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Question 1
A nurse who provides care on an acute medicine unit has frequently recommended the use of nicotine replacement gum for patients who express a willingness to quit smoking during their admission or following their discharge. For which of the following patients would nicotine gum be contraindicated? A. A patient whose stage III pressure ulcer required intravenous antibiotics and a vacuum dressing B. A patient with a history of angina who experienced a non-ST wave myocardial infarction C. A patient who received treatment for kidney failure due to an overdose of acetaminophen D. A patient whose pulmonary embolism was treated with a heparin infusion 1 points Question 2 A patient who has been taking buspirone (BuSpar) for 1 week calls the clinic and reports to the nurse that the drug is not working. The patient informs the nurse that she is still having symptoms of anxiety. The nurse will tell the patient that A. she will report this to the physician immediately. B. it may take up to 6 months for the drug to relieve her anxiety. C. optimum relief of anxiety usually occurs after 3 to 4 weeks of treatment. D. the drug is not going to work for her and the medication needs to be changed. 1 points Question 3 A patient has been admitted to the ICU because of multiple traumas due to a motor vehicle accident. The physician has ordered propofol (Diprivan) to be used for maintenance of sedation. Before administration of propofol, a priority assessment by the nurse would be to check for a history of A. diabetic hyperlipidemia. B. increased intraocular pressure. C. seizure disorders. D. low blood pressure. 1 points Question 4 A 39-year-old patient who is having trouble sleeping is beginning drug treatment with zaleplon (Sonata). The nurse will be sure to ask the patient if she is taking A. oxycodone (Percodan). B. secobarbital (Seconal). C. cimetidine (Zantac). D. meperidine (Demerol). 1 points Question 5 A nurse is caring for a patient who has been admitted with acute cocaine intoxication. Which of the following vital signs would the nurse expect to find initially when assessing the patient? A. BP: 130/88, P: 92, R: 28 B. Blood pressure (BP): 98/50, pulse (P): 120, respirations (R): 40 1 points Question 6
C. BP: 170/98, P:110, R: 20 D. BP: 150/90, P: 80, R: 16 A nurse is caring for a patient who abuses marijuana. The treatment for marijuana abuse consists mainly of 1 points Question 7
- no nursing action unless the patient experiences a “bad trip.”
- nonpharmacologic interventions combined with an exercise program.
- aggressive respiratory assistance
- drug therapy with bromocriptine (Parlodel). A patient is suffering from acute inhalant intoxication. The priority nursing intervention will be to A. assess the patient's psychosocial status. B. administer oxygen therapy. C. provide an emesis basin. D. administer epinephrine. 1 points Question 8 A 20-year-old man has begun treatment of the psychotic symptoms of schizophrenia using olanzapine (Zyprexa). Which of the following symptoms would be categorized as a negative symptom of schizophrenia? A. Visual hallucinations B. Auditory hallucinations C. Delusional thinking D. Lack of interest in normal activities 1 points Question 9 A homeless man who is well known to care providers at the local hospital has been admitted to the emergency department after having a seizure outside a mall. The man is known to be a heavy alcohol user and is malnourished with a very low body mass index. How are this patient's characteristics likely to influence possible treatment with phenytoin? A. The patient's heavy alcohol use will compete with phenytoin for binding sites and he will require a higher-than-normal dose. B. The patient's protein deficit will likely increase the levels of the free drug in his blood. C. Phenytoin is contraindicated within 48 hours of alcohol use due to the possibility of paradoxical effects. D. The patient will require oral phenytoin rather than intravenous administration. 1 points Question 10 The wife of a patient who is taking haloperidol calls the clinic and reports that her husband has taken the
