Exam Question 1

DRUGS AND NURSING IMPLICATIONS

Factor Affecting Drug Action

1. Taking antibiotics with food will
a. Delay rate of absorption
b. Increase rate of absorption
c. Prevent side effects
d. Enhance action of drug

2. The elderly tend to have decreased serum albumin levels, which may cause
a. Enhanced absorption
b. Toxic drug effects
c. Enhanced drug distribution
d. An increase in the therapeutic effects

3. The nurse needs to be aware that if a central nervous system (CNS) depressant is administered to an infant, toxic effect can occur primarily due to
a. Increased drug absorption
b. Increased drug distribution
c. Decreased drug half-life
d. Decreased drug excretion

Drug Administration

1. The order reads Digoxin 0.375 mg once daily. The bottle reads Digoxin 0.25 mg per tablet. How much should the nurse administer?
2. The order is chloral hydrate 200 mg. The bottle reads chloral hydrate 0.1 g/capsule. Give _____________ capsules.
3. The order is penicillin 50,000 units. The vial reads penicillin 500,000 units. Add 4.3 ml to yield 5 ml. Give ______________ ml.
4. The order is ampicillin 0.4 mg/kg. Client weighs 38.5 pounds. The bottle reads ampicillin 10 mg/ml. Give ____________ ml.
5. Phenytoin (Dilantin) 5 mg/kg is ordered for a 40 pounds child. It is to be administered daily. The drug is available in an oral suspension containing 125 mg/ml. How many ml should be administered?
6. The order is for 1.2 million units of penicillin G (Bicillin) IM. Available is 600,000 units/ml. How much should the nurse administered?
7. Order is for 2500 ml D5W over 24 hours. Drop factor is 15 gtts/ml. Run IV at _________ gtts/minute.
8. Order is for 2000 ml D5W over 24 hours. Drop factor is 60 gtts/ml. Run IV at __________ gtts/minute.
9. Enoxaparin sodium (Lovenox) 25mg SC q.12 hours is ordered. The label reads 30 mg/0.3 ml. How much should the nurse administered?
10. The order is for meperidine 50 mg IM q.4 hour’s prn. The label reads meperidine 75mg/ml. How much should the nurse administer?

11. An adult is on continuous IV heparin therapy for thrombophlebitis. The IV contains 15,000 units of heparin in 500 cc of 5% dextrose (D5W) at the rate of 20 cc per hour. How many units per hour is the client receiving?
a. 60 units
b. 25 units
c. 600 units
d. 700 units

12. The order is for Ancef 1 gram IV in 50 cc 5% dextrose (D5W) to run in over 30 minutes every 6 hours. The administration set delivers 10 gtts/ml. What should the drip rate be?
a. 8 gtts/minute
b. 15 gtts/minute
c. 17 gtts/minute
d. 25 gtts/minute

Local Anesthetics

1. Epinephrine is added to local anesthetic preparations to
e. Prolong anesthetic action
f. Lower blood pressure
g. Prevent arrhythmias
h. Increase blood flow to injection site

2. A client complaint of severe sore throat after the extraction of two wisdom teeth. Viscous lidocaine (Xylocaine) is ordered. Which of the following should be included in client teaching concerning the use of viscous lidocaine (Xylocaine)
i. Take viscous lidocaine with fluids to soothe sore throat.
j. Instruct client to use a humidifier while taking viscous lidocaine.
k. Advise client to wait 60 minutes before eating after drug application.
l. Encourage client to take viscous lidocaine with food to reduce GI distress.

Non Narcotic Analgesics and Antipyretics

1. Which of the following should be included in teaching concerning the administration of indonmethacin (Indocin)?
a. Have periodic ophthalmic examinations.
b. Take on an empty stomach.
c. Take aspirin for headache relief.
d. Eat high fiber foods to prevent constipation,

2. In comparing aspirin to acetaminophen (Tylenol): acetaminophen
a. is contraindicated in clients with peptic ulcer disease.
b. is contraindicated in clients with asthma.
c. is as effective as aspirin for reducing fever.
d. has a stronger anti inflammatory effect than aspirin.

