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PHARM EXAM 4 TEST BANK
A nurse is teaching a group of nursing students about substance abuse. Which statement by a student indicates a need for further teaching? "Patients who experience physical dependence will show compulsive drug-seeking behavior." "People who are addicted to a drug do not necessarily have tolerance to that drug." "Physical dependence means that abstinence syndrome will occur if a drug is withdrawn." "Physical dependence often contributes to addictive behavior but does not cause it." ANS: A Physical dependence occurs with prolonged drug exposure and, through neuroadaptive processes, results in abstinence syndrome if a drug is withdrawn. It does not necessarily result in compulsive drug-seeking behavior. Patients can have drug addiction, which involves compulsive drug seeking without having developed a tolerance to drug effects. Addictive behavior is the result of psychologic dependence with an intense subjective need for a drug. Because abstinence syndrome is uncomfortable, physical dependence can increase subjective feelings for a drug. A patient is ready for discharge home from a lengthy hospital stay after a motor vehicle accident. The patient suffered multiple fractures and required large doses of morphine for several weeks. The nurse preparing the patient for discharge notes that the patient requests the maximum dose of the oral opioid analgesic at the exact intervals it is prescribed. The nurse is correct to suspect what has occurred? Addiction Compulsive drug seeking Cross-tolerance Drug tolerance ANS: D Patients who use a drug regularly develop tolerance to the drug when a dose produces a smaller response than it did initially. This patient has been on large doses of opioids for several weeks and has developed tolerance to this class of drugs. Addiction is characterized by compulsive drug seeking, which has not occurred. A patient using narcotics for severe pain is not a compulsive drug seeker. Cross-tolerance occurs when tolerance to one drug confers tolerance to another drug. The opioid analgesic for home use is in the same drug classification, so this is not cross- tolerance. We have an expert-written solution to this problem! A patient who has been taking a medication with a side effect of drowsiness stops taking the medication after several weeks. The patient reports feeling anxious and jittery. The nurse understands that this response is due to: addiction. psychologic dependence.
tolerance. withdrawal syndrome. ANS: D Withdrawal syndrome occurs when patients have developed a physical dependence on a drug and then often show symptoms that are the opposite of the drug's effect when the drug is withdrawn. Addiction is characterized by compulsive drug seeking. Psychologic dependence is an intense subjective need for a drug. Tolerance develops when increased amounts of a drug are needed to achieve the drug's effects. A nurse is caring for four patients. The nurse would be concerned about which patient developing a substance use disorder? A college student who reports having experimented with marijuana in the past year An older adult patient with terminal cancer who requires twice the normal dose of morphine for pain relief A patient in moderate to severe pain after a total hip replacement who asks for pain medication an hour before the next dose is due A patient whose history indicates the use of prescription narcotic analgesics for back and headache pain ANS: D Patients who use narcotics for minor pains are more likely to be compulsive drug seekers. A college student who experiments with an illegal substance is not necessarily going to develop a substance use disorder. An elderly patient with terminal cancer pain has most likely developed physical dependence and tolerance to morphine but is not a substance abuser. Patients with significant pain who ask for more frequent dosing are not showing substance use disorder. A nursing student is caring for a patient who is addicted to several drugs. The student tells the nurse that the patient "got this way on purpose." Which response by the nurse is most appropriate? "Peer pressure and social factors determine individual choices." "Physical dependence is necessary for addiction to occur." "Pre-existing psychopathology underlies most drug abuse." "Some individuals are more vulnerable to drug abuse than others." ANS: D Some individuals are more prone to becoming substance abusers than others for a variety of reasons, including physiologic, psychologic, social, emotional, and genetic reasons. Peer pressure, social factors, the development of physical dependence, and underlying psychologic disorders contribute to the development of addiction but are not determining factors. A nurse is teaching a class on addiction. Which statement by one of the class participants indicates a need for further teaching? "Addictive drugs lead to dopamine release in amounts similar to those released by normal reward circuits." "Neural remodeling leads to decreased dopamine release, leaving users with