B. cognitive deficits. C. acute renal failure. D. liver damage. 1 points Question 15 A patient has been hospitalized for treatment of substance abuse after being arrested and jailed for the past 24 hours. The patient is experiencing severe muscle and abdominal cramps, seizures, and acute psychosis due to abrupt withdrawal. Which of the following drug classes is the most likely cause of these severe and potentially fatal withdrawal symptoms? A. Amphetamines B. Opioids C. Benzodiazepines D. Sedative–hypnotic drugs 1 points Question 16 A 59-year-old woman has presented to a clinic requesting a prescription for lorazepam (Ativan) in order to treat her recurrent anxiety. Her care provider, however, believes that a selective serotonin reuptake inhibitor (SSRI) would be more appropriate. What advantage do SSRIs have over benzodiazepines in the treatment of anxiety? A. SSRIs have a more rapid therapeutic effect. B. SSRIs require administration once per week, versus daily or twice daily with benzodiazepines. C. SSRIs generally have fewer adverse effects. D. SSRIs do not require serial blood tests during therapy. 1 points Question 17 A 64-year-old-patient has been prescribed lorazepam (Ativan) because of increasing periods of anxiety. The nurse should be careful to assess for A. a history of current or past alcohol use. B. a diet high in fat. C. current nicotine use. D. a diet high in carbohydrates. 1 points Question 18 Which of the following would be an expected outcome in a patient who has been given atropine during a medical emergency? A. Restoration of normal sinus rhythm B. Resolution of respiratory acidosis C. Reduction of severe hypertension D. Increased level of consciousness 1 points Question 19 A trauma patient has been receiving frequent doses of morphine in the 6 days since his accident. This pattern of analgesic administration should prompt the nurse to carefully monitor the patient's A. bowel patterns. B. urine specific gravity. C. skin integrity.
D. core body temperature. 1 points Question 20 A middle-aged patient was diagnosed with major depression after a suicide attempt several months ago and has failed to respond appreciably to treatment with SSRIs. As a result, his psychiatrist has prescribed phenelzine. When planning this patient's subsequent care, what nursing diagnosis should the nurse prioritize? 1 points
- Risk for Injury related to drug–drug interactions or drug–nutrient interactions
- Risk for Constipation related to decreased gastrointestinal peristalsis
- Risk for Ineffective Peripheral Tissue Perfusion related to cardiovascular effects of phenelzine
- Risk for Infection related to immunosuppressive effects of phenelzine Question 21 A nurse works in a sleep disorder clinic and is responsible for administering medications to the patients. Which of the following patients would be most likely to receive zaleplon (Sonata)? A. A 20-year-old woman who will take the drug about once a week B. A 46-year-old man who receives an antidepressant and needs a sleep aid C. A 35-year-old man who is having difficulty falling asleep, but once asleep can stay asleep D. A 52-year-old woman who needs to fall asleep quickly and stay asleep all night 1 points Question 22 A 26-year-old professional began using cocaine recreationally several months ago and has begun using the drug on a daily basis over the past few weeks. He has noticed that he now needs to take larger doses of cocaine in order to enjoy the same high that he used to experience when he first used the drug. A nurse should recognize that this pattern exemplifies A. drug tolerance. B. dependence. C. addiction. D. withdrawal. 1 points Question 23 A postsurgical patient has been provided with a morphine patient-controlled analgesic (PCA) but has expressed her reluctance to use it for fear of becoming addicted. How can the nurse best respond to this patient's concerns? A. “It is not uncommon to develop a dependence on pain medications, but this usually takes place over a long period and is not the same as addiction.”
