The patient is being discharged home on warfarin therapy.
Which information will the nurse
include when teaching the patient?
INTERNATIONAL NORMALIZED RATIO (INR) RESULTS SHOULD BE BETWEEN 2 AND
3. Today, the international normalized ratio (INR) is the laboratory test most frequently
used to report PT results; a value of 2 to 3 is considered acceptable. Partial thromboplastin
time (PTT) and activated partial thromboplastin time (aPTT) are laboratory tests to detect
deficiencies of certain clotting factors, and these tests are used to monitor heparin
therapy. Tarry stools indicate GI bleeding. Green leafy vegetables contain vitamin K, which
is the antidote for warfarin (Coumadin).
A patient’s serum lipids are cholesterol 197 mg/dL, low-density lipoprotein (LDL) 110
mg/dL, and high-density lipoprotein (HDL) 35 mg/dL. The nurse knows what about these
values?
CHOLESTEROL IS WITHIN DESIRABLE VALUE, BUT LDL AND HDL ARE NOT. The
normal range for cholesterol is 150 to 200. The normal range for LDL is less than 100. The
normal range for HDL is 45 to 60.
A nurse who is administering atorvastatin calcium realizes the importance of monitoring
for which serious adverse reaction?
RHABDOMYOLYSIS Serious adverse reactions of atorvastatin include rhabdomyolysis,
myalgia, photosensitivity, and cataracts. Less serious side effects include headache, rash,
pruritus, constipation, diarrhea, sinusitis, and pharyngitis.
A patient is scheduled to receive gemfibrozil. It is most important for the nurse to assess
for concurrent use of which medication?
WARFARIN Gemfibrozil (Lopid) is highly protein-bound and should not be taken with
anticoagulants, because they compete for protein sites. Anticoagulant dose should be
reduced during antihyperlipidemic therapy, and the international normalized ratio (INR)
should be closely monitored.
A patient is receiving medication therapy for peripheral vascular disease. Which
medication does the nurse identify as an antiplatelet drug?
CILOSTAZOL Cilostazol (Pletal) is an antiplatelet drug. Papaverine (Para-Time) is a direct-
acting peripheral vasodilator. Prazosin (Minipress) is an alpha blocker, and nifedipine
(Procardia) is a calcium channel blocker.
Which herb is most often associated with the treatment of intermittent claudication?
GINKGO BILOBA The herb Ginkgo biloba, taken with an antiplatelet drug, has been used
to treat intermittent claudication, because of its vasodilating and antioxidant effects,
although this herb has not been approved by the FDA.
Ondansetron has been ordered for the patient undergoing cancer chemotherapy to control
the severe nausea and vomiting. What side effects should the nurse observe for?
HEADACHE, DIZZINESS, AND FATIGUE Side effects of ondansetron (Zofran) include
headache, dizziness, and fatigue.
Bisacodyl has been ordered for a patient who is constipated. The nurse realizes that
bisacodyl
INCREASES PERISTALSIS TO PRODUCE A BOWEL MOVEMENT Dulcolax increases
peristalsis by direct effect on intestinal smooth muscle. Alcohol and pregnancy are not
affected by Dulcolax. Dulcolax does not cause paralytic ileus.
A patient is ordered a phenothiazine antiemetic for treatment of nausea and vomiting
associated with chemotherapy. The drug will be most effective if administered
THE NIGHT BEFORE TREATMENT, THE DAY OF TREATMENT, AND FOR 24 HOURS
AFTER TREATMENT. When used in patients with cancer, phenothiazine antiemetics are
commonly given the night before treatment, the day of treatment, and for 24 hours after
treatment.
A toddler ingests a small amount of household cleaning fluid. What is the safest advice for
the nurse to provide the caregiver?
CALL THE POISON CONTROL CENTER AND FOLLOW DIRECTIONS. It is safest to call
the poison control center and follow directions. Fluids should not be ingested because the
caustic substance may spread, causing more tissue damage. Ipecac syrup should not be
administered routinely in the management of poisoned individuals.
A patient is ordered bisacodyl. Before administering the drug, it is most important for the
nurse to assess the patient for what?
APPENDICITIS Contraindications to use of bisacodyl (Dulcolax) include hypersensitivity,
fecal impaction, intestinal/biliary obstruction, GI bleeding, appendicitis, abdominal pain,
nausea, vomiting, and rectal fissures.
