Davis’s Drug Guide For Nurses 15Th Edition – Test Bank

Complete Test Bank With Answers

 

 

Sample Questions Posted Below

 

 

MULTIPLE CHOICE

1. The nurse is providing care for an 82-year-old client with glaucoma. Diamox (acetazolamide) 250 mg orally twice daily has been ordered as a new medication. The nurse would be most concerned by which of the following?
A. The client has a listed allergy to sulfonamides.
B. The client has a history of rheumatoid arthritis.
C. The client takes Cogentin (benztropine) daily.
D. The client’s potassium is 3.6 mEq/dL.

ANS: A
See Contraindications/Precautions for acetazolamide. Hypersensitivity or cross-sensitivity with sulfonamides may occur.

KEY: Cognitive Level: Application 

DIF: Medium 

TOP: Therapeutic Classification: Anticonvulsants, Antiglaucoma agents 

REF: Drugguide.com

2. A 21-year-old client is brought to the emergency room with suspected overdose with Tylenol (acetaminophen). Which of the following medications would the nurse expect to be ordered?
A. Protamine sulfate
B. Primaxin (imipenem)
C. Acetadote (acetylcysteine)
D. Diabeta (glyburide)

ANS: C
See Toxicity and overdose for acetaminophen and Indications for acetylcysteine:  Acetylcysteine is the antidote for the management of potentially hepatotoxic overdose of acetaminophen.

KEY: Cognitive Level: Application 

DIF: Medium 

TOP: Therapeutic Classification: Antidotes, mucolytic 

REF: Pages 102 and 104 

3. The nurse is providing care for a 64-year-old client on the telemetry unit whose heart rate suddenly jumps to 144 bpm. Telemetry shows supraventricular tachycardia and the client reports feeling a bit lightheaded and dizzy. The nurse attempts vagal stimulation without success and prepares to administer Adenocard (adenosine) 6 mg IV push. The nurse would expect which of the following to occur?
A. A gradual slowing of the heart rate over the next 30 min with an end result of normal sinus rhythm and improved symptoms.
B. Slowing of the tachycardia with an end rate between 100–120 bpm and improved dizziness within 5 min.
C. Loss of consciousness for the client in preparation for electric shock/cardioversion.

D. A short period of heart block or asystole immediately after injection followed by conversion to normal sinus rhythm.

ANS: D
See Nursing Implications adenosine: Monitor heart rate frequently (every 15–30 sec) and ECG continuously during therapy. Short transient periods of 1st, 2nd, or 3rd degree heart block or asystole may occur following injection; usually resolves quickly due to short duration of adenosine. Once conversion to normal sinus rhythm is achieved, transient arrhythmias may occur but generally last a few seconds.

KEY: Cognitive Level: Application 

DIF: Hard 

TOP: Therapeutic Classification: Antiarrythmics 

REF: Page 113

4. The nurse is caring for a 34-year-old patient with a large hilar mass due to lymphoma. Chemotherapy is being provided and the client also has orders for Zyloprim (allopurinol) 300 mg orally twice daily. When providing this medication, the nurse would include which of the following statements in the client teaching?
A. “This medication will help prevent gout, which occurs when clients are given radiation therapy.”
B. “Allopurinol binds to the uric acid being released by the destroyed cancer cells and prevents it from damaging your kidneys.”
C. “Chemotherapy agents can reduce the number of white blood cells, red blood cells, and platelets in your body; this medication helps protect those cells.”
D. “This is part of the chemotherapy regimen since some chemo agents are given in your IV and others are given by mouth.”

ANS: B
See Indications for allopurinol: Treatment of secondary hyperuricemia, which may occur during treatment of tumors or leukemias. 

KEY: Cognitive Level: Analysis 

DIF: Hard 

TOP: Therapeutic Classification: Antigout, antihyperuremics 

REF: Page 125

5. The nurse is providing Ethyol (amifostine) to a 51-year-old woman with ovarian cancer who is also receiving Cisplatin. Which of the following nursing assessments during the infusion is of the highest priority?
A. Monitor client blood sugar every hr.
B. Monitor client’s respiratory rate every 30 min.
C. Monitor client’s blood pressure every 5 min.
D. Monitor client’s urine output every 4 hr.

ANS: C
See Nursing Implications Assessment for amifostine. Monitor BP before and every 5 min during infusion. Discontinue antihypertensives 24 hr prior to the treatment. If significant hypotension requiring interruption of therapy occurs, place client in Trendelenburg position and administer an infusion of 0.9% NaCl using separate IV line.

KEY: Cognitive Level: Analysis 

DIF: Hard 

TOP: Therapeutic Classification: Cytoprotective agents

REF: Page 133

6. While preparing to give Fungizone (amphotericin B) to a client who is also receiving Dexasone (dexamethasone), the nurse recognizes the client is at increased risk for which of the following?
A. Hypoglycemia
B. Hyponatremia
C. Hypocalcemia
D. Hypokalemia

ANS: D
See Interactions for amphotericin B with corticosteroids. Concurrent use with corticosteroids increases risk of hypokalemia.

