Question 1

The nurse is caring for a patient receiving intravenous antibiotic therapy with tobramycin 100 mg every 8 hr.Which of the following nursing actions are appropriate for this medication? Select all that apply.
A)Mixed IVPB solutions are stable at room temperature for 24 hr.
B)IVPB doses should be administered over 30-60 min.
C)Monitor the patient for signs of tinnitus,dizziness,or hearing loss.
D)Monitor renal function before and during therapy.
E)May mix or infuse simultaneously with other antibiotics.
F)Monitor for symptoms of a super infection.

Accepted Answer

See Nursing Implications/IV Administration (tobramycin)for Aminoglycosides: IVPB mixtures are stable for 24 hr at room temperature.Infuse slowly over 30-60 min in both adult and pediatric patients.Evaluate the eighth cranial nerve function by audiometry before and throughout therapy.Hearing loss is usually in the high-frequency range.Prompt recognition and intervention are essential in preventing permanent damage.Also monitor for vestibular dysfunction (vertigo,ataxia,nausea,and vomiting).Monitor renal function by urinalysis,specific gravity,BUN,creatinine,and CCr before and during therapy.Manufacturer recommends administering separately;do not admix.Assess patient for signs of super infection.

Question 2

While caring for elderly residents in a nursing home,the nurse recognizes the use of Advil (ibuprofen)places these clients at increased risk for which of the following? Select all that apply.
A)Gastrointestinal bleeding
B)Renal toxicity
C)Hepatic toxicity
D)Cerebrovascular accident
E)Pulmonary embolism
F)Peripheral vascular disease

Accepted Answer

See Nursing Implications for ibuprofen.Geri: Higher risk for poor outcomes or death from GI bleeding.Age-related renal impairment increases risk of hepatic and renal toxicity.Assess for signs and symptoms of GI bleeding (tarry stools,lightheadedness,and hypotension),renal dysfunction (elevated BUN and creatinine levels and decreased urine output),and hepatic impairment (elevated liver enzymes and jaundice).

Question 3

The nurse is preparing to provide Norvasc (amlodipine)to a 69-year-old patient with a history of multifocal premature ventricular contractions (PVCs).His cardiac monitor has shown normal sinus rhythm with rare PVCs for the past 24 hr.Which of the following assessment findings would cause the nurse to withhold the medication? Select all that apply.
A)Blood pressure = 86/50
B)Blood pressure = 112/68
C)Pulse = 88 bpm
D)Pulse = 48 bpm
E)Monitor shows normal sinus rhythm
F)Monitor shows three PVCs in past 24 hr

Accepted Answer

See Nursing Implications for amlodipine: Norvasc is used in the management of hypertension,angina pectoris,and vasospastic angina.Monitor blood pressure and pulse before therapy,during dose titration,and periodically during therapy.Contraindicated in systolic blood pressure less than 90 mmHg.Instruct patient to contact health-care provider if heart rate is less than 50 bpm.

Question 4

A nurse working with patients in an HIV clinic recognizes the following medications as antivirals that may be included in patient medication regimens.Select all that apply.
A)Famciclovir
B)Emtriva (emtricitabine)
C)Sustiva (efavirenz)
D)Lodine (etodolac)
E)Afinitor (everolimus)
F)Enbrel (etanercept)

Accepted Answer

See Indications for famciclovir,emtricitabine,efavirenz,etodolac,etoposide,and etanercept.Famvir,Emtriva,and Sustiva are all antivirals or antiretrovirals used in the treatment of HIV or in the treatment of recurrent herpes simplex virus infection in patients with HIV.Etodolac and Enbrel are used in the treatment of arthritis.Afinitor is a chemotherapy agent.

Question 5

Which of the following lab values must be monitored during therapy with Tegretol CR (carbamazepine)? Select all that apply.
A)Uric acid level
B)Hemoglobin
C)Creatinine
D)Alkaline phosphatase
E)Platelet count
F)Serum iron

Accepted Answer

See Nursing Implications/Lab Test Considerations for carbamazepine: Monitor CBC,including platelet count,reticulocyte count,and serum iron,weekly during the first 2 mo and yearly thereafter for evidence of potentially fatal blood cell abnormalities.Medication should be discontinued if bone marrow depression occurs.

