Question 1

An infant being treated for colic was prescribed Mylicon (simethicone)drops and has returned to the clinic for follow-up evaluation.Which of the following nursing action has the highest priority?
A)Assessment of the infant's startle reflex.
B)Gentle palpation of the anterior fontanel.
C)Inspection and auscultation of the abdomen.
D)Measurement of the infant's head circumference.

Accepted Answer

See Assessment for simethicone.Assess patient for abdominal pain,distention,and bowel sounds prior to and periodically throughout course of therapy.

Question 2

A nurse caring for a patient who's prescribed Inderal LA (propranolol)is being tapered off over a 2-wk period.The nurse would include which of the following statements in the patient teaching?
A)"I bet you're glad to be getting off this medication since it is so expensive."
B)"Stopping this medication suddenly can be very dangerous,so it is important that you follow the taper schedule carefully."
C)"Patients usually only take this drug for a 1-2 wk cycle before switching to another medication."
D)"By slowly weaning you from this drug,the risk of rebound headaches is reduced."

Accepted Answer

See Assessment for propranolol.Abrupt withdrawal of propranolol may precipitate life-threatening arrhythmias,hypertension,or myocardial ischemia.Drug should be tapered off over a 2-wk period before discontinuation.Assess patient carefully during tapering and after medication is discontinued.Consider that patients taking propranolol for noncardiac indications may have undiagnosed cardiac disease.Abrupt discontinuation or withdrawal over too short a period of time (less than 9 days)should be avoided.While the cost of medications is important,it is not the highest priority.

Question 3

While preparing to discharge a patient who has started taking Lopressor (metoprolol)during their hospitalization,the nurse recognizes further teaching is necessary by which of the following statements:
A)"I should take my pulse every day before taking this medication."
B)"I need to stay on a low-salt diet to help control my blood pressure."
C)"I'll have to have my blood drawn frequently to monitor for toxic levels of this medication."
D)"I should contact the physician immediately if I notice any wheezing,difficulty breathing,or dizziness."

Accepted Answer

See Patient/Family Teaching for metoprolol.Blood levels are not followed for this medication.Teach patient and family how to check pulse daily and blood pressure biweekly and to report significant changes to a health-care professional.Reinforce the need to continue additional therapies for hypertension (weight loss,sodium restriction,stress reduction,regular exercise,moderation of alcohol consumption,and smoking cessation).Advise patient to notify health-care professional if slow pulse,difficulty breathing,wheezing,cold hands and feet,dizziness,light-headedness,confusion,depression,rash,fever,sore throat,unusual bleeding,or bruising occurs.

Question 4

The nurse is caring for an infant with oral thrush whose medications include Mycostatin (nystatin)suspension 5 mL QID.Which of the following actions should the nurse take?
A)Dilute the medication in 30 mL of water and provide it to the infant in a bottle.
B)Use a needleless syringe to gently squirt small amounts into the baby's mouth.
C)Dip a pacifier into the medication and allow the infant to suck on the pacifier;repeat until the dose is consumed.
D)Use a cotton swab to paint the inside of the infant's cheeks,gums,and tongue.

Accepted Answer

See Implementation for nystatin.For neonates and infants,paint suspension into recesses of the mouth.

Question 5

The nurse is caring for a patient with tuberculosis who is on a diet with honey-thick liquids.Which action should the nurse take to administer the dose of Rifadin (rifampin)?
A)Obtain the medication in liquid form.
B)Give the pill with a small sip of water.
C)Call the pharmacy to request a parenteral dose.
D)Open the capsule onto a spoonful of applesauce.

Accepted Answer

See Implementation for rifampin.Capsules may be opened and contents mixed with applesauce or jelly for patients with difficulty swallowing.While the pharmacist can compound a syrup for patients unable to swallow solids,this patient has difficulty swallowing liquids.If honey-thick liquids are ordered,nonthickened water should be avoided.Parenteral therapy is not required.