"Drinking more than two drinks a day protects the heart from atherosclerosis." "Long-term alcohol use can damage the heart and cause heart failure." "Over time, alcohol use can lower your blood pressure." ANS: C Chronic abuse of alcohol results in direct damage to the myocardium, increasing the risk of heart failure. Chronic alcohol abuse has a significant effect on the heart and also affects the liver. Drinking fewer than two alcoholic beverages a day potentially protects the heart from atherosclerosis. Alcohol consumption produces a dose-dependent elevation of blood pressure. An alcoholic patient's spouse asks a nurse about recovery from chronic alcoholism. The patient is confused and has abnormal eye movements and nystagmus. Which statement by the nurse is correct? "The symptoms your spouse shows are partly reversible in most people." "These symptoms can be reversed with vitamin therapy and good nutrition." "Your spouse has symptoms of an irreversible encephalopathy." "Your spouse will probably recover completely after detoxification." ANS: B Chronic use of alcohol can produce severe neurologic and psychiatric disorders. This patient shows signs of Wernicke's encephalopathy, which is readily reversible with thiamine. With proper nutrition, the symptoms will clear completely. Korsakoff's psychosis is not reversible; signs of this disorder include polyneuropathy, memory disorders, and confabulation. Wernicke's encephalopathy requires thiamine supplementation and not just detoxification, which is treatment to withdraw alcohol from the patient's system. A nurse is discussing alcohol abuse with a group of nursing students. One student asks whether alcohol consumption has any beneficial effects. The nurse replies that, in moderate amounts, alcohol: helps people to sleep well. improves sexual responsiveness. may protect against dementia. prevents hypothermia. ANS: C In moderate amounts, alcohol helps preserve cognitive function in the older adult and may protect against dementia. Alcohol disrupts sleep and alters sleep cycles, reducing total sleeping time and the quality of sleep. Alcohol lowers inhibitions but diminishes sexual responsiveness. Alcohol dilates cutaneous blood vessels, which actually promotes heat loss. A patient tells a nurse that she drinks wine for its cardioprotective effects. She wants to know how much is safe. The nurse is correct in telling her that: "A couple of glasses of wine 1 or 2 days a week will help prevent heart disease." "Abstaining from alcohol completely is the best way to prevent heart disease." "If you drink only on weekends, you will minimize your risk of developing heart disease." "Cardioprotective effects are greatest in people who live an unhealthy lifestyle." ANS: D Moderate consumption, which for women is 1 drink a day or less, has been shown to reduce the incidence of ischemic stroke, coronary artery disease, myocardial infarction,
and heart failure. The pattern determines protection as well; moderate consumption 3 or 4 days a week rather than 1 or 2 days is more protective. These effects are greatest in people who have an unhealthy lifestyle, who do not eat fruits and vegetables, and who smoke. Having a couple of glasses of wine exceeds the moderate amount for women. Moderate consumption, as just described, has better protective benefits than complete abstinence. Drinking on weekends does not fit the pattern of 3 or 4 days per week that has been shown to be protective. A patient who is an active alcoholic is admitted to the hospital for surgery. The nurse reviewing orders for this patient would be correct to question which postoperative medication for this patient? a. Acetaminophen b. Diazepam c. Morphine d. Thiamine ANS: A Acetaminophen poses a risk of fatal liver damage in alcoholics, because evidence indicates that even modest alcohol consumption combined with acetaminophen has this effect. Diazepam would probably be useful in this case, because it is used to aid alcohol withdrawal. However, diazepam cannot be taken with alcohol, because the central nervous system (CNS)-depressive effects would be compounded. Likewise, morphine is safe as long as it is not given with alcohol. Thiamine is a vitamin that often is deficient in alcoholics, so thiamine would be indicated. A nurse is screening a patient being admitted to the hospital. The patient reports being fired for drinking at work. On further questioning, the patient reveals a history of daily alcohol consumption of more than six packs of beer each day, regular morning drinking, and several unsuccessful attempts to stop drinking. The nurse detects alcohol on the patient's breath. The nurse will inform the provider of these findings and request an order for which medication? Chlordiazepoxide [Librium] Clonidine Disulfiram [Antabuse] Naltrexone [ReVia] ANS: A This patient shows signs of alcohol use disorder, according to the AUDIT Screening Instrument, and has a score of at least 21 points from the information included in this history. A score of 8 or higher for men up to age 60 and a score of 4 or higher for others are positive screening results. The patient recently has consumed alcohol, as evidenced by the detectable smell, although the amount consumed and the time since the last drink cannot be determined. Because this patient is an active alcoholic, the risk of withdrawal symptoms is high; therefore, the patient needs medication to facilitate withdrawal. Benzodiazepines are the safest, most effective medications for this purpose, and those with longer half-lives, including chlordiazepoxide, are preferred. Clonidine is useful as an adjunct to help reduce autonomic symptoms associated with withdrawal. Disulfiram is used to maintain abstinence; its use along with alcohol can produce dangerous symptoms. Naltrexone is used to maintain abstinence by reducing cravings; it does not facilitate withdrawal.
