Question 1

While checking orders for a patient newly admitted with abdominal pain and suspected pancreatitis,the nurse notes the following order,"meperidine 50-100 mg IM q 3-4 hr prn for pain." Which of the following medications currently taken by the patient would cause the nurse to contact the physician?
A)Isordil (isosorbide)20 mg po q 6 hr
B)Trandate (labetalol)100 mg BID
C)Nardil (phenelzine)15 mg po TID
D)Indocin (indomethacin)25 mg po QID

Accepted Answer

See Interactions for meperidine.Do not use in patients receiving MAO inhibitors or procarbazine (may cause fatal reaction-contraindicated within 14-21 days of MAO inhibitor therapy).

Question 2

A nurse from the medical unit is floated to the cardiology floor.While preparing to provide morning medications,the nurse realizes many patients are taking bisoprolol and knows the drug must be given cautiously or in reduced doses to which of the following patients? Select all that apply.
A)A 56-year-old patient with a history of pulmonary disease.
B)A 68-year-old patient with a history of gastroesophogeal reflux disease.
C)A 71-year-old patient with chronic renal failure.
D)A 66-year-old patient with elevated liver enzymes.
E)A 59-year-old patient with a history of diverticulitis.
F)A 74-year-old patient with a history of Alzheimer's disease.

Accepted Answer

See Contraindications/Precautions for bisoprolol: Use cautiously in renal impairment (dosage reduction recommended),hepatic impairment (dosage reduction recommended),pulmonary disease (including asthma;beta1 selectivity may be lost at higher doses;avoid use if possible),diabetes mellitus (may mask signs of hypoglycemia),and thyrotoxicosis (may mask symptoms).There is no contraindication for gastroesophageal reflux,diverticulitis,or Alzheimer's disease.

Question 3

While providing care to a 68-year-old man taking Lopid (gemfibrozil),the nurse recognizes that which of the following assessments indicates the medication and treatment plan are effective?
A)The patient has lost 4 pounds this month.
B)The patient's HDL drops from 55 mg/dL to 49 mg/dL.
C)The patient's cholesterol drops from 265 mg/dL to 238 mg/dL.
D)The patient's LDL is 175 mg/dL.

Accepted Answer

See Evaluation for gemfibrozil.Lopid is given to decrease serum triglyceride and cholesterol levels and to improve HDL to total cholesterol ratios.Weight loss may be seen with low-fat,low-cholesterol dietary restrictions but is not wholly reflective of the medication's efficacy.With HDL (good)cholesterol,higher levels are better.Low HDL cholesterol (less than 40 mg/dL for men,less than 50 mg/dL for women)puts one at higher risk for heart disease.An LDL between 160 and 189 mg/dL is considered high and indicates increased risk for heart disease.

Question 4

The nurse is providing care for a 12-year-old child whose order reads,"Ciprofloxin 15 mg/kg po q 12 hr." The child weighs 88 pounds (40 kg).What dose of Ciprofloxin should be provided?
A)500 mg tablet every 12 hr
B)500 mg tablet and a 100 mg tablet every 12 hr
C)750 mg tablet every 12 hr
D)Two 500 mg tablets every 12 hr

Accepted Answer

See Route/Dosage and Availability for fluoroquinolones.Ciprofloxin dosage for a child is 10-15 mg/kg q 12 hr (not to exceed 750 mg/dose).Tablets are available as 100 mg,250 mg,500 mg,and 750 mg.The child's order is 15 mg/kg,and the child weighs 40 kg;15 mg/kg x 40 kg = 600 mg per dose.

Question 5

The nurse is caring for a patient being treated for tuberculosis who is taking INH (isoniazid).Which of the following statements indicates the need for further teaching?
A)"I know I need to take this medication for at least 6 months."
B)"I need to call the doctor if I notice any yellow color to my skin or eyes."
C)"I'll have to have regular checkups and eye exams to monitor for side effects."
D)"I should limit my alcohol intake to no more than 3 beers a day while I'm taking this medicine."

