develop large-print handouts that reflect the verbal information presented.
5. When the nurse teaches a skill such as self-injection of insulin to the patient, what is the best way to set up the teaching/learning session?
a. Provide written pamphlets for instruction.
b. Show a video, and allow the patient to practice as needed on his own.
c. Verbally explain the procedure, and provide written handouts for reinforcement.
d. After demonstrating the procedure, allow the patient to do several return demonstrations.
6. A patient with a new prescription for a diuretic has just reviewed with the nurse how to include more potassium in her diet. This reflects learning in which domain?
a. Cognitive
b. Affective
c. Physical
d. Psychomotor
7. During an admission assessment, the nurse discovers that the patient does not speak English. Which is considered the ideal resource for translation?
a. A family member of the patient
b. A close family friend of the patient
c. A translator who does not know the patient
d. Prewritten note cards with both English and the patient’s language
8. The nurse is teaching a 16-year-old patient who has a new diagnosis of type 1 diabetes about blood glucose monitoring and the importance of regulating glucose intake. When developing a teaching plan for this teenager, which of Erikson’s stages of development should the nurse consider?
a. Trust versus mistrust
b. Intimacy versus isolation
c. Industry versus inferiority
d. Identity versus role confusion
9. A 60-year-old patient is on several new medications and expresses worry that she will forget to take her pills. Which action by the nurse would be most helpful in this situation?
a. Teaching effective coping strategies
b. Asking the patient’s prescriber to reduce the number of drugs prescribed
c. Assuring the patient that she will not forget once she is accustomed to the routine
d. Assisting the patient with obtaining and learning to use a calendar or pill container
Chapter 07: Over-the-Counter Drugs and Herbal and Dietary Supplements
1. A 25-year-old woman is visiting the prenatal clinic and shares with the nurse her desire to go “natural” with her pregnancy. She shows the nurse a list of herbal remedies that she wants to buy so that she can “avoid taking any drugs.” Which statement by the nurse is correct?
a. “Most herbal remedies are not harmful and are safe for use during pregnancy.”
b. “Please read each label carefully before use to check for cautionary warnings.”
c. “Keep in mind that products from different manufacturers are required to contain consistent amounts of the herbal products.”
d. “It’s important to remember that herbal remedies do not have proven safety ratings for pregnant women.”
2. The patient is asking the nurse about current U.S. laws and regulations of herbal products. According to the Dietary Supplement and Health Education Act of 1994, which statement is true?
a. Medicinal herbs are viewed as dietary supplements.
b. Herbal remedies are held to the same standards as drugs.
c. Producers of herbal products must prove therapeutic efficacy.
d. Herbal remedies are protected by patent laws.
3. The patient wants to take the herb valerian to help him rest at night. The nurse would be concerned about potential interactions if he is taking a medication from which class of drugs?
a. Digitalis
b. Anticoagulants
c. Sedatives
d. Immunosuppressants
4. The patient has been taking an over-the-counter (OTC) acid-reducing drug because he has had “stomach problems” for several months. He tells the nurse that the medicine helps as long as he takes it, but once he stops it, the symptoms return. Which statement by the nurse is the best advice for this patient?
a. “The over-the-counter drug has helped you, so you should continue to take it.”
b. “The over-the-counter dosage may not be strong enough. You should be taking prescription-strength for best effects.”
c. “For best results, you need to watch what you eat in addition to taking this drug.”
d. “Using this drug may relieve your symptoms, but it does not address the cause. You should be seen by your health care provider.”
5. During an assessment, the patient tells the nurse that he eats large amounts of garlic for its cardiovascular benefits. Which drug or drug class, if taken, would have a potential interaction with the garlic?
a. Acetaminophen (Tylenol)
b. Insulin
c. Antilipemic drugs
d. Sedatives
6. A patient calls the clinic to ask about taking cranberry dietary supplement capsules because a friend recommended them. The nurse will discuss which possible concern when a patient is taking cranberry supplements?
a. It may increase the risk for bleeding if the patient is taking anticoagulants.
b. It may increase the risk of toxicity of some psychotherapeutic drugs.
c. It may reduce elimination of drugs that are excreted by the kidneys.
d. Cranberry may increase the intensity and duration of effects of caffeine.
7. A patient wants to take the herb gingko to help his memory. The nurse reviews his current medication list and would be concerned about potential interactions if he is taking a medication from which class of drugs?
a. Digitalis
b. Anticoagulants
c. Sedatives
d. Immunosuppressants
Chapter 08: Gene Therapy and Pharmacogenomics
1. The nurse is reviewing the applications of gene therapy. Which drug is manufactured as a result of indirect gene therapy?
a. Vitamin K
b. Warfarin
c. Human insulin
d. Heparin
2. The nurse is discussing gene therapy in a continuing education class. Which is the best definition of eugenics?
a. The use of gene therapy to prevent disease
b. The development of new drugs based on gene therapy
c. Intentional selection, before birth, of genotypes that are considered more desirable than others
d. The determination of genetic factors that influence a person’s response to medications
3. The nurse is explaining the Human Genome Project to colleagues. Which of these is the main purpose of the Human Genome Project?
a. The study of genetic diseases.
b. The study of genetic traits in humans.
c. The discovery new genetic diseases.
d. To describe the entire genome of a human being.
4. A patient has just been told that she has the genetic markers for a severe type of breast cancer. After the patient meets with the physician, the patient’s daughter asks the nurse, “What did the doctor tell my mother? She seems upset.” What is the nurse’s best response?
a. “I’m sorry, but I’m not allowed to discuss that.”
b. “The physician will discuss this with you.”
c. “It seems that your mother has the genetic markers for a type of breast cancer.”
d. “This is information that your mother will need to discuss with you.”
