Test Bank for Pharmacology Clear and Simple A Guide to Drug Classifications and Dosage Calculations, 4th Edition (Chapters 1-20)
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Test Bank For Pharmacology Clear and Simple A Guide to Drug Classifications and Dosage Calculations 4th Edition By Cynthia J. Watkins
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Chapter 1. History of Pharmacology Multiple Choice Identify the choice that best completes the statement or answers the question. 1. While caring for a client who is taking furosemide (Lasix), the nurse recognizes dietary teaching has been effective if the patient includes which of the following foods in his daily menus? A. Broccoli and kiwi B. Oranges and sweet potatoes C. Kale and cucumbers D. Bananas and melon 2. A client newly diagnosed with diabetes tells the nurse, ―I can’t take any insulin made from pigs or cows.‖ Which of the following responses by the nurse is best? A. ―Most insulin comes from animal sources, but I’m sure alternative options are available.‖ B. ―Medications that are derived from animals are typically less expensive than synthetic medications, but synthetic insulin is commonly available.‖ C. ―Most insulin is synthetic now to help reduce the risk of disease transmission.‖ D. ―The animals aren’t hurt in the production of medications, so you don’t need to worry.‖ 3. While providing medications to clients on the cardiac unit, the nurse anticipates that hydralazine hydrochloride and isosorbide dinitrate (BiDil) would most likely be prescribed for which of the following clients? A. A 48 - year - old Caucasian male diagnosed with atrial fibrillation B. A 55 - year - old African American female diagnosed with hypertension C. A 63 - year - old Caucasian female diagnosed with sick sinus syndrome D. A 64 - year - old African American male diagnosed with heart failure 4. While caring for a patient scheduled for knee replacement surgery, the nurse provides cefazolin (Ancef) as ordered 30 minutes pre - operatively. The nurse knows that teaching has been effective by which of the following client statements? A. ―The antibiotic is given as a prophylactic to help reduce the risk of infection after surgery.‖ B. ―This is a palliative medication to help ease the pain from surgery.‖ C. ―This medication will replace vitamins and minerals that may be lost due to bleeding during surgery.‖ D. ―This medication will help the surgeon identify areas of bone destruction due to arthritis.‖ 5. While caring for a patient with a history of hypothyroidism, the nurse expects which of the following medications to be included in the patient’s medication list? A. Levothyroxine sodium (Synthroid) B. Estrogen (Estradiol) C. Iodine 131 D. Carbimazole (Methimazole)
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6. The nurse is receiving a shift - to - shift report on a medical unit and is informed that a 55 - year - old patient with a history of vomiting is scheduled for a diagnostic radiograph of the upper gastrointestinal tract. Which of the following statements would the nurse include in the client’s teaching? A. ―You will need to drink a large amount of prep to clear out your system before the test.‖ B. ―It is important that you be given a prophylactic medication to prevent aspiration during the test.‖ C. ―You will be asked to drink a barium contrast about 30 minutes before the test to help highlight any digestive problems.‖ D. ―You will be given a sedative to help make you sleepy during the testing procedure.‖ 7. A student nurse is providing care for a 29 - year - old patient with advanced cervical cancer who was recently admitted with metastatic disease. While reviewing the patient’s medication list, the student would categorize which of the following medications as palliative in nature? A. Cisplatin (Platinol) 50 mg IV weekly to start day 8 B. Sorafenib (Nexavar) 200 mg orally twice daily for 7 days C. Ondansetron (Zofran) 4 mg IV prior to chemotherapy D. Morphine sulfate (Roxanol) 5 mg po every 4 hours as needed for pain 8. A woman experiencing menopausal symptoms asks the nurse about conjugated estrogen (Premarin). Which of the following statements by the individual indicates an understanding of the medication’s origin? A. ―I’m against animal cruelty, so I don’t want to take anything made from animal flesh.‖ B. ―I was told the medication is actually derived from the urine of pregnant horses.‖ C. ―Because I’m Jewish, I can’t take the medication since it comes from pigs.‖ D. ―I think harvesting medicines from cows seems rather odd.‖ 9. The nurse working in a diagnostic center is responsible for verifying client allergies prior to testing. A 47 - year - old woman reports being allergic to iodine, and thus is unable to have which test? A. Computerized axial tomography (CAT) scan B. Magnetic resonance imaging (MRI) C. Colonoscopy D. Thyroid scan Multiple Response Identify one or more choices that best complete the statement or answer the question. 1. While working with patients in home care, a nurse becomes interested in additional ways to support patient healing and comfort. Which of the following is recognized as an alternative therapy? (Select all that apply.) A. Acupuncture B. Aromatherapy C. Therapeutic touch D. Stem cell treatment E. Vegetarianism F. Acupressure
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Chapter 1. History of Pharmacology Answer Section MULTIPLE CHOICE 1. ANS: B PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Diuretic KEY: Application MSC: NCLEX Category: Basic Care and Comfort NOT: See Minerals (p. 7): Diuretic drugs such as furosemide (Lasix) cause the body to lose excess water through the kidneys, and potassium, a vital mineral is also excreted with the water. Potassium is contained in sweet potatoes, bananas, and oranges. 2. ANS: C PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Anti - diabetic medication KEY: Analysis MSC: NCLEX Category: Pharmacological Therapies NOT: See Synthetic Medications (p. 8): Insulin can be obtained from pigs or cows, but a synthetic source is most commonly used. This change occurred because of concern over the possible transmission of diseases from animals to humans. Synthetic medications are usually more inexpensive because they are mass produced. 3. ANS: D PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Combination drug (diuretic/nitrate) KEY: Analysis MSC: NCLEX Category: Pharmacologic and Parenteral Therapy NOT: See Synthetic medications (p. 8). BiDil is a combination of two generic drugs and is used to treat African American patients with heart failure. 4. ANS: A PTS: 1 DIF: Easy TOP: Therapeutic Classification: Antibiotics KEY: Analysis MSC: NCLEX Category: Pharmacological Therapies NOT: See Categorizing Medications (p. 8): Prophylactic medications are given to prevent problems such as antibiotics given before surgery to prevent infection. Example of cefazolin is listed in Table 1.2. 5. ANS: A Difficulty Level: Easy PTS: 1 DIF: Easy TOP: Therapeutic Classification: Replacement hormones KEY: Knowledge MSC: NCLEX Category: Pharmacological Therapies NOT: See Categorizing Medications (p. 9): Replacement drugs are given to replace missing substances. Levothyroxine sodium (Synthroid) is a drug that replaces missing thyroid hormone. Estrogen may be given to women once they enter menopause. Iodine 131 is a radioactive medication used to help diagnose thyroid abnormalities. Carbimazole is used to inhibit the production of thyroid hormone to treat hyperthyroidism. 6. ANS: C PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Diagnostic contrast KEY: Analysis MSC: NCLEX Category: Reduction of Risk Potential NOT: See Categorizing Medications (p. 8): Some drugs help diagnose a disease such as barium that patients swallow to help highlight digestive problems on radiograph. 7. ANS: D PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Narcotics KEY: Analysis MSC: NCLEX Category: Pharmacological Therapies NOT: See Categorizing Medications (p. 8): Palliative drugs, such as pain relievers, do not cure disease, but they make patients more comfortable. Morphine is listed as an example in Table 1.2. Cisplatin is an antineoplastic agent and sorafenib is a biologi c agent; both are designed to treat the cancer (destructive medications), while ondansetron is given in a prophylactic measure to prevent nausea and vomiting related to the chemotherapy. 8. ANS: B PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Hormonal therapy KEY: Analysis MSC: NCLEX Category: Pharmacological Therapies
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NOT: See Sources of Drugs (p. 6): Cows and pigs are good sources of hormone replacements, but conjugated estrogen (Premarin) comes from a pregnant mare’s urine. 9. ANS: D PTS: 1 DIF: Moderate TOP: Therapeutic Classification: NA KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Toxins (p. 7): Radioactive iodine in small doses can help pinpoint problems in a patient’s thyroid. Because the client is allergic to iodine, she should not have this test. MULTIPLE RESPONSE 1. ANS: A, B, D, F PTS: 1 DIF: Easy TOP: Therapeutic Classification: NA KEY: Knowledge MSC: NCLEX Category: Basic Care and Comfort NOT: See Pharmacology in the 21st century (p. 5): Alternative therapies now seem to have a place in the healing of patients. For example, aromatherapy involves the use of fragrant oils in baths; acupressure originates from an ancient Chinese art. Along sim ilar lines is acupuncture; therapeutic touch involves the use of hand movements to stimulate circulation and healing. Stem cell research is considered mainstream medical treatment. Dietary manipulation may promote health but is not a recognized alternative therapy. Chapter 2. Basics of Pharmacology Multiple Choice Identify the choice that best completes the statement or answers the question. 1. The nurse is preparing to apply valacyclovir (Valtrex) ointment to the shingles lesions located across a client’s left side and lower back. Which of the following actions should the nurse take first? A. Place the patient in a supine position. B. Determine when the rash was first noted. C. Ensure that the skin is clean and dry. D. Take the patient’s vital signs. 2. The nurse is providing care for a client at 32 weeks’ gestation who started low - molecular heparin injections after developing a deep vein thrombosis. The client asks the nurse, ―Why do I have to take a shot? Why can’t I take the blood clot medicine that my dad takes orally?‖ Which of the following responses by the nurse is best? A. ―Anything that is fat - soluble, including warfarin (Coumadin), is able to cross the placental barrier. Heparin is not fat - soluble so it doesn’t cross the barrier well.‖ B. ―The placenta is easily crossed by anything you take by mouth while you are pregnant, but not by things absorbed in other ways.‖ C. ―Only water - soluble substances such as vitamins can cross the placental barrier, so you could take either medication, but heparin is cheaper.‖ D. ―They are the same medication, but the shot is absorbed faster than the pill so the doctor wants you to take daily shots.‖ 3. The nurse is providing care to a client with HIV who has been prescribed fosamprenavir (Lexiva). Which of the following statements by the client indicates that further teaching is necessary? A. ―The metabolites of this medication may be excreted in active form.‖ B. ―I’m glad my kidneys work so well; otherwise the medication wouldn’t work.‖ C. ―This drug actually has to be broken down by my body to fight the virus.‖ D. ―Isn’t it fascinating that my liver has to metabolize the drug for it to work?‖ 4. The nurse is working with a client who was recently started on insulin therapy. The client’s young daughter asks, ―Why do you have to give her a shot? Why can’t you just give her a pill?‖ Which of the following responses by the nurse is best? A. ―Our bodies make insulin normally, so it is a liquid medication.‖
