Question 1

The nurse is caring for a patient admitted with suspected overdose with Codeine.Which of the following medications would the nurse anticipate being ordered?
A)Pamelor (nortriptyline)
B)Narcan (naloxone)
C)Naprosyn (naproxen)
D)Nicobid (niacin)

Accepted Answer

See Indications for naloxone,and/or Nursing Implications/Toxicity Overdose for Codeine.Codeine is a narcotic,and Narcan is an antidote for narcotic overdose.

Question 2

A nurse working with a patient who started taking Bentyl (dicyclomine)recognizes that patient further teaching is necessary by which of the following statements?
A)"I'll call the doctor immediately if I have any eye pain or sensitivity to light."
B)"I won't have any restrictions on my driving or other activities if I take this drug."
C)"I will get up slowly since this medication may make me dizzy."
D)"People who take this medication sweat less,so it is important not to get overheated."

Accepted Answer

See Patient/Family Teaching for dicyclomine.Advise patient to notify a health-care professional immediately if eye pain or increased sensitivity to light occurs.Medication may cause drowsiness and blurred vision.Caution patient to avoid driving or other activities requiring alertness until response to the medication is known.Advise patient receiving dicyclomine to make position changes slowly to minimize the effects of drug-induced orthostatic hypotension.Caution patient to avoid extremes of temperature.This medication decreases the ability to sweat and may increase the risk of heat stroke.

Question 3

A nurse working in hospice is providing care for a patient recently started on a transdermal fentanyl patch.Which of the following statements,made by the patient's caretaker,indicates further teaching is required?
A)"I can wash right over the patch,and it won't come off."
B)"I should change the patch every 3 days."
C)"I put the first patch on him this morning at 8 a.m. ,so he shouldn't need any more pain medicine today."
D)"The medicine can cause constipation,so it is important to give him the stool softener and increase fluid if possible."

Accepted Answer

See Dosage and Nursing Implications for fentanyl transdermal.It is important to use supplemental doses of short-acting opioid analgesics to manage pain until relief is obtained with the transdermal system.The patch may be worn while bathing,showering,or swimming.Transdermal patches lasts 72 hr in most patients.Prevent constipation with increased intake of fluids and bulk as well as laxatives to minimize constipating effects.

Question 4

A patient undergoing chemotherapy for breast cancer tells the nurse,"I feel so tired I can barely do anything.Even getting out of bed makes me dizzy." After laboratory results are obtained,which of the following medications would most likely help relieve these symptoms?
A)Aranesp (darbepoetin)
B)Neupogen (filgrastim)
C)Kytril (granisetron)
D)Plavix (clopidrogel)

Accepted Answer

See Indications for darbepoetin,filgrastim,granisetron,and clopidrogel.The patient is exhibiting symptoms associated with anemia,which is common with chemotherapy.Aranesp is one of the erythroid colony-stimulating factors designed to stimulate production of red blood cells and improve symptoms associated with chemotherapy-induced anemia.

Question 5

The nurse is providing care for a patient taking Plavix (clopidogrel).Which of the following laboratory results would be most important for the nurse to evaluate?
A)Urine-specific gravity
B)Albumin
C)Bleeding time
D)Potassium

Accepted Answer

See Nursing Assessment for clopidogrel.Plavix is an antiplatelet medication,so it is important to monitor bleeding time throughout therapy.

Question 6

The nurse is providing care for a patient admitted after an acute myocardial infarction.Which of the following medications should the nurse anticipate to be part of the patient's treatment plan?
A)Anzemet (dolasetron)
B)Celexa (citalopram)
C)Aricept (donepezil)
D)Colace (docusate)

Accepted Answer

See Indications for docusate.It is important to prevent additional strain on the heart during recovery.Docusate is used in the prevention constipation (in patients who should avoid straining,such as after a myocardial infarction or rectal surgery).Anzemet is an antiemetic used to prevent chemotherapy-induced nausea and vomiting,Celexa is used in the treatment of depression,and Aricept is used to improve cognition and slow Alzheimer's disease.

Question 7

The nurse is caring for a patient who just received parenteral Valium (diazepam).Which of the following nursing actions is best?
A)Monitor patient's serum calcium levels for the next 12 hr.
B)Ensure fluid intake of 3,000 mL over the next 24 hr.
C)Place patient on bed rest and monitor vital signs closely.
D)Call for a hypothermia blanket to prevent rigors.