Lactulose is ordered for a patient with liver disease. What would indicate the medication is
exerting a positive therapeutic effect on the patient?
DECREASED AMMONIA LEVEL Lactulose, another saline laxative that is not absorbed,
draws water into the intestines to form a soft stool. It decreases the serum ammonia level
and is useful in liver diseases, such as cirrhosis.
Which medications are most likely to be included in a dual drug therapy program for peptic
ulcer disease from H. pylori?
OMEPRAZOLE AND CLARITHROMYCIN Omeprazole and clarithromycin are commonly
included in a dual drug therapy program for peptic ulcer disease from H. pylori.
A patient with peptic ulcer disease is noted to have a positive breath test for H. pylori. The
nurse would anticipate treating the patient with
PROTON PUMP INHIBITORS AND ANTIBIOTICS. A common treatment protocol for H.
pylori is triple antibiotic therapy and a proton pump inhibitor.
An older adult patient reports taking aluminum hydroxide on a daily basis to relieve
symptoms of gastroesophageal reflux disease. The nurse needs to evaluate for which
condition?
CONSTIPATION Use of aluminum hydroxide most often causes constipation. Magnesium
products can cause diarrhea.
When administering the histamine2 blocker ranitidine, the nurse will
SEPARATE RANITIDINE AND ANTACID DOSAGE BY AT LEAST 1 HOUR IF POSSIBLE.
Antacids can be given 1 hour before or after ranitidine (Zantac) as part of the antiulcer
drug regimen. Ranitidine (Zantac) can increase the effect of oral anticoagulants. Patients
on ranitidine (Zantac) should eat a diet rich in vitamin B12 to avoid deficiency as a result
of drug therapy. The patient’s abdominal pain is expected to decrease after 1 to 2 weeks of
drug therapy.
A patient with a gastric ulcer is ordered sucralfate. This medication works to
COAT THE GASTRIC LINING. Sucralfate (Carafate) is a mucosal protective drug. It forms
a viscous substance that covers the ulcer and protects it from acid and pepsin.
A patient who complains of gastric distress from aspirin will most likely benefit from the
administration of which medication?
MISOPROSTOL Patients who complain of gastric distress from NSAIDs such as aspirin or
indomethacin prescribed for long-term therapy can benefit from misoprostol.
The patient tells the nurse that he has been treating his stomach pain with a lot of calcium
carbonate. It is most important for the nurse to assess the patient for
BURNETT’S SYNDROME. Hypercalcemia and Burnett’s syndrome, formerly called milk-
alkali syndrome, can result from excessive use of calcium carbonate. Excess sodium
bicarbonate use may cause hypernatremia and water retention, metabolic alkalosis caused
by excess bicarbonate, and acid rebound.
The patient is ordered cimetidine. It is most important for the nurse to teach the patient
about what dietary needs?
EAT FOODS RICH IN VITAMIN B12. Teach patient to eat foods rich in vitamin B12 to
avoid deficiency as a result of drug therapy.
The nurse is teaching a patient with glaucoma. Which herbal product should the nurse
include as not recommended for patients with glaucoma?
GOLDENSEAL
The nurse is showing the parent of a 2-year-old child how to administer eardrops. Which
are correct statements? (Select all that apply.)
PULL DOWN ON AURICLE
POSITION CHILD’S HEAD WITH AFFECTED EAR UP
Pilocarpine has which action on the eye?
MIOSIS
Which is the most common side effect/adverse reaction associated with prostaglandin
analogues for the treatment of glaucoma?
OCULAR HYPEREMIA
A child is treated four times during the summer for external ear infections or “swimmer’s
ear.” The nurse teaches the family to prevent these infections by
USING CUSTOM-FITTED EAR PLUGS.
Finasteride is used to treat male pattern baldness. The nurse knows that in higher doses,
the drug is used to treat which condition?
BENIGN PROSTATIC HYPERTROPHY
A patient is ordered to receive isotretinoin for acne vulgaris. What is considered priority
information in teaching this patient?
CONTRACEPTION OR ABSTINENCE FROM SEXUAL INTERCOURSE
A patient is admitted to the emergency department with a burn that consists of pearly
white skin with areas that are charred. The patient is not in pain. The nurse documents the
burn as
FULL THICKNESS
Patients receiving extensive amounts of mafenide acetate for the treatment of burns are
most at risk for the development of which imbalance?