3. Which condition is an indication for aspirin use?
a. Asthma
b. TIA
c. Gout
d. Nasal polyps

4. Which drug is the drug of choice used to treat primary dysmenorrheal?
a. Acetaminophen (Tylenol)
b. Piroxicam (Feldene)
c. Indomethacin (Indocin)
d. Ibuprofen (Motrin)

Narcotic Analgesics

1. A female is one day post op. She tells the nurse that she’s worried she will become addicted to painkillers so she wants to wait for the pain to become very intense before she takes anything. The best response to her statement by the nurse is:
a. “Meperidine (Demerol) is very addicting. You shouldn’t request pain medication unless you really need it”
b. “Meperidine (Demerol) is not appropriate for you. I’ll ask the physician to order a non narcotic pain medication for you”
c. “Meperidine (Demerol) will be most effective if you take it before your pain becomes severe. This will decrease your needing excess amounts of a narcotic”
d. “Meperidine (Demerol) is ordered for you to help manage your pain. You really should take it”
2. Before administering meperidine (Demerol), which assessment is most important for the nurse to make?
a. Apical pulse rate
b. Respiratory rate
c. Blood pressure
d. Level of consciousness

3. Which adverse effect would the nurse NOT expect to observe in a client receiving a narcotic analgesic?
a. Urine retention
b. Constipation
c. Hypoglycemia
d. Hypotension

Narcotic Antagonists

1. Which of the following observations by the nurse indicates an adverse effect of naloxone hydrochloride (Narcan) on the client?
a. Hypotension
b. Bradycardia
c. Tremors
d. Increased urine output

2. Which client should have cautious use of naloxone hydrochloride (Narcan)?
a. Meperidine (Demerol) addict.
b. Brittle diabetic
c. Asthmatic
d. Postoperative radical neck.

Sedatives and Hypnotics

1. Adverse effects of pentobarbital sodium (Nembutal) include all the following except
a. Respiratory depression
b. Anxiety and hand tremors
c. Hypotension and bradycardia
d. Dry mouth and urinary retention

2. Which group should not receive barbiturates?
a. Children < 5 years of age
b. Pregnant women
c. Nursing mothers
d. Adults with bleeding ulcers

Anticonvulsants

1. The nurse should teach clients to watch for which common adverse effect of phenytoin (Dilantin)?
a. Alopecia
b. Edema
c. Gingival hyperplasia
d. Hallucinations

2. The drug of choice for status epilepticus is
a. Phenytoin (Dilantin)
b. Carbamazepine (Tegretol)
c. Phenobarbital (Luminal)
d. Diazepam (Valium)

Muscle Relaxants

1. Which statement indicates a need for more teaching about baclofen (Lioresal) by the nurse?
a. “I’ll take my pills with my meals”
b. “I’ll drive myself to work each day”
c. “I won’t have wine with dinner anymore”
d. “I’ll use sunscreen when I go outside”

Antipsychotic Agents

1. The psychiatrist orders chlorpromazine (Thorazine) IM. The nurse should handle the medication carefully to prevent
a. Skin discoloration
b. Skin irritation
c. Headache
d. Dizziness

2. Which of the following interventions should be included in a care plan concerning chlorpromazine (Thorazine) therapy?
a. Supervise ambulation
b. Take a hot bath to reduce agitation
c. Restrict fluid intake to prevent edema
d. Discontinue drug if sedation occurs

3. Which phenothiazine is used specifically as an antiemetic and rarely causes extrapyramidal symptoms?
a. Thioridazine (Mellaril)
b. Fluphenazine (Prolixin)
c. Promethazine (Phenergan)
d. Chlorpromazine (Thorazine)

4. Which antipsychotic agent is also used to treat Tourette’s syndrome and causes less sedation than other phenothiazines?
a. Haloperidol (Haldol)
b. Thioridazine (Mellaril)
c. Fluphenazine (Prolixin)
d. Chlopromazine (Thorazine)

5. Which of the following interventions should the nurse stress while a client is on lithium therapy?
a. Weigh self once a month
b. Restrict fluid intake to prevent edema
c. Do not restrict sodium intake
d. Avoid eating cheese and bananas and drinking wine

6. Which of the following is included in client teaching concerning imipramine (Tofranil)?
a. Expect to see improvement of depression in 2-3 days
b. Stop taking drug if dizziness occurs
c. Do not drive or operate machinery
d. Take drug on an empty stomach

7. When should the client expect to see improvement of depression while on imipramine (Tofranil)?
a. 1-2 days
b. 1 week
c. Several weeks
d. Immediately after first dose

8. Which foods/beverages should be avoided while taking phenelzine (Nardil)?
a. Cheese
b. Apples
c. Pasta
d. Cereal

9. Which statement indicates a need for more teaching by the nurse concerning fluoxetine (Prozac) therapy?
a. “I will take this medication in the morning”
b. “I will use calamine lotion if I get a skin rash”
c. “It will take a month before I feel better”
d.“I will check with my physician before I take any other medications”

* I will post the answer and the rationale on the following weeks.