teacher and is concerned about feeling sedated at work? A. Lorazepam (Ativan) B. Diazepam (Valium) C. Alprazolam (Xanax) D. Buspirone (BuSpar) 1 points Question 28 A nurse is caring for a patient who is in severe pain and is receiving an opioid analgesic. Which of the following would be the nurse's priority assessments? A. Liver function studies, pain intensity, and blood glucose level B. Pain intensity, respiratory rate, and level of consciousness C. Respiratory rate, seizure activity, and electrolytes D. Respiratory rate, pain intensity, and mental status 1 points Question 29 A male patient has been brought to the emergency department during an episode of status epilepticus. Diazepam is to be administered intravenously. The nurse will be sure to A. administer after diluting the drug with gabapentin in intravenous solution. B. inject very slowly, no faster than 100 mg/minute. C. inject the diazepam very quickly, 15 mg in 10 to15 seconds. D. avoid the small veins in the dorsum of the hand or the wrist. 1 points Question 30 A 30-year-old woman is taking phenelzine (Nardil) 30mg PO tid. The nurse knows that at that dosage, the patient will need to be carefully monitored for A. increased secretions. B. facial flushing. C. dizziness. D. diarrhea. Attempt Score 28 out of 30 points Time Elapsed 1 hour, 6 minutes out of 1 hour and 15 minutes Instructions Please answer each question below and click Submit when you have completed the Quiz. Results Displayed Feedback
- Question 1
A nurse who provides care on an acute medicine unit has frequently recommended the use of nicotine replacement gum for patients who 1 out of 1 points express a willingness to quit smoking during their admission or following their discharge. For which of the following patients would nicotine gum be contraindicated? Response Feedback : Nicotine in any dosage form should not be used in patients immediately after myocardial infarction, or in those with life- threatening arrhythmias or severe or worsening angina pectoris. Antibiotics, anticoagulants, and renal failure are not contraindications for the use of nicotine as an aid to smoking cessation.
- Question 2 1 out of 1 points A patient who has been taking buspirone (BuSpar) for 1 week calls the clinic and reports to the nurse that the drug is not working. The patient informs the nurse that she is still having symptoms of anxiety. The nurse will tell the patient that Response Feedback : The nurse will inform the patient that it will likely take 3 to 4 weeks of treatment before she notices consistent relief of her anxiety. However, some improvement is often seen within 7 to 10 days of starting therapy. Since the patient had only been taking the drug 1 week, there is no need to inform the physician. The nurse would not make the assumption that the medication is not going to work for the patient nor would she tell her that it would take up to 6 months to see therapeutic results. - Question 3 0 out of 1 points A patient has been admitted to the ICU because of multiple traumas due to a motor vehicle accident. The physician has ordered propofol (Diprivan) to be used for maintenance of sedation. Before administration of propofol, a
Cocaine impairs the uptake of norepinephrine and epinephrine by presynaptic nerve endings, thus activating the adrenergic systems and causing hypertension, tachycardia, and vasoconstriction.
- Question 6 1 out of 1 points A nurse is caring for a patient who abuses marijuana. The treatment for marijuana abuse consists mainly of Response Feedback : Treatment for marijuana abuse consists mainly of nonpharmacologic interventions combined with an exercise program to help deal with withdrawal symptoms and cravings for the drug. Treatment of LSD and PCP use is necessary only when the user experiences a “bad trip.” Parlodel is given for cocaine addiction. Patients with acute inhalant intoxication may need respirator assistance. - Question 7 1 out of 1 points A patient is suffering from acute inhalant intoxication. The priority nursing intervention will be to Response Feedback : Patients suffering from acute inhalant intoxication may experience hypoxia from CNS depression; therefore, the patient will most likely be receiving oxygen therapy. Epinephrine is contraindicated because of possible cardiac stimulation. Arrhythmias may occur. Monitoring blood pressure and pulse is important; however, the patient could be short of breath due to the hypoxia. Therefore, monitoring respirations would be the priority. Nausea and vomiting could be present, and the nurse would need to provide the patient with an emesis basin, but it would not be the most important nursing intervention. - Question 8 A 20-year-old man has begun treatment of the psychotic symptoms of schizophrenia using olanzapine (Zyprexa). Which of the following
1 out of 1 points symptoms would be categorized as a negative symptom of schizophrenia? Response Feedback : The negative symptoms of schizophrenia include flat or blunted emotions, lack of pleasure or interest in things (anhedonia), and limited speech. The positive symptoms of schizophrenia, and the most recognizable symptoms, include delusions (e.g., paranoia or distorted perceptions of other people's intentions) and hallucinations.