KEY: Cognitive Level: Knowledge 

DIF: Hard 

TOP: Therapeutic Classification: Antifungals 

REF: Page 154

7. A client with breast cancer is taking Arimidex (anastrozole). The nurse recognizes that teaching has been effective by which of the following client statements?
A. “If I miss a dose, I should take a double dose the next day.”
B. “I must take this medication on an empty stomach before going to bed each night.”
C. “Oral chemotherapy generally has fewer side effects and is much safer.”
D. “There is a risk of allergic reaction for this medication so I need to notify the doctor right away if I have any swelling in my face, difficulty swallowing, or rashes.”

ANS: D
See Patient/Family Teaching for anastrozole. Inform client of potential for adverse reactions and advise client to notify health care professional immediately if allergic reactions or chest pain occurs.

KEY: Cognitive Level: Analysis 

DIF: Easy 

TOP: Therapeutic Classification: Antineoplastics 

REF: Page 163

8. A nurse is receiving shift-to-shift report for a client in the intensive care unit with multiple medical problems. The client is receiving Argatroban infusion. The nurse recognizes this medication is ordered to address which of the following health-care problems for the client?
A. Ventilator-associated pneumonia
B. Deep vein thrombosis
C. Hypotension
D. Urosepsis

ANS: B
See Indications for Argatroban. Prophylaxis or treatment of thrombosis in client with heparin-induced thrombocytopenia.

KEY: Cognitive Level: Application 

DIF: Easy 

TOP: Therapeutic Classification: Anticoagulations 

REF: Page 182

9. The nurse is caring for a 6-month-old patient receiving oral Moxatag (amoxicillin) 25 mg/kg/day divided into two doses and distributed as 50 mg/mL oral suspension. The child weighs 33 pounds. How much medication (in mL) will this nurse pour/provide each dose?

ANS: 3.75 mL = 3.8 mL
See Availability for amoxicillin and perform drug calculation. 2.2 pounds = 1 kg so weight conversion is 33 pounds divided by 2.2 = 15 kg. Calculate daily drug dose by multiplying 25 mg/kg and 15 = 375 mg. Divide by 2 for single dose = 187.5. Since medication comes 50 mg/mL, divide by 50 to calculate oral amount in each dose = 3.75 mL

KEY: Cognitive Level: Analysis 

DIF: Hard 

TOP: Therapeutic Classification: Anti-infectives, Anti-ulcer agents

REF: Page 148

10. While providing care for a client who is to receive Abilify (aripiprazole), the nurse recognizes that the client understands this medication by which of the following statements?
A. “This medication may cause me to have a dry mouth or lower my saliva production.”
B. “This medication will reduce my nicotine cravings and help me quit smoking.”
C. “I need to let the doctor know right away if I have any thoughts of suicide or worsening depression.”
D. “I need to be sure and drink at least 4 quarts of water each day while I’m taking this medication.”

ANS: C
See Patient Family Teaching for aripiprazole. Advise patient and family to notify health care professional if thoughts about suicide or dying, attempts to commit suicide, new or worse depression, or new or worse anxiety occur. The medication can cause tardive dyskinesia or neuroleptic malignant syndrome but does not typically cause a dry mouth nor are increased fluids required.

KEY: Cognitive level: Application 

DIF: Medium 

TOP: Therapeutic Classification: Antipsychotics, Mood stabilizers 

REF: Pages 187-188

11. In reviewing new orders, the nurse notes Azactam (aztreonam) 1 gram IV every 8 hr has been ordered. Before initiating therapy, the nurse should assess for an allergy history to which of the following? Select all that apply.
A. Penicillins
B. MAO inhibitors
C. Antifungals
D. Cephalosporins
E. Non-steroidal anti-inflammatory agents

ANS: A, D
See Nursing Implications Assessment for aztreonam. Obtain a history before initiating therapy to determine previous use of and reaction to penicillins and cephalosporins.

KEY: Cognitive Level: Knowledge 

DIF: Medium 

TOP: Therapeutic Classification: Anti-infectives 

REF: Pages 212-213

12. While caring for a client with Parkinson disease who has recently started taking Cogentin (benztropine), the client reports, “My mouth seems so dry all the time.” Which of the following statements by the nurse is best?
A. “Dry mouth is common with your new medications. You should rinse frequently and consider using hard sugarless candies or gum to help with the symptom.”
B. “I wonder if your dose is too high; try taking half the pill twice a day instead of all at once and see if that helps.”
C. “You should call your doctor and let them know about that—it could be a serious side effect of the new medication.”
D. “Have you noticed any fever or night sweats lately?”

ANS: A
See Patient/Family Teaching for benztropine. Instruct patient that frequent rinsing of mouth and good oral hygiene, and sugarless gum or candy may decrease dry mouth.