consuming six cans of beer a day would be able to cut the amount in half. Moreover, daily drinking in itself may still constitute an alcohol use disorder, depending on other factors. During a health history, the nurse asks a male patient about alcohol use. The patient tells the nurse that he and his wife are trying to conceive a pregnancy and he is using alcohol to lower his inhibitions. What will the nurse counsel this patient? "Alcohol causes increased masculinization." "Alcohol may cause testicular atrophy and sterility." "Alcohol will improve your chances of conceiving." "Alcohol will also help you to ejaculate." ANS: B Alcohol may induce feminization and cause testicular atrophy, impotence, sterility, and breast enlargement. Alcohol significantly decreases the ability to ejaculate in spite of lowering inhibitions. A pregnant patient in labor tells the nurse that she is afraid she may have harmed her fetus by consuming alcohol. What is an appropriate response by the nurse? Ask the patient how much alcohol she consumed, and at which stage of her pregnancy. Reassure the patient that the risk is likely to be minimal. Tell the patient that no amount of alcohol is considered safe during pregnancy. Tell the patient that the full range of outcomes may not be evident for years. ANS: A Although heavy use of alcohol has known adverse effects on the fetus, the effects of lower levels are unknown. The nurse should first question the patient about the amount of alcohol consumed at which stages of pregnancy to better determine the potential risk. Many women consume alcohol before knowing they are pregnant without any seeming ill effects. Reassuring this patient that her risks are low is not appropriate without further information. Moreover, reassuring her without getting more information only belittles her fears. Telling a patient that no amount of alcohol is safe during pregnancy would be an appropriate intervention during counseling of a woman who has just discovered she is pregnant; however, it would only intensify the fears of this patient. Telling the patient that the outcomes will not be evident for years would only intensify her fears. A patient is brought to the emergency department after a motor vehicle accident. The patient's speech is slurred. The nurse notes the smell of alcohol on the patient's breath and observes hand tremors. The patient's blood alcohol level is 0.4%. The nurse will expect to: find that the patient has lost consciousness within a short time. administer naltrexone [ReVia] and prepare for gastric lavage. give carbamazepine to reduce the risk of seizures. provide mechanical ventilation and oxygen. ANS: D A blood alcohol level that exceeds 0.4% poses a substantial risk of respiratory depression. Patients who are chronic abusers of alcohol may develop tolerance to other effects of increased blood levels, such as sedation, or behavioral changes, but there is very little tolerance to respiratory depression. A patient with a blood alcohol level of 0.4% must be treated for respiratory depression, usually with mechanical ventilation. If
this patient has developed tolerance, which is likely because loss of consciousness has not already occurred, the nurse cannot expect that the patient will lose consciousness. Naltrexone is not used for acute toxicity. Carbamazepine is used as an adjunct to benzodiazepines and may be used after this patient's immediate needs have been addressed. A nursing student asks a nurse to discuss alcoholism and alcohol use disorder. Which statement by the nurse is correct? "Alcohol use disorder can occur without the development of tolerance or physical dependence." "Individuals with alcohol use disorder develop cross-tolerance with opioid analgesics." "Initial symptoms of abstinence syndrome occur within 1 to 2 hours after withdrawal of alcohol." "With severe alcoholism, most alcoholics have delirium tremens when alcohol is withdrawn." ANS: A Alcohol abuse can occur without the development of tolerance or physical dependence, although these generally develop with long-term use of alcohol. Cross-tolerance occurs between alcohol and general anesthetics and other CNS depressants, but not with opioids. The