Question 1

The nurse is counseling a patient who has been given a prescription for Imitrex (sumatriptan)for migraine headaches.Which of the following statements indicates teaching has been effective?
A)"This medication will prevent migraine headaches."
B)"I can take this medication at any time during a migraine headache attack."
C)"I can repeat the medication in 15 minutes if I have not gotten relief from the first injection."
D)"I can use up to 4 doses in a 24-hour period."

Accepted Answer

See Patient/Family Teaching for sumatriptan.Instruct patient to administer sumatriptan as soon as symptoms of a migraine attack appear,but it may be administered at any time during an attack.Inform patient that sumatriptan should be used only during a migraine attack.It is meant to be used for relief of migraine attacks but not to prevent or reduce the number of attacks.If migraine symptoms return,a second injection may be used.Allow at least 1 hr between doses,and do not use more than two injections in any 24-hr period.

Question 2

The nurse recognizes that the treatment plan for which of the following individuals would likely include Metamucil (psyllium)? Select all that apply.
A)A 72-year-old patient who drinks prune juice on a daily basis and has a soft brown stool daily.
B)A 61-year-old patient hospitalized for an anterior myocardial infarction.
C)A 29-year-old patient with the flu who reports having diarrhea.
D)A 57-year-old patient reporting increased difficulty with constipation since the onset of menopause.
E)A 65-year-old patient who recently had a hemorrhoidectomy.
F)An 84-year-old patient who reports walking 3 miles every day in the mall.

Accepted Answer

See Indications for psyllium.They include management of simple or chronic constipation,particularly if associated with a low-fiber diet.It is useful in situations in which straining should be avoided (after MI,rectal surgery,or prolonged bed rest).It is used in the management of chronic watery diarrhea.

Question 3

The nurse is caring for a patient who takes Betapace (sotalol)80 mg po BID.Prior to administering the dose,which of the following actions should the nurse take first?
A)Assess respiratory rate and depth.
B)Determine apical pulse rate and rhythm.
C)Identify recent food intake.
D)Check color and presence of pulses in lower extremities.

Accepted Answer

See Implementation for sotalol.Take apical pulse prior to administering.If less than 50 bpm or if arrhythmia occurs,withhold medication and notify physician or other health-care professional.

Question 4

While caring for an individual taking Demadex (torsemide)for hypertension,the nurse would be most concerned by which of the following assessments?
A)Patient's resting pulse is 68 bpm.
B)Patient reports abdominal cramps and nausea.
C)Patient has lost 2 pounds in one day.
D)Patient eats two bananas for breakfast.

Accepted Answer

See Patient/Family Teaching for torsemide.Advise patient to contact a health-care professional immediately if muscle weakness,cramps,nausea,dizziness,numbness,or tingling of extremities occurs.Advise patient to contact a health-care professional if they gain more than 2-3 pounds per day.Instruct patient to consult a health-care professional regarding a diet high in potassium.

Question 5

The nurse is caring for an individual receiving intravenous Vancocin (vancomycin).Which of the following assessments is most important to prevent permanent complication?
A)Serum vancomycin levels
B)Visual acuity
C)Gag reflex
D)Deep tendon reflexes

Accepted Answer

See Assessment for vancomycin.Evaluate eighth cranial nerve function by audiometry and serum vancomycin levels prior to and throughout therapy in patients with borderline renal function or those older than 60 years of age.Prompt recognition and intervention are essential in preventing permanent damage.No alteration in vision or reflexes is anticipated with vancomycin.

Question 6

An individual with a history of angina takes sublingual nitroglycerine to relieve chest pain ranked 6/10.Five min later,the chest pain is 4/10.What action should the nurse take next?
A)Have a family member call 911.
B)Tell the individual to take a warm shower.
C)Instruct the individual to take another sublingual nitroglycerine tablet.
D)Monitor the individual for an additional 10 min before taking any action.

Accepted Answer

See Patient/Family Teaching for nitroglycerin.For an acute anginal attack,advise patient to sit down and use medication at first sign of attack.Relief usually occurs within 5 min.Dose may be repeated if pain is not relieved in 5-10 min.Call health-care professional or go to nearest emergency room if anginal pain is not relieved by 3 tablets in 15 min.

Question 7

While caring for a client with a history of epilepsy,the nurse would expect which of the following medications to be included in the patient's treatment plan? Select all that apply.
A)Clinoril (sulindac)
B)Dilantin (phenytoin)
C)Phenobarbital
D)Depakote (divalproex sodium)
E)Nabumetone
F)Tegretol (carbamazepine)

Accepted Answer

See Indications for sulindec,phenytoin,phenobarbital,divalproex sodium,nabumetone and carbamazepine.Phenytoin,phenobarbital,divalproex sodium and carbamazepine are all used in the treatment/prevention of tonic-clonic (grand mal)seizures and complex partial seizures.Sulindac and nabumetone are used in the treatment of arthritis.

