NUR 635 FINAL EXAM 2 (VERSION A AND B) LATEST VERSIONS, Exams of Nursing

Download NUR 635 FINAL EXAM 2 (VERSION A AND B) LATEST VERSIONS and more Exams Nursing in PDF only on Docsity! 1 | P a g e NUR 635 FINAL EXAM 2 (VERSION A AND B) LATEST VERSIONS WITH ACTUAL CORRECT QUESTIONS AND VERIFIED DETAILED RATIONALES ANSWERS 2024(NEWEST) ALREADY GRADED A+ NURS 635 FINAL EXAM VERSION A A patient who has gastroesophageal reflux disease (GERD) receives a prescription for a proton pump inhibitor medication. What till the nurse include when teaching the patient about this drug? a. "The FDA has determined that there is a gastric cancer risk with this drug b. "This drug will be given on a short-term basis only" c. "You may experience hypermagnesemia when taking this drug" d. "You should report any fever and cough to your provider" d. "You should report any fever and cough to your provider" PPIs can increase the risk of community-acquired pneumonia. When determining appropriate antimicrobial treatment, the NP utilizes which tool to assess local resistance patterns? a. Antigen tests b. Antibiogram c. Antibiotic survey d. Culture and sensitivity testing b. Antibiogram Antibiogram shows local resistance patterns After receiving Flagyl for a diverticulitis flare up, the patient calls the clinic complaining of nausea, vomiting, and abdominal pain. The NP focuses on which part of the SOAP note to rule out a disulfiram reaction? a. HPI b. Medications c. Allergies d. Social history 2 | P a g e d. Social history focuses on alcohol use history 1. When metronidazole (Flagyl) is a component of the H. Pylori treatment regimen, the patient must be instructed to do what? a. Avoid any alcoholic beverages b. Avoids foods containing tyramine c. Take the drug on an empty stomach d. Take the drug with food a. Avoid any alcoholic beverages The patient should be instructed to avoid alcoholic beverages because a disulfiram-like reaction can occur if metronidazole is taken with alcohol Which patient should receive fluoroquinolone therapy for a CAP diagnosis? a. A 22-year-old postal worker b. A 44-year-old female with diabetes c. 58-year-old African American d. A 6-month-old immigrant b. A 44-year-old female with diabetes Anyone with a comorbidity should be treated. Sulfonamides should be avoided in patient's with a G6PD deficiency due to the risk of? a. Tendon rupture b. Steven Johnson's syndrome c. Hemolytic anemia d. Liver failure c. Hemolytic anemia A nurse is caring for an African-American who has been admitted to the unit for long-term antibiotic therapy with sulfonamides. The patient develops fever, pallor, and jaundice. The nurse would be correct to suspect that the patient has developed? a. Stevens-Johnson syndrome b. Kernicterus c. Hepatotoxicity d. Hemolytic anemia d. Hemolytic anemia 5 | P a g e A 2 year old child is seen in the clinic in July with otalgia, erythematous, bulging tympanic membranes (TMs), and rupture of the right TM. The child also has a temperature of 39.4 C. The child's parents tells the nurse, "This is the fifth ear infection this year. What can we do?". The nurse will expect the provider to: a. Administer ceftriaxone (Rocephin) IM and give the influenza vaccine b. Begin prophylactic antibiotic therapy with trimethoprim/sulfamethoxazole (Septra) c. Prescribe amoxicillin-clavulanate (Augmentin) and refer the child to an otolaryngolist d. Prescribe high-dose amoxicillin (Amoxil) and administer the influenza vaccine c. Prescribe amoxicillin-clavulanate (Augmentin) and refer the child to an otolaryngolist Recurrent AOM is defined as AOM that occurs three or more times within 6 months o four or more times in a year. Giving an antibiotic, such as Augment, is appropriate for each episode. A 6 year old is seen with symptoms of acute otitis media without a fever. The NP recommends which treatment for this patient? a. Watchful waiting, determine if symptoms resolve in 2-3 days spontaneously b. Watchful waiting with a post-dated prescription for antibiotics c. Start the patient on lidocaine drops to help with ear pain d. Refer the patient to the ER for further evaluation c. Start the patient on lidocaine drops to help with ear pain A provider has told a parent that a 3-year-old child has a minor ear infection and that an antibiotic would be prescribed in a couple of days if the child's symptoms worsened. The parent asks the nurse why the child cannot get an antibiotic today. Which response by the nurse is correct? a. "If the eardrum ruptures, we can culture the fluid to determine which antibiotic is best" b. "Most ear infection are caused by viruses, so antibiotics are not effective" c. "Most ear infections will resolve on their own without antibiotics" d. "Your child will develop tolerance to antibiotics if they are prescribed too often" c. "Most ear infections will resolve on their own without antibiotics" A patient begins using timolol (Timoptic) to treat primary open-angle glaucoma (POAG). The nurse gives a dose and notes that the patient develops shortness of breath. The nurse assesses the patient and auscultates wheezes in both lungs. The nurse will ask this patient about a history of which condition? a. Asthma b. Atrioventricular heart block c. Pulmonary hypertension d. Sinus bradycardia 6 | P a g e a. Asthma Timolol is a beta blocker and can precipitate bronchoconstriction when absorbed systemically. An adolescent has recently been experiencing pimples. The nurse notes several closed comedones across the patient's forehead and on the nose. The nurse will expect to teach the patient about the use of which medication? a. Benzoyl peroxide b. Topical clindamycin c. Topical erythromycin d. Topical retinoids a. Benzoyl peroxide Benzoyl peroxide is a first-line drug for mild to moderate acne. A patient will begin initial treatment for severe acne. What regimen will the nurse expect the provider to order? a. Clindamycin/benzoyl peroxide [BenzaClin] and tretinoin b. Doxycycline [Vibramycin] and tretinoin [Retin-A] c. Erythromycin [Ery-Tab] and benzoyl peroxide d. Topical clindamycin and isotretinoin [Accutane] b. Doxycycline [Vibramycin] and tretinoin [Retin-A] Oral antibiotics are used for moderate to severe acne and are usually combine with a topical retinoid. A 34-year-old female comes to the clinic complaining of dysuria, frequency, and urgency. Which additional information does the NP need prior to deciding on a treatment plan? a. Is the infection in the upper or lower urinary tract b. Does the patient have any history of predisposing factors c. Does the patient have a history of recent UTIs d. Is the patient pregnant a. Is the infection in the upper or lower urinary tract b. Does the patient have any history of predisposing factors c. Does the patient have a history of recent UTIs d. Is the patient pregnant A young, nonpregnant female patient with a history of previous urinary tract infection is experiencing dysuria, urinary urgency and frequency, and suprapubic pain of 3 days duration. She is afebrile. A urine culture is positive for more than 100,000 ml of urine. The nurse caring for this patient knows that which treatment is most effective? 7 | P a g e a. A 14-day course of amoxicillin with clavulanic acid (Augmentin) b. A 7-day course of ciprofloxacin (Cipro) c. A single dose of Fosfomycin (Monurol) d. A 3-day course of trimethoprim/sulfamethoxazole (Bactrim) d. A 3-day course of trimethoprim/sulfamethoxazole (Bactrim) Short course therapy is recommended for uncomplicated, community-acquired lower urinary tract infections Which patient with a urinary tract infection will require hospitalization and intravenous antibiotics? a. A 5-year-old child with a fever of 100.5 F, dysuria, and bacteriuria b. A pregnant woman with bacteriuria, suprapubic pain, and fever c. A young man with dysuria, flank pain, and a previous urinary tract infectin d. An older adult man with a low-grade fever, flank pain, and an indwelling catheter d. An older adult man with a low-grade fever, flank pain, and an indwelling catheter The patient with an indwelling catheter and signs of pyelonephritis shows signs of a complicated UTI, which is best treated with intravenous antibiotics A woman complains of burning on urination and increased frequency. The patient has a history of frequent urinary tract infections and is going out of town in 2 days. To treat the infection quickly, the nurse would expect the health care provider to order? a. Aztreonam (Azactam) b. Fosfomycin (Monurol) c. Trimethoprim/sulfamethoxazole (Bactrim) d. Vancomycin (Vancocin) b. Fosfomycin (Monurol) Fosfomycin has been approved for single-dose therapy of UTIs in women. A patient shows signs and symptoms of conjunctivitis. What aminoglycoside would the nurse expect to be ordered? a. Amikacin (Amikin) b. Kanamycin (Kantrex) c. Neomycin (neomycin) Paromomycin (humantin) c. Neomycin (neomycin) Neomycin is used for topical treatment of infections of the eye, ear, and skin. 10 | P a g e c. Norfloxacin (noroxin) d. Ciprofloxacin (Cipro) a. Daptomycin (cubicin) Daptomycin is active against MRSA A patient receiving a cephalosporin develops a secondary intestinal infection caused by C. diff. What is an appropriate treatment for this patient? a. Adding an antibiotic, such as vancomycin (Vancocin) to the patient's regimen b. Discontinuing the cephalosporin and beginning metronidazole (flagyl) c. Discontinuing all antibiotics and providing fluid replacement d. Increasing the dose of the cephalosporin and providing isolation measures b. Discontinuing the cephalosporin and beginning metronidazole (flagyl) Patients who develop C diff infection as a result of taking a cephalosporin o other antibiotics need to stop taking the antibiotic in question and begin taking either metronidazole or vancomycin. A patient with an infection caused by pseudomonas aeruginosa is being treated with piperacillin. The nurse providing care reviews the patient's laboratory reports and notes that the patient's blood urea nitrogen and serum creatinine levels are elevated. The nurse will contact the provider to discuss? a. Adding an aminoglycoside b. Changing to penicillin G c. Reducing the dose of piperacillin d. Ordering nafcillin c. Reducing the dose of piperacillin Patients with renal impairment should receive lower doses of piperacillin than patients with normal renal function. A child with an ear infection is not responding to treatment with amoxicillin (Amoxil). The nurse will expect the provider to order? a. Amoxicillin-clavulanic acid (Augmentin) b. Ampicillin c. Nafcillin d. Penicillin G (Benzylpenicillin) a. Amoxicillin-clavulanic acid (Augmentin) Beta-lactamase inhibitors are drugs that inhibit bacterial beta-lactamases. Augmentin contains amoxicillin and clavulanic acid and is often used when patients fail to respond to amoxicillin alone. 11 | P a g e An older adult patient with chronic obstructive pulmonary disease (COPD) develops bronchitis. The patient has a temperature of 39.5 C. The nurse will expect the provider to: a. Obtain a sputum culture and wait for the results before prescribing antibiotics b. Order empiric antibiotics while waiting for sputum culture results c. Treat symptomatically, because antibiotics are usually ineffective against bronchitis d. Treat the patient with more than one antibiotic without obtaining cultures b. Order empiric antibiotics while waiting for sputum culture results Patients with severe infections should be treated while culture results are pending. The nurse is obtaining a history from a patient who discloses daily use of St. Johns wort in addition to prescription drugs. Which effect of this dietary supplement would most concern the nurse? a. It accelerates the metabolism of some drugs b. It enhances the effects of digoxin c. It counteracts the effects of CNS depressants d. It increases the risk of bleeding a. It accelerates the metabolism of some drugs St. John's wort has the potential to interact with many drugs through three different mechanisms. One mechanism, induction of P450, accelerates the metabolism of many drugs. A patient will begin taking phentermine and topiramate (Osymia) to help with weight loss and asks the nurse why the second ingredient is necessary. Which is the correct response by the nurse? a. "Topiramate helps reduce the risk of seizures that can occur with phentermine" b. "Topiramate helps produce feelings of satiety to augment the drug effects" c. "Topiramate increases the appetite suppression caused by phentermine" d. "Topiramate increases the heart rate of weight loss by acting as a stimulant" b. "Topiramate helps produce feelings of satiety to augment the drug effects" Topiramate is an antiseizure medication that acts to induce a sense of satiety in patients taking the combination product. A patient has been taking phentermine and topiramate (Osymia) for 6 months for weight loss. The nurse weighs the patient and notes 3% weight loss since beginning the drug. The nurse will expect the prescriber to: a. Continue the current dosage for 4 more weeks b. Discontinue the drug c. Increase the drug dosage d. Switch to another nonamphetamine agent 12 | P a g e b. Discontinue the drug If a patient who is taking phentermine and topiramate has not lost 5% of weight by 6 months, the drug should be discontinued An adult who has been self-medicating using nutritional therapy for an elevated