[rtf] saunders comprehensive review for the nclex-rn® examination, 5th edition pharmacology test...

Silvestri: Saunders Comprehensive Review for the NCLEX-RN Examination, 5th Edition

83

Test Bank

Elsevier items and derived items 2011, 2008, 2005, 2002 by Saunders, an imprint of Elsevier Inc.

Elsevier items and derived items 2011, 2008, 2005, 2002 by Saunders, an imprint of Elsevier Inc.

Silvestri: Saunders Comprehensive Review for the NCLEX-RN Examination, 5th Edition

Pharmacology

Test Bank

MULTIPLE CHOICE

1.The nurse is caring for a client in labor. The nurse reviews the physicians prescriptions and notes that the client has a prescription for butorphanol tartrate (Stadol). The nurse understands that this medication is prescribed for:

1.

Pain relief

2.

Increasing uterine contractions

3.

Decreasing uterine contractions

4.

Promoting fetal lung maturity

ANS:1

Rationale: The client in labor may be given parenteral analgesia during the first stage of labor, up to 2 to 3 hours before the anticipated delivery. Butorphanol tartrate is a medication that may be prescribed for pain relief. Increasing uterine contractions, decreasing uterine contractions, and promoting fetal lung maturity are not actions of this medication.

Test-Taking Strategy: Knowledge of the action of butorphanol tartrate is required to answer this question. Remember that this medication is used for pain relief. Review the action of this medication if you had difficulty with this question and are unfamiliar with this medication.

PTS:1

DIF:Level of Cognitive Ability: Understanding

REF:Lehne, R. (2010). Pharmacology for nursing care (7th ed.). St. Louis: Saunders.

OBJ:Client Needs: Physiological Integrity

TOP:Content Area: Pharmacology

MSC:Integrated Process: Nursing ProcessPlanning

2.The postpartum nurse is caring for a client with an epidural catheter in place for opioid analgesic administration following cesarean birth. If the client develops respiratory depression and requires naloxone (Narcan) as an antidote, the client may complain of which of the following?

1.

Increase in her pain level

2.

Decrease in her pain level

3.

Increase in the amount of itching from the opioid used in the epidural

4.

Decrease in the amount of itching from the opioid used in the epidural

ANS:1

Rationale: Remember that opioids are used for epidural analgesia. Naloxone is an opioid antagonist, which reverses the effects of opioids. If it is given, the client may complain of an increase in her pain level. Therefore decrease in her pain level, increase in the amount of itching from the opioid used in the epidural, and decrease in the amount of itching from the opioid used in the epidural are incorrect.

Test-Taking Strategy: To answer this question accurately, you must know that opioid analgesics are the medications used with epidural analgesia to relieve pain. Therefore if naloxone is administered as an antidote for an opioid analgesic, the clients pain will increase. Review the effects of naloxone if this question was difficult.

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MSC:Integrated Process: Nursing ProcessAssessment

3.A client experiencing preterm labor at the twenty-ninth week of gestation has been admitted to the hospital. The client has a prescription to receive betamethasone (Celestone). The nurse understands that the medication will do which of the following?

1.

Prevent spontaneous delivery.

2.

Stop the uterine contractions.

3.

Promote maturation of the fetal lungs.

4.

Accelerate the growth rate of the fetus.

ANS:3

Rationale: Betamethasone (Celestone) is classified as an anti-inflammatory and corticosteroid. It increases the surfactant level and lung maturity in the fetus, which reduces the incidence of respiratory distress syndrome. Delivery must be delayed for at least 48 hours after administration of betamethasone to allow time for the lungs of the fetus to mature.

Test-Taking Strategy: Options that are comparable or alike are not likely to be correct. With this in mind, eliminate prevent spontaneous delivery and stop the uterine contractions. Note the strategic words twenty-ninth week of gestation. Specific knowledge about the medication and knowledge of the problems encountered by premature infants will assist in answering this question. Review the action of this medication if this question was difficult.

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REF:McKinney, E., James, S., Murray, S., & Ashwill, J. (2009). Maternal-child nursing (3rd ed.). St. Louis: Saunders.OBJ:Client Needs: Physiological Integrity



4.A client with preeclampsia is receiving magnesium sulfate. The nurse assesses the client closely for which sign of magnesium toxicity?

1.

Proteinuria

2.

Hyperactive deep tendon reflexes

3.

Respiratory rate of 10 breaths/min

4.

Serum magnesium level of 5 mEq/L

ANS:3

Rationale: Magnesium toxicity is a risk associated with magnesium sulfate therapy. Signs of magnesium toxicity relate to central nervous system (CNS) depression and include respiratory depression, loss of deep tendon reflexes, and sudden drop in fetal heart rate and/or maternal heart rate and blood pressure. Magnesium is excreted through the kidneys. If renal impairment is present, magnesium toxicity can develop very quickly. Therapeutic serum levels of magnesium are 4 to 7 mEq/L.

Test-Taking Strategy: To answer this question accurately, you must recall that magnesium sulfate is a CNS depressant. Begin to answer this question by eliminating proteinuria and hyperactive deep tendon reflexes, which are signs of preeclampsia. Select between the last two options using medication knowledge and recalling that the therapeutic serum levels of magnesium are 4 to 7 mEq/L. Review this medication and the normal magnesium level if this question was difficult.

PTS:1

DIF:Level of Cognitive Ability: Analyzing

REF:Lowdermilk, D., Perry, S., & Cashion, K. (2010). Maternity nursing (8th ed.). St. Louis: Mosby.OBJ:Client Needs: Physiological Integrity



5.A pregnant client who has human immunodeficiency virus (HIV) infection is being seen in the antenatal clinic. The nurse recalls that zidovudine (AZT) therapy will be initiated when the fetus has reached how many weeks of gestation?

1.

4

2.

14

3.

24

4.

34

ANS:2

Rationale: The pregnant women with HIV infection will be prescribed oral AZT in the fourteenth week of gestation. Before this time, the fetus is at risk because of the teratogenic effects of the medication. In addition, a bolus of AZT is given intravenously during labor, and the neonate is treated for six weeks after birth.

Test-Taking Strategy: To answer this question accurately, you must be familiar with pharmacological therapy for clients who are HIV-positive. Knowing that the fetus is most vulnerable to the effects of medications and chemicals during the period of organogenesis will assist you in selecting the correct answer. Review treatment measures for the pregnant client with HIV infection if you had difficulty with this question.

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6.The nurse has a routine prescription to instill erythromycin ointment (Ilotycin) into the eyes of a newborn. The nurse plans to explain to the parents that the purpose of the medication is to:

1.

Help the newborn to see more clearly.

2.

Guard against infection acquired during intrauterine life.

3.

Ensure the sterility of the conjunctiva in the newborn.

4.

Protect the newborn from contracting an eye infection during birth.

ANS:4

Rationale: The use of eye prophylaxis with an agent such as erythromycin protects the newborn from contracting a conjunctival infection during birth. This infection, called ophthalmia neonatorum, results from maternal vaginal infection with chlamydia or gonorrhea. This prophylaxis is mandatory in the United States. Help the newborn to see more clearly, guard against infection acquired during intrauterine life, and ensure the sterility of the conjunctiva in the newborn do not describe the purposes of this medication.

Test-Taking Strategy: Familiarity with the purpose of this medication is needed to answer this question. Remember erythromycin protects the newborn from contracting a conjunctival infection during birth. Review the purpose of this medication if you had difficulty with this question.

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DIF:Level of Cognitive Ability: Applying


OBJ:Client Needs: Health Promotion and Maintenance


MSC:Integrated Process: Teaching and Learning

7.The nurse has a routine prescription to administer an injection of phytonadione (vitamin K) to the newborn. Before giving the medication, the nurse explains to the client that this medication will:

1.