KEY: Cognitive Level: Analysis 

DIF: Medium 

TOP: Therapeutic Classification: Antiparkinson agents 

REF: Page 223

13. The nurse is providing instructions to a client who has started therapy with Buprenex (buprenorphine) to assist with opioid withdrawal. The nurse instructs the client to avoid which of the following natural substances/herbs? Select all that apply.

A. Kava-kava
B. Valerian
C. Garlic
D. Ginger
E. Chamomile
F. Hops

ANS: A, B, E, F
See Drug-Natural Products under Interactions for buprenorphine. Concomitant use of kava-kava, valerian, chamomile, or hops can increase CNS depression.

KEY: Cognitive Level: Knowledge 

DIF: Hard 

TOP: Therapeutic Classification: Opioid analgesics 

REF: Page 248

14. While providing care for an 84-year-old patient with Parkinson disease who is taking Sinemet (carbidopa/levodopa), the nurse notes abnormalities in the client’s lab values. Which of the following could be attributed to the medication?
A. Platelet count—440,000 c/mm³
B. Hemoglobin—10.4 g/dL
C. Albumin—3.2 g/dL
D. B-type natriuretic peptide (BNP)—449 pg/mL

ANS: B
See Nursing Implications for carbidopa/levodopa. May cause decreased hemoglobin/hematocrit, agranulocytosis, hemolytic and non-hemolytic anemia, thrombocytopenia, leucopenia, and increased WBC. The listed platelet count is high, which is not expected with the drug, the hemoglobin is low and could be attributed to the drug, the protein value is low with no correlation to the drug, and the BNP is high with no correlation to the drug.

KEY: Cognitive Level: Analysis 

DIF: Hard 

TOP: Therapeutic Classification: Anti-Parkinson Agents

REF: Page 279

15. While caring for a client taking Clozaril (clozapine), the nurse determines the medication is effective by which of the following findings?
A. Decreased swelling noted at the site of cellulitis in the left hand.
B. Apical heart rate is regular at 72 bpm.
C. Client is cooperative; oriented to person, place, and time; and has no hallucinations or delusions.
D. Breath sounds are clear throughout anterior, lateral, and posterior aspects.

ANS: C
See Indications and Evaluation/Desired Outcomes for clozapine. Used in the treatment of schizophrenia. The medication will have no impact on infection, heart rate, or breath sounds but will help reduce psychotic behaviors.

KEY: Cognitive Level: Analysis 

DIF: Medium 

TOP: Therapeutic Classification: Antipsychotics 

REF: Pages 336-339

16. While caring for a client who is taking Sandimmune (cyclosporine) after a cardiac transplant, the nurse is aware that it is most important to monitor for which of the following?
A. Hypokalemia
B. Hypotension
C. Anorexia
D. Nephrotoxicity

ANS: D

See Adverse Reactions/Side Effects for cyclosporine: Can cause hyperkalemia and hypertension (not hypokalemia or hypotension) as well as anorexia and nephrotoxicity—the highest priority of those listed (anorexia and nephrotoxicity) is nephrotoxicity.

KEY: Cognitive Level: Application

DIF: Hard

TOP: Therapeutic Classification: Immunosuppressants

REF: Page 378

17. A client admitted with atrial fibrillation would most likely be started on which of the following medications to reduce the risk of embolization?
A. Pradaxa (dabigatran)
B. DDAVP (desmopressin)
C. Effexor (venlafaxine)
D. Flomax (tamsulosin)

ANS: A
See Indications for dabigatran: to reduce the risk of stroke/systemic embolization associated with non-valvular atrial fibrillation. DDAVP is used in the treatment of diabetes insipidus. Venlafexine is an antidepressant and tamsulosin is an anti-adrenergic agent used for prostatic hyperplasia.

KEY: Cognitive Level: Knowledge 

DIF: Hard 

TOP: Therapeutic Classification: Anticoagulants 

REF: Page 385

18. While caring for a client who is receiving Desferal (deferoxamine), the nurse notes the client’s urine is reddish colored. Which of the following conclusions should the nurse draw?
A. There is a risk of hemolytic cystitis with this medication and the next dose should be held.
B. The client may be experiencing liver toxicity; the physician should be contacted to request laboratory analysis be done.
C. This is an expected and normal finding with the medication due to the excretion of iron.
D. The client may have a secondary urinary tract infection and a urinalysis should be sent.

ANS: C
See Action and Adverse Reactions/Side Effects of deferoxamine. Chelates unbound iron, forming a water-soluble complex that is easily excreted by the kidneys; red urine is a frequent side effect.

