NONPRESCRIBED MEDICATIONS COMPREHENSIVE
EXAMINATION ANSWERS AND RATIONALES
1. 1. This would indicate that vitamin A therapy
is effective.
2. This would indicate zinc therapy is effective.
3. The potassium level would not indicate that
iron therapy was effective.
4. The effectiveness of iron therapy can be
determined by a normal Hgb level and by
the client denying fatigue or shortness of
breath.
MEDICATION MEMORY JOGGER: The nurse
determines the effectiveness of a medi-
cation by assessing for the symptoms, or
lack thereof, for which the medication was
prescribed.
2. 1. These symptoms and the client’s age sug-
gest that she is having “hot flashes” asso-
ciated with menopause. There are OTC
preparations and hormone replacement
therapy (HRT) that help the symptoms of
menopause.
2. There are some natural estrogen
enhancers such as soy (e.g., in the form
of soy milk, some vitamins containing
soy) that many women believe help the
symptoms of menopause. This is the best
response.
3. In some instances the HCP will prescribe
HRT for a woman experiencing menopause,
but this is rarely done now because current
research indicates that, although HRT
protects against osteoporosis and treats the
symptoms of menopause, it also increases
the risk of heart attack, stroke, and breast
cancer.
4. The client is asking for information, not
expressing a need to discuss feelings.
3. 1. Vitamin C is a water-soluble vitamin that
aids in the absorption of iron and con-
version of folic acid.
2. Vitamin D is a fat-soluble vitamin that
has a major role in regulating calcium and
phosphorus metabolism and is needed for
calcium absorption from the intestines.
3. Folic acid is a water-soluble vitamin that
is essential for body growth. It is needed
for DNA synthesis. Without folic acid,
there is a disruption in cellular division.
4. Vitamin B12 is a water-soluble vitamin
that, like folic acid, is essential for DNA
synthesis. It aids in the conversion of
folic acid to its active form.
6924_Ch16_401-416.indd 413
5. Vitamin K is a fat-soluble vitamin that is
needed for synthesis of prothrombin and
clotting factors VII, IX, and X.
4. 1. Chasteberry exerts effects similar to
those of progesterone. When used
during menopause and postmenopause,
it may help reverse vaginal changes and
diminished libido.
2. The client is postmenopausal; therefore,
the client does not have regular menstrual
cycles.
3. The client would have a decrease in hot
flashes and mood swings if the herb was
helping decrease menopausal discomforts.
4. This would indicate the herb was help-
ing a client diagnosed with premenstrual
syndrome.
5. 1. Melatonin decreases alertness and decreases
the body temperature, both of which make
sleep more inviting; therefore, this is a false
statement.
2. Melatonin should not be taken by clients
who are pregnant because there is a lack
of studies that indicate its safety. Large
doses of melatonin have been shown
to inhibit ovulation, so women trying
to conceive should reconsider taking
melatonin. This is the most appropriate
response from the nurse.
3. Melatonin does show efficacy for helping
the client sleep, but because the client is
27 years old, the nurse’s best response is to
discuss pregnancy.
4. OTC medications, herbs, and natural
hormones have been proved to help clients
sleep; therefore, a prescription medication is
not absolutely necessary.
MEDICATION MEMORY JOGGER: The test
taker should question administering any
medication to a client who is pregnant or
may become pregnant. Many medications
cross the placental barrier and could affect
the fetus.
6. 1. Licorice does not increase gastric acid
production.
2. Frequent use of pure licorice root can
contribute to sodium and water retention,
hypertension, and other ill effects; therefore,
this is not the nurse’s best response.
3. The client is not asking what the best thing
is for a stomach ulcer. The nurse’s best
response is to answer the client’s question.
413
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 414 PHARMACOLOGY SUCCESS
4. Licorice, a weak-tasting herb, contains
substances that protect the lining of the
stomach. It has been shown in several
studies to help heal ulcers. It protects
the stomach by increasing mucus
production and blood flow through the
membranes.
7. 1. Dandelion, an herb, is used as a diges-
tive aid, laxative, diuretic, and liver and
gallbladder protectant, and it prevents
iron-deficiency anemia. It is not used to
heal minor burns.
2. Peppermint helps soothe the stomach.
It has a direct spasmolytic action on the
smooth muscles of the digestive tract.
3. Cascara is used as a laxative. It stimu-
lates peristalsis.
4. Witch hazel is used as an astringent, not as
an antidepressant.
8. 1. St. John’s wort is used for its antidepres-
sant effects.
2. Ginkgo biloba has been shown to
improve mental functioning and stabi-
lize Alzheimer’s disease.
3. Psyllium is used as a laxative.
4. The herb sarsaparilla is best used as a
flavoring agent in soft drinks.