Question 6

A nurse working on the postpartum floor is checking orders and notes the following,"Methergine (methylergonovine)200 mcg po q 6 hr for 48 hr." Which of the following nursing interventions should be added to the patient's plan of care?
A)Assess respiratory rate and rhythm q 2 hr.
B)Monitor for signs of uterine atony or change in menstrual bleeding.
C)Instruct patient to wear a tight-fitting bra and avoid facing the water during shower.
D)Collect urine for protein dipstick every 4 hr.

Accepted Answer

See Assessment for methylergonovine.Methergine is used in the treatment of postpartum hemorrhage.Monitor blood pressure,heart rate,and uterine response frequently during medication administration.

Question 7

Which of the following would indicate to the nurse that treatment was effective in a patient being treated with propylthiouracil?
A)Patient reports sleeping 12 hr a day.
B)Fine tremors noted in both hands.
C)Patient gains 2 pounds in 4 days.
D)Pulse is 110 bpm.

Accepted Answer

See Evaluation for propylthiouracil.PTU decreases the severity of symptoms of hyperthyroidism (lowered pulse rate and weight gain).Symptoms of hyperthyroidism include tachycardia,palpitations,nervousness,insomnia,fever,diaphoresis,heat intolerance,tremors,weight loss,and diarrhea.Symptoms of hypothyroidism include intolerance to cold,constipation,dry skin,headache,listlessness,tiredness,or weakness.

Question 8

To monitor the peak efficacy after providing oral Dilaudid (hydromorphone)Immediate Release for a patient reporting pain ranked 6 out of 10 on a numeric pain scale.The patient should report some relief in pain at the peak action of the drug.Which of the following reflects the peak action of Dilaudid Immediate Release?
A)15-30min
B)30-90 min
C)1-2 hr
D)Over 2 hr

Accepted Answer

See Pharmacokinetics for hydromorphone.The peak action for this medication is 30-90 min.

Question 9

While caring for a patient with myasthenia gravis and a history of dysphasia who is taking Mestinon (pyridostigmine),the nurse recognizes the need for further teaching by which of the following statements?
A)"I should set an alarm clock to make sure I take my medication on time."
B)"I may have trouble swallowing if I do not take my medication correctly."
C)"I will have to take this medication for a few months before my condition resolves."
D)"I should carry an identification card with my diagnosis and medication list at all times."

Accepted Answer

See Patient/Family Teaching for pyridostigmine.Patients with a history of dysphagia should have a nonelectric or battery-operated back-up alarm clock to remind them of exact dose time.Patients with dysphagia may not be able to swallow medication if the dose is not taken exactly on time.Taking dose late may result in myasthenic crisis.Taking dose early may result in cholinergic crisis.Patients with myasthenia gravis must continue this regimen as a life-long therapy.Advise patient to carry identification describing their disease and medication regimen at all times.

Question 10

The nurse observing a patient who uses a prescribed Serevent Diskus (salmeterol)recognizes that teaching has been effective if which of the following is observed?
A)The patient shakes the diskus vigorously before taking a dose.
B)The patient rinses the mouthpiece after administration.
C)The patient keeps the diskus horizontal at all times throughout administration.
D)The patient exhales into the diskus before inhaling a dose of medication.

Accepted Answer

See Patient/Family Teaching for salmeterol.Instruct patient using powder for inhalation never to exhale into diskus device and always to hold device in a level horizontal position.Mouthpiece should be kept dry and should never be washed.

Question 11

The nurse is caring for a patient who recently started taking Compro (prochlorperazine)10 mg po QID.Which of the following symptoms would cause the nurse to contact the physician immediately?
A)Temp = 104.5°F and new onset urinary incontinence.
B)Pulse = 70 bpm and patient complains of constipation.
C)Blood pressure = 126/64 mmHg and complaints of hiccups.
D)Respirations = 18 per min and patient reports mild nausea.

Accepted Answer

See Assessment for prochlorperazine.Monitor for development of neuroleptic malignant syndrome (fever,respiratory distress,tachycardia,seizures,diaphoresis,hypertension or hypotension,pallor,tiredness,severe muscle stiffness,and loss of bladder control).Notify physician or other health-care professional immediately if these symptoms occur.Constipation is a known side effect with this medication,and the pulse is normal.Blood pressure is within normal limits and hiccups are not immediately concerning.Respirations are within normal parameters,and Compro is taken for nausea,so mild nausea may be expected.