Accepted Answer

See Patient/Family Teaching for isoniazid.Caution patient to avoid the use of alcohol during this therapy,as this may increase the risk of hepatotoxicity.Emphasize the importance of continuing therapy even after symptoms have subsided.Therapy may be continued for 6 months to 2 years.Advise patient to notify health-care professional promptly if signs and symptoms of hepatitis (yellow eyes and skin,nausea,vomiting,anorexia,dark urine,unusual tiredness,or weakness)or peripheral neuritis (numbness,tingling,or paresthesia)occur.Emphasize the importance of regular follow-up physical and ophthalmological exams to monitor progress and to check for side effects.

Question 6

The nurse is asked by the parent of a 13-year-old girl,"How does the new cervical cancer vaccine work?" Which of the following statements by the nurse is best?
A)"It is a series of three vaccinations over a 6-month period of time designed to prevent cervical cancer and genital warts caused by a virus we call human papilloma virus (HPV)."
B)"Gardasil helps reduce sexually transmitted diseases and female cancers by stimulating an immune response to the herpes virus."
C)"Your daughter would get a single shot to help prevent cervical,ovarian,and vaginal cancer."
D)"You should really ask the doctor about the vaccination because it is still controversial."

Accepted Answer

See Route/Dosage and Indications for the HPV Vaccine.It is given via three 0.5 ml doses at 0,2,and 6 months.The vaccine is designed to prevent squamous cell cervical cancer,other cervical and vaginal neoplasias,and genital warts related to the HPV.Gardasil will not prevent other sexually transmitted diseases or other "female" cancers such as ovarian,uterine,or breast cancer,and it is not associated with the herpes virus.Three doses (shots)are required for the series.The nurse should be able to answer this parent's questions,and teaching is considered a nursing function.

Question 7

A nurse caring for a patient with a history of diabetes mellitus notes that his prebreakfast blood glucose is 268.The nurse understands the patient most likely has sliding scale insulin using which of the following?
A)Novolog Mix 70/30
B)Humulin R
C)Humulin N
D)Lantus

Accepted Answer

See Pharmacokinetics for Insulin Regular.Humulin R is short-acting insulin with an onset of action of 30-60 min when given subcutaneously.Novolog 70/30 is mixed insulin with both short- and long-acting insulins.Humulin N is an intermediate-acting insulin.Lantus is a long-acting insulin.

Question 8

The nurse is talking to a friend who recently revealed that she is 6 weeks pregnant.The woman says,"The doctor told me to take prenatal vitamins that have folic acid in them;what is that for?" Which of the following is the best response by the nurse?
A)"Folic acid helps prevent miscarriage."
B)"Folic acid boosts your immune system."
C)"Folic acid actually helps fetal development."
D)"Folic acid reduces the amount of nausea caused by prenatal vitamins."

Accepted Answer

See Indications for folic acid.Folic acid is given during pregnancy to promote normal fetal development.

Question 9

The nurse is providing care for a 54-year-old woman with insulin-dependent diabetes.The woman is pale,diaphoretic,groggy,and difficulty to arouse.Her blood glucose result is 49.Which of the following actions should the nurse take next?
A)Notify the physician.
B)Encourage the patient to drink orange juice with a teaspoon of added sugar.
C)Request a stat lab blood draw and await results.
D)Provide 1 mg IV glucagon per protocol.

Accepted Answer

See Indications for glucagon.Glucagon is used in the acute management of severe hypoglycemia with the administration of glucose is not feasible.Because this patient is groggy,it would be dangerous to provide oral fluids.Use of bedside finger stick blood glucose determination methods is recommended for rapid results.Follow-up lab results may be ordered to validate finger stick values,but do not delay treatment while awaiting lab results,as this could result in neurological injury or death.

Question 10

The nurse is providing care for a patient who has new orders to start Pacerone (amiodarone)po 400 mg BID.Which of the following orders should the nurse anticipate? Select all that apply.
A)Monitor vital signs every 4 hr.
B)Telemetry monitoring.
C)Liver function tests every morning for the next 3 days.
D)Initiate seizure precautions.
E)Notify physician of visual changes.
F)Do not serve grapefruit juice.

Accepted Answer

See Adverse Reactions,Nursing Implications,and Patient/Family Teaching for amiodarone: Seizures are not an identified adverse reaction to amiodarone,so seizure precautions are not necessary.The ECG should be monitored continuously,and the nurse should assess for signs of pulmonary toxicity and monitor blood pressure frequently.Ophthalmic examinations should be performed before and regularly during therapy and whenever visual changes occur.Advise patient to avoid drinking grapefruit juice during therapy.