cholesterol level, complains of repeated episodes of flushing. The nurse suspects that the patient has been taking: a. Niacin b. Thiamine c. Riboflavin d. Pyridoxine a. Niacin Niacin is used to reduce cholesterol levels. When taken in large doses, nicotinic acid can cause vasodilation, with resultant flushing, dizziness, and nausea A patient with a history of elevated triglycerides and LDL cholesterol begins taking nicotinic acid [Niacin]. The patient reports uncomfortable flushing of the face, neck, and ears when taking the drug. What will the nurse advise the patient? a. "Ask your provider about taking an immediate-release form of the medication" b. "Ask your provider about assessing your serum uric acid levels which may be elevated" c. "You should stop taking the niacin immediately since this is a serious adverse effect" d. "You should take 325 mg of aspirin half an hour before each dose of Niacin to prevent this effect" d. "You should take 325 mg of aspirin half an hour before each dose of Niacin to prevent this effect" Intense flushing of the face, neck, and ears occurs in practically all patients taking nicotinic acid in pharmacologic doses. A nurse is caring for a patient who is undergoing a third round of chemotherapy is preparing to administer ondansetron (Zofran) 30 minutes before initiation of the chemotherapy. The patient tells the nurse that the ondansetron did not work as well the last time as it had the first time. What will the nurse do? a. Administer the ondansetron at the same time as the chemotherapy b. Contact the provider to suggest using high-dose intravenous dolasetron [Anzemet] c. Request an order to administer dexamethasone with the ondansetron d. Suggest to the provider that loperamide [Lomotil] be given with the ondansetron c. Request an order to administer dexamethasone with the ondansetron Ondansetron is a serotonin receptor antagonist; drugs in this class are the most effective drugs available for suppressing nausea and vomiting associated with anticancer drugs. The drug is even more effective when combined with dexamethasone 15 | P a g e C. Question the patient about the consumption of milk and any other dairy products D. Request an order to increase this patient's dose of glucocorticoids A. Withhold the dose of ciprofloxacin and notify the provider of the patient's symptoms A rare but serious adverse effect associated with fluoroquinolones is tendon rupture. A nurse caring for a 5-year-old child notes that the child has discoloration of several teeth. When taking a medication history, the nurse will ask about which group of medications? a. Glucocorticoids b. Salicylates c. Sulfonamides d. Tetracyclines d. Tetracyclines Tetracyclines cause discoloration in developing teeth in children. 1. To prevent yellow or brown discoloration of teeth in children, tetracyclines should not be given: a. To children once permanent teeth develop b. To patient taking calcium supplements c. To pregnant patients after the fourth month of gestation d. With dairy products or antacids c. To pregnant patients after the fourth month of gestation Tetracyclines bind to calcium in developing teeth, resulting in yellow or brown discoloration. They should not be given to pregnant women after the fourth month of gestation because it will cause staining of deciduous teeth in the fetus. A pregnant adolescent patient asks the nurse whether she should continue to take her prescription for tetracycline [Sumycin] to clear up her acne. Which response by the nurse is correct? a. "Tetracycline can be harmful to the baby's teeth and should be avoided." b. "Tetracycline is safe to take during pregnancy." c. "Tetracycline may cause allergic reactions in pregnant women." d. "Tetracycline will prevent asymptomatic urinary tract infections." a. "Tetracycline can be harmful to the baby's teeth and should be avoided." Tetracyclines can cause discoloration of deciduous teeth of infants if taken by the mother after the fourth month of gestation. A patient has been taking isoniazid for 4 months for latent tuberculosis. The patient reports bilateral tingling and numbness of the hands and feet, as well as feeling clumsy. The nurse expects the provider to: 16 | P a g e a. Discontinue the isoniazid b. Lower the isoniazid dose and add rifampin c. Order pyridoxine 100 mg per day d. Recheck the tuberculin skin test to see whether it worsens c. Order pyridoxine 100 mg per day Patients sometimes develop peripheral neuropathy, characterized by paresthesias, clumsiness, and muscle aches. If these occur, they may be reversed by administering pyridoxine (vitamin B6) An adolescent patient with mild cervicitis is diagnosed with gonorrhea, the nurse will expect the provider to order what drug? a. Azithromycin (Zithromax) 1 g PO once, and doxycycline (Vibramycin) 100 mg PO twice daily for 7 days b. Ceftriaxone (Rocephin) 250 mg IM once and azithromycin (Zithromax) 1 gm PO once c. Ceftriaxone (Rocephin) 125 mg IM once d. Doxycycline (Vibramycin) 100 mg twice daily for 12 days b. Ceftriaxone (Rocephin) 250 mg IM once and azithromycin (Zithromax) 1 gm PO once The only options for treating cervical infection with gonorrhea are cefixime and ceftriaxone. Doxycycline or azithromycin should be given unless chlamydia has already been ruled out. A patient with severe allergic conjunctivitis who has been using Cromolyn ophthalmic drops for 2 days calls the nurse to report persistence of symptoms. When the nurse explains it takes several weeks for maximum benefit to occur, the patient asks if there is something else to use in the meantime. The nurse will suggest that the patient discuss which drug with the provider? A. An ophthalmic demulcent B. H1-receptor antagonist C. Glucocorticoid drops Ocular decongestants B. H1-receptor antagonist Histamine receptor antagonists can be used to provide immediate symptom relief, so until the cromolyn has provided relief, they may be useful for treating symptoms. A nurse administers timolol [Timoptic] ophthalmic drops to a patient who has glaucoma. The patient reports stinging of the eyes shortly after the drops were administered. What will the nurse do? a. Monitor the patient's heart rate, respiratory rate, and blood pressure. b. Notify the provider that the patient shows signs of angle-closure glaucoma. c. Reassure the patient that these are localized, reversible effects of the drug. d. Request an order for an antihistamine to treat this allergic response to the drug. 17 | P a g e c. Reassure the patient that these are localized, reversible effects of the drug. Local effects of timolol and other beta blockers are generally minimal, but transient, ocular stinging can occur. A 6-year-old child has otitis media and is being treated with amoxicillin [Amoxil] and ibuprofen [Motrin]. The child's parent calls the nurse to report that the child's pain is not relieved with the ibuprofen. The child is afebrile and there is no drainage from either ear. The nurse will discuss which additional treatment with the child's provider? a. Adding acetaminophen [Tylenol] to the pain medication regimen b. Applying antipyrine and benzocaine [Aurodex] solution to the ear canals c. Changing the antibiotic to amoxicillin/clavulanate [Augmentin] d. Performing a tympanostomy to relieve pressure in the middle ear b. Applying antipyrine and benzocaine [Aurodex] solution to the ear canals For children over age 5 years, the AAP guidelines recommend topical anesthetic ear drops for pain relief; this is contraindicated if the TM is perforated. This child does not have drainage, indicating intact eardrums. A patient with stable COPD is prescribed a bronchodilator medication. Which type of bronchodilator is preferred for this patient? a. A long-acting inhaled beta2 agonist b. An oral beta2 agonist c. A short-acting beta2 agonist d. An intravenous methylxanthine a. A long-acting inhaled beta2 agonist LABAs are preferred over SABAs for COPD. Which medication should be used for asthma patients as part of step 1 management? a. Combination inhaled glucocorticoids/long-acting beta2 agonists b. Inhaled low-dose glucocorticoids c. Long-acting beta2 agonist d. Short-acting beta2 agonists d. Short-acting beta2 agonists Patients needing step 1 management have intermittent, mild symptoms and can be managed with a SABA as needed. A patient with stable COPD receives prescriptions for an inhaled glucocorticoid and an inhaled beta2- adrenergic agonist. Which statement by the patient indicates understanding of this medication 20 | P a g e this patient? a. "These symptoms are common and will disappear over time." b. "These symptoms may indicate an underlying psychiatric disorder." c. "You may need an increased dose to overcome these symptoms of nicotine withdrawal." d. "You should notify your provider of these symptoms immediately." d. "You should notify your provider of these symptoms immediately." Varenicline can cause serious neuropsychiatric effects, including mood swings, depression, and self- injurious behavior. Because suicidality is a risk, patients experiencing these effects should contact their provider immediately. A patient complains of painful urination. A physical examination reveals vesicles on her labia, vagina, and the foreskin of her clitoris. The nurse will expect to teach this patient about which medication? a. Acyclovir [Zovirax] b. Azithromycin [Zithromax] c. Metronidazole [Flagyl] d. Tinidazole [Tindamax] a. Acyclovir [Zovirax] Genital herpes can be treated with acyclovir, famciclovir, or valacyclovir, which are antiviral medications. A 60-year-old female patient is about to begin long-term therapy with a glucocorticoid. Which of the following will be important for minimizing the risk of osteoporosis? a. Baseline vitamin D level b. Calcium and vitamin D supplements c. Estrogen therapy d. Skeletal x-rays before treatment b. Calcium and vitamin D supplements Calcium and vitamin D supplements can help minimize the patient's risk of developing osteoporosis. A postmenopausal patient who has had a hysterectomy and who has a family history of coronary heart disease reports experiencing vaginal dryness and pain with intercourse but tells the nurse that she does not want to take hormones because she is afraid of adverse effects. The nurse will suggest that the woman ask her provider about: a. Depo Provera. b. Estraderm. c. low-dose estrogens. d. Premarin vaginal. 21 | P a g e d. Premarin vaginal. Estrogens for intravaginal administration are used for local effects, primarily to treat vulval and vaginal atrophy. The nurse is caring for a patient receiving intravenous acyclovir [Zovirax]. To prevent nephrotoxicity associated with intravenous acyclovir, the nurse will: a. hydrate the patient during the infusion and for 2 hours after the infusion. b. increase the patient's intake of foods rich in vitamin C. c. monitor urinary output every 30 minutes. d. provide a low-protein diet for 1 day before and 2 days after the acyclovir infusion. a. hydrate the patient during the infusion and for 2 hours after the infusion. The nurse should ensure that the patient is hydrated during the acyclovir infusion and for 2 hours after the infusion to prevent nephrotoxicity. A woman complains of burning on urination and increased frequency. The patient has a history of frequent urinary tract infections (UTIs) and is going out of town in 2 days. To treat the infection quickly, the nurse would expect the health care provider to order: a. aztreonam [Azactam]. b. fosfomycin [Monurol]. c. trimethoprim/sulfamethoxazole [Bactrim]. d. vancomycin [Vancocin]. b. fosfomycin [Monurol]. Fosfomycin has been approved for single-dose therapy of UTIs in women. A young adult woman will begin using an inhaled glucocorticoid to treat asthma. The nurse will teach this patient about the importance of which action? a. Lowering her calcium intake and increasing her vitamin D intake b. Participating in weight-bearing exercises on a regular basis c. Taking oral glucocorticoids during times of acute stress d. Using two reliable forms of birth control to prevent pregnancy b. Participating in weight-bearing exercises on a regular basis Like oral glucocorticoids, inhaled glucocorticoids can promote bone loss in premenopausal women. Patients should be encouraged to participate in weight-bearing exercises to help minimize this side effect. A patient receives a drug that has a narrow therapeutic range. The nurse administering this medication will expect to do what? 22 | P a g e a. Administer the drug at intervals longer than the drug half-life. b. Administer this medication intravenously. c. Monitor plasma drug levels. d. Teach the patient that maximum drug effects will occur within a short period. c. Monitor plasma drug levels. A patient claims to get better effects with a tablet of Brand X of a drug than with a tablet of Brand Y of the same drug. Both brands contain the same amount of the active ingredient. What does the nurse know to be most likely? a. Advertising by pharmaceutical companies can enhance patient expectations ofone brand over another, leading to a placebo effect. b. Because the drug preparations are chemically equivalent, the effects of the two brands must be identical. c. Tablets can differ in composition and can have differing rates of disintegration and dissolution, which can alter the drug's effects in the body. d. The bioavailability of