some are wrong answers
many mistakes in this answers
____ 1. A nurse is acting as a preceptor for a new nurse on the oncology unit. To evaluate the new nurse’s understanding of pain, the nurse asks, “Which statement is correct regarding the differences between nociceptive and neuropathic pain?”
a. The two types of pain result from injury to nerves.
b. The two types of pain respond differently to analgesic drugs.
c. Somatic pain is a common subtype of neuropathic pain.
d. Neuropathic pain is more common than nociceptive pain in cancer patients.
____ 2. A nurse is caring for a patient undergoing chemotherapy. A patient asks for ibuprofen (Motrin) and states, “I didn’t bring mine with me. I usually take them about four times a day. The nurse should notify the prescriber and anticipate an order for a(n)
a. serum creatinine level. c. salicylate level.
b. platelet count. d. absolute neutrophil count.
____ 3. A patient with cancer has been undergoing chemotherapy and also has risk factors associated with thrombocytopenia. The patient rates the pain as a 5 on a scale of 0 to 10, with 10 being the greatest pain. Which medication would the nurse anticipate being ordered for this patient?
a. Ibuprofen (Motrin) c. Acetylsalicylic acid (aspirin)
b. Celecoxib (Celebrex) d. Choline salicylate (Arthropan)
____ 4. When asked the significance of tolerance as it relates to drug therapy, the nurse’s best response would be that
a. “It means more drug is needed to produce the same effect after opioids have been used for longer than 1 to 2 weeks.”
b. “Addiction to opioids is developing, and the drugs should be discontinued.”
c. “The patient needs a smaller amount of drug to produce the same effect.”
d. “Organ toxicity has occurred, and the drug should be discontinued.”
____ 5. A nurse is caring for an anxious patient who has cancer. The patient has been experiencing nausea, and his pain is controlled most of the time by opiate analgesics. What prn medication can the nurse administer to help alleviate the nausea and also facilitate pain control?
a. Dextroamphetamine (Dexedrine) c. Hydroxyzine (Vistaril)
b. Carbamazepine (Tegretol) d. Dexamethasone (Decadron)
____ 6. A nurse is providing patient education about the use of a fentanyl transdermal delivery system. The nurse correctly instructs the patient to administer the patch at what time?
a. When pain recurs c. Every 72 hours
b. Every 24 hours d. Once a week
____ 7. A prescriber orders sumatriptan (Imitrex) for a patient for a migraine headache. Prior to administration of this drug, it would be important for the nurse to gather which vital assessment information?
a. Does the patient have a family history of migraines?
b. Has the patient taken ergotamine in the past 24 hours?
c. Has the patient taken acetaminophen in the past 3 hours?
d. Is the patient allergic to sulfa compounds?
____ 8. A 27-year-old female patient comes to the clinic with complaints of increasingly frequent migraines. The patient has been taking nonsteroidal anti-inflammatory drugs for previous migraines but states that they are not as effective as they once were. The patient is prescribed ergotamine with a first dose now. What action should the nurse take?
a. Ask the patient if she is pregnant or thinks she may be pregnant.
b. Instruct the patient to take the medication with food.
c. Instruct the patient to avoid the concurrent use of nonsteroidal anti-inflammatory drugs.
d. Have the laboratory draw blood for a complete blood count.
____ 9. A nurse teaching a class on migraine headaches is discussing ergotamine. One of the class participants asks the nurse why ergotamine is coupled with caffeine. Which of the following statements is most appropriate for the nurse to give?
a. “Caffeine is used to counteract the fatigue caused by ergotamine.”
b. “Caffeine is given with ergotamine to suppress emesis.”
c. “Caffeine enhances vasoconstriction and ergotamine absorption.”
d. “Caffeine potentiates the analgesic effects of ergotamine.”