Question 6

The nurse is caring for a patient who had a total hip replacement yesterday.Based on the patient's risk of developing deep vein thrombosis or pulmonary emboli,which of the following would the nurse expect to find in the patient's plan of care? Select all that apply.
A)Bilateral thigh-high sequential compression stockings
B)Fragmin (dalteparin)5,000 IU SQ every day
C)Strict bed rest for 3 days
D)Vital signs and pulse oximetry every 4 hr
E)Lovenox (enoxaparin)30 mg IV push-single dose now
F)Aspirin 650 mg every 4 hr while awake

Accepted Answer

See Nursing Implications for Heparins (low molecular weight): Compression device stockings are routinely used in the prevention of DVT and PE postoperatively.Fragmin is dosed 5,000 IU evening before surgery,then once daily for 5-10 days.Patients are encouraged to increase activity unless contraindicated;most patients with hip replacement surgery are assisted out of bed on the first post-op day.Intravenous push Lovenox is used in the treatment of acute ST segment MI,not as DVT prophylaxis.Instruct patient not to take aspirin or NSAIDs without consulting a health-care professional while on therapy since aspirin products will increase the risk of bleeding.

Question 7

Which of the following medications can be used to prevent or treat nausea and vomiting? Select all that apply.
A)Chlorpromazine)
B)Zofran (ondansetron)
C)Adrenalne (epinephrine)
D)Reglan (metoclopramide)
E)Emend (aprepitant)
F)Catapres (clonodine)

Accepted Answer

See Classification for chlorpromazine,ondansetron,epinepherine,metoclopramide,aprepitant,and clonodine: Medications that prevent or treat nausea and vomiting are known as anti-emetics.

Question 8

A nurse working in the intensive care unit would expect albumin as part of the treatment plan for which of the following patients? Select all that apply.
A)A 33-year-old patient with profound plastic anemia
B)A 55-year-old patient with second- and third-degree burns to 40% of his body
C)A 29-year-old patient with rectal bleeding
D)A 71-year-old patient with lung cancer and congestive heart failure
E)A 68-year-old patient with symptoms of septic shock
F)A 37-year-old patient with end-stage liver disease

Accepted Answer

See Indications for albumin.These include expansion of plasma volume and maintenance of cardiac output in situations associated with fluid volume deficit,including shock,hemorrhage,and burns.Temporary replacement of albumin in diseases associated with low levels of plasma proteins,such as nephrotic syndrome or end-stage liver disease,results in relief or reduction of associated edema.Albumin is contraindicated in patients with allergic reactions to albumin,severe anemia,CHF,and normal or increased intravascular volume.

Question 9

The nurse is preparing to provide the first dose of Maxipime (cefepime)1 gm in 50 mL D5W via intravenous piggyback to a patient diagnosed with febrile neutropenia.Place the following steps in the appropriate order:
A)Set rate at 100 mL/hr.
B)Verify right drug,dose,and time.
C)Observe for symptoms of anaphylaxis.
D)Discontinue the infusion.
E)Verify correct patient using two identifiers.
F)Begin infusion.

Accepted Answer

See Nursing Implications for cefepime.Correct medication administration requires using the five rights-right medication,right dose,right time,right route,and right patient.The medication order (drug,dose,route,and time)should be verified when the nurse obtains the medication in preparation for provision.The right patient should be identified using two patient identifiers once the drug is verified.Maxipime should be infused over 30 min (100 mL/hr),and the patient should be monitored for signs of anaphylaxis.Finally the infusion can be discontinued upon completion.
Verify right drug,dose,and time.
Verify correct patient using two identifiers.
Set IV pump rate at 100 mL/hr.
Begin infusion.
Observe for symptoms of anaphylaxis.
Discontinue the infusion.

Question 10

The nurse is providing care for a patient who is to take Tagamet (cimetidine)400 mg BID upon discharge.Which of the following statements should the nurse include in the patient's teaching? Select all that apply.
A)"The medication may make your stool black;this is normal."
B)"Smoking interferes with the action of this medication,so it is important not to smoke after taking your last dose of the day."
C)"Do not take any over-the-counter medications with aspirin or nonsteroidal anti-inflammatory agents without talking to your physician."
D)"You should take this medication first thing in the morning on an empty stomach."
E)"This medication may make you feel sleepy."
F)"This medication will improve your heartburn symptoms and help reduce stomach acid from irritating your esophagus."