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B. ―We do have diabetic medications in pill form. I’m not sure why the doctor ordered it this way for your mom.‖ C. ―Insulin is manufactured and given this way so it absorbs more rapidly into the body.‖ D. ―The acid in your mother’s stomach would destroy this medication, so it can’t be swallowed.‖ 5. The nurse is providing care for a 48 - year - old male on the surgical unit. Gentamicin (Garamycin) 2 mg/kg every 8 hours has been started. The nurse would be most concerned by which of the following findings? A. Blood levels have been ordered every 24 hours B. The patient’s EGFR = 40 mL/min C. The patient’s hemoglobin = 11.8 g/dL D. The patient’s WBC = 14,000 c/mm 3 6. A 16 - year - old client comes to the urgent care clinic with symptoms of tonsillitis. The client tells the nurse she takes tetracycline (Doxycycline) daily for the treatment of acne. The nurse would be most concerned if the health care provider prescribed whi ch of the following? A. Amoxicillin clavulanate (Augmentin) B. Cefdinir (Omnicef) C. Cefixime (Suprax) D. Ciprofloxacin (Cipro) 7. The nurse is providing care for a client experiencing muscle spasms. The physician has ordered cyclobenzaprine (Flexeril). The nurse would inform the client to anticipate which of the following side effects? A. Hypocalcemia and hypotension B. Dizziness and drowsiness C. Nausea and headache D. Flaccidity and urinary retention 8. While caring for clients on the medical unit, the nurse would see which of the following clients first? A. A 28 - year - old patient with HIV who has a temperature of 99.2°F B. A 54 - year - old patient with diverticulitis whose diet was just advanced to solid food C. A 61 - year - old patient who takes ibuprofen for arthritis complaining of severe stomach pain D. A 37 - year - old patient with a kidney stone who is due for pain medication in 20 minutes 9. While preparing to provide a patient admitted to the hospital for a laparoscopic hysterectomy the prescribed dose of ibuprofen (Motrin) 800 mg orally, which of the following actions would take highest priority? A. Determine if the client has eaten within the past hour. B. Assess the client’s vaginal discharge. C. Help the client ambulate in the hall. D. Evaluate the client’s most recent renal panel labs. 10. The nurse is providing care for clients on the orthopedic unit. Which of the following assessment findings is most concerning to the nurse? A. A client who takes lisinopril (Zestril) and is complaining of limited range of motion after shoulder surgery B. A client with a fractured pelvis who takes warfarin sodium (Coumadin) and reports having a black tarry stool during the night C. A client 2 days post - op for knee replacement who takes hydrocodone/acetaminophen (Vicodin) and refused to have labs drawn this morning
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D. A client 4 days after hip replacement surgery taking omeprazole (Prilosec) who ordered spinach for dinner 11. While working in the neonatal intensive care unit, the nurse notes an infant’s oxygen saturation has been 98% for the past 4 hours. The infant has been receiving oxygen at 4 L. Which of the following actions by the nurse is best? A. Turn the oxygen level down to 3 L and monitor closely to reduce the risk of eye damage. B. Leave the oxygen level at its current rate to reduce the risk of lung damage. C. Turn the oxygen level down to 2 L and monitor closely to evaluate the infant’s readiness for transfer out of the ICU. D. Leave the oxygen level at its current rate and inform the parents the baby will need supplemental oxygen at home. Multiple Response Identify one or more choices that best complete the statement or answer the question. 1. While providing oral medications, the nurse recognizes which of the following is true regarding the absorption rate of a medication? (Select all that apply.) A. The drug’s level of fat solubility should be high to ensure absorption. B. A medication will be more readily absorbed if it has a high pH. C. A drug will be more readily absorbed if it is acidic in nature. D. Absorption will be more rapid if it is provided in liquid form. E. Absorption is slower in the presence of food. F. A lozenge should be chewed to release the maximum amount of medication. 2. While caring for multiple clients on the medical/surgical unit, the nurse would monitor which of the following individuals for potential liver toxicity? (Select all that apply.) A. A 14 - year - old patient taking atomoxetine (Strattera) who has a history of ADHD B. A 44 - year - old patient admitted for pneumonia who has been taking acetaminophen (Tylenol) C. A 63 - year - old patient with a history of atrial fibrillation who has an irregular apical pulse D. A 19 - year - old patient with a history of alcohol abuse admitted for a tonsillectomy E. A 71 - year - old patient with a history of tuberculosis who took isoniazid (Laniazid) F. A 15 - year - old patient who took multiple aspirin as part of a suicide attempt 3. While working in the gastrointestinal diagnostic clinic, the nurse identifies which of the following individuals as at high risk for developing a gastric ulcer? (Select all that apply.) A. A 41 - year - old patient with a family history of Crohn’s disease B. A 54 - year - old patient who reports smoking 1.5 packs of cigarettes/day for the past 40 years C. A 29 - year - old patient taking misoprostol (Cytotec) D. A 16 - year - old patient with a 6 - month history of bulimia E. A 44 - year - old patient who reports taking ibuprofen (Advil) daily for low back pain 4. While providing medications to clients in the long - term care facility, which of the following actions would the nurse use to prevent gastrointestinal side effects? (Select all that apply.) A. Give clients yogurt to prevent diarrhea. B. Increase client intake of fiber to reduce gastric motility. C. Provide milk or food with some medications to reduce the occurrence of nausea. D. Improve absorption of the medication by giving it at night with a large snack. E. Prevent constipation by providing fiber laxatives.
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Chapter 2. Basics of Pharmacology Answer Section MULTIPLE CHOICE 1. ANS: C PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Medication Provision; antivirals KEY: Analysis MSC: NCLEX Category: Pharmacological Therapies NOT: See Absorption (p. 15). When administering an ointment for a rash, make sure the skin is clean and dry. 2. ANS: A PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Anticoagulant therapy KEY: Analysis MSC: NCLEX Category: Pharmacological Therapies NOT: See Distribution (p. 16): The blood - placental barrier helps to filter drugs and other substances passing from mother to fetus. Most lipid - soluble drugs readily cross this barrier but water - soluble drugs do not. Warfarin (Coumadin) is fat - soluble and c rosses the placental barrier while heparin does not. They are not the same medication and cost is not part of the therapeutic decision. 3. ANS: B PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Medication Administration; antivirals KEY: Analysis MSC: NCLEX Category: Pharmacological Therapies NOT: See Metabolism (p. 16): The liver does most of the work of drug metabolism. In some instances, a drug is administered in its inactive form to become activated through metabolism. This category of drugs is known as prodrugs. An example of a prodrug is fosamprenavir (Lexiva). 4. ANS: D PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Antidiabetics KEY: Analysis MSC: NCLEX Category: Pharmacological Therapies NOT: See Metabolism (p. 16): Insulin given by mouth is virtually useless; stomach acid breaks down insulin to an inactive form before it can be absorbed into the bloodstream. Oral diabetic medications are not forms of insulin; they stimulate the pancreas t o release insulin. 5. ANS: B PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Antibiotics KEY: Analysis MSC: NCLEX Category: Pharmacological Therapies NOT: See Issues Affecting the Drug Cycle (p. 17): Gentamicin is known to be both nephrotoxic (toxic to the kidneys) and ototoxic (toxic to the ears). Thus, kidney function and hearing would be monitored closely. The EGFR is the best measurement of kidney f unction. Normal value is >60 mL/min. While the client’s hemoglobin is low, the kidney function is more concerning. An elevated WBC count is expected in the presence of an infection, which is the reason antibiotic therapy is provided. Routine blood levels t o monitor drug dosage is expected to help prevent toxicity. 6. ANS: A PTS: 1 DIF: Hard TOP: Therapeutic Classification: Antibiotics KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Issues Affecting Drug Cycle (p. 18): Antagonist drugs do the opposite by rendering another drug less powerful. The antibiotic tetracycline becomes ineffective when it is taken with penicillin. Amoxicillin clavulanate is a penicillin derivative. 7. ANS: B PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Muscle relaxants KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See The Importance of Side Effects (p. 18): Muscle relaxants such as Flexeril cause dizziness and drowsiness in addition to their intended actions. 8. ANS: C PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Anti - inflammatory agents KEY: Analysis MSC: NCLEX Category: Pharmacological Therapies NOT: See Side Effects (p. 19): Clients who take nonsteroidal anti - inflammatory medications on a long - term basis run the risk of developing ulcers. This client is the most unstable and should be seen first.