KEY: Cognitive Level: Analysis

DIF: Hard

TOP: Therapeutic Classification: Antidotes

REF: Pages 407-408

19. The nurse is providing care for a 41-year-old patient with a severe head injury following a motor vehicle accident. The nurse notes the client’s urinary output for the past four hr is 900 mL. Which of the following medications would the nurse anticipate being ordered?
A. DDAVP (desmopressin)
B. Lasix (furosemide)
C. Lopurin (allopurinol)
D. Dexedrine (dextroamphetamine)

ANS: A
See Indications for desmopressin: Treatment of central diabetes insipidus caused by deficiency of vasopressin. Diabetes insipidus, often seen in the presence of a head injury, result in profound dieresis. Treatment with diuretics (Lasix and Allopurinol) would be contraindicated. Dextroamphetamine is a CNS stimulant used in the treatment of ADHD and narcolepsy.

KEY: Cognitive Level: Analysis 

DIF: Medium 

TOP: Therapeutic Classification: Antidiuretic hormones 

REF: Pages 413-414

20. While counseling a client taking Pristiq (desvenlafaxine), the nurse recognizes that further teaching is necessary based on which of the following client statements?
A. “I’ll be sure to let my doctor know if I have any thoughts of suicide.”
B. “If I need something for pain, I should take aspirin, ibuprofen, or another non-steroidal anti-inflammatory instead of Tylenol while I’m taking this medication.”
C. “I shouldn’t drive a car for a few weeks since this medication can cause dizziness.”
D. “I should avoid drinking alcohol while I’m taking this medication.”

ANS: B
See Patient/Family Teaching for desvenlafaxine: Increased risk of bleeding with concomitant use of NSAIDs, aspirin, or other drugs that affect coagulation. Advise patient and family to look for suicidality. May cause dizziness or drowsiness. Caution patient to avoid driving until response to the drug is known. Caution patient to avoid taking alcohol or other CNS depressants. 

KEY: Cognitive Level: Application 

DIF: Medium 

TOP: Therapeutic Classification: Antidepressants 

REF: Page 417-418

21. The nurse is caring for a 68-year-old male who is taking Cardura (doxazosin). He denies any history of hypertension. The nurse recognizes this medication can also be used to treat which of the following conditions?
A. Psoriasis
B. Gout
C. Lymphoma
D. Benign prostatic hypertrophy

ANS: D
See Indications for doxazosin: Symptomatic benign prostatic hypertrophy.

KEY: Cognitive Level: Knowledge 

DIF: Medium 

TOP: Therapeutic Classification: Antihypertensives, Peripherally acting antiadrenergics 

REF: Page 461

22. The nurse is providing Epogen (epoetin) subcutaneously to a client with chronic kidney disease. Which of the following would indicate that the therapy is effective? Select all that apply.
A. The client’s hematocrit rises from 27.4 to 32.9%.
B. The client’s serum creatinine falls from 5.6 mg/dL to 4.9 mg/dL.
C. The client reports decreased fatigue and dyspnea.
D. The client reports 500 mL of urine output in a 24-hr period.
E. The client’s WBC = 7.4 u/L.
F. The client has remained afebrile for 2 wk.

ANS: A, C
See Evaluation/Desired Outcomes for epoetin. Increase in hematocrit to 30–36% with improvement in symptoms of anemia in patients with chronic renal failure.

KEY: Cognitive Level: Analysis 

DIF: Hard 

TOP: Therapeutic Classification: Antianemics 

REF: Page 512

23. The nurse is providing Tarceva (erlotinib) intravenously for a client who has small cell lung cancer. The client begins to appear slightly short of breath, respiratory rate has gone from 14 breaths per min to 20 breaths per min and he has been coughing mildly for the past 10 min. Which of the following actions should the nurse take first?
A. Listen to breath sounds to determine if the client is experiencing fluid volume overload.
B. Stop the infusion since there is a risk of interstitial lung disease with this medication.
C. Check the client’s temperature to determine if he is developing pneumonia.
D. Reassure the client that a cough is normal as cancer cells are destroyed and continue to monitor closely.

ANS: B
See Nursing Implications for erlotinib. Assess respiratory status prior to and periodically during therapy. If dyspnea, cough, or fever occur, discontinue erlotinib, assess for interstitial lung disease, and institute treatment as needed. Treatment must be stopped as the first priority.

KEY: Cognitive Level: Analysis 

DIF: Hard 

TOP: Therapeutic Classification: Antineoplastics 

REF: Page 515

24. The nurse is talking to a neighbor who spent 3 days in the hospital on intravenous antibiotics including erythromycin the week before. The individual states, “I’ve had such bad diarrhea all night and it really isn’t any better today.” Which of the following statements by the nurse is best?
A. “Are you taking any oral antibiotics now?”
B. “Antibiotics commonly cause diarrhea; be sure to drink plenty of fluids.”
C. “Have you noticed any blood or pus in the stool?”
D. “Is anyone else in the family experiencing the same symptoms?”

ANS: C
See Nursing Implications for erythromycin. Monitor bowel function. Diarrhea, abdominal cramping, fever, and bloody stools should be reported promptly as a sign of pseudomembranous colitis. May begin up to several weeks following cessation of therapy.