METABOLIC ACIDOSIS
Which medication does the nurse anticipate administering to a patient with venereal
warts?
PODOPHYLLUM RESIN
A patient has adrenocortical insufficiency and was taking hydrocortisone 240 mg every 12
h IV. Before discharge the drug was switched to prednisone. Which is appropriate teaching
for discharging a patient with oral prednisone?
THE DOSE NEEDS TO BE TAPERED OFF OVER 1 TO 2 WEEKS.
A nurse has been teaching a patient about levothyroxine. Which side effect should the
nurse teach the patient to observe for?
NERVOUSNESS
The nurse will teach a patient taking levothyroxine for hypothyroidism to notify the health
care provider if he or she experiences
PALPITATIONS
During a diagnostic test for parathyroid function, a patient asks the nurse what the
parathyroid gland does. The nurse correctly informs the patient that the parathyroid gland
is responsible for
REGULATING CLACIUM LEVELS
Which drug would the nurse administer for the treatment of a patient with
hyperthyroidism?
METHIMAZOLE
The nurse identifies which of the following as the drug of choice for the treatment of
chronic lymphocytic (Hashimoto) thyroiditis?
LEVOTHYROXINE SODIUM
A patient has hypoparathyroidism. The nurse anticipates administration of which
medication?
CALCITRIOL
Which time frame would be most appropriate for administering sliding-scale lispro insulin?
WHEN THE BREAKFAST TRAY IS SERVED AND READY TO EAT
A patient is prescribed metformin. Which is a side effect/adverse effect common to
metformin?
BITTER OR METALLIC TASTE
A patient received regular insulin at 7:30 AM. At 9:30 AM the patient feels slightly hungry
and has a dull headache. The nurse should
TEST THE PATIENT’S BLOOD GLUCOSE LEVEL.
A nurse gives a patient NPH insulin at 8:00 AM. At 2:00 PM the nurse finds the patient
extremely lethargic but conscious. The patient is diaphoretic and slightly combative. The
nurse should
PROVIDE THE PATIENT WITH 4 OUNCES OF ORANGE JUICE.
Which statement by a patient taking glipizide indicates that more teaching is indicated?
“I WILL USE A NEW NEEDLE EVERY TIME I TAKE THE MEDICATION.”
When teaching the patient about the storage of insulin, which statement will the nurse
include?
DO NOT PLACE INSULIN IN SUNLIGHT OR A WARM ENVIRONMENT.
The patient experiences the Somogyi effect. Which statement regarding the Somogyi
effect does the nurse identify as being true?
IT IS A RESPONSE TO EXCESSIVE INSULIN.
A patient with type 1 diabetes mellitus is ordered insulin therapy once daily to be
administered at bedtime. What is the type of insulin the patient is most likely receiving?
INSULIN GLARGINE
A patient entering the medical clinic has been diagnosed with an overactive bladder.
Which medication would the nurse expect to be ordered?
TOLTERODINE TARTRATE
Patients taking methenamine for urinary tract infections are counseled to drink cranberry
juice in order to
LOWER THE PH OF THE URINE.
A patient with an urinary tract infection is complaining of pain with urination. The nurse
would anticipate the patient’s receiving
PHENAZOPYRIDINE.
Which medication is indicated in the treatment of hypotonic or atonic bladder?
BETHANECHOL
A female patient has been diagnosed with a lower urinary tract infection caused by E. coli.
The patient has been prescribed nitrofurantoin. Which information will the nurse include
when teaching the patient about nitrofurantoin therapy?
WARN PATIENT NOT TO DRIVE A MOTOR VEHICLE.
A patient presents to the emergency department with severe respiratory distress, hives,
and edema after being stung on the face by a bee. Which are accurate nursing
assessments of the situation? (Select all that apply.
HYPOTENSION AND BRONCHOSPASM WILL PROGRESS RAPIDLY IF TREATMENT IS
DELAYED.
THE PATIENT IS SUFFERING FROM ANAPHYLACTIC SHOCK.
EPINEPHRINE AND DIPHENHYDRAMINE ARE THE DRUGS OF CHOICE AS FIRST-LINE
AGENTS.
Which finding indicates that administration of glucagon has been effective? The patient
experiences
AN IMPROVEMENT IN LEVEL OF CONSCIOUSNESS.
A patient is experiencing both atrial and ventricular dysrhythmias. The nurse anticipates
administration of which medication?
AMIODARONE