Question 8

Which of the following patients would most likely be taking Quinidine Gluconate (quinidine)?
A)A 45-year-old patient with atrial fibrillation.
B)A 59-year-old patient with pneumocystis carni pneumonia.
C)A 68-year-old patient with gastroesophogeal reflux disease.
D)A 33-year-old patient with acute pyelonephritis.

Accepted Answer

See Indications for quinidine.They include restoration and maintenance of sinus rhythm in patients with atrial fibrillation or flutter,prevention of recurrent ventricular arrhythmias,and treatment of malaria.

Question 9

The nurse recognizes that which of the following individuals will need to receive supplemental vitamin B₁₂ injections?
A)A 37-year-old patient with acute renal calculi.
B)A 59-year-old patient with gastric resection for stomach cancer.
C)A 24-year-old patient with sickle cell anemia.
D)A 58-year-old patient with congestive heart failure.

Accepted Answer

See Implementation for vitamin B₁₂ Preparation.Patients with small bowel disease,malabsorption syndrome,or gastric or ileal resections require parenteral administration.

Question 10

While caring for a patient taking Carafate (sucralfate),the nurse recognizes the medication is effective by which of the following?
A)Patient is able to pass formed stool daily.
B)Patient has increased range of motion in the small joints of her hands.
C)Patient reports decreased abdominal pain.
D)Patient remains afebrile for 24 hr.

Accepted Answer

See Evaluation for sucralfate.Carafate is used in the treatment of duodenal ulcers,and desired results include decrease in abdominal pain.

Question 11

Which of the following would be included in the patient teaching for a client receiving Lithobid (lithium)therapy? Select all that apply.
A)"This medication may cause dizziness or drowsiness so you should avoid driving until you know how the medication will affect you."
B)"It is important to reduce your fluid intake while taking this medication."
C)"Avoid drinking excessive amounts of coffee,tea,and colas while on this medication."
D)"Weight loss may occur with this medication,so you should try to eat at least 3,000 calories a day."
E)"Since you have a history of heart disease,you will need to have periodic electrocardiogram tests done."
F)"Notify the physician immediately if you have any fainting or difficulty breathing while taking this medication."

Accepted Answer

See Patient/Family Teaching for lithium.Lithium may cause dizziness or drowsiness.Caution patient to avoid driving or other activities requiring alertness until response to medication is known.Advise patient to drink 2,000-3,000 mL fluid each day and eat a diet with consistent and moderate sodium intake.Excessive amounts of coffee,tea,and cola should be avoided because of diuretic effect.Advise patient that weight gain may occur.Review principles of a low-calorie diet.Explain to patients with cardiovascular disease or over 40 years of age the need for ECG evaluation before and periodically during therapy.Patient should inform health-care professional if fainting,irregular pulse,or difficulty breathing occurs.

Question 12

A nurse is counseling the parent of a 3-year-old child with chronic ear infections and fluid in the ears.The physician recommends Silfedrine Children's (pseudoephedrine)as a decongestant.Which of the following statements indicate that teaching has been effective? Select all that apply.
A)"The decongestant will help clear the fluid from his ears."
B)"I should give this medication at bedtime to help him sleep."
C)"I should call the doctor if I notice he is having any difficulty breathing."
D)"This medication will kill the bacteria causing the infection in his ears."
E)"Too much of this medication can alter his heart rate,so I need to keep it out of his reach."
F)"I should limit his fluid intake to help reduce the congestion in his ears."

Accepted Answer

See Indications and Patient/Family Teaching and Assessment for pseudoephedrine.It is used to open obstructed eustachian tubes in chronic otic inflammation or infection;it does not kill bacteria.Instruct patient to notify a health-care professional if nervousness,slow or fast heart rate,breathing difficulties,hallucinations,or seizures occur because these symptoms may indicate overdose.Administer pseudoephedrine at least 2 hr before bedtime to minimize insomnia.Maintain fluid intake of 1,500-2,000 mL/day to decrease viscosity of secretions.