- Question 9 1 out of 1 points A homeless man who is well known to care providers at the local hospital has been admitted to the emergency department after having a seizure outside a mall. The man is known to be a heavy alcohol user and is malnourished with a very low body mass index. How are this patient's characteristics likely to influence possible treatment with phenytoin? Response Feedback : A protein deficit puts the patient at greater risk for having greater amounts of free, active drug in the blood because less protein albumin is available for binding than would normally be expected. Alcohol does not compete with phenytoin for binding sites and the drug is not necessarily contraindicated with recent alcohol intake, though alcohol does influence the metabolism of phenytoin. Oral phenytoin would not significantly minimize the risk of adverse effects. - Question 10 1 out of 1 points The wife of a patient who is taking haloperidol calls the clinic and reports that her husband has taken the first dose of the drug and it is not having a therapeutic effect. An appropriate response by the nurse would be Response Feedback: The nurse should instruct the wife to continue offering her husband the drug
Response Feedback : Acetylcholine and cevimeline are both cholinergic agonists, and, like carbachol, would be contraindicated in this patient. Administration of either of these drugs could be fatal. Nicotine is a direct-acting nicotinic agonist and is not indicated in cholinergic poisoning. Atropine is considered the antidote for cholinergic poisoning. The actions of atropine are a reduction in salivary, bronchial, and sweat gland secretions; mydriasis; cycloplegia; changes in heart rate; contraction of the bladder detrusor muscle and of the gastrointestinal smooth muscle; decreased gastric secretion; and decreased gastrointestinal motility.
- Question 14 1 out of 1 points A patient with mild low back pain has been advised to take acetaminophen. The nurse will inform him that excessive intake of acetaminophen may result in Response Feedback : A patient taking acetaminophen should be taught the common adverse effects of the drug, which include rash, urticaria, and nausea. Nausea, not gastrointestinal distress, is a common adverse effect of acetaminophen. Flushing, dizziness, and feelings of tingling, heat, and fatigue are the most common adverse effects of sumatriptan, not acetaminophen. - Question 15 1 out of 1 points A patient has been hospitalized for treatment of substance abuse after being arrested and jailed for the past 24 hours. The patient is experiencing severe muscle and abdominal cramps, seizures, and acute psychosis due to abrupt withdrawal. Which of the following drug classes is the most likely cause of these severe and potentially fatal withdrawal symptoms? Response Feedback : Abrupt withdrawal from long-term use of sedative–hypnotic drugs should never be attempted because withdrawal symptoms are serious and potentially fatal. Withdrawal symptoms include agitation, dysphoria, insomnia, vomiting, diarrhea, ataxia, hallucinations, acute psychosis, muscle
and abdominal cramps, anorexia, and seizures. These symptoms may occur 12 to 72 hours after the last use of the drug and may last up to 14 days. The abrupt withdrawal of benzodiazepines, opioids, and amphetamines does not cause such severe and potentially fatal withdrawal symptoms.
- Question 16 1 out of 1 points A 59-year-old woman has presented to a clinic requesting a prescription for lorazepam (Ativan) in order to treat her recurrent anxiety. Her care provider, however, believes that a selective serotonin reuptake inhibitor (SSRI) would be more appropriate. What advantage do SSRIs have over benzodiazepines in the treatment of anxiety? Response Feedback : SSRIs are generally well tolerated with few adverse effects. Unlike the benzodiazepines, they do not cause diminished alertness or ataxia. However, they take longer to have a therapeutic effect. Neither class of drug necessitates serial blood testing. SSRIs are normally taken daily. - Question 17 1 out of 1 points A 64-year-old-patient has been prescribed lorazepam (Ativan) because of increasing periods of anxiety. The nurse should be careful to assess for Response Feedback : The patient who has history of alcohol or substance abuse may be a poor candidate for lorazepam because the patient is more likely to develop dependence on the drug. Alcohol will also have an additive effect with lorazepam. A diet high in fat and carbohydrates or nicotine use should not affect the use of lorazepam. - Question 18 1 out of 1 points Which of the following would be an expected outcome in a patient who has been given atropine during a medical emergency? Response Feedback :
The nurse will most likely administer the zaleplon to the 35- year-old man who is having difficulty falling asleep, but once asleep can stay asleep. Zolpidem would most likely be administered to the 20-year-old who will take a sleep aid only once a week. Eszopiclone (Lunesta) will be given to the 52- year- old woman who needs to fall asleep quickly and has trouble staying asleep. The 46-year-old man will likely receive trazodone (Desyrel). This drug is given as a sleep aid for a patient who is taking an antidepressant.
