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Toccata and Fugue
Alan Alda
Quiz by Alan Alda, updated more than 1 year ago
Alan Alda
Created by Alan Alda about 5 years ago
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Resource summary

Question 1

Question
A patient about to receive a morning dose of digoxin has an apical pulse of 53 beats/min. What will the nurse do next?
Answer
  • Administer the dose.
  • Administer the dose, and notify the prescriber.
  • Check the radial pulse for 1 full minute.
  • Withhold the dose, and notify the prescriber.

Question 2

Question
A patient is taking digoxin (Lanoxin) and a loop diuretic daily. When the nurse enters the room with the morning medications, the patient states, “I am seeing a funny yellow color around the lights.” What is the nurse’s next action?
Answer
  • Assess the patient for symptoms of digoxin toxicity.
  • Withhold the next dose of the diuretic.
  • Administer the digoxin and diuretic together as ordered.
  • Document this finding, and reassess in 1 hour.

Question 3

Question
While assessing a patient who is receiving intravenous digitalis, the nurse recognizes that the drug has a negative chronotropic effect. How would this drug effect be evident in the patient?
Answer
  • Decreased blood pressure
  • Decreased heart rate
  • Decreased conduction
  • Decreased ectopic beats

Question 4

Question
A patient has been taking digoxin at home but took an accidental overdose and has developed toxicity. The patient has been admitted to the telemetry unit, where the physician has ordered digoxin immune Fab (Digifab). The patient asks the nurse why the medication is ordered. What is the nurse’s best response?
Answer
  • “It will increase your heart rate.”
  • “This drug helps to lower your potassium levels.”
  • “It helps to convert the irregular heart rhythm to a more normal rhythm.”
  • “This drug is an antidote to digoxin and will help to lower the blood levels.”

Question 5

Question
A patient has been placed on a milrinone (Primacor) infusion as part of the therapy for end-stage heart failure. What adverse effect of this drug will the nurse watch for when assessing this patient during the infusion?
Answer
  • Hypertension
  • Hyperkalemia
  • Nausea and vomiting
  • Cardiac dysrhythmias

Question 6

Question
A patient has a digoxin level of 1.1 ng/mL. Which interpretation by the nurse is correct?
Answer
  • It is below the therapeutic level.
  • It is within the therapeutic range.
  • It is above the therapeutic level.
  • It is at a toxic level.

Question 7

Question
The nurse is reviewing discharge teaching for a patient who will be taking digoxin (Lanoxin) therapy. The nurse will teach the patient to avoid which foods when taking the digoxin?
Answer
  • Leafy green vegetables
  • Dairy products
  • Grapefruit juice
  • Bran muffins

Question 8

Question
In assessing a patient before administration of a cardiac glycoside, the nurse knows that which lab result can increase the toxicity of the drug?
Answer
  • Potassium level 2.8 mEq/L
  • Potassium level 4.9 mEq/L
  • Sodium level 140 mEq/L
  • Calcium level 10 mg/dL

Question 9

Question
The nurse administering the phosphodiesterase inhibitor milrinone (Primacor) recognizes that this drug will have a positive inotropic effect. Which result reflects this effect?
Answer
  • Increased heart rate
  • Increased blood vessel dilation
  • Increased force of cardiac contractions
  • Increased conduction of electrical impulses across the heart

Question 10

Question
The nurse notes in a patient’s medical record that nesiritide (Natrecor) has been ordered. Based on this order, the nurse interprets that the patient has which disorder?
Answer
  • Atrial fibrillation
  • Acutely decompensated heart failure with dyspnea at rest
  • Systolic heart failure
  • Chronic, stable heart failure

Question 11

Question
When administering digoxin immune Fab (Digibind) to a patient with severe digoxin toxicity, the nurse knows that each vial can bind with how much digoxin?
Answer
  • 0.5 mg
  • 5 mg
  • 5.5 mg
  • 15 mg

Question 12

Question
A patient is in the intensive care unit and receiving an infusion of milrinone (Primacor) for severe heart failure. The prescriber has written an order for an intravenous dose of furosemide (Lasix). How will the nurse give this drug?
Answer
  • Infuse the drug into the same intravenous line as the milrinone.
  • Stop the milrinone, flush the line, and then administer the furosemide.
  • Administer the furosemide in a separate intravenous line.
  • Notify the prescriber that the furosemide cannot be given at this time.

Question 13

Question
When a patient is experiencing digoxin toxicity, which clinical situation would necessitate the use of digoxin immune Fab (Digifab)? (Select all that apply.)
Answer
  • The patient reports seeing colorful halos around lights.
  • The patient’s serum potassium level is above 5 mEq/L.
  • The patient is experiencing nausea and anorexia.
  • The patient is experiencing severe sinus bradycardia that does not respond to cardiac pacing.
  • The patient has received an overdose of greater than 10 mg of digoxin.
  • The patient reports fatigue and headaches.

Question 14

Question
Which drug classes are considered first-line treatment for heart failure? (Select all that apply.)
Answer
  • Angiotensin-converting enzyme (ACE) inhibitors
  • Angiotensin II receptor blockers (ARBs)
  • Digoxin (cardiac glycoside)
  • Beta blockers
  • Nesiritide (Natrecor), the B-type natriuretic peptide

Question 15

Question
The medication order for a 4-year-old child reads, “Give digoxin elixir, 15 mcg/kg, PO now.” Convert the micrograms to milligrams. [blank_start]__________[blank_end]
Answer
  • 0.015 mg

Question 16

Question
The nurse is reviewing the classes of antidysrhythmic drugs. Amiodarone (Cordarone) is classified on the Vaughan Williams classification as a class III drug, which means it works by which mechanism of action?
Answer
  • Blocking slow calcium channels
  • Prolonging action potential duration
  • Blocking sodium channels and affecting phase 0
  • Decreasing spontaneous depolarization and affecting phase 4