a drug is determined by the amount of the drug in eachdose. c. Tablets can differ in composition and can have differing rates of disintegration and dissolution, which can alter the drug's effects in the body. Even if two brands of a drug are chemically equivalent (i.e., they have identical amounts of the same chemical compound), they can have different effects in the body if they differ in bioavailability. Tablets made by different manufacturers contain different binders and fillers, which disintegrate and dissolve at different rates and affect the bioavailability of the drug. A patient is receiving intravenous gentamicin. A serum drug test reveals toxic levels. The dosing is correct, and this medication has been tolerated bythis patient in the past. Which could be a probable cause of the test result? a. A loading dose was not given. b. The drug was not completely dissolved in the IV solution. c. The patient is taking another medication that binds to serum albumin. d. The medication is being given at a frequency that is longer than its half-life. c. The patient is taking another medication that binds to serum albumin. Gentamicin binds to albumin, but only weakly, and in the presence of another drug that binds to albumin, it can rise to toxic levels in blood serum. A nurse is reviewing a medication administration record before administering medications. Which order will the nurse implement? a. Furosemide [Lasix] 20 mg QD PO b. Furosemide [Lasix] 20 mg qd PO 25 | P a g e A patient is wheezing and short of breath. The nurse assesses a heart rate of 88 beats/minute, a respiratory rate of 24 breaths/minute, and a blood pressure of 124/78 mm Hg. The prescriber orders a nonspecific beta agonist medication. Besides evaluating the patient fora reduction in respiratory distress, the nurse will monitor for which side effect? a. Hypotension b. Tachycardia c. Tachypnea d. Urinary retention b. Tachycardia Beta agonists are used for asthma because of their beta2 effects on bronchial smooth muscle, causing dilation. Beta1 effects cause tachycardia and hypertension. A prescriber has ordered pilocarpine [Pilocar]. A nurse understands that the drug stimulates muscarinic receptors and would expect the drug to have which action? a. Reduction of excessive secretions in a postoperative patient b. Lowering of intraocular pressure in patients with glaucoma c. Inhibition of muscular activity in the bladder d. Prevention of hypertensive crisis b. Lowering of intraocular pressure in patients with glaucoma Pilocarpine is a muscarinic agonist used mainly for topical therapy of glaucoma to reduce intraocular pressure. A prescriber has ordered bethanechol [Urecholine] for a postoperative patient who has urinary retention. The nurse reviews the patient's chart before giving the drug. Which part of the patient's history would be a contraindication to using this drug? a. Asthma as a child b. Gastroesophageal reflux c. Hypertension d. Hypothyroidism a. Asthma as a child Bethanechol is contraindicated in patients with active or latent asthma, because activation of muscarinic receptors in the lungs causes bronchoconstriction. A patient who experiences motion sickness is about to go on a cruise. The prescriber orders transdermal scopolamine [Transderm Scop]. The patient asks the nurse why an oral agent is not ordered. The nurse will explain that the transdermal preparation: a. can be applied as needed at the first sign of nausea. 26 | P a g e b. has less intense anticholinergic effects than the oral form. c. is less sedating than the oral preparation. d. provides direct effects, because it is placed close to the vestibular apparatus of the ear. b. has less intense anticholinergic effects than the oral form. The transdermal system of scopolamine is preferred because it may have less intense anticholinergic effects than oral or subcutaneous dosing A patient who has a lower back injury exhibits muscle spasms. The provider orders cyclobenzaprine [Flexeril] 10 mg three times a day. What will the nurse include when teaching this patient about this drug? a. "This drug carries some risk of developing hallucinations and psychotic symptoms." b. "This medication may cause your urine to turn brown, black, or dark green." c. "You may experience blurred vision, dry mouth, or constipation." d. "You will need to have liver function tests performed while taking this medication." c. "You may experience blurred vision, dry mouth, or constipation." Cyclobenzaprine has significant anticholinergic effects and patients should be warned about dry mouth, blurred vision, and constipation A nurse is caring for a patient who has been taking an antiepileptic drug for several weeks. The nurse asks the patient if the therapy is effective. The patient reports little change in seizure frequency. What will the nurse do? a. Ask the patient to complete a seizure frequency chart for the past few weeks. b. contact the provider to request an order for serum drug levels c. Reinforce the need to take the medications as prescribed. d. Request an order to increase the dose of the antiepileptic drug. b. contact the provider to request an order for serum drug levels If medication therapy is not effective, it is important to measure serum drug levels of the medication to determine whether therapeutic levels have been reached and to help monitor patient compliance. A pregnant patient in her third trimester asks the nurse whether she can take aspirin for headaches. Which response by the nurse is correct? a. "Aspirin is safe during the second and third trimesters of pregnancy." b. "Aspirin may cause premature closure of the ductus arteriosus in your baby." c. "Aspirin may induce premature labor and should be avoided in the third trimester." d. "You should use a first-generation nonsteroidal anti-inflammatory medication." 27 | P a g e b. "Aspirin may cause premature closure of the ductus arteriosus in your baby." Aspirin poses risks to the pregnant patient and her fetus, including premature closure of the ductus arteriosus. A patient is about to receive prednisone for tendonitis. The nurse reviewing the chart would be concerned about which of the following in the patient's medical history? a. Asthma and allergic rhinitis b. Gouty arthritis c. Seborrheic dermatitis d. Systemic fungal infection d. Systemic fungal infection Glucocorticoids are contraindicated in patients with a history of systemic fungal infections. A 11-year-old boy received all childhood immunizations before attending school as a kindergartner. Which vaccines are recommended for this child at his current age? a. DTaP, MCV4, Varivax b. PCV-23, Td, MMR c. Tdap, MCV4, HPV d. Tdap, Varivax, hepatitis B c. Tdap, MCV4, HPV At age 11, both males and females should receive a booster of diphtheria, tetanus, and pertussis (Tdap); the Menactra vaccine against meningitis (MCV4); and the human papillomavirus (HPV) vaccine. A patient who has been diagnosed with rheumatoid arthritis (RA) for 1 month and has generalized symptoms is taking high-dose nonsteroidal anti-inflammatory drugs (NSAIDs) and an oral glucocorticoid. The provider has ordered methotrexate [Rheumatrex]. The patient asks the nurse why methotrexate is necessary since pain and swelling have been well controlled with the other medications. The nurse will tell the patient that: A. methotrexate regimen can reduce overall costs and side effects of treatment. B. starting methotrexate early can help delay joint degeneration. C. starting methotrexate now will help increase life expectancy. D. with methotrexate, doses of NSAIDs can be reduced to less toxic levels. B. starting methotrexate early can help delay joint degeneration. Current guidelines for treatment of RA recommend starting a disease-modifying antirheumatic drug (DMARD) early—within 3 months of diagnosis for most patients—in order to delay joint degeneration. 30 | P a g e c. Lactulose d. Polyethylene glycol [MiraLax] a. Docusate sodium [Colace] Oxycodone can be constipating. The patient needs something prophylactically, such as docusate sodium, that can be taken daily to prevent constipation A patient who is known to be a heavy drinker is brought to the emergency department with ataxia and confusion. The patient cannot remember the events of the previous day. The examination reveals nystagmus, and the patient reports having double vision. The nurse will expect to administer which vitamin to this patient? a. Ascorbic acid (vitamin C) IV b. Intramuscular pyridoxine (vitamin B6) c. Intravenous thiamine (vitamin B1) d. Nicotinic acid (niacin) PO c. Intravenous thiamine (vitamin B1) Alcoholics who are malnourished have a form of thiamine deficiency called Wernicke-Korsakoff syndrome, which is characterized by nystagmus, diplopia, ataxia, confusion, and short-term memory loss. Parenteral thiamine is indicated for treatment. A patient is about to begin treatment with isoniazid. The nurse learns that the patient also takes phenytoin [Dilantin] for seizures. The nurse will contact the provider to discuss: a. increasing the phenytoin dose. b. reducing the isoniazid dose. c. monitoring isoniazid levels. d. monitoring phenytoin levels. d. monitoring phenytoin levels. Isoniazid is a strong inhibitor of three cytochrome P450 enzymes, and inhibition of these enzymes can raise the levels of other drugs, including phenytoin. Patients taking phenytoin should have the levels of this drug monitored, and the dose should be reduced if appropriate. A patient is to begin taking phenytoin [Dilantin] for seizures. The patient tells the nurse that she is taking oral contraceptives. What will the nurse tell the patient? a. She may need to increase her dose of phenytoin while taking oral contraceptives. b. She should consider a different form of birth control while taking phenytoin. c. She should remain on oral contraceptives, because phenytoin causes birth defects. d. She should stop taking oral contraceptives, because they reduce the effectiveness of phenytoin. 31 | P a g e b. She should consider a different form of birth control while taking phenytoin. Because phenytoin can reduce the effects of oral contraceptive pills (OCPs) and because avoiding pregnancy is desirable when taking phenytoin, patients should be advised to increase the dose of oral contraceptives or use an alternative method of birth control. A nurse is caring for a patient who recently immigrated from a third world country. The patient is thin and appears malnourished. The nurse notes that the patient has loose and missing teeth, gingivitis, and bleeding gums. The patient has multiple sores and ecchymoses. The nurse will expect the provider to order? a. Cyanocobalamin (vitamin B12) b. High-dose nicotinic acid c. Intramuscular thiamine for 1 to 2 weeks d. Intravenous ascorbic acid d. Intravenous ascorbic acid This patient has scurvy with acute, severe symptoms, and needs intravenous vitamin C. First line drug of choice for community acquired pneumonia in a previously healthy is? a. Penicillin b. Amoxicillin c. Azithromycin d. Levaquin c. Azithromycin One month after starting phenytoin for seizures, a 28-year-old male presents with complaints of fever, rash, and swollen lymph nodes. The NP suspects which syndrome? a. Phenytoin toxicity b. Phenytoin hypersensitivity reaction c. Normal side effects of phenytoin d. Mononucleosis b. Phenytoin hypersensitivity reaction A patient with previous compliant levels of carbamazepine now presents with subtherapeutic blood levels. The NP suspects? a. Noncompliance b. Patient financial strain c. Malnutrition d. Expected lab finding 32 | P a g e d. Expected lab finding Carbamazepine auto induces metabolism leading to lower levels of the drug. The nurse is performing a physical assessment on a patient who is receiving treatment with abacavir, zidovudine, and lamivudine [Trizivir]. The patient complains of fatigue. Upon further assessment, the nurse finds a rash and notes that the patient has a temperature of 101.1 F. What is the nurse's best course of action? a. Tell the patient that this is an expected response to these medications and to continue the agents as prescribed b. Have the patient hold the medications and arrange for an immediate evaluation by the prescriber c. Have the patient continue the abacavir but discontinue the other two agents for 3 weeks d. Instruct the patient to continue all three medications and administer an antihistamine for the symptoms b. Have the patient hold the medications and arrange for an immediate evaluation by the prescriber a. ANS: B- The patient is showing early symptoms of a fatal hypersensitivity reaction. The NP educates the patient regarding the black box warning on carbamazepine by advising the patient to report signs and symptoms indicative of? a. Liver toxicity b. Kidney failure c. Skin reaction d. Suicidal tendencies c. Skin reaction Carbamazepine can cause SJS and TEN (toxic epidermal necrolysis) Carbamazepine monitoring should include all of the following except? a. Routine CBC b. Osteoporosis screening c. Carbamazepine drug levels d. Monthly glucose d. Monthly glucose A patient with bipolar disorder takes lamotrigine [Lamictal]. Which statement by the patient would prompt the nurse to hold the drug and notify the prescriber for further assessment? a. "I get a little dizzy sometimes" b. "I had a headache last week that lasted for about an hour" 