5. The nurse is asking a patient about his family history as part of an assessment. Which component is included in an effective family history?
a. Asking the patient about the current and past health status of the patient’s children
b. Covering at least three generations of family history
c. Obtaining a family history of the patient’s spouse
d. Asking about the family history for the patient’s siblings and parents only
Chapter 09: Photo Atlas of Drug Administration
1. Before administering any medication, what is the nurse’s priority action regarding patient safety?
a. Verifying orders with another nurse
b. Documenting the medications given
c. Counting medications in the medication cart drawers
d. Checking the patient’s identification using two identifiers
2. The nurse is giving an intradermal (ID) injection and will choose which syringe for this injection?
3. A patient is to receive a penicillin intramuscular (IM) injection in the ventrogluteal site. The nurse will use which angle for the needle insertion?
a. 15 degrees
b. 45 degrees
c. 60 degrees
d. 90 degrees
4. When administering medication by IV bolus (push), the nurse will occlude the IV line by which method?
a. Not pinching the IV tubing at all
b. Pinching the tubing just above the injection port
c. Pinching the tubing just below the injection port
d. Pinching the tubing just above the drip chamber of the infusion set
5. The nurse has an order to administer an intramuscular (IM) immunization to a 2-month-old child. Which site is considered the best choice for this injection?
a. Deltoid
b. Dorsogluteal
c. Ventrogluteal
d. Vastus lateralis
6. The nurse needs to administer insulin subcutaneously to an obese patient. Which is the proper technique for this injection?
a. Using the Z-track method
b. Inserting the needle at a 5- to 15-degree angle until resistance is felt
c. Pinching the skin at the injection site, and then inserting the needle to below the tissue fold at a 90-degree angle
d. Spreading the skin tightly over the injection site, inserting the needle, and then releasing the skin
7. The nurse will plan to use the Z-track method of intramuscular (IM) injections for which situation?
a. The medication is known to be irritating to tissues.
b. The patient is emaciated and has very little muscle mass.
c. The medication must be absorbed quickly into the tissues.
d. The patient is obese and has a deep fat layer below the muscle mass.
8. After administering an intradermal (ID) injection for a skin test, the nurse notices a small bleb at the injection site. The best action for the nurse to take at this time is to:
a. apply heat.
b. massage the area.
c. do nothing.
d. report the bleb to the physician.
9. The nurse is administering an IV push medication through an IV lock. After injecting the medication, which action will be taken next?
a. Flushing the lock
b. Regulating the IV flow
c. Clamping the tubing for 10 minutes
d. Holding the patient’s arm up to improve blood flow
10. When adding medications to a bag of intravenous (IV) fluid, the nurse will use which method to mix the solution?
a. Shaking the bag or bottle vigorously
b. Turning the bag or bottle gently from side to side
c. Inverting the bag or bottle one time after injecting the medication
d. Allowing the IV solution to stand for 10 minutes to enhance even distribution of medication
Chapter 10: Analgesic Drugs
1. A patient was diagnosed with pancreatic cancer last month, and has complained of a dull ache in the abdomen for the past 4 months. This pain has been gradually increasing, and the pain relievers taken at home are no longer effective. What type of pain is the patient experiencing?
a. Acute pain
b. Chronic pain
c. Somatic pain
d. Neuropathic pain
2. An 18-year-old basketball player fell and twisted his ankle during a game. The nurse will expect to administer which type of analgesic?
a. Synthetic opioid, such as meperidine (Demerol)
b. Opium alkaloid, such as morphine sulfate
c. Opioid antagonist, such as naloxone HCL (Narcan)
d. Nonopioid analgesic, such as indomethacin (Indocin)
3. A patient is recovering from abdominal surgery, which he had this morning. He is groggy but complaining of severe pain around his incision. What is the most important assessment data to consider before the nurse administers a dose of morphine sulfate to the patient?
a. His pulse rate
b. His respiratory rate
c. The appearance of the incision
d. The date of his last bowel movement
4. A 78-year-old patient is in the recovery room after having a lengthy surgery on his hip. As he is gradually awakening, he requests pain medication. Within 10 minutes after receiving a dose of morphine sulfate, he is very lethargic and his respirations are shallow, with a rate of 7 per minute. The nurse prepares for which priority action at this time?
a. Assessment of the patient’s pain level
b. Immediate intubation and artificial ventilation
c. Administration of naloxone (Narcan)
d. Close observation of signs of opioid tolerance
5. A patient will be discharged with a 1-week supply of an opioid analgesic for pain management after abdominal surgery. The nurse will include which information in the teaching plan?
a. How to prevent dehydration due to diarrhea
b. The importance of taking the drug only when the pain becomes severe
c. How to prevent constipation
d. The importance of taking the drug on an empty stomach
6. A patient has been treated for lung cancer for 3 years. Over the past few months, the patient has noticed that the opioid analgesic is not helping as much as it had previously and more medication is needed for the same pain relief. The nurse is aware that this patient is experiencing which of these?
a. Opioid addiction
b. Opioid tolerance
c. Opioid toxicity
d. Opioid abstinence syndrome
7. A 38-year-old man has come into the urgent care center with severe hip pain after falling from a ladder at work. He says he has taken several pain pills over the past few hours but cannot remember how many he has taken. He hands the nurse an empty bottle of acetaminophen (Tylenol). The nurse is aware that the most serious toxic effect of acute acetaminophen overdose is which condition?
a. Tachycardia
b. Central nervous system depression
c. Hepatic necrosis
d. Nephropathy
8. A 57-year-old woman being treated for end-stage breast cancer has been using a transdermal opioid analgesic as part of the management of pain. Lately, she has been experiencing breakthrough pain. The nurse expects this type of pain to be managed by which of these interventions?