Question 17

Question
A patient is taking procainamide (Pronestyl) for a cardiac dysrhythmia. The nurse will monitor the patient for which possible adverse effect?
Answer
  • Bradycardia
  • Shortened QT interval
  • Dyspnea
  • Diarrhea

Question 18

Question
Which nursing diagnosis is appropriate for a patient receiving antidysrhythmics?
Answer
  • Risk for infection
  • Deficient knowledge
  • Deficient fluid volume
  • Urinary retention

Question 19

Question
A patient will be discharged on quinidine sulfate (Quinidex) extended-release tablets for the treatment of ventricular ectopy. The nurse will include which information in the teaching plan?
Answer
  • The medication should be stopped once the cardiac symptoms subside.
  • Signs of cinchonism, such as tinnitus, loss of hearing, or slight blurring of vision, may occur.
  • It is important to use sunscreen products when outside because of increased photosensitivity.
  • If any tablet or capsule is visible in the stool, contact the prescriber immediately.

Question 20

Question
A patient is in the intensive care unit because of an acute myocardial infarction. He is experiencing severe ventricular dysrhythmias. The nurse will prepare to give which drug of choice for this dysrhythmia?
Answer
  • Diltiazem (Cardizem)
  • Verapamil (Calan)
  • Amiodarone (Cordarone)
  • Adenosine (Adenocard)

Question 21

Question
The nurse is preparing to administer adenosine (Adenocard) to a patient who is experiencing an acute episode of paroxysmal supraventricular tachycardia. When giving this medication, which is important to remember?
Answer
  • The onset of action occurs in 5 minutes.
  • The medication must be given as a slow intravenous (IV) push.
  • Asystole may occur for a few seconds after administration.
  • The medication has a long half-life, and therefore duration of action is very long.

Question 22

Question
A 62-year-old man is to receive lidocaine as treatment for a symptomatic dysrhythmia. Upon assessment, the nurse notes that he has a history of alcoholism and has late-stage liver failure. The nurse will expect which adjustments to his drug therapy?
Answer
  • The dosage will be reduced by 50%.
  • A diuretic will be added to the lidocaine.
  • The lidocaine will be changed to an oral dosage form.
  • An increased dosage of lidocaine will be prescribed so as to obtain adequate blood levels.

Question 23

Question
A patient has been started on therapy of a continuous infusion of lidocaine after receiving a loading dose of the drug. The nurse will monitor the patient for which adverse effect?
Answer
  • Drowsiness
  • Nystagmus
  • Dry mouth
  • Convulsions

Question 24

Question
When starting a patient on antidysrhythmic therapy, the nurse will remember that which problem is a potential adverse effect of any antidysrhythmic drug?
Answer
  • Deficiency of fat-soluble vitamins
  • Hyperkalemia
  • Heart failure
  • Dysrhythmias

Question 25

Question
A patient is in the emergency department with a new onset of rapid-rate atrial fibrillation, and the nurse is preparing a continuous infusion. Which drug is most appropriate for this dysrhythmia?
Answer
  • Diltiazem (Cardizem)
  • Atenolol (Tenormin)
  • Lidocaine
  • Adenosine (Adenocard)

Question 26

Question
The nurse notes in the patient’s medication orders that the patient will be taking ibutilide (Corvert). Based on this finding, the nurse interprets that the patient has which disorder?
Answer
  • Ventricular ectopy
  • Atrial fibrillation
  • Supraventricular tachycardia
  • Bradycardia

Question 27

Question
Which patient-teaching instructions are appropriate for a patient taking an antidysrhythmic drug? (Select all that apply.)
Answer
  • “Do not chew or crush extended-release forms of medication.”
  • “Take the medication with food if gastrointestinal distress occurs.”
  • “If a dose is missed, the missed dose should be taken along with the next dose that is due to be taken.”
  • “Take the medications with an antacid if gastrointestinal distress occurs.”
  • “Limit or avoid the use of caffeine.”
  • “The presence of a capsule in the stool should be reported to the physician immediately.”

Question 28

Question
The nurse is monitoring for adverse effects in a patient who is receiving an amiodarone (Cordarone) infusion. Which are adverse effects for amiodarone? (Select all that apply.)
Answer
  • Tachycardia
  • Constipation
  • Chest pain
  • QT prolongation
  • Headache
  • Hypotension
  • Blue-gray coloring of the skin on the face, arms, and neck

Question 29

Question
The nurse is preparing to administer a bolus dose of verapamil (Calan) as follows: “Give 5-mg bolus of verapamil, IV push, over 2 minutes. May repeat in 30 minutes if needed.” The medication is available in a 2.5-mg/mL strength solution. Identify how many milliliters will the nurse draw into the syringe for this dose. [blank_start]_______[blank_end]
Answer
  • 2 mL

Question 30

Question
The nurse notes in a patient’s medication history that the patient has been taking desmopressin (DDAVP). Based on this finding, the nurse interprets that the patient has which disorder?
Answer
  • Diabetes mellitus
  • Diabetes insipidus
  • Adrenocortical insufficiency
  • Carcinoid tumor

Question 31

Question
A 16-year-old boy who is taking somatropin comes into the office because he had an asthma attack during a race at school. Because of this new development, the nurse expects which intervention to occur next?
Answer
  • He will need to stop participating in school physical education classes.
  • The somatropin must be discontinued immediately.
  • The somatropin dosage may be adjusted.
  • His growth will be documented and monitored for changes.

