Question 1

While responding to a rapid response called on the cardiac step-down unit,the nurse from intensive care observes the unit nurse massaging a patient's neck and instructing the patient to bear down.Which of the following medications will most likely be used if the patient's pulse does not return to normal?
A)Adenocard (adenosine)
B)Adrenaline (epinephrine)
C)Tenormin (atenolol)
D)Saphris (asenapine)

Accepted Answer

See adenosine Indications: Adenosine is used for the conversion of paroxysmal supraventricular tachycardia (PVST)to normal sinus rhythm when vagal maneuvers are unsuccessful.Epinephrine is a bronchodilator used in the management of reversible airway disease.Atenolol is a beta blocker used in the management of hypertension.Asenapine is an antipsychotic mood stabilizer used in the acute treatment of schizophrenia or manic/mixed episodes associated with bipolar I disorder.

Question 2

The nurse is caring for a patient with otitis media who reports an allergy to penicillin.Orders are received for ampicillin 500 mg every 8 hr.Which of the following actions by the nurse is best?
A)Provide the medication as ordered.
B)Call the pharmacist to request a substitution.
C)Ask the patient if he or she has taken ampicillin in the past.
D)Hold the medication.

Accepted Answer

See contraindications/precautions for ampicillin: Contraindicated in hypersensitivity to penicillin.This medication should be held due to the stated allergy to penicillin.

Question 3

The nurse receives orders to begin Cardura (doxazosin)1 mg daily with the first dose to start today.Which of the following assessments is the highest priority within the first 2 to 4 hr after provision?
A)Urinary output
B)Respiratory rate
C)Pain relief
D)Orthostatic hypotension

Accepted Answer

See Nursing Implications for doxazosin: Assess for first-dose orthostatic hypotension and syncope.The medication can be used in the treatment of benign prostatic hyperplasia,but orthostatic hypotension is a bigger concern and should be the first concern.No effect on the respiratory rate or pain is anticipated.

Question 4

The nurse is providing care for a patient scheduled to take Precose (acarbose)25 mg three times daily with meals.The patient reports feeling sweaty,weak,and tremulous.Which of the following actions by the nurse is best?
A)Reassure the patient that these are common side effects with the medication.
B)Call the pharmacy to report an adverse drug reaction.
C)Check the patient's blood glucose level.
D)Determine if the patient has a history of anemia.

Accepted Answer

See Nursing Implications for acarbose: Observe the patient for signs and symptoms of hypoglycemia.Acarbose alone does not cause hypoglycemia;however,other concurrently administered hypoglycemic agents may produce hypoglycemia,requiring treatment.Ignoring these symptoms would be dangerous,but it is not considered an adverse drug reaction requiring an official report.The patient is experiencing symptoms of hypoglycemia not anemia.

Question 5

The nurse is instructing the parent of a 6-year-old patient recently started on a ProAir HFA (albuterol)inhaler for exercise-induced asthma.The nurse recognizes that further teaching is necessary by which of the following client statements?
A)"He may feel like his heart is racing after he takes his inhaler."
B)"He can use the inhaler as many times during football practice as he needs it."
C)"He should avoid cola and other caffeinated drinks since they may increase his heart rate."
D)"He should take two puffs about 15 minutes before gym class."

Accepted Answer

See Contraindications/Precautions,Interactions,and Dosage for albuterol.Excess inhaler use may lead to tolerance and paradoxical bronchospasm.Use with caffeine-containing herbs (cola nut,guarana,tea,coffee)increases stimulant effect.Two inhalations every 4-6 hr or two inhalations 15 min prior to exercise).Tachycardia is an expected side effect with this medication.

Question 6

The nurse is providing care for a patient who returned from surgery 4 hr earlier.The patient reports adequate pain control with the use of patient-controlled analgesia but states she is having significant nausea.Which of the following medications should the nurse provide?
A)Inapsine (droperidol)2.5 mg IV
B)Benadryl (diphenhydramine)25 mg IV
C)Morphine (morphine sulfate)2 mg IV
D)Colace 100 mg po

Accepted Answer

Inapsine (droperidol) is an antiemetic medication commonly used in postoperative patients who experience significant nausea and vomiting. It works by blocking the dopamine receptors in the brain, which are responsible for triggering nausea and vomiting. Morphine and Colace are not appropriate for treating nausea, and Benadryl is typically used for allergic reactions or sedation, not nausea.