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9. ANS: D PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Anti - inflammatory agents KEY: Analysis MSC: NCLEX Category: Pharmacological Therapies NOT: See Side Effects (p. 19): If kidney damage or impairment is suspected, BUN levels may be monitored to evaluate kidney function. Clients taking anti - inflammatory agents are at increased risk of kidney damage because these drugs are primarily metabolize d through the kidneys instead of the liver. 10. ANS: B PTS: 1 DIF: Hard TOP: Therapeutic Classification: Anticoagulants KEY: Analysis MSC: NCLEX Category: Pharmacological Therapies NOT: See Side Effects (p. 19): Any patient taking an anticoagulant such as Coumadin to decrease clotting should be carefully monitored for signs of bleeding, including dark tarry stools. Coumadin levels should be monitored to ensure the drug level is thera peutic but not toxic. 11. ANS: A PTS: 1 DIF: Moderate TOP: Therapeutic Classification: NA KEY: Analysis MSC: NCLEX Category: Pharmacological Therapies NOT: See Side Effects (p. 19): A serious problem is the use of oxygen in premature infants. At high doses, oxygen is very damaging to the eyes. For this reason, oxygen is now used at the lowest therapeutic dose possible for all age groups. This oxygen satu ration level is very good, has been stable for 4 hours, and thus a trial on lower concentrations is warranted. Transfer out of ICU will depend on additional factors. Long - term use of oxygen can’t be determined at this time. MULTIPLE RESPONSE 1. ANS: A, C, D, E PTS: 1 DIF: Hard TOP: Therapeutic Classification: NA KEY: Analysis MSC: NCLEX Category: Pharmacological Therapies NOT: See Absorption (p. 15): The more soluble a medication is in fat or lipids, the more easily it is absorbed through the stomach. Medications with a low (acidic) pH are easily absorbed in the stomach. Liquid medications act faster than pills. A large amo unt of food slows absorption. If a patient sucks on a lozenge, more medication is released in the mouth than if the lozenge is chewed or swallowed. 2. ANS: B, D, E, F PTS: 1 DIF: Hard TOP: Therapeutic Classification: Medication Administration KEY: Analysis MSC: NCLEX Category: Pharmacological Therapies NOT: See Side Effects (p. 18): Alcohol, acetaminophen, isoniazid, and aspirin can cause liver damage. 3. ANS: B, E PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Anti - inflammatory agents KEY: Analysis MSC: NCLEX Category: Pharmacological Therapies NOT: See Side Effects (p. 19): The synthetic prostaglandin misoprostol (Cytotec) may be given to prevent the development of ulcers. Clients taking anti - inflammatory agents such as ibuprofen are at increased risk for ulcer formation. These patients are also urged to stop smoking to reduce the risk of ulcers. 4. ANS: A, C, E PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Medication Administration KEY: Analysis MSC: NCLEX Category: Pharmacological Therapies NOT: See Side Effects (p. 19): Side effects are managed on an individual basis. Some medications require ingestion with milk or food. For certain drugs, adding yogurt to the diet is suggested to prevent diarrhea, and other drugs may require the addition of a high - fiber laxative to the diet to prevent constipation. Fiber will increase GI motility. The presence of food slows absorption rates. Chapter 3. Patient Safety in Medication Administration Multiple Choice Identify the choice that best completes the statement or answers the question. 1. The student nurse is preparing to provide medications to a client scheduled to receive lisinopril (Zestril) 10 mg PO daily and ofloxacin (Floxin) 2 drops o.s. three times daily. Which of the following actions by the student is best? A. Provide the lisinopril by mouth and the ofloxacin into the right ear.
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B. Provide the lisinopril into the right ear and the ofloxacin into the right eye. C. Provide the lisinopril into the left ear and the ofloxacin orally. D. Provide the lisinopril orally and the ofloxacin into the left eye. 2. When providing medications from floor stock to a client on the Alzheimer’s unit of a long - term - care facility, the nurse demonstrates the principle of right drug by which of the following? A. Checks the label before taking the medication out of the cabinet, checks the label before pouring the medication, checks the label before placing the bottle back in the cabinet B. Checks the label before taking the medication out of the cabinet, checks the label before pouring the medication, checks the label before leaving the medication room C. Checks the label after removing the bottle from the cabinet, checks the label after pouring the dose of medication, checks the label before closing the cabinet door D. Checks the label while removing the bottle from the cabinet, checks the label after pouring the dose of medication, checks the label while replacing the bottle in the cabinet 3. The nurse is preparing to discharge a client originally admitted for community - acquired pneumonia who has a discharge prescription for cefditoren (Spectracef). Which of the following instructions would the nurse include in the discharge teaching? A. ―Be sure to take the medication until your cough is gone.‖ B. ―It is important that you take the medication with meals.‖ C. ―Taking the medication at set time intervals will help blood levels stay constant.‖ D. ―Keeping the medication on the counter top will help you remember to take it.‖ 4. While working in an urgent care center, the nurse assists in the care of a client with allergic rhinitis who has been given a prescription for beclomethasone nasal spray (Beconase), 2 sprays in each nostril 2 to 4 times daily. The nurse would provide furth er instruction to which of the following client statements? A. ―This will help my nose to not run so constantly.‖ B. ―I should spray this in each nostril whenever my nose starts to drip.‖ C. ―I can use this before I go to work, midday, and again at bedtime.‖ D. ―This medication is a mild steroid and will reduce swelling and irritation of my nasal passages.‖ 5. The nurse is conducting a home visit for a 43 - year - old client. The client, who has three children under the age of 12, is 3 days post - mastectomy. The nurse would be most concerned by which of the following? A. The client has a calendar for appointments and a list with physician contact information by the phone. B. The client keeps her medications in a daily pill box that sits on the kitchen windowsill. C. The client reports that it was too uncomfortable to wear the temporary prosthesis she had been given. D. The children are participating in a support group for family members of people with cancer. 6. The nurse is providing medications to a client with a gastrostomy tube. Diclofenac (Cambia) has been ordered. Prior to administration, the nurse should take which of the following actions? A. Ensure that the medication comes as a liquid preparation. B. Obtain a 3 - mL syringe and needle with a safety device. C. Document the medication provision. D. Ask the client to state her name and room number. 7. A nurse on the pediatric unit is preparing to pass medications for a 10 - year - old client with exacerbation of asthma. Amphetamine (Adderall) and fluticasone (Advair) are scheduled. The nurse must be aware of which of the following?
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A. Adderall and Advair should not be given at the same time. B. Adderall is used to reduce bronchospasms. C. Advair must be given with food. D. Adderall and Advair each have look - alike/sound - alike medications. 8. A nurse working in the GI clinic is performing pre - op phone calls. The nurse calls a client who is scheduled for a colonoscopy to inform the client of the following orders, ―Begin clear liquid diet 24 hours prior to the exam; take magnesium citrate (Citroma) 1 bottle PO 12 hours prior to the exam and another 8 hours prior to the exam; remain NPO for 6 h ours prior to the study.‖ The test is scheduled the next day at 2 p.m. The nurse would instruct the patient to: A. ―Only have liquids to drink at this point until the test. Use the enema prep at 2 a.m. and then again at 6 a.m. You can’t have anything to eat or drink after waking in the morning.‖ B. ―Start a clear liquid diet today at 2 p.m. Drink a bottle of prep at 2 a.m. and another at 6 a.m., and then don’t eat or drink anything after 8 a.m.‖ C. ―Don’t eat anything solid starting with lunch today. Give yourself an enema with the prep at 6 a.m. and again at noon, and don’t have anything to eat or drink after 8 a.m.‖ D. ―Start a clear liquid diet with dinner today. Drink the prep 12 hours and 8 hours before your test at 2 p.m. tomorrow, and be sure not to eat anything solid after you get up in the morning.‖ 9. While working in a surgical clinic, the nurse notes orders that read, ―.25 mg digoxin (Lanoxin) IV now.‖ Which action by the nurse is best? A. Give .25 mg of digoxin intravenously. B. Give 25 mg of digoxin as an injection into the skin. C. Contact the physician for clarification of the order. D. Give .25 mL of digoxin as an intramuscular injection. 10. A client being seen in the outpatient clinic has been given a new prescription for tetracycline (Doxycycline) orally each day. The client reported current medications include a multivitamin with calcium, St. John’s Wort, and omeprazole (Prilosec). The nurs e would provide additional teaching for which client statement? A. ―I should try to take the medication at roughly the same time each day.‖ B. ―I can take this medication with my other morning meds.‖ C. ―I should take this medication at least an hour before or 2 hours after I eat.‖ D. ―Drinking extra water is important when taking this medication.‖ 11. The nurse receives a phone call from an elderly woman who states that her husband has recently started taking atorvastatin (Lipitor) and is complaining of having sore muscles. Which response by the nurse is best? A. ―Does your husband smoke cigarettes?‖ B. ―What type of exercise is your husband doing?‖ C. ―Does your husband have a history of heart disease?‖ D. ―Your husband should be seen in the clinic today for some tests.‖ 12. A nurse from the adult medical unit is pulled to the geriatric unit. The nurse notes many of the common medications provided are in lower doses than typically prescribed. What action by the nurse is the highest priority? A. Notify the charge nurse that clients may have received inappropriate medication dosages. B. Call the nursing supervisor to investigate the nurse’s concerns. C. Don’t worry about the discrepancy since this is not the nurse’s unit.