symptoms of abstinence syndrome begin to manifest 12 to 72 hours after the last drink. Fewer than 1% of alcoholics experience delirium tremens. We have an expert-written solution to this problem! A nurse is obtaining an admission history on a patient who reports daily drinking for several years. When the nurse questions the patient further, the patient reports drinking up to five or six drinks each day. The patient expresses worry about liver damage. What will the nurse do? Contact the patient's provider to request liver function studies. Explain that hepatitis, progressing to severe liver impairment, is likely. Inform the patient that the history indicates that cirrhosis is likely to occur. Tell the patient that stopping drinking will reverse any effects on the liver ANS: A Chronic drinking can lead to hepatitis in about 90% of heavy users. The nurse would be correct to request laboratory studies of liver function. Until the laboratory values are known, the degree of damage to the liver is unknown, so the likelihood of severe outcomes cannot be predicted. Acute drinking causes the accumulation of fat and protein in the liver, which is reversible, but this may not be the case with chronic drinking. A patient who has undergone treatment for alcoholism several times, with relapse occurring shortly after each treatment, has just completed detoxification. The patient requests a medication to help maintain abstinence. Which drug will the nurse expect the provider to prescribe? Acamprosate [Campral] Chlordiazepoxide [Librium] Disulfiram [Antabuse] Naltrexone [ReVia]
Nicotine lowers blood pressure. Nicotine settles the stomach and reduces nausea and vomiting. ANS: B Nicotine increases alertness, facilitates memory, and improves cognition. Even though users report feeling relaxed when using nicotine, it actually increases arousal and does not cause relaxation. Nicotine elevates blood pressure. Nicotine causes the gastrointestinal (GI) side effects of nausea, vomiting, and increased motility. A 4-year-old child is brought to the emergency department with symptoms of nausea and vomiting, and is found to have a weak, thready pulse of 120 beats per minute after ingesting several cigarettes at home. The nurse caring for this child will expect to provide which treatment? Gastric lavage Hemodialysis Respiratory support Vasoconstrictors ANS: C Nicotine is highly toxic, and the most prominent symptoms are those involving the cardiovascular, GI, and central nervous systems. This child is showing signs of toxicity. Respiratory arrest can occur, because nicotine affects the muscles of respiration. Respiratory support is the key to management; no antidote is available to nicotine poisoning. Nicotine undergoes rapid metabolism, so recovery can occur in a few hours. Gastric lavage, hemodialysis, and vasoconstrictors are not recommended. A patient reports a desire to stop smoking and asks what is available without a prescription to help with smoking cessation. The nurse tells the patient that which method is best? Abrupt discontinuation to shorten withdrawal effects Nicotine replacement and 1-800-QUITNOW Nicotine replacement products tapered over a year Support groups without the use of medications ANS: B Nicotine addiction can be treated with pharmacologic agents or counseling, but the combination of these two approaches is more effective than either one alone. Abrupt cessation is better than tapering off, because the withdrawal effects are not so prolonged; however, this approach is not recommended as the best way to quit. Nicotine replacement products should be discontinued after a few weeks to months after quitting smoking, because they contain nicotine, which is both harmful and addicting. Support groups alone can work but are not as effective as the combination of support groups and medications. We have an expert-written solution to this problem! A patient with a desire to stop smoking asks a nurse about nicotine chewing gum [Nicorette]. The patient currently smokes 30 cigarettes per day. Which statement by the nurse is correct? "Stop using the gum 6 months after you stop using cigarettes." "Use the 4-mg strength gum and chew one piece every 2 to 3 hours."