Prevent clotting abnormalities in the newborn.

2.

Stimulate the liver to produce vitamin K.

3.

Prevent vitamin deficiency of fat-soluble vitamins.

4.

Supplement the infant, because breast milk and formula are low in vitamin K.

ANS:1

Rationale: Vitamin K is given to the newborn to prevent clotting abnormalities. Vitamin K is usually produced by bacteria in the gastrointestinal tract, which is sterile in the newborn. The other options are incorrect reasons for administering this medication to a newborn.

Test-Taking Strategy: Use the process of elimination. Thinking about the action and purpose of vitamin K will assist in answering correctly. Review the rationale for this newborn prophylaxis if this question was difficult.

PTS:1


REF:Perry, S., Hockenberry, M., Lowdermilk, D., & Wilson, D. (2010). Maternal child nursing care (4th ed.). St. Louis: Mosby.OBJ:Client Needs: Physiological Integrity


MSC:Integrated Process: Nursing ProcessImplementation

8.The client who has developed atrial fibrillation is not responding to medication therapy and has been placed on warfarin (Coumadin). The nurse is doing discharge dietary teaching with the client. The nurse would tell the client to avoid which of the following foods while taking this medication?

1.

Cherries

2.

Potatoes

3.

Broccoli

4.

Spaghetti

ANS:3

Rationale: Anticoagulant medications work by antagonizing the action of vitamin K, which is needed for clotting. When a client is taking an anticoagulant, foods high in vitamin K are often omitted from the diet. Vitamin K is found in large amounts in green leafy vegetables, such as broccoli, cabbage, turnip greens, and lettuce. The other options listed are foods that are lower in vitamin K.

Test-Taking Strategy: Knowledge about the relationship between warfarin and vitamin K is needed to answer this question. Note the strategic word avoid in the question. This tells you that the correct option is a food that is high in vitamin K. If you had difficulty with this question, review foods high in vitamin K.

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9.A client in preterm labor is being started on intravenous magnesium sulfate to stop the contractions. The nurse checks the medication to ensure that which medication is available as an antidote if needed?

1.

Magnesium oxide

2.

Vitamin K

3.

Aluminum hydroxide

4.

Calcium gluconate

ANS:4

Rationale: The antidote for magnesium sulfate is calcium gluconate. This medication should be available if the client experiences magnesium toxicity. The other options are incorrect. Magnesium oxide and aluminum hydroxide are antacids. Vitamin K is the antidote for warfarin (Coumadin).

Test-Taking Strategy: Eliminate magnesium oxide and aluminum hydroxide first because they are comparable or alike and are antacids. For the remaining options, recall that vitamin K is the antidote for warfarin (Coumadin). Remember that the antidote for magnesium sulfate is calcium gluconate. If this question was difficult, review this medication and the relationship between magnesium and calcium.

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10.The nurse had just given an intramuscular dose of methylergonovine (Methergine) to a client following delivery of an infant. The nurse determines that this medication had the intended effect after evaluating for which of the following findings?

1.

Decreased pulse rate

2.

Increased urine output

3.

Improved uterine tone

4.

Increased blood pressure

ANS:3

Rationale: Methylergonovine is an ergot alkaloid that is given following delivery to treat postpartum hemorrhage. It acts by vasoconstricting arterioles and directly stimulating uterine muscle contractions. Blood pressure may increase, but this is not the intended therapeutic effect. Decreased pulse rate and increased urine output are unrelated to the effects of this medication.

Test-Taking Strategy: To answer this question accurately, recall the action of the medication and its use in the immediate postpartum period. Remember that this medication improves uterine tone. Review the action of methylergonovine if you had difficulty with this question.

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DIF:Level of Cognitive Ability: Evaluating



MSC:Integrated Process: Nursing ProcessEvaluation

11.The nurse is told that the result of a serum carbamazepine (Tegretol) level for a child who is receiving the medication for the control of seizures is 10 mcg/mL. Based on this laboratory result, the nurse anticipates that the physician will prescribe:

1.

Discontinuation of the medication

2.

A decrease of the dosage of the medication

3.

An increase of the dosage of the medication

4.

Continuation of the presently prescribed dosage

ANS:4

Rationale: When carbamazepine is administered, blood levels need to be monitored periodically to check for the childs absorption of the medication. The amount of the medication prescribed is based on the blood level achieved. The therapeutic serum range of carbamazepine is 4 to 12 mcg/mL. The nurse would anticipate that the physician will continue the presently prescribed dosage.

Test-Taking Strategy: Knowing the therapeutic serum drug level of carbamazepine will direct you to the correct option. Remember that the therapeutic serum range is 4 to 12 mcg/mL. If you had difficulty with this question, learn the therapeutic serum drug level of carbamazepine.

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12.The nurse is providing instructions to a mother of a child with atopic dermatitis (eczema) regarding the application of topical cortisone cream to the affected skin sites. Which of the following statements, if made by the mother, indicates an understanding of the use of this medication?

1.

I shouldnt rub the medication into the skin.

2.

The medication is applied everywhere except the face.

3.

I need to wash the sites gently before I apply the medication.

4.

I need to apply the medication generously and allow it to absorb.

ANS:3

Rationale: Topical corticosteroids should be applied sparingly and rubbed into the area thoroughly. The affected area should be cleansed gently prior to application. It should not be applied everywhere or over extensive areas. Systemic absorption is more likely to occur with extensive application. It is applied to the affected sites.

Test-Taking Strategy: Note the strategic words indicates an understanding. Look for the option that indicates that the mother understands how to apply the cream. Eliminate The medication is applied everywhere except the face. because cream should be applied only to areas that are affected. Eliminate I need to apply the medication generously and allow it to absorb. because of the strategic word generously. Eliminate I shouldnt rub the medication into the skin. because of the strategic words shouldnt rub. Review the procedure for application of this cream if you had difficulty with this question.

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13.The nurse working in the ambulatory care center is providing medication instructions about methylphenidate (Ritalin) to the mother of a child with attention-deficit/hyperactivity disorder (ADHD). The nurse recommends that the mother give the medication to the child:

1.

At bedtime

2.

With the evening meal

3.

Just before the noontime meal

4.

In the morning, 2 hours before breakfast

ANS:3

Rationale: Methylphenidate is best taken shortly before a meal. It should not be taken after 12 noon or 1 PM for children or after 6 PM for adults, because the stimulating effect may keep the client awake. The other options are incorrect.

Test-Taking Strategy: Knowledge about the correct administration procedure for this medication is required to answer this question. Remember that it is best to administer it shortly before the noontime meal. If you had difficulty with this question, review the client teaching points for methylphenidate.

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14.A child has been prescribed to take tetracycline hydrochloride. The nurse providing medication information to the mother would plan to emphasize which of the following most important instructions about giving this medication to the child?

1.

Give the medication with milk.

2.

Give the medication with ice cream.

3.

Mix the medication in a Styrofoam cup.

4.

Use a straw when giving the medication.

ANS:4

Rationale: Because tetracycline can cause staining of the teeth, straws should be used and the mouth rinsed after administration. The medication should be administered 1 hour before or 2 hours after the administration of milk, which would eliminate give the medication with milk and give the medication with ice cream. Mix the medication in a Styrofoam cup is unnecessary.

Test-Taking Strategy: Eliminate give the medication with milk and give the medication with ice cream first because they are comparable or alikethey are both milk products. Recalling that tetracycline can cause staining of the teeth will direct you to the correct option from those remaining. If you had difficulty with this question, review the client teaching points related to the administration of tetracycline hydrochloride.