Accepted Answer

See Patient/Family Education and Evaluation Desired Outcomes for Histamine H₂ Antagonists: Advise patient to report onset of black,tarry stools;fever;sore throat;diarrhea;dizziness;rash;confusion;or hallucinations to a health-care professional promptly.Inform patient that smoking interferes with the action of histamine antagonists.Encourage patient to quit smoking or at least not to smoke after last dose of the day.Administer with meals or immediately afterward and at bedtime to prolong effect.It may cause drowsiness or dizziness.Caution patient to avoid driving or other activities requiring alertness until response to the drug is known.Advise patient to avoid alcohol,products containing aspirin or NSAIDs,and foods that may cause an increase in GI irritation.Decreased symptoms of esophageal reflux and treatment of heartburn,acid indigestion,and sour stomach.

Question 11

The nurse is providing education for an immunosuppressed patient with recurrent oral herpes simplex lesions (cold sores)who is being treated with topical acyclovir ointment.Which of the following statements would be included in the nurse's teaching? Select all that apply.
A)"Apply the ointment every 3 hr each day for 7 days."
B)"Other topical ointments should be avoided as they may cause the lesions to spread or worsen."
C)"This medication should cure the lesions and recurrence is rare."
D)"You should wear a glove when applying the ointment to prevent spreading."
E)"You cannot eat or drink for 2 hr after application."
F)"There are no activity restrictions while you are taking this medication."

Accepted Answer

See Route/Dosage and Patient/Family Teaching for acyclovir: Instruct patient to apply ointment in sufficient quantity to cover all lesions every 3 hr,6 times/day for 7 days.Additional use of OTC creams,lotions,and ointments may delay healing and may cause spreading of lesions.Use a finger cot or glove when applying to prevent inoculation of other areas or spread to other people.Inform patient that acyclovir is not a cure.The virus lies dormant in the ganglia,and acyclovir will not prevent the spread of infection to others.No eating or drinking restrictions are required.No sexual contact should be made while lesions are present.

Question 12

The nurse is providing care for a 59-year-old patient with a long-term history of asthma for an acute exacerbation.The client is started on an infusion of aminophylline.Which of the following orders would the nurse expect to be written?
A)Place on telemetry and monitor patient for reports of chest pain.
B)Theophylline levels every 6 hr x4.
C)O₂ to keep saturation greater than 93%.
D)Strict I/O.
E)NG to intermittent suction.
F)Pleurovac to 20 cm water seal.

Accepted Answer

See Nursing Implications/Assessment for Bronchodilators (Xanthines): Patients with a history of cardiovascular problems should be monitored for chest pain and ECG changes.Monitor drug levels routinely.Ensure that oxygen therapy is correctly instituted during acute asthma attacks.Monitor intake and output ratios for an increase in diuresis or fluid overload.

Question 13

The nurse providing patient education about Questran (cholestyramine)would include which of the following statements in the education? Select all that apply.
A)"Diarrhea may occur."
B)"This medication should be taken before meals."
C)"It can be mixed with water,milk,juice,or another noncarbonated beverage."
D)"It is still important to follow a low-fat,low-cholesterol diet."
E)"Notify the physician if your stool becomes frothy or foul smelling."
F)"This medication may cause dry mouth or a rapid heart rate;that is normal."

Accepted Answer

See Patient/Family Teaching for cholestyramine: Instruct patient to take medication before meals.Mix cholestyramine with 4-6 oz water,milk,fruit juice,or other noncarbonated beverages.Shake vigorously.Slowly stir in a large glass.Rinse glass with small amount of additional beverage to ensure all medication is taken.Advise patient that this medication should be used in conjunction with dietary restrictions (fat,cholesterol,carbohydrates,and alcohol),exercise,and cessation of smoking.Explain that constipation may occur.Increase in fluids and bulk in diet,exercise,stool softeners,and laxatives may be required to minimize the constipating effects.Instruct patient to notify a health-care professional if constipation,nausea,flatulence,and heartburn persist or if stools become frothy and foul smelling.