KEY: Cognitive Level: Analysis 

DIF: Medium 

TOP: Therapeutic Classification: Anti-infectives 

REF: Page 519

25. The nurse is reviewing the home medication list for a client with identified hypercholesterolemia. The client reports taking Zetia (ezetimibe) daily. The nurse understands this medication is designed to reduce the client’s risk for which of the following?
A. Atherosclerosis
B. Angina
C. Deep vein thrombosis
D. Gastric ulceration

ANS: A
See Indications and Therapeutic Effects for ezetimibe. Lowers cholesterol, a known risk factor for atherosclerosis.

KEY: Cognitive Level: Comprehension 

DIF: Easy 

TOP: Therapeutic Classification: Lipid-lowering agents 

REF: Page 545

26. While investigating the medications taken by a client in the hospital, the student nurse understands that Plendil (felodipine) works to lower blood pressure by causing which of the following physiologic changes?
A. Dilatation of the vascular wall
B. Blocking the transport of calcium
C. Inhibiting the beta receptors on cell membranes
D. Reducing the formation of ectopic beats

ANS: B
See Action for felodipine. Inhibits the transport of calcium into myocardial and vascular smooth muscle cells, resulting in inhibition of excitation-contraction coupling and subsequent contraction.

KEY: Cognitive Level: Comprehension 

DIF: Easy 

TOP: Therapeutic Classification: Antianginals, Calcium channel blockers 

REF: Page 549

27. A nurse caring for a client with chronic obstructive pulmonary disease notes the recent addition of a new inhaler, formoterol. The nurse knows this medication is designed to prevent which of the following symptoms?
A. Mucous production
B. Salivation
C. Bleb formation
D. Bronchospasm

ANS: D
See Indications for formoterol: As concomitant therapy for the treatment of asthma and the prevention of bronchospasm.

KEY: Cognitive Level: Knowledge 

DIF: Easy 

TOP: Therapeutic Classification: Bronchodilators 

REF: Page 595

28. A client with Alzheimer is started on Razadyne (galantamine) 4 mg twice daily. The family has been told to return to the physician’s office in 4 wk. Which of the following statements by the nurse is best?
A. “Sometimes a higher dose of this medication is needed to see improvement.”
B. “You should notice improvement within a day or two.”
C. “If you forget a dose one day, just have her take two the next day.”
D. “This medication can cause dizziness so be extra careful to avoid falls.”

ANS: D
See Patient/Family Teaching. Increased dosage may be needed but the risk of falls due to dizziness is a higher priority. Improvement may not been seen for weeks to months and doses should not be doubled.

KEY: Cognitive Level: Analysis 

DIF: Medium 

TOP: Therapeutic Classification: Anti-Alzheimer agents 

REF: Page 608

29. While observing in the operating room, the student nurse notes a client was given Robinul (glycopyrrolate) pre-operatively as part of the anesthesia regimen. The student recognizes this medication will cause which of the following?
A. Decreased pain perception during the procedure
B. Reduced oral and respiratory secretions
C. Neuromuscular blockage and paralysis
D. Reduced consciousness and sedation

ANS: B
See Indications for glycopyrrolate: Inhibits salivation and excessive respiratory secretions when given preoperatively.

KEY: Cognitive Level: Comprehension 

DIF: Medium 

TOP: Therapeutic Classification: Antispasmodics 

REF: Page 619

30. The nurse is preparing to provide a chemotherapy treatment for a client with non-small cell lung cancer. It is day 8 of the 28-day chemotherapy cycle and the client is scheduled to receive Gemzar (gemcitabine) IV. Match the following nursing actions in the correct order for provision.

A. Infuse over 30 min.
B. Identify absolute granulocyte and platelet counts.
C. Monitor vital signs every 15 min.
D. Obtain medication from pharmacy.

1. ANS: B
2. ANS: D
3. ANS: A
4. ANS: C

See Nursing Implications/labs for gemcitabine: Dose guidelines are based on CBC results, so this must be determined first. Administer over 30 min—longer infusions have a greater incidence of toxicity. Monitor vital signs before and frequently during therapy.

KEY: Cognitive Level: Analysis
DIF: Easy
TOP: Therapeutic Classification: Antineoplastics
REF: Pages 612-613

31. While working in the psychiatric hospital, the nurse provides Fanapt (iloperidone) 2 mg twice daily. Which of the following assessments indicates the medication is effective?
A. The client’s mood is stabilized.
B. The client is able to sleep for 8 hr at night.
C. The client denies hearing voices.
D. The client’s weight is stabilized.

ANS: C
See Action/Therapeutic Effects: Decreased symptoms of schizophrenia.