PTS:1


REF:Kee, J., Hayes, E., & McCuistion, L. (2009). Pharmacology: a nursing process approach (6th ed.). St. Louis: Saunders.OBJ:Client Needs: Physiological Integrity



15.The nurse is providing instructions to the parent of a child with iron deficiency anemia about the administration of a liquid oral iron supplement. Which of the following statements, if made by the parent, indicates an understanding of the administration of this medication?

1.

I should give the iron with food.

2.

I can mix the iron with cereal to give it.

3.

I should add the iron to the formula in the babys bottle.

4.

I should use a medicine dropper and place the iron near the back of the throat.

ANS:4

Rationale: Oral iron supplement should be administered through a straw or medicine dropper placed at the back of the mouth because it will stain the teeth. The parents should be instructed to brush or wipe the teeth after administration. Iron is administered between meals because absorption is decreased if there is food in the stomach. Iron requires an acidic environment to facilitate its absorption in the duodenum.

Test-Taking Strategy: Eliminate I should give the iron with food. I can mix the iron with cereal to give it. and I should add the iron to the formula in the babys bottle. first because they are comparable or alike and because medication should not be added to formula and food. Also, note the strategic word liquid in the question. This should assist in recalling that liquid iron stains teeth. Review the teaching points related to this medication if you had difficulty with this question.

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16.The client with psoriasis is being treated with calcipotriene (Dovonex) cream. Administration of high doses of this medication can cause which side effect?

1.

Alopecia

2.

Hyperkalemia

3.

Hypercalcemia

4.

Thinning of the skin

ANS:3

Rationale: Calcipotriene (Dovonex), an analogue of vitamin D3, is indicated for mild to moderate psoriasis. Responses are equal to those achieved with medium-potency topical glucocorticoids. The most common adverse effect is local irritation. Unlike glucocorticoids, calcipotriene does not cause thinning of the skin. At high doses, calcipotriene has caused hypercalcemia. Hyperkalemia is not a side effect.

Test-Taking Strategy: Note the strategic words high doses. Remember that hypercalcemia is a concern. Note that the relationship between the name of the medication and hypercalcemia. The medication name begins with calci-, which is similar to calcium. Review this medication if you had difficulty with this question.

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17.Collagenase (Santyl) is prescribed for a client with a severe burn to the hand. The nurse is providing instructions to the client and spouse regarding wound treatment. Which of the following should the nurse include in the instructions?

1.

Apply twice a day, and leave it open to the air.

2.

Apply once a day, and leave it open to the air.

3.

Apply twice a day, and cover it with a sterile dressing.

4.

Apply once a day, and cover it with a sterile dressing.

ANS:4

Rationale: Collagenase is used in the treatment of dermal lesions and severe burns. Its action is to dbride the affected area. It is applied once daily and covered with a sterile dressing. Apply twice a day, and leave it open to the air, apply once a day, and leave it open to the air, and apply twice a day, and cover it with a sterile dressing are incorrect application procedures.

Test-Taking Strategy: Knowledge regarding the use of this medication is required to answer this question. Remember that this medication is applied daily and covered with a sterile dressing. Review the procedure for applying collagenase if you had difficulty with this question.

PTS:1


REF:Ignatavicius, D., & Workman, M. (2010). Medical-surgical nursing: patient-centered collaborative care (6th ed.). St. Louis: Saunders.




18.A nurse is caring for a female client at home with a diagnosis of actinic keratosis. The client tells the nurse that her skin is very dry and irritated. The treatment includes diclofenac sodium (Solaraze). The nurse teaches the client that this medication is from which class of medications?

1.

Anti-infectives

2.

Vitamin A lotions

3.

Coal tar preparations

4.

Nonsteroidal anti-inflammatory drugs (NSAIDs)

ANS:4

Rationale: Diclofenac sodium (Solaraze) is a nonsteroidal anti-inflammatory drug (NSAID) for topical use. It is indicated for use for actinic keratosis. The mechanism underlying its benefits is unknown. The most common side effects are dry skin, itching, redness, and rash at the site of application. Diclofenac may sensitize the skin to ultraviolet radiation, and clients should therefore avoid sunlamps and minimize exposure to sunlight. Vitamin A would be contraindicated in the treatment of actinic keratosis. Coal tar is for psoriasis.

Test-Taking Strategy: Focus on the clients diagnosis and the name of the medication. Also noting the strategic word irritated in the question will direct you to nonsteroidal anti-inflammatory drugs (NSAIDs). Review this medication if you had difficulty with this question.

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19.The client with muscle aches and a diagnosis of rheumatism has been given a prescription for capsaicin topical cream. The nurse evaluates that the client understands the use of the medication if the client states that:

1.

The medication will act as a local analgesic.

2.

The medication acts by decreasing muscle spasms.

3.

The medication will cause redness, flaking, and the skin to peel.

4.

A heating pad should be put on the area after applying the medication.

ANS:1

Rationale: Capsaicin is used for the temporary relief of muscular aches, rheumatism, arthritis, sprains, and neuralgia. It is one of a group of products known as rubs or liniments, which contain combinations of antiseptics, local anesthetics, analgesics, and counterirritants. The skin should not become red, flaky, or peel; if this occurs, the physician should be notified. The medication does not act systemically. A heating pad should not be applied, because it could cause skin irritation or burning.

Test-Taking Strategy: Focus on the diagnosis to assist in eliminating the medication will cause redness, flaking, and the skin to peel. Next eliminate a heating pad should be put on the area after applying the medication because a heating pad should not be placed over this cream because of the risk of burns. Choose correctly between the remaining two options by differentiating a systemic from a topical response. Review this medication if you had difficulty with this question.

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20.The client with a burn injury is applying mafenide (Sulfamylon) to the wound. The client calls the physicians office and tells the nurse that the medication is uncomfortable and is causing a burning sensation. The nurse instructs the client to:

1.

Discontinue the medication.

2.

Apply a thinner film than prescribed to the burn site.

3.

Continue with the treatment, as this is expected.

4.

Come to the office to see the physician immediately.

ANS:3

Rationale: Mafenide is used to treat partial- and full-thickness burns. It is bacteriostatic for both gram-negative and gram-positive organisms present in avascular tissues. The client should be warned that the medication will cause local discomfort and burning. The nurse does not instruct a client to alter a medication prescription (discontinue the medication and apply a thinner film than prescribed to the burn site). It is not necessary that the client see the physician immediately at this time.

Test-Taking Strategy: Eliminate discontinue the medication and apply a thinner film than prescribed to the burn site because they represent, in effect, a change in medication prescription, which is outside the realm of legal nursing practice. To choose correctly between the last two options, you must be familiar with this medication and its expected effects. Remember that this medication will cause local discomfort and burning. If you had difficulty with this question, review this medication now.

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21.The client with an infected leg wound that is draining purulent material has a prescription for sodium hypochlorite (Dakin solution) to be used in the care of the wound. The nurse would do which of the following while using this solution?

1.

Rinse off immediately following irrigation.

2.

Pour onto sterile sponges, and pack in wound.

3.

Let the solution run freely over normal skin tissue.

4.

Use each bottle of solution for 2 weeks before replacing.

ANS:1

Rationale: Dakin solution is a hypochlorite solution that is used for irrigating and cleaning necrotic or purulent wounds. It cannot be used to pack purulent wounds, because the solution is inactivated by copious pus. (It can be used to pack necrotic wounds, however.) It should not come into contact with healing or normal tissue, and it should be rinsed off immediately if used for irrigation. The solution is unstable, and it is best to prepare a fresh solution for use during each dressing change.

Test-Taking Strategy: Note the strategic words draining purulent material. This will direct you to rinse off immediately following irrigation. If you are unfamiliar with the use of this solution, review this content.