9. 1. Garlic appears to provide some protec-
tion against atherosclerosis and stroke
and may reduce blood cholesterol and
blood pressure.
2. The herb gotu kola has the ability to pro-
mote wound healing.
3. This is a judgmental response, and the
nurse should not be judgmental toward
alternate therapy. Herbal treatment has
shown efficacy.
4. Eucalyptus has shown some efficacy in
treating respiratory disorders.
10. 1. Antioxidants protect the body from
damage caused by harmful molecules
called free radicals. This damage is a
factor in the development of athero-
sclerosis. Vitamin C captures the free
radical and neutralizes it before it
causes damage.
2. Vitamin D is not an antioxidant. It is a
fat-soluble vitamin that has a major role in
regulating calcium and phosphorus metab-
olism and is needed for calcium absorption
from the intestines.
3. Vitamin E is a chain-breaking antioxi-
dant. Whenever vitamin E is sitting on
a cell membrane, it breaks the chain
6924_Ch16_401-416.indd 414
reaction before the free radicals cause
damage.
4. Selenium is an antioxidant that has
shown efficacy in decreasing the risk
for lung cancer, prostate cancer, and
colorectal cancer.
5. Copper is a mineral, but it is not an antiox-
idant. Copper is needed for the formation
of RBCs and connective tissue.
11. 1. Cyanocobalamin (Cyanabin), vitamin
B12, is contraindicated in clients diag-
nosed with severe pulmonary disease
and is used cautiously in clients with
heart disease. Clients with these con-
ditions may develop pulmonary edema
and heart failure. The nurse should
question administering this medication.
2. Prenatal vitamins with iron are part of a
pregnant woman’s routine medications.
Ferrous sulfate is pregnancy category A,
which means it has been proved safe for
the fetus. The nurse would not question
administering this medication.
3. The normal INR is 2 to 3; therefore, the
nurse would not question administering
this medication because it is the antidote
for overdose of Coumadin.
4. Hypocalcemia occurs when a serum
calcium level falls below 4.5 mEq/L;
therefore, the nurse would not question
administering this medication to the client
whose serum calcium level is low.
12. 1. Pulmocare is a supplement recommended
for clients diagnosed with chronic lung
disease because the supplement does not
have as much carbon dioxide as a by-
product of its metabolism as do other sup-
plements; however, the stem did not state
the client had lung disease.
2. Glucerna is the supplement recommended
for clients who have diabetes because this
supplement has a slower release of carbo-
hydrates and provides more controllable
blood glucose, but the stem did not state
that the client has diabetes.
3. Because of the added fiber, Boost would be
the supplement recommended for clients
diagnosed with cancer who have significant
pain and are taking narcotic pain medi-
cations, but this client is newly diagnosed
and pain was not mentioned in the stem of
the question.
4. Newly diagnosed clients should try
homemade supplements to support
their diets. Supplements are expensive
(ranging from $1.75 to more than $2.00
7/11/18 4:39 PM

per can), and if the client develops an
aversion to the taste, then it is unlikely
that anyone else in the family will want
to drink the supplement. The nurse
should suggest the client try to make
milkshakes and use canned soups to
supplement the diet first.
13. 1. Many medications that are available
only by prescription in the United
States are available OTC in other coun-
tries. Antibiotics, narcotics, and steroids
are some of the medications that can
be purchased OTC in Mexico. The
nurse should investigate to determine
if the Tylenol purchased in Mexico was
Tylenol #2, #3, or #4. All of these medi-
cations have codeine in them.
2. The FDA is responsible for the safety of
medications in the United States, but the
agency does not require the manufacturers
of Tylenol to halve the dose of each pill.
3. Pain is what the client says it is and pain
relief is what the client says it is. This is
not an appropriate question.
4. This is a therapeutic response. The nurse
should assess the situation and provide
factual information.
14. 1. The ointment and suppositories should be
used after the area is cleaned and patted
dry.
2. The medication will not harm the fetus.
3. The labeling directions for Preparation
H state four times a day as part of the
safe administration guidelines. The
phenylephrine shrinks the size of the
hemorrhoids and provides relief from
the pain and burning, and the cocoa
butter provides some emollient relief
for expelling feces.
4. Tucks will provide relief from burning and
itching, but will not shrink the hemor-
rhoids. Tucks may initially sting when
applied to the area.
5. The client should avoid having a
bowel movement for 1 to 3 hours after
using the medication for maximum
effectiveness.
15. 1. Head and Shoulders is a dandruff sham-
poo. It is not effective in controlling
psoriasis.
2. T-Gel is a shampoo formulated with
coal tar and is recommended for clients
with mild psoriasis.
3. Scalpicin has hydrocortisone and is
marketed for mild psoriasis symptoms.
6924_Ch16_401-416.indd 415
CHAPTER 16 NONPRESCRIBED MEDICATIONS 415
4. Ketoconazole is an antifungal medica-
tion that has some efficacy for psoriasis.