Question 32

Question
When a patient is receiving vasopressin (Pitressin), the nurse will monitor for which therapeutic response?
Answer
  • Improved appetite
  • Increased serum albumin levels
  • Increased serum potassium levels
  • Decreased urinary output

Question 33

Question
An 8-year-old child has been diagnosed with true pituitary dwarfism and is being treated with somatropin. In follow-up visits, the nurse will monitor for which expected outcome?
Answer
  • Increased growth
  • Decreased urinary output
  • Increased muscle strength
  • Increased height when the child reaches puberty

Question 34

Question
When reviewing the medication profile of a patient with a new order for desmopressin (DDAVP), the nurse notes that a drug interaction will occur if which drug is taken with desmopressin?
Answer
  • Aspirin
  • Digoxin
  • Lithium
  • Penicillin

Question 35

Question
A patient’s medication order indicates that he is to receive a dose of cosyntropin (Cortrosyn). The nurse is aware that this drug is used to diagnose which condition?
Answer
  • Adrenocortical insufficiency
  • Diabetes insipidus
  • Myasthenia gravis
  • Pituitary dwarfism

Question 36

Question
A patient is about to receive a dose of octreotide (Sandostatin). The nurse will assess for which contraindications or cautions? (Select all that apply.)
Answer
  • Carcinoid crisis
  • Diarrhea
  • Type 1 diabetes mellitus
  • Gallbladder disease
  • Chronic renal failure
  • Esophageal varices

Question 37

Question
A patient is to receive vasopressin (Pitressin) 5 units subcut BID. The medication is available in a vial that contains 20 units/mL. Identify how many milliliters will the nurse draw up for this dose. (record answer using two decimal places) [blank_start]_______[blank_end]
Answer
  • 0.25 mL

Question 38

Question
A patient, newly diagnosed with hypothyroidism, receives a prescription for a thyroid hormone replacement drug. The nurse assesses for which potential contraindication to this drug?
Answer
  • Infection
  • Diabetes mellitus
  • Liver disease
  • Recent myocardial infarction

Question 39

Question
A patient with hypothyroidism is given a prescription for levothyroxine (Synthroid). When the nurse explains that this is a synthetic form of the thyroid hormone, he states that he prefers to receive more “natural” forms of drugs. What will the nurse explain to him about the advantages of levothyroxine?
Answer
  • It has a stronger effect than the natural forms.
  • Levothyroxine is less expensive than the natural forms.
  • The synthetic form has fewer adverse effects on the gastrointestinal tract.
  • The half-life of levothyroxine is long enough to permit once-daily dosing.

Question 40

Question
The order reads, “Give levothyroxine (Synthroid), 200 mg, PO once every morning.” Which action by the nurse is correct?
Answer
  • Give the medication as ordered.
  • Change the dose to 200 mcg because that is what the prescriber meant.
  • Hold the drug until the prescriber returns to see the patient.
  • Question the order because the dose is higher than 200 mcg.

Question 41

Question
During a teaching session for a patient on antithyroid drugs, the nurse will discuss which dietary instructions
Answer
  • Using iodized salt when cooking
  • Avoiding foods containing iodine
  • Restricting fluid intake to 2500 mL/day
  • Increasing intake of sodium- and potassium-containing foods

Question 42

Question
A patient who is taking propylthiouracil (PTU) for hyperthyroidism wants to know how this medicine works. Which explanation by the nurse is accurate?
Answer
  • It blocks the action of thyroid hormone.
  • It slows down the formation of thyroid hormone.
  • It destroys overactive cells in the thyroid gland.
  • It inactivates already existing thyroid hormone in the bloodstream.

Question 43

Question
A 19-year-old student was diagnosed with hypothyroidism and has started thyroid replacement therapy with levothyroxine (Synthroid). After 1 week, she called the clinic to report that she does not feel better. Which response from the nurse is correct?
Answer
  • “It will probably require surgery for a cure to happen.”
  • “The full therapeutic effects may not occur for 3 to 4 weeks.”
  • “Is it possible that you did not take your medication as instructed?”
  • “Let’s review your diet; it may be causing absorption problems.”

Question 44

Question
A patient, newly diagnosed with hypothyroidism, has received a prescription for thyroid replacement therapy. The nurse will instruct the patient to take this medication at which time of day?
Answer
  • In the morning
  • With the noon meal
  • With the evening meal
  • At bedtime

Question 45

Question
When reviewing the laboratory values of a patient who is taking antithyroid drugs, the nurse will monitor for which adverse effect?
Answer
  • Decreased glucose levels
  • Decreased white blood cell count
  • Increased red blood cell count
  • Increased platelet count

Question 46

Question
A patient has been taking levothyroxine (Synthroid) for more than one decade for primary hypothyroidism. Today she calls because she has a cousin who can get her the same medication in a generic form from a pharmaceutical supply company. Which is the nurse’s best advice?
Answer
  • “This would be a great way to save money.”
  • “There’s no difference in brands of this medication.”
  • “This should never be done; once you start with a certain brand, you must stay with it.”
  • “It’s better not to switch brands unless we check with your doctor.”

Question 47

Question
A patient has a diagnosis of primary hypothyroidism. Which statement accurately describes this problem?
Answer
  • The hypothalamus is not secreting thyrotropin-releasing hormone (TRH); therefore, thyroid-stimulating hormone (TSH) is not released from the pituitary gland.
  • The pituitary gland is dysfunctional and is not secreting TSH.
  • The abnormality is in the thyroid gland itself.
  • The abnormality is caused by an insufficient intake of iodine.

Question 48

Question
A 19-year-old woman has been diagnosed with hypothyroidism and has started thyroid replacement therapy with levothyroxine (Synthroid). After 6 months, she calls the nurse to say that she feels better and wants to stop the medication. Which response by the nurse is correct?
Answer
  • “You can stop the medication if your symptoms have improved.”
  • “You need to stay on the medication for at least 1 year before a decision about stopping it can be made.”
  • “You need to stay on this medication until you become pregnant.”
  • “Medication therapy for hypothyroidism is usually lifelong, and you should not stop taking the medication.”