"Use the gum whenever you feel a craving for a cigarette." "You should start with 30 pieces of the 2-mg strength gum per day." ANS: B Nicorette gum is available in two strengths, 2 and 4 mg. Patients who smoke more than 25 cigarettes per day should use the 4-mg strength. Dosing the gum on a regular schedule of every 2 to 3 hours has proved to be more effective than as-needed use. Use of the gum longer than 6 months total is not recommended, and the gum should be stopped 3 months after the last cigarette. PRN dosing is not as effective as regular dosing. The dose for a heavy smoker is 4-mg strength gum, one piece every 2 to 3 hours. A patient asks about nicotine patches for smoking cessation and wants to know the difference between the 24-hour patch and the 16-hour patch. Which response by the nurse is correct? "The 16-hour patch is for patients who have trouble sleeping." "The 16-hour patch simulates usual nicotine ingestion patterns." "The 24-hour patch is for persons weighing more than 100 pounds." "The 24-hour patch is recommended for heavier smokers." ANS: B Nicotine transdermal patches usually are packaged in systems, with progressively smaller doses of nicotine. The 16-hour patch is designed to be removed at bedtime; this simulates the usual nicotine dosing produced by smoking. It does not necessarily affect the ability to sleep. Individuals who weigh less than 100 lb are advised to use smaller patches. Heavier smokers are advised to begin with larger patches. A prescriber has ordered nicotine nasal spray for a patient to assist with smoking cessation. Which statement will the nurse include when teaching the patient about the medication? "This will produce a steady level of nicotine to reduce your cravings." "You should gradually reduce the dose after 3 months of use." "You should use 1 spray in each nostril per dose up to 5 times per hour." "You will not develop dependence on the nicotine in the nasal spray." ANS: C Dosing for the nicotine nasal spray should be 1 spray in each nostril once or twice an hour, up to 5 times per hour. The spray causes a rapid rise in blood nicotine levels with each dose, which more closely simulates smoking. After 4 to 6 weeks, dosing should be gradually reduced and then stopped. Many people become dependent on the spray. A patient who wants to quit smoking has a prescription for varenicline [Chantix], which will be used with a nicotine patch. The patient asks the nurse why the varenicline is necessary. Which statement by the nurse is correct? "It helps patients experiencing withdrawal to sleep better." "It helps reduce anxiety and other withdrawal symptoms." "It will help reduce the likelihood of addiction to the patch." "The drug blocks nicotine's access to 'pleasure' receptors." ANS: D Varenicline is a partial agonist at nicotinic receptors and helps block nicotine's access to these receptors. A common side effect is sleep disturbances. Buspirone is a smoking
Initial "rush" similar to orgasm Peer pressure Prolonged sense of euphoria ANS: D The primary reason for opioid abuse is the prolonged sense of euphoria that occurs after the initial rush. Healthcare professionals have easy access to opioids, which makes them more vulnerable to abuse of these drugs, but this is not the primary reason for abuse in the greater population. The initial rush lasts about 45 seconds and is not the primary reason for opioid abuse. Peer pressure is not the primary reason for opioid abuse. A nurse is discussing the differences between OxyContin OC and OxyContin OP with a group of nursing students. Which statement by a student indicates understanding of the teaching? "OxyContin OC cannot be drawn into a syringe for injection." "OxyContin OP has greater solubility in water and alcohol." "OxyContin OP is not easily crushed into a powder." "Patients using OxyContin OP are less likely to overdose." ANS: C OxyContin OP is a newer formulation that is designed to reduce OxyContin abuse. The OP formulation is much harder to crush into a powder. The OC preparation can be crushed and dissolved in water or alcohol and can easily be drawn into a syringe. The OP preparation does not dissolve easily in these solutions. Despite the differences in preparation, there is no indication that either form is less subject to abuse or overdose. A patient arrives in the emergency department complaining of dizziness, lightheadedness, and a pulsating headache. Further assessment reveals a blood pressure of 82/60 mm Hg and palpitations. The patient's friends tell the nurse that they were experimenting with "poppers." The nurse will expect to administer which medication? Diazepam [Valium] Haloperidol [Haldol] Methylene blue and supplemental oxygen Naloxone [Narcan] ANS: C These findings are consistent with volatile nitrate overdose, as evidenced by the venous dilation. The primary toxicity is methemoglobinemia, which can be treated with methylene blue and supplemental oxygen. Diazepam would not be used for patients experiencing volatile nitrate overdose, but it may be used in patients who have overdosed on hallucinogens. Haloperidol would be used in patients who have overdosed on amphetamines. Naloxone would be used to treat an opioid overdose. A patient who has a long-term addiction to opioids takes an overdose of barbiturates. The nurse preparing to care for this patient will anticipate: a severe abstinence syndrome when the effects of the barbiturates are reversed. minimal respiratory depression, because the patient has developed a tolerance to opioids. observing pinpoint pupils, respiratory depression, and possibly coma in this patient.