Question 13

A nurse working in the health department recognizes that the shingles vaccine (Zostavax)is contraindicated for which of the following individuals? Select all that apply.
A)A 55-year-old patient with a history of atrial fibrillation
B)A 49-year-old patient with HIV
C)A 61-year-old patient with an upper respiratory infection;T = 101.4°F
D)A 33-year-old patient who is 6 wk pregnant
E)A 42-year-old patient with an allergy to eggs
F)A 51-year-old patient with a history of chronic obstructive pulmonary disease

Accepted Answer

See Contraindications for the Zoster Vaccine.It is contraindicated in a history of anaphylactic/anaphylactoid reactions to gelatin,neomycin;active infections;immunosuppression (including HIV);and pregnancy.There is no contraindication for chronic medical conditions that do not impart immunosuppression.Sensitivity to eggs is contraindicated for flu vaccine,but not for the shingles vaccine.

Question 14

The nurse recognizes which of the following individuals is at highest risk for developing orthostatic hypotension?
A)A 53-year-old patient taking Tigacil (tigecycline).
B)A 61-year-old patient taking Coumadin (warfarin).
C)A 49-year-old patient taking Zincate (zinc sulfate).
D)A 64-year-old patient taking Calan (verapamil).

Accepted Answer

See Adverse Reactions/Side Effects for verapamil.Calan is an antihypertensive that can cause orthostatic hypotension.Tigacil is an anti-infective that causes sedation.Coumadin is an anticoagulant without noted CNS side effects.Zincate is a mineral supplement without noted CNS side effects.

Question 15

An individual with chronic schizophrenia who recently started taking Zyprexa (olanzapine)is smacking his lips,puffing his cheeks,and chewing.Which of the following statements by the nurse is best?
A)"Don't worry,this is commonly seen with advancing schizophrenia;you may need a higher dose of medication."
B)"These are symptoms seen in withdrawal from the medication;have you stopped taking your medication for some reason?"
C)"These movements are a side effect of the medication;you should stop taking it."
D)"We see this a lot,it will go away after you've been on the medication for a month or so."

Accepted Answer

See Assessment for olanzapine.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 blinking of eyes).Report immediately,as it may be irreversible.

Question 16

While caring for a client who reports taking Prilosec (omeprazole),the nurse recognizes the need for further teaching if the client also reports taking which of the following? Select all that apply.
A)Tylenol for occasional headaches
B)Ibuprofen daily for arthritis
C)Baby aspirin daily to prevent heart pain
D)Maalox occasionally to reduce heartburn
E)Flaxseed supplement to increase omega-3 intake
F)Multi-vitamin with iron to promote health

Accepted Answer

See Patient/Family Teaching for omeprazole.Advise patient to avoid alcohol,products containing aspirin or NSAIDs,and foods that may cause an increase in GI irritation.

Question 17

The nurse is advising a client whose triglyceride levels remain elevated despite 3 mo of following a low-fat,low-cholesterol diet.The client is started on Lovaza (omega-3 acid ethyl esters).Which of the following statements would the nurse include in the teaching? Select all that apply.
A)"You still need to follow a low-fat diet while you're taking this medication."
B)"This medication may be taken with meals."
C)"Limiting cholesterol intake is not as critical as limiting intake of carbohydrates."
D)"Diabetes contributes to elevated triglyceride levels,so it is important to maintain good control or your diabetes."
E)"It is important to establish an exercise routine that works with diet and medication to help control your weight."
F)"You probably inherited this from one of your parents,so aside from medication,there isn't much you can do."

Accepted Answer

See Patient/Family Teaching for omega-3 acid ethyl esters.It may be administered with meals.Advise patient that this medication should be used in conjunction with diet restrictions (fat,cholesterol,carbohydrates,and alcohol),exercise,weight loss in overweight patients,and control of medical problems (such as diabetes mellitus and hypothyroidism)that may contribute to hypertriglyceridemia.

Question 18

Which of the following interventions would be helpful for a patient taking Claritin (loratadine)who complains of a dry mouth? Select all that apply.
A)Frequent oral rinses with water
B)Sugarless gum or candy
C)Flossing twice daily
D)Increased intake of caffeine
E)Fluid intake of 1,000 mL/day
F)Use of alcohol-based mouth wash

Accepted Answer

See Patient/Family Teaching for loratadine.Advise patient that good oral hygiene,frequent rinsing of mouth with water,and sugarless gum or candy may minimize dry mouth.Patient should notify dentist if dry mouth persists longer than 2 wk.Flossing is not helpful in addressing dry mouth.Caffeine has a diuretic effect and will not be helpful.Normal recommended fluid intake is 1,500-2,000 mL/day.Alcohol-based mouth rinse may increase a sensation of dryness.