Question 49

Question
Levothyroxine (Synthroid) has been prescribed for a patient with hypothyroidism. The nurse reviews the patient’s current medications for potential interactions. Which of these drugs or drug classes interact with levothyroxine? (Select all that apply.)
Answer
  • Phenytoin (Dilantin)
  • Estrogens
  • Beta blockers
  • Warfarin (Coumadin)
  • Penicillins
  • Iron supplements

Question 50

Question
The nurse is giving morning medications. The Medication Administration Record has an order for levothyroxine, 75 mcg PO. The drug-dispensing cabinet contains levothyroxine tablets in milligram strengths instead of micrograms. Calculate the milligram equivalent dose of 75 mcg. [blank_start]_______[blank_end]
Answer
  • 0.075 mg

Question 51

Question
The nurse is administering insulin lispro (Humalog) and will keep in mind that this insulin will start to have an effect within which time frame?
Answer
  • 15 minutes
  • 1 to 2 hours
  • 80 minutes
  • 3 to 5 hours

Question 52

Question
When teaching about hypoglycemia, the nurse will make sure that the patient is aware of the early signs of hypoglycemia, including:
Answer
  • hypothermia and seizures.
  • nausea and diarrhea.
  • confusion and sweating.
  • fruity, acetone odor to the breath.

Question 53

Question
The nurse is teaching a group of patients about self-administration of insulin. What content is important to include?
Answer
  • Patients need to use the injection site that is the most accessible.
  • If two different insulins are ordered, they need to be given in separate injections.
  • When mixing insulins, the cloudy (such as NPH) insulin is drawn up into the syringe first.
  • When mixing insulins, the clear (such as regular) insulin is drawn up into the syringe first.

Question 54

Question
When monitoring a patient’s response to oral antidiabetic drugs, the nurse knows that which laboratory result would indicate a therapeutic response?
Answer
  • Random blood glucose level 180 mg/dL
  • Blood glucose level of 50 mg/dL after meals
  • Fasting blood glucose level between 92 mg/dL
  • Evening blood glucose level below 80 mg/dL

Question 55

Question
A 75-year-old woman with type 2 diabetes has recently been placed on glipizide (Glucotrol), 10 mg daily. She asks the nurse when the best time would be to take this medication. What is the nurse’s best response?
Answer
  • “Take this medication in the morning, 30 minutes before breakfast.”
  • “Take this medication in the evening with a snack.”
  • “This medication needs to be taken after the midday meal.”
  • “It does not matter what time of day you take this medication.”

Question 56

Question
A patient who has type 2 diabetes is scheduled for an oral endoscopy and has been NPO (nothing by mouth) since midnight. What is the best action by the nurse regarding the administration of her oral antidiabetic drugs?
Answer
  • Administer half the original dose.
  • Withhold all medications as ordered.
  • Contact the prescriber for further orders.
  • Give the medication with a sip of water.

Question 57

Question
The nurse is reviewing instructions for a patient with type 2 diabetes who also takes insulin injections as part of the therapy. The nurse asks the patient, “What should you do if your fasting blood glucose is 47 mg/dL?” Which response by the patient reflects a correct understanding of insulin therapy?
Answer
  • “I will call my doctor right away.”
  • “I will give myself the regular insulin.”
  • “I will take an oral form of glucose.”
  • “I will rest until the symptoms pass.”

Question 58

Question
The nurse is teaching patients about self-injection of insulin. Which statement is true regarding injection sites
Answer
  • Avoid the abdomen because absorption there is irregular.
  • Choose a different site at random for each injection.
  • Give the injection in the same area each time.
  • Rotate sites within the same location for about 1 week before rotating to a new location.

Question 59

Question
Which action is most appropriate regarding the nurse’s administration of a rapid-acting insulin to a hospitalized patient?
Answer
  • Give it within 15 minutes of mealtime.
  • Give it after the meal has been completed.
  • Administer it once daily at the time of the midday meal.
  • Administer it with a snack before bedtime.

Question 60

Question
After starting treatment for type 2 diabetes mellitus 6 months earlier, a patient is in the office for a follow-up examination. The nurse will monitor which laboratory test to evaluate the patient’s adherence to the antidiabetic therapy over the past few months?
Answer
  • Hemoglobin levels
  • Hemoglobin A1C level
  • Fingerstick fasting blood glucose level
  • Serum insulin levels

Question 61

Question
A patient in the emergency department was showing signs of hypoglycemia and had a fingerstick glucose level of 34 mg/dL. The patient has just become unconscious. What is the nurse’s next action?
Answer
  • Have the patient eat glucose tablets.
  • Have the patient consume fruit juice, a nondiet soft drink, or crackers.
  • Administer intravenous glucose (50% dextrose).
  • Call the lab to order a fasting blood glucose level.

Question 62

Question
The nurse is preparing to administer insulin intravenously. Which statement about the administration of intravenous insulin is true?
Answer
  • Insulin is never given intravenously.
  • Only regular insulin can be administered intravenously.
  • Insulin aspart or insulin lispro can be administered intravenously, but there must be a 50% dose reduction.
  • Any form of insulin can be administered intravenously at the same dose as that is ordered for subcutaneous administration.

Question 63

Question
A patient with a history of chronic obstructive pulmonary disease (COPD) and type 2 diabetes has been treated for pneumonia for the past week. The patient has been receiving intravenous corticosteroids as well as antibiotics as part of his therapy. At this time, the pneumonia has resolved, but when monitoring the blood glucose levels, the nurse notices that the level is still elevated. What is the best explanation for this elevation?
Answer
  • The antibiotics may cause an increase in glucose levels.
  • The corticosteroids may cause an increase in glucose levels.
  • His type 2 diabetes has converted to type 1.
  • The hypoxia caused by the COPD causes an increased need for insulin.