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D. Evaluate the lab values of each client to determine liver and kidney function. 13. While working on a geriatric unit, the nurse would be most concerned by which of these findings? A. An 81 - year - old client is scheduled to take 12 pills at 9 a.m. B. A 72 - year - old client given a sleeping pill the night before seems confused. C. A 69 - year - old client with a deep vein thrombosis has an order for an anticoagulant. D. A 74 - year - old client with diabetes has a fasting glucose result of 88 g/dL. 14. The nurse notes that an elderly client admitted with metastatic cancer has a low serum protein level. Which action by the nurse is best? A. No action is required because the patient is terminal. B. Increase the frequency of vital sign monitoring. C. Determine the most recent complete blood count (CBC) results. D. Increase awareness and assessment of potential medication side effects. 15. Shortly after providing a new sleeping pill to a client on the medical unit, the nurse answers the client’s call light. Which of the following findings would indicate to the nurse that the client is experiencing an anaphylactic reaction to the medication? A. The client’s respiratory rate is 28 and slightly labored. B. The client complains of continued wakefulness and agitation. C. The client states that she feels nauseated and has a headache.
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D. The client reports feeling hot and has a rash across her chest. 16. A nurse working at the poison control center receives a call from a young woman babysitting for a 4 - year - old child who reportedly swallowed some of the parent’s medication. Which statement by the nurse is best? A. ―I’m calling emergency personnel for you now.‖ B. ―What do the pills look like?‖ C. ―Have the child drink a glass of milk.‖ D. ―What is the name of the pills?‖ 17. The nurse is preparing to provide medications to a client in a double room. The client’s roommate has multiple visitors present. Which of the following actions would the nurse take first? A. Identify the action and side effect of each medication as it is provided. B. Pull the client’s bedside curtain and talk in subdued tones. C. Ask the client to state his name and birth date to verify identity. D. Determine what questions the client has about his medications. Multiple Response Identify one or more choices that best complete the statement or answer the question. 1. While providing medications in the clinical lab, a student would perform actions related to safe administration that include which of the following? (Select all that apply.) A. Right medication B. Right dose C. Right time D. Right room E. Right patient F. Right route 2. While supervising a student nurse providing morning medications to clients in the long - term - care facility, the nurse would intervene if the student was observed performing which of the following actions? (Select all that apply.) A. The student checks the patient’s arm band to verify identity. B. The student verifies the medication order. C. The student scans the medication with the computer scanner. D. The student checks the medication’s expiration date. E. The student prepares a medication scheduled for 1800. F. The student asks the client to state his first name prior to giving the medication. 3. A female nursing student is 18 weeks pregnant while attending her pharmacology class. Which of the following facts related to fetal effects of medications will the student recognize as true? (Select all that apply.) A. Category A drugs are known to have minimal risk to the fetus. B. Category C drugs are known to cause severe risk to the fetus in human trials. C. Drugs that are classified as teratogenic are not able to cross the placental barrier. D. Category X drugs have not been studied in pregnant women. E. Category B drugs have slight risk to the fetus; both animal and human studies have been done.
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4. A nurse is working with a group of male veterans participating in a smoking - cessation program. The nurse recognizes that which of the following statements related to medications in these clients is true? (Select all that apply.) A. An increased number of medications will have teratogenic effects in this population. B. Medications are likely to be absorbed and distributed more rapidly. C. This population has a decreased lipase secretion. D. These clients may need larger doses of liver - metabolized drugs. E. Drugs will be metabolized more slowly by this population. 5. A nurse working in the emergency room is preparing for the admission of a 34 - year - old client with a drug overdose. Which of the following equipment and/or orders will the nurse anticipate? A. Telemetry monitoring B. Blood transfusion C. Activated charcoal D. Dialysis machine E. Nasogastric tube and 60 - mL syringe for lavage F. Contrast for magnetic resonance imaging (MRI) testing 6. A nurse working on the orthopedic unit is providing discharge instructions for a client with a fractured femur. When explaining the client’s narcotic pain medication, the nurse would include which statement? (Select all that apply.) A. ―This medication may make you sleepy, so you can’t drive while taking it.‖ B. ―Narcotics can cause constipation, so be sure to drink extra fluid and eat a high - fiber diet.‖ C. ―Many patients who take this feel dizzy or light - headed, so you must be careful of falls, especially at night.‖ D. ―Only take the number of pills prescribed per day. Taking more can be dangerous.‖ E. ―You can take this medication as many times as needed for pain control.‖ 7. An RN is working to support clinical trials in clients with cancer. Which of the following would be an anticipated part of this role? (Select all that apply.) A. Educating the clients about the treatment, side effects, and alternative therapies B. Ensuring that informed consent to participate is obtained C. Documenting client and family understanding related to the trial D. Providing payment to the client for participation in the trial E. Ordering medications from the pharmacy based on clients’ height and weight Matching Place the following steps of medication administration for an ordered medication in the correct order. A. Ask the client to state his/her name and birth date. B. Open the medication packaging. C. Verify the medication and dose. D. Scan the medication with the computer scanner. 1. First 2. Second 3. Third
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4. Fourth
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Chapter 3. Patient Safety in Medication Administration Answer Section MULTIPLE CHOICE 1. ANS: D PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Medication Administration KEY: Analysis MSC: NCLEX Category: Pharmacological Therapies NOT: See Table 3.2 (p. 29): PO is by mouth (orally) and o.s. is left eye. 2. ANS: A PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Medication Administration KEY: Analysis MSC: NCLEX Category: Pharmacological Therapies NOT: See Patient Rights for Safety (p. 26): Check the label before you take the bottle from the shelf, check the label before you pour the drug out, check the label before you put the bottle back on the shelf. 3. ANS: C PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Antibiotics KEY: Analysis MSC: NCLEX Category: Pharmacological Therapies NOT: See Patient Rights for Safety (p. 26): Some medications, such as antibiotics need to be given a standard number of hours apart around the clock to maintain a consistent blood level. Most antibiotics work best when taken on an empty stomach (p. 31). St ore medications safely locked away. 4. ANS: B PTS: 1 DIF: Easy TOP: Therapeutic Classification: Inhaled Steroids KEY: Analysis MSC: NCLEX Category: Pharmacological Therapies NOT: See Patient Rights for Safety (p. 26): Emphasize that patients need to adhere to the exact prescription and avoid self - medication. 5. ANS: B PTS: 1 DIF: Moderate TOP: Therapeutic Classification: NA KEY: Analysis MSC: NCLEX Category: Pharmacological Therapies NOT: See Fast Tip 3.1 (p. 27): Store medications safely no matter what age others are in the household. Discomfort at the surgical incision site should be investigated to ensure that no infection is present, but tenderness 3 days after surgery is still exp ected and may interfere with prosthetic use. 6. ANS: A PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Anti - inflammatory agents KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: Patient Rights for Safety (p. 27): A liquid formulation may be necessary if the drug must be given through a feeding tube. A needle should not be necessary for g - tube administration. Documentation should not occur until after the medication is given. Clients should be asked to state name and birth date for proper identification. 7. ANS: D PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Amphetamine mixtures KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Medication Administration Table 3.1 (p. 28): Adderall and Advair each have other drugs with look - alike/sound - alike names. Adderall is used to treat ADHD symptoms. Advair is provided in diskus/inhalation format for clients with asthma and food is n ot a factor in its provision. These two medications can be given at the same time. 8. ANS: B PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Laxatives KEY: Analysis MSC: NCLEX Category: Pharmacological Therapies NOT: See Table 3.2: NPO means nothing by mouth; PO means orally. Giving specific directions/instructions, including times for prep, will help ensure that clients understand and follow the correct procedure for medication administration. 9. ANS: C PTS: 1 DIF: Moderate