____ 10. Haloperidol (Haldol Decanoate) has been ordered for a patient admitted with schizophrenia. A nurse understands that this drug should be administered at what intervals?
a. Twice per day c. Every 2 to 4 weeks
b. Once per week d. As needed
____ 11. A nurse is providing patient education for a patient just starting therapy with an antipsychotic agent. The nurse teaches the patient about the extrapyramidal effects of antipsychotic drugs and provides information about symptoms that may develop early in therapy. The patient demonstrates understanding when he identifies which of the following as early extrapyramidal symptoms?
a. Mild spasms of the muscles of the tongue, face, neck, or back
b. Pacing and squirming
c. Involuntary upward deviation of the eyes
d. Cramping that causes joint dislocation
____ 12. Since the initiation of an antipsychotic drug, a patient complains of light-headedness and dizziness upon standing. What is the most appropriate comment the nurse can offer the patient?
a. “This is an unfortunate and permanent effect of this class of drugs.”
b. “Get up slowly. Tolerance to this effect should develop in 2 to 3 months.”
c. “The drug must be discontinued immediately to avoid injury.”
d. “We need to increase your fluid intake, which should fix the problem.”
____ 13. A patient taking an antipsychotic agent begins to drool and displays tremors, rigidity, and a shuffling gait. The nurse is correct to suspect that the patient is experiencing extrapyramidal symptoms that are consistent with assessment findings for which of the following disorders?
a. Akathisia c. Parkinsonism
b. Tourette’s syndrome d. Tardive dyskinesia
____ 14. A nurse is checking on patients. The nurse enters the room of a patient who takes an antipsychotic agent. The patient is confused, has a sudden fever, and develops “lead pipe” rigidity. The nurse recognizes these as symptoms of which of the following?
a. Tardive dyskinesia c. Neuroleptic malignant syndrome
b. Acute dystonia d. Parkinsonism
____ 15. An obesity-prone patient who takes an antipsychotic agent has been trying diligently to lose weight. The patient expresses her concern to the nurse and asks, “Is there a medication that I can take that causes less weight gain than the others?” The nurse would be correct to suggest to the patient that she discuss with the prescriber the possibility of switching to which drug?
a. Thioridazine (Mellaril) c. Olanzapine (Zyprexa)
b. Quetiapine (Seroquel) d. Ziprasidone (Geodon)
____ 16. A nurse assesses a patient receiving perphenazine (Trilafon), a traditional antipsychotic medication. The nurse notices that the patient is squirming and pacing. When composing the nurse’s notes, the nurse would describe the assessment findings by which terminology?
a. Dystonia c. Parkinsonism
b. Central nervous system effects d. Akathisia
____ 17. Clozapine (Clozaril) is prescribed for a patient with a schizophreniform disorder. Which information would be the most important to include in the teaching plan for this patient?
a. Strategies to manage breast enlargement and nipple discharge
b. The importance of promptly reporting flulike symptoms
c. Contraceptive measures and expected changes in menstruation
d. Proper technique for measuring blood pressure
____ 18. A nurse is reviewing a patient’s antidepressant medications. The nurse understands that the monoamine oxidase inhibitor antidepressants are typically used for which patient?
a. A patient who has just started on antidepressants
b. A patient who has not responded to selective serotonin reuptake inhibitors and tricyclic antidepressants
c. A patient who has developed serotonin syndrome
d. A patient who has difficulty sleeping
____ 19. A patient diagnosed with panic disorder is placed on a tricyclic antidepressant. The patient asks a nurse when the medication will take full effect. The nurse’s best response would be which of the following time frames?
a. 3 to 7 days c. 1 to 2 months
b. 1 to 3 weeks d. 6 months
____ 20. A nurse is providing education to nurses in the psychiatric unit on antidepressant medications. To evaluate their learning, the educator asks one of the nurses, “How does fluoxetine (Prozac) achieve its effects?” The nurse would be correct to state that fluoxetine (Prozac) achieves its effects by which of the following mechanisms of action?
a. Selectively inhibiting serotonin reuptake
b. Blocking the uptake of monoamines
c. Inhibiting monoamine oxidase-A in nerve terminals
d. Direct stimulation of serotonin receptors
____ 21. A patient taking amitriptyline (Elavil) complains of having blurred vision and dry mouth, and he states that he hasn’t had a bowel movement in 3 days, whereas he normally has one daily. His vital signs are temperature 97.6° F, pulse 78/minute, blood pressure 130/79 mm Hg, and respirations 20/minute. Based on this assessment, the nurse should suspect which of the following causes?