using naloxone [Narcan] to reverse the effects of the barbiturates, because cross- tolerance is likely. ANS: C Patients tolerant to opioids do not have cross-tolerance to barbiturates, so this patient will show signs of overdose such as pinpoint pupils, respiratory depression, and coma. Because there is no cross-tolerance, a patient addicted to opioids will not have an abstinence syndrome when the effects of the barbiturates are reversed. Respiratory depression will be severe. Naloxone cannot be used to reverse the effects of the barbiturates. We have an expert-written solution to this problem! A patient who is a heroin addict is admitted to a methadone substitution program. After administering the first dose of methadone, the nurse notes that the patient shows signs of euphoria and complains of nausea. What will the nurse do? Administer nalmefene [Revex]. Contact the provider to obtain an order for naloxone [Narcan]. Question the patient about heroin use that day. Suspect that the patient exaggerated the amount of heroin used. ANS: D Patients entering a methadone substitution program must be carefully questioned about the amount of heroin used; patients may exaggerate the amount used to obtain higher doses of methadone or may minimize the amount used to downplay the extent of their addiction. In patients who exaggerate use, the amount of methadone given may cause euphoria, nausea, and vomiting. Nalmefene and naloxone are used to treat overdose and are not indicated. A patient receiving methadone along with a usual heroin dose would be likely to have signs of toxicity. We have an expert-written solution to this problem! A patient who is an opioid addict has undergone detoxification with buprenorphine [Subutex] and has been given a prescription for buprenorphine with naloxone [Suboxone]. The patient asks the nurse why the drug was changed. Which response by the nurse is correct? "Suboxone has a lower risk of abuse." "Suboxone has a longer half-life." "Subutex causes more respiratory depression." "Subutex has more buprenorphine." ANS: A The combination of buprenorphine and naloxone [Suboxone] discourages intravenous abuse, because with IV use, the naloxone precipitates withdrawal; this effect does not occur with sublingual dosing [Subutex]. Suboxone does not differ from Subutex in terms of drug half-life. Subutex does not cause more respiratory depression and does not contain more buprenorphine. A nurse is caring for a patient who is addicted to barbiturates and who will begin receiving phenobarbital. The nurse discusses the care of this patient with a nursing student. Which statement by the student indicates understanding of the teaching?
answering questions and has trouble remembering simple details. The nurse suspects abuse of which substance? a. Cocaine b. Ecstasy c. Marijuana d. Methamphetamine ANS: D Methamphetamine causes all of the symptoms shown by this patient. These are not symptoms associated with cocaine, Ecstasy, or marijuana. A school nurse is teaching a high school health class about the effects of marijuana use. Which statement by a student indicates a need for further teaching? "Chronic use of marijuana can result in irreversible brain changes." "Higher doses of marijuana are likely to produce increased euphoria." "Marijuana is unique in that it produces euphoria, sedation, and hallucinations." "Marijuana has more prolonged effects when it is ingested than when it is smoked." ANS: B With higher doses of marijuana, euphoria may be displaced by intense anxiety. Chronic use may cause irreversible brain changes. Euphoria, sedation, and hallucinations can all occur with marijuana use. Ingesting marijuana causes prolonged effects. A pregnant patient reports using marijuana during her pregnancy. She asks the nurse whether this will affect the fetus. What should the nurse tell her? Children born to patients who use marijuana will have smaller brains. Neonates born to patients who use marijuana will have withdrawal syndromes. Preschool-aged children born to patients who use marijuana are more likely to be hyperactive. School-aged children born to patients who use marijuana often have difficulty with memory. ANS: D School-aged children born to patients who use marijuana may show deficits in memory, attentiveness, and problem solving. Chronic marijuana use alters brain size in individuals who use marijuana but not in children born to parents who use marijuana. Newborns will not show withdrawal symptoms. Preschool-aged children have difficulty with memory and sustained attention. A college student admits frequent use of LSD to a nurse and reports plans to stop using it. What will the nurse tell this student? Flashback episodes and episodic visual disturbances are common. Tolerance to the effects of LSD will fade quickly once use of the drug has stopped. Withdrawal symptoms can be mitigated with haloperidol [Haldol]. Withdrawal from LSD is associated with a severe abstinence syndrome. ANS: B Tolerance to the effects of LSD develops rapidly but fades quickly when the drug is stopped. Flashback episodes may occur but are not common. Haloperidol may actually intensify symptoms associated with an acute panic reaction; it is not indicated for LSD withdrawal. Abstinence syndrome does not occur when LSD is stopped.