Question 7

While providing care for an adolescent patient newly prescribed Elavil (amitriptyline),the nurse should be most concerned by which of the following patient statements?
A)"My mouth seems really dry and I'm thirsty all the time."
B)"I take a nap most afternoons now because I feel sleepy sometimes."
C)"I'm not sure why we should even bother anymore;everything seems so pointless."
D)"I drink a cup of coffee most days with breakfast."

Accepted Answer

See Contraindications/Precautions for amitriptyline: the use of this medication may increase the risk of suicide attempt/ideation especially during dose early treatment or dose adjustment;risk may be greater in children or adolescents.Sedation is an expected side effect.Dry mouth is an expected side effect.There is no directive to avoid caffeine with this medication.

Question 8

The nurse prepares to provide Colcrys (colchicine)to a patient.The nurse should assess which of the following prior to administration of the medication?
A)Blood pressure
B)Complete blood count
C)Triglyceride level
D)Oxygen saturation

Accepted Answer

See Nursing Implications/assessment for colchicine: In patients receiving prolonged therapy,monitor baseline and periodic CBC;may cause decreased platelet count,leukopenia,aplastic anemia,and agranulocytosis.No alteration in the blood pressure,triglyceride,or oxygenation is expected.

Question 9

The nurse is tracking patient symptoms related to acute alcohol intoxication and withdrawal.Which of the following medications would the nurse expect to provide in the management of these symptoms?
A)Plavix (clopidogrel)
B)Zyban (bupropion)
C)Prilosec (omeprazole)
D)Tranxene (clorazepate)

Accepted Answer

See Indications for clorazepate: Clorazepate is used in the management of simple partial seizures,anxiety disorder,symptoms of anxiety,and acute alcohol withdrawal.Clopidogrel is an antiplatelet agent.Bupropion is an antidepressant.Omeprazole is an antiulcer agent.

Question 10

The home-care nurse is preparing to see a patient being treated for diabetic foot ulcerations with Regranex (becaplermin).Which of the following instructions will the nurse include in the patient teaching?
A)"Apply the wound gel three times daily to promote healing."
B)"Store the gel in the refrigerator."
C)"Complete healing is expected within 3 days."
D)"After applying the wound gel,cover with a transparent adhesive dressing."

Accepted Answer

See Implementation for becaplermin: Calculated amount is applied as a thin layer and covered with a moist saline dressing for 12 hr;dressing is removed,ulcer rinsed,and redressed with moist dressing without becaplermin for rest of day.Process is repeated daily.Store gel in refrigerator;do not freeze.If ulcer does not decrease in size by 30% within 10 wk,continuation of therapy should be reassessed.Cover with a moist saline dressing for 12 hr.Then,remove dressing,rinse ulcer,and redress with moist dressing without becaplermin for rest of day.

Question 11

The nurse is counseling a patient with diabetes,hypertension,and chronic obstructive pulmonary disease on his medications.To verify patient understanding of his medications,the nurse states,"You are taking Cymbalta (duloxetine)60 mg once a day;do you know why you take that medication?" The nurse determines the patient has a good understanding of his medications if which of the following responses is given?
A)"I take that one to keep my blood sugar under control."
B)"I don't know honey,is that my little blue pill?"
C)"That helps with the pain in my feet."
D)"I think that is to lower my blood pressure."

Accepted Answer

See Indications for duloxetine: Duloxetine is used for major depressive disorder,diabetic peripheral neuropathic pain,generalized anxiety disorder and fibromyalgia.Patient education and verification of his or her understanding regarding medication use and purpose is an important component of health care.

Question 12

The nurse receives a call from a patient who recently began taking Zyrtec (cetirizine)5 mg daily.The patient reports that her mouth frequently feels dry.Which of the following responses by the nurse is best?
A)"Dry mouth is a common side effect of Zyrtec.Rinse your mouth frequently,and try using sugarless chewing gum or candy for relief."
B)"You may be taking too strong of a dose.You should take half a pill each day to reduce the risk of side effects."
C)"You might be having an allergic reaction to the medication.Are you able to come to the doctor's office today?"
D)"It is important that you take the medication with a full meal and drink at least 12 glasses of water each day."