Accepted Answer

See Nursing Implications for diazepam.Parenteral therapy with Valium may alter vital signs or cause sedation,increasing the patient's risk for falls.Patient should be kept on bed rest and observed for at least 3 hr following parenteral administration.Valium will not alter serum calcium levels,induce dieresis,or alter core temperature.

Question 8

The nurse is providing care for a patient who received surgical intervention for mitral valve prolapse.The patient is taking Persantine (dipyridamole)75 mg po TID.The nurse recognizes the medication is effective by which of the following patient outcomes?
A)Patient reports chest pain is less after receiving the medication.
B)Patient remains free from deep vein thrombosis throughout hospital stay.
C)Patient's heart rhythm is regular without ectopic beats for 48 hr postprocedure.
D)Patient's lung sounds remain clear without evidence of fluid overload throughout hospital stay.

Accepted Answer

See Indications for dipyridamole.Persantine is given to prevent thromboembolism in patients with prosthetic heart valves.

Question 9

The nurse is working with a patient who has elevated triglyceride levels despite dietary changes.The physician has ordered TriLipix (fenofibric acid)135 mg per day.Which of the following statements should the nurse include in the teaching?
A)"Since I take Coumadin,I'll need to have my bleeding labs checked more frequently for a while."
B)"This will be much easier than following all of those dietary restrictions;I know how hard that can be."
C)"This medicine will really help you lose weight,just be sure you're drinking enough water."
D)"This medicine sometimes causes stomach pain and fatty,clay-colored stools,so if I experience that,I shouldn't worry."

Accepted Answer

See Nursing Implications for fenofibric acid.Patients taking anticoagulants concurrently should have prothrombin time and INR monitored frequently until levels stabilize.Patients must still follow a low-fat,low-cholesterol diet.The medication is not designed to cause weight loss.Assess patient for cholethiasis.If symptoms occur,gall bladder studies are indicated;fatty,clay-colored stools,and abdominal pain are symptoms of gall bladder dysfunction.

Question 10

While counseling a patient receiving Inspra (eplerenone)for hypertension,the nurse recognizes the need for further teaching by which of the following statements?
A)"I'll follow a cardiac diet to help lower my blood pressure."
B)"It is important that I stop smoking to reduce my risk of a heart attack."
C)"I can use salt substitutes if I want more seasoning."
D)"It is important to check my blood pressure at home at least once a week."

Accepted Answer

See Patient/Family Teaching for eplerenone.Inform patient not to use potassium supplements,salt substitutes containing potassium,or other Rx or OTC medications without consulting a health-care professional.Encourage the patient to comply with additional interventions for hypertension (weight reduction,discontinuation of smoking,moderation of alcohol consumption,regular exercise,and stress management).Medication controls,but does not cure,hypertension.Instruct patient and family on correct technique for monitoring blood pressure.Advise them to monitor blood pressure at least weekly.

Question 11

A nurse in the labor and delivery unit is caring for a patient who is receiving Marcaine (bupivicaine)epidural anesthesia.Which of the following symptoms would be recognized as indicative of systemic toxicity?
A)BP drops from 112/74 to 106/68.
B)Patient complains,"I can't feel the baby moving anymore."
C)Patient reports,"I can hear ringing in my ears."
D)Respiratory rate drops from 22 to 16 respirations per minute.

Accepted Answer

See Nursing Implications for Epidural local anesthetics,Systemic Toxicity: Assess for systemic toxicity each shift (circumoral tingling and numbness,ringing in ears,metallic taste,dizziness,blurred vision,tremors,slow speech,irritability,twitching,seizures,and cardiac dysrhythmias).Report to physician or other health-care professional.Mild hypotension is common.Respirations will most likely slow as pain is well controlled.

Question 12

The nurse receives a call from the parent of an 8-year-old boy who is home sick from school with a headache,sinus congestion,and a cough.The parent asks,"Can I give him some Benadryl to help him breathe easier?" Which of the following statements by the nurse is best?
A)"How long has your child been ill?"
B)"It should be fine if he weighs more than 50 pounds."
C)"What other over-the-counter medications have you given him?"
D)"That might make him sleepy,so it is best to give it at night."