35 | P a g e c. Taking Benadryl for seasonal allergies d. Inadequate hydration status c. Taking Benadryl for seasonal allergies Due to anticholinergic effects A patient recently diagnosed with pneumonia is also found to have osteoporosis, anemia, and vitamin B12 deficiency. The NP suspects which treatments is causing the patients issues? a. Recent treatment for GERD b. Long term PPI therapy c. History of gastric bypass d. Undiagnosed malabsorption issue b. Long term PPI therapy Often prescribed with levodopa/carbidopa in the treatment of Parkinson's Disease Bromocriptine What medication may cause serious or possibly life-threatening sleep behaviors, such as sleep driving? Ambien Taking too much of this type of drug can make you "blind as a bat" or "mad as a hatter" Anticholinergics, antimuscarinics Absorption, Distribution, Metabolism, excretion Pharmacokinetics Drugs used to relieve a myasthenic crisis Neostigmine, pyridostigmine This drug has a very narrow therapeutic index and high risk for toxicity, therefore levels should be monitored frequently Lithium The drug class that carries an increased risk of suicidality in children, adolescents, and young adults SSRIs/SNRIs The antidote for organophosphate poisoning Atropine This drug class double the rate of mortality in older adults with dementia Antipsychotics 36 | P a g e In infants, this is not fully developed and therefore infants are more sensitive to CNS drugs Blood Brain Barrier Time of development that fetus is at highest risk of teratogenicity from a drug First trimester Do not stop this class of drug abruptly due to an increased risk of cardiovascular events Beta-blockers Agents that indirectly block the breakdown of acetylcholine and are often used in treatment of Alzheimer's Disease Cholinesterase inhibitors Adverse drug reaction that causes difficulty speaking and chewing and worm-like movements of the tongue Tardive Dyskinesia Receptor found in the lungs that causes bronchodilation when activated Beta 2 Receptors This drug has led to the death of children in ultrarapid metabolizers as 10% of the drug is converted to morphine Codeine Leading cause of acute liver failure in the U.S. Hepatotoxic drugs An autoimmune disease that attacks the nicotinic receptors in skeletal muscle Myasthenia Gravis An opioid antagonist that works to quickly reverse CNS and respiratory depression Naloxone (Narcan) How the drug affects the body Pharmacodynamics Term for the amount of drug that reaches systemic circulation. Often affected by route of administration Bioavailability Symptoms for this syndrome include confusion, irritability, tachycardia, hypertension, diaphoresis, and is caused by having too much of this "happy" substance Serotonin 37 | P a g e Dopamine agonist often used in treatment of Parkinson's Disease that is least likely to cause sleep attacks Pramipexole Clonidine is often prescribed to children to treat this disorder ADHD Drug most effective in alcohol withdrawal Lorazepam (ativan) Drug used for anaphylactic reaction or cardiac arrest Epinephrine 1st line drugs for migraine prevention Beta Blockers Parasympatholytic used for unstable bradycardia Atropine Drug class used to treat ADHD Stimulants Drugs that have no medical use and high potential for abuse Schedule I controlled substances This drug is an antispasmodic muscle relaxant that must be tapered off due to risk of seizure or hallucinations if stopped abruptly Baclofen 3Muscle relaxant that is also a schedule IV controlled substance Carisoprodal (Soma) 1st line abortive drug class for mild to moderate headaches NSAIDs 1st line abortive drug for moderate to severe migraine headaches Sumatriptan (Imitrex) Used in the treatment of non-hypovolemic hypotension Norepinephrine or phenyleprine Drug used for acute management of seizures 40 | P a g e A contraindication for a triptan includes: hypertension, MAOI, CAD Your friend breaks out in hives and has wheezing after eating PB, what do you do? Epinephrine IM (epi-pen) Beta blockers have been used for: post MI, HTN, HF What drug route allows for 100% bioavailability? Intravenous Chronic renal failure will affect what element of pharmacokinetics? excretion TRUE OR FALSE: Andrenergic antagonists or alpha blockers cause vasoconstriction? false Symptoms of BPH include: urinary hesitation common side effect of ACE inhibitors: cough TRUE OR FALSE: angina pain is caused by cardiac ischemia? true All patients with angina should receive this medication to reduce mortality? Aspirin Lifestyle modifications to reduce cardiac risk include: stop smoking, daily exercise, weight loss (at least 10 pounds) a patient with heart failure that has anginal pain with walking and slight limitation of activity is what class? II A patient is taking HCTZ (hydrochlorothiazide) for HTN. What lab is most important to monitor? potassium (K) TRUE OR FALSE: one primary mechanism that worsens heart failure is cardiac remodeling? TRUE 41 | P a g e Which class of medication is indicated in patients post MI to precent cardiac remodeling? ACE inhibitors TRUE OR FALSE: when treating hyperlipidemia, calculating ASCVD risk will help to determine treatment? TRUE Which class of medication is contraindicated in patients with liver failure? HMG-CoA inhibitors (statins) Which anticoagulant has the quickest onset of action? heparin Patients receiving heparin are at risk for what adverse reaction? thrombocytopenia Why would heparin and warfarin be given together? warfarin has a delayed effect All of the following could increase a patient's ability to bleed: herbal supplements, aspirin, TPA Factor Xa levels may be monitored for patient's on this medication? low molecular weight heparin Which blood pressure medication can be taken during pregnancy? beta blockers after a hip replacement, what drug is often used to prevent DVT? enoxaparin A patient started on warfarin for A-fib should be taught that... the INR should be between 2-3 What is not true about epoetin alfa? treats patients with pernicious anemia Pernicious anemia is due to deficiency of B12 Lab monitoring for iron deficiency anemia include the following reticulocyte count in 1 week, TIBC in 4 weeks, Hgb/Hct/ferritin in 4 weeks Which class of antidiabetic medication is contraindicated in CKD stage 4, 5 42 | P a g e metformin A pregnant diabetic woman wants to know if she should continue her diabetes medication, you tell her she will be switched to insulin during pregnancy metformin helps to control blood glucose levels by decreasing glycogenolysis by the liver, reduces glucose absorption in the gut, increasing skeletal muscles uptake of glucose When starting a basal insulin, which class of medication should you reduce or d/c? sulfonylurea TRUE OR FALSE: beta-blockers can mask effect of hypoglycemia TRUE TRUE OR FALSE: alcohol can mask the signs and symptoms of hypoglycemia TRUE Signs and symptoms of hypoglycemia include: confusion, tachycardia, diaphoresis A diabetic patient has developed hypertension, which class of medication should be started? ACE inhibitor Levothyroxine should be taken at what time of day? first thing in the morning, 30 minutes prior to eating How would you know effectiveness of levothyroxine Decrease in TSH levels Which form of estrogen has the least side effects? transdermal a post-menopausal woman is being seen for HRT, what questions should you ask? Do you smoke cigarettes? Hx of DVT/PE? Hx of hysterectomy? Your male patient on testosterone has had a 7 pound weight gain and needs early refill on testosterone, you suspect? he is using more than prescribed What should you avoid while taking the antibiotic metronidazole (Flagyl) to avoid adverse effects? Alcohol 45 | P a g e ADHD What are the big side effects of Parkinson Drugs? EPS, risky behaviors, hallucinations, sleep attacks What medication can be added to Levidopa/Carbidopa? Bromocriptine (need to decrease dosing when adding) Why do CNS drugs cause sleepiness? because they cross over the blood brain barrier What can happen if you abruptly stop taking baclofen? hallucinations Who do we give baclofen to? Spasticity patients - MS, SCIs, cerebral palsy What is Rivastigmine? For alzheimer's disease - transdermal patch changed daily If a patient has frequent migraines, what meds can we give for prevention? Propranolol (not for asthmatics), topamex If prescribing oxycodone and a patient states that this medication does not work for them anymore, what would you do? change to something stronger/longer acting What can methadone change physiologically? QT prolongation What is the biggest side effect of first generation antipsychotics? Tardive dyskinesia If a patient is being switched from an MAOI to an SSRI, what needs to happen? stop one for two weeks before starting the other What kind of drug should be given to someone who suffers from panic attacks? SSRIs If giving HRT for postmenopausal women, which dosing preparation should we utilize? Transdermal - less side effects Oral contraceptive choice for a teenage girl who is noncompliant with daily pills? 46 | P a g e Medroxy-progesterone acetate (depo) What should you do for a women on an OC who has a major surgery coming up? switch her to a progesterone only medication to lower risk of clots What do we prescribe androgen therapy for? If they start gaining weight, why is this a concern? Hypogonadism patients - check levels they may not be receiving a high enough dose How do we know if a BPH medication is effective? Easier urination A patient is to begin taking phenytoin [Dilantin] for seizures. The patient tells the nurse that she is taking oral contraceptives. What will the nurse tell the patient? a. She may need to increase her dose of phenytoin while taking oral contraceptives. b. She should consider a different form of birth control while taking phenytoin. c. She should remain on oral contraceptives, because phenytoin causes birth defects. d. She should stop taking oral contraceptives, because they reduce the effectiveness of phenytoin. b. She should consider a different form of birth control while taking phenytoin. Because phenytoin can reduce the effects of oral contraceptive pills (OCPs) and because avoiding pregnancy is desirable when taking phenytoin, patients should be advised to increase the dose of oral contraceptives or use an alternative method of birth control. A nurse is caring for a patient who recently immigrated from a third world country. The patient is thin and appears malnourished. The nurse notes that the patient has loose and missing teeth, gingivitis, and bleeding gums. The patient has multiple sores and ecchymoses. The nurse will expect the provider to order? a. Cyanocobalamin (vitamin B12) b. High-dose nicotinic acid c. Intramuscular thiamine for 1 to 2 weeks d. Intravenous ascorbic acid d. Intravenous ascorbic acid This patient has scurvy with acute, severe symptoms, and needs intravenous vitamin C. First line drug of choice for community acquired pneumonia in a previously healthy is? a. Penicillin b. Amoxicillin c. Azithromycin d. Levaquin c. Azithromycin 47 | P a g e One month after starting phenytoin for seizures, a 28-year-old male presents with complaints of fever, rash, and swollen lymph nodes. The NP suspects which syndrome? a. Phenytoin toxicity b. Phenytoin hypersensitivity reaction c. Normal side effects of phenytoin d. Mononucleosis b. Phenytoin hypersensitivity reaction A patient with previous compliant levels of carbamazepine now presents with subtherapeutic blood levels. The NP suspects? a. Noncompliance b. Patient financial strain c. Malnutrition d. Expected lab finding d. Expected lab finding Carbamazepine auto induces metabolism leading to lower levels of the drug. The nurse is performing a physical assessment on a patient who is receiving treatment with abacavir, zidovudine, and lamivudine [Trizivir]. The patient complains of fatigue. Upon further assessment, the nurse finds a rash and notes that the patient has a temperature of 101.1 F. What is the nurse's best course of action? a. Tell the patient that this is an expected response to these medications and to continue the agents as prescribed b. Have the patient hold the medications and arrange for an immediate evaluation by the prescriber c. Have the patient continue the abacavir but discontinue the other two agents for 3 weeks d. Instruct the patient to continue all three medications and administer an antihistamine for the symptoms b. Have the patient hold the medications and arrange for an immediate evaluation by the prescriber a. ANS: B- The patient is showing early symptoms of a fatal hypersensitivity reaction. The NP educates the patient regarding the black box warning on carbamazepine by advising the patient to report signs and symptoms indicative of? a. Liver toxicity b. Kidney failure c. Skin reaction d. Suicidal tendencies 50 | P a g e The NP believes the patient needs additional education regarding long acting beta agonist's black box warning when the patient verbalizes? a. I need to take this medication every day b. I take this medication in case of an asthma attack c. I still need to carry my rescue inhaler with me d. This medication can help prevent asthma attacks b. I take this medication in case of an asthma attack LABA do not fix asthma attacks. A 72 year old presents to the clinic with complaints of "I can't pee". Which history does the NP suspect may be causing this symptom? a. Taking antihypertensive medications b. The use of Zofran for nausea c. Taking Benadryl for seasonal allergies d. Inadequate hydration status c. Taking Benadryl for seasonal allergies Due to anticholinergic effects A patient recently diagnosed with pneumonia is also found to have osteoporosis, anemia, and vitamin B12 deficiency. The NP suspects which treatments is causing the patients issues? a. Recent treatment for GERD b. Long term PPI therapy c. History of gastric bypass d. Undiagnosed malabsorption issue b. Long term PPI therapy A patient who has gastroesophageal reflux disease (GERD) receives a prescription for a proton pump inhibitor medication. What till the nurse include when teaching the patient about this drug? a. "The FDA has determined that there is a gastric cancer risk with this drug b. "This drug will be given on a short-term basis only" c. "You may experience hypermagnesemia when taking this drug" d. "You should report any fever and cough to your provider" d. "You should report any fever and cough to your provider" PPIs can increase the risk of community-acquired pneumonia. When determining appropriate antimicrobial treatment, the NP utilizes which tool to assess local resistance patterns? 