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22.An adolescent client with severe cystic acne has been prescribed isotretinoin (Accutane). Which statement by the client would suggest the need for further teaching?

1.

I will return to the clinic for blood tests.

2.

If my lips begin to burn, it is probably because of the medication.

3.

My eyes may become dry and burn as a result of the medication.

4.

I need to take my vitamin A supplement so that the treatment will work.

ANS:4

Rationale: Isotretinoin (Accutane) is used to inhibit inflammation in the client with severe cystic acne. Adverse effects include elevated triglyceride levels, skin dryness, and eye discomfort, such as dryness and burning. Lip inflammation, called cheilitis, can also occur. Vitamin A supplements are stopped during this treatment because of their additive effects.

Test-Taking Strategy: Use the process of elimination and note the strategic words need for further teaching. These words indicate a negative event query and the need to select the incorrect option. Remember that vitamin A supplements are stopped during treatment. This will also assist in answering questions similar to this one. If you are unfamiliar with this medication and the client teaching points involved, review this content.

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23.An ambulatory care client with allergic dermatitis has been given a prescription for a tube of diphenhydramine (Benadryl) 1% to use as a topical agent. The nurse determines that the medication was effective if which of the following was assessed?

1.

Nighttime sedation

2.

Decrease in urticaria

3.

Absence of ecchymoses

4.

Healing of burned tissue

ANS:2

Rationale: Diphenhydramine reduces the symptoms of allergic reaction, such as itching or urticaria, when used as a topical agent on the skin. The oral form also has other uses, such as to provide mild nighttime sedation. It is not used to treat burns or ecchymoses.

Test-Taking Strategy: The strategic words are dermatitis and effective. This tells you that the correct option is one that indicates relief of an allergic skin condition. Knowledge of the medications antihistamine effect will direct you to the correct option. Review this medication if you had difficulty with this question.

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24.The client with cancer has received a course of chemotherapy and received fluorouracil (Adrucil). The nurse should plan to tell the client to report which of the following immediately?

1.

Alopecia

2.

Headache

3.

Stomatitis and diarrhea

4.

Changes in color vision

ANS:3

Rationale: Fluorouracil (Adrucil) should be discontinued as soon as reactions (stomatitis, diarrhea) occur. Dosage can also be limited by palmar-plantar erythrodysesthesia syndrome (also called hand-foot syndrome), characterized by tingling, burning, redness, flaking, swelling, and blistering of the palms and soles. Alopecia is common and would not require immediate reporting. Headache and vision changes are not associated with fluorouracil.

Test-Taking Strategy: General knowledge of the adverse effects associated with the administration of antineoplastic medications is required to answer this question. Remember that stomatitis and diarrhea is a concern with fluorouracil (Adrucil). Review the adverse effects of this medication if you had difficulty with this question.

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25.The nurse reviewing a medical record notes that high concentrations of methotrexate followed by leucovorin (citrovorum factor, folic acid) are being given to the client with cancer. The nurse correctly interprets that the reason for therapy with leucovorin is to:

1.

Preserve normal cells.

2.

Promote protein synthesis.

3.

Promote medication excretion.

4.

Hasten the effect of the methotrexate.

ANS:1

Rationale: The administration of leucovorin with methotrexate is known as leucovorin rescue. High concentrations of methotrexate cause harm and damage to normal cells. Leucovorin bypasses the metabolic block caused by methotrexate, thereby permitting normal cells to synthesize. Leucovorin rescue is potentially hazardous, because failure to administer leucovorin in the right dose at the right time can be fatal.

Test-Taking Strategy: To answer this question accurately, it is necessary to understand the action of leucovorin and the reason for administering it with methotrexate. Eliminate hasten the effect of the methotrexate first, because increased fluids and diuretics normally are prescribed and administered to hasten the effect of methotrexate. To select from the remaining options, you must be familiar with this medication. If you had difficulty with this question, review leucovorin rescue.

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MSC:Integrated Process: Nursing ProcessAnalysis

26.The nurse understands that an indication for the use of asparaginase (Elspar) is:

1.

Lung cancer

2.

Breast cancer

3.

Metastatic prostate cancer

4.

Acute lymphocytic leukemia

ANS:4

Rationale: Asparaginase is indicated for the treatment of acute lymphocytic leukemia. Lung cancer, breast cancer, and metastatic prostate cancer are treated with other antineoplastic agents.

Test-Taking Strategy: Knowledge regarding the indications for use of specific antineoplastic agents is required to answer this question. Remember that acute lymphocytic leukemia may be treated with asparaginase. Review the specific uses of this medication if you had difficulty answering this question.

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27.The nurse is caring for a client on the oncology unit who has developed stomatitis during chemotherapy. The nurse would plan which of the following measures to treat this complication?

1.

Rinse the mouth with diluted baking soda or saline.

2.

Use lemon and glycerin swabs liberally on painful oral lesions.

3.

Place the client on NPO status for 12 hours, then resume liquids.

4.

Brush the teeth and use nonwaxed dental floss at least twice a day.

ANS:1

Rationale: Stomatitis, or mouth ulcerations, occurs with the administration of many antineoplastic medications. The clients mouth should be examined daily for signs of ulceration. If stomatitis occurs, the client should be instructed to rinse the mouth with baking soda or saline. Food and fluids are important and should not be restricted. If chewing and swallowing are painful, the client may switch to a liquid diet. Instruct the client to avoid spicy foods and foods with hard crusts or edges. The client should avoid tooth brushing and flossing when stomatitis is severe. Lemon and glycerin swabs may cause pain and further irritation.

Test-Taking Strategy: Begin to answer this question by recalling the characteristics of stomatitis. Eliminate use lemon and glycerin swabs liberally on painful oral lesions, because lemon can be irritating to ulcerated lesions. Eliminate place the client on NPO status for 12 hours, then resume liquids, because foods and fluids would not be restricted for a client who received antineoplastic medication. Eliminate brush the teeth and use nonwaxed dental floss at least twice a day, because a toothbrush and floss will irritate ulcerations and also may cause bleeding. If you had difficulty with this question, review the procedures for caring for stomatitis.

PTS:1


REF:Black, J., & Hawks, J. (2009). Medical-surgical nursing: clinical management for positive outcomes (8th ed.). St. Louis: Saunders.




28.The client who has been diagnosed with cancer is to receive chemotherapy with both cisplatin (Platinol-AQ) and vincristine (Oncovin). The client asks the nurse why both medications must be given together. The nurse's response is based on the understanding that the purpose of using both medications is to:

1.

Prevent the destruction of normal cells.

2.

Increase the destruction of tumor cells.

3.

Decrease the risk of the alopecia and stomatitis.

4.

Increase the likelihood of erythrocyte and leukocyte recovery.

ANS:2

Rationale: Cisplatin (Platinol-AQ) is an alkylating-like medication, and vincristine (Oncovin) is a vinca alkaloid. Alkylating medications are cell cycle phasenonspecific. Vinca alkaloids are cell cycle phasespecific and act on the M phase. Single-agent medication therapy seldom is used. Combinations of medications are used to increase the destruction of tumor cells.

Test-Taking Strategy: Knowledge of the rationale for combination medication therapy is required to answer the question. Read each option carefully and remember that combinations of medications are used to increase the destruction of tumor cells. If this question was difficult, review the purpose of combination chemotherapy.

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29.The nurse tells the client with leukemia who is receiving chemotherapy that allopurinol (Zyloprim) has been added to the medication list. When the client asks the purpose of the new medication, the nurse responds that the allopurinol is intended to prevent:

1.

Nausea

2.

Diarrhea

3.

Muscle spasms

4.