Question 14

The nurse caring for a patient taking hydrochlorothiazide and Lanoxin (digoxin)instructs the patient to notify the physician with which of the following symptoms? Select all that apply.
A)Systolic blood pressure less than 150
B)Anorexia,nausea,and vomiting
C)Muscle cramps
D)Confusion
E)Numbness and tingling in extremities
F)Nocturia

Accepted Answer

See Nursing Implications for Diuretics (thiazide)and Lanoxin: Assess patient,especially if taking digoxin,for anorexia,nausea,vomiting,muscle cramps,paresthesia,and confusion;report signs of electrolyte imbalance.Patients taking digoxin have an increased risk of digitalis toxicity due to the potassium-depleting effect of the diuretic.Hydrochlorothiazide is an antihypertensive/diuretic;systolic BP less than 150 is a desired effect;nocturia may be present when the patient is taking a diuretic.

Question 15

A nurse assisting in the care of an elderly patient who received PO Librium (chlordiazepoxide)in the treatment of acute alcohol intoxication would include which of the following in the plan of care? Select all that apply.
A)Place patient in leather restraints.
B)Institute seizure precautions.
C)Assess for tremors.
D)Administer higher doses in morning
E)Institute fall precautions.
F)Administer after meals or with milk

Accepted Answer

See Nursing Implications/Assessment for chlordiazepoxide: With alcohol withdrawal assess for tremors,agitation,delirium,and hallucinations.Protect patient from injury.Institute seizure precautions.Geri: Assess risk of falls and institute fall prevention strategies.Administer greater dose at bedtime to avoid daytime sedation.Patients should only be placed in restraints as a last resort-there are no indications restraints are needed in this scenario.Administer Librium after meals or with milk to minimize GI irritation.

Question 16

A nurse providing hypertension screening and education recognizes which of the following medications as an ACE inhibitor? Select all that apply.
A)Tenormin (atenolol)
B)captopril)
C)Vasotec (enalopril)
D)Teveten (eprosartan)
E)Lotensin (benazepril)
F)Atacand (candesartan)

Accepted Answer

See drug list for angiotensin-converting enzyme inhibitors.ACE inhibitors can be recognized by the ending "pril." Atenolol is a beta blocker-recognized by the ending "olol." Teveten and atacand are angiotensin II receptor antagonists-recognized by the ending "sartan."

Question 17

Which of the following are classified as potassium-sparing diuretics? Select all that apply.
A)Lasix (furosemide)
B)Aldactone (spirinolactone)
C)Dyrenium (triamterene)
D)Diuril (chlorothiazide)
E)Midamor (amiloride)
F)Microzide (hydrochlorothiazide)

Accepted Answer

See Drug List/Classification for Diuretics (potassium sparing,thiazide)and furosemide: Aldactone,Dyrenium,and Midamor are all potassium-sparing diuretics.Furosemide is a loop diuretic and depletes potassium.Diuril and Microzide are thiazide diuretics and deplete potassium.

Question 18

The nurse is providing care for a patient with recurrent lymphocytic leukemia who is receiving weekly treatment with Campath (alemtuzumab).Which of the following lab results would the nurse be expected to monitor prior to initiating therapy? Select all that apply.
A)Prothrombin time (PTT)
B)Urine-specific gravity
C)White blood cell count (WBC)
D)Platelet count
E)CD-8 count
F)Red blood cell count (RBC)

Accepted Answer

See Nursing Implications/Assessment for alemtuzumab.Lab Test Considerations: Obtain CBC and platelet counts weekly during therapy and more frequently if worsening anemia,neutropenia,or thrombocytopenia is observed.CD4 counts are assessed after treatment until recovery.

Question 19

The nurse is counseling a patient who has been given a prescription for Prozac (fluoxetine).Which of the following statements should the nurse include in the patient's teaching? Select all that apply.
A)"The medicine can cause some dizziness,so you should change position slowly."
B)"Sugarless gum or candy may help the feeling of dry mouth that some patient's experience with this medicine."
C)"Most likely you will notice a huge change in your mood immediately."
D)"You may experience a decrease in your sex drive while on this medication."
E)"It is important to wear protective clothing and sunscreen since the drug can cause increased sensitivity to the sun."
F)"This medicine should always be taken on an empty stomach."

Accepted Answer

See Patient/Family Teaching and Desired Effects for fluoxetine: Caution patient to change positions slowly to minimize dizziness.Inform patient that frequent mouth rinses,good oral hygiene,and sugarless gum or candy may minimize dry mouth.Inform patient that medication may cause decreased libido.Caution patient to wear protective clothing and use sunscreen to prevent photosensitivity reactions.May be administered with food to minimize GI irritation.