KEY: Cognitive Level: Application 

DIF: Medium 

TOP: Therapeutic Classification: Antipsychotics 

REF: Page 672

32. The nurse is caring for a client newly admitted with pelvic inflammatory disease. An order for Primaxin (imipenem/cilastatin) 500 mg IV every 6 hr is noted. The nurse would be most concerned by which of the following findings in the client’s history?
A. Use of an intrauterine device for birth control
B. Family history of hypertension
C. Order for morphine sulfate 2 mg IV every 4 hr as needed for pain
D. History of seizures

ANS: D
See Contraindications/Precautions for imipenem/cilastatin. Previous history of seizure disorder—medication can cause seizures.

KEY: Cognitive Level: Application 

DIF: Easy 

TOP: Therapeutic Classification: Anti-infectives 

REF: Page 677

33. The nurse responds to a call light for a client with chronic obstructive pulmonary disease and finds the client slightly dyspneic with a respiratory rate of 20 and wheezing noted in the anterior and posterior upper lung fields. The nurse knows the client has orders for Arcapta (indacaterol) inhaler once daily, which is due in 1 hr. Which of the following actions by the nurse is best?
A. Provide the Arcapta (indacaterol) inhaler at this time.
B. Check the client’s temperature.
C. Determine if the client has an order for other respiratory inhalers/treatment.
D. Identify the most recent chest x-ray results.

ANS: C
See Nursing Implications: Consult health care professional about alternative medications if severe bronchospasm is present; onset of action is too slow for client in acute distress.

KEY: Cognitive Level: Analysis 

DIF: Medium 

TOP: Therapeutic Classification: Bronchodilators 

REF: Page 682

34. The nurse is providing care for a client with end stage renal disease who is receiving Fosrenol (lanthanum carbonate). The nurse recognizes this medication is effective by which of the following laboratory values?
A. Serum potassium = 3.7 mEq/L
B. Hemoglobin = 10.2 g/dL
C. Uric acid = 3.7 mg/dL
D. Serum phosphate = 5.4 mg/dL

ANS: D
See Evaluation/Desired Outcome: Decrease in serum phosphate to below 6.0 mg/dL in clients with end stage renal disease.

KEY: Cognitive Level: Analysis

DIF: Medium 

TOP: Therapeutic Classification: Hypophosphatemics 

REF: Page 747

35. While observing in the oncology clinic, a student nurse is reviewing chemotherapy orders for a client with advanced colorectal cancer. The nurse providing care explains the client is to receive “high dose methotrexate with leucovorin rescue.” The student understands the leucovorin calcium is given for which of the following reasons?
A. As a catalyst to increase the number of cancer cells destroyed by the methotrexate.
B. As an antidote to the methotrexate to reduce the destruction of blood cells.
C. As a second chemotherapeutic agent that will destroy cancer cells using a different mechanism.
D. As a carrying agent to ensure delivery of the methotrexate into the cells.

ANS: B
See Indications of leucovorin calcium: Minimizes hematologic effects of high-dose methotrexate therapy.

KEY: Cognitive Level: Comprehension 

DIF: Medium 

TOP: Therapeutic Classification: Antidotes 

REF: Page 759

36. The student nurse reviews a list of medications a client takes at home. Xopenex (levalbuterol) is on the list. The student expects this medication is provided in which of the following ways?
A. Orally
B. Topically
C. Rectally
D. Metered dose inhaler

ANS: D
See Availability: Metered dose inhaler.

KEY: Cognitive Level: Knowledge 

DIF: Easy 

TOP: Therapeutic Classification: Bronchodilators 

REF: Page 764

MULTIPLE RESPONSE

37. A student nurse is preparing to participate in a mission-trip to South Africa and is prescribed Plaquenil (hydroxychloroquine). Which of the following side effects may be experienced by the student? Select all that apply.
A. Rash
B. Headache
C. Ringing in the ears
D. Anorexia
E. Diarrhea
F. Hypertension

ANS: B, C, D, E
See Adverse Reactions/Side Effects of hydroxychloroquine: Can cause headache, fatigue, hypotension (not hypertension), abdominal cramps, diarrhea, anorexia, alopecia, photosensitivity, and hyper pigmentation (not rash).

KEY: Cognitive Level: Knowledge

DIF: Hard 

TOP: Therapeutic Classification: Antimalarials 

REF: Pages 661-662

38. As part of a new treatment regimen for hypothyroidism, a 48-year-old woman is prescribed Levoxyl (levothyroxine). The nurse should include which of the following statements in the client teaching? Select all that apply.
A. “You should take this medication at roughly the same time each day.”
B. “Once you’ve been taking this medication for a few weeks, you should be cured and the doctor will stop it.”
C. “Let the doctor know if you lose more than 2 pounds per week while taking this medication.”
D. “Do not take this medication at the same time as any other medications.”
E. “Avoid eating beef or pork while taking this medication.”
F. “Some clients experience headaches, nervousness, sweating, and palpitations while taking this medication.”

ANS: A, C, D, F
See Patient/Family Teaching for levothyroxine. Instruct patient to take medication as directed at the same time each day. Explain the medication does not cure hypothyroidism; therapy is life-long. Advise patient to notify health care provider if headache, nervousness, diarrhea, excessive sweating, heat intolerance, weight loss of more than 2 pounds/wk, or any unusual symptoms occur. Caution patient to avoid taking other medications concurrently.