Hyperuricemia

ANS:4

Rationale: Chemotherapy destroys cells leading to the release of uric acid into the blood stream. The client is then at risk of experiencing uric acid nephropathy, renal stones, and acute renal failure. Allopurinol (Zyloprim), an antigout medication, is used with chemotherapy to prevent or treat this complication of therapy. It also may be used in mouthwash following fluorouracil (Adrucil) therapy to prevent stomatitis. Allopurinol is not used to treat nausea, diarrhea, or muscle spasms.

Test-Taking Strategy: Focus on the subject, the purpose of allopurinol in the client receiving chemotherapy. Remember that allopurinol is also used to remove uric acid from the body in clients with gout. This will assist in directing you to hyperuricemia. Review the purpose of allopurinol in the client receiving chemotherapy if you had difficulty with this question.

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30.The client with breast cancer has been given a prescription for cyclophosphamide (Cytoxan). The nurse determines that the client understands the proper use of the medication if the client states that he or she will:

1.

Increase dietary intake of potassium.

2.

Take the medication with large meals.

3.

Decrease dietary intake of magnesium.

4.

Increase fluid intake to 2 to 3 L/day.

ANS:4

Rationale: A toxic effect of cyclophosphamide (Cytoxan) is hemorrhagic cystitis. The client should drink large amounts of fluid during the administration of this medication. Clients also should observe for hematuria. The medication should be taken on an empty stomach, unless gastrointestinal upset occurs. Hyperkalemia can result from the use of the medication; therefore, the client would not be encouraged to increase potassium intake. The client would not be instructed to alter magnesium intake.

Test-Taking Strategy: Knowledge of the toxic effects of cyclophosphamide will assist you to answer this question correctly. If you correlated cyclophosphamide with hemorrhagic cystitis, by the process of elimination, increase fluid intake to 2 to 3 L/day would then be selected. If you had difficulty with this question, review the toxic effects associated with this medication.

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31.The nurse should be prepared to institute bleeding precautions in the client receiving antineoplastic medication if which of the following results were reported from the lab?

1.

Clotting time, 12 seconds

2.

Ammonia level, 28 mcg/dL

3.

Platelet count, 50,000 cells/mm3

4.

White blood cell count (WBC), 4500/mm3

ANS:2

Rationale: Platelets are the building blocks of blood clots. The normal platelet count is 150,000 to 450,000 cells/mm3. Bleeding precautions should be instituted when the platelet count drops to a critically low level, as defined by agency policy. Bleeding precautions include avoiding all trauma, such as rectal temperatures or injections. The normal clotting time is 8 to 15 seconds. The normal ammonia value is 10 to 80 mcg/dL. The normal WBC is 5000 to 10,000 cells/mm3. When the WBC count drops, neutropenic precautions should be implemented.

Test-Taking Strategy: Knowledge of normal laboratory values and the significance of the specific laboratory tests is required to answer the question. Eliminate clotting time, 12 seconds and ammonia level, 28 mcg/dL, because they identify normal laboratory values. To select between the last two options, correlate a low platelet count with the need for bleeding precautions and a low WBC count with the need for neutropenic precautions. Review bleeding precautions if you had difficulty with this question.

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OBJ:Client Needs: Safe and Effective Care Environment



32.The client with cancer is about to be started on mitomycin (Mutamycin). The nurse should suggest contacting the physician after noting that the client is also taking which of the following medications?

1.

Furosemide (Lasix)

2.

Ondansetron (Zofran)

3.

Warfarin (Coumadin)

4.

Allopurinol (Zyloprim)

ANS:3

Rationale: Mitomycin is an antitumor antibiotic. The use of aspirin, anticoagulants, and thrombolytic agents should be avoided concurrent with this medication, because mitomycin causes thrombocytopenia. Warfarin (Coumadin) is an anticoagulant, and the risk of bleeding is increased if administered during mitomycin therapy. Furosemide is a diuretic and is not related to the question. Ondansetron (Zofran) is an antiemetic used to prevent or treat nausea and vomiting during chemotherapy. Allopurinol is an antigout medication, which prevents or treats hyperuricemia resulting from blood dyscrasias caused by cancer chemotherapy.

Test-Taking Strategy: To answer this question accurately, you must be familiar with the adverse effects of this medication and how to minimize the risk of their occurrence. Remember that warfarin increases the risk of bleeding. If you are unfamiliar with this medication, review this content.

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OBJ:Client Needs: Safe and Effective Care Environment


MSC:Integrated Process: Nursing ProcessAnalysis

33.A client with diabetes mellitus taking daily NPH insulin has been started on therapy with dexamethasone (Decadron). The nurse anticipates that which of the following adjustments in medication dosage will be made?

1.

Decreased NPH insulin

2.

Increased NPH insulin

3.

Lower dose of dexamethasone (Decadron) than usual

4.

Higher dose of dexamethasone (Decadron) than usual

ANS:2

Rationale: Dexamethasone is a glucocorticoid (corticosteroid) and therefore can elevate the blood glucose level. Diabetic clients may need their dosage of insulin or oral hypoglycemic medications increased during glucocorticoid therapy. This is most often a temporary change, needed to compensate for the actions of the medication.

Test-Taking Strategy: Focus on the medications in the question and recall that medication names ending in the letters -sone are glucocorticoids. Next, remember that glucocorticoids can increase the blood glucose level. This concept will direct you to the correct option. Review the effects of corticosteroids if you had difficulty with this question.

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34.The nurse monitors the blood glucose level of the client who received NPH insulin at 7 AM with an understanding that the client may experience a hypoglycemic reaction between:

1.

9 to 11 AM

2.

1 to 7 PM

3.

7 to 11 PM

4.

Midnight to 6 AM

ANS:2

Rationale: NPH insulin is an intermediate-acting insulin. It peaks in 6 to 12 hours after administration. (Its onset is in 1 to 2 hours, and its duration is 18 to 24 hours.) If the medication was given at 7 AM, the nurse would monitor for hypoglycemia during the time of peak action, which would be between 1 and 7 PM.

Test-Taking Strategy: Read the question carefully, noting that the question is asking about NPH insulin. Knowledge regarding the timing of the peak action is required to answer the question. Peak action time is the time that a hypoglycemic reaction will most likely occur. Review these points regarding NPH (and regular) insulin if you are unfamiliar with them.

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35.The nurse evaluates that the family of a client newly diagnosed with diabetes mellitus correctly understands the reason for having glucagon on hand for emergency home use if the family indicates that the purpose of the medication is to treat:

1.

Diabetic ketoacidosis

2.

Hypoglycemia from insulin overdose

3.

Hyperglycemia from insufficient insulin

4.

Hyperglycemia occurring on sick days

ANS:2

Rationale: Glucagon is used to treat hypoglycemia resulting from insulin overdose. The family of the client is instructed in how to administer the medication. In an unconscious client, consciousness usually returns within 20 minutes of glucagon injection. After the client has regained consciousness, oral carbohydrates should be given. The other options are incorrect.

Test-Taking Strategy: Note that the word glucagon is similar to the word glucose. This may help you recall that the medication raises blood glucose levels. Remember also that options that are comparable or alike are not likely to be correct. Each incorrect option contains hyperglycemia as the clinical problem. If you are unfamiliar with the use of glucagon, review this medication.

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36.The nurse is teaching a client with hyperthyroidism regarding the prescribed medication propylthiouracil (PTU). The nurse determines that teaching has been successful if the client states that he will report which of the following symptoms to the physician?

1.

Fever

2.

Nervousness

3.

Tiredness

4.

Fatigue

ANS:1

Rationale: An adverse effect of propylthiouracil (PTU) is agranulocytosis. The client should be alert for this effect by noting the presence of fever or sore throat, which should be reported immediately. Muscle aches and excitability are neither side effects nor adverse effects of this medication. Tiredness may be an occasional side effect of the medication but does not warrant physician notification.