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TOP: Therapeutic Classification: Amionoglycocides KEY: Analysis MSC: NCLEX Category: Pharmacological Therapies NOT: See Table 3.2 and 3.3: IV means intravenous (into a vein), but without a zero in front of the decimal point, this order should be clarified. 10. ANS: B PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Antibiotics KEY: Analysis MSC: NCLEX Category: Pharmacological Therapies NOT: See Factors Affecting Medication Administration (p. 31): Administering tetracycline with calcium prevents the absorption of the antibiotic. Most antibiotics work best when taken on an empty stomach. Many antibiotics can cause diarrhea, so drinking ext ra fluids is important. 11. ANS: D PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Lipid lowering agents KEY: Analysis MSC: NCLEX Category: Pharmacological Therapies NOT: See Age, gender and culture (p. 31): Toxic drug levels can be found in elderly patients, even with normal doses. The aging process alters liver and kidney function and leads to accumulation of medications. Atorvastatin can cause muscle breakdown, a co ndition that is worsened in the presence of kidney or liver disease, so it will be important to have the client evaluated and have laboratory testing done. 12. ANS: D PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Medication administration KEY: Analysis MSC: NCLEX Category: Dosage Calculations NOT: See Age, gender and culture (p. 31): The aging process alters liver and kidney function and leads to accumulation of medications. Because of these factors, doses may need to be adjusted for elderly patients. 13. ANS: B PTS: 1 DIF: Moderate TOP: Therapeutic Classification: NA KEY: Analysis MSC: NCLEX Category: Coordinated Care NOT: See Age, gender and culture (p. 31): Of special concern are sedative - hypnotics. These medications are commonly associated with adverse drug events and can worsen agitation and exacerbate dementia. Another concern for geriatric patients is polypharmacy , but this is not the highest priority in this scenario. Anticoagulant medication is an appropriate treatment for deep vein thrombosis. A reading of 88 g/dL is a normal fasting blood glucose. 14. ANS: D PTS: 1 DIF: Moderate TOP: Therapeutic Classification: NA KEY: Application MSC: NCLEX Category: Physiological Adaptation NOT: See Patients with Organ Dysfunction (p. 34): Decreased serum protein levels can alter the capacity of a drug to bond. More unbound medication is therefore available and this can lead to side effects. Serum protein levels may indirectly impact blood vo lume and therefore blood pressure, but this is not the highest priority. Recent CBC results may be indirectly affected by low serum protein levels, but this is not the highest priority for this scenario. 15. ANS: A PTS: 1 DIF: Moderate TOP: Therapeutic Classification: NA KEY: Analysis MSC: NCLEX Category: Pharmacological Therapies NOT: See Patient Emergencies (p. 36): A severe allergic reaction is called anaphylaxis. Patients experiencing anaphylaxis have difficulty breathing and may have other symptoms such as itching, wheezing, anxiety, and light - headedness. 16. ANS: A PTS: 1 DIF: Moderate TOP: Therapeutic Classification: NA KEY: Analysis MSC: NCLEX Category: Safety and Infection Control NOT: See Patient Emergencies (p. 36): If you receive a call from a patient who has ingested a toxic substance, call 911. This child needs immediate medical attention, which should take priority over other actions or assessment. Learning more about the medi cations will be helpful and milk may be appropriate to reduce acidity, but the priority is to have emergency personnel respond first. 17. ANS: B PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Medication Administration KEY: Analysis MSC: NCLEX Category: Pharmacological Therapies
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NOT: See Patient Consent (p. 35): Patients have the right to receive medications in a quiet, private place. The first action in this scenario is to attempt to provide client privacy by pulling the bedside curtain and speaking in subdued tones. MULTIPLE RESPONSE 1. ANS: A, B, C, E, F PTS: 1 DIF: Easy TOP: Therapeutic Classification: Medication Administration KEY: Knowledge MSC: NCLEX Category: Pharmacological Therapies NOT: See Patient Rights for Safety (p. 26) The seven right of medication administration include right patient, right drug, right dose, right time, right route, right technique, and right documentation. 2. ANS: E, F PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Medication administration KEY: Analysis MSC: NCLEX Category: Pharmacological Therapies NOT: See Patient Rights for Safety (p. 26) The seven rights of medication administration include right patient, right drug, right dose, right time, right route, right technique, and right documentation. Before you administer any medication, make sure that you have the right patient by asking the individual to state his or her full name and birth date. Verify that you have the correct medication for the patient. In a hospital, scanning a bar code to double - check a medication with a computer system may help r educe medication errors. 1800 is 6 p.m.; this is not a morning medication and would not be provided at this time. Both first and last name and birthdate should be stated prior to provision of medications. 3. ANS: A, E PTS: 1 DIF: Hard TOP: Therapeutic Classification: NA KEY: Knowledge MSC: NCLEX Category: Pharmacological Therapies NOT: See Pregnancy and Table 3.5 (p. 33): Category A medications have the lowest risk. Category B medications have slight risk, with animal studies showing no risk or, if risk is noted, human studies have shown no risk. Category C medications have moderate risk based on animal studies, and controlled studies have not been done on women. Category X medications have the highest risk as studies have shown significant risk. Teratogenic drugs cross the placental barrier and cause deformities. 4. ANS: B, D PTS: 1 DIF: Hard TOP: Therapeutic Classification: NA KEY: Knowledge MSC: NCLEX Category: Pharmacological Therapies NOT: See Age, gender and culture (p. 32 – 33): Medications are absorbed and distributed in the body more quickly in men than in women. Smoking cigarettes induces liver enzymes to metabolize drugs more rapidly, so clients may need larger doses of liver - metabo lized drugs. Teratogenic effects are related to fetal development and will not impact male clients. Lipase secretion is decreased in infants as compared with adults. 5. ANS: A, C, E PTS: 1 DIF: Moderate TOP: Therapeutic Classification: NA KEY: Application MSC: NCLEX Category: Physiological Adaptation NOT: See Patient Emergencies (p. 36): Actions will depend on the type of toxin but may include administration of activated charcoal, lavage (pumping of the patient’s stomach), and monitoring the patient for changes in vital signs, including heart rate (tel emetry). Blood transfusion, dialysis, and MRI testing is not immediately anticipated and would only be ordered if the client was experiencing bleeding, kidney failure, or symptoms of a stroke, respectively. 6. ANS: A, B, C, D PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Narcotics KEY: Analysis MSC: NCLEX Category: Pharmacological Therapies NOT: See Protecting the Patient: Ethical and Safety Considerations (p. 34): It is your responsibility as a health professional to educate the patient about the risks associated with taking more than the prescribed dose. 7. ANS: A, B, C PTS: 1 DIF: Hard TOP: Therapeutic Classification: NA KEY: Application MSC: NCLEX Category: Coordinated Care NOT: See Patient consent (p. 35): A patient who is taking an experimental drug has the right to informed consent, which includes understanding the treatment and its effects, alternative treatments, and possible
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outcome if the treatment is declined. It is essential to document informed consent. Clients are generally not paid to participate in clinical trials. RNs are not able to order medications. MATCHING 1. ANS: A PTS: 1 DIF: Easy TOP: Therapeutic Classification: Medication Administration KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Patient Rights for Safety (p. 26): Before you administer any medication, make sure that you have the right patient by asking the individual to state his or her full name and birth date. Verify that you have the correct medication for the patient. In a hospital, scanning bar codes to double - check a medication with a computer system may help reduce medication errors. 2. ANS: D PTS: 1 DIF: Easy TOP: Therapeutic Classification: Medication Administration KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Patient Rights for Safety (p. 26): Before you administer any medication, make sure that you have the right patient by asking the individual to state his or her full name and birth date. Verify that you have the correct medication for the patient. In a hospital, scanning bar codes to double - check a medication with a computer system may help reduce medication errors. 3. ANS: B PTS: 1 DIF: Easy TOP: Therapeutic Classification: Medication Administration KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Patient Rights for Safety (p. 26): Before you administer any medication, make sure that you have the right patient by asking the individual to state his or her full name and birth date. Verify that you have the correct medication for the patient. In a hospital, scanning bar codes to double - check a medication with a computer system may help reduce medication errors. 4. ANS: C PTS: 1 DIF: Easy TOP: Therapeutic Classification: Medication Administration KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Patient Rights for Safety (p. 26): Before you administer any medication, make sure that you have the right patient by asking the individual to state his or her full name and birth date. Verify that you have the correct medication for the patient. In a hospital, scanning bar codes to double - check a medication with a computer system may help reduce medication errors. Chapter 4. Regulations Multiple Choice Identify the choice that best completes the statement or answers the question. 1. While shopping for an over - the - counter cough suppressant, the nurse identifies the medication will be classified as: A. A Schedule I medication B. A Schedule III medication C. A Schedule V medication D. Nonscheduled medication 2. Nurses are protected from unnecessary job - related risks due to the regulations set by: A. Food and Drug Administration (FDA) B. Drug Enforcement Administration (DEA) C. Occupational Safety and Health Administration (OSHA) D. Joint Commission on Accreditation of Healthcare Organizations (JCAHO) 3. The nurse provides a client admitted with gastroesophageal reflux a dose of intravenous pantoprazole (Protonix). Fifteen minutes later, the client calls for help and is gasping for breath. Emergency measures are