51 | P a g e a. Antigen tests b. Antibiogram c. Antibiotic survey d. Culture and sensitivity testing b. Antibiogram Antibiogram shows local resistance patterns After receiving Flagyl for a diverticulitis flare up, the patient calls the clinic complaining of nausea, vomiting, and abdominal pain. The NP focuses on which part of the SOAP note to rule out a disulfiram reaction? a. HPI b. Medications c. Allergies d. Social history d. Social history focuses on alcohol use history 1. When metronidazole (Flagyl) is a component of the H. Pylori treatment regimen, the patient must be instructed to do what? a. Avoid any alcoholic beverages b. Avoids foods containing tyramine c. Take the drug on an empty stomach d. Take the drug with food a. Avoid any alcoholic beverages The patient should be instructed to avoid alcoholic beverages because a disulfiram-like reaction can occur if metronidazole is taken with alcohol Which patient should receive fluoroquinolone therapy for a CAP diagnosis? a. A 22-year-old postal worker b. A 44-year-old female with diabetes c. 58-year-old African American d. A 6-month-old immigrant b. A 44-year-old female with diabetes Anyone with a comorbidity should be treated. 52 | P a g e Sulfonamides should be avoided in patient's with a G6PD deficiency due to the risk of? a. Tendon rupture b. Steven Johnson's syndrome c. Hemolytic anemia d. Liver failure c. Hemolytic anemia A nurse is caring for an African-American who has been admitted to the unit for long-term antibiotic therapy with sulfonamides. The patient develops fever, pallor, and jaundice. The nurse would be correct to suspect that the patient has developed? a. Stevens-Johnson syndrome b. Kernicterus c. Hepatotoxicity d. Hemolytic anemia d. Hemolytic anemia Sulfonamides can cause hemolytic anemia in patients of African-American and Mediterranean origin usually because of genetic deficiency. A 16-year-old presents to the clinic for treatment of her acne. The NP prescribes which medication? a. Minocycline b. Topical retinoids c. Tetracycline d. Combination antibiotic and topical d. Combination antibiotic and topical The most effective is combination antibiotic and topical. A 14-year-old patient has moderate acne that has not responded to topical drugs. The nurse will suggest that the patient and her parents discuss which treatment with the provider? a. Combination oral contraceptive medication b. Doxycycline (Vibramycin) c. Isotretinoin (Accutane) d. Sprironolactone b. Doxycycline (Vibramycin) For moderate to severe acne, oral antibiotics are indicated. Doxycycline is the drug of first choice. A teenager comes to the clinic with complaint of headache. The NP suspects minocycline may be causing the symptoms due to its risk of: 55 | P a g e a. "If the eardrum ruptures, we can culture the fluid to determine which antibiotic is best" b. "Most ear infection are caused by viruses, so antibiotics are not effective" c. "Most ear infections will resolve on their own without antibiotics" d. "Your child will develop tolerance to antibiotics if they are prescribed too often" c. "Most ear infections will resolve on their own without antibiotics" The vast majority of acute otitis media episodes resolve without treatment. A patient begins using timolol (Timoptic) to treat primary open-angle glaucoma (POAG). The nurse gives a dose and notes that the patient develops shortness of breath. The nurse assesses the patient and auscultates wheezes in both lungs. The nurse will ask this patient about a history of which condition? a. Asthma b. Atrioventricular heart block c. Pulmonary hypertension d. Sinus bradycardia a. Asthma Timolol is a beta blocker and can precipitate bronchoconstriction when absorbed systemically. An adolescent has recently been experiencing pimples. The nurse notes several closed comedones across the patient's forehead and on the nose. The nurse will expect to teach the patient about the use of which medication? a. Benzoyl peroxide b. Topical clindamycin c. Topical erythromycin d. Topical retinoids a. Benzoyl peroxide Benzoyl peroxide is a first-line drug for mild to moderate acne. A patient will begin initial treatment for severe acne. What regimen will the nurse expect the provider to order? a. Clindamycin/benzoyl peroxide [BenzaClin] and tretinoin b. Doxycycline [Vibramycin] and tretinoin [Retin-A] c. Erythromycin [Ery-Tab] and benzoyl peroxide d. Topical clindamycin and isotretinoin [Accutane] b. Doxycycline [Vibramycin] and tretinoin [Retin-A] Oral antibiotics are used for moderate to severe acne and are usually combine with a topical retinoid. 56 | P a g e A 34-year-old female comes to the clinic complaining of dysuria, frequency, and urgency. Which additional information does the NP need prior to deciding on a treatment plan? a. Is the infection in the upper or lower urinary tract b. Does the patient have any history of predisposing factors c. Does the patient have a history of recent UTIs d. Is the patient pregnant a. Is the infection in the upper or lower urinary tract b. Does the patient have any history of predisposing factors c. Does the patient have a history of recent UTIs d. Is the patient pregnant A young, nonpregnant female patient with a history of previous urinary tract infection is experiencing dysuria, urinary urgency and frequency, and suprapubic pain of 3 days duration. She is afebrile. A urine culture is positive for more than 100,000 ml of urine. The nurse caring for this patient knows that which treatment is most effective? a. A 14-day course of amoxicillin with clavulanic acid (Augmentin) b. A 7-day course of ciprofloxacin (Cipro) c. A single dose of Fosfomycin (Monurol) d. A 3-day course of trimethoprim/sulfamethoxazole (Bactrim) d. A 3-day course of trimethoprim/sulfamethoxazole (Bactrim) Short course therapy is recommended for uncomplicated, community-acquired lower urinary tract infections Which patient with a urinary tract infection will require hospitalization and intravenous antibiotics? a. A 5-year-old child with a fever of 100.5 F, dysuria, and bacteriuria b. A pregnant woman with bacteriuria, suprapubic pain, and fever c. A young man with dysuria, flank pain, and a previous urinary tract infectin d. An older adult man with a low-grade fever, flank pain, and an indwelling catheter d. An older adult man with a low-grade fever, flank pain, and an indwelling catheter The patient with an indwelling catheter and signs of pyelonephritis shows signs of a complicated UTI, which is best treated with intravenous antibiotics A woman complains of burning on urination and increased frequency. The patient has a history of frequent urinary tract infections and is going out of town in 2 days. To treat the infection quickly, the nurse would expect the health care provider to order? a. Aztreonam (Azactam) b. Fosfomycin (Monurol) 57 | P a g e c. Trimethoprim/sulfamethoxazole (Bactrim) d. Vancomycin (Vancocin) b. Fosfomycin (Monurol) Fosfomycin has been approved for single-dose therapy of UTIs in women. A patient shows signs and symptoms of conjunctivitis. What aminoglycoside would the nurse expect to be ordered? a. Amikacin (Amikin) b. Kanamycin (Kantrex) c. Neomycin (neomycin) Paromomycin (humantin) c. Neomycin (neomycin) Neomycin is used for topical treatment of infections of the eye, ear, and skin. A patient who is receiving intravenous ciprofloxacin for pneumonia develops diarrhea. A stool culture is positive for clostridium difficile. The nurse will expect the provider to: a. Add metronidazole (Flagyl) b. Increase the dose of ciprofloxacin c. Restrict dietary products Switch to Gemifloxacin a. Add metronidazole (Flagyl) C. difficilie is resistant to fluorquinolones; metronidazole is the drug of choice to treat this infection. Metronidazole is lethal only to anaerobic organisms. A nurse is reviewing the culture results of a patient receiving an aminoglycoside. The report reveals an anaerobic organism as the cause of infection. What will the nurse do? a. Contact the provider to discuss an increased risk of aminoglycoside toxicity b. Continue giving the aminoglycoside as ordered c. Request an order for a different class of antibiotic Suggest adding a penicillin to the patient's drug regimen c. Request an order for a different class of antibiotic Aminoglycosides are not effective against anaerobic microbes, so another class of antibiotics is indicated. A patient received 500 mg of azithromycin (Zithromax) at 0800 as a first dose. What are the usual amount and time of the second dose of azithromycin? 60 | P a g e c. Reducing the dose of piperacillin Patients with renal impairment should receive lower doses of piperacillin than patients with normal renal function. A child with an ear infection is not responding to treatment with amoxicillin (Amoxil). The nurse will expect the provider to order? a. Amoxicillin-clavulanic acid (Augmentin) b. Ampicillin c. Nafcillin d. Penicillin G (Benzylpenicillin) a. Amoxicillin-clavulanic acid (Augmentin) Beta-lactamase inhibitors are drugs that inhibit bacterial beta-lactamases. Augmentin contains amoxicillin and clavulanic acid and is often used when patients fail to respond to amoxicillin alone. An older adult patient with chronic obstructive pulmonary disease (COPD) develops bronchitis. The patient has a temperature of 39.5 C. The nurse will expect the provider to: a. Obtain a sputum culture and wait for the results before prescribing antibiotics b. Order empiric antibiotics while waiting for sputum culture results c. Treat symptomatically, because antibiotics are usually ineffective against bronchitis d. Treat the patient with more than one antibiotic without obtaining cultures b. Order empiric antibiotics while waiting for sputum culture results Patients with severe infections should be treated while culture results are pending. The nurse is obtaining a history from a patient who discloses daily use of St. Johns wort in addition to prescription drugs. Which effect of this dietary supplement would most concern the nurse? a. It accelerates the metabolism of some drugs b. It enhances the effects of digoxin c. It counteracts the effects of CNS depressants d. It increases the risk of bleeding a. It accelerates the metabolism of some drugs St. John's wort has the potential to interact with many drugs through three different mechanisms. One mechanism, induction of P450, accelerates the metabolism of many drugs. A patient will begin taking phentermine and topiramate (Osymia) to help with weight loss and asks the nurse why the second ingredient is necessary. Which is the correct response by the nurse? a. "Topiramate helps reduce the risk of seizures that can occur with phentermine" 61 | P a g e b. "Topiramate helps produce feelings of satiety to augment the drug effects" c. "Topiramate increases the appetite suppression caused by phentermine" d. "Topiramate increases the heart rate of weight loss by acting as a stimulant" b. "Topiramate helps produce feelings of satiety to augment the drug effects" Topiramate is an antiseizure medication that acts to induce a sense of satiety in patients taking the combination product. A patient has been taking phentermine and topiramate (Osymia) for 6 months for weight loss. The nurse weighs the patient and notes 3% weight loss since beginning the drug. The nurse will expect the prescriber to: a. Continue the current dosage for 4 more weeks b. Discontinue the drug c. Increase the drug dosage d. Switch to another nonamphetamine agent b. Discontinue the drug If a patient who is taking phentermine and topiramate has not lost 5% of weight by 6 months, the drug should be discontinued An adult who has been self-medicating using nutritional therapy for an elevated cholesterol level, complains of repeated episodes of flushing. The nurse suspects that the patient has been taking: a. Niacin b. Thiamine c. Riboflavin d. Pyridoxine a. Niacin Niacin is used to reduce cholesterol levels. When taken in large doses, nicotinic acid can cause vasodilation, with resultant flushing, dizziness, and nausea A patient with a history of elevated triglycerides and LDL cholesterol begins taking nicotinic