Deck 2: Detecting and Managing Adverse Drug Reactions
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Deck 2: Detecting and Managing Adverse Drug Reactions
1
The nurse is caring for a patient with a known history of narcotic abuse.The patient is started on methadone 30 mg po daily during detoxification.Which of the following assessments would indicate the patient's dose may need to be decreased?
A)Chills
B)Irritability
C)Respirations = 8 per min
D)Diaphoresis
A)Chills
B)Irritability
C)Respirations = 8 per min
D)Diaphoresis
D
See Assessment for methadone.If respiratory rate is less than 10 breaths per min,assess level of sedation.Dose may need to be decreased by 25-50%.Chills,irritability,and diaphoresis are all symptoms of narcotic withdraw and may be expected during detoxification.
See Assessment for methadone.If respiratory rate is less than 10 breaths per min,assess level of sedation.Dose may need to be decreased by 25-50%.Chills,irritability,and diaphoresis are all symptoms of narcotic withdraw and may be expected during detoxification.
2
The nurse is caring for a patient taking Xenical (orlistat).Which of the following symptoms would be most concerning to the nurse?
A)Nausea and vomiting
B)Orange-colored oil noted in stool
C)Reports of fecal urgency
D)Flatus with discharge
A)Nausea and vomiting
B)Orange-colored oil noted in stool
C)Reports of fecal urgency
D)Flatus with discharge
A
See Side Effects for orlistat.Nausea and vomiting are not expected with this drug.Common GI side effects include fecal urgency,flatus with discharge,increased defecation,oily evacuation,oily spotting,and fecal incontinence.
See Side Effects for orlistat.Nausea and vomiting are not expected with this drug.Common GI side effects include fecal urgency,flatus with discharge,increased defecation,oily evacuation,oily spotting,and fecal incontinence.
3
The nurse receives a call from an 82-year-old patient with advanced prostate cancer who is being treated with Eligard (leuprolide)therapy.Which of the following statements requires immediate notification of the physician?
A)"I've been having hot flashes lately,what should I do?"
B)"The pain in my bones seems worse since I started this medication."
C)"I forgot to get my shot 3 hours ago like I usually do,so I was going to take it now;is that okay?"
D)"My legs feel numb and weak;is that normal with this medication?"
A)"I've been having hot flashes lately,what should I do?"
B)"The pain in my bones seems worse since I started this medication."
C)"I forgot to get my shot 3 hours ago like I usually do,so I was going to take it now;is that okay?"
D)"My legs feel numb and weak;is that normal with this medication?"
D
See Patient/Family Teaching for leuprolide.Instruct patient to notify a health-care professional promptly if difficulty urinating,weakness,or numbness occurs.Advise patient that medication may cause hot flashes.Advise patient that bone pain may increase at initiation of therapy.This will resolve with time.Instruct patient to take medication exactly as directed.If a dose is missed,take as soon as remembered unless not remembered until next day.
See Patient/Family Teaching for leuprolide.Instruct patient to notify a health-care professional promptly if difficulty urinating,weakness,or numbness occurs.Advise patient that medication may cause hot flashes.Advise patient that bone pain may increase at initiation of therapy.This will resolve with time.Instruct patient to take medication exactly as directed.If a dose is missed,take as soon as remembered unless not remembered until next day.
4
The nurse would be most concerned if a patient taking phenobarbital reported daily consumption of which of the following?
A)Grapefruit juice
B)Beer
C)Milk
D)Coffee
A)Grapefruit juice
B)Beer
C)Milk
D)Coffee
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5
The nurse is caring for a patient with multiple medications,including Sinemet (carbidopa/levodopa)QID.The nurse knows this medication is effective by which of the following signs or symptoms?
A)The patient has fewer hand tremors.
B)The patient's apical pulse is regular.
C)The patient has less edema in the ankles bilaterally.
D)The patient's cough is well controlled.
A)The patient has fewer hand tremors.
B)The patient's apical pulse is regular.
C)The patient has less edema in the ankles bilaterally.
D)The patient's cough is well controlled.
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6
A nurse is caring for a 14-year-old patient with epilepsy.The child takes phenytoin and started taking Lamictal (lamotrigine)50 mg/day approximately 10 days ago.The child's mother calls to report a newly noted rash across the girl's face and arms.Which of the following statements by the nurse is best?