a. Administering NSAIDs
b. Administering an immediate-release opioid
c. Changing the opioid route to the rectal route
d. Making no changes to the current therapy
9. The nurse is reviewing herbal therapies. Which is a common use of the herb feverfew?
a. Muscle aches
b. Migraine headaches
c. Leg cramps
d. Incision pain after surgery
10. A patient is to receive acetylcysteine (Mucomyst) as part of the treatment for an acetaminophen (Tylenol) overdose. Which action by the nurse is appropriate when giving this medication?
a. Giving the medication undiluted for full effect
b. Avoiding the use of a straw when giving this medication
c. Disguising the flavor with soda or flavored water
d. Preparing to give this medication via a nebulizer
Chapter 11: General and Local Anesthetics
1. During a fishing trip, a patient pierced his finger with a large fishhook. He is now in the emergency department to have it removed. The nurse anticipates that which type of anesthesia will be used for this procedure?
a. No anesthesia
b. Topical benzocaine spray on the area
c. Topical prilocaine (EMLA) cream around the site
d. Infiltration of the puncture wound with lidocaine
2. While monitoring a patient who had surgery under general anesthesia 2 hours ago, the nurse notes a sudden elevation in body temperature. This finding may be an indication of which problem?
a. Tachyphylaxis
b. Postoperative infection
c. Malignant hypertension
d. Malignant hyperthermia
3. When assessing patients in the preoperative area, the nurse knows that which patient is at a higher risk for an altered response to anesthesia?
a. The 21-year-old patient who has never had surgery before
b. The 35-year-old patient who stopped smoking 8 years ago
c. The 40-year-old patient who is to have a kidney stone removed
d. The 82-year-old patient who is to have gallbladder removal
4. A patient is undergoing abdominal surgery and has been anesthetized for 3 hours. Which nursing diagnosis would be appropriate for this patient?
a. Anxiety related to the use of an anesthetic
b. Risk for injury related to increased sensorium from general anesthesia
c. Decreased cardiac output related to systemic effects of local anesthesia
d. Impaired gas exchange related to central nervous system depression produced by general anesthesia
5. When administering a neuromuscular blocking drug, the nurse needs to remember which principle?
a. It is used instead of general anesthesia during surgery.
b. Only skeletal muscles are paralyzed; respiratory muscles remain functional.
c. It causes sedation and pain relief while allowing for lower doses of anesthetics.
d. Artificial mechanical ventilation is required because of paralyzed respiratory muscles.
6. A patient is being prepared for an oral endoscopy, and the nurse anesthetist reminds him that he will be awake during the procedure but probably will not remember it. What type of anesthetic technique is used in this situation?
a. Local anesthesia
b. Moderate sedation
c. Topical anesthesia
d. Spinal anesthesia
7. During the immediate postoperative period, the Post Anesthesia Care Unit nurse is assessing a patient who had hip surgery. The patient is experiencing tachycardia, tachypnea, and muscle rigidity, and his temperature is 103° F (39.4° C). The nurse will prepare for what immediate treatment?
a. Naltrexone hydrochloride (Narcan) injection, an opioid reversal drug
b. Dantrolene (Dantrium) injection, a skeletal muscle relaxant
c. An anticholinesterase drug, such as neostigmine
d. Cardiopulmonary resuscitation (CPR) and intubation
Chapter 12: Central Nervous System Depressants and Muscle Relaxants
1. A patient who has received some traumatic news is panicking and asks for some medication to help settle down. The nurse anticipates giving which drug that is most appropriate for this situation?
a. Diazepam (Valium)
b. Zolpidem (Ambien)
c. Phenobarbital
d. Cyclobenzaprine (Flexeril)
2. A patient has been taking phenobarbital for 2 weeks as part of his therapy for epilepsy. He tells the nurse that he feels tense and that “the least little thing” bothers him now. Which is the correct explanation for this problem?
a. These are adverse effects that usually subside after a few weeks.
b. The drug must be stopped immediately because of possible adverse effects.
c. This drug causes the rapid eye movement (REM) sleep period to increase, resulting in nightmares and restlessness.
d. This drug causes deprivation of REM sleep and may cause the inability to deal with normal stress.
3. A 50-year-old man who has been taking phenobarbital for 1 week is found very lethargic and unable to walk after eating out for dinner. His wife states that he has no other prescriptions and that he did not take an overdose—the correct number of pills is in the bottle. The nurse suspects that which of these may have happened?
a. He took a multivitamin.
b. He drank a glass of wine.
c. He took a dose of aspirin.
d. He developed an allergy to the drug.
4. A patient has been taking temazepam (Restoril) for intermittent insomnia. She calls the nurse to say that when she takes it, she sleeps well, but the next day she feels “so tired.” Which explanation by the nurse is correct?
a. “Long-term use of this drug results in a sedative effect.”
b. “If you take the drug every night, this hangover effect will be reduced.”
c. “These drugs affect the sleep cycle, resulting in daytime sleepiness.”
d. “These drugs increase the activity of the central nervous system, making you tired the next day.”
