1. What lab value will best reflect renal function in a client taking multiple medicines?
A) creatinine clearance
B) potassium levels
C) sodium levels
D) urinalysis
2. Which teaching point is correct with respect to the concept of "tolerance"?
A) Tolerance is a state where people become used to pain, and therefore need less pain medicine.
B) In tolerance, larger doses are needed to achieve prior effects because a body learns to push back.
C) Tolerance occurs in slow metabolizers. Slow metabolism leads to prolonged sedation.
D) When sedatives help people cope better with their suffering, we call it "drug tolerance".
3. Which statement regarding the blood-brain barrier demonstrates a need for further teaching?
A) "It can protect the brain from potentially toxic substance injuries."
B) "It can be a significant obstacle to entry of therapeutic agents."
C) "It is not fully developed at birth."
D) "It lets in therapeutic agents in but filters out everything else."
Feedback: The blood-brain barrier is a mixed blessing. On the positive side, it protects the brain from toxic substance injuries, but it can also blocks therapeutic agents; It isn't fully developed at birth; (Comprehension-Education-Pharmacotherapies-Concepts-Blood Brain Barrier)
4. A client who has been taking an antiepileptic medication with a narrow therapeutic window for 2 weeks seems confused and forgetful. What should be the priority action of the nurse?
A) Call the prescriber and have them change the seizure medication changed.
B) Give an antihistamine like diphenhydramine under house protocol for a suspected allergy.
C) Seek a plasma drug level from the client's physician.
D) Set up oxygen and obtain an order for activated charcoal.
Feedback: The risk of developing toxicity it great with any medication that has a narrow therapeutic window, and confusion is a hallmark sign of toxicity. On the other hand the symptoms could indicate recent seizure activity. A blood level should be drawn to rule out toxicity. (Analysis-Implementation-Pharmacotherapies- Kinetics-toxicity p 9)
Table for Individual Question Feedback
Points Earned: 0.0/1.0
Correct Answer(s): C
5. Before giving an adrenergic drug for wheezing, which sign would concern the nurse most?
A) Pulse oximetry saturation of 88%
B) Blood pressure of 110/62
C) Respiratory rate of 28
D) Irregular heart rate of 122
6. A nurse is caring for a client being treated with Minipress (prazosin), an alpha blocker. What counseling should the client receive?
A) Rise slowly from lying to standing to avoid dizziness and a possible fall.
B) Void before taking the medication to avoid urine retention
C) Take a daily laxative to avoid constipation
D) Avoid drinking more than 600 mls of fluid per day while taking this medication
7. For which client would a beta adrenergic blocker be indicated?
A) A client with urinary retention
B) A client who suffers from diarrhea
C) A hypertensive client with a heart rate of 104
D) A client who suffers from asthma
8. How would a nurse explain the way pilocarpine (Salagen) would resolve related dry mouth.
A) It stimulates salivation by blocking nicotinic receptors
B) It stimulates salivation by stimulating muscarinic receptors
C) It stimulates salivation by stimulating alpha receptors in the brain
D) It stimulates salivation by redirecting fluid from the optic nerve
9. A client with Alzheimer's disease has been taking Exelon (rivastigmine), a cholinesterase inhibitor for a week. What anticipated side effects of this cholinergic medication would the nurse anticipate?
A) Numbness and tingling in the extremities
B) Hypertension
C) Diarrhea, urgency and possible bradycardia
D) Tinnitus and hearing loss
10. A nurse in the emergency department is caring for a client whose family reports that she had taken an overdose of diazepam. Which of the following medications should the nurse have available to reverse the CNS depression caused by this drug?
A) Ondasteron (Zofran)
B) Magnesium sulfate
C) Flumazanil (Romazicon)
D) Protamine sulfate
11. The client diagnosed with a general anxiety disorder is prescribed alprazolam (Xanax), a benzodiazepine. Which information should the clinic nurse discuss with the client?
A) Explain to the client that this medication is for short-term use.
B) Inform the client that rage and excitement are expected side effects
C) Tell the client to avoid foods that are high in vitamin K
D) Instruct the client to take the medication before driving to avoid transit anxiety
Feedback: Xanax (alprazolam) has the potential for dependency, but that potential can be minimized by using the lowest effective dosage for the shortest time necessary. Benzodiazepines are habit forming medications and because they lead to tolerance, they can lead to drug seeking behaviors and dependence on strong tranquilizers with potentially lethal effects. (Application-Education-Pharmacotherapies-Sedatives)
12. A nurse is caring for a patient who has been taking phenytoin (Dilantin) for 6 weeks. Upon review of the laboratory results, the nurse notes that the patient's phenytoin level is 18 mcg/mL. What is the nurse's best action?