Question 19

A nurse caring for an individual with diabetes insipidus who is taking Vasostrict (vasopressin).Which of the following assessments would indicate treatment has been effective?
A)Urine output is 800 mL at the end of an 8-hr shift.
B)Urine specific gravity is 0.998.
C)Patient has lost 2 pounds in 1 day.
D)Mucous membranes are dry and sticky.

Accepted Answer

See Evaluation for vasopressin.Desired outcome includes decrease in urine volume,relief of polydipsia,and increased urine osmolality in patients with central diabetes insipidus.Normal urine output is 60-100 mL/hr,so this value is within normal limits and indicates successful management of diabetes insipidus.Normal urine specific gravity is 1.010-1.030.Signs of dehydration indicate on-going fluid loss associated with diabetes insipidus.

Question 20

While caring for a 31-year-old female client who is initiating therapy with Thalomid (thalidomide),the nurse recognizes the need for further teaching by which of the following statements.
A)"I can't start the medication until I've had a negative pregnancy test."
B)"I must have a pregnancy test every month for the first 3 months I take this medication."
C)"I must use two methods of birth control while I am taking this medication."
D)"I will not be able to donate blood while taking this medication."

Accepted Answer

See Implementation for thalidomide.Pregnancy testing must occur weekly during first month of therapy.Due to teratogenic effects,thalidomide may be prescribed only by prescribers registered in the System for Thalidomide Education and Prescribing Safety (STEPS)program.Thalidomide is started within 24 hr of a negative pregnancy test with a sensitivity of at least 50 mIU/mL and then monthly thereafter in women with a regular menstrual cycle.For women of childbearing years,two methods of reliable contraception must be used unless complete abstinence is used.For women with irregular menses,pregnancy testing should occur every 2 wk.If pregnancy occurs,thalidomide should be discontinued immediately.Instruct patient not to donate blood and male patients not to donate sperm while taking thalidomide.

Quiz 2: Detecting and Managing Adverse Drug Reactions

The nurse is counseling a patient who has been given a prescription for Imitrex (sumatriptan) for migraine headaches.Which of the following statements indicates teaching has been effective?

The nurse recognizes that the treatment plan for which of the following individuals would likely include Metamucil (psyllium) ? Select all that apply.

The nurse is caring for a patient who takes Betapace (sotalol) 80 mg po BID.Prior to administering the dose,which of the following actions should the nurse take first?

While caring for an individual taking Demadex (torsemide) for hypertension,the nurse would be most concerned by which of the following assessments?

The nurse is caring for an individual receiving intravenous Vancocin (vancomycin) .Which of the following assessments is most important to prevent permanent complication?

An individual with a history of angina takes sublingual nitroglycerine to relieve chest pain ranked 6/10.Five min later,the chest pain is 4/10.What action should the nurse take next?

While caring for a client with a history of epilepsy,the nurse would expect which of the following medications to be included in the patient's treatment plan? Select all that apply.

Which of the following patients would most likely be taking Quinidine Gluconate (quinidine) ?

The nurse recognizes that which of the following individuals will need to receive supplemental vitamin B₁₂ injections?

While caring for a patient taking Carafate (sucralfate) ,the nurse recognizes the medication is effective by which of the following?

Which of the following would be included in the patient teaching for a client receiving Lithobid (lithium) therapy? Select all that apply.

A nurse is counseling the parent of a 3-year-old child with chronic ear infections and fluid in the ears.The physician recommends Silfedrine Children's (pseudoephedrine) as a decongestant.Which of the following statements indicate that teaching has been effective? Select all that apply.

A nurse working in the health department recognizes that the shingles vaccine (Zostavax) is contraindicated for which of the following individuals? Select all that apply.

The nurse recognizes which of the following individuals is at highest risk for developing orthostatic hypotension?

An individual with chronic schizophrenia who recently started taking Zyprexa (olanzapine) is smacking his lips,puffing his cheeks,and chewing.Which of the following statements by the nurse is best?

While caring for a client who reports taking Prilosec (omeprazole) ,the nurse recognizes the need for further teaching if the client also reports taking which of the following? Select all that apply.

The nurse is advising a client whose triglyceride levels remain elevated despite 3 mo of following a low-fat,low-cholesterol diet.The client is started on Lovaza (omega-3 acid ethyl esters) .Which of the following statements would the nurse include in the teaching? Select all that apply.

Which of the following interventions would be helpful for a patient taking Claritin (loratadine) who complains of a dry mouth? Select all that apply.

A nurse caring for an individual with diabetes insipidus who is taking Vasostrict (vasopressin) .Which of the following assessments would indicate treatment has been effective?

While caring for a 31-year-old female client who is initiating therapy with Thalomid (thalidomide) ,the nurse recognizes the need for further teaching by which of the following statements.