Accepted Answer

See Patient/Family Teaching on diphenhydramine.Benadryl has many uses and can be safely given to children,but it is found in numerous OTC medications and risk of overdose may be present.Therefore,it is important to know what other medications the parent has given.Caution patient not to use oral OTC diphenhydramine products with any other product containing diphenhydramine.The other assessments are not as important,and ANS B misses the opportunity to assess for potential overdose.

Question 13

The nurse is caring for a 56-year-old patient with a history of atrial fibrillation who takes Lanoxin (digoxin)0.5 mg/day.Which of the following assessments should cause the nurse to hold the patient's dose?
A)BP = 112/70 mmHg
B)Lung sounds with fine bibasilar crackles
C)Urine output = 300 mL in 3 hr
D)P = 58 bpm

Accepted Answer

See Nursing Assessment for digoxin.Monitor apical pulse for 1 full min before administering.Withhold dose and notify physician if pulse rate is less than 60 bpm in an adult.

Question 14

A nurse caring for a patient who recently started taking Pletal (cilostazol)recognizes the further need for teaching by which of the following statements?
A)"I'm able to walk three blocks a day now instead of one."
B)"I take the medication with breakfast every day."
C)"I've given up grapefruit juice and grapefruits entirely."
D)"I've stopped smoking all together."

Accepted Answer

See Nursing Implications for cilostazol.Cilostazol is given to reduce the symptoms of intermittent claudication and improve walking endurance.It is taken on an empty stomach,1 hr before or 2 hr after meals and should not be taken with grapefruit juice to avoid increased cilostazol levels.

Question 15

The nurse is providing a follow-up phone call to a patient who recently started taking Allegra (fexofenadine).Which of the following statements by the patient would indicate the medication has been effective?
A)"My arthritis is much better;I can even write letters again."
B)"My nose isn't running and itchy all the time now."
C)"I don't have to get up to go to the bathroom in the middle of the night anymore."
D)"I'm sleeping a lot better,and I don't have any headaches anymore."

Accepted Answer

See Evaluation/Desired Effects for fexofenadine.Allegra is designed to decrease in allergic symptoms.

Question 16

The nurse recognizes that Celexa (citalopram)may be prescribed for which of the following patients?
A)A 42-year-old patient with a history of depression
B)A 22-year-old patient with a history of schizophrenia
C)A 37-year-old patient taking MAO inhibitors
D)A 55-year-old patient with a history of alcoholism

Accepted Answer

See Indications for citalopram.Celexa is used in the treatment of depression.It may cause serious,potentially fatal reactions when used with MAO inhibitors and should be used cautiously with other centrally acting drugs including alcohol.

Question 17

The nurse is taking a medication history over the phone for a patient scheduled for knee replacement in 3 days.Which of the following medications,if reported by the patient,should be reported to the surgeon?
A)Zantac (ranitidine)
B)Proventil (albuterol)
C)Lotrimin (clortrimazole)
D)Klonopin (clonazepam)

Accepted Answer

Klonopin (clonazepam) is a benzodiazepine, which can potentiate the effects of anesthesia and cause respiratory depression. Therefore, it should be reported to the surgeon to ensure proper monitoring and management during and after the procedure. The other medications (Zantac, Proventil, and Lotrimin) are not typically of concern for knee replacement surgery.

Question 18

The nurse is caring for a patient admitted with diarrhea for the past 3 days.Stool cultures are negative,and the physician orders Lomotil,two tablets orally now and one tablet after each loose stool OR every 3-4 hr as needed.Which of the following parameters would the nurse expect to accompany the order?
A)"Do not exceed 8 tablets per day."
B)"Do not exceed 4 doses per day."
C)"Do not give for more than 2 days."
D)No parameters are necessary.

Accepted Answer

See Dosage for diphenoxylate.PO (adults): 2 tablets initially,then 1 tablet after each loose stool,or every 3-4 hr as needed (not to exceed 8 tablets/day).