acid [Niacin]. The patient reports uncomfortable flushing of the face, neck, and ears when taking the drug. What will the nurse advise the patient? a. "Ask your provider about taking an immediate-release form of the medication" b. "Ask your provider about assessing your serum uric acid levels which may be elevated" c. "You should stop taking the niacin immediately since this is a serious adverse effect" d. "You should take 325 mg of aspirin half an hour before each dose of Niacin to prevent this effect" d. "You should take 325 mg of aspirin half an hour before each dose of Niacin to prevent this effect" 62 | P a g e Intense flushing of the face, neck, and ears occurs in practically all patients taking nicotinic acid in pharmacologic doses. A nurse is caring for a patient who is undergoing a third round of chemotherapy is preparing to administer ondansetron (Zofran) 30 minutes before initiation of the chemotherapy. The patient tells the nurse that the ondansetron did not work as well the last time as it had the first time. What will the nurse do? a. Administer the ondansetron at the same time as the chemotherapy b. Contact the provider to suggest using high-dose intravenous dolasetron [Anzemet] c. Request an order to administer dexamethasone with the ondansetron d. Suggest to the provider that loperamide [Lomotil] be given with the ondansetron c. Request an order to administer dexamethasone with the ondansetron Ondansetron is a serotonin receptor antagonist; drugs in this class are the most effective drugs available for suppressing nausea and vomiting associated with anticancer drugs. The drug is even more effective when combined with dexamethasone A patient is being treated for chemotherapy-induced nausea and vomiting (CINV) with ondansetron (Zofran) and dexamethasone. The patient reports getting relief during and immediately after chemotherapy but has significant nausea and vomiting several days after each chemotherapy treatment. What will the nurse do? a. Contact the provider to discuss increasing the dose of ondansetron b. Suggest giving prolonged doses of dexamethasone c. Suggest adding aprepitant (Emend) to the medication regimen d. Tell the patient to ask the provider about changing the ondansetron to aprepitant c. Suggest adding aprepitant (Emend) to the medication regimen The current regimen of choice for patients taking highly emetogenic drugs consists of three agents: aprepitant plus dexamethasone plus a 5-HT3 antagonist, such as ondansetron. A patient with a history of chronic alcohol abuse has been admitted to the unit with cirrhosis. Upon review of the patient's laboratory results, the nurse notes that the patient's ammonia level is elevated at 218 ug/dL. What medication should the nurse prepare to administer? a. 0.9% NS b. Docusate sodium (Colace) c. Lactulose d. Polyethylene glycol (MiraLax) c. Lactulose Lactulose is the only laxative known to lower ammonia levels in patients with portal hypertension and hepatic encephalopathy secondary to liver disease. 65 | P a g e should not be given to pregnant women after the fourth month of gestation because it will cause staining of deciduous teeth in the fetus. A pregnant adolescent patient asks the nurse whether she should continue to take her prescription for tetracycline [Sumycin] to clear up her acne. Which response by the nurse is correct? a. "Tetracycline can be harmful to the baby's teeth and should be avoided." b. "Tetracycline is safe to take during pregnancy." c. "Tetracycline may cause allergic reactions in pregnant women." d. "Tetracycline will prevent asymptomatic urinary tract infections." a. "Tetracycline can be harmful to the baby's teeth and should be avoided." Tetracyclines can cause discoloration of deciduous teeth of infants if taken by the mother after the fourth month of gestation. A patient has been taking isoniazid for 4 months for latent tuberculosis. The patient reports bilateral tingling and numbness of the hands and feet, as well as feeling clumsy. The nurse expects the provider to: a. Discontinue the isoniazid b. Lower the isoniazid dose and add rifampin c. Order pyridoxine 100 mg per day d. Recheck the tuberculin skin test to see whether it worsens c. Order pyridoxine 100 mg per day Patients sometimes develop peripheral neuropathy, characterized by paresthesias, clumsiness, and muscle aches. If these occur, they may be reversed by administering pyridoxine (vitamin B6) An adolescent patient with mild cervicitis is diagnosed with gonorrhea, the nurse will expect the provider to order what drug? a. Azithromycin (Zithromax) 1 g PO once, and doxycycline (Vibramycin) 100 mg PO twice daily for 7 days b. Ceftriaxone (Rocephin) 250 mg IM once and azithromycin (Zithromax) 1 gm PO once c. Ceftriaxone (Rocephin) 125 mg IM once d. Doxycycline (Vibramycin) 100 mg twice daily for 12 days b. Ceftriaxone (Rocephin) 250 mg IM once and azithromycin (Zithromax) 1 gm PO once The only options for treating cervical infection with gonorrhea are cefixime and ceftriaxone. Doxycycline or azithromycin should be given unless chlamydia has already been ruled out. A patient with severe allergic conjunctivitis who has been using Cromolyn ophthalmic drops for 2 days calls the nurse to report persistence of symptoms. When the nurse explains it takes several weeks for maximum benefit to occur, the patient asks if there is something else to use in the meantime. The nurse will suggest that the patient discuss which drug with the provider? 66 | P a g e A. An ophthalmic demulcent B. H1-receptor antagonist C. Glucocorticoid drops Ocular decongestants B. H1-receptor antagonist Histamine receptor antagonists can be used to provide immediate symptom relief, so until the cromolyn has provided relief, they may be useful for treating symptoms. A nurse administers timolol [Timoptic] ophthalmic drops to a patient who has glaucoma. The patient reports stinging of the eyes shortly after the drops were administered. What will the nurse do? a. Monitor the patient's heart rate, respiratory rate, and blood pressure. b. Notify the provider that the patient shows signs of angle-closure glaucoma. c. Reassure the patient that these are localized, reversible effects of the drug. d. Request an order for an antihistamine to treat this allergic response to the drug. c. Reassure the patient that these are localized, reversible effects of the drug. Local effects of timolol and other beta blockers are generally minimal, but transient, ocular stinging can occur. A 6-year-old child has otitis media and is being treated with amoxicillin [Amoxil] and ibuprofen [Motrin]. The child's parent calls the nurse to report that the child's pain is not relieved with the ibuprofen. The child is afebrile and there is no drainage from either ear. The nurse will discuss which additional treatment with the child's provider? a. Adding acetaminophen [Tylenol] to the pain medication regimen b. Applying antipyrine and benzocaine [Aurodex] solution to the ear canals c. Changing the antibiotic to amoxicillin/clavulanate [Augmentin] d. Performing a tympanostomy to relieve pressure in the middle ear b. Applying antipyrine and benzocaine [Aurodex] solution to the ear canals For children over age 5 years, the AAP guidelines recommend topical anesthetic ear drops for pain relief; this is contraindicated if the TM is perforated. This child does not have drainage, indicating intact eardrums. A patient with stable COPD is prescribed a bronchodilator medication. Which type of bronchodilator is preferred for this patient? a. A long-acting inhaled beta2 agonist b. An oral beta2 agonist c. A short-acting beta2 agonist d. An intravenous methylxanthine 67 | P a g e a. A long-acting inhaled beta2 agonist LABAs are preferred over SABAs for COPD. Which medication should be used for asthma patients as part of step 1 management? a. Combination inhaled glucocorticoids/long-acting beta2 agonists b. Inhaled low-dose glucocorticoids c. Long-acting beta2 agonist d. Short-acting beta2 agonists d. Short-acting beta2 agonists Patients needing step 1 management have intermittent, mild symptoms and can be managed with a SABA as needed. A patient with stable COPD receives prescriptions for an inhaled glucocorticoid and an inhaled beta2- adrenergic agonist. Which statement by the patient indicates understanding of this medication regimen? a. "I should use the glucocorticoid as needed when symptoms flare." b. "I will need to use the beta2-adrenergic agonist drug daily." c. "The beta2-adrenergic agonist suppresses the synthesis of inflammatory mediators." d. "The glucocorticoid is used as prophylaxis to prevent exacerbations." d. "The glucocorticoid is used as prophylaxis to prevent exacerbations." Inhaled glucocorticoids are used daily to prevent acute attacks. They are not used PRN. A patient with severe, chronic COPD uses an inhaled LABA/glucocorticoid but continues to have frequent exacerbation of symptoms. The nurse will contact the provider to discuss: a. adding roflumilast [Daliresp] once daily. b. changing to oral theophylline twice daily. c. prescribing oral steroids once daily. d. Using an ipratropium/albuterol combination twice daily. a. adding roflumilast [Daliresp] once daily. For patients with chronic, severe COPD, the risk of exacerbations may be reduced with roflumilast. A patient with gastroesophageal reflux disease (GERD) is to begin taking oral metoclopramide [Reglan]. The patient asks the nurse about the medication. Which response by the nurse is correct? a. "After 3 months, if the drug is not effective, you may need to increase the dose." b. "Metoclopramide may cause hiccups, especially after meals." 70 | P a g e a. Baseline vitamin D level b. Calcium and vitamin D supplements c. Estrogen therapy d. Skeletal x-rays before treatment b. Calcium and vitamin D supplements Calcium and vitamin D supplements can help minimize the patient's risk of developing osteoporosis. A postmenopausal patient who has had a hysterectomy and who has a family history of coronary heart disease reports experiencing vaginal dryness and pain with intercourse but tells the nurse that she does not want to take hormones because she is afraid of adverse effects. The nurse will suggest that the woman ask her provider about: a. Depo Provera. b. Estraderm. c. low-dose estrogens. d. Premarin vaginal. d. Premarin vaginal. Estrogens for intravaginal administration are used for local effects, primarily to treat vulval and vaginal atrophy. The nurse is caring for a patient receiving intravenous acyclovir [Zovirax]. To prevent nephrotoxicity associated with intravenous acyclovir, the nurse will: a. hydrate the patient during the infusion and for 2 hours after the infusion. b. increase the patient's intake of foods rich in vitamin C. c. monitor urinary output every 30 minutes. d. provide a low-protein diet for 1 day before and 2 days after the acyclovir infusion. a. hydrate the patient during the infusion and for 2 hours after the infusion. The nurse should ensure that the patient is hydrated during the acyclovir infusion and for 2 hours after the infusion to prevent nephrotoxicity. A woman complains of burning on urination and increased frequency. The patient has a history of frequent urinary tract infections (UTIs) and is going out of town in 2 days. To treat the infection quickly, the nurse would expect the health care provider to order: a. aztreonam [Azactam]. b. fosfomycin [Monurol]. c. trimethoprim/sulfamethoxazole [Bactrim]. d. vancomycin [Vancocin]. 