5. A patient is recovering from a minor automobile accident that occurred 1 week ago. He is taking cyclobenzaprine (Flexeril) for muscular pain and goes to physical therapy three times a week. Which nursing diagnosis would be appropriate for him?
a. Risk for injury related to decreased sensorium
b. Risk for addiction related to psychologic dependency
c. Decreased fluid volume related to potential adverse effects
d. Disturbed sleep pattern related to the drug’s interference with REM sleep
6. A patient is taking flurazepam (Dalmane) three to four nights a week for sleeplessness. She is concerned that she cannot get to sleep without taking the medication. What nonpharmacologic measures should the nurse suggest to promote sleep for this patient?
a. Providing a quiet environment
b. Exercising before bedtime to become tired
c. Consuming heavy meals in the evening to promote sleepiness
d. Drinking hot tea or coffee just before bedtime
7. A patient is brought to the emergency department for treatment of a suspected overdose. The patient was found with an empty prescription bottle of a barbiturate by his bedside. He is lethargic and barely breathing. The nurse would expect which immediate intervention?
a. Starting an intravenous infusion of diluted bicarbonate solution
b. Administering medications to increase blood pressure
c. Implementing measures to maintain the airway and support respirations
d. Administrating naloxone (Narcan) as an antagonist
8. Ramelteon (Rozerem) is prescribed for a patient with insomnia. The nurse checks the patient’s medical history, knowing that this medication is contraindicated in which disorder?
a. Coronary artery disease
b. Renal insufficiency
c. Liver disease
d. Anemia
9. The nurse notes in the patient’s medication history that the patient is taking cyclobenzaprine (Flexeril). Based on this finding, the nurse interprets that the patient has which disorder?
a. A musculoskeletal injury
b. Insomnia
c. Epilepsy
d. Agitation
10. A patient has experienced insomnia for months, and the physician has prescribed a medication to help with this problem. The nurse expects which drug to be used for long-term treatment of insomnia?
a. Secobarbital (Seconal), a barbiturate
b. Diazepam (Valium), a benzodiazepine
c. Midazolam (Versed), a benzodiazepine
d. Eszopiclone (Lunesta), a nonbenzodiazepine sleep aid
Chapter 13: Central Nervous System Stimulants and Related Drugs
1. A patient is receiving instructions regarding the use of caffeine. The nurse shares that caffeine should be used with caution if which of these conditions is present?
a. A history of peptic ulcers
b. Migraine headaches
c. Asthma
d. A history of kidney stones
2. A patient who started taking orlistat (Xenical) 1 month ago calls the clinic to report some “embarrassing” adverse effects. She tells the nurse that she has had episodes of “not being able to control my bowel movements.” Which statement is true about this situation?
a. These are expected adverse effects that will eventually diminish.
b. The patient will need to stop this drug immediately if these adverse effects are occurring.
c. The patient will need to increase her fat intake to prevent these adverse effects.
d. The patient will need to restrict fat intake to less than 30% to help reduce these adverse effects.
3. A 6-year-old boy has been started on an extended-release form of methylphenidate hydrochloride (Ritalin) for the treatment of attention deficit hyperactivity disorder (ADHD). During a follow-up visit, his mother tells the nurse that she has been giving the medication at bedtime so that it will be “in his system” when he goes to school the next morning. What is the nurse’s appropriate evaluation of the mother’s actions?
a. She is giving him the medication dosage appropriately.
b. The medication should not be taken until he is at school.
c. The medication should be taken with meals for optimal absorption.
d. The medication should be given 4 to 6 hours before bedtime to diminish insomnia.
4. A 22-year-old nursing student has been taking NoDoz (caffeine) tablets for the past few weeks to “make it through” the end of the semester and exam week. She is in the university clinic today because she is “exhausted.” What nursing diagnosis may be appropriate for her?
a. Noncompliance
b. Impaired physical mobility
c. Disturbed sleep pattern
d. Imbalanced nutrition: less than body requirements
5. A 10-year-old patient will be started on methylphenidate hydrochloride (Ritalin) therapy. The nurse will perform which essential baseline assessment before this drug is started?
a. Eye examination
b. Height and weight
c. Liver function studies
d. Hearing test
6. When evaluating a patient who is taking orlistat (Xenical), which is an intended therapeutic effect?
a. Increased wakefulness
b. Increased appetite
c. Decreased weight
d. Decreased hyperactivity
7. The nurse is teaching a patient how to self-administer triptan injections for migraine headaches. Which statement by the patient indicates that he needs further teaching?
a. “I will take this medication regularly to prevent a migraine headache from occurring.”
b. “I will take this medication when I feel a migraine headache starting.”
c. “This medication does not reduce the number of migraines I will have.”
d. “I will keep a journal to record the headaches I have and how the injections are working.”
Chapter 14: Antiepileptic Drugs
1. The nurse is reviewing the dosage schedule for several different antiepileptic drugs (AEDs). Which antiepileptic drug allows for once-a-day dosing?
a. Levetiracetam (Keppra)
b. Phenobarbital
c. Valproic acid (Depakote)
d. Gabapentin (Neurontin)
2. The nurse has given medication instructions to a patient receiving phenytoin (Dilantin). Which statement by the patient indicates that the patient has an adequate understanding of the instructions?
a. “I will need to take extra care of my teeth and gums while on this medication.”
b. “I can go out for a beer while on this medication.”
c. “I can skip doses if the side effects bother me.”
d. “I will be able to stop taking this drug once the seizures stop.”
3. When teaching a patient about taking a newly prescribed antiepileptic drug (AED) at home, the nurse will include which instruction?
a. “Driving is allowed after 2 weeks of therapy.”
b. “If seizures recur, take a double dose of the medication.”
c. “Antacids can be taken with the AED to reduce gastrointestinal adverse effects.”
d. “Regular, consistent dosing is important for successful treatment.”
4. A patient has a 9-year history of a seizure disorder that has been managed well with oral phenytoin (Dilantin) therapy. He is to be NPO (consume nothing by mouth) for surgery in the morning. What will the nurse do about his morning dose of phenytoin?
a. Give the same dose intravenously.
b. Give the morning dose with a small sip of water.
c. Contact the prescriber for another dosage form of the medication.
d. Notify the operating room that the medication has been withheld.