KEY: Cognitive Level: Analysis

DIF: Medium 

TOP: Therapeutic Classification: Hormones 

REF: Page 771

39. The nurse is providing care for a client who has new orders to start Victoza (liraglutide) 0.6 mg subcutaneously each day. Which of the following orders should the nurse anticipate? Select all that apply.
A. Check blood sugar before meals and at bedtime.
B. Teach client self-injection techniques.
C. Conduct liver function tests every morning for the next 3 days.
D. Discontinue low molecular weight heparin.
E. Notify physician of acute abdominal pain, nausea, or vomiting.
F. Hold all aspirin products.

ANS: A, B, E
See Indications, Availability, and Assessment for liraglutide: Used in the management of type 2 diabetes, provided as a subcutaneous injection with/without pre-filled pen, monitor for pancreatitis. No contraindication for heparin or aspirin products; no change in liver enzymes expected.

KEY: Cognitive Level: Application 

DIF: Medium 

TOP: Therapeutic Classification: Antidiabetics 

REF: Pages 781-782

40. A nurse from the medical unit is floated to the surgical unit. While preparing to provide morning medications, the nurse realizes many clients are taking Demerol (meperidine) and knows the drug must be given cautiously or in reduced doses to which of the following clients? Select all that apply.
A. A 42-year-old patient taking Nitro-Bid (nitroglycerine)
B. A 68-year-old patient taking Prozac (fluoxetine)
C. A 74-year-old patient taking Matulane (procarbazine)
D. A 66-year-old patient taking Dilantin (phenytoin)
E. A 51-year-old patient taking Zovirax (acyclovir)
F. A 76-year-old patient taking Synthroid (levothyroxine)

ANS: C, D, E
See Interactions Drug-Drug for meperidine: Do not use in clients receiving MAO inhibitors or procarbazine. Phenytoin increases metabolism and may decrease effects. Acyclovir may increase plasma concentrations. No listed interaction with nitroglycerine, fluoxetine, or levothyroxine.

KEY: Cognitive Level: Application 

DIF: Hard 

TOP: Therapeutic Classification: Opioid analgesics 

REF: Pages 814-815

41. A nurse caring for a client who is to initiate therapy with Merrem (meropenem) 500 mg intravenously every 12 hr would include which of the following statements in the client teaching? Select all that apply.
A. “This medication is used to treat various infections.”
B. “The dose is reduced since you have a history of renal impairment.”
C. “Be sure to let us know if you develop any diarrhea.”
D. “Since you have an allergy to penicillin, there is no risk of allergy to this medication.”
E. “The medication can cause dizziness for some people so be sure to call for help when you need to get up out of bed.”

ANS: A, B, C, E
See Indications, Route/Dosage (Renal Impairment), and Patient/Family Teaching for meropenem. Treatment of intra-abdominal infections, bacterial meningitis, skin and skin structure infections, reduce dose to 500 mg every 12 hr CCr 10–25 mL/min, caution patient to notify health care provider with fever and diarrhea; may cause dizziness.

KEY: Cognitive Level: Application 

DIF: Medium 

TOP: Therapeutic Classification: Anti-infectives 

REF: Pages 817-819

42. Which of the following would cause the nurse to suspect that a client taking Glucophage (metformin) may be developing lactic acidosis? Select all that apply.
A. Client reports chills and muscle aches.
B. Blood pressure = 98/54 mmHg.
C. Client reports profound headache and ringing in the ears.
D. Client complains of dizziness and diarrhea.
E. White blood cell count = 7,500 cell/mm³.
F. Pupils are dilated and unresponsive to light.

ANS: A, B, D
See Patient/Family Teaching for metformin. Explain to patient the risk of lactic acidosis. Symptoms include chills, diarrhea, dizziness, low BP, muscle pain, sleepiness, slow heartbeat or pulse, dyspnea, or weakness.

KEY: Cognitive Level: Analysis 

DIF: Hard 

TOP: Therapeutic Classification: Antidiabetics 

REF: Page 826

43. The nurse is caring for a client taking Skelaxin (metaxalone). The nurse knows teaching has been effective by which of the following statements? Select all that apply.
A. “I might be constipated while I’m on this medication.”
B. “Most people who take this medication have fewer muscle spasms and less pain.”
C. “This can cause dizziness, blurred vision, and sleepiness so I shouldn’t drive while I’m on it.”
D. “I need to move slowly so I don’t faint.”
E. “I can drink up to 2 beers per day safely while I’m on this medication.”
F. “If I forget this medication, I can take it within one hour or skip that dose and remain on the schedule.”