71 | P a g e b. fosfomycin [Monurol]. Fosfomycin has been approved for single-dose therapy of UTIs in women. A young adult woman will begin using an inhaled glucocorticoid to treat asthma. The nurse will teach this patient about the importance of which action? a. Lowering her calcium intake and increasing her vitamin D intake b. Participating in weight-bearing exercises on a regular basis c. Taking oral glucocorticoids during times of acute stress d. Using two reliable forms of birth control to prevent pregnancy b. Participating in weight-bearing exercises on a regular basis Like oral glucocorticoids, inhaled glucocorticoids can promote bone loss in premenopausal women. Patients should be encouraged to participate in weight-bearing exercises to help minimize this side effect. A patient receives a drug that has a narrow therapeutic range. The nurse administering this medication will expect to do what? a. Administer the drug at intervals longer than the drug half-life. b. Administer this medication intravenously. c. Monitor plasma drug levels. d. Teach the patient that maximum drug effects will occur within a short period. c. Monitor plasma drug levels. A patient claims to get better effects with a tablet of Brand X of a drug than with a tablet of Brand Y of the same drug. Both brands contain the same amount of the active ingredient. What does the nurse know to be most likely? a. Advertising by pharmaceutical companies can enhance patient expectations ofone brand over another, leading to a placebo effect. b. Because the drug preparations are chemically equivalent, the effects of the two brands must be identical. c. Tablets can differ in composition and can have differing rates of disintegration and dissolution, which can alter the drug's effects in the body. d. The bioavailability of a drug is determined by the amount of the drug in eachdose. c. Tablets can differ in composition and can have differing rates of disintegration and dissolution, which can alter the drug's effects in the body. Even if two brands of a drug are chemically equivalent (i.e., they have identical amounts of the same chemical compound), they can have different effects in the body if they differ in bioavailability. Tablets made by different manufacturers contain different binders and fillers, which disintegrate and dissolve at different rates and affect the bioavailability of the drug. 72 | P a g e A patient is receiving intravenous gentamicin. A serum drug test reveals toxic levels. The dosing is correct, and this medication has been tolerated bythis patient in the past. Which could be a probable cause of the test result? a. A loading dose was not given. b. The drug was not completely dissolved in the IV solution. c. The patient is taking another medication that binds to serum albumin. d. The medication is being given at a frequency that is longer than its half-life. c. The patient is taking another medication that binds to serum albumin. Gentamicin binds to albumin, but only weakly, and in the presence of another drug that binds to albumin, it can rise to toxic levels in blood serum. A nurse is reviewing a medication administration record before administering medications. Which order will the nurse implement? a. Furosemide [Lasix] 20 mg QD PO b. Furosemide [Lasix] 20 mg qd PO c. Furosemide [Lasix] 20 mg daily d. Furosemide [Lasix] 20 mg PO daily d. Furosemide [Lasix] 20 mg PO daily The correct answer is a complete order; it contains the medication, dose, route, and time. "qd" is no longer an accepted abbreviation; it should be written out as "daily" or "every day." A patient asks a nurse to explain what drug tolerance means. The nurse responds by telling the patient that when tolerance occurs, it means the patient: a. has developed a psychologic dependence on the drug. b. may need increased amounts of the drug over time. c. will cause an abstinence syndrome if the drug is discontinued abruptly. d. will have increased sensitivity to drug side effects. b. may need increased amounts of the drug over time. When tolerance develops, a dose increase may be needed, because a decreased response may occur with prolonged use. A patient with cancer has been taking an opioid analgesic four times daily for several months and reports needing increased doses for pain. What will the nurse tell the patient? a. PRN dosing of the drug may be more effective. b. The risk of respiratory depression increases over time. c. The patient should discuss increasing the dose with the provider. d. The patient should request the addition of a benzodiazepine to augment pain relief. 75 | P a g e A prescriber has ordered bethanechol [Urecholine] for a postoperative patient who has urinary retention. The nurse reviews the patient's chart before giving the drug. Which part of the patient's history would be a contraindication to using this drug? a. Asthma as a child b. Gastroesophageal reflux c. Hypertension d. Hypothyroidism a. Asthma as a child Bethanechol is contraindicated in patients with active or latent asthma, because activation of muscarinic receptors in the lungs causes bronchoconstriction. A patient who experiences motion sickness is about to go on a cruise. The prescriber orders transdermal scopolamine [Transderm Scop]. The patient asks the nurse why an oral agent is not ordered. The nurse will explain that the transdermal preparation: a. can be applied as needed at the first sign of nausea. b. has less intense anticholinergic effects than the oral form. c. is less sedating than the oral preparation. d. provides direct effects, because it is placed close to the vestibular apparatus of the ear. b. has less intense anticholinergic effects than the oral form. The transdermal system of scopolamine is preferred because it may have less intense anticholinergic effects than oral or subcutaneous dosing A patient who has a lower back injury exhibits muscle spasms. The provider orders cyclobenzaprine [Flexeril] 10 mg three times a day. What will the nurse include when teaching this patient about this drug? a. "This drug carries some risk of developing hallucinations and psychotic symptoms." b. "This medication may cause your urine to turn brown, black, or dark green." c. "You may experience blurred vision, dry mouth, or constipation." d. "You will need to have liver function tests performed while taking this medication." c. "You may experience blurred vision, dry mouth, or constipation." Cyclobenzaprine has significant anticholinergic effects and patients should be warned about dry mouth, blurred vision, and constipation A nurse is caring for a patient who has been taking an antiepileptic drug for several weeks. The nurse asks the patient if the therapy is effective. The patient reports little change in seizure frequency. What will the nurse do? 76 | P a g e a. Ask the patient to complete a seizure frequency chart for the past few weeks. b. contact the provider to request an order for serum drug levels c. Reinforce the need to take the medications as prescribed. d. Request an order to increase the dose of the antiepileptic drug. b. contact the provider to request an order for serum drug levels If medication therapy is not effective, it is important to measure serum drug levels of the medication to determine whether therapeutic levels have been reached and to help monitor patient compliance. A pregnant patient in her third trimester asks the nurse whether she can take aspirin for headaches. Which response by the nurse is correct? a. "Aspirin is safe during the second and third trimesters of pregnancy." b. "Aspirin may cause premature closure of the ductus arteriosus in your baby." c. "Aspirin may induce premature labor and should be avoided in the third trimester." d. "You should use a first-generation nonsteroidal anti-inflammatory medication." b. "Aspirin may cause premature closure of the ductus arteriosus in your baby." Aspirin poses risks to the pregnant patient and her fetus, including premature closure of the ductus arteriosus. A patient is about to receive prednisone for tendonitis. The nurse reviewing the chart would be concerned about which of the following in the patient's medical history? a. Asthma and allergic rhinitis b. Gouty arthritis c. Seborrheic dermatitis d. Systemic fungal infection d. Systemic fungal infection Glucocorticoids are contraindicated in patients with a history of systemic fungal infections. A 11-year-old boy received all childhood immunizations before attending school as a kindergartner. Which vaccines are recommended for this child at his current age? a. DTaP, MCV4, Varivax b. PCV-23, Td, MMR c. Tdap, MCV4, HPV d. Tdap, Varivax, hepatitis B c. Tdap, MCV4, HPV At age 11, both males and females should receive a booster of diphtheria, tetanus, and pertussis (Tdap); the Menactra vaccine against meningitis (MCV4); and the human papillomavirus (HPV) vaccine. 77 | P a g e A patient who has been diagnosed with rheumatoid arthritis (RA) for 1 month and has generalized symptoms is taking high-dose nonsteroidal anti-inflammatory drugs (NSAIDs) and an oral glucocorticoid. The provider has ordered methotrexate [Rheumatrex]. The patient asks the nurse why methotrexate is necessary since pain and swelling have been well controlled with the other medications. The nurse will tell the patient that: A. methotrexate regimen can reduce overall costs and side effects of treatment. B. starting methotrexate early can help delay joint degeneration. C. starting methotrexate now will help increase life expectancy. D. with methotrexate, doses of NSAIDs can be reduced to less toxic levels. B. starting methotrexate early can help delay joint degeneration. Current guidelines for treatment of RA recommend starting a disease-modifying antirheumatic drug (DMARD) early—within 3 months of diagnosis for most patients—in order to delay joint degeneration. A patient with chronic gout has an acute gouty episode and is admitted to the hospital. The patient has been taking nonsteroidal anti-inflammatory drugs for several months. The prescriber plans to begin therapy with probenecid. What will the nurse do? a. Give the medication as ordered and observe the patient closely for gastrointestinal side effects. b. Request an order to lower the dose of the nonsteroidal anti-inflammatory drug. c. Restrict the patient's fluid intake to minimize the risk of renal injury. d. Suggest delaying the probenecid therapy until the acute episode has subsided. d. Suggest delaying the probenecid therapy until the acute episode has subsided. Probenecid may exacerbate acute episodes of gout, so treatment with this drug should be delayed until the acute attack has passed. A patient is being treated with warfarin [Coumadin] to prevent thrombus. The patient develops hyperuricemia, and the provider orders allopurinol [Zyloprim]. The nurse will contact the provider to discuss the dose. a. increasing; allopurinol b. increasing; warfarin c. reducing; allopurinol d. reducing; warfarin d. reducing; warfarin Allopurinol can inhibit hepatic drug-metabolizing enzymes and thus delay the inactivation of other drugs. This is a particular concern in patients taking warfarin; therefore, the warfarin dose should be reduced when allopurinol is also used. A patient has had three gouty flare-ups in the past year. Which drug class will the nurse expect the provider to order for this patient? 80 | P a g e d. monitoring phenytoin levels. Isoniazid is a strong inhibitor of three cytochrome P450 enzymes, and inhibition of these enzymes can raise the levels of other drugs, including phenytoin. Patients taking phenytoin should have the levels of this drug monitored, and the dose should be reduced if appropriate. Why can NPs prescribe? Increase access to healthcare How do you titrate medications? Monitor plasma levels closely Sam is a 90 y/o pt who requires a new RX. what changes in drug distribution with aging would influence rxing for Sadie Decreased plasma proteins 10mg Percocet vs 10mg oxy one works better because of..? The filler changes metabolism of the medication Medications need albumin to bind to and they are toxic (therapeutic index), is something competing for the albumin? Check other drugs When writing a prescription what is not allowed? Abbreviations that are not allowed Qd What medication causes gray teeth? Tetracycline A patient on seizure medication is still having seizures after a few weeks what do you want to do? Check serum drug levels because of narrow therapeutic index A patient is on phenytoin cannot be started on oral contraceptives they need a barrier method? Anything other than oral contraceptives When do you stop tetragons? Stop before the patient becomes pregnant A pregnant women is taking aspirin why is that bad? Causes PDA premature closure of __ A patient is taking Phenytoin for seizures and has a rash a month later what has happened? hypersensitivity can happen a month later 81 | P a g e A young healthy female has frequency and burning what do we prescribe? tx with Macrobid What is the 1st line drug choice for a previously healthy adult pt dx with community acquired pneumonia? Azithromycin How do you treat community acquired pneumonia with comorbidities? Tx with Rocephin and Azithromycin (a Macrolide) do NOT tx with LEVAQUIN. Why do we not treat onychomycosis (a fungal infection of the nails) ? Treatment can lead to liver/hepatotoxicity How do we titrate pancreatic enzymes? Look at poop color. Who needs pancreatic enzymes? CF pts & Gastric bypass pts need pancreatic enzymes statarea (color of poop) How do we prescribe for pancreatic enzymes? Prescribe units of lipase for pancreatic enzymes based on your poop color A patients daughter said she took Demerol/Meperidine for her surgery and wants it for her dads hip replacement: We do not give Demerol anymore it is DIRTY! A Lot of side effects. The pt has returned to the floor from surgery after a hip arthroplasty. For the first 48 hrs postoperatively, meperidine (Demerol) is order for pain control. During the time the pt is taking meperidine, frequent monitoring of what is required?A) blood pressureB) pulseC) temperatureD) urine output A ) blood pressure Typical or traditional antipsychotics may cause EPS or pseudoparkinsonism. Which symptom is considered an EPS?A) downward eye movementB) intentional tremorsC) loss of hearingD) shuffling gait D) shuffling gait The pt has a hx of depression and is taking fluoxetine (Prozac). The pt presents to the ED complaining of a severe headache. She is diaphoretic and is unable to sit still. Her family tells the nurse that the pt has been taking "some herb." Which herb does the nurse suspect the pt has been taking?A) ephedraB) feverfewC) garlicD) St. John's wort D) St. John's wort A 35 y/o pt presents to the clinic with a complaint of sore throat. VS are T 39.2, BP 132/60, HR 98, RR 18. She is allergic to dextromethorphan and takes oral contraceptives, vitamin C, and fexofenadine. She is 82 | P a g e dx with strep throat and prescribed amoxicillin/clavulanate potassium (Augmentin). What instruction should the nurse include in discharge teaching regarding the medication? - C) use an alternate method of birth control When to stop teterogens? Before getting pregnant bc of first trimester A patient it taking Phenytoin for the tx of seizures and experiences a reaction a month later what is happening? hypersensitivity can happen a month later A patient has a back spasm and we prescribe flexeril/ Cyclobenzaprine educate on side effects such as? urinary retention, constipation, dry mouth What is the blackbox warning with Fluroquinolones ex levaquin? leads to tendon rupture! What do we avoid if a patient has an infection? Steroids Immunizations the patient is 11 what does he need now? DON'T NEED HEP B already given, DON'T NEED PCV 23 given later A patient has a new diagnosis of Rheumatoid arthritis what do you start them on? Methotrexate What do we prescribe for chronic gout? Probenecid What do we treat Paget's disease with? calcitonin salmon How do we treat post-menopausal osteoporosis & education? Allegiant and take 30 minutes & drink a lot of water What is a major side effect of Afrin nasal spray? Rebound congestion: intranasal steroids while we withdrawal the Afrin addiction M of A for Guaifenesin? thins secretions and increases cough. Normal Step 1 management of Asthma? 