5. The nurse is monitoring a patient who has been taking carbamazepine (Tegretol) for 2 months. Which effects would indicate that autoinduction has started to occur?
a. The drug levels for carbamazepine are higher than expected.
b. The drug levels for carbamazepine are lower than expected.
c. The patient is experiencing fewer seizures.
d. The patient is experiencing toxic effects from the drug.
6. The nurse is giving an intravenous dose of phenytoin (Dilantin). Which action is correct when administering this drug?
a. Give the dose as a fast intravenous (IV) bolus.
b. Mix the drug with normal saline, and give it as a slow IV push.
c. Mix the drug with dextrose (D5W), and give it as a slow IV push.
d. Mix the drug with any available solution as long as the administration rate is correct.
7. The U.S. Food and Drug Administration has issued a warning for users of antiepileptic drugs. Based on this report, the nurse will monitor for which potential problems with this class of drugs?
a. Increased risk of suicidal thoughts and behaviors
b. Signs of bone marrow depression
c. Indications of drug addiction and dependency
d. Increased risk of cardiovascular events, such as strokes
8. A patient is experiencing status epilepticus. The nurse prepares to give which drug of choice for the treatment of this condition?
a. Diazepam (Valium)
b. Midazolam (Versed)
c. Valproic acid (Depakote)
d. Carbamazepine (Tegretol)
9. Phenytoin (Dilantin) has a narrow therapeutic index. The nurse recognizes that this characteristic indicates which of these?
a. The safe and the toxic plasma levels of the drug are very close to each other.
b. The phenytoin has a low chance of being effective.
c. There is no difference between safe and toxic plasma levels.
d. A very small dosage can result in the desired therapeutic effect.
10. A patient has been taking an AED for several years as part of his treatment for partial seizures. His wife has called because he ran out of medication this morning and wonders if he can go without it for a week until she has a chance to go to the drugstore. What is the nurse’s best response?
a. “He is taking another antiepileptic drug, so he can go without the medication for a week.”
b. “Stopping this medication abruptly may cause withdrawal seizures. A refill is needed right away.”
c. “He can temporarily increase the dosage of his other antiseizure medications until you get the refill.”
d. “He can stop all medications because he has been treated for several years now.”
Chapter 15: Antiparkinson Drugs
1. A patient has been taking selegiline (Eldepryl), 20 mg/day for 1 month. Today, during his office visit, he tells the nurse that he forgot and had a beer with dinner last evening, and “felt awful.” What did the patient most likely experience?
a. Hypotension
b. Hypertension
c. Urinary discomfort
d. Gastrointestinal upset
2. A patient has been given a prescription for levodopa-carbidopa (Sinemet) for her newly diagnosed Parkinson’s disease. She asks the nurse, “Why are there two drugs in this pill?” The nurse’s best response reflects which fact?
a. Carbidopa allows for larger doses of levodopa to be given.
b. Carbidopa prevents the breakdown of levodopa in the periphery.
c. There are concerns about drug-food interactions with levodopa therapy that do not exist with the combination therapy.
d. Carbidopa is the biologic precursor of dopamine and can penetrate into the central nervous system.
3. When a patient is taking an anticholinergic such as benztropine (Cogentin) as part of the treatment for Parkinson’s disease, the nurse should include which information in the teaching plan?
a. Minimize the amount of fluid taken while on this drug.
b. Discontinue the medication if adverse effects occur.
c. Take the medication on an empty stomach to enhance absorption.
d. Use artificial saliva, sugarless gum, or hard candy to counteract dry mouth.
4. A patient has been treated with antiparkinson medications for 3 months. What therapeutic responses should the nurse look for when assessing this patient?
a. Decreased appetite
b. Gradual development of cogwheel rigidity
c. Newly developed dyskinesias
d. Improved ability to perform activities of daily living
5. Carbidopa-levodopa (Sinemet) is prescribed for a patient with Parkinson’s disease. The nurse informs the patient that which common adverse effects can occur with this medication?
a. Drowsiness, headache, weight loss
b. Dizziness, insomnia, nausea
c. Peripheral edema, fatigue, syncope
d. Heart palpitations, hypotension, urinary retention
6. The nurse is assessing the medication history of a patient with a new diagnosis of Parkinson’s disease. Which condition is a contraindication for the patient, who will be taking tolcapone (Tasmar)?
a. Glaucoma
b. Seizure disorder
c. Liver failure
d. Benign prostatic hyperplasia
7. The nurse is developing a care plan for a patient who is taking an anticholinergic drug. Which nursing diagnosis would be appropriate for this patient?
a. Diarrhea
b. Urinary retention
c. Risk for infection
d. Disturbed sleep pattern
8. A patient has a new order for a catechol ortho-methyltransferase (COMT) inhibitor as part of treatment for Parkinson’s disease. The nurse recognizes that which of these is an advantage of this drug class?
a. It has a shorter duration of action.
b. It causes less gastrointestinal distress.
c. It has a slower onset than traditional Parkinson’s disease drugs.
d. It is associated with fewer wearing-off effects.
9. A patient taking entacapone (Comtan) for the first time calls the clinic to report a dark discoloration of his urine. After listening to the patient, the nurse realizes that what is happening in this situation?
a. This is a harmless effect of the drug.
b. The patient has taken this drug along with red wine or cheese.
c. The patient is having an allergic reaction to the drug.
d. The ordered dose is too high for this patient.