A)"Did your daughter use a new soap?"
B)"Has your daughter been exposed to poison ivy or other plant irritants?"
C)"Do not give the Lamictal;your daughter will need to be seen by the doctor today."
D)"This is commonly seen with Lamictal.A mild soap and calamine lotion may reduce any itching."
A)"Did your daughter use a new soap?"
B)"Has your daughter been exposed to poison ivy or other plant irritants?"
C)"Do not give the Lamictal;your daughter will need to be seen by the doctor today."
D)"This is commonly seen with Lamictal.A mild soap and calamine lotion may reduce any itching."
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7
The nurse prepares to provide Zofran (ondansetron)in orally disintegrating tablet.Which of the following instructions should the nurse provide?
A)"Simply suck on the pill like a lozenge,and it will dissolve over a few minutes."
B)"Place the tablet on your tongue;it will melt in seconds and then you can swallow."
C)"Take this with a full swallow of water."
D)"I will dissolve this in some water,and you can drink it in one sip."
A)"Simply suck on the pill like a lozenge,and it will dissolve over a few minutes."
B)"Place the tablet on your tongue;it will melt in seconds and then you can swallow."
C)"Take this with a full swallow of water."
D)"I will dissolve this in some water,and you can drink it in one sip."
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8
The nurse is caring for a patient who has an order for Osmitrol (mannitol)1 g/kg to be infused over an hour.Which of the following actions should the nurse take prior to administering the medication?
A)Assess deep tendon reflexes.
B)Determine the blood pressure.
C)Evaluate level of consciousness.
D)Listen to bowel sounds.
A)Assess deep tendon reflexes.
B)Determine the blood pressure.
C)Evaluate level of consciousness.
D)Listen to bowel sounds.
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9
While caring for a patient who is taking Imodium (loperamide),the nurse would be most concerned by which of the following symptoms?
A)Patient reports abdominal cramping and loose stool.
B)Patient complains of a headache and a sore throat.
C)Pupils are equal,round,and reactive to direct and indirect light.
D)Tenting across the clavicular region and decreased reflexes are noted.
A)Patient reports abdominal cramping and loose stool.
B)Patient complains of a headache and a sore throat.
C)Pupils are equal,round,and reactive to direct and indirect light.
D)Tenting across the clavicular region and decreased reflexes are noted.
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10
Which of the following lab values should be followed periodically for a patient taking Paxil (paroxetine)?
A)Complete blood count
B)Electrolytes
C)Thyroxine
D)Creatinine
A)Complete blood count
B)Electrolytes
C)Thyroxine
D)Creatinine
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11
A student nurse caring for a patient who is taking Creon (pancrelipase)would include which of the following statements when reviewing medications with the instructor?
A)"This reduces inflammation of the pancreas seen with pancreatitis."
B)"This increases absorption of fats since the pancreas is not excreting normal enzymes."
C)"This is used to bind with proteins and reduce protein excretion in the urine."
D)"This helps relieve abdominal pain caused by liver damage in patients with a history of alcohol abuse."
A)"This reduces inflammation of the pancreas seen with pancreatitis."
B)"This increases absorption of fats since the pancreas is not excreting normal enzymes."
C)"This is used to bind with proteins and reduce protein excretion in the urine."
D)"This helps relieve abdominal pain caused by liver damage in patients with a history of alcohol abuse."
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12
The nurse is caring for a client who is to receive Trileptal (oxcarbazepine).The nurse recognizes this client most likely has a history of which of the following?
A)Diabetes mellitus
B)Depression
C)Seizures
D)Hypothyroidism
A)Diabetes mellitus
B)Depression
C)Seizures
D)Hypothyroidism
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13
While caring for a patient who uses oral birth control pills and is taking PO (procaine penicillin G),which of the following instructions should the nurse include in the client teaching?
A)"You should stop taking your birth control pills for at least 3 months since you have to take this medication."
B)"You will need to use a barrier method of birth control through this therapy and until your next menstrual cycle."
C)"The doctor will want to give you a hormone patch in addition to the birth control pills for the next 30 days."
D)"There is no need to alter your method of birth control while you are taking this medication."
A)"You should stop taking your birth control pills for at least 3 months since you have to take this medication."
