Question 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

Accepted Answer

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.

Question 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

Accepted Answer

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.

Question 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?"

Accepted Answer

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.

Question 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

Accepted Answer

See Patient/Family Teaching for phenobarbital.Caution patient to avoid taking alcohol or other CNS depressants concurrently with this medication.

Question 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.

Accepted Answer

See Evaluation/Desired Effect for carbidopa/levodopa.Effects include resolution of parkinsonian signs and symptoms.Therapeutic effects usually become evident after 2-3 wk of therapy but may require up to 6 months.

Question 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."

Accepted Answer

See Nursing Implications/Assessment for lamotrigine.Assess patient for skin rash frequently during therapy.Discontinue lamotrigine at first sign of rash;it may be life-threatening.Stevens-Johnson syndrome or toxic epidermal necrolysis may develop.The rash usually occurs during the initial 2-8 wk of therapy and is more frequent in patients taking multiple antiepileptic agents,especially valproic acid,and is much more frequent in patients <16 yr.

Question 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."

Accepted Answer

See Implementation for ondansetron.Immediately place tablet on tongue;it will dissolve in seconds.Then swallow with saliva.

Question 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.

Accepted Answer

See Assessment for mannitol.Mannitol is a diuretic used in the treatment of acute oliguric renal failure,edema,and increased intracranial or intraocular pressure.Monitor vital signs,urine output,CVP,and pulmonary artery pressures before and hourly throughout administration.

Question 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.

Accepted Answer

See Assessment for loperamide.Assess fluid and electrolyte balance and skin turgor for dehydration.Tenting is an indication of dehydration,and decreased deep tendon reflexes are indicative of hypokalemia.The patient is taking Imodium,which is used in the treatment of diarrhea,so symptoms of abdominal cramping and loose stool are expected.Viral symptoms are not the first priority and may be related to the cause of the diarrhea.PERRL is a normal finding.Diarrhea places the patient at risk for dehydration and hypokalemia,so this is the first priority.

Question 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

Accepted Answer

See Assessment/Lab test considerations for paroxetine.Lab Test Considerations: Monitor CBC and differential periodically during therapy.Report leukopenia or anemia.

Question 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."

Accepted Answer

See Action/Therapeutic Effect for pancrelipase.Effects include increased digestion of fats,carbohydrates,and proteins in the GI tract.

Question 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

Accepted Answer

See Indications for oxcarbazepine.Trileptal is used as monotherapy or adjunctive therapy of partial seizures in adults and children 4 years and older with epilepsy.

Question 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."

Accepted Answer

See Patient/Family Teaching for penicillin.Advise patient taking oral contraceptives to use an additional nonhormonal method of contraception during therapy with penicillin and until next menstrual period.

Question 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)

Accepted Answer

See Indications and Actions for zoledronic acid.Zometa is used in the treatment of hypercalcemia of malignancy.It inhibits bone resorption by inhibiting increased osteoclast activity and skeletal calcium release induced by tumors.Therapeutic effects include decreased serum calcium.Oscal is a calcium supplement and should be avoided if the patient's serum calcium level is too high.Sandostatin is used in the treatment of severe diarrhea including that caused by carcinoid tumors.Emend is used in the treatment of nausea/vomiting during chemotherapy.

Question 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.

Accepted Answer

See Patient/Family Teaching for pentazocine.Medication may cause drowsiness,dizziness,or hallucinations,particularly in geriatric patients.Advise patient to call for assistance when ambulating.

Question 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.

Accepted Answer

See Implementation for pantoprazole.Do not break,crush,or chew tablets.

Question 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

Accepted Answer

See Side effects and Assessment for pamidronate.Observe for evidence of hypocalcaemia (paresthesia,muscle twitching,laryngospasm,and Chvostek's or Trousseau's sign).

Question 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)

Accepted Answer

See Indications for lorazepam.Ativan is an antianxiety agent.Atarax is provided for itching.Bonine is provided for vertigo.Adalat CC in provided for hypertension.

Question 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.

Accepted Answer

See Implementation for metformin.Because the patient is NPO,the medication should be held and blood sugars should be monitored frequently.Patients stabilized on a diabetic regimen who are exposed to stress,fever,trauma,infection,or surgery may require administration of insulin.Withhold metformin and reinstitute after resolution of acute episode.

Question 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.

Accepted Answer

See Patient Teaching for zolpidem.Because of rapid onset,advise patient to go to bed immediately after taking zolpidem.Onset of action is 30 min or more and is increased in geriatric patients and patients with hepatic impairment.Do not administer with or immediately after a meal as food slows absorption.Due to the habit-forming nature of this medication,it should not be used for more than 7-10 days.

Quiz 2: Detecting and Managing Adverse Drug Reactions

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?

The nurse is caring for a patient taking Xenical (orlistat) .Which of the following symptoms would be most concerning to the nurse?

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?

The nurse would be most concerned if a patient taking phenobarbital reported daily consumption of which of the following?

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?

The nurse prepares to provide Zofran (ondansetron) in orally disintegrating tablet.Which of the following instructions should the nurse provide?

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?

While caring for a patient who is taking Imodium (loperamide) ,the nurse would be most concerned by which of the following symptoms?

Which of the following lab values should be followed periodically for a patient taking Paxil (paroxetine) ?

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?

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?

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?

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?

The nurse is caring for a woman in labor who is given Talwin (pentazocine) .Which of the following actions should the nurse take next?

Which of the following would cause the nurse to intervene for a patient taking Protonix (pantoprazole) ?

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 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?

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?