Chapter 2 Davis’s Drug Guide For Nurses 15Th Edition

Chapter 2  Davis’s Drug Guide For Nurses 15Th Edition

Complete Chapter Questions And Answers
 

Sample Questions

MULTIPLE CHOICE

1. 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.”

ANS: C
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.

KEY: Cognitive Level: Application
DIF: Medium
TOP: Therapeutic Classification: Anticonvulsants
REF: Page 744

2. 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?”

ANS: 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.

KEY: Cognitive Level: Analysis
DIF: Medium
TOP: Therapeutic Classification: Antineoplastics
REF: Page 763

3. 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)

ANS: A
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.

KEY: Cognitive Level: Application
DIF: Medium
TOP: Therapeutic Classification: Bone resorption inhibitors, Electrolyte modifiers, Hypocalcemics
REF: Page 1292

4. 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.

ANS: B
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.

KEY: Cognitive Level: Application
DIF: Medium
TOP: Therapeutic Classification: Sedative/Hypnotics
REF: Pages 1297-1298

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.

ANS: A
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.

KEY: Cognitive Level: Analysis
DIF: Medium
TOP: Therapeutic Classification: Antiparkinson agents
REF: Page 282

6. 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.

ANS: D
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.

KEY: Cognitive Level: Analysis
DIF: Hard
TOP: Therapeutic Classification: Antidiarrheals
REF: Page 787