B)"You will need to use a barrier method of birth control through this therapy and until your next menstrual cycle."
C)"The doctor will want to give you a hormone patch in addition to the birth control pills for the next 30 days."
D)"There is no need to alter your method of birth control while you are taking this medication."
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14
The nurse is caring for a woman with metastatic breast cancer who was recently admitted with hypercalcemia.Which of the following medications does the nurse anticipate would be included in the treatment plan?
A)Zometa (zoledronic acid)
B)Oscal (calcium carbonate)
C)Sandostatin (octreotide)
D)Emend (aprepitant)
A)Zometa (zoledronic acid)
B)Oscal (calcium carbonate)
C)Sandostatin (octreotide)
D)Emend (aprepitant)
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15
The nurse is caring for a woman in labor who is given Talwin (pentazocine).Which of the following actions should the nurse take next?
A)Elevate the side rails and instruct the patient to call before attempting to ambulate.
B)Prepare for the placement of an internal monitoring device.
C)Encourage the client to lie on her right side.
D)Monitor the patient's blood pressure every 15 min.
A)Elevate the side rails and instruct the patient to call before attempting to ambulate.
B)Prepare for the placement of an internal monitoring device.
C)Encourage the client to lie on her right side.
D)Monitor the patient's blood pressure every 15 min.
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16
Which of the following would cause the nurse to intervene for a patient taking Protonix (pantoprazole)?
A)The client takes the medication an hour before breakfast.
B)The client orders eggs and bacon for breakfast.
C)The client drinks a glass of orange juice when taking the medication.
D)The client chews the medication before swallowing.
A)The client takes the medication an hour before breakfast.
B)The client orders eggs and bacon for breakfast.
C)The client drinks a glass of orange juice when taking the medication.
D)The client chews the medication before swallowing.
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17
The nurse is caring for a patient receiving Aredia (pamidronate)for the treatment of Paget's disease.Which of the following symptoms would be most concerning to the nurse?
A)Anorexia
B)Bone pain
C)Constipation
D)Muscle twitching
A)Anorexia
B)Bone pain
C)Constipation
D)Muscle twitching
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18
A student nurse caring for a client with a history of anxiety disorder would expect which of the following medications to be included in the patient's treatment plan?
A)Atarax (hydroxyzine)
B)Bonine (meclizine)
C)Ativan (lorazepam)
D)Adalat CC (nifedipine)
A)Atarax (hydroxyzine)
B)Bonine (meclizine)
C)Ativan (lorazepam)
D)Adalat CC (nifedipine)
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19
The nurse is caring for a patient who is NPO after midnight for a cardiac catheterization scheduled for 1 p.m.The patient normally receives Glucophage (metformin)1,000 mg po BID,and the morning dose is due at 8:30 a.m.The patient's blood glucose result was 115.Which of the following actions should the nurse take?
A)Hold the medication.
B)Give the medication with a glass of juice.
C)Give the medication with a sip of water.
D)Call the physician for direction.
A)Hold the medication.
B)Give the medication with a glass of juice.
C)Give the medication with a sip of water.
D)Call the physician for direction.
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20
The nurse is providing care for a 92-year-old patient who has a standing order for Ambien (zolpidem)prn for insomnia.When providing the medication for the patient as requested,which of the following actions by the nurse is best?
A)Inform the patient the medication will work within 10 min.
B)Ensure the patient is in bed,ready for sleep,and raise the bed side rails.
C)Instruct the patient to eat some crackers to reduce stomach irritation caused by the medication.
D)Suggest the patient take the medication routinely every night.
A)Inform the patient the medication will work within 10 min.
B)Ensure the patient is in bed,ready for sleep,and raise the bed side rails.
C)Instruct the patient to eat some crackers to reduce stomach irritation caused by the medication.
D)Suggest the patient take the medication routinely every night.
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21
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.
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.
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22
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."
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."
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23
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."
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."
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24
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.
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.
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25
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.
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.
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26
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.
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.
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27
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.
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.
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28
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
A)15-30min
B)30-90 min
C)1-2 hr
D)Over 2 hr
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29
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."
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."
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30
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.
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.
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31
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.
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.