5. Psoriasis is a painful skin problem accom-
panied by intense itching. A mild shampoo
without some other ingredient will not be
effective for this client.
MEDICATION MEMORY JOGGER: Nurses
are frequently asked to provide informa-
tion about OTC medications and prepa-
rations. The test taker could eliminate
option 5 in the previous question because
of the diagnosis of psoriasis.
16. 1. The OTC antispasmodic is masking some
of the client’s symptoms. The nurse should
recognize the symptoms of a urinary tract
infection (UTI). The client should see the
HCP and have a urine culture performed.
2. The client should increase her amount of
fluids when there is a suspicion of a urinary
tract infection.
3. The client has symptoms of a urinary
tract infection and should see the HCP
for a urine culture and prescription for
antibiotics.
4. Cranberry juice is helpful in preventing
UTIs, but this client already has the symp-
toms of a UTI.
17. 1. Glargine (Lantus), a steady-state insulin,
is not available OTC. A prescription is
required.
2. Humulin R, N, L, and U are all avail-
able OTC, but they are usually kept
behind the counter with the pharma-
cist. These insulins can be purchased
without a prescription. In some states
syringes may be purchased without
a prescription. A prescription is only
required if the client has insurance that
will pay part of the cost.
3. Glucose tablets are recommended for
clients to carry with them in case of a
hypoglycemic reaction and may be pur-
chased without a prescription.
4. Glucose-monitoring devices and strips
may be purchased without a prescrip-
tion; however, if the client has insur-
ance that will pay for the equipment, a
prescription is required.
5. Humulin R, N, and L are all avail-
able OTC. They are kept behind the
counter with the pharmacist, but can
be purchased without a prescription. In
some states syringes may be purchased
without a prescription. A prescription is
only required if the client has insurance
that will pay part of the cost.
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 416 PHARMACOLOGY SUCCESS
18. 1. Permethrin (Nix) is applied once, and the
clean hair is combed to get rid of the nits.
2. Permethrin (Nix) and pyrethrin with
piperonyl butoxide (RID) are OTC medi-
cations that treat lice.
3. The Centers for Disease Control
(CDC) state that head lice is a nui-
sance but has not been shown to cause
disease. Both the American Academy
of Pediatrics (AAP) and the National
Association of School Nurses (NASN)
advocate that “no-nit” policies should
be discontinued; therefore, the child
should be allowed to attend school
during treatment.
4. This is the correct procedure for treat-
ing lice.
5. Head lice is spread by direct con-
tact with infected hair; therefore, all
household members and close contacts
should check for lice or nits.
19. 1. The most common local anesthetic
used in dental procedures is a “-caine”
medication, procaine (Novocaine);
therefore, a client allergic to procaine
(Novocaine) could be allergic to benzo-
caine (Lanacane), a topical preparation
for sunburns.
2. The most common local anesthetic
used in dental procedures is a “-caine”
medication, lidocaine; therefore, a
client allergic to procaine (Novocaine)
could be allergic to benzalkonium and
lidocaine (Bactine), an antiseptic/pain
reliever.
3. The most common local anesthetic
used in dental procedures is a “-caine”
medication, dibucaine (Nupercainal);
therefore, a client allergic to procaine
6924_Ch16_401-416.indd 416
(Novocaine) could be allergic to dibu-
caine (Nupercainal), for the pain, itch-
ing, and burning of hemorrhoids.
4. Mineral oil, a lubricant laxative used as a
preparation for a radiologic exam, is not a
“-caine”; therefore, the nurse would not
caution the client using this medication.
5. Miconazole (Monistat) vaginal cream, for
a client diagnosed with a yeast infection,
is not a “-caine”; therefore, the nurse
would not caution the client using this
medication.
MEDICATION MEMORY JOGGER: If the
test taker was not familiar with the local
anesthetic procaine (Novocaine), the test
taker could possibly still get this ques-
tion correct by reading the ending of the
generic medication names in the first
three options.
20. 1. There is evidence that CoQ10 in combi-
nation with fish oil (omega-3 fatty acid) or
flaxseed oil will reduce damage to blood
vessels and may delay degeneration of the
macula.
2. CoQ10 is a fat-soluble antioxidant
found in almost every cell in the body.
Flaxseed oil (or omega-3 fatty acid)
is taken in conjunction with CoQ10
to help the body utilize the CoQ10.
Antioxidants are supportive of arterial
health by decreasing fat deposits in the
vessels.
3. CoQ10 is not an omega-3 fatty acid.
4. There is no cure for macular degeneration.
An injection, Ranibizumab (Lucentis),
has been approved by the FDA for use by
some clients with macular degeneration.
The medication is injected into the eye on
a monthly basis.
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