Question 12

A nurse working at an adult care center for individuals with mental illness provides an individual with their dose of Risperdal (risperidone).The nurse should intervene if the client mixes the liquid medication with which of the following?
A)Milk
B)Cola
C)Orange juice
D)Water

Accepted Answer

See Implementation for risperidone.Oral solution can be mixed with water,coffee,orange juice,or low-fat milk;do not mix with cola or tea.

Question 13

A nurse caring for an individual taking Avandia (rosiglitazone)monitors which of the following lab results to help evaluate treatment effectiveness?
A)Glycosylated hemoglobin
B)Serum calcium
C)Serum iron
D)Cardiac troponin

Accepted Answer

See Assessment/Lab test considerations for rosiglitazone.Monitor serum glucose and glycosylated hemoglobin periodically during therapy to evaluate effectiveness.

Question 14

While in the recovery room,the nurse cares for a post-anesthesia patient who reports severe nausea.The nurse would most likely request an order for which of the following medications?
A)Eldepryl (selegiline)
B)Transderm-Scop (scopolamine)
C)Januvia (sitagliptin)
D)Cialis (tadalafil)

Accepted Answer

See Indications for scopolamine.Scopolamine is used in the management of nausea and vomiting associated with opioid analgesia or general anesthesia/recovery from anesthesia.Eldepryl is used in the management of Parkinson disease.Januvia is used in the management of diabetes.Cialis is used for erectile dysfunction.

Question 15

A nurse caring for a patient with non-Hodgkin lymphoma prepares to provide Leukine (sargramostim).Which of the following will indicate successful response to the medication?
A)Patient's white blood cell count increases.
B)Patient's platelet count increases.
C)Patient denies nausea or vomiting with chemotherapy.
D)Patient's hair does not fall out after chemotherapy.

Accepted Answer

See Action for sargramostim.Indications include accelerated recovery of bone marrow after autologous bone marrow transplantation,resulting in decreased risk of infection and other complications.

Question 16

A hospice nurse is caring for a patient with end-stage stomach cancer who has a new order to be kept NPO.The patient complains of nausea and has a standard order for promethazine for this complaint.Which of the following actions should the nurse take?
A)Request intravenous dosing from pharmacy and start an IV.
B)Call pharmacy to request an oral tablet,and allow the patient to take it with one sip of water.
C)Obtain oral liquid preparation and add thick-it to reduce aspiration risk.
D)Request and provide the medication in rectal suppository form.

Accepted Answer

See Routes/dosages for promethazine.Because the patient has orders to be kept NPO,any oral preparation is contraindicated without an overriding order.Rectal dosing is available and can be used effectively,although it may be less reliable.This noninvasive route should be chosen over starting an IV.

Question 17

At a follow-up appointment at the urologist's office,the nurse is gathering data on a patient who takes VESIcare (solifenacin)for an overactive bladder.Which of the following statements would be most concerning to the nurse?
A)I started taking an aerobics class twice a week.
B)I drink three cups of coffee each day.
C)I smoke a half pack of cigarettes a day.
D)A friend recommended St.John's wort and I've been taking that for a few weeks now.

Accepted Answer

See Patient/Family Teaching for solifenacin.Advise patient to consult a health-care professional prior to taking Rx,OTC,or herbal products with solifenacin.Drug-Drug: Drugs that induce or inhibit the CYP3A4 enzyme system may significantly alter blood levels of solifenacin;ketoconazole ↑ blood levels and risk of toxicity (do not exceed 5 mg/day).

Question 18

A client taking vitamin B₆ (pyridoxine)calls the nurse at 3 p.m.to report she is at work and didn't take the pill at breakfast.Which of the following statements by the nurse is best?
A)"You should make arrangements to take the missed dose as soon as possible."
B)"Missing a single dose is not critical."
C)"Why didn't you take the medication?"
D)"How are you feeling right now?"

Accepted Answer

See Patient/Family Teaching for pyridoxine.Instruct patient to take medication as directed.If a dose is missed,it may be omitted because an extended period of time is required to become deficient in vitamin B₆.