Accepted Answer

See Patient/Family Teaching for cetirizine: Advise patient that good oral hygiene,frequent rinsing of the mouth with water,and sugarless gum or candy may minimize dry mouth.It is outside the nursing scope of practice to alter dosage of a medication.Dry mouth is not a symptom of an allergic reaction and the patient does not need to be seen by a physician-if dry mouth persists beyond 2 wk,the patient should notify a dentist.The medication can be taken without regard to food.

Question 13

While providing care for patients on a neuroscience unit,which of the following medications should the nurse provide first?
A)Dantrium (dantrolene)1 mg/kg IV to a patient with malignant hyperthermia
B)Norpramin (desipramine)100 mg orally to a patient admitted with syncope
C)Enablex (darifenacin)15 mg orally to a patient admitted for cerebrovascular accident
D)Cymbalta (duloxetine)20 mg to a patient with diabetes

Accepted Answer

See Indications for dantrolene: Emergency treatment of malignant hyperthermia,which can cause seizures.This is an emergency situation and must be the nurse's highest priority.Desipramine is an antidepressant.It is not a priority.Darifenacin is used to treat overactive bladder spasms.It is not a priority.Duloxetine is an antidepressant.It is not a priority.

Question 14

The nurse is caring for a patient who takes Dexedrine (dextroamphetamine).The nurse should be most concerned by which of the following patient statements?
A)"I seem to be able to focus better and I'm less distracted now."
B)"I've been having some trouble falling asleep at night lately."
C)"I started taking St.John's wort this week to help with my depression."
D)"I forgot to take my medication in the morning last week so I took it at lunch time."

Accepted Answer

See Interactions for dextroamphetamine: St.John's wort may increase serious side effects;concurrent use is not recommended.Dextroamphetamine is used in the treatment of ADHD,so improved focus is a desired effect.Insomnia is commonly seen and the patient should be instructed to take the medication at least 6 hr prior to bedtime.The medication is generally given 1-2 times each day,and missed doses should be taken as soon as remembered up to 6 hr prior to bedtime.

Question 15

The nurse is preparing to provide medications for a patient newly admitted with a cerebral vascular accident who reportedly had difficulty swallowing pills during the previous shift.The nurse plans to crush the patient's medications and provide them in applesauce.Which of the following medications will require an alternative form of administration?
A)Aspirin 81 mg daily
B)Enablex (darifenacin-XR)15 mg daily
C)Claritin (loratadine)10 mg daily
D)CalCarb (calcium carbonate)500 mg daily

Accepted Answer

See Implementation/Nursing Implications for Enablex: Extended-release tablets must be swallowed whole;do not break or crush.Doing so can result in the immediate release of the full dose.Enablex (darifenacin-XR)is a urinary tract antispasmodic.

Question 16

The nurse is transcribing new orders for a patient with multiple sclerosis.Amrix (cyclobenzaprine)10 mg orally three times daily has been ordered.Which of the following would require an immediate intervention by the nurse?
A)The patient has a noted allergy to acetaminophen.
B)The patient has a family history of breast cancer.
C)The patient is currently taking Nardil (phenelzine).
D)The patient is diabetic.

Accepted Answer

See Contraindications/Precautions for cyclobenzaprine: Should not be used within 14 days of MAO inhibitor therapy.Phenelzine is an MAO inhibitor.The other factors will not impact the safe provision of cyclobenzaprine.

Question 17

The nurse is counseling a patient started on Zithromax (azithromycin)for the treatment of an upper respiratory infection.The nurse recognizes that teaching has been effective by which of the following patient statements?
A)"The med pack will have five pills,one for each of the next 5 days."
B)"If I don't feel better next week,I can get a refill from the pharmacist."
C)"I only need to take one pill,but my symptoms may not clear for 3 days."
D)"I can take this medication safely even though I'm allergic to erythromycin."

Accepted Answer

See Route/Dosage for azithromycin: 500 mg on 1st day,then 250 mg/day for 4 more days.Instruct the patent to notify health-care professional if symptoms do not improve.Teach the patient to take medication as directed and to finish the drug completely.Azithromycin is contraindicated in patients with an allergy to erythromycin.

Question 18

The nurse is caring for a patient with a history of Parkinson disease who recently started taking Comtan (entacapone).The nurse notes the patient's urine has a brownish-orange discoloration.Which of the following actions should the nurse take next?
A)Notify the physician.
B)Determine the patient's current weight.
C)Ask the patient what he or she ate for breakfast.
D)Note the assessment finding in the chart.