10. While a patient is receiving drug therapy for Parkinson’s disease, the nurse monitors for dyskinesia, which is manifested by which finding?
a. Rigid, tense muscles
b. Difficulty in performing voluntary movements
c. Limp extremities with weak muscle tone
d. Confusion and altered mental status
Chapter 16: Psychotherapeutic Drugs
1. The nurse reads in the patient’s medication history that the patient is taking buspirone (BuSpar). The nurse interprets that the patient may have which disorder?
a. Anxiety disorder
b. Depression
c. Schizophrenia
d. Bipolar disorder
2. Before beginning a patient’s therapy with selective serotonin reuptake inhibitor (SSRI) antidepressants, the nurse will assess for concurrent use of which medications or medication class?
a. Aspirin
b. Anticoagulants
c. Diuretics
d. Nonsteroidal anti-inflammatory drugs
3. When a patient is receiving a second-generation antipsychotic drug, such as risperidone (Risperdal), the nurse will monitor for which therapeutic effect?
a. Fewer panic attacks
b. Decreased paranoia and delusions
c. Decreased feeling of hopelessness
d. Improved tardive dyskinesia
4. A patient has been taking haloperidol (Haldol) for 3 months for a psychotic disorder, and the nurse is concerned about the development of extrapyramidal symptoms. The nurse will monitor the patient closely for which effects?
a. Increased paranoia
b. Drowsiness and dizziness
c. Tremors and muscle twitching
d. Dry mouth and constipation
5. A patient has been taking the monoamine oxidase inhibitor (MAOI) phenelzine (Nardil) for 6 months. The patient wants to go to a party and asks the nurse, “Will just one beer be a problem?” Which advice from the nurse is correct?
a. “You can drink beer as long as you have a designated driver.”
b. “Now that you’ve had the last dose of that medication, there will be no further dietary restrictions.”
c. “If you begin to experience a throbbing headache, rapid pulse, or nausea, you’ll need to stop drinking.”
d. “You need to avoid all foods that contain tyramine, including beer, while taking this medication.”
6. A 22-year-old patient has been taking lithium for 1 year, and the most recent lithium level is 0.9 mEq/L. Which statement about the laboratory result is correct?
a. The lithium level is therapeutic.
b. The lithium level is too low.
c. The lithium level is too high.
d. Lithium is not usually monitored with blood levels.
7. A patient with the diagnosis of schizophrenia is hospitalized and is taking a phenothiazine drug. Which statement by this patient indicates that he is experiencing a common adverse effect of phenothiazines?
a. “I can’t sleep at night.”
b. “I feel hungry all the time.”
c. “Look at how red my hands are.”
d. “My mouth has been so dry lately.”
8. A patient has been taking the selective serotonin reuptake inhibitor (SSRI) sertraline (Zoloft) for about 6 months. At a recent visit, she tells the nurse that she has been interested in herbal therapies and wants to start taking St. John’s wort. Which response by the nurse is appropriate?
a. “That should be no problem.”
b. “Good idea! Hopefully you’ll be able to stop taking the Zoloft.”
c. “Be sure to stop taking the herb if you notice a change in side effects.”
d. “Taking St. John’s wort with Zoloft may cause severe interactions and is not recommended.”
9. While monitoring a depressed patient who has just started SSRI antidepressant therapy, the nurse will observe for which problem during the early time frame of this therapy?
a. Hypertensive crisis
b. Self-injury or suicidal tendencies
c. Extrapyramidal symptoms
d. Loss of appetite
10. A patient has been admitted to the emergency department with a suspected overdose of a tricyclic antidepressant. The nurse will prepare for what immediate concern?
a. Hypertension
b. Renal failure
c. Cardiac dysrhythmias
d. Gastrointestinal bleeding
Chapter 17: Substance Abuse
1. A 38-year-old male patient stopped smoking 6 months ago. He tells the nurse that he still feels strong cigarette cravings and wonders if he is ever going to feel “normal” again. Which statement by the nurse is correct?
a. “It’s possible that these cravings will never stop.”
b. “These cravings may persist for several months.”
c. “The cravings tell us that you are still using nicotine.”
d. “The cravings show that you are about to experience nicotine withdrawal.”
2. A patient in a rehabilitation center is beginning to experience opioid withdrawal symptoms. The nurse expects to administer which drug as part of the treatment?
a. Diazepam (Valium)
b. Methadone
c. Disulfiram (Antabuse)
d. Bupropion (Zyban)
3. A patient has been taking naltrexone (ReVia) as part of the treatment for addiction to heroin. The nurse expects that the naltrexone will have which therapeutic effect for this patient?
a. Naltrexone prevents the cravings for opioid drugs.
b. Naltrexone works as a safer substitute for the heroin until the patient completes withdrawal.
c. The patient will experience flushing, sweating, and severe nausea if he takes heroin while on naltrexone.
d. If opioid drugs are used while taking naltrexone, euphoria is not produced; thus, the opioid’s desired effects are lost.
4. The nurse is presenting a substance-abuse lecture for teenage girls and is asked about “roofies.” The nurse recognizes that this is the slang term for which substance?
a. Cocaine
b. Flunitrazepam
c. Secobarbital
d. Methamphetamine
5. A 29-year-old male patient is admitted to the intensive care unit with the following symptoms: restlessness, hyperactive reflexes, talkativeness, confusion and periods of panic and euphoria, tachycardia, and fever. The nurse suspects that he may be experiencing the effects of taking which substance?
a. Opioids
b. Alcohol
c. Stimulants
d. Depressants
6. When admitting a patient with a suspected diagnosis of chronic alcohol use, the nurse will keep in mind that chronic use of alcohol might result in which condition?
a. Renal failure
b. Cerebrovascular accident
c. Korsakoff’s psychosis
d. Alzheimer’s disease
7. A patient is being treated for ethanol alcohol abuse in a rehabilitation center. The nurse will include which information when teaching him about disulfiram (Antabuse) therapy?
a. He should not smoke cigarettes while on this drug.
b. He needs to know about the common over-the-counter substances that contain alcohol.
c. This drug will cause the same effects as the alcohol did, without the euphoric effects.
d. Mouthwashes and cough medicines that contain alcohol are safe because they are used in small amounts.