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instituted and the client is transferred to the intensive care unit. Which action should be included in the nurse’s follow - up activities? A. Notify the nursing supervisor that the client experienced a common side effect to the drug. B. Identify the episode as an adverse reaction and ensure it is reported to the FDA. C. Call the hospital administrator to report an act of medication fraud. D. Contact the local news channel to arrange an investigation. 4. A client with advanced colorectal cancer is going to start taking long - acting morphine sulfate (MS Contin). Which of the following statements by the nurse is best? A. ―I will call the prescription into your local pharmacy.‖ B. ―You are only allowed to have one refill on this medication before you have to see the doctor again.‖ C. ―This is considered a Schedule IV medication, so there are strict guidelines we must follow.‖ D. ―I am faxing the prescription to the pharmacy, but you must also take this written prescription with you to pick it up.‖ 5. A client with a compressed disc in the lumbar region takes Vicodin every 6 hours for pain control. He tells the nurse, ―This pain medication just doesn’t seem to be working anymore.‖ Which response by the nurse is best? A. ―Are you taking the medication with a full glass of water?‖ B. ―You may be developing a tolerance to the medication.‖ C. ―We will have to draw some lab work to see if your stomach is digesting the medication correctly.‖ D. ―How did you rank your pain on a 0 – 10 scale with your original injury?‖ 6. A co - worker tearfully confides that she is struggling with a growing dependence on sleeping medication and other drugs to maintain her work schedule on the night shift. Which action by the nurse is best? A. Refer the co - worker to the employee assistance program. B. Encourage the co - worker to switch to herbal remedies. C. Suggest the co - worker try to get a daytime position. D. Ask if the co - worker needs help with childcare. Multiple Response Identify one or more choices that best complete the statement or answer the question. 1. A student nurse is reminded to follow OSHA guidelines when providing care to clients in the hospital. Which of the following actions will the student take to comply with this direction? (Select all that apply.) A. Wear a uniform that identifies the student’s status B. Wear gloves when providing a client bath C. Hand washing before providing client care D. Needle disposal in an identified ―sharps‖ container E. Wear a face mask when caring for a client with heart failure 2. A clinical trial nurse is helping to register a patient to a phase II double - blind trial comparing a new medication to a placebo. Which of the following would the nurse include in the patient teaching? (Select all that apply.) A. ―Neither you, the doctor, or I will know if you are getting the real medication or not.‖ B. ―A computer will randomly determine which people get the actual study drug.‖ C. ―This trial is designed to determine if a benefit is found when using the drug.‖ D. ―Less than 100 people will be participating in this study.‖ E. ―The results of the study will not be known for at least 5 years.‖
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3. A nurse working with a client who is experiencing withdrawal from a medication would track which of the following symptoms? (Select all that apply.) A. Tremors B. Pin - point pupils C. Hallucinations D. Low blood pressure E. Emotional distress F. Feelings of euphoria 4. The nurse manager on a surgical unit suspects one of the nurses may be dealing with a substance abuse problem. Which of the following symptoms would support this suspicion? (Select all that apply.) A. The individual’s uniform is frequently wrinkled or disheveled. B. The individual has called in sick three times in the past month. C. The individual has made two medication errors in the past week. D. The individual is irritable and withdrawn. E. The individual was seen crying in the medication room after a patient death. F. The individual has lost an estimated 10 pounds in the past 8 weeks. Chapter 4. Regulations Answer Section MULTIPLE CHOICE 1. ANS: C PTS: 1 DIF: Moderate TOP: Therapeutic Classification: NA KEY: Comprehension MSC: NCLEX Category: Pharmacological Therapies NOT: See Table 4.4 (p. 45) and Table 4.7 (p. 57): Schedule I medications have high abuse potential. Schedule III medications have lower abuse potential with moderate to low dependence risk. Schedule V medications have even lower abuse potential and include over - the - counter cough suppressants. 2. ANS: C PTS: 1 DIF: Easy TOP: Therapeutic Classification: NA KEY: Knowledge MSC: NCLEX Category: Pharmacological Therapies NOT: See Modern Regulating Agencies (p. 46): OSHA is a branch of the Department of Labor that helps ensure all workers are not exposed to unnecessary job - related risks. 3. ANS: B PTS: 1 DIF: Moderate TOP: Therapeutic Classification: GERD agents KEY: Analysis MSC: NCLEX Category: Safety and Infection Control NOT: See Food and Drug Administration (p. 47): A side effect that can cause severe harm or death is commonly called an adverse reaction. An example is airway swelling. It is your responsibility as an allied health professional to report an adverse reaction to a medication to the FDA’s MedWatch. 4. ANS: D PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Narcotics KEY: Analysis MSC: NCLEX Category: Psychosocial Integrity NOT: See Drug Control (p. 57): Morphine is a Schedule II medication. An office assistant cannot call in the prescription, and no refills are permitted. The office staff may fax the prescription to the pharmacy, but the clients must also give a handwritten prescription to the pharmacist to receive the medication. 5. ANS: B PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Narcotics KEY: Analysis MSC: NCLEX Category: Psychosocial Integrity NOT: See Substance Abuse (p. 59): Requiring greater amounts of a drug occurs when clients develop a tolerance to the medication. The amount of water consumed will not contribute to drug efficacy. Kidney or liver dysfunction may contribute to drug metabolis m, but lab results are not typically used to determine digestion of a medication. The level of pain associated with the original injury is not helpful to the current situation. 6. ANS: A PTS: 1 DIF: Moderate TOP: Therapeutic Classification: NA
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KEY: Application MSC: NCLEX Category: Coordinated Care NOT: See Treating Substance Abuse (p. 60): Follow your facility’s protocol on referral of impaired employees for substance abuse treatment. Many employers have employee assistance programs or support groups organized through the human resource department. MULTIPLE RESPONSE 1. ANS: B, C, D PTS: 1 DIF: Moderate TOP: Therapeutic Classification: NA KEY: Analysis MSC: NCLEX Category: Safety and Infection Control NOT: See Modern Regulating Agencies (p. 46): OSHA regulations for protecting yourself on the job include hand washing before any patient is handled. Medications should not be touched without wearing gloves. Gloves should be worn during client care in case of exposure to blood or body fluids. Sharp objects should be disposed of in a specialized sharps disposal container. Face masks are part of additional precautions when providing care for clients with a respiratory infection - a client with heart failure is not considered infectious. 2. ANS: A, B, C PTS: 1 DIF: Hard TOP: Therapeutic Classification: NA KEY: Analysis MSC: NCLEX Category: Pharmacological Therapies NOT: See Clinical Trials (p. 51 - 52) and Table 4.6: Clinical trials are studies performed after testing is done in a laboratory. During the study the effect of the active drug is compared to a placebo (an inactive substance). Most studies are double - blind, meaning neither the participant nor the clinicians know who is receiving the active drug. Phase II clinical trials involve hundreds of patients and are designed to see whether a drug works as desired. Phase II trials last several months to 2 years. 3. ANS: A, C, E PTS: 1 DIF: Moderate TOP: Therapeutic Classification: NA KEY: Knowledge MSC: NCLEX Category: Psychosocial Integrity NOT: See Substance Abuse (p. 59): Patients who stop taking a medication may experience symptoms of withdrawal, such as tremors, emotional distress, and hallucinations. 4. ANS: A, B, C, D, F PTS: 1 DIF: Moderate TOP: Therapeutic Classification: NA KEY: Application MSC: NCLEX Category: Psychosocial Integrity NOT: See Box 4.3 (p. 61): Signs of possible substance abuse include: being late or absent frequently due to illness, irritable and defensive or withdrawn behavior, frequent mistakes, changes in appearance such as weight change, and poor or deteriorated hyg iene. Chapter 5. Prescriptions and Labels Multiple Choice Identify the choice that best completes the statement or answers the question. 1. The nurse notes orders for lorazepam (Ativan) 1 mg PO qhs prn. Which action by the nurse is best? A. Give the client 1 mg at noon each day. B. Ask the client at bedtime if he/she would like to take an Ativan. C. Schedule the Ativan daily with breakfast. D. Instruct the client to ask for Ativan any time it is needed. 2. The following order is written for a 28 - year - old client with asthma, ―Budesonide nasal (Pulmicort) 2 sprays each nostril bid.‖ The nurse will instruct the client to take this medication: A. Once daily with two sprays in each nostril B. Once each evening with one spray in each nostril C. One spray in each nostril twice daily D. Two sprays in each nostril two times each day 3. A client with Alzheimer’s disease is started on donepezil (Aricept) 10 mg PO qhs. The nurse will administer this medication at: A. 6 p.m. B. 6 a.m. C. 9 p.m.