85 | P a g e Propranolol Patient with migraine is started on Propranolol needs to be started on ipratropium (safe with beta blockers) Who is at risk for a fatal asthma attack? Patients who have had severe reactions before PMH: Have you ever been intubated for your asthma? Carbamazepine tx of seizures: black box warning for? and in what patient population? Steven Johnson syndrome Prevalent in elle in Asian patients Carbamazepine can cause toxic __________ __________. toxic epidermal necrolysis What can Carbamazepine cause and what labs are needed? Monitor CBC because it can cause blood disorders: CBC at least 3-4 times a year/every 3-4 months An older patient takes Benadryl what does he need to be monitored for? Monitor for urinary retention What is the first choice medication for allergies for an older patient? First choice is a second generation to prevent CNS depression/ sedation Ex Older population avoid first generation histamines and gear toward second generation? Avoid sedation. No Benadryl more need clarain -2nd generation antihistamines such as loratidine (Claritin) are prescribed for seasonal allergies because they are: less sedating than the 1st generation antihistamines What antibiotic is used to treat gonorrhea? Ceftriaxone How do we treat Eye conjunctivitis with gonorrhea? IM ceftriaxone TX with Doxycycline/ Rocephin for STI for a 25y/o females who takes oral contraceptives? Use a backup contraceptive until their next period If a patient is allergic to Penicillin they also cannot have cephalosporins! Why? Because of the Bata Lactam ring. They are vulnerable to Beta-lactamase producing organisms. Why do LABAS have a black box warning? Can accidentally be taken for acute attack and are at a high risk for death. GERD: affects lower esophageal tone. What aggravates their gastroesophageal tone? 86 | P a g e Estrogen What is the treatment for PUD? 1. Check for H Pylori 2. First line triple tx: PPI (Omeprazole), amoxicillin AND clarithromycin 3. If they cannot tolerate all three prescribe clarithromycin for 5 days then amoxicillin for 5 days- Step approach What is the step approach for GERD patients? 1. start them on a PPI omeprazole 2 x daily for 4-8 wks 1. First step therapy for GERD: Pepcid H2blocker twice a day - When using the step up approach in caring for pts with GERD, the step up from OTC antacid use is: histamine 2 receptor antagonist Rantidine for 4-8 wks What is the M of A for Reglan (Metoclopramide)? Tx for GERD. Increases motility and increases lower gastroesophageal tone Patients whose total dose of prednisone will exceed 1 gm will most likely need a second rx for? Omeprazole, PPI to prevent peptic ulcer disease A 37 y/o female who is newly depressed what labs do we get? Thyroid R/O hypothyroid T3, T4, TSH if normal and she is depressed start what? TSH is normal what do we start her on: SSRI Lexapro or citalopram NO ATIVAN ICS :inhaled corticosteroid steroid: Education Rinse your mouth to prevent oral thrush Long term lactulose we have to monitor? Potassium and Chloride Patient with asthma and COPD: how often are you using your inhaler? Monitoring of: Beta what??? -Bata 2 agonist use!! Tx of pneumonia with antibiotics improvement should be within? 48-72 hours if not CHANGE antibiotics! Antibiotic education: finish course to prevent resistance. Antimicrobial resistance: Overuse leads to tx failure in pts with PUD associated with H pylori may be due to: antimicrobial resistance Most important key takeaway for clindamycin? 87 | P a g e Watch out for diarrhea and Adequate fluid intake. Clindamycin: Look out for diarrhea. Take probiotics and drink a lot of water! To prevent dehydration Along with rxing ABX, adults with PNA should be instructed on lifestyle modifications to improve outcomes: adequate fluid intake. Zpack Azithromycin Dosing Titrate down each day: 250mg =then dose down -Prednisone pack titrate down each day Prescribed an aminoglycoside for an anerobic bacteria?? Change the antibiotic Lithium education Manage their sodium intake: Sodium alters their lithium drastically to prevent toxicity or deficiency. Sodium consistency GERD tx with Antacids: _______________ pH because it increases bases and is ANTI ACIDS Increasing gastric pH Eyedrops to patient education Throw away your makeup, don't touch the bottle to your eye, don't wear your contacts. Always wash your hands between medications and touching your eye Antifugal therapy leads to? Hepatotoxicity What medication is used to treat motion sickness? Dimenhydrinate or scopolamine for: Motion sickness: take before 15 minutes before? When giving Haldol monitor for? Shuffling gait EPS scale: AMES abnormal involuntary movement scale How do we treat Otitis media and conjunctivitis? high dose amoxicillin or Augmentin How do we treat Neuropathic pain? Gabapentin Sprained ankle with negative x-ray a lot of soft tissue damage tx with NSAID Kirk sprained his ankle and is asking for pain medication for his mild-moderate pain. appropriate 1st line medication would be? Ibuprofen 90 | P a g e Aggression, anxiety, depression and suicidal ideation are mental health issues when taking this medication How are we going to get an elderly old man to not take benadryl? Causes urinary retention Why do we use the second generation antihistamines more often for seasonal allergies? They are more selective which makes them less sedative When you take calcium carbonate antacids chronically what do they put themselves at risk for? Kidney stones Patients on long term PPI (can create osteoporosis through calcium decrease absorption) can also have what else occurs? Iron deficiency Vitamin B12 deficiency anemia osteoporosis Methylnaltrexone is used to treat? Opioid induced constipation If you give an elderly patient lactulose every day what do you need to monitor? Electrolytes Inappropriate use of antimicrobials? Creates resistance to the medications What is an antibiogram? Every hospital has this, chart of the local resistance patterns that are being monitored Carbamazepine has a lot of warnings, black box warning for what allele? Asian ancestry has an increased risk for steven johnsons syndrome "Burning man rash" Chromyln eye drops can they wear their contacts? No they are not allowed to First line drug for a moderate GAD? 91 | P a g e Buspar Working someone up for depression, what lab do you get? Thyroid Good drug for treatment with depression and anxiety? Lexapro Go to taper an SSRI you do this how? You reduce the dose for 50% for 3-4 days then Then reduce by 50% after that If you prescribe someone fluoxetine (SSRI), why is it important they take it the same time every day and do not run out of their rx)? Short half life Rule with asthma, when do you do up or down? If they use their SAB more than 2x a week you adjust If your asthma patient is on an inhaled beta agonist and an inhaled steroid which one do you tell them to use first? The beta one is to be used first to bronchodilator them then use the steroid. When you get a tmt plan for asthma what do you need to know? Severity, and control How bad, how long do they last, how often TMT for mild intermittent asthma? SABA (short acting bronchodilator) then add on low dose corticosteroids What past medical history patients are at risk for a beta agonist attack? Intubation or an ICU admission for asthma What causes antimicrobial resistance? Inappropriate use of antimicrobials What's an antibiogram? Your pattern of local resistance Sensitivity and cross resistance between cephalosporins and penicillins, has what in common that causes the cross sensitivity? 92 | P a g e Beta lactate ring DECREASE the dose If you have someone that is on long-term anti-fungal treatment, what labs are you going to monitor? LFTs Ketoconazole What is the rule about Flagyl and alcohol? Don't do it What do we reserve fluoroquinolone for? Community acquired pneumonia with patients with co-morbidities A 44 year old female with diabetes - comorbidities receive fluoroquinolones What is the black box warning for fluoroquinolones? Tendon rupture Clindamycin Gives people cdiff, also known as pseudomembranous colitis Advise the patient to discontinue the medication if the stools were 10-20 a day and start the patient on vancomycin for c.diff related diarrhea If you are on the medication they are at risk for C.diff, you want to know how many times a day this is happening. G6PD faba beans and sulfonamides (bactrim) - develop anemia Do use tetracyclines in Pregnancy - NO Renal dysfunction - NO Hepatic dysfunction - NO Adolescence - YES You have a 16-year-old girl taking Minocycline for acne has headaches Pseudotumor cerebri 95 | P a g e Know risk of hepatic and renal injury - on an antifungal for that long to treat a nail infection Postmenopausal patient with atrophic vaginitis 59, breast cancer at age 40, what is the most appropriate treatment Estrogen cream - not oral Shingles, patient is miserable Acyclovir plus NSAIDs What do you prescribe for neuropathic pain with shingles Gabapentin Community acquired PNA and an adult with comorbidities. Azithromycin plus ceftriaxone PO for community acquired MRSA soft tissue infection Bactrim What drug causes long term osteopenia Steroids Which of the following about pancreatic enzymes is true? We give these for statarea (fat in stools). What other medical states can trigger the need for pancreatic enzymes? Bariatric procedures Prescribing a pancreatic enzyme replacement (Lipase, Proease, Amylase) Prescribing for units of Lipase Metronidazole bacterial vaginosis, patient drinks. Tell patient not to drink Do the gell instead Or clindamycin Take their SOCIAL hx Why NP need prescriptive authority Access to care Prescribing drug with narrow therapeutic index 96 | P a g e Do labs frequently Patient brings in x tablets and y tablets - same drug, different brands The inactive ingredients can be different Cause rates of dissolution to be different (dissolve differently) IV gentamicin, labs show toxic levels, on normal dose Gentamicin highly bound to serum albumin - check if patient is taking other medications that are binding to serum albumin. When you write a prescription what does it need? Sig (directions) Drug Dose Frequency Route Refills ie. given - Lasix, 20mg, PO, daily Narcotic analgesic for chronic pain, patient is taking more than prescription, patient is alert, oriented and VSS. What's going on? Tolerance When is the highest risk for teratogenic risk in pregnancy First trimester 5 year old has gray teeth Tetracycline Older adult, routine visit, on highly protein bound drug (like warfarin), what are you concerned about? Serum albumin level Son here, concerned, father had total hip, in pain, son is adamant that he gets demerol (meperidine) what do you tell him Education and morphine Patient is wheezing, SOB, hr 80, resp 24, 124/78, provider orders nonselective beta agonist medication. What side effect of that is a primary concern? Tachycardia What do we use pilocarpine for? 97 | P a g e Lowers intraocular pressure in patients with glaucoma. A provider reviews a patient's chart before using bethanechol for post op urinary retention. Which is contraindicated in using this treatment? Stimulates cholinergic receptors, asthma patients take anticholinergic drugs. Can cause bronchoconstriction Medication for seasickness Scopalopine S/E of cyclobenzaprine (10mg a day - big dose) Blurred vision Dry mouth Constipation Patient with seizures, place on antiepileptic drug, seizures aren't getting better Check the levels Phenytoin for seizures, want an oral contraceptive, what would you tell them Consider different form of hormone You do not prescribe these together, you will prescribe something a non oral contraceptive medication instead Is it ok for patients in their third trimester to take ASA No - closes ductus arteriosus Prescribing prednisone for tendonitis, patient says they are being treated for valley fever- do we still prescribe? No - increases immunocompromised Select all. 11 yo has all vaccines, wellness check, do they need their: Hep B NO PCV 23 NO TDap YES MCV4 YES HPV YES What is one of the reason we start methotrexate early in RA Reduces damage Patient with gout while taking NSAID for a couple months - gonna start privenicine, but now they have an acute gout outbreak. Do we start privenicine?