8. The nurse is conducting a smoking-cessation program. Which statement regarding drugs used in cigarette-smoking–cessation programs is true?
a. Rapid chewing of the nicotine gum releases an immediate dose of nicotine.
b. Quick relief from withdrawal symptoms is most easily achieved by using a transdermal patch.
c. Compliance with treatment is higher with use of the gum rather than the transdermal patch.
d. The nicotine gum can be used only up to six times per day.
Chapter 18: Adrenergic Drugs
1. The nurse is aware that adrenergic drugs produce effects similar to which of these nervous systems?
a. Central nervous system
b. Somatic nervous system
c. Sympathetic nervous system
d. Parasympathetic nervous system
2. When an adrenergic drug stimulates beta1-adrenergic receptors, the result is an increased force of contraction, which is known as what type of effect?
a. Positive inotropic
b. Anti-adrenergic
c. Negative dromotropic
d. Positive chronotropic
3. When a patient is taking an adrenergic drug, the nurse expects to observe which effect?
a. Increased heart rate
b. Bronchial constriction
c. Constricted pupils
d. Increased intestinal peristalsis
4. An adrenergic agonist is ordered for a patient in shock. The nurse will note that this drug has had its primary intended effect if which expected outcome occurs?
a. Volume restoration
b. Increased cardiac output
c. Decreased urine output
d. Reduced anxiety
5. The nurse is administering a stat dose of epinephrine. Epinephrine is appropriate for which situation?
a. Severe hypertension
b. Angina
c. Cardiac arrest
d. Tachycardia
6. A patient is on a low-dose dobutamine drip for heart failure. She had been feeling better but now has a sense of tightness in her chest, palpitations, and a bit of anxiety. Her heart rate is up to 110 per minute, and her blood pressure is 150/98 mm Hg (increased from previous readings of 86 per minute and 120/80 mm Hg). What is the nurse’s immediate concern for this patient?
a. She is experiencing normal adverse effects of dobutamine therapy.
b. She may be experiencing an allergic reaction to the dobutamine.
c. The medication may be causing a worsening of a pre-existing cardiac disorder.
d. The dosage of the dobutamine needs to be increased to control the symptoms better.
7. A 14-year-old patient has been treated for asthma for almost 4 months. Two weeks ago, she was given salmeterol as part of her medication regimen. However, her mother has called the clinic to report that it does not seem to work when her daughter is having an asthma attack. Which response by the nurse is appropriate?
a. “It takes time for a therapeutic response to develop.”
b. “She is too young for this particular medication; it will be changed.”
c. “She needs to take up to two puffs every 4 hours to ensure adequate blood levels.”
d. “This medication is indicated for prevention of bronchospasms, not for relief of acute symptoms.”
8. A hospitalized patient is experiencing a severe anaphylactic reaction to a dose of intravenous penicillin. Which drug will the nurse expect to use to treat this condition?
a. Ephedra
b. Epinephrine
c. Phenylephrine
d. Pseudoephedrine
9. The nurse recognizes that adrenergic drugs cause relaxation of the bronchi and bronchodilation by stimulating which type of receptors?
a. Dopaminergic
b. Beta1 adrenergic
c. Beta2 adrenergic
d. Alpha1 adrenergic
10. The nurse is preparing to administer dopamine. Which is the correct technique for administering dopamine?
a. Orally
b. Intravenous (IV) push injection
c. Intermittent IV infusions (IV piggyback)
d. Continuous IV infusion with an infusion pump
Chapter 19: Adrenergic-Blocking Drugs
1. During therapy with a beta blocker, the patient notices that she has swollen feet, has gained 3 pounds within 2 days, feels short of breath even when walking around the house, and has been dizzy. The nurse suspects that which of these is occurring?
a. The patient is experiencing an allergic reaction.
b. The patient may be developing heart failure.
c. More time is needed for the patient to see a therapeutic response to the drug.
d. The patient is experiencing expected adverse effects of the drug.
2. A patient is going home with a new prescription for the beta-blocker atenolol (Tenormin). The nurse will include which content when teaching the patient about this drug?
a. Never stop taking this medication abruptly.
b. The medication will be stopped once symptoms subside.
c. If adverse effects occur, stop taking the drug for 24 hours, and then resume.
d. Be watchful for first-dose hypotension.
3. During initial rounds, the nurse notes that a dobutamine infusion has extravasated into the forearm of a patient. After stopping the infusion, the nurse follows standing orders and immediately injects phentolamine (Regitine) subcutaneously in a circular fashion around the extravasation site. What is the mechanism of action of the phentolamine in this situation?
a. It neutralizes the extravasated dobutamine immediately.
b. It causes arterial vasoconstriction and reduced pain and swelling at the site.
c. It increases peripheral vascular resistance and reduces arterial pressure at the site.
d. It increases blood flow to the ischemic site by vasodilation to prevent tissue damage.