Test-Taking Strategy: Eliminate tiredness and fatigue because they are comparable or alike. Next eliminate nervousness because it is a characteristic of hyperthyroidism. If you are unfamiliar with this medication, review its adverse effects.

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37.The nurse teaches the client with hypocalcemia to take calcium carbonate (Os-Cal) at which time?

1.

With breakfast

2.

At lunch time

3.

Just before a meal

4.

One hour after a meal

ANS:4

Rationale: Calcium carbonate is best administered 1 to 1 hours after meals. The tablets should be given with a full glass of water. Therefore with breakfast, at lunch time, and just before a meal are incorrect.

Test-Taking Strategy: Eliminate with breakfast, at lunch time, and just before a meal because they are comparable or alike and indicate that the medications should be taken with food. Remember that it is best to take calcium carbonate 1 to 1 hours after meals. If you had difficulty with this question, review the administration of this medication.

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REF:Skidmore-Roth, L. (2011). Mosbys drug guide for nurses (9th ed.). St. Louis: Mosby.OBJ:Client Needs: Physiological Integrity



38.The nurse teaches the client being discharged to home with a prescription for a daily dose of prednisone to take the medication:

1.

In the early morning

2.

In the middle of the day

3.

An hour before bedtime

4.

Anytime of the day

ANS:1

Rationale: The client should be instructed to take glucocorticoids (corticosteroids) before 9 AM. This helps minimize adrenal insufficiency and also mimics the burst of glucocorticoids released naturally by the adrenal glands each morning. Therefore in the middle of the day, an hour before bedtime, and anytime of the day are incorrect.

Test-Taking Strategy: Knowledge regarding the administration of glucocorticoids is required to answer this question. Remember that it is best to take the medication in the early morning. If you had difficulty with this question, review the procedure for the administration of glucocorticoids.

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39.The nurse monitors the client taking octreotide acetate (Sandostatin) for acromegaly for which most frequent side effect of this medication?

1.

Diarrhea

2.

Dyspnea

3.

Constipation

4.

Bradycardia

ANS:1

Rationale: Octreotide acetate (Sandostatin) is used to reduce growth hormone levels in clients with acromegaly. The most common side effects of this medication are diarrhea, nausea, gallstone formation, and abdominal discomfort. Hypertension, although rare, may occur. Constipation, bradycardia, and dyspnea are not associated with use of this medication.

Test-Taking Strategy: Knowledge regarding the side effects associated with octreotide acetate is required to answer the question. Remember that diarrhea can occur with this medication. Review the side effects of this medication if you had difficulty with this question.

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40.A client with a history of coronary artery disease has developed diabetes insipidus as a result of cranial surgery. The client's medication therapy will include vasopressin (Pitressin). The nurse monitors this client most carefully for which of the following sign/ symptom that indicates an adverse effect of this medication?

1.

Depression

2.

Chest pain

3.

Nagging cough

4.

Joint stiffness

ANS:2

Rationale: Because of its powerful vasoconstrictor actions, vasopressin can cause adverse cardiovascular effects. By constricting arteries of the heart, vasopressin can cause angina pectoris and even myocardial infarction (MI), especially if administered to clients with coronary artery disease. In addition, vasopressin may cause gangrene by decreasing blood flow in the periphery. The other options are incorrect are nit signs/symptoms of adverse effects of the medication.

Test-Taking Strategy: Use the process of elimination to answer the question. The name vasopressin implies an effect on blood vessels. Therefore, correlate this name with an option that represents a cardiovascular problem. If you are unfamiliar with precautions associated with administering vasopressin, review this content.

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41.The client has a prescription for sucralfate (Carafate) four times daily. The nurse writes in the medication record to administer the medication at which of the following times?

1.

With meals and at bedtime

2.

Every 6 hours around the clock

3.

One hour after meals and at bedtime

4.

One hour before meals and at bedtime

ANS:4

Rationale: Sucralfate is a gastric protectant. The medication should be scheduled for administration 1 hour before meals and at bedtime. The medication is scheduled so that it has time to bind to the base of ulcers and erosions and form a protective coating before food intake stimulates chemical and mechanical irritation in the stomach. Therefore with meals and at bedtime, every 6 hours around the clock, and one hour after meals and at bedtime are incorrect.

Test-Taking Strategy: Specific knowledge of this medication and its action and timing is needed to answer this question. Recalling that this medication is a gastric acid protectant will help you eliminate with meals and at bedtime, every 6 hours around the clock, and one hour after meals and at bedtime. If needed, review this medication and its method of administration.

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42.The client who chronically uses nonsteroidal anti-inflammatory drugs (NSAIDs) has begun taking misoprostol (Cytotec). Evaluation of the effectiveness of the misoprostol in preventing a side effect of chronic NSAID use is determined by the nurse if the client reports which of the following?

1.

I have fewer muscle aches.

2.

My joint mobility has improved.

3.

I no longer have pain above my stomach.

4.

I am no longer experiencing constipation.

ANS:3

Rationale: The client who chronically uses NSAIDs is prone to gastric mucosal injury. Misoprostol is a gastric protectant and is given specifically to prevent this occurrence. Constipation is not associated with the use of NSAIDs. I have fewer muscle aches. and My joint mobility has improved. are incorrect because they are intended effects of the NSAID.

Test-Taking Strategy: Focus on the name of the medication to eliminate I have fewer muscle aches. and My joint mobility has improved. To select from the remaining options, recall that NSAIDs are irritating to the gastrointestinal tract. Review the side effects of NSAIDs if you had difficulty with this question.

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43.The client in the preoperative holding area has been given a dose of scopolamine. The nurse assesses the client for which of the following side effects of the medication?

1.

Dry mouth

2.

Diaphoresis

3.

Excessive urination

4.

Pupillary constriction

ANS:1

Rationale: Scopolamine is an anticholinergic medication that can be used preoperatively. It causes frequent side effects, such as dry mouth, urinary retention, decreased sweating, and dilation of the pupils. The other options are incorrect.

Test-Taking Strategy: To answer this question accurately, you must be familiar with this medication and its uses and/or the fact that it is an anticholinergic medication. Focusing on the strategic word preoperative and recalling the purpose of administering medications in the preoperative period will assist in directing you to the correct option. If the medication is unfamiliar to you, review its side effects.

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44.The client with gastroesophageal reflux disease (GERD) has a new prescription for pantoprazole (Protonix). Which of the following instructions should the nurse plan to provide to the client?

1.

Chew the pill thoroughly.

2.

Swallow the tablet whole.

3.

Crush the pill if it is difficult to swallow.

4.

Headache is expected to occur.

ANS:2

Rationale: Protonix, a proton pump inhibitor, is a delayed-release medication and should be swallowed whole. It should not be chewed or crushed. Headache is a potential side effect of the medication and should be reported to the health care provider.

Test-Taking Strategy: To answer this question accurately, you must be familiar with this medication and its administration. Chew the pill thoroughly and crush the pill if it is difficult to swallow can be eliminated first, because chewing and crushing will interrupt the delayed release of the medication. Eliminate headache is expected to occur because headache is a potential side effect of the medication and should be reported to the health care provider. If this medication is unfamiliar to you, review its method of administration.

PTS:1


REF:Skidmore-Roth, L. (2010). 2010 Mosbys nursing drug reference (23rd ed.). St. Louis: Mosby.OBJ:Client Needs: Physiological Integrity



45.The client is experiencing diarrhea. The nurse reviews the clients PRN medication prescription sheet and plans to administer which of the following medications for this problem?

1.

Sennosides (Senokot)

2.

Bisacodyl (Dulcolax Bowel Prep Kit)

3.