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D. 9 a.m. 4. A client with diabetes mellitus is ordered sliding scale insulin glulisine (Apidra) 2 to 10 units ac and hs based on blood glucose results. The nurse will need to check the client’s blood sugar: A. Before each meal and at bedtime B. Fasting in the morning and again at bedtime C. Just before breakfast and again at dinner D. After each meal 5. A neighbor calls the nurse saying, ―This bottle of infant acetaminophen (Tylenol) doesn’t have a dropper; it has a little cup. How do I know how much to give to my 3 - month - old daughter?‖ Which response by the nurse is best? A. ―How much did you give your three - year - old son when he was a baby?‖ B. ―Read the label on the back of the box to find the strength and recommended dosage.‖ C. ―Why do you need to give the baby Tylenol?‖ D. ―Tylenol is no longer given to infants or children.‖ 6. While caring for a client being sent home with a prescription for oxycodone and acetaminophen (Percocet), the nurse must caution the client to avoid which of the following? A. Eye drops or medications causing pupil constriction B. Alcoholic beverages and grapefruit juice C. Cold remedies and other products containing Tylenol D. Fiber laxatives and other stool softeners 7. An 18 - year - old patient calls a physician’s office to request a refill for birth control pills. Which response by the nurse is best? A. ―The physician must see you at least every 6 months to provide prescription refills.‖ B. ―If you’ve been seen by the doctor in the last year, a prescription refill can be called to your pharmacy.‖ C. ―All birth control medications require a hand - written prescription, so you will need to pick this up at the desk at your convenience.‖ D. ―Are you sexually active?‖ 8. The nurse is providing care for a client who is taking dulasteride (Avodart) for benign prostatic hypertrophy (BPH). The client’s prescription reads, ―Take daily by mouth.‖ Thirty pills have been dispensed and the prescription allows for five refills. The nurse anticipates seeing the client again in: A. 1 month B. 3 months C. 6 months D. 1 year Multiple Response Identify one or more choices that best complete the statement or answer the question. 1. The nurse notes a prescription for eletriptan (Relpax) to be taken prn for migraine headaches. What additional information would the nurse expect to see on the prescription bottle? (Select all that apply.) A. Picture of the medication B. Drug dosage C. Physician DEA number D. Subscription information
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E. Client’s name and address F. Pharmacy contact information 2. A 34 - year - old patient recovering from a motor vehicle accident is receiving physical therapy. The client has been prescribed metaxalone (Skelaxin) 800 mg tablet qid. Which of following directions or warning labels would the nurse expect to see on the presc ription label? (Select all that apply.) A. Avoid alcoholic beverages when taking this medication B. Take four times each day C. Take three times a day with meals D. May cause drowsiness or dizziness E. Shake well Chapter 5. Prescriptions and Labels Answer Section MULTIPLE CHOICE 1. ANS: B PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Antianxiety agents KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Medication Labels/Abbreviations (p. 70): PO means the medication is given orally; prn means it is given as needed/desired; qhs means given at bedtime. 2. ANS: D PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Asthma medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Medication Labels/Abbreviations (p. 70): Bid stands for twice daily. The prescription is written for 2 sprays in each nostril. 3. ANS: C PTS: 1 DIF: Easy TOP: Therapeutic Classification: Alzheimer’s agents KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Medication Labels/Abbreviations (p. 70): Qhs means at bedtime. 4. ANS: A PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Antidiabetic agents KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Medication Labels/Abbreviations (p. 70): Ac means before meals; hs means at bedtime. 5. ANS: B PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Pain medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Manufacturer Labels and Names (p. 73): Over - the - counter drugs also contain labels or instructions on drug use based on age and weight. Infant Tylenol concentration has recently been changed to match the pediatric dosing, but the product is still s afely administered to infants and children. 6. ANS: C PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Narcotics KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Manufacturer Labels and Names (p. 73): Over - the - counter medications can interact negatively with prescription drugs. Some cold medications increase the action of sedatives so a person taking both would be sleepier than expected. Percocet is a narc otic. Alcoholic beverages should be avoided but there is no interaction with grapefruit juice. A daily limit of 3 grams of Tylenol is recommended so products containing additional Tylenol should be avoided. 7. ANS: B PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Hormonal therapy KEY: Application MSC: NCLEX Category: Pharmacological Therapies
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NOT: See Medication Labels/Abbreviations (p. 69): A prescriber may refill a prescription without asking to see the patient again, especially if the patient has a chronic condition or is taking birth control pills. 8. ANS: C PTS: 1 DIF: Moderate TOP: Therapeutic Classification: BPH agents KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Inscription (p. 69): The medication is taken daily and an estimated 6 - month supply has been provided (current script plus five refills). MULTIPLE RESPONSE 1. ANS: B, D, E, F PTS: 1 DIF: Hard TOP: Therapeutic Classification: Antimigraine agents KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Medication Labels (p. 71): A pharmacy label will contain the pharmacy contact information, date filled, prescription number, client name, address, prescription directions including drug name, dose, and directions, subscription information includin g number of pills prescribed and refill information, and the physician’s name and contact information. The DEA number is required on the written, faxed, or phoned - in prescription, but is not necessarily printed on the prescription label. Pictures of the me dication can be found in a physician’s desk reference but are not located on the prescription label. 2. ANS: A, B, D PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Muscle relaxants KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Medication Labels/Abbreviations (p. 70 – 71): Qid means four times each day. Metaxalone is a muscle relaxant that can cause drowsiness; clients should avoid alcoholic beverages. There is no need to shake tablets. Chapter 6. Basic Review of Mathematics Problem 1. The nurse is caring for a client on peritoneal dialysis. During a dialysis session, 2,000 mL of dialysate solution was infused and 1850 mL returned. The client consumed 1 cup of coffee, 120 mL of apple juice, and 1 bowl of oatmeal without milk. Calculate t he client’s intake in mL. 2. While caring for a client on a 1,700 - calorie diet restriction, the nurse notes the client has consumed 415 calories for breakfast. If 300 calories are allotted for beverages and snacks, how many calories remain for the client’s meals? 3. The nurse is caring for a client who takes lisinopril (Zestril) 10 mg tid. Discharge orders include a prescription for a 30 - day supply. How many pills will be in the bottle when the prescription is filled? 4. A young girl is started on 5 mg of paroxetine (Paxil) daily. The pharmacy provides 10 - mg tablets. How much will the nurse provide? 5. The nurse is providing ondansetron (Zofran) 4 mg as an intravenous injection. The pharmacy provides ondansetron in 8 mg/2 mL vials. How much medication will the nurse draw up? Provide the answer in mL. 6. The nurse is caring for a client placed on a 2,000 - calorie diet. If two snacks are responsible for 20% of the caloric intake, how many calories can be consumed with each snack? 7. While assisting with meal planning for a client placed on an 1,800 - calorie diet, the nurse plans for meals to make up 80% of the calorie consumption and wants to make each meal equivalent. How many calories should the nurse plan for each of three meals? 8. A client consumes 1/2 cup grape juice, 2/3 of a 10 oz bowl of broth, 1/4 of a 4 oz bowl of gelatin, and 1/3 a carton of milk, which holds 240 mL. Calculate the client’s intake in mL. 9. While working in the pediatric clinic, the nurse receives a call from a client trying to figure out how much infant acetaminophen (Tylenol) to give to her child. The doctor has prescribed 45 mg every 4
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hours. The medication is provided in 60 mg/5 mL concentration. How much medication (in mL) should the client provide per dose? (Round to the nearest mL) 10. The physician recommends a teenager start taking 600 mg ibuprofen (Advil) tid starting 2 days prior to her menstrual cycle and that she continue the medication for one week. The medication comes in 200 - mg strength tablets. How many tablets will the client consume during the week? Chapter 6. Basic Review of Mathematics Answer Section PROBLEM 1. ANS: 510 mL PTS: 1 DIF: Moderate TOP: Therapeutic Classification: NA KEY: Application MSC: NCLEX Category: Basic Care and Comfort NOT: See Addition Calculations (p. 79 – 80): The client has 150 mL dialysate solution, 240 mL coffee, 120 mL juice. 150 + 240 + 120 is 510 mL. 2. ANS: 985 calories PTS: 1 DIF: Moderate TOP: Therapeutic Classification: NA KEY: Application MSC: NCLEX Category: Basic Care and Comfort NOT: See Subtraction Calculations (p. 80 – 81): 1,700 calories allowed each day, minus the calories for breakfast (415) and snacks (300) is written as: 1,700 – 715 and totals 985. 3. ANS: 90 pills PTS: 1 DIF: Easy TOP: Therapeutic Classification: Antihypertensive KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Multiplication Calculations (p. 81): Tid means three times per day, so the client will take 3 pills per day for 30 days (3 x 30), totaling 90 pills. 4. ANS: 1/2 pill PTS: 1 DIF: Easy TOP: Therapeutic Classification: Antidepressants KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Adding Fractions (p. 87): Sometimes a patient is required to take partial tablets. The dose is one - half (5 divided by 10) the available pill, so 1/2 pill is given. 5. ANS: 1 mL PTS: 1 DIF: Easy TOP: Therapeutic Classification: Antiemetics KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Solving for Unknown (p. 99): The ordered dose is 4 mg. The medication is provided in 8 - mg vials. The dose is half of the available vial (4 divided by 8) so half the vial will be given. Because there are 2 mL in each vial, half the vial is (1/2 mul tiplied by 2), which equals 1 mL. 6. ANS: 200 calories PTS: 1 DIF: Easy TOP: Therapeutic Classification: NA KEY: Application MSC: NCLEX Category: Basic Care and Comfort NOT: See Percentages (p. 95): 20% of 2,000 calories is 400 calories (0.2 x 2000), divided by 2 results in 200 calories per snack. 7. ANS: 480 calories PTS: 1 DIF: Moderate TOP: Therapeutic Classification: NA KEY: Application MSC: NCLEX Category: Basic Care and Comfort