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32
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
A)Milk
B)Cola
C)Orange juice
D)Water
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33
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
A)Glycosylated hemoglobin
B)Serum calcium
C)Serum iron
D)Cardiac troponin
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34
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)
A)Eldepryl (selegiline)
B)Transderm-Scop (scopolamine)
C)Januvia (sitagliptin)
D)Cialis (tadalafil)
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35
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.
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.
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36
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.
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.
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37
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.
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.
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38
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?"
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?"
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39
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
A)Narcan
B)Vitamin K
C)Atropine
D)Epinephrine
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40
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.
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.
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41
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."
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."
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42
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.
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.
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43
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.
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.
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44
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.
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.
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45
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
A)Serum vancomycin levels
B)Visual acuity
C)Gag reflex
D)Deep tendon reflexes
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46
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.
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.
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47
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)
A)Clinoril (sulindac)
B)Dilantin (phenytoin)
C)Phenobarbital
D)Depakote (divalproex sodium)
E)Nabumetone
F)Tegretol (carbamazepine)
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48
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.
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.
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49
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.
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.
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50
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.
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.
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51
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."
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."
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52
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."
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."
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53
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
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
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54
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).
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).
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55
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."
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."
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56
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
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
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57
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."
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."
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58
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
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
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59
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.
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.
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60
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."
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."
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61
The nurse is caring for a patient receiving chemotherapy that includes ifosfamide 1.2 g/m² and mesna;20% of the mesna dose is to be given via IV at the same time as the ifosfamide;repeat 4 hr and 8 hr later.The patient's body surface area is 2 m².The nurse anticipates that the pharmacy will supply a ____ mg dose of mesna.
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62
An order for Restoril (temazepam)30 mg po prn for sleep would be questioned for which of the following patients? Select all that apply.
A)A 42-year-old patient hospitalized with a broken femur
B)A 29-year-old patient admitted with depression and attempted suicide
C)A 51-year-old patient admitted with migraine headache
D)A 33-year-old patient admitted with exacerbation of Crohn's disease
E)A 79-year-old patient admitted with a hip fracture
F)A 48-year-old patient admitted with cirrhosis
A)A 42-year-old patient hospitalized with a broken femur
B)A 29-year-old patient admitted with depression and attempted suicide
C)A 51-year-old patient admitted with migraine headache
D)A 33-year-old patient admitted with exacerbation of Crohn's disease
E)A 79-year-old patient admitted with a hip fracture
F)A 48-year-old patient admitted with cirrhosis
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63
The nurse is preparing to provide Namenda (memantine)in liquid form.The ordered dose is 10 mg po BID.Liquid preparation is available in 2 mg/mL.The nurse should provide __________________ mL.
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64
Which of the following laboratory values will be closely monitored for a patient newly started on procainamide after cardioversion? Select all that apply.
A)Mean corpuscular volume
B)Triglycerides
C)White blood cell count
D)Platelet count
E)Magnesium
F)Protein
A)Mean corpuscular volume
B)Triglycerides
C)White blood cell count
D)Platelet count
E)Magnesium
F)Protein
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65
In the treatment of a postmenopausal woman with osteoporosis who has been prescribed Evista (raloxifene),which of the following should be included in the patient's plan of care? Select all that apply.
A)Daily weight-bearing exercises
B)Supplemental iron
C)Education on smoking cessation
D)Instruction to limit alcohol consumption
E)Prolonged bed rest
F)Dietary teaching to increase protein intake
A)Daily weight-bearing exercises
B)Supplemental iron
C)Education on smoking cessation
D)Instruction to limit alcohol consumption
E)Prolonged bed rest
F)Dietary teaching to increase protein intake
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66
A neighbor says to the nurse,"My arthritis is getting worse in this cold weather;what can I take?" The nurse would base the response on the knowledge that which of the following medications would provide both pain relief and help decrease inflammation associated with arthritis.Select all that apply.
A)Ecotrin (aspirin)
B)Choline and magnesium salicylates
C)Tylenol (acetaminophen)
D)Advil (ibuprofen)
E)Excedrin
F)Acephen (acetaminophen)
A)Ecotrin (aspirin)
B)Choline and magnesium salicylates
C)Tylenol (acetaminophen)
D)Advil (ibuprofen)
E)Excedrin
F)Acephen (acetaminophen)
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