ANS: B, C, D, F
See Patient/Family Teaching for metaxalone: Used for muscle spasm. Medication may cause dizziness, drowsiness, and blurred vision. Advise patient to avoid driving and other activities requiring alertness. Instruct patient to make position changes slowly to minimize orthostatic hypotension. Instruct patient to take medication as directed, take missed doses within 1 hr, if not, and return to regular dosing schedule. Advise patient to avoid concurrent use of alcohol and other CNS depressants. Does not usually cause constipation. 

KEY: Cognitive Level: Application 

DIF: Medium 

TOP: Therapeutic Classification: Skeletal muscle relaxants 

REF: Page 824

44. While providing care for a 45-year-old woman client who has been started on Tapazole (methimazole) 15 mg every 4 hr, the nurse would include which of the following in the plan of care? Select all that apply.
A. Teach client self-injection techniques.
B. Monitor for signs and symptoms of hyper- or hypothyroidism.
C. Place client in protective isolation.
D. Assess white blood cell and differential counts.
E. Strain all urine.
F. Monitor for signs or symptoms of bleeding.

ANS: B, D
See Nursing Implications for methimazole: Monitor response for symptoms of hyperthyroidism; assess for development of hypothyroidism. Monitor WBC and differential counts periodically during therapy. Medication is provided orally, no effect on urine or formation of kidney stones, does not require protective isolation or cause bleeding.

KEY: Cognitive Level: Application 

DIF: Hard 

TOP: Therapeutic Classification: Antithyroid agents 

REF: Page 830

45. While reviewing a client’s medication list, the nurse notes the client takes Remeron (mirtazapine) 15 mg daily. The nurse recognizes this medication has multiple indications and is used both on and off label for various reasons including which of the following? Select all that apply.
A. Major depressive disorder
B. Schizophrenia
C. Anorexia nervosa
D. Panic disorder
E. Generalized anxiety disorder
F. Post-traumatic stress disorder

ANS: A, D, E, F
See Indications for mirtazapine: Major depressive disorder. Unlabeled use: panic disorder, generalized anxiety disorder, post-traumatic stress disorder.

KEY: Cognitive Level: Application 

DIF: Hard 

TOP: Therapeutic Classification: Antidepressants 

REF: Page 865

46. While caring for a client receiving methyldopa for hypertension, the nurse recognizes elevations in which of the following labs may be caused by the medication? Select all that apply.
A. Serum creatinine
B. White blood cells
C. Amylase
D. Albumin
E. Potassium
F. Sodium

ANS: A, E, F
See Nursing Implications for methyldopa: May cause increase in BUN, serum creatinine, potassium, sodium, prolactin, uric acid, AST, ALT, alkaline phosphatase, and bilirubin concentration.

KEY: Cognitive Level: Application 

DIF: Medium 

TOP: Therapeutic Classification: Antihypertensives

REF: Page 836

COMPLETION

47. A new order for Foscavir (foscarnet) 60 mg/kg IV every 8 hr has been noted. The patient weighs 50 kg. With a dilution required concentration of 12 mg/mL, what size IV bag will the nurse need to infuse this medication ___________________?

ANS: 250 mL IV bag
See Implementation/IV Administration for foscarnet: Drug calculation: 60 mg x 50 kg = 3,000 mg. 3,000 mg divided by 12 mg = 250. The nurse will need a 250 mL IV bag. 

KEY: Cognitive Level: Application 

DIF: Easy 

TOP: Therapeutic Classification: Antivirals 

REF: Pages 597-598

48. The nurse receives orders to begin Robaxin (methocarbamol) 4.5 grams per day in 3 equally divided doses. The medication is available in 500 mg tablets. How many pills will the nurse provide with each dose? __________ pills

ANS: 3
Dose calculation: 4.5 grams divided by 3 is 1.5 grams per dose. 1.5 grams x 1,000 mg/g divided by 500 mg/tablet = 3 tablets

KEY: Cognitive Level: Application 

DIF: Easy 

TOP: Therapeutic Classification: Skeletal muscle relaxants 

REF: Page 831 

49. The nurse is preparing to start therapy with IV Dobutrex (dobutamine). The pre-mixed solution has 250 mg in 250 mL. The orders read 5 mcg/kg/min and the client weighs 165 pounds. At what rate, expressed in mL/hr, should the infusion be started? (Round to the nearest tenths place.) ___________ mL/hr

ANS: 22.5
See Route/Dosage and Availability for dobutamine. Drug calculation involves converting client’s weight to kg [165 divided by 2.2 = 75 kg] followed by calculation of the dose [5 mcg x 75 kg = 375 mcg/min] followed by dose conversion to mg [375 divided by 1,000 = 0.375 mg/min] followed by calculation for an hourly rate [0.375 x 60 = 22.5 mg/hr] since the solution has 1 mg/mL, the final conversion does not change the rate [22.5 x 1 = 22.5 mL/hr].

KEY: Cognitive Level: Knowledge 

DIF: Hard 

TOP: Therapeutic Classification: Inotropics 

REF: Page 449