Question 20

The nurse is teaching a patient with prostate cancer about the planned treatment of Casodex (bicalutamide)and Goserelin (an LHRH analog).Which of the following statements should be included in the patient teaching? Select all that apply.
A)"Diarrhea is common,so it is important to increase fluid intake."
B)"You may experience hot flashes while taking these medications."
C)"The doctor will follow CA-125 levels periodically to monitor the tumor's response to the medications."
D)"You may experience hair loss while taking Casodex."
E)"These medications block the effects of testosterone in your body and keep the prostate cancer from growing."
F)"You must take this medication first thing in the morning while sitting upright and wait for at least an hour before eating anything."

Accepted Answer

See Nursing Implications and Adverse Reactions/Side Effects for bicalutamide: Diarrhea and hot flashes are common with Casodex,and potential hair loss should be discussed.Casodex antagonizes the effects of androgen at the cellular level and is used to decrease the spread of prostate cancer.Prostate-specific antigen levels are followed to indicate tumor response.Casodex can be taken without regard to food.

Quiz 1: Medication Errors: Improving Practices and Patient Safety

The nurse is caring for a patient receiving intravenous antibiotic therapy with tobramycin 100 mg every 8 hr.Which of the following nursing actions are appropriate for this medication? Select all that apply.

While caring for elderly residents in a nursing home,the nurse recognizes the use of Advil (ibuprofen) places these clients at increased risk for which of the following? Select all that apply.

A nurse working with patients in an HIV clinic recognizes the following medications as antivirals that may be included in patient medication regimens.Select all that apply.

Which of the following lab values must be monitored during therapy with Tegretol CR (carbamazepine) ? Select all that apply.

The nurse is caring for a patient who had a total hip replacement yesterday.Based on the patient's risk of developing deep vein thrombosis or pulmonary emboli,which of the following would the nurse expect to find in the patient's plan of care? Select all that apply.

Which of the following medications can be used to prevent or treat nausea and vomiting? Select all that apply.

A nurse working in the intensive care unit would expect albumin as part of the treatment plan for which of the following patients? Select all that apply.

The nurse is preparing to provide the first dose of Maxipime (cefepime) 1 gm in 50 mL D5W via intravenous piggyback to a patient diagnosed with febrile neutropenia.Place the following steps in the appropriate order:

The nurse is providing care for a patient who is to take Tagamet (cimetidine) 400 mg BID upon discharge.Which of the following statements should the nurse include in the patient's teaching? Select all that apply.

The nurse is providing education for an immunosuppressed patient with recurrent oral herpes simplex lesions (cold sores) who is being treated with topical acyclovir ointment.Which of the following statements would be included in the nurse's teaching? Select all that apply.

The nurse is providing care for a 59-year-old patient with a long-term history of asthma for an acute exacerbation.The client is started on an infusion of aminophylline.Which of the following orders would the nurse expect to be written?

The nurse providing patient education about Questran (cholestyramine) would include which of the following statements in the education? Select all that apply.

The nurse caring for a patient taking hydrochlorothiazide and Lanoxin (digoxin) instructs the patient to notify the physician with which of the following symptoms? Select all that apply.

A nurse assisting in the care of an elderly patient who received PO Librium (chlordiazepoxide) in the treatment of acute alcohol intoxication would include which of the following in the plan of care? Select all that apply.

A nurse providing hypertension screening and education recognizes which of the following medications as an ACE inhibitor? Select all that apply.

Which of the following are classified as potassium-sparing diuretics? Select all that apply.

The nurse is providing care for a patient with recurrent lymphocytic leukemia who is receiving weekly treatment with Campath (alemtuzumab) .Which of the following lab results would the nurse be expected to monitor prior to initiating therapy? Select all that apply.

The nurse is counseling a patient who has been given a prescription for Prozac (fluoxetine) .Which of the following statements should the nurse include in the patient's teaching? Select all that apply.

The nurse is teaching a patient with prostate cancer about the planned treatment of Casodex (bicalutamide) and Goserelin (an LHRH analog) .Which of the following statements should be included in the patient teaching? Select all that apply.