a. Possible toxicity c. Dehydration
b. Cholinergic effects d. Anticholinergic effects
____ 22. A college student is brought into the emergency department. Her friends state that she took at least 20 antidepressant pills all at once. Which of the following antidepressants could lead to the worst outcome for the patient?
a. Venlafaxine (Effexor) c. Paroxetine (Paxil)
b. Fluoxetine (Prozac) d. Sertraline (Zoloft)
____ 23. A patient with a history of gastric ulcers is admitted to the unit. A nurse reviews the admission medications. During the health history, the nurse notes that the patient has been taking nonsteroidal anti-inflammatory drugs and fluoxetine (Prozac). With regard to laboratory tests, the nurse’s priority should be to make sure the prescriber has ordered which of the following?
a. Sodium level c. Fluoxetine (Prozac) level
b. Platelet level d. Potassium level
____ 24. A nurse is reviewing a patient’s laboratory findings prior to medication administration. The most recent serum lithium level is 2.2 mEq/L and was drawn yesterday. The patient takes 300 mg of lithium carbonate four times a day. Which of the following is the nurse’s most appropriate action?
a. Administer the drug as prescribed.
b. Recognize that the dose is subtherapeutic.
c. Administer half of the dose.
d. Hold the next dose and notify the prescriber.
____ 25. A nurse is discussing a patient’s lithium levels with another nurse. The laboratory findings show a lithium level of 0.6 mEq/L. Which statement made by one of the nurses best demonstrates an understanding of lithium levels?
a. “The patient’s plasma level is below the toxic level of 3 mEq/L and is considered therapeutic.”
b. “The patient’s plasma level exceeds 0.5 mEq/L and is therefore toxic.”
c. “The patient’s plasma level is between 0.4 and 1 mEq/L and is considered therapeutic.”
d. “The patient’s plasma level is below the 2.5 mEq/L level that would indicate toxicity.”
____ 26. A patient with a history of bipolar disorder has been on lithium therapy for 3 years. The patient begins to develop hypertension. Which class of drugs, if given concurrently with lithium, would result in an adverse drug-to-drug interaction?
a. ACE inhibitors c. Diuretics
b. Vasodilators d. Calcium channel blockers
____ 27. A nurse is reviewing medications for a patient with bipolar disorder. The nurse has received an order to discontinue the lithium and begin valproic acid (Depakene). The nurse understands the prescriber’s change of order based on which mechanism of action?
a. Valproic acid works slower and has a lower therapeutic index.
b. Valproic acid has no serious side effects.
c. Valproic acid does not require plasma drug levels.
d. Valproic acid works faster and has a higher therapeutic index.
____ 28. A nurse is reviewing laboratory findings for a patient with bipolar disorder. The patient is to be started on carbamazepine (Tegretol). Which laboratory value should the nurse be prepared to obtain as a baseline level?
a. Blood urea nitrogen c. Complete blood count
b. Direct bilirubin d. Thyroid function studies
____ 29. A patient is being treated for muscle spasms. A nurse is preparing to administer a prn medication for this patient. The nurse is aware that the only benzodiazepine commonly used to relieve muscle spasm is which of the following?
a. Diazepam (Valium) c. Estazolam (Prosom)
b. Lorazepam (Ativan) d. Clonazepam (Klonopin)
____ 30. A nurse is assessing a patient on benzodiazepines who exhibits drowsiness, lethargy, and confusion and has respirations of 11/minute. The nurse recognizes these signs and symptoms and should prepare to administer which drugs ordered by the prescriber?
a. Flumazenil (Romazicon) c. Epinephrine (Adrenaline)
b. Naloxone (Narcan) d. Atropine (AtroPen)
____ 31. A nurse is making patient rounds and determines that one of the patients is having paradoxical symptoms related to the use of benzodiazepines. Which of the following symptoms would the patient manifest?
a. Insomnia, excitation, euphoria, and rage
b. Laryngeal edema, hypotension, and wheals
c. Vasodilation, flushing, and orthostatic hypotension
d. Confusion, central nervous system depression, and disorientation
____ 32. A drug representative is providing education on barbiturates to the nurses on a unit. The drug representative correctly explains that most barbiturates are considered nonselective central nervous system depressants, with the exception of
a. thiopental. c. butabarbital (Butisol).
b. secobarbital (Seconal). d. phenobarbital (Luminal).