Psyllium (Metamucil)

4.

Loperamide (Imodium)

ANS:4

Rationale: Loperamide is an antidiarrheal agent. It inhibits peristalsis in the intestinal wall and inhibits intestinal secretion so that the number of stools and water content are decreased. Sennosides (Senokot), bisacodyl (Dulcolax Bowel Prep Kit), and psyllium (Metamucil) are laxatives.

Test-Taking Strategy: Eliminate sennosides (Senokot), bisacodyl (Dulcolax Bowel Prep Kit), and psyllium (Metamucil) because they are comparable or alike, and because they are laxatives. If needed, review the uses of the medications listed in the options.

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46.The client with recurrent constipation has been prescribed psyllium (Metamucil). Teaching provided by the nurse should include which of the following instructions?

1.

Mix the psyllium powder with any cold beverage.

2.

Mix the psyllium powder with 4 oz of a hot beverage.

3.

Mix the psyllium powder with gelatin, applesauce, or pudding.

4.

Mix the psyllium powder with 8 oz of water or juice followed by drinking an additional 8 oz of liquid.

ANS:4

Rationale: Metamucil is a bulk-forming laxative. It should be mixed with 8 oz of water or juice, followed by drinking another 8 oz of liquid. This will help prevent impaction of the medication in the stomach or small intestine. The other options are incorrect methods of administration.

Test-Taking Strategy: Use knowledge of this common medication to eliminate each of the incorrect options systematically. Recalling that the medication can cause an impaction will assist in directing you to mix the psyllium powder with 8 oz of water or juice followed by drinking an additional 8 oz of liquid. If this question was difficult, review the procedure for the administration of psyllium.

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47.The nurse is reading the medication list for a postoperative client and notes that a PRN prescription for ondansetron (Zofran) was administered. Evaluation of the effectiveness of the medication is determined by the nurse if the client makes which of the following statements?

1.

My headache is gone.

2.

The dizziness has stopped.

3.

I no longer feel nauseous.

4.

The pain at my incision has decreased.

ANS:3

Rationale: Ondansetron is an antiemetic used in the treatment of postoperative nausea and vomiting, as well as nausea and vomiting associated with chemotherapy. All the other options are incorrect.

Test-Taking Strategy: To answer this question accurately, you must know the classification of this medication. Remember that ondansetron (Zofran) is an antiemetic. If you are unfamiliar with the action and use of this medication, review this content.

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48.An older client has been receiving cimetidine (Tagamet). The nurse should report to the physician that the client is experiencing a side effect of the medication if which of the following is noted during the assessment?

1.

Tremors

2.

Stiff joints

3.

Confusion

4.

Constipation

ANS:3

Rationale: Older clients are especially susceptible to central nervous system (CNS) side effects of cimetidine; the most frequent of these is confusion. Additionally, renal impairment in this population further increases this risk for confusion. Less common CNS side effects include headache, dizziness, drowsiness, and hallucinations.

Test-Taking Strategy: Use growth and development concepts related to the older client and the side effects of this medication to choose correctly. Remember when a specific age or age grouping of a client is given in the question, it is usually significant to the expected response to the question. Remember that older clients can experience CNS side effects of cimetidine. Review this medication and its effect on the older client if you had difficulty with this question.

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49.The nurse monitors the client receiving the first dose of albuterol (Proventil HFA) for which of the following side effects of this medication?

1.

Drowsiness

2.

Tachycardia

3.

Hyperglycemia

4.

Hyperkalemia

ANS:2

Rationale: Albuterol is a bronchodilator. Side effects can include tachycardia, hypertension, chest pain, dysrhythmias, nervousness, restlessness, and headache, among others. The nurse monitors for these effects during therapy. The items in the other options are not side effects of this medication.

Test-Taking Strategy: To answer this question accurately, it is necessary to understand that this medication is a bronchodilator. Thinking about the physiological effects of a bronchodilator will assist in answering correctly. Remember that tachycardia is a side effect. Review the side effects of this medication if you had difficulty with this question.

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50.The client has a prescription to receive pirbuterol (Maxair) two puffs and beclomethasone two puffs by metered-dose inhaler. The nurse plans to give these medications most effectively by:

1.

Administering the beclomethasone before the pirbuterol

2.

Administering the pirbuterol before the beclomethasone

3.

Alternating a single puff of each hourly, beginning with the beclomethasone

4.

Alternating a single puff of each hourly, beginning with the pirbuterol

ANS:2

Rationale: Pirbuterol is a bronchodilator. Beclomethasone is a glucocorticoid. Bronchodilators are administered before glucocorticoids when both are to be given on the same time schedule. This allows for widening of the air passages by the bronchodilator, which then makes the glucocorticoid more effective.

Test-Taking Strategy: To answer this question correctly, it is necessary to know two different items. First, you must know that a bronchodilator is always given before a glucocorticoid. This would allow you to eliminate alternating a single puff of each hourly, beginning with the beclomethasone and alternating a single puff of each hourly, beginning with the pirbuterol, because you would not alternate the medications hourly. To select between the last two options, you must know that pirbuterol is a bronchodilator, whereas beclomethasone is a glucocorticoid. Review these medications and their method of administration if you had difficulty with this question.

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51.The client with chronic obstructive pulmonary disease (COPD) is being changed from an oral glucocorticoid to triamcinolone (Azmacort) by inhalation. The nurse plans to monitor the client for which of the following signs and symptoms during the change?

1.

Chills, fever, generalized rash

2.

Vomiting and diarrhea, increased thirst

3.

Blurred vision, headache, and insomnia

4.

Anorexia, nausea, weakness, and fatigue

ANS:4

Rationale: Triamcinolone (Azmacort) is an adrenocortical steroid. The client who is being changed from an oral to an inhalation glucocorticoid could experience signs of adrenal insufficiency. The nurse should monitor the client for anorexia, nausea, weakness, and fatigue. The nurse should also monitor for hypotension and hypoglycemia.

Test-Taking Strategy: To answer this question accurately, you must know that tapering of adrenocortical steroids could result in adrenal insufficiency and know the signs and symptoms of this possible effect. This knowledge will direct you to anorexia, nausea, weakness, and fatigue. If this question was difficult, review this medication and the side effects of medication tapering of an adrenocortical steroid.

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REF:Edmunds, M. (2010). Introduction to clinical pharmacology (6th ed.). St. Louis: Mosby.OBJ:Client Needs: Physiological Integrity



52.The client taking theophylline has a serum theophylline level of 15 mcg/mL. The nurse interprets that this result is _____ the therapeutic range.

1.

Below

2.

Near the top of

3.

In excess of

4.

In the middle of

ANS:4

Rationale: The normal therapeutic range for the theophylline level is 10 to 20 mcg/mL. A level above 20 mcg/mL is considered toxic. The value of 15 mcg/mL places the client in the middle of the therapeutic range.

Test-Taking Strategy: Specific knowledge regarding the therapeutic drug level for this medication is required to answer this question. Remember that this therapeutic range is 10 to 20 mcg/mL. Review this therapeutic range if you had difficulty with this question.

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53.The client is taking cetirizine (Zyrtec). The nurse teaches the client to expect which of the following side effects of this medication?

1.

Diarrhea

2.

Excitability

3.

Drowsiness

4.

Excess salivation

ANS:3

Rationale: Cetirizine (Zyrtec) is an antihistamine; frequent side effects are drowsiness or sedation. Others include blurred vision, hypertension (and sometimes hypotension), dry mouth, constipation, urinary retention, and sweating. Therefore the other options are incorrect.