Question 19

A patient is admitted with suspected overdose of Bloxiverz (neostigmine).Which of the following will be used as an antidote?
A)Narcan
B)Vitamin K
C)Atropine
D)Epinephrine

Accepted Answer

See Assessment/Toxicity and Overdose for neostigmine.If an overdose occurs,atropine is the antidote.

Question 20

The nurse is providing care for a patient in hospice who has been converted to a continuous infusion of morphine for pain control via the use of a patient-controlled analgesia pump.The nurse recognizes that break-through pain should be handled in which of the following ways?
A)No break-through pain is expected since the patient is on a continuous infusion of narcotic.
B)Additional intravenous bolus doses can be given by the nurse every 15-30 min
C)Additional predetermined bolus doses can be programmed to be available at patient request every 90 min.
D)Oral morphine can be given in liquid form every 2 hr.

Accepted Answer

See Assessment for Morphine.Patients on a continuous infusion should have additional bolus doses provided every 15-30 min,as needed,for break-through pain.

Quiz 2: Detecting and Managing Adverse Drug Reactions

An infant being treated for colic was prescribed Mylicon (simethicone) drops and has returned to the clinic for follow-up evaluation.Which of the following nursing action has the highest priority?

A nurse caring for a patient who's prescribed Inderal LA (propranolol) is being tapered off over a 2-wk period.The nurse would include which of the following statements in the patient teaching?

While preparing to discharge a patient who has started taking Lopressor (metoprolol) during their hospitalization,the nurse recognizes further teaching is necessary by which of the following statements:

The nurse is caring for an infant with oral thrush whose medications include Mycostatin (nystatin) suspension 5 mL QID.Which of the following actions should the nurse take?

The nurse is caring for a patient with tuberculosis who is on a diet with honey-thick liquids.Which action should the nurse take to administer the dose of Rifadin (rifampin) ?

A nurse working on the postpartum floor is checking orders and notes the following,"Methergine (methylergonovine) 200 mcg po q 6 hr for 48 hr." Which of the following nursing interventions should be added to the patient's plan of care?

Which of the following would indicate to the nurse that treatment was effective in a patient being treated with propylthiouracil?

While caring for a patient with myasthenia gravis and a history of dysphasia who is taking Mestinon (pyridostigmine) ,the nurse recognizes the need for further teaching by which of the following statements?

The nurse observing a patient who uses a prescribed Serevent Diskus (salmeterol) recognizes that teaching has been effective if which of the following is observed?

The nurse is caring for a patient who recently started taking Compro (prochlorperazine) 10 mg po QID.Which of the following symptoms would cause the nurse to contact the physician immediately?

A nurse working at an adult care center for individuals with mental illness provides an individual with their dose of Risperdal (risperidone) .The nurse should intervene if the client mixes the liquid medication with which of the following?

A nurse caring for an individual taking Avandia (rosiglitazone) monitors which of the following lab results to help evaluate treatment effectiveness?

While in the recovery room,the nurse cares for a post-anesthesia patient who reports severe nausea.The nurse would most likely request an order for which of the following medications?

A nurse caring for a patient with non-Hodgkin lymphoma prepares to provide Leukine (sargramostim) .Which of the following will indicate successful response to the medication?

A hospice nurse is caring for a patient with end-stage stomach cancer who has a new order to be kept NPO.The patient complains of nausea and has a standard order for promethazine for this complaint.Which of the following actions should the nurse take?

At a follow-up appointment at the urologist's office,the nurse is gathering data on a patient who takes VESIcare (solifenacin) for an overactive bladder.Which of the following statements would be most concerning to the nurse?

A client taking vitamin B₆ (pyridoxine) calls the nurse at 3 p.m.to report she is at work and didn't take the pill at breakfast.Which of the following statements by the nurse is best?

A patient is admitted with suspected overdose of Bloxiverz (neostigmine) .Which of the following will be used as an antidote?

The nurse is providing care for a patient in hospice who has been converted to a continuous infusion of morphine for pain control via the use of a patient-controlled analgesia pump.The nurse recognizes that break-through pain should be handled in which of the following ways?