4. A 58-year-old man has had a myocardial infarction (MI), has begun rehabilitation, and is ready for discharge. He is given a prescription for metoprolol (Lopressor) and becomes upset after reading the patient education pamphlet. “I don’t have high blood pressure—why did my doctor give me this medicine?” Which explanation by the nurse is correct?
a. “This medication will prevent blood clots that may lead to another heart attack.”
b. “Beta blockers will improve blood flow to the kidneys.”
c. “This drug is prescribed to prevent the high blood pressure that often occurs after a heart attack.”
d. “Studies have shown that this medication has greatly increased survival rates in patients who have had a heart attack.”
5. The teaching for a patient who is taking tamsulosin (Flomax) to reduce urinary obstruction due to benign prostatic hyperplasia will include which of these?
a. Fluids need to be restricted while on this medication.
b. Take the medication with breakfast to promote the maximum effects of the drug.
c. Get up slowly from a sitting or lying position.
d. Blood pressure must be monitored because the medication may cause hypertension.
6. The nurse is screening a patient who will be taking a nonspecific/nonselective beta blocker. Which condition, if present, may cause serious problems if the patient takes this medication?
a. Angina
b. Hypertension
c. Glaucoma
d. Asthma
7. A patient is experiencing diastolic heart failure. The nurse expects which beta blocker to be ordered for this patient?
a. Atenolol (Tenormin)
b. Carvedilol (Coreg)
c. Acebutolol (Sectral)
d. Esmolol (Brevibloc)
8. During a teaching session about self-monitoring while taking a beta blocker at home, the nurse has taught the patient to take his apical pulse daily for 1 minute. If the pulse rate decreases to less than 60 beats/min, the nurse will instruct the patient to:
a. notify his prescriber.
b. reduce the dose of his beta blocker by half.
c. continue the medication because this is an expected effect.
d. skip the medication dose that day, and check his pulse again the next day.
9. A 49-year-old patient is in the clinic for a follow-up visit 6 months after starting a beta blocker for treatment of hypertension. During this visit, his blood pressure is 169/98 mm Hg, and he eventually confesses that he stopped taking this medicine 2 months ago because of an “embarrassing problem.” What problem did the patient most likely experience with this medication that caused him to stop taking it?
a. Urge incontinence
b. Dizziness when standing up
c. Excessive flatus
d. Impotence
10. A patient has a new prescription for tamsulosin (Flomax) as treatment for benign prostatic hyperplasia. The nurse is checking his current medication list and will contact the prescriber regarding a potential interaction if the patient is also taking which drug?
a. Levothyroxine (Synthroid) for hypothyroidism
b. Sildenafil (Viagra), an erectile dysfunction medication
c. Omeprazole (Prilosec), a proton pump inhibitor
d. Low-dose aspirin for stroke prevention
Chapter 20: Cholinergic Drugs
1. When monitoring a patient who is taking a low-dose cholinergic drug, the nurse will watch for which cardiovascular effect?
a. Bradycardia
b. Tachycardia
c. Vasoconstriction
d. Palpitations
2. The nurse notes in a patient’s medication history that the patient is taking pilocarpine (Pilocar). Based on this finding, the nurse interprets that the patient has which disorder?
a. Anticholinergic poisoning
b. Glaucoma
c. Bladder atony
d. Myasthenia gravis
3. A patient has had an overdose of an intravenous cholinergic drug. The nurse expects to administer which drug as an antidote?
a. Atenolol (Tenormin)
b. Bethanechol (Urecholine)
c. Dobutamine
d. Atropine sulfate
4. A patient who has had abdominal surgery has been discharged on a cholinergic drug to assist in increasing gastrointestinal peristalsis. The nurse will teach this patient to look for which therapeutic effect?
a. Decreased pulse rate
b. Abdominal cramping
c. Passage of flatus
d. Decreased urge to void
5. A cholinergic drug is prescribed for a patient with a new diagnosis of myasthenia gravis, and the nurse provides instructions to the patient about the medication. What is important to include in the teaching?
a. Take the medication with meals to avoid gastrointestinal distress.
b. Give daytime doses close together for maximal therapeutic effect.
c. Take the medication 30 minutes before eating to improve swallowing and chewing.
d. Take the medication only if difficulty swallowing occurs during a meal.
6. A factory worker has been admitted to the emergency department after an industrial accident involving organophosphate insecticides. The nurse will prepare to administer which drug?
a. Pilocarpine (Salagen)
b. Bethanechol (Urecholine)
c. Physostigmine (Antilirium)
d. Tacrine (Cognex)
7. The nurse is providing teaching regarding drug therapy to the husband of a woman with Alzheimer’s disease. She was diagnosed 3 months ago, has mild memory loss, and will be receiving donepezil (Aricept). What is the drug’s expected action?
a. Prevents memory loss in later stages
b. Reverses the course of Alzheimer’s disease
c. Provides sedation to prevent agitation and restlessness
d. May help to improve the mood and decrease confusion
8. A patient has been taking donepezil (Aricept) for 2 weeks as part of the treatment for early stages of Alzheimer’s disease. Her daughter calls the prescriber’s office and is upset because “Mother has not improved one bit!” Which response by the nurse is appropriate?
a. “Increase the dosage to twice daily.”
b. “It takes time for the cure to take effect.”
c. “It may take up to 6 weeks to see an improvement.”
d. “Take the medication on an empty stomach for improved absorption.”
9. A patient who has been diagnosed with Sjögren’s syndrome will be given cevimeline for the treatment of xerostomia. The nurse will monitor for what therapeutic effect?
a. Reduction of salivation
b. Stimulation of salivation
c. Reduction of gastrointestinal peristalsis
d. Improvement of fine-motor control
10. The nurse is reviewing the mechanism of action of cholinergic drugs. The undesired effects of cholinergic drugs come from the stimulation of which receptors?
a. Muscarinic
b. Nicotinic
c. Cholinergic
d. Ganglionic