Question 64

Question
The nurse knows to administer acarbose (Precose), an alpha-glucosidase inhibitor, at which time?
Answer
  • 30 minutes before breakfast
  • With the first bite of each main meal
  • 30 minutes after breakfast
  • Once daily at bedtime

Question 65

Question
A patient has been diagnosed with metabolic syndrome and is started on the biguanide metformin (Glucophage). The nurse knows that the purpose of the metformin, in this situation, is which of these?
Answer
  • To increase the pancreatic secretion of insulin
  • To decrease insulin resistance
  • To increase blood glucose levels
  • To decrease the pancreatic secretion of insulin

Question 66

Question
When administering morning medications for a newly admitted patient, the nurse notes that the patient has an allergy to sulfa drugs. There is an order for the sulfonylurea glipizide (Glucotrol). Which action by the nurse is correct?
Answer
  • Give the drug as ordered 30 minutes before breakfast.
  • Hold the drug, and check the order with the prescriber.
  • Give a reduced dose of the drug with breakfast.
  • Give the drug, and monitor for adverse effects.

Question 67

Question
The nurse is reviewing a patient’s medication list and notes that sitagliptin (Januvia) is ordered. The nurse will question an additional order for which drug or drug class?
Answer
  • Glitazone
  • Insulin
  • Metformin (Glucophage)
  • Sulfonylurea

Question 68

Question
The nurse is teaching a review class to nurses about diabetes mellitus. Which statement by the nurse is correct?
Answer
  • “Patients with type 2 diabetes will never need insulin.”
  • “Oral antidiabetic drugs are safe for use during pregnancy.”
  • “Pediatric patients cannot take insulin.”
  • “Insulin therapy is possible during pregnancy if managed carefully.”

Question 69

Question
The nurse is teaching a group of patients about management of diabetes. Which statement about basal dosing is correct?
Answer
  • “Basal dosing delivers a constant dose of insulin.”
  • “With basal dosing, you can eat what you want and then give yourself a dose of insulin.”
  • “Glargine insulin is given as a bolus with meals.”
  • “Basal-bolus dosing is the traditional method of managing blood glucose levels.”

Question 70

Question
When teaching a patient who is starting metformin (Glucophage), which instruction by the nurse is correct?
Answer
  • “Take metformin if your blood glucose level is above 150 mg/dL.”
  • “Take this 60 minutes after breakfast.”
  • “Take the medication on an empty stomach 1 hour before meals.”
  • “Take the medication with food to reduce gastrointestinal (GI) effects.”

Question 71

Question
A patient is taking a sulfonylurea medication for new-onset type 2 diabetes mellitus. When reviewing potential adverse effects during patient teaching, the nurse will include information about which of these effects? (Select all that apply.)
Answer
  • Hypoglycemia
  • Nausea
  • Diarrhea
  • Weight gain
  • Peripheral edema

Question 72

Question
The nurse is administering adrenal drugs to a patient. Which action by the nurse is appropriate for this patient?
Answer
  • Administering oral drugs on an empty stomach to maximize absorption
  • Rinsing the oral cavity after using corticosteroid inhalers
  • Administering the corticosteroids before bedtime to minimize adrenal suppression
  • Discontinuing the medication immediately if weight gain of 5 pounds or more in 1 week occurs

Question 73

Question
A patient will be starting therapy with a corticosteroid. The nurse reviews the patient’s orders and notes that an interaction may occur if the corticosteroid is taken with which of these drug classes?
Answer
  • Nonsteroidal anti-inflammatory drugs
  • Antibiotics
  • Opioid analgesics
  • Antidepressants

Question 74

Question
A patient is concerned about the body changes that have resulted from long-term prednisone therapy for the treatment of asthma. Which effect of this drug therapy would be present to support the nursing diagnosis of disturbed body image?
Answer
  • Weight loss
  • Weight gain
  • Pale skin color
  • Hair loss

Question 75

Question
A patient is taking fludrocortisone (Florinef) for Addison’s disease, and his wife is concerned about all of the problems that may occur with this therapy. When teaching them about therapy with this drug, the nurse will include which information?
Answer
  • It may cause severe postural hypotension.
  • It needs to be taken with food or milk to minimize gastrointestinal upset.
  • The medication needs to be stopped immediately if nausea or vomiting occurs.
  • Weight gain of 5 pounds or more in 1 week is an expected adverse effect.

Question 76

Question
When monitoring a patient who is taking a systemically administered glucocorticoid, the nurse will monitor for signs of which condition?
Answer
  • Dehydration
  • Hypokalemia
  • Hyponatremia
  • Hypoglycemia

Question 77

Question
A glucocorticoid is prescribed for a patient. The nurse checks the patient’s medical history knowing that glucocorticoid therapy is contraindicated in which disorder?
Answer
  • Cerebral edema
  • Peptic ulcer disease
  • Tuberculous meningitis
  • Chronic obstructive pulmonary disease

Question 78

Question
A patient who has been on long-term corticosteroid therapy has had surgery to correct an abdominal hernia. The nurse keeps in mind that which potential effect of this medication may have the most impact on the patient’s recovery?
Answer
  • Hypotension
  • Delayed wound healing
  • Muscle weakness
  • Osteoporosis

Question 79

Question
The nurse is reviewing therapy with glucocorticoid drugs. Which conditions are indications for glucocorticoid drugs? (Select all that apply.)
Answer
  • Glaucoma
  • Cerebral edema
  • Chronic obstructive pulmonary disease and asthma
  • Organ transplantation
  • Varicella
  • Septicemia