Accepted Answer

See Adverse Reactions/Side Effects GU for entacapone: This is a normal finding for patients taking entacapone.There is no need to take a specific action,and the assessments listed will not help determine the presence of other side effects or concerns.

Question 19

While caring for a patient in hospice who is actively dying,the nurse notes moderate respiratory distress,copious oral secretion,and a frequent moist cough.Which of the following prn medications would most promote comfort for the patient?
A)Morphine (morphine sulfate)2 mg IV bolus
B)Atro-Pen (atropine)0.4 mg IV bolus
C)Ativan (lorazepam)0.5 mg IV bolus
D)Benadryl (diphenhydramine)25 mg IV bolus

Accepted Answer

The answer of While caring for a patient in hospice...

Question 20

A young woman reports to the emergency department with frank vaginal bleeding and a stated history of being 10 wk pregnant.Ultrasound confirms an incomplete miscarriage,and the woman is scheduled for a dilatation and curettage.Which of the following medications should the nurse anticipate being provided after the surgical procedure?
A)Rheumatrex (methotrexate)
B)Methergine (methylergonovine)
C)Magnesium sulfate
D)Terbutaline

Accepted Answer

See indications for methylergonovine: Prevention and treatment of postpartum or postabortion hemorrhage caused by uterine atony or involution.Methotrexate is a neoplastic agent that has been used to induce chemical abortion.Magnesium sulfate is given in the treatment of preeclampsia.Terbutaline is used off label to reduce uterine contraction in the prevention of preterm labor.

Quiz 1: Medication Errors: Improving Practices and Patient Safety

The nurse is caring for a patient with otitis media who reports an allergy to penicillin.Orders are received for ampicillin 500 mg every 8 hr.Which of the following actions by the nurse is best?

The nurse receives orders to begin Cardura (doxazosin) 1 mg daily with the first dose to start today.Which of the following assessments is the highest priority within the first 2 to 4 hr after provision?

The nurse is providing care for a patient scheduled to take Precose (acarbose) 25 mg three times daily with meals.The patient reports feeling sweaty,weak,and tremulous.Which of the following actions by the nurse is best?

The nurse is instructing the parent of a 6-year-old patient recently started on a ProAir HFA (albuterol) inhaler for exercise-induced asthma.The nurse recognizes that further teaching is necessary by which of the following client statements?

The nurse is providing care for a patient who returned from surgery 4 hr earlier.The patient reports adequate pain control with the use of patient-controlled analgesia but states she is having significant nausea.Which of the following medications should the nurse provide?

While providing care for an adolescent patient newly prescribed Elavil (amitriptyline) ,the nurse should be most concerned by which of the following patient statements?

The nurse prepares to provide Colcrys (colchicine) to a patient.The nurse should assess which of the following prior to administration of the medication?

The nurse is tracking patient symptoms related to acute alcohol intoxication and withdrawal.Which of the following medications would the nurse expect to provide in the management of these symptoms?

The home-care nurse is preparing to see a patient being treated for diabetic foot ulcerations with Regranex (becaplermin) .Which of the following instructions will the nurse include in the patient teaching?

The nurse receives a call from a patient who recently began taking Zyrtec (cetirizine) 5 mg daily.The patient reports that her mouth frequently feels dry.Which of the following responses by the nurse is best?

While providing care for patients on a neuroscience unit,which of the following medications should the nurse provide first?

The nurse is caring for a patient who takes Dexedrine (dextroamphetamine) .The nurse should be most concerned by which of the following patient statements?

The nurse is transcribing new orders for a patient with multiple sclerosis.Amrix (cyclobenzaprine) 10 mg orally three times daily has been ordered.Which of the following would require an immediate intervention by the nurse?

The nurse is counseling a patient started on Zithromax (azithromycin) for the treatment of an upper respiratory infection.The nurse recognizes that teaching has been effective by which of the following patient statements?

The nurse is caring for a patient with a history of Parkinson disease who recently started taking Comtan (entacapone) .The nurse notes the patient's urine has a brownish-orange discoloration.Which of the following actions should the nurse take next?

While caring for a patient in hospice who is actively dying,the nurse notes moderate respiratory distress,copious oral secretion,and a frequent moist cough.Which of the following prn medications would most promote comfort for the patient?