Question 11

The nurse is caring for an 82-year-old woman with superior vena cava syndrome due to a clot formed around the patient's implanted port.The patient is on a heparin drip at 12 units/hr.Which of the following laboratory values will be used to titrate the infusion rate?
A)Hemoglobin (Hgb)
B)Platelet count (Plt)
C)Partial thromboplastin time (aPTT)
D)Clotting time

Accepted Answer

See Nursing Assessment/Lab Test Considerations for heparin.During continuous administration,monitor aPTT levels every 4 hr during early therapy.

Question 12

The nurse is caring for a patient taking Nexium (esomeprazole).The nurse knows teaching has been effective by which of the following statements? Select all that apply.
A)"I should take this pill with my meals."
B)"This medication helps reduce the release of stomach acid and reduces my reflux."
C)"I should not chew or crush the pellets."
D)"If I miss a dose,it should be skipped for the day."
E)"I've eliminated alcohol from my diet completely."
F)"I can keep taking Advil for my arthritis pain."

Accepted Answer

See Nursing Implications for esomeprazole: Esomeprazole is an antiulcer agent that prevents the final transport of hydrogen ions into the gastric lumen.It is given at least 1 hr before meals.Capsules should be swallowed whole;do not crush or chew pellets.Advise patients to avoid alcohol,products containing aspirin or NSAIDs,and foods that cause an increase in GI irritation.

Question 13

As part of a new treatment regimen for migraine headaches,an 18-year-old girl is prescribed Axert (almotriptan).The nurse should include which of the following statements in the patient teaching? Select all that apply.
A)"You will take this medication daily to help prevent the onset of migraines."
B)"You should avoid alcohol when you are taking this medication."
C)"You can take this medication every 2-4 hr as needed for up to eight doses per day."
D)"Take the medication as soon as you notice the onset of a migraine headache."
E)"Avoid taking over-the-counter medications that have not been prescribed by your doctor while taking this medication."
F)"If taking this medication causes any pain or tightness in your chest,you should notify the physician immediately."

Accepted Answer

See Nursing Implications for almotriptan.Instruct the patient to administer almotriptan as soon as symptoms of a migraine attack appear,but it may be administered any time during an attack.If migraine symptoms return,a second dose may be used.Allow at least 2 hr between doses,and do not use more than 2 doses in any 24-hr period.Advise patients to notify health-care professional prior to next dose of almotriptan if pain or tightness in the chest occurs during use.Advise patient to avoid alcohol,which aggravates headaches,during almotriptan use.Advise patient to consult a health-care professional before taking other prescriptions or OTC or herbal products concurrently.

Question 14

A nurse working in an outpatient psychiatric clinic is assessing a 39-year-old patient with a history of schizophrenia who started taking Haldol (haloperidol)3 mg po TID last week.Which of the following should be reported to the physician immediately?
A)The patient is smacking his lips and chewing while the nurse is asking questions.
B)The patient says,"I heard the angels talking again last night."
C)The patient reports he is staying at a homeless shelter downtown.
D)The patient tells the nurse he forgot to bring in his pills but that he needs more.

Accepted Answer

See Nursing Assessment for haloperidol.Monitor for tardive dyskinesia (uncontrolled rhythmic movement of mouth,face,and extremities;lip smacking or puckering;puffing of cheeks;uncontrolled chewing;rapid or worm-like movements of tongue;and excessive eye blinking).Report these immediately,as they may be irreversible.Hallucinations are a positive sign of schizophrenia and may be seen despite medication since it may require several weeks of therapy to obtain desired effects.Individuals with psychiatric disorders may be homeless;since this patient has housing,this is not the priority.It is important to monitor compliance with the medication schedule and prevent hoarding of pills,but this is not the priority.

Question 15

The nurse is providing care for a patient with hepatic encephalopathy who is receiving lactulose via a nasogastric tube QID.Which of the following indicates the patient is responding appropriately to the medication?
A)The patient's serum ammonia level returns to normal limits.
B)The patient's potassium level returns to normal limits.
C)The patient's blood alcohol level returns to normal limits.
D)The patient's serum calcium level returns to normal limits.