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NOT: See Percentages (p. 95): 80% of the 1,800 calorie intake is 1,440 calories (0.8 x 1,800). 1,440 is divided equally between three meals (1,440/3) for 480 calories per meal. 8. ANS: 430 mL PTS: 1 DIF: Moderate TOP: Therapeutic Classification: NA KEY: Application MSC: NCLEX Category: Basic Care and Comfort NOT: See Fractions (p. 87): 1/2 cup is 120 mL, 2/3 of 10 oz (300 mL) is 200 mL, 1/4 of 4 oz (120 mL) is 30 mL, 1/3 of 240 mL is 80 mL. 120 + 200 + 30 + 80 is 430. 9. ANS: 4 mL PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Medication Administration KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Fractions (p. 87): 60 mg in 5 mL is equivalent to 12 mg per mL. 45 mg divided by 12 mg/mL is 3.75 mL, which is rounded to 4 mL. 10. ANS: 63 tablets PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Medication Administration KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Multiplication Calculations (p. 81): A 600 - mg dose requires 3 pills per dose (600 mg/200 mg per pill). Tid means the client takes three doses per day, which is 9 pills per day (3 pills x 3 doses per day). One week of medication is 7 days x 9 pills per day, or 63 pills total for the week. Chapter 7. Measurement Systems Completion Complete each statement. 1. The nurse is providing care for a newborn that weighs 8 lb 8 oz. The physician has ordered medications based on a kg weight. How much does the infant weigh in kg? Round to the nearest whole number. 2. While working in the pediatric clinic, the nurse weighs a 5 - year - old child as 20.5 kg. The mother asks, ―How much is that in pounds?‖ Provide the child’s weight to the nearest whole pound. 3. While removing the dinner tray from a client’s room, the nurse notes the client drank 1 cup of water, 6 oz of beef broth, 4 oz of gelatin, 120 mL of juice and 1 2 - oz popsicle. What would the nurse record for intake in mL? 4. While attempting to track the intake of an elderly client, the nurse asks the client to identify what the client drank that day. The client reports, ―I had a small cup of tea, a juice glass full of juice, and 2 cups of milk.‖ The nurse would record how man y oz for this client’s intake? 5. While preparing to dispense a dose of liquid medication for a client with a gastrostomy tube, the nurse notes the ordered dose is 15 mL. How many cc will the nurse draw into the cath - tipped syringe when dispensing the medication? 6. The physician has ordered a child’s antibiotic dose as 5 mg/kg. The child weighs 14 kg. The antibiotic is provided in a vial with 10 mg/mL. How many mL of antibiotic will be dispensed? Round to the nearest whole number. 7. The nurse is mixing diluent with a powdered medication. The package directions instruct the nurse to mix 3 mL of sterile water to achieve a concentration of 4 mg/mL. The client’s dose is 6 mg. How many mL will the nurse withdraw to provide to the client? R ound to the nearest tenth. 8. A client is ordered 25 mg of diphenhydramine (Benadryl) by intramuscular injection. The medication is supplied in a 1 - mL vial with 50 mg dosage. How much will the nurse inject? 9. The nurse is preparing to provide sliding scale insulin coverage to a client with diabetes. The client’s blood sugar is 240 g/dL. The sliding scale indicates the client should receive 8 units of
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insulin. The insulin is provided in a multi - dose vial with a concentration of 100 units/10 mL. How many mL of insulin will the nurse provide? 10. The nurse is caring for a client who is to receive cefoperazone (Cefodbid) 1.5 g in 100 mL normal saline intravenously over 30 minutes. The nurse begins the infusion and a little while later the client calls to report itching so the nurse stops the infusio n. The pump reading has recorded 44 mL infused. Approximately how much medication (in mg) did the client receive? Chapter 7. Measurement Systems Answer Section COMPLETION 1. ANS: 4 kg PTS: 1 DIF: Easy TOP: Therapeutic Classification: Medication Administration KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Measurement System (p. 109): 1 kg equals 2.2 lb; 1 lb equals 0.45 kg; 1 lb equals 16 oz. The infant weights 8 lb, 8 oz. 8oz is one - half pound, so 8.5 lb x 0.45 equals 3.825 or 4 kg. 2. ANS: 45 lb PTS: 1 DIF: Easy TOP: Therapeutic Classification: NA KEY: Application MSC: NCLEX Category: Pharmacological Therapies 3. ANS: 720 mL PTS: 1 DIF: Moderate TOP: Therapeutic Classification: NA KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Household System (p. 112): 8 oz equals 1 cup equals 240 mL. 1 cup of water is 240 mL, 6 oz beef broth is 180 mL, 4 oz of gelatin is 120 mL, 120 mL of juice, and 2 oz of popsicle is 60 mL. Add 240 + 180 + 120 + 120 + 30 for a total of 720 mL. 4. ANS: 26 oz PTS: 1 DIF: Easy TOP: Therapeutic Classification: NA KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Household System (p. 110): A teacup is 6 oz, the juice glass is 4 oz, the 2 cups of milk are 16 oz, so 6 + 4 + 16 equals 26 oz. 5. ANS: 15 cc PTS: 1 DIF: Easy TOP: Therapeutic Classification: Medication Administration KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Metric System (p. 112 – 113): 1 cubic centimeter (cc) equals 1 mL of fluid. 6. ANS: 7 mL PTS: 1 DIF: Easy TOP: Therapeutic Classification: Medication Administration KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Household and Metric System (p. 110, 115): 14 kg multiplied by 5 mg/kg equals 70 mg. 70 mg divided by 10 mg/mL equals 7 mL. 7. ANS: 1.5 mL PTS: 1 DIF: Easy TOP: Therapeutic Classification: Medication Administration KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Metric System (p. 117): The dose of 6 mg is divided by 4 mg/mL for a total of 1.5 mL. 8. ANS: 0.5 mL PTS: 1 DIF: Easy TOP: Therapeutic Classification: Medication Administration KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Metric System (p. 115): The 25 - mg dose is one half of the supplied dose, so 0.5 mL will be injected. 9. ANS: 0.8 mL PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Medication Administration KEY: Application MSC: NCLEX Category: Pharmacological Therapies
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NOT: See Metric System (p. 117): 100 units in 10 mL is equivalent to 10 units per mL. The client is to receive 8 units of insulin coverage. 8 units divided by 10 units/mL equals 0.8 mL. 10. ANS: 660 mg PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Medication Administration KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Metric System (p. 117): 1.5 g in 100 mL is equivalent to 1,500 mg in 100 mL or 15 mg in 1 mL. 44 mL of medication has infused. 44 times 15 equals 660 mg. Chapter 8. Dosage Calculations Multiple Choice Identify the choice that best completes the statement or answers the question. 1. The nurse provides a client with 20 mL of megestrol acetate (Megace 40 mg/mL strength) and the client reports, ―I usually take one teaspoon of the long - acting formulation; are you sure this is the right stuff?‖ The nurse checks with the pharmacy and learns 5 mL of megestrol extended release (Megace ES 125 mg/mL) is equivalent to 800 mg of Megace. Which response by the nurse is best? A. ―You are right; you should only take 5 mL of this medication.‖ B. ―The two doses are equal since we don’t carry the long - acting medication.‖ C. ―You should be taking 20 mL of medication at home as well.‖ D. ―We will hold the medication at this time and verify the order with the physician.‖ 2. A client admitted to the hospital with acute renal failure typically takes moexipril (Univasc) for hypertension. The client’s creatinine clearance is 32 mL/min and the pharmacy recommends a 50% dose reduction for this medication. The client’s typical dose is 7.5 mg. The nurse would expect the physician to order: A. 3.75 mg B. 2.25 mg C. 4.25 mg D. 5.75 mg 3. The nurse is preparing potassium bicarbonate (TriLyte) for a pediatric client scheduled for a colonoscopy. The directions state to provide the prep at an estimated rate of 25 mL/kg/hr. The child weighs 55 lb. The nurse should encourage the child to drink h ow much of the solution each hour? A. 1 cup B. 2 cups C. 2.5 cups D. 4 cups 4. The student nurse is preparing to give a client 20 mEq of potassium chloride (K - LOR). Directions say to mix the powdered medication with at least 4 oz of juice or water. The instructor would be satisfied with the student’s preparation if the student had wh ich of the following? A. 80 mL of apple juice B. 120 mL of grape juice C. 2/3 cup of water D. 1 cup of fruit punch 5. While monitoring a client receiving chemotherapy set to infuse over 3 hours, the nurse notes after the first hour that just over 160 mL of the original 500 mL has infused. Which action by the nurse is best? A. Alter the pump setting to infuse at 150 mL/hr. B. Alter the pump setting to infuse at 200 mL/hr to ensure the medication finishes on time. C. Assure the client the infusion is running appropriately and document current assessment.
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D. Instruct the client the infusion will be completed in another 2.5 hours and do not change the infusion rate. 6. The nurse is caring for a client starting diuretic therapy and is placed on strict intake and output measurements. In counseling this client to maintain at least 1,500 mL intake per day, which beverages should the nurse instruct the client to avoid? A. Citrus juices and alcohol B. Coffee, beer, and most soda pop C. Tomato juice, diet drinks, and lemonade D. Electrolyte - based drinks, tea, and artificial sweeteners 7. The nurse is preparing to provide evening medications. It is currently 8 p.m. The nurse will pass medications scheduled at which military time? A. 1600 B. 1800 C. 2000 D. 2200 Completion Complete each statement. 1. The nurse is preparing to provide finasteride (Proscar) 5 mg daily in combination with doxazosin (Cardura) 2 mg daily to a client with benign prostatic hypertrophy. The pharmacy provides the finasteride in a 5 - mg tablet and the doxazosin in a 1 - mg tablet. How many pills will the nurse provide? 2. While working in the pediatric clinic, the nurse examines the mouth of a 5 - year - old patient being treated for leukemia and notes white patches and scattered ecchymosis. The nurse suspects the child has thrush and expects the physician to order fluconazole (Diflucan). This medication is typically dosed at 3 mg/kg. The child weighs 42 lb. How many mg will be in each dose? (Round to the nearest 10 mg). 3. The nurse is passing morning meds for a client with hypertension taking fosinopril (Monopril) 30 mg. The pharmacy supplies this medication as a 20 - mg tablet. How many tablets will the nurse provide? 4. The nurse is preparing to provide losartan (Cozaar) suspension (2.5 mg/mL) for a client whose dose is 50 mg. How many mL will be provided? 5. The nurse receives orders to start metronidazole (Flagyl) 50 mg/kg/24 hours divided into three equal doses for a child that weighs 33 lbs. The medication is provided in 250 - mg tablets. How many tablets will the nurse provide with each dose? 6. Meloxicam (Mobic) is dispensed in solution with 7.5 mg/5 mL. The physician has ordered 0.125 mg/kg daily for a child with juvenile arthritis who weighs 68 lbs. How many mL will the nurse provide? (Round to the nearest tenth). 7. Trimethoprim and sulfamethoxazole (Septra) suspension contains 200 mg sulfamethaxazole in each teaspoon. The physician has ordered 2 teaspoons every 12 hours. What is the total daily dose of sulfamethaxazole in mg? 8. The nurse is caring for a 12 - year - old patient who, after a kidney transplantation, is to receive sirolimus (Rapamune). The child weighs 38 kg and has a body surface area of 1.2 m 2 . The medication has been ordered at a dose of 1 mg/m 2 /day and is provided by pharmacy in a 60 mg/60 mL - solution mixed in glass bottle for oral provision. How many mL will the nurse provide? 9. A nurse working in the oncology clinic is providing doxorubicin (Adriamycin) 60 mg/m 2 to a client whose body surface area is 1.6 m 2 . What dose of doxorubicin (in mg) will be sent by the pharmacy?
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