____ 33. A patient is brought to the emergency department by friends, who say that they were all partying with alcohol and a mix of barbiturates and benzodiazepines. They state that the patient had “a lot to drink and took a handful of pills a couple of hours ago.” Upon assessment, the patient is nonresponsive and has pinpoint pupils and respirations of 6/minute. After oxygen is administered, the nurse should prepare the patient for which of the following interventions?
a. Both gastric lavage and hemodialysis
b. Both naloxone (Narcan) and a cathartic
c. Both activated charcoal and flumazenil (Romazicon)
d. Both a central nervous system stimulant and IV fluids
____ 34. A patient on triazolam (Halcion) begins to complain of forgetfulness. The nurse should consider the possibility that which of the following effects may be occurring?
a. Retrograde amnesia c. The expected effect
b. Toxicity d. Anterograde amnesia
____ 35. A patient taking fluoxetine (Prozac) complains of insomnia. The nurse reports the patient’s complaint to the prescriber and should anticipate that which of the following medications would be ordered?
a. Trazodone (Desyrel) c. Diphenhydramine (Nytol)
b. Ramelteon (Rozerem) d. Zolpidem (Ambien)
____ 36. A patient is to continue taking sustained-released benzodiazepines at home. A nurse has provided patient education about the medication. Which statement made by the patient demonstrates the need for further teaching?
a. “I can take my medicine with food to reduce stomach upset.”
b. “I should take two pills if I miss a dose.”
c. “I should not crush or chew my pills.”
d. “I should try not to drive if I am sleepy during the day.”
____ 37. A patient is brought to the emergency department in a state of extreme uncontrolled anxiety. The prescriber orders a benzodiazepine. A nurse understands that benzodiazepines are used in this clinical situation based on which of the following principles?
a. Benzodiazepines have a very short half-life.
b. There is no risk of physical dependence when taking benzodiazepines.
c. Benzodiazepines are known to cure generalized anxiety.
d. Benzodiazepines have a rapid onset of action.
____ 38. A nurse provides education for a patient who has just started taking buspirone (BuSpar). The patient asks the nurse, “When should I expect to see the best effect from the medication?” The nurse’s best response would be based on the understanding that the effects of buspirone begin in most patients during which time frame?
a. 3 days c. 1 day
b. 24 to 48 hours d. 4 to 6 weeks
____ 39. A patient is being discharged from the hospital on buspirone (BuSpar). A nurse is providing education on the effects and side effects of the medication. What statement made by the patient would most concern the nurse?
a. “I will take the medication with grapefruit juice.”
b. “I will limit alcohol-containing products.”
c. “I can take the medication with food.”
d. “This drug is not addicting.”
____ 40. A patient who is also a nurse is being treated for anxiety with a selective serotonin reuptake inhibitor. The patient asks about the rationale for use of this agent rather than a benzodiazepine. Which of the following is the nurse’s best response?
a. “Selective serotonin reuptake inhibitors are better for the control of bodily symptoms than benzodiazepines.”
b. “Selective serotonin reuptake inhibitors provide a more rapid and durable response to the uncomfortable anxiety symptoms.”
c. “Benzodiazepines currently have no role in the treatment of anxiety.”
d. “Selective serotonin reuptake inhibitors are better for reducing the cognitive and psychic symptoms of anxiety than benzodiazepines.”