Accepted Answer

See Action of lactulose.It lowers the pH of the colon,which inhibits the diffusion of ammonia from the colon into the blood,thereby reducing blood ammonia levels.

Question 16

Which of the following would cause the nurse to suspect that a patient taking Lexapro (escitalopram)may be developing serotonin syndrome? Select all that apply.
A)Pulse = 122 bpm
B)Patient reports seeing blue spiders on the wall.
C)Patient's blood glucose = 93 g/dL.
D)Patient complains of nausea and diarrhea.
E)White blood cell count = 5,500 cell/mm³.
F)Urinary output = 600 mL in 8 hr.

Accepted Answer

See Nursing Implications for escitalopram.Assess for serotonin syndrome (mental changes [agitation,hallucinations,and coma],autonomic instability [tachycardia,labile blood pressure,and hyperthermia],neuromuscular aberrations [hyperreflexia and incoordination],and/or GI symptoms [nausea,vomiting,and diarrhea]),especially in patients taking other serotonergic drugs (SSRIs,SNRIs,or triptans).

Question 17

The nurse is assisting in the care of a patient complaining of severe pruritis.Which of the following medications does the nurse anticipate being available on an as-needed basis for the patient?
A)Toradol (ketorolac)
B)Atarax (hydroxyzine)
C)Dilaudid (hydromorphone)
D)Hyzodro ER (hydrocodone)

Accepted Answer

See Indications for hydroxyzine.Atarax is an antiprurutic,Toradol is a nonsteroidal anti-inflammatory,Dilaudid is an opioid analgesic,and Hyzodro ER is an opioid analgesic,antitussive.

Question 18

While providing initial chemotherapy teaching for a patient who is scheduled to receive cisplatin for metastatic ovarian cancer,the nurse recognizes that teaching has been effective by which of the following client statements? Select all that apply.
A)"This medication is usually taken as a pill every day for a week."
B)"You will need to check my lab values each time I'm due for chemotherapy to make sure I can safely take each scheduled treatment."
C)"It is very important that I continue to take the medication that prevents nausea and vomiting consistently throughout my day of treatment."
D)"Aside from nausea,this medication has few other side effects."
E)"I may have nausea or loss of appetite for up to a week after taking this medication."
F)"I will come into an infusion center to get my chemotherapy in an IV."

Accepted Answer

See Nursing Implications for cisplatin: Severe and protracted nausea and vomiting usually occur 1-4 hr after a dose;vomiting may last for 24 hr.Administer parenteral antiemetic agents 30-45 min before therapy and routinely around the clock for the next 24 hr.Nausea and anorexia may persist for up to 1 week.Monitor CBC with differential and platelet count before and routinely throughout therapy.Additional side effects occur including bone marrow suppression,ototoxicity,neurotoxicity,and renal compromise.The medication is given as an intravenous infusion.

Question 19

A nurse caring for a patient who is to initiate therapy with Zostrix (capsaicin)would include which of the following statements in the patient teaching? Select all that apply.
A)"This medication is used to treat local skin infections."
B)"Apply the medication topically 3-4 times daily."
C)"Keep the ointment away from the eyes or any open skin areas."
D)"Rub the cream into the affected area well so little or no cream is left on the surface."
E)"The medication helps reduce the pain associated with arthritis."
F)"Capsaicin is taken in pill form on an empty stomach once daily."

Accepted Answer

See Indications,Contraindications,and Nursing Implications for capsaicin: Capsaicin offers temporary management of pain due to rheumatoid arthritis and osteoarthritis and treatment of pain associated with postherpetic neuralgia or diabetic neuropathy.It is not for use near eyes or on open or broken skin.Topical: Apply to affected areas 3-4 times daily.Rub cream into affected area well so that little or no cream is left on the surface.

Question 20

The nurse contacts a patient whose physician has ordered Feosol (carbonyl iron)60 mg BID after routine lab work revealed mild iron-deficiency anemia.Which of the following statements would be included in the patient teaching?
A)"Since you are taking an iron supplement,you should reduce the amount of iron in your diet to prevent overdose."
B)"The iron may make your stool a dark green or black color;this is nothing to worry about."
C)"It is alright to take both doses together if you prefer."
D)"Iron is fairly harmless,so there is little concern if you take extra when you are on your menstrual cycle."