Question 80

Question
The nurse expects that a patient is experiencing undersecretion of adrenocortical hormones when which conditions are found upon assessment? (Select all that apply.)
Answer
  • Dehydration
  • Weight loss
  • Steroid psychosis
  • Increased potassium levels
  • Increased blood glucose levels
  • Decreased serum sodium levels

Question 81

Question
A patient has been admitted for an exacerbation of chronic obstructive pulmonary disease and will be receiving methylprednisolone (Solu-Medrol) 30 mg intravenously every 6 hours. The medication is available in 40-mg/mL vials. Identify how many milliliters will the nurse draw up for this dose. [blank_start]_______[blank_end]
Answer
  • 0.75 mL

Question 82

Question
A patient was diagnosed with pancreatic cancer last month, and has complained of a dull ache in the abdomen for the past 4 months. This pain has been gradually increasing, and the pain relievers taken at home are no longer effective. What type of pain is the patient experiencing?
Answer
  • Acute pain
  • Chronic pain
  • Somatic pain
  • Neuropathic pain

Question 83

Question
An 18-year-old basketball player fell and twisted his ankle during a game. The nurse will expect to administer which type of analgesic?
Answer
  • Synthetic opioid, such as meperidine (Demerol)
  • Opium alkaloid, such as morphine sulfate
  • Opioid antagonist, such as naloxone HCL (Narcan)
  • Nonopioid analgesic, such as indomethacin (Indocin)

Question 84

Question
A patient is recovering from abdominal surgery, which he had this morning. He is groggy but complaining of severe pain around his incision. What is the most important assessment data to consider before the nurse administers a dose of morphine sulfate to the patient?
Answer
  • His pulse rate
  • His respiratory rate
  • The appearance of the incision
  • The date of his last bowel movement

Question 85

Question
A 78-year-old patient is in the recovery room after having a lengthy surgery on his hip. As he is gradually awakening, he requests pain medication. Within 10 minutes after receiving a dose of morphine sulfate, he is very lethargic and his respirations are shallow, with a rate of 7 per minute. The nurse prepares for which priority action at this time?
Answer
  • Assessment of the patient’s pain level
  • Immediate intubation and artificial ventilation
  • Administration of naloxone (Narcan)
  • Close observation of signs of opioid tolerance

Question 86

Question
A patient will be discharged with a 1-week supply of an opioid analgesic for pain management after abdominal surgery. The nurse will include which information in the teaching plan?
Answer
  • How to prevent dehydration due to diarrhea
  • The importance of taking the drug only when the pain becomes severe
  • How to prevent constipation
  • The importance of taking the drug on an empty stomach

Question 87

Question
A patient has been treated for lung cancer for 3 years. Over the past few months, the patient has noticed that the opioid analgesic is not helping as much as it had previously and more medication is needed for the same pain relief. The nurse is aware that this patient is experiencing which of these?
Answer
  • Opioid addiction
  • Opioid tolerance
  • Opioid toxicity
  • Opioid abstinence syndrome

Question 88

Question
A 38-year-old man has come into the urgent care center with severe hip pain after falling from a ladder at work. He says he has taken several pain pills over the past few hours but cannot remember how many he has taken. He hands the nurse an empty bottle of acetaminophen (Tylenol). The nurse is aware that the most serious toxic effect of acute acetaminophen overdose is which condition?
Answer
  • Tachycardia
  • Central nervous system depression
  • Hepatic necrosis
  • Nephropathy

Question 89

Question
A 57-year-old woman being treated for end-stage breast cancer has been using a transdermal opioid analgesic as part of the management of pain. Lately, she has been experiencing breakthrough pain. The nurse expects this type of pain to be managed by which of these interventions?
Answer
  • Administering NSAIDs
  • Administering an immediate-release opioid
  • Changing the opioid route to the rectal route
  • Making no changes to the current therapy

Question 90

Question
The nurse is reviewing herbal therapies. Which is a common use of the herb feverfew?
Answer
  • Muscle aches
  • Migraine headaches
  • Leg cramps
  • Incision pain after surgery

Question 91

Question
A patient is to receive acetylcysteine (Mucomyst) as part of the treatment for an acetaminophen (Tylenol) overdose. Which action by the nurse is appropriate when giving this medication?
Answer
  • Giving the medication undiluted for full effect
  • Avoiding the use of a straw when giving this medication
  • Disguising the flavor with soda or flavored water
  • Preparing to give this medication via a nebulizer

Question 92

Question
A patient is receiving gabapentin (Neurontin), an anticonvulsant, but has no history of seizures. The nurse expects that the patient is receiving this drug for which condition?
Answer
  • Inflammation pain
  • Pain associated with peripheral neuropathy
  • Depression associated with chronic pain
  • Prevention of seizures

Question 93

Question
The nurse is assessing a patient who has been admitted to the emergency department for a possible opioid overdose. Which assessment finding is characteristic of an opioid drug overdose?
Answer
  • Dilated pupils
  • Restlessness
  • Respiration rate of 6 breaths/min
  • Heart rate of 55 beats/min

Question 94

Question
The drug nalbuphine (Nubain) is an agonist-antagonist (partial agonist). The nurse understands that which is a characteristic of partial agonists?
Answer
  • They have anti-inflammatory effects.
  • They are given to reverse the effects of opiates.
  • They have a higher potency than agonists.
  • They have a lower dependency potential than agonists.