____ 41. A 7-year-old child is to begin taking methylphenidate (Ritalin SR) twice daily. The nurse should teach the parents to monitor the child closely for which of the following side effects of methylphenidate?
a. Insomnia c. Increased appetite
b. Lethargy d. Urticaria
____ 42. A toddler is brought to the emergency department by ambulance. The parents state that they think the child “got into something” at a friend’s house. The nursing assessment reveals stiffness in the face and neck and hyperreflexes. The nurse is correct to suspect ingestion of which of the following agents?
a. Strychnine c. Methamphetamine
b. Cocaine d. Modafinil (Provigil)
____ 43. An adolescent has been prescribed atomoxetine (Strattera) for attention-deficit/hyperactivity disorder. During the health history, the parents state that they hope this medication will improve the girl’s ability to make friends, because at times she seems so sad. In the discharge instructions to the patient and family, what teaching would be most important for the nurse to include?
a. Atomoxetine can cause nausea and vomiting.
b. Atomoxetine can cause suicidal thinking.
c. Atomoxetine can cause difficulty sleeping.
d. Atomoxetine can cause euphoria.
____ 44. A nurse is caring for a patient with meningitis who is receiving spironolactone (Aldactone). A prescriber writes an order for potassium penicillin. What considerations should the nurse focus on prior to administration?
a. Obtain the blood pressure. c. Assess the level of consciousness.
b. Obtain the serum potassium levels. d. Assess the serum sodium levels.
____ 45. A patient has 2+ pitting edema of the lower extremities bilaterally; auscultation of the lungs reveals crackles bilaterally; and the serum potassium level is 6 mEq/L. Which diuretic agent ordered by the prescriber should the nurse question?
a. Bumetanide (Bumex) c. Spironolactone (Aldactone)
b. Furosemide (Lasix) d. Hydrochlorothiazide (HydroDIURIL)
____ 46. A nurse is preparing to administer morning medications. The nurse notes that a patient with a history of hypertension is taking the ACE inhibitor captopril (Capoten) concurrently with spironolactone (Aldactone). Morning laboratory results reveal a serum sodium level of 144 mg/dL, a serum potassium level of 5.1 mEq/L, and a blood glucose level of 128 mg/dL. Which of the following interventions should the nurse use?
a. Administer the medications as ordered.
b. Clarify the order with the prescriber.
c. Hold the medication and recheck the potassium level.
d. Administer the captopril but hold the spironolactone until the potassium levels are lower.
____ 47. A patient has been taking furosemide (Lasix) for 6 months. A prescriber has just started the patient on digoxin (Lanoxin). Which of the following assessment data should most concern the nurse prior to the administration of digoxin?
a. Crackles and respirations of 22 breaths per minute
b. Digoxin level of 0.5 mg/dL
c. Blood pressure of 140/90 mm Hg
d. Apical pulse rate of 56 beats per minute
____ 48. A patient admitted with an infected right stump secondary to a below-the-knee amputation (BKA) also has heart failure. The patient is taking the aminoglycoside antibiotic gentamicin (Garamycin) and the diuretic furosemide (Lasix). What patient education should the nurse include?
a. Report any ringing in the ears or dizziness.
b. Report frequent nocturia.
c. Elevate the affected extremity.
d. Immediately report any tendon tenderness.
____ 49. A nurse is discussing the mechanism of action of spironolactone (Aldactone) with a group of nurses. The nurse states that spironolactone has been demonstrated to prolong survival as well as improve heart failure symptoms by which of the following actions?
a. Decreasing the excretion of sodium c. Redistributing edema
b. Blocking receptors for aldosterone d. Increasing the excretion of potassium
____ 50. Upon assessment a patient is found to have evidence of respiratory compromise from pulmonary edema. A nurse prepares to administer 40 mg of furosemide (Lasix) IV. How should the nurse administer the drug?
a. Give it in an IV push over 10 minutes.
b. Add the drug to 200 mL of fluid and give it over 20 minutes.
c. Give it in an IV push over 2 minutes.
d. Administer it over 2 hours in 250 mL of normal saline.
A nurse is checking on patients. The nurse enters the room of a patient who takes an antipsychotic agent. The patient is confused, has a sudden fever, and develops “lead pipe” rigidity. The nurse recognizes these as symptoms of which of the following?
Question # 13 answer is neuroleptic malignant syndrome
9.) is C. Caffeine enhances vasoconstriction and ergotamine absorption
a b c d e a d
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