Question 19

The nurse is caring for a patient with colorectal cancer who has been receiving continuous infusion chemotherapy at home.The patient complains of mouth sores and difficulty swallowing.Upon exam,the homecare nurse notes a whitish coating on the tongue and mucosal breakdown on the inner cheeks and lips.The nurse informs the patient,"The sores in your mouth are caused by the chemotherapy,but it looks like you may also have a secondary yeast infection in your mouth and throat.I will call the doctor so you can be seen right away." The nurse recognizes which of the following medications will most likely be ordered to treat the esophageal candidiasis once the patient is seen by a physician?
A)Ditropan XL (oxybutynin)
B)Fosamax (alendronate)
C)Fluoroplex (fluorouracil)
D)Diflucan (fluconazole)

Accepted Answer

See Indications for alendronate,fluconazole,fluorouracil and oxybutynin.Diflucan is used to treat fungal infections caused by susceptible organisms,including oropharyngeal or esophageal candidiasis.Ditropan XL is used in the management overactive bladder,and alendronate is a bisphosphonate used to decrease bone resorption.Fluorouracil is a chemotherapy agent commonly used in the treatment of colorectal cancer and causes stomatitis-it is most likely what the patient is receiving for his treatment,and it will need to be held at this time with probable dose reduction when treatment resumes.

Question 20

A nurse working on the postpartum unit is caring for a woman who had a spontaneous delivery of a 9 lb,6 oz baby 6 hr earlier.The nurse notes the patient has soaked four peri-pads and that her uterine fundus is boggy.Which of the following medications does the nurse anticipate being ordered?
A)Pitocin (oxytocin)
B)Methylergonovine (methergine)
C)Brethine (terbutaline)
D)Magnesium sulfate (magnesium sulfate)

Accepted Answer

See Indications for Methylergonovine.Methylergonovine is used in the prevention and treatment of postpartum or postabortion hemorrhage caused by uterine atony or involution.

Quiz 1: Medication Errors: Improving Practices and Patient Safety

The nurse is caring for a patient admitted with suspected overdose with Codeine.Which of the following medications would the nurse anticipate being ordered?

A nurse working with a patient who started taking Bentyl (dicyclomine) recognizes that patient further teaching is necessary by which of the following statements?

A nurse working in hospice is providing care for a patient recently started on a transdermal fentanyl patch.Which of the following statements,made by the patient's caretaker,indicates further teaching is required?

A patient undergoing chemotherapy for breast cancer tells the nurse,"I feel so tired I can barely do anything.Even getting out of bed makes me dizzy." After laboratory results are obtained,which of the following medications would most likely help relieve these symptoms?

The nurse is providing care for a patient taking Plavix (clopidogrel) .Which of the following laboratory results would be most important for the nurse to evaluate?

The nurse is providing care for a patient admitted after an acute myocardial infarction.Which of the following medications should the nurse anticipate to be part of the patient's treatment plan?

The nurse is caring for a patient who just received parenteral Valium (diazepam) .Which of the following nursing actions is best?

The nurse is providing care for a patient who received surgical intervention for mitral valve prolapse.The patient is taking Persantine (dipyridamole) 75 mg po TID.The nurse recognizes the medication is effective by which of the following patient outcomes?

The nurse is working with a patient who has elevated triglyceride levels despite dietary changes.The physician has ordered TriLipix (fenofibric acid) 135 mg per day.Which of the following statements should the nurse include in the teaching?

While counseling a patient receiving Inspra (eplerenone) for hypertension,the nurse recognizes the need for further teaching by which of the following statements?

A nurse in the labor and delivery unit is caring for a patient who is receiving Marcaine (bupivicaine) epidural anesthesia.Which of the following symptoms would be recognized as indicative of systemic toxicity?

The nurse receives a call from the parent of an 8-year-old boy who is home sick from school with a headache,sinus congestion,and a cough.The parent asks,"Can I give him some Benadryl to help him breathe easier?" Which of the following statements by the nurse is best?

The nurse is caring for a 56-year-old patient with a history of atrial fibrillation who takes Lanoxin (digoxin) 0.5 mg/day.Which of the following assessments should cause the nurse to hold the patient's dose?

A nurse caring for a patient who recently started taking Pletal (cilostazol) recognizes the further need for teaching by which of the following statements?

The nurse is providing a follow-up phone call to a patient who recently started taking Allegra (fexofenadine) .Which of the following statements by the patient would indicate the medication has been effective?

The nurse recognizes that Celexa (citalopram) may be prescribed for which of the following patients?

The nurse is taking a medication history over the phone for a patient scheduled for knee replacement in 3 days.Which of the following medications,if reported by the patient,should be reported to the surgeon?

A nurse working on the postpartum unit is caring for a woman who had a spontaneous delivery of a 9 lb,6 oz baby 6 hr earlier.The nurse notes the patient has soaked four peri-pads and that her uterine fundus is boggy.Which of the following medications does the nurse anticipate being ordered?