Question 95

Question
The nurse is assessing a patient for contraindications to drug therapy with acetaminophen (Tylenol). Which patient should not receive acetaminophen?
Answer
  • A patient with a fever of 101° F (38.3° C)
  • A patient who is complaining of a mild headache
  • A patient with a history of liver disease
  • A patient with a history of peptic ulcer disease

Question 96

Question
A patient arrives at the urgent care center complaining of leg pain after a fall when rock climbing. The x-rays show no broken bones, but he has a large bruise on his thigh. The patient says he drives a truck and does not want to take anything strong because he needs to stay awake. Which statement by the nurse is most appropriate?
Answer
  • “It would be best for you not to take anything if you are planning to drive your truck.”
  • “We will discuss with your doctor about taking an opioid because that would work best for your pain.”
  • “You can take acetaminophen, also known as Tylenol, for pain, but no more than 1000 mg per day.”
  • “You can take acetaminophen, also known as Tylenol, for pain, but no more than 3000 mg per day.”

Question 97

Question
A patient is suffering from tendonitis of the knee. The nurse is reviewing the patient’s medication administration record and recognizes that which adjuvant medication is most appropriate for this type of pain?
Answer
  • Antidepressant
  • Anticonvulsant
  • Corticosteroid
  • Local anesthesia

Question 98

Question
Vicodin (acetaminophen/hydrocodone) is prescribed for a patient who has had surgery. The nurse informs the patient that which common adverse effects can occur with this medication? (Select all that apply.)
Answer
  • Diarrhea
  • Constipation
  • Lightheadedness
  • Nervousness
  • Urinary retention
  • Itching

Question 99

Question
A patient is to receive codeine, 40 mg subcutaneously, every 6 hours as needed for pain. The solution is available in a concentration of 30 mg/mL. Identify how many milliliters of codeine will be drawn up for this dose. (record answer to one decimal place) [blank_start]_______[blank_end]
Answer
  • 1.3 mL

Question 100

Question
A 38-year-old male patient stopped smoking 6 months ago. He tells the nurse that he still feels strong cigarette cravings and wonders if he is ever going to feel “normal” again. Which statement by the nurse is correct?
Answer
  • “It’s possible that these cravings will never stop.”
  • “These cravings may persist for several months.”
  • “The cravings tell us that you are still using nicotine.”
  • “The cravings show that you are about to experience nicotine withdrawal.”

Question 101

Question
A patient in a rehabilitation center is beginning to experience opioid withdrawal symptoms. The nurse expects to administer which drug as part of the treatment?
Answer
  • Diazepam (Valium)
  • Methadone
  • Disulfiram (Antabuse)
  • Bupropion (Zyban)

Question 102

Question
A patient has been taking naltrexone (ReVia) as part of the treatment for addiction to heroin. The nurse expects that the naltrexone will have which therapeutic effect for this patient?
Answer
  • Naltrexone prevents the cravings for opioid drugs.
  • Naltrexone works as a safer substitute for the heroin until the patient completes withdrawal.
  • The patient will experience flushing, sweating, and severe nausea if he takes heroin while on naltrexone.
  • If opioid drugs are used while taking naltrexone, euphoria is not produced; thus, the opioid’s desired effects are lost.

Question 103

Question
The nurse is presenting a substance-abuse lecture for teenage girls and is asked about “roofies.” The nurse recognizes that this is the slang term for which substance?
Answer
  • Cocaine
  • Flunitrazepam
  • Secobarbital
  • Methamphetamine

Question 104

Question
A 29-year-old male patient is admitted to the intensive care unit with the following symptoms: restlessness, hyperactive reflexes, talkativeness, confusion and periods of panic and euphoria, tachycardia, and fever. The nurse suspects that he may be experiencing the effects of taking which substance?
Answer
  • Opioids
  • Alcohol
  • Stimulants
  • Depressants

Question 105

Question
When admitting a patient with a suspected diagnosis of chronic alcohol use, the nurse will keep in mind that chronic use of alcohol might result in which condition?
Answer
  • Renal failure
  • Cerebrovascular accident
  • Korsakoff’s psychosis
  • Alzheimer’s disease

Question 106

Question
A patient is being treated for ethanol alcohol abuse in a rehabilitation center. The nurse will include which information when teaching him about disulfiram (Antabuse) therapy?
Answer
  • He should not smoke cigarettes while on this drug.
  • He needs to know about the common over-the-counter substances that contain alcohol.
  • This drug will cause the same effects as the alcohol did, without the euphoric effects.
  • Mouthwashes and cough medicines that contain alcohol are safe because they are used in small amounts.

Question 107

Question
The nurse is conducting a smoking-cessation program. Which statement regarding drugs used in cigarette-smoking–cessation programs is true?
Answer
  • Rapid chewing of the nicotine gum releases an immediate dose of nicotine.
  • Quick relief from withdrawal symptoms is most easily achieved by using a transdermal patch.
  • Compliance with treatment is higher with use of the gum rather than the transdermal patch.
  • The nicotine gum can be used only up to six times per day.

Question 108

Question
A nurse is providing teaching for a patient who will be taking varenicline (Chantix) as part of a smoking-cessation program. Which teaching points are appropriate for a patient taking this medication? (Select all that apply.)
Answer
  • This drug is available as a chewing gum that can be taken to reduce cravings.
  • Use caution when driving because drowsiness may be a problem.
  • There have been very few adverse effects reported for this drug.
  • Notify the prescriber immediately if feelings of sadness or thoughts of suicide occur.
  • Avoid caffeine while on this drug.