A) The nurse should contact the prescriber to suggest a dose increase.
B) This drug level is in the therapeutic range, so the nurse can give the medicine as ordered.
C) Suspect that another drug is preventing Phenytoin metabolism, and hold the causative medication.
D) This drug level is too high; the nurse should contact the prescriber about reducing the dose.
13. The provider is considering starting a diabetic client on valproic acid (Depakote) for nerve pain this week. During the health history, the patient tells the nurse, "I drink a six pack of beer daily and two to three six packs on weekends." The priority nursing action would be to
A) Obtain a lab order to assess his current level of valproic acid.
B) Tell the client his alcoholism is causing his nerve pain, so medicine won't help.
C) Obtain a lab order for liver function studies to determine if the prescription is safe for him
D) Reassure the client that beer and Depakote are compatible
14. A nurse is reviewing a client's list of medications and notices that he is taking two anticholinergics. Which of his recent symptoms could be caused by his anticholinergic medications? (Select all that apply)
A) Epigastric distress
B) Tachycardia
C) Dry mouth
D) Frequent loose stools
E) Blurred vision
15. A client is using a prn scopolamine patch for motion sickness. Knowing that the medication has anticholinergic side effects, the client should be taught to anticipate which side effects? (Select all that apply!)
A) Urine retention
B) Blurred vision
C) Dry mouth
D) Diarrhea
E) Wheezes
16. A nurse is taking a history on a client admitted for medication related syncope. Which of these comments from the client needs to be reported to the physician? (Select all that apply)
A) "I just gave you my medication list the last time I was here. Nothing's changed! Look it up!"
B) "I'm taking an herbal supplements to help me sleep, but nothing else is changes."
C) "I'm taking over the counter substitutes for the medicines I can't afford.
D) "I get my medicines over the internet, so I never run out of medicine. It's cheaper"
E) "I wish I didn't have to bother the doctor every time I need a medication refill.
F) "My cardiologist never orders anything. He just tells my regular doctor what to order."
17. The most common adverse effect associated with antiepileptic medications is CNS depression. Knowing this, which signs and symptoms would the nurse watch for during assessments? (Select all that apply!)
A) Drooling
B) Insomnia
C) Confusion
D) Hyperventilation
E) Unsteady gait
Feedback: Confusion, unsteady gait, hypotension, slurred speech and respiratory depression are all signs of central nervous system depression. (Application-Assessment-Pharmacotherapies-Sedatives)
18. A nurse recognizes that the actions of benzodiazepines include which of the following benefits? (Select all that apply.)
A) Sleep facilitation
B) Relief of general anxiety
C) Suppression of seizures and/or seizure activity
D) Reversal of Parkinsonism
E) Improvement of muscle coordination
Feedback: Benzodiazepines are indicated to relieve the symptoms of general anxiety and to suppress the central nervous system, thereby suppressing seizures and/or seizure activity. Benzodiazepines cause sleepiness, They don't resolve parkinsonism because they don't elevate dopamine levels. They impair muscle coordination and cause an unsteady gait. (Application-Assessment-Pharmacotherapies-Benzodiazepines)
Table for Individual Question Feedback
Points Earned: 0.0/1.0
Correct Answer(s): A, B, C
19. What advice should parents of a child taking Ritalin (methylphenidate) receive? (Select all that apply)
A) Insomnia is a risk so give the medication in the morning
B) The medication is absorbed better on an empty stomach so give in before the meal
C) It is cheaper (wise) to order the medication via the internet.
D) The physician must be seen every time the prescription needs to be refilled due to C2 status
E) As a parent you should remain in control of this medication due to its street value
F) There is no need to worry about addiction in these medications in well-adjusted children.
20. A 68 year old male has a history of seizures and has been taking phenytoin (Dilantin) for years. His last seizure occurred 2 years ago, so he has decided that he no longer needs the medication. What would be the best action of the nurse? (Select all that apply.)
A) Recommend that he start cutting his pills in half, and see how it goes
B) Affirm his plan to stop taking it, but advise that he should restart it if tremors occur
C) Recommend that he develop a withdrawal plan with his prescriber
D) Educate the client that suddenly stopping the drug could precipitate seizures.
E) Advise the client that once a medication for seizures is started it can never be stopped.