Test-Taking Strategy: To answer this question correctly, it is necessary to know that cetirizine (Zyrtec) is an antihistamine. Knowledge of the effects of antihistamines and that antihistamine use typically causes drowsiness in users helps you eliminate each incorrect option. Review the side effects of antihistamines if you had difficulty with this question.

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54.The client is scheduled to receive acetylcysteine (Mucomyst) 20% solution diluted in 0.9% normal saline by nebulizer. Which of the following outcomes would the nurse expect to see as a result of the administration of this medication?

1.

Bronchodilation

2.

Decreased coughing

3.

Absence of wheezing

4.

Thinning of respiratory secretions

ANS:4

Rationale: Acetylcysteine is administered to thin bronchial secretions and is considered a mucolytic. The other three options are the outcomes of respiratory medication therapy, but not of acetylcysteine.

Test-Taking Strategy: Focus on the name of the medication. Recalling that it is a mucolytic agent will direct you to thinning of respiratory secretions. If you had difficulty with this question, review the purpose of this medication and the related nursing interventions.

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55.The physician prescribes cromolyn (Intal) for the client with asthma. The nurse identifies that the client correctly understands the purpose of this medication when the client states that the medication will:

1.

Suppress an allergic response.

2.

Promote bronchodilation.

3.

Decrease the risk of infection.

4.

Eliminate the need for a rescue inhaler.

ANS:1

Rationale:. Cromolyn is a first-line therapy for prophylactic treatment of asthma; it is a mast-cell stabilizer, antiasthmatic, and antiallergic. It does not decrease the risk of infection. It is not a bronchodilator. The medication acts in part by stabilizing the cytoplasmic membrane of mast cells, thereby preventing release of histamine and other mediators. It does not eliminate the need for the rescue inhaler.

Test-Taking Strategy: Specific knowledge about this medication is needed to answer this question. Focus on the name of the medication and remember that cromolyn is a mast-cell stabilizer, antiasthmatic, and antiallergic. Review this medication, its actions, and uses if you had difficulty with this question.

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56.The nurse teaching the client about the effects of diphenhydramine (Benadryl), an ingredient in the cough suppressant prescribed for the client, should plan to tell the client to do which of the following while taking this medication?

1.

Take it on an empty stomach.

2.

Avoid activities requiring mental alertness.

3.

Use alcohol for additional effect in reducing cough.

4.

Avoid chewing sugarless gum or using oral rinses mouth.

ANS:2

Rationale: Diphenhydramine (Benadryl) has several uses, including antihistamine, antitussive, antidyskinetic, and sedative-hypnotic. Because the medication causes drowsiness, the client should avoid use of alcohol or central nervous system (CNS) depressants, operating a car, or engaging in other activities requiring mental acuity during use. It should be taken with food or milk to decrease gastrointestinal upset, and oral rinses, sugarless gum, or hard candy may be used to minimize dry mouth.

Test-Taking Strategy: Focus on the name of the medication, its classification, and side effects. Recalling that this medication has sedative effects and keeping client safety issues in mind will direct you to avoid activities requiring mental alertness. If you had difficulty with this question, review client education related to this medication.

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57.The physician has prescribed codeine sulfate for a client with a nonproductive cough to suppress the cough reflex. The nurse teaches the client to monitor for:

1.

Constipation

2.

Painful coughing

3.

Difficulty swallowing

4.

Increased urination

ANS:1

Rationale: Codeine sulfate is an opioid analgesic and a frequent side effect of is constipation. Additional side effects include drowsiness, nausea, and vomiting. Urinary retention is also a concern, and urine output should be monitored. Painful coughing and difficulty swallowing are unrelated to the administration of this medication.

Test-Taking Strategy: Use the process of elimination and knowledge regarding the side effects associated with this medication to answer this question. Remember that codeine sulfate is an opioid and most opioids can cause constipation. Review the side effects of codeine sulfate if you had difficulty with this question.

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58.A client with heart disease is taking digoxin (Lanoxin) and complains of having no appetite, diarrhea, and blurry vision. The nurse notes that the clients serum potassium (K) level is 3.0 ng/mL. Based on analysis of the data, what might the nurse anticipate assessing when reviewing the digoxin level results?

1.

Digoxin level lower than 0.5 ng/mL

2.

Digoxin level higher than 2 ng/mL

3.

Digoxin level of 1.8 ng/mL

4.

Digoxin level of 0 ng/mL because of diarrhea

ANS:2

Rationale: When the client is taking digoxin, digoxin toxicity is a concern. The therapeutic digoxin level is 0.5 to 2 ng/mL. Anorexia, diarrhea, and visual disturbances are symptoms of digoxin toxicity. In addition, a low serum potassium level potentiates the risk for digoxin toxicity. This clients potassium level is low at 3.0 ng/mL. The clients complaints are indicative of digoxin toxicity. Therefore the only correct option is digoxin level higher than 2 ng/mL.

Test-Taking Strategy: Focus on the data in the question and use knowledge about digoxin toxicity and the therapeutic digoxin level. This will direct you to digoxin level higher than 2 ng/mL because the results in this option exceed the therapeutic range. Also recalling the relationship between digoxin toxicity and a low potassium level will direct you to digoxin level higher than 2 ng/mL. If you had difficulty with this question, review digoxin and the indications of digoxin toxicity.

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59.The nurse is providing medication information to a client who is beginning medication therapy with enalapril (Vasotec). The nurse reminds the client that which of the following is an anticipated, although unpleasant, side effect of this medication?

1.

Rapid pulse

2.

Persistent dry cough

3.

Increased blood pressure

4.

Metallic taste in the mouth

ANS:2

Rationale: The principal adverse effects of enalapril, an angiotensin-converting enzyme (ACE) inhibitor, are persistent cough, first-dose hypotension, and hyperkalemia. The medication is used to treat hypertension. A rapid pulse and metallic taste in the mouth are not side effects.

Test-Taking Strategy: Focus on the name of the medication and recall that most ACE inhibitors medication names end with the letters -pril. Next remember that ACE inhibitors cause a persistent cough. Review the side effects of this medication if you had difficulty with this question.

PTS:1






60.A client has recently begun medication therapy with propranolol (Inderal). The long-term care nurse should plan to notify the physician if which of the following assessment findings is noted?

1.

Complaints of insomnia

2.

Audible expiratory wheezes

3.

Decrease in heart rate from 86 to 78 beats/min

4.

Decrease in blood pressure from 162/90 to 136/84 mm Hg

ANS:2

Rationale: Propranolol (Inderal) is a beta-blocker. Audible expiratory wheezes could indicate bronchospasm, a serious adverse reaction. Beta blockers that are not cardioselective, such as propranolol, may induce this reaction, particularly in clients with chronic obstructive pulmonary disease (COPD) or asthma. A normal decrease in blood pressure and heart rate is expected. Insomnia is a frequent mild side effect and should continue to be monitored.

Test-Taking Strategy: Use the process of elimination. Eliminate decrease in heart rate from 86 to 78 beats/min and decrease in blood pressure from 162/90 to 136/84 mm Hg, which are expected responses to the medication. Next note the strategic words plan to notify the physician to help you select the most serious complication associated with the use of this medication. This will direct you to audible expiratory wheezes. Review the adverse effects of propranolol if you had difficulty with this question.

PTS:1






61.A client having a myocardial infarction is receiving alteplase (Activase) therapy. Which of the following actions should be carried out by the nurse to monitor for the most frequent adverse effect?

1.

Monitor for bleeding.

2.

Assess for allergic reaction.

3.

Evaluate the client for muscle weakness.

4.

Monitor for signs and symptoms of infection.

ANS:1

Rationale: Alteplase is a thrombolytic medication, which means that it breaks down or dissolves clots; therefore

[rtf] saunders comprehensive review for the nclex-rn® examination, 5th edition pharmacology test...

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