We have an expert-written solution to this problem! A college student is brought to the emergency department by a group of friends who report that they had been dancing at a nightclub when their friend collapsed. The patient has a temperature of 105°F and shows jaw clenching and confusion. The nurse will expect to administer which medication? Dantrolene [Dantrium] Haloperidol [Haldol] Methadone Naloxone [Narcan] ANS: A This patient shows signs of Ecstasy toxicity. Dantrolene can be given to relax skeletal muscle to reduce heat generation and prevent the risk of rhabdomyolysis. The other medications are not used to treat Ecstasy toxicity. In discussing the rationale for using methadone to ease opioid withdrawal, the nurse would explain that it has which pharmacologic properties or characteristics? Methadone can prevent abstinence syndrome. Methadone has a shorter duration of action than other opioids. Methadone is a nonopioid agent. Methadone lacks cross-tolerance with other opioids. ANS: A Methadone is used to ease opioid withdrawal and can prevent abstinence syndrome. Methadone does not have a shorter duration of action. Methadone is not a nonopioid agent. Methadone does not lack cross-tolerance with other opioids. A college student tells the nurse that several friends have been using synthetic marijuana to get high. What will the nurse tell this patient about this type of substance? "These substances are fairly safe because they are derived from herbs." "They can cause hypertension, nausea, vomiting, and hallucinations." "These substances do not have mind-altering affects." "These substances produce a high and they are not illegal." ANS: B Synthetic marijuana can produce severe symptoms including hypertension, nausea, vomiting, and hallucinations. Although once thought safe, it is no longer considered safe. It produces a high and can cause hallucinations. Many types of synthetic marijuana are now illegal. Which factors make meperidine an opioid of choice among nurses and physicians who abuse opioids? (Select all that apply.) Easy access to syringes for administration of the drug Highly effective oral dosing Increased effects on smooth muscle function Less pupillary constriction than other opioids Shorter half-life than other opioids ANS: B, D Meperidine is often abused by medical personnel because oral dosing is highly effective, so telltale injection marks are unnecessary. Also, the drug causes less pupillary constriction than other opioids. Access to syringes is not necessary with oral
A patient is diagnosed with H. Pylori positive peptic ulcer disease. The patient is otherwise healthy. The nurse learns that the patient does not smoke and that he drinks 1 or 2 glasses of wine with meals each week. The nurse anticipates that the provider will prescribe which drugs? Amoxicillin [Amoxil], clarithromycin, and omeprazole [Prilosec] Amoxicillin [Amoxil], metronidazole [Flagyl], and cimetidine [Tagamet] Clarithromycin, metronidazole [Flagyl], and omeprazole [Prilosec] Tetracycline, cimetidine [Tagamet], and lansoprazole [Prevacid] ANS: A The regimen recommended for the treatment of PUD infected with H. Pylori includes two antibiotics and an antisecretory agent. Amoxicillin, clarithromycin, and omeprazole would meet this recommendation. Patients taking metronidazole cannot consume alcohol, as this would precipitate a disulfiram-like reaction. The last option does not include two antibiotics. A 30-year-old male patient will begin a three-drug regimen to treat peptic ulcer disease. The regimen will consist of bismuth subsalicylate, tetracycline, and cimetidine [Tagamet]. The nurse will include which information when teaching this patient about this drug regimen? Black discoloration of the tongue and stools should be reported immediately. Central nervous system depression and confusion are likely to occur. Decreased libido, impotence, and gynecomastia are reversible side effects. Staining of the teeth may occur and is an indication for discontinuation of these drugs. ANS: C