Question 109

Question
A patient has been taking disulfiram (Antabuse) as part of his rehabilitation therapy. However, this evening, he attended a party and drank half a beer. As a result, he became ill and his friends took him to the emergency department. The nurse will look for which adverse effects associated with acetaldehyde syndrome? (Select all that apply.)
Answer
  • Euphoria
  • Severe vomiting
  • Diarrhea
  • Pulsating headache
  • Difficulty breathing
  • Sweating

Question 110

Question
The nurse is monitoring a patient who is experiencing severe ethanol withdrawal. Which are signs and symptoms of severe ethanol withdrawal? (Select all that apply.)
Answer
  • Agitation
  • Drowsiness
  • Tremors
  • Systolic blood pressure higher than 200 mm Hg
  • Temperature over 100° F (37.7° C)
  • Pulse rate 110 beats/min

Question 111

Question
The nurse is reviewing the therapeutic effects of nonsteroidal anti-inflammatory drugs (NSAIDs), which include which effect?
Answer
  • Anxiolytic
  • Sedative
  • Antipyretic
  • Antimicrobial

Question 112

Question
A patient is taking the nonsteroidal anti-inflammatory drug indomethacin (Indocin) as treatment for pericarditis. The nurse will teach the patient to watch for which adverse effect?
Answer
  • Tachycardia
  • Nervousness
  • Nausea and vomiting
  • Dizziness

Question 113

Question
A patient with gout has been treated with allopurinol (Zyloprim) for 2 months. The nurse will monitor laboratory results for which therapeutic effect?
Answer
  • Decreased uric acid levels
  • Decreased prothrombin time
  • Decreased white blood cell count
  • Increased hemoglobin and hematocrit levels

Question 114

Question
The nurse is teaching a patient who is taking colchicine for the treatment of gout. Which instruction will the nurse include during the teaching session?
Answer
  • “Fluids should be restricted while on colchicine therapy.”
  • “Take colchicine with meals.”
  • “The drug will be discontinued when symptoms are reduced.”
  • “Call your doctor if you have increased pain or blood in the urine.”

Question 115

Question
A mother brings her toddler into the emergency department and tells the nurse that she thinks the toddler has eaten an entire bottle of chewable aspirin tablets. The nurse will assess for which most common signs of salicylate intoxication in children?
Answer
  • Photosensitivity and nervousness
  • Tinnitus and hearing loss
  • Acute gastrointestinal bleeding
  • Hyperventilation and drowsiness

Question 116

Question
A 6-year-old child who has chickenpox also has a fever of 102.9° F (39.4° C). The child’s mother asks the nurse if she should use aspirin to reduce the fever. What is the best response by the nurse?
Answer
  • “It’s best to wait to see if the fever gets worse.”
  • “You can use the aspirin, but watch for worsening symptoms.”
  • “Acetaminophen (Tylenol) should be used to reduce his fever, not aspirin.”
  • “You can use aspirin, but be sure to follow the instructions on the bottle.”

Question 117

Question
A patient has used enteric aspirin for several years as treatment for osteoarthritis. However, the symptoms are now worse and she is given a prescription for a nonsteroidal anti-inflammatory drug and misoprostol (Cytotec). The patient asks the nurse, “Why am I now taking two pills for arthritis?” What is the nurse’s best response?
Answer
  • “Cytotec will also reduce the symptoms of your arthritis.”
  • “Cytotec helps the action of the NSAID so that it will work better.”
  • “Cytotec reduces the mucous secretions in the stomach, which reduces gastric irritation.”
  • “Cytotec may help to prevent gastric ulcers that may occur in patients taking NSAIDs.”

Question 118

Question
A patient who has a history of coronary artery disease has been instructed to take one 81-mg aspirin tablet a day. The patient asks about the purpose of this aspirin. Which response by the nurse is correct?
Answer
  • “Aspirin is given reduce anxiety.”
  • “It helps to reduce inflammation.”
  • “Aspirin is given to relieve pain.”
  • “It will help to prevent clot formation.”

Question 119

Question
During assessment of a patient with osteoarthritis pain, the nurse knows that which condition is a contraindication to the use of nonsteroidal anti-inflammatory drugs (NSAIDs)?
Answer
  • Renal disease
  • Diabetes mellitus
  • Headaches
  • Rheumatoid arthritis

Question 120

Question
The nurse notes in a patient’s medication history that the patient is taking allopurinol (Zyloprim). Based on this finding, the nurse interprets that the patient has which disorder?
Answer
  • Rheumatoid arthritis
  • Gout
  • Osteoarthritis
  • Systemic lupus erythematosus

Question 121

Question
A patient calls the clinic to ask about taking a glucosamine-chondroitin supplement for arthritis. The nurse reviews the medication history and notes that there will be a concern for drug interactions if the patient is also taking medications for which disorder?
Answer
  • Type 2 diabetes mellitus
  • Hypothyroidism
  • Hypertension
  • Angina

Question 122

Question
The nurse is reviewing the history of a patient who has a new order for a nonsteroidal anti-inflammatory drug (NSAID) to treat tendonitis. Which conditions are contraindications to the use of NSAIDs? (Select all that apply.)
Answer
  • Vitamin K deficiency
  • Arthralgia
  • Peptic ulcer disease
  • Neuropathy
  • Pericarditis

Question 123

Question
A 75-year-old woman has been given a nonsteroidal anti-inflammatory drug (an NSAID for the treatment of rheumatoid arthritis. The nurse is reviewing the patient's medication history and notes that which types of medications could have an interaction with the NSAID? (Select all that apply.)
Answer
  • Antibiotics
  • Decongestants
  • Anticoagulants
  • Beta blockers
  • Diuretics
  • Corticosteroids

Question 124

Question
There is a new order for Naproxen (Naprosyn) 250 mg PO every 6 hours. The drug is available as an oral suspension that contains 125 mg/5 mL. Identify how many milliliters will the nurse administer for 1 dose of this medication. [blank_start]_______[blank_end]
Answer
  • 10 mL

Question 125

Question
The insulin order reads, “Check blood glucose levels before meals and at bedtime. For every 5 mg/dL over 150, give 1 unit of regular Humulin insulin, subcutaneously.” The patient’s blood glucose level at 11:30 ., before lunch, was 253 mg/dL. In units, identify how much insulin will the nurse give. [blank_start]_______[blank_end]
Answer
  • 20 units
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