- Question 22 A 26-year-old professional began using cocaine recreationally several 1 out of 1 points months ago and has begun using the drug on a daily basis over the past few weeks. He has noticed that he now needs to take larger doses of cocaine in order to enjoy the same high that he used to experience when he first used the drug. A nurse should recognize that this pattern exemplifies Response Feedback: With drug use over time, tolerance develops. Tolerance occurs when the body develops a natural resistance to the drug's physical or euphoric effects, making it necessary to take increasing doses more frequently to achieve the desired effect. - Question 23 A postsurgical patient has been provided with a morphine patient- 1 out of 1 points controlled analgesic (PCA) but has expressed her reluctance to use it for fear of becoming addicted. How can the nurse best respond to this patient's concerns? Response Feedback : Addiction to opioids is a rare occurrence among hospital patients
who do not have a history of drug abuse. It would be inappropriate to downplay the patient's concerns, however. A more appropriate response would be to explain the phenomenon of dependence and to differentiate it from addiction.
- Question 24 - out of 1 points A patient has been prescribed zolpidem (Ambien) for short-term treatment of insomnia. Which of the following will the nurse include in a teaching plan for this patient? (Select all that apply.) Response Feedback : Zolpidem generally is not used for more than 7 to 10 days at a time. It induces sleep rapidly and should be taken immediately before going to bed. It is true that the drug does not seem to produce residual effects the next morning or cause prolonged rebound effects when it is discontinued. It is available in both quick-onset and continuous-release oral forms, and common adverse effects of the drug are headache, prolonged drowsiness, and dizziness. - Question 25
- out of 1 points A patient who is experiencing withdrawal from heavy alcohol use have developed psychosis and been treated with haloperidol. Which of the following assessment findings should prompt the care team to assess the patient for neuroleptic malignant syndrome? Response Feedback : Neuroleptic malignant syndrome is characterized by fever, sweating, tachycardia, muscle rigidity, tremor, incontinence, stupor, leukocytosis, elevated creatinine phosphokinase levels, and renal failure. Agitation, pruritis, thirst, and increased urine output are not indicative of neuroleptic malignant syndrome. - Question 26 1 out of 1 points A nurse is providing care for a patient who suffered extensive burns to his extremities during a recent industrial accident. Topical
analgesics. Seizure activity, electrolytes, liver function, blood glucose level, and mental status may need to be assessed during opioid analgesic therapy related to adverse effects, but they would not be the priority assessments.
- Question 29 1 out of 1 points A male patient has been brought to the emergency department during an episode of status epilepticus. Diazepam is to be administered intravenously. The nurse will be sure to Response Feedback : When diazepam is administered intravenously during status epilepticus, the small veins in the dorsum of the hand or the wrist should be avoided. It should be injected slowly, no faster than 5 mg in 1 minute. Diazepam should not be mixed or diluted with other solutions or drugs, either in the syringe or in intravenous solutions. - Question 30 1 out of 1 points A 30-year-old woman is taking phenelzine (Nardil) 30mg PO tid. The nurse knows that at that dosage, the patient will need to be carefully monitored for Response Feedback : The nurse will closely monitor for the adverse effects of phenelzine related to the anticholinergic effect of the drug, such as dizziness that tends to be more pronounced at dosages above 45 mg/day. Dizziness is also a sign of a phenelzine drug overdose. Constipation and dry mouth are also adverse effects, not diarrhea and increased secretions. Facial flushing is not an identified adverse effect of phenelzine.