Cimetidine has antiandrogenic effects and can cause decreased libido, impotence, and gynecomastia. These effects are reversible. Black stools and discoloration of the tongue are side effects associated with bismuth but are not harmful. Central nervous system (CNS) depression and confusion are not likely. Staining of the teeth associated with tetracycline use occurs only in developing teeth; it is a problem in children younger than 8 years and in pregnant woman because of this risk to the fetus. When metronidazole [Flagyl] is a component of the H. pylori treatment regimen, the patient must be instructed to do what? Avoid any alcoholic beverages. Avoid foods containing tyramine. Take the drug on an empty stomach. Take the drug with food. ANS: A The patient should be instructed to avoid alcoholic beverages, because a disulfiram-like reaction can occur if metronidazole is taken with alcohol. Nothing indicates that the patient should avoid foods containing tyramine. Metronidazole may be taken with or without food. The nurse is providing education to a patient who has been prescribed both an antacid and cimetidine [Tagamet]. Which instruction should the nurse give the patient about taking the medications? "Take the antacid 1 hour after the ranitidine." "The antacid and ranitidine should be taken at the same time for better effect."
"Take the antacid 15 minutes before the ranitidine." "Take the antacid 30 minutes after the ranitidine." ANS: A Because antacids raise the gastric pH, they can affect the dissolution and absorption of ranitidine; therefore, 1 hour should separate administration of antacids and ranitidine. Antacids and ranitidine should not be taken at the same time, because dissolution and absorption of ranitidine will be reduced. One hour should separate administration of antacids and ranitidine; intervals of 15 and 30 minutes are not long enough. A patient is diagnosed with Zollinger-Ellison syndrome. Which medication does the nurse expect the provider to order for this patient? Cimetidine [Tagamet] Esomeprazole [Nexium] Omeprazole [Prilosec] Sucralfate [Carafate] ANS: A Cimetidine is the treatment of choice for Zollinger-Ellison syndrome. Ranitidine was used previously but was recently withdrawn from the market. Esomeprazole, omeprazole, and sucralfate are not indicated. An older adult patient with severe gastroesophageal reflux disease (GERD) has had only minimal relief using a histamine2-receptor antagonist (H2RA). The patient is to begin taking omeprazole [Prilosec]. What will the nurse teach this patient? A complete cure is expected with this medication. Lifestyle changes can be as effective as medication therapy. Long-term therapy may be needed. The medication will be used until surgery can be performed. ANS: C Proton pump inhibitors, such as omeprazole, are much better than H2RAs for treating GERD. For patients with severe GERD, long-term maintenance therapy is recommended. These drugs do not cure GERD; relapse is common when the drugs are discontinued. Lifestyle changes can help but should not be considered a substitute for drugs. Surgery is reserved for young, healthy patients who cannot or will not stick to a drug regimen. A patient stops taking a proton pump inhibitor (PPI) after 6 weeks of therapy for treatment of peptic ulcer disease. The patient reports symptoms of dyspepsia to the nurse. The nurse will tell this patient to: come to the clinic to be tested for Clostridium difficile. resume taking the PPI, because long-term therapy is necessary. resume taking the PPI until symptoms resolve completely. try an antacid to see whether it relieves these symptoms. ANS: D When patients stop taking a PPI, a rebound hypersecretion of gastric acid can cause dyspepsia. This can be managed with an antacid. Although C. difficile infection is associated with dose- related increases in PPIs, the symptoms include diarrhea, not dyspepsia, so testing is not indicated for this patient. Resuming the PPI is not indicated, because these symptoms can be managed with antacids.