Accepted Answer

See Patient/Family Teaching for Iron Supplements.Advise patient that stools may become dark green or black and that this change is harmless.Instruct patient to follow a diet high in iron.Encourage patient to comply with medication regimen.Take missed doses as soon as remembered within 12 hr;otherwise,return to regular dosing schedule.Do not double doses.Discuss with parents the risk of children overdosing on iron.

Quiz 1: Medication Errors: Improving Practices and Patient Safety

While checking orders for a patient newly admitted with abdominal pain and suspected pancreatitis,the nurse notes the following order,"meperidine 50-100 mg IM q 3-4 hr prn for pain." Which of the following medications currently taken by the patient would cause the nurse to contact the physician?

A nurse from the medical unit is floated to the cardiology floor.While preparing to provide morning medications,the nurse realizes many patients are taking bisoprolol and knows the drug must be given cautiously or in reduced doses to which of the following patients? Select all that apply.

While providing care to a 68-year-old man taking Lopid (gemfibrozil) ,the nurse recognizes that which of the following assessments indicates the medication and treatment plan are effective?

The nurse is providing care for a 12-year-old child whose order reads,"Ciprofloxin 15 mg/kg po q 12 hr." The child weighs 88 pounds (40 kg) .What dose of Ciprofloxin should be provided?

The nurse is caring for a patient being treated for tuberculosis who is taking INH (isoniazid) .Which of the following statements indicates the need for further teaching?

The nurse is asked by the parent of a 13-year-old girl,"How does the new cervical cancer vaccine work?" Which of the following statements by the nurse is best?

A nurse caring for a patient with a history of diabetes mellitus notes that his prebreakfast blood glucose is 268.The nurse understands the patient most likely has sliding scale insulin using which of the following?

The nurse is talking to a friend who recently revealed that she is 6 weeks pregnant.The woman says,"The doctor told me to take prenatal vitamins that have folic acid in them;what is that for?" Which of the following is the best response by the nurse?

The nurse is providing care for a 54-year-old woman with insulin-dependent diabetes.The woman is pale,diaphoretic,groggy,and difficulty to arouse.Her blood glucose result is 49.Which of the following actions should the nurse take next?

The nurse is providing care for a patient who has new orders to start Pacerone (amiodarone) po 400 mg BID.Which of the following orders should the nurse anticipate? Select all that apply.

The nurse is caring for an 82-year-old woman with superior vena cava syndrome due to a clot formed around the patient's implanted port.The patient is on a heparin drip at 12 units/hr.Which of the following laboratory values will be used to titrate the infusion rate?

The nurse is caring for a patient taking Nexium (esomeprazole) .The nurse knows teaching has been effective by which of the following statements? Select all that apply.

As part of a new treatment regimen for migraine headaches,an 18-year-old girl is prescribed Axert (almotriptan) .The nurse should include which of the following statements in the patient teaching? Select all that apply.

A nurse working in an outpatient psychiatric clinic is assessing a 39-year-old patient with a history of schizophrenia who started taking Haldol (haloperidol) 3 mg po TID last week.Which of the following should be reported to the physician immediately?

The nurse is providing care for a patient with hepatic encephalopathy who is receiving lactulose via a nasogastric tube QID.Which of the following indicates the patient is responding appropriately to the medication?

Which of the following would cause the nurse to suspect that a patient taking Lexapro (escitalopram) may be developing serotonin syndrome? Select all that apply.

The nurse is assisting in the care of a patient complaining of severe pruritis.Which of the following medications does the nurse anticipate being available on an as-needed basis for the patient?

While providing initial chemotherapy teaching for a patient who is scheduled to receive cisplatin for metastatic ovarian cancer,the nurse recognizes that teaching has been effective by which of the following client statements? Select all that apply.

A nurse caring for a patient who is to initiate therapy with Zostrix (capsaicin) would include which of the following statements in the patient teaching? Select all that apply.

The nurse contacts a patient whose physician has ordered Feosol (carbonyl iron) 60 mg BID after routine lab work revealed mild iron-deficiency